Painful Scars, Swelling, Fatigue, Weight Troubles Take Long-Term Toll

By Jeanie Lerche Davis
WebMD Medical News  Reviewed By Brunilda  Nazario, MD
on Tuesday, August 31, 2004


Aug. 31, 2004 -- For cancer survivors, physical and emotional problems
continue long after treatment ends. In fact, even long-term cancer
survivors fare worse -- in terms of quality of life -- than people who
have not faced cancer, according to new research.

These results, from a new nationwide study, appear in this month's issue
of the Journal of the National Cancer Institute.
Hidden Costs of Cancer

Other studies have looked at economic costs of cancer care. But in this
study, quality-of-life issues -- lost productivity at work, limitations
in everyday activities, and changes in overall health -- are examined.
"It's what economists call intangibles, nonmedical costs," researcher K.
Robin Yabroff, PhD, MBA, an epidemiologist with the National Cancer
Institute, tells WebMD.

Improvements in early diagnosis and treatment have led to improved
survival, and that trend is likely to continue, writes Yabroff. But with
the aging baby boomer population, more and more people will be at
various stages of cancer treatment and remission. How are they faring in
their day-to-day life? That's the question she sought to answer.

She based her study on surveys completed by more than 7,000 adults --
including 1,800 cancer survivors and 5,500 adults with no cancer
history. In the surveys, they provided details about their health,
limitations in activities, employment status, sick days taken, and
cancer history.

Among the questions they answered: Did they have back problems?
Arthritis? Heart problems? High blood pressure? Weight problems?
Depression? Did they smoke? Did they ever get a cancer diagnosis? How
long ago? They reported limitations in usual activities such as everyday
household chores and limitations in productivity and they rated their
health.
Those originally diagnosed with lung, colon, breast, prostate cancer, as
well as other cancers with short survival times, such as liver cancer,
suffered the most, Yarbroff reports.

Overall, cancer survivors had worse quality of life, less work
productivity, and more health limitations compared with cancer-free
people. They were less likely to be employed. If they had jobs, they
took more sick days. Their working hours -- even the type of work they
could do -- were limited. They rated their health as fair or poor. They
needed help with everyday living. They also spent more days in bed.

Whether they were working or not -- whether retired or on medical leave
-- the cancer survivors had many more days when they were not
productive, she adds.
These losses are "substantial, even among those who have survived well
beyond five years following diagnosis," she says. "Contrary to our
expectations, long-term cancer survivors, even 11 or more years after
diagnosis, had a significantly higher burden. ... These findings did not
appear to be due to older age."

Fatigue, Swelling, Pain Last Many Years
Jerome Yates, MD, national vice-president for research at the American
Cancer Society, was not involved in the study but offers his insights.

Breast cancer is a perfect example of these long-term "hidden" effects,
he says.
"Even if a woman has a lumpectomy [rather than having a breast removed],
surgery is involved. There is an incision and a scar, and that may
always be painful," Yates tells WebMD. "If she has a lymph node removed,
she will have swelling in her arms for years. Or she may have shoulder
pain if she didn't get adequate rehabilitation after surgery."
Also, there's the stress, anger, and fear the cancer will come back.

For other cancer survivors, the physical changes may lead to fatigue,
skin sensitivity, mouth and teeth problems, weight troubles, bowel and
bladder control, hot flashes, and sexual problems.
"In the past, the attitude has been if you're cured of cancer then you
shouldn't have long-term problems," Yates explains. "The reality is
there are a variety of physical and emotional problems that can continue
for years afterwards."

"This is a superb article…It points to the fact that we need to do
more looking at late-effect problems of cancer survivors," says Yates.

SOURCES: Yabroff, R. Journal of the National Cancer Institute; Sept. 1,
2004; vol 96: pp 1322-1330. Robin Yabroff, PhD, MBA, an epidemiologist,
National Cancer Institute. Jerome Yates, MD, national vice-president for
research, American Cancer Society.

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."