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Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs
and cancer survivors in all age groups report higher rates of chronic illness compared with their counterparts with no history of the illness. National Health Interview Survey (NHIS) data from 1998, 1999, and 2000 indicate that a medical history of cancer at least doubles an individual’s likelihood of poor health and disability. Individuals with a history of cancer also have significantly higher rates of other chronic illnesses, such as cardiovascular disease. When cancer and another chronic illness co-occur, poor health and disability rates are 5 to 10 times higher than otherwise expected (Hewitt et al., 2003).
Survivors of childhood cancer similarly have much higher than average rates of chronic illness beginning in their early or middle adult years. A retrospective study of more than 10,000 adults who had been diagnosed with certain cancers4 before age 21 and who survived at least 5 years after diagnosis found that 62 percent of those between the ages of 18 and 48 (mean age 26.6 years) had at least one chronic health condition; 27 percent had a condition that was severe, life-threatening (e.g., kidney failure or need for dialysis, seizure disorder, congestive heart failure), or disabling. This was on average 17.5 years after diagnosis (range 6–31 years). Even 30 years after diagnosis, almost three-fourths had a chronic health condition; more than 40 percent had a condition that was severe, life-threatening, disabling, or fatal; and 39 percent had multiple conditions. None of these estimates include mental health problems (Oeffinger et al., 2006).
Cognitive impairment also is found in some children and adults treated for cancer. Studies of children treated for acute lymphoblastic leukemia and brain tumors (the two most common childhood cancers), for example, indicate that impairment of cognitive abilities (e.g., attention and concentration, working memory, information processing speed, sequencing ability, and visual–motor integration) is common (IOM and NRC, 2003; Butler and Mulhern, 2005). These late effects of cancer and treatment can contribute to problems in reading, language development, and ability to perform complex mathematics. Children can have difficulties doing work in the classroom and require more time to complete homework. They can also have problems in such areas as handwriting, organizing material on a page, lining up columns for arithmetic problems, and being able to complete computer-readable standardized testing forms—all of which can affect school performance and learning. Even if cancer survivors are initially asymptomatic at reentry to school, neurocognitive deficits may develop years later (IOM and NRC, 2003).
Cognitive impairment has also been documented in adults. Although the cause of such impairment (dubbed “chemobrain” by some cancer survivors)
Leukemia, central nervous system tumor, Hodgkins disease, non-Hodgkins lymphoma, Wilms’ tumor, neuroblastoma, sarcoma, or bone tumor.