Friday, 29 March, 2024
HomeEditor's PickCancer survivors age faster and die earlier

Cancer survivors age faster and die earlier

Cancer survivorsPeople who have had cancer age faster than those who haven’t lived with the disease, found researchers at the College of Medicine, Mayo Clinic Rochester. The experts have called for more research to be done to reduce the accelerated ageing process, lengthen lifespan and improve the quality of their lives.

Thanks to more effective diagnosis and treatment, the number of cancer survivors is set to rise. Currently there are 30m around the globe, but by 2025, around 19m new diagnoses will be made every year and most of these will produce long term survivors, the researchers said.

Researchers said cancer survivors are more likely to develop long-term conditions, and sooner than the rest of the general population. The report says they hypothesised that this is most likely due to the damage caused by chemotherapy and radiotherapy to normal healthy tissues. These types of treatment can diminish “physiological reserve” – the capacity in organs and biological body systems given to us at birth – and the body’s natural resilience to overcome internal and external biological stressors

“While ageing prematurely is a better alternative to dying prematurely, a better understanding of what drives this process presents an opportunity for improvement,” said researchers.

The report says they trawled databases for published evidence on the cellular processes involved in ageing and the potential impact of cancer treatments on these and found a wide range of side effects and late complications, which have implications not only for the individuals concerned, but also for health services.

The key findings of the study were: childhood cancer survivors are between three and six times as likely to develop a second cancer; childhood cancer survivors’ estimated life expectancy is 30% lower than that of the general population; the risk of frailty among bone marrow transplant recipients is around eight times as high as that of their siblings; long term steroid treatment, a component of many cancer treatment strategies, is associated with a higher risk of cataracts, osteoporosis, nerve damage, skin thinning, infection and impaired wound healing; cancer treatment is associated with various aspects of biological ageing; certain primary cancer drugs are associated with hearing loss, reduced thyroid gland activity, high blood pressure, congestive heart failure, muscular weakness, arthritis, kidney and liver diseases, chronic constipation, and infertility; radiotherapy is associated with dementia, memory loss, carotid artery hardening, and secondary bone marrow cell and blood cancers; and Tamoxifen (adjuvant treatment to stave off the return of cancer) is associated with cataracts.

The researchers said that despite these undesirable side effects, cancer treatments are worthwhile for scores of patients with the disease, and that ageing is ‘part of life’. But, they are quoted in the report as saying, accelerated ageing, experienced by many cancer survivors as a direct consequence of their treatment is something that can, and should be, minimised. For one thing, cancer survivors deserve it, and for another, it’s a public health issue, they said. “We believe that cancer survivors deserve long-term follow up for the mitigation of the late effects,” they concluded.

“Future research to better understand mechanisms of accelerated ageing-like phenotypes is essential for the oncology community as well as from a public health and health policy perspective.

“The ultimate goal of these studies will be to prevent late complications using early interventions, including lifestyle changes and medications.”

In response, Dr Aine McCarthy, from Cancer Research UK, said in the report: “The results of this study highlight that while more people are surviving cancer than ever before, we have to do more to ensure cancer survivors have a good quality of life. A big part of this will be carrying out more research to develop kinder treatments that still work, but have fewer short and long-term side effects.”

Macmillan’s specialist advisor for treatment and recovery, Dany Bell, is quoted in the report as saying: “This research reflects just how much the story of cancer has changed in this country. A cancer diagnosis is now a moment that is frequently not life-ending, but nearly always life-changing.

“Earlier diagnosis and more effective cancer treatment means that more people are living for longer after a cancer diagnosis. Whilst this is welcome, surviving does not always mean living well, with thousands of people living with long-term side effects of treatment that can have a profound effect on the body.

“These findings hammer home that whilst survival rates are important, they aren’t the only measure of success. An important part of cancer care should be for patients to be able to discuss with their doctor how their cancer experience might affect their quality of life in the longer term. People must also have access to a personalised package of care and support from the point of diagnosis so they are able to have as good a quality of life as possible, for as long as possible.”

Abstract
Over 30 million cancer survivors exist worldwide. Survivors have an earlier onset and higher incidence of chronic comorbidities, including endocrinopathies, cardiac dysfunction, osteoporosis, pulmonary fibrosis, secondary cancers and frailty than the general population; however, the fundamental basis of these changes at the cellular level is unknown. An electronic search was performed on Embase, Medline In-Process & Other Non-Indexed Citations, and the Cochrane Central Register of Controlled Trials. Original articles addressing the cellular biology of ageing and/or the mechanisms of cancer therapies similar to ageing mechanisms were included, and references of these articles were reviewed for further search. We found multiple biological process of ageing at the cellular level and their association with cancer therapies, as well as with clinical effects. The direct effects of various chemotherapies and radiation on telomere length, senescent cells, epigenetic modifications and microRNA were found. We review the effects of cancer therapies on recognised hallmarks of ageing. Long-term comorbidities seen in cancer survivors mimic the phenotypes of ageing and likely result from the interaction between therapeutic exposures and the underlying biology of ageing. Long-term follow-up of cancer survivors and research on prevention strategies should be pursued to increase the length and quality of life among the growing population of cancer survivors

Authors
Margaret C Cupit-Link, James L Kirkland, Kirsten K Ness, Gregory T Armstrong, Tamar Tchkonia, Nathan K LeBrasseur, Saro H Armenian, Kathryn J Ruddy, Shahrukh K Hashmi

[link url="http://www.huffingtonpost.co.uk/entry/cancer-survivors-age-faster_uk_5a33a49ce4b01d429cc7b4e8"]The Huffington Post material[/link]
[link url="http://esmoopen.bmj.com/content/2/5/e000250"]ESMO Open abstract[/link]

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