More than ten and a half million people in the United States live with a past or current diagnosis of some type of cancer (Ries et al., 2007); 1.4 million1 Americans are projected to receive a new diagnosis of cancer in 2007 alone (Jemal et al., 2007). Reflecting cancer’s reach, 1 in 10 American households now includes a family member who has been diagnosed or treated for cancer within the past 5 years (USA Today et al., 2006), and 41 percent of Americans can expect to be diagnosed with cancer at some point in their life (Ries et al., 2007).
While more than half a million Americans will likely die from cancer in 20072 (Jemal et al., 2007), numerous others are being effectively treated and will survive cancer-free for many years. Still others will have a type of cancer that is chronic and that will need to be controlled by intermittent or continuous treatment, not unlike patients with heart disease or diabetes.
Although cancers historically have not been thought of as such, they increasingly meet the definition of chronic diseases: “They are permanent, leave residual disability, are caused by nonreversible pathological alteration, require special training of the patient for rehabilitation, or may be expected to require a long period of supervision, observation, or care” (Timmreck, 1987:100).3 As described in the next section, many of the more than 100 specific types of cancer frequently leave patients with residual disability and/or nonreversible pathological alteration, and require long periods of supervision, observation, or care. Treatment protocols by themselves for some cancers—such as breast, prostate, and colon cancer (among the most common types of cancers)—can last months; individuals on certain oral chemotherapeutic regimens for breast cancer or some forms of leukemia sometimes remain on chemotherapy for years. Even after completing treatment, cancer survivors (particularly survivors of pediatric cancers) often require care from multiple specialists and primary care providers to manage the long-term sequelae of the illness and its treatment. Thus the trajectories of various cancers vary according to the type of cancer, stage at diagnosis, and other factors (see Figure 1-1).
In addition to coping with the worry and stress brought about by their diagnosis, patients with cancer and their families must cope with the stresses induced by physically demanding (and also often life-threatening) treatments for the illness and the permanent health impairment and
1This figure excludes non-melanoma skin cancers and in situ carcinomas except in the urinary bladder.
2One in four deaths in the United States is due to cancer—the leading cause of death for those under age 85 (Jemal et al., 2007).
3The definition of chronic disease used in the National Library of Medicine’s Medical Subject Headings (MeSH).