Here's to more survivors
Mortality rates for cancer patients continue to drop, which is just one of many pieces of good news from the Annual Report to the Nation on the Status of Cancer released earlier this summer. The report is a joint effort between the National Cancer Institute (NCI), the U.S. Centers for Disease Control and Prevention, the American Cancer Society, and the North American Association of Central Cancer Registries (NAACCR), and this year it was published in the Journal of the National Cancer Institute.
The report looked at cancer death rates for men, women and children nationwide from 1999 to 2016. Overall mortality rates from 2012 to 2016 were down, decreasing 1.8 percent per year in men and 1.4 percent per year in women. The decline in mortality rates is thought to be due to a variety of factors, including greater focus on early cancer screening and more effective therapies.
In addition to mortality rates dropping, overall incidence rates of new cases of cancer also displayed a positive trend: incidence rates dropped in men from 2008 to 2015 (after increasing from 1999 to 2008) and remained stable in women from 1999 to 2015. When looking at overall incidence rates from 2011 to 2015, incidence rates stayed stable in women and decreased 2.1 percent per year in men. The decrease can likely be attributed to increased public awareness of the importance of modifying one's lifestyle and behaviors, such as public campaigns detailing how wearing sunscreen or quitting a smoking habit can drastically reduce the risk of skin and lung cancer, respectively.
“We are encouraged by the fact that this year’s report continues to show declining cancer mortality for men, women and children, as well as other indicators of progress,” said Betsy A. Kohler, executive director of NAACCR. “There are also several findings that highlight the importance of continued research and cancer prevention efforts.”
From 2011 to 2015, the average annual incidence rate was about 1.2 times high among men than women, and the average annual death rate from 2012 to 2016 was also higher in men than women—about 1.4 times higher. In men and women ages 20 to 49, however, incidence and death rates were higher among women. From 2011 to 2015, men saw an average annual incidence rate of 115.3 (per 100,000 people) and women saw an average rate of 203.3, with incidence rates decreasing an average of 0.7 percent per year and increasing an average of 1.3 percent per year, respectively. As for death rates from 2012 to 2016 in this age group, the averages came out to 22.8 (per 100,000 people) for men and 27.1 for women.
The report found that from 2012 to 2016, death rates from cancer in this age group dropped 2.3 percent per year among men and 1.7 percent per year among women.
“It is important to recognize that cancer mortality rates are declining in the 20-to-49-year-old age group, and that the rates of decline among women in this age group are faster than those in older women,” pointed out Dr. Douglas R. Lowy, acting director of the NCI.
Incidence and mortality rates don't simply differ between the sexes, but also between ethnicities. The report found that of those studied, black men and women had the highest mortality rates from cancer, while black men and white women had the highest overall incidence rates. Asian/Pacific Islander men and women had the lowest overall incidence rates, and non-Hispanic men and women had higher overall incidence rates than Hispanic men and women.
“Major declines overall in cancer mortality point in the right direction, yet significant differences remain in cancer cases and deaths based on gender, ethnicity and race,” remarked Dr. Robert R. Redfield, director of the U.S. Centers for Disease Control and Prevention. “A better understanding of these discrepancies improves cancer diagnosis and recovery for all patients and is vital to our public health mission.”
In keeping with the decreasing mortality numbers, survivorship numbers are on the rise. In addition to the Annual Report, the American Cancer Society also released Cancer Treatment & Survivorship Facts & Figures 2019-2021 earlier this year.
This report is an effort by the American Cancer Society and the NCI, in which the two organizations “collaborate every three years to estimate cancer prevalence in the United States using incidence and survival data from the Surveillance, Epidemiology, and End Results cancer registries; vital statistics from the Centers for Disease Control and Prevention's National Center for Health Statistics; and population projections from the US Census Bureau.”
“More than 16.9 million Americans (8.1 million males and 8.8 million females) with a history of cancer were alive on Jan. 1, 2019; this number is projected to reach more than 22.1 million by Jan. 1, 2030, based on the growth and aging of the population alone,” the report states. “The three most prevalent cancers in 2019 are prostate (3,650,030), colon and rectum (776,120), and melanoma of the skin (684,470) among males, and breast (3,861,520), uterine corpus (807,860), and colon and rectum (768,650) among females. More than one-half (56 percent) of survivors were diagnosed within the past 10 years, and almost two-thirds (64 percent) are aged 65 years or older.”
Echoing the Annual Report, Cancer Treatment & Survivorship Facts & Figures notes that survivorship varies among different racial/ethnic populations, as does cancer treatment: “Even after accounting for differences in stage at diagnosis, the five-year relative survival is lower for blacks compared with whites for most cancers.1 Studies have found that a substantial proportion of these disparities are driven by health insurance differences.24, 25 Underrepresentation of racial/ethnic minorities in large clinical trials has also been identified as a major barrier to health equity in cancer treatment.155 In the posttreatment phase, black cancer survivors report poorer physical functioning and less access to culturally appropriate support services compared with white survivors and receive inadequate posttreatment surveillance.”
The authors also detail how the growing population of cancer survivors is shining light on some aspects of their healthcare journey that need to be addressed. For example, a chief concern among survivors is the cost of their treatment, which represents both a financial and a mental burden. The report cited one study ("Medical financial hardship among cancer survivors in the United States," Cancer) that found that roughly 35 percent of cancer survivors between the ages of 18 and 49 struggled to pay their medical bills, compared to 25 percent for individuals with no history of cancer. In people 50 to 64 years of age, 27 percent of survivors reported such difficulties, compared to 23 percent of those without cancer.
Navigating life after cancer remission can also be complicated by physical aftereffects of treatment—such as decreased or loss of fertility for patients who have undergone chemotherapy—and psychological/emotional issues such as fear of recurrence. Fortunately, according to the report, “There is increasing emphasis on improving cancer survivors' overall well-being and quality of life through the application of cancer rehabilitation; psychosocial interventions; principles of disease self-management; and the promotion of healthy lifestyles, such as avoiding tobacco, maintaining a healthy body weight, avoiding intense ultraviolet radiation exposure, and being physically active throughout life. Several practical interventions have been developed for diet, weight, and physical activity among cancer survivors.”
As mortality rates decrease and survivorship rates increase, the healthcare industry needs to be prepared to adjust to survivors' different needs, such as recurrence monitoring and support in maintaining a healthy lifestyle. However, as these impacts on the industry are the resulting of more people outliving their cancers every year, it's a positive change to be facing.