Cancer Prevention after Cancer: Changing the Paradigm-a Report from the American Society of Preventive Oncology

The state of cancer survivorship science has made significant advances, yet there still remain knowledge gaps (Fig. 5). First, there is an overall need to continue establishing a robust evidence base. In childhood cancer survivorship, research is needed that shows the effectiveness of the screening and surveillance guidelines developed, how best to inform adult childhood cancer survivors of these guidelines, and ways to improve patient-provider communication about this care. In tobacco cessation, more research is needed to examine and document the adverse effects of tobacco use on cancer treatment and survival, particularly, mechanisms underlying effect of tobacco on chemotherapy and other emerging modalities. In addition, more research is needed on the effectiveness of cessation programs tailored to different types of cancer survivors (by disease, age, and gender) and the effective timing of such interventions. Finally, in the area of energy balance, more randomized controlled trials are needed to elucidate the mechanisms by which diet, weight, and physical activity are associated with recurrence and survival, and to examine more downstream processes, such as the direct effects on and interactions with genetic, epigenetic, and molecular markers. Survivorship issues in diverse populations (e.g., low income status, rural geographic locations, or ethnic minority populations) remain a largely unexplored area in cancer survivorship science. A potential area of disparity research in childhood cancer survivorship would be the effectiveness and uptake rates of the screening and surveillance guidelines in rural and other underserved geographic locations, where access to healthcare professionals that are knowledgeable of these guidelines may be particularly scarce. Important diversity issues in tobacco research may include the effects of continued smoking on cancer treatment in different ethnic minority populations, such as African Americans who have a higher incidence of more advanced head and neck squamous cell carcinoma and poorer survival (44, 45). Finally, energy balance research on effective interventions for underserved populations would increase the generalizability of survival benefits; for instance, among African American breast and colorectal cancer survivors with high mortality (46). For cancer survivorship science to continue advancing, transdisciplinary research is critical. New advances in genomics and questions of gene-environment interactions can help inform survivorship science of the most effective interventions in different survivor populations and lead to personalization of these to produce the most successful outcomes. Furthermore, we need to build our capacity to deliver effective interventions more broadly if we are to significantly reduce the incidence of cancer recurrence and second cancers, and enhance quality of life. The first step would be educating physicians about effective interventions, such as the importance of prioritizing attention to tobacco cessation among cancer patients and survivors, and the need for special cancer screening guidelines for specific subsets of adult survivors of childhood cancers. In the area of energy balance, as more evidence of survival benefits comes forth, these interventions could be readily prescribed to overweight or obese cancer survivors, just as cardiac rehabilitation is prescribed for cardiovascular patients. Finally, design of evidence-based interventions that can be readily incorporated into standard clinical and community settings will lead to wider dissemination that will help improve the lives of more cancer survivors. The increasing prevalence of cancer survivors underscores a need for clinicians and public health professionals to provide health promotion interventions in this population. We need to continue to expand the evidence base with regard to the following: (i) healthy behaviors to reduce risk for new or recurrent cancers, maintain or improve health and quality of life, and (ii) early detection or guidelines for childhood cancer survivors to increase likelihood of survival with new or recurrent cancers. It is never too late for cancer survivors - or their healthcare providers - to make these changes. ©2011 American Association for Cancer Research.