From description to prescription
Historically, survivorship research has gone through three phases, says Lisa Diller, MD, director of the Perini Family Survivors' Center and a leader of several survival studies. The first step, dating from the 1960s and '70s, involved descriptive investigations that tracked physical and cognitive outcomes in childhood cancer survivors. That was followed by an analytic phase, in which researchers tried to "connect the dots" between specific treatments and survivors' long-term risk for health problems.
Jennifer Ligibel, MD, (right) is probing links between exercise and cancer, working with study participant Sylvia Rudolph.
The latest crop of studies focuses on prevention and screening: using what has been learned so far to improve treatments for current and future patients. "The idea is that once we know the risk factors for lateoccurring problems, we can try to change existing therapies and find ways of helping those who've already been treated," says Diller.
A prime example of that approach involves Hodgkin's disease, a cancer of the lymph system often arising in adolescents and young adults. Treatment traditionally involved high doses of radiation to the chest, which raised female patients' risk for breast cancer. To reduce those odds, doctors now deliver lower but still effective levels of radiation, irradiate a smaller portion of the body, or use only chemotherapy for treatment. Women who received radiation therapy as children are counseled to have regular mammograms and breast exams, and studies are under way to determine if surgical removal of the breasts, screening with magnetic resonance imaging (MRI), or preventive drug treatment can lower their chance of developing breast cancer.
Research has produced a trove of information about the unique health risks that former cancer patients face&and about the resilience they so often demonstrate. Doctors know the medical problems that can follow treatment: organ damage, changes in sexual or reproductive function, sensory declines, chronic pain and fatigue, delays in cognitive development&all dependent on the type and intensity of therapy and on patients' individual characteristics. They're also aware of possible psychological difficulties, such as anxiety, depression, and concerns over employment, finances, and personal relationships.
"Studying survivors' quality of life has become a major movement within the cancer research community," says Diller. Her interest in the field dates from her time as a first-year clinical fellow at Dana-Farber in the late 1980s, when she treated a former Hodgkin's patient who had developed a large mass in his stomach. "He'd had every complication associated with Hodgkin's treatment&thyroid failure, a skin cancer, pneumonia, fertility problems, and then gastric cancer," she recalls. "I thought, 'There has to be a better way to take care of cancer survivors.'"
Diller's work and that of her colleagues have made Dana-Farber a trailblazer in survivorship research. "The Perini Clinic has never been 'just' a clinic," she relates. "There has always been a research component of what we do here."
- Next: A range of research
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