Ongoing therapeutic advances coupled with an aging population has led to an increasing number of cancer survivors nationwide. As a result, it is imperative that the health care system is equipped to provide optimal care and support to these individuals.
"To help meet the needs of this growing population, the public health community must be informed about its size and characteristics, so every few years the American Cancer Society collaborates with the National Cancer Institute to provide contemporary estimates of the number of cancer survivors in the U.S. by cancer type and age," noted study author Rebecca Siegel, MPH, a cancer epidemiologist and Senior Scientific Director of Surveillance Research at the American Cancer Society. "We also provide information on treatment patterns by cancer site and stage that were also presented separately by race this year."
This collaborative research effort revealed that more than 18 million Americans with a history of cancer were alive on January 1, 2022 (CA Cancer J Clin 2022; https://doi.org/10.3322/caac.21731). These estimates, the study authors noted, do not include carcinoma in situ of any site except urinary bladder or basal cell and squamous cell skin cancers.
"They also do not reflect the impact of diagnostic and treatment delays related to the COVID-19 pandemic because they are based on available pre-pandemic, observed cancer incidence, mortality, and survival data through 2018," they reported.
"The key findings were that the most prevalent cancers are breast (>4 million women) and prostate (>3.5 million men) cancers and that two-thirds of survivors are 65 and older, and thus at increasing risk of subsequent primary cancers," Siegel told Oncology Times. "In addition, Black individuals are less likely to receive surgery than White patients with the same disease stage."
Study Details
This analysis used population-based cancer surveillance data during 1975-2018 from NCI's SEER registries, mortality data from the National Center for Health Statistics, and population estimates from the U.S. Census Bureau to estimate cancer prevalence as of January 1, 2022, according to Siegel.
"The National Cancer Database, a hospital-based registry jointly sponsored by American Cancer Society and the American College of Surgeons Commission on Cancer, was the basis for information on first course of treatment for individuals diagnosed in 2018," she said.
The analysis revealed that more than 18 million Americans-8.3 million males and 9.7 million females-with a history of cancer were alive on January 1, 2022. The research team reported that the three most prevalent cancers are prostate (3,523,230), melanoma of the skin (760,640), and colon and rectum (726,450) among males. The most prevalent cancer types in women are breast (4,055,770), uterine corpus (891,560), and thyroid (823,800). They found that 53 percent of survivors were diagnosed within the past 10 years. Sixty-seven percent of survivors were aged 65 years or older, the data showed.
According to the study authors, one of the largest racial disparities in treatment occurs in rectal cancer. The findings showed that 41 percent of Black patients with Stage I disease receive proctectomy or proctocolectomy versus 66 percent of White patients. "Surgical receipt is also substantially lower among Black patients with non-small cell lung cancer, 49 percent for Stages I-II and 16 percent for Stage III versus 55 percent and 22 percent for White patients, respectively," they reported.
"These treatment disparities are exacerbated by the fact that Black patients continue to be less likely to be diagnosed with Stage I disease than White patients for most cancers, with some of the largest disparities for female breast (53% vs. 68%) and endometrial (59% vs. 73%)," Siegel and colleagues noted.
"Although there are a growing number of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based strategies and equitable access to available resources are needed to mitigate disparities for communities of color and optimize care for people with a history of cancer."
Significance & Next Steps
While discussing their research, Siegel underscored its importance. "It quantifies the size and scope of the growing cancer survivor population-more than 18 million as of January 1 of this year," she said. "With that knowledge comes responsibility, and one of the gaps in care from my perspective is patient-provider communication.
"For example, many patients are reluctant to discuss treatment-related side effects that lower their quality of life, when oftentimes these issues can be resolved with appropriate medical care," Siegel continued. "Improved communication in the oncology setting would also help facilitate the transition to primary care."
Siegel acknowledged that their research was not able to unpack racial disparities in treatment. However, she noted the research is so overwhelming that Black patients are less likely to receive surgery even for localized disease. "More research is needed to better understand these discrepancies and develop effective strategies to eliminate them."
With a cancer survivor population that continues to grow and age, there is an increasing need for formalized guidance around more tailored primary care. This is especially true given established long-term and late effects of treatment, including an elevated risk of new primary cancers, Siegel said.
"Despite increasing awareness of this need, the transition from the oncology to primary care setting continues to be challenged by our fractured health care system," she concluded. "As I mentioned before, I think some of this could be averted by increased communication, both between providers and between patient and provider."
Catlin Nalley is a contributing writer.