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National Cancer Institute

Physical and Long-Term and Late Effects

Karen Syrjala, Ph.D.
Co-Director of Survivorship Program and Director of Biobehavioral Sciences
Fred Hutchinson Cancer Research Center
Seattle, WA

  • An estimated 60 to 80 percent of cancer survivors report good to excellent health at 5 or more years posttreatment, largely due to early diagnosis and use of less toxic treatments. Physical impairments, however, do have a major impact on function and quality of life in a significant minority of survivors. Risks vary by disease, treatment type (which in turn is related to stage at diagnosis), age, time since treatment, and genetic vulnerability.
  • Late effects are different for survivors of different cancer types. Breast cancer survivors report impairments that vary depending on treatment, and prostate cancer survivors report increased fatigue regardless of treatment type. Prostate cancer survivors also report urinary symptoms and sexual dysfunction. Testicular cancer survivors report only a slight decrease in vitality. Specific deficits reported at higher rates by cancer survivors than those without cancer include thyroid dysfunction (may be subclinical), cataracts, dental problems, and hearing and vision loss.
  • The National Health and Nutrition Examination Survey (NHANES) found that 53 percent of long-term survivors reported physical limitation, compared to 21 percent of those without cancer. Among survivors, 31 percent reported restricted participation in activities (compared to 13 percent of those without cancer). Fatigue was the most common problem reported by survivors. Mental health was the strongest predictor of fatigue, but it is unknown at this point whether survivors suffer fatigue because of depression or depression because of fatigue. A sedentary lifestyle also may exacerbate fatigue; cancer survivors reported similar levels of exercise, but fewer hours of activity per day than controls.
  • Sexual dysfunction is especially high in survivors of prostate, breast, and hematologic cancers, and in survivors of cervical cancer who received radiation. Few clinical trials examine this issue. Men express concern about sexual problems, but few seek treatment. Women often fail to recover from sexual problems associated with cancer diagnosis and treatment; in one study, more than 40 percent of female cancer survivors were not sexually active even after completing treatment.

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