A new issue for the 21st century

Prevention and treatment of cancer are improving. There are now 2 million people living in the UK after a cancer diagnosis. This will rise to 4 million by 2030. More survivors are now living long enough to develop treatment related conditions.1 The current estimate is that at least one in five of those who survive cancer can expect ongoing physical and psychological problems. These can include persistent fatigue, breathlessness, neuropathy, cognitive impairment, poor bowel and urine control, skin necrosis, bone fracture and endocrine failure as well as an increased risk of common chronic illnesses such as heart failure, osteoporosis and second primary cancer. Symptoms may persist after initial therapy or they may develop months or years later, after a period of normal health, when neither the patient nor their health professional links them to previous cancer. For a significant minority, the ongoing impact of cancer treatment can be devastating.2 Most consequences of cancer treatment do not have to be disabling and after appropriate specialist assessment and diagnosis can be managed effectively, often by patients themselves. However, a minority will have more complex problems requiring specialist multidisciplinary management. Recent estimates suggest that this will involve 5%–10% of patients with the common cancer types over a 20-year period.

The US National Health Interview Study compared 5000 cancer survivors with over 90 000 people without a history of cancer and found that cancer survivors were more likely to report poor health than those without a cancer diagnosis.3 Similar findings have now been reported in UK studies,4 where data linkage studies suggest that a significant proportion of morbidity is associated with specific cancer treatments.

Most modern surgery, radiotherapy chemotherapy and biological treatments can have consequences which either develop immediately or became apparent years or even decades later. Adults treated as …