RT Book, Section
A1 Freter, Carl E.
A1 Longo, Dan L.
A2 Longo, Dan L.
SR Print(0)
ID 1128358732
T1 LATE CONSEQUENCES OF CANCER AND ITS TREATMENT
T2 Harrison's Hematology and Oncology, 2e
YR 2013
FD 2013
PB McGraw-Hill Education
PP New York, NY
SN 9780071814904
LK hemonc.mhmedical.com/content.aspx?aid=1128358732
RD 2024/04/19
AB Over  10  million  Americans  are  cancer  survivors.  The  vast  majority  of  these  people  will  bear  some  mark  of  their  cancer  and/or  its  treatment,  and  a  large  proportion  will  experience  long-term  consequences  that  include  medical  problems,  psychosocial  dysfunction,  economic  hardship,  sexual  dysfunction,  and  discrimination  in  employment  and  insurance.  Many  of  these  problems  are  directly  related  to  cancer  treatment.  As  patients  with  more  types  of  malignancies  survive  longer,  the  biologic  toll  that  very  imperfect  therapies  take  in  terms  of  morbidity  and  mortality  rates  is  being  recognized  increasingly.  These  consequences  of  therapy  confront  the  patients  and  the  cancer  specialists  and  general  internists  who  manage  them  every  day.  Although  long-term  survivors  of  childhood  leukemias,  Hodgkin's  lymphoma,  and  testicular  cancer  have  increased  knowledge  about  the  consequences  of  cancer  treatment,  researchers  and  physicians  keep  learning  more  as  patients  survive  longer  with  newer  therapies.  The  pace  of  the  development  of  therapies  that  mitigate  treatment-related  consequences  has  been  slow,  partly  due  to  an  understandable  aversion  to  altering  regimens  that  work  and  partly  due  to  a  lack  of  new,  effective,  less  toxic  therapeutic  agents  with  less  "collateral  damage"  to  replace  known  agents  with  known  toxicities.  The  types  of  damage  from  cancer  treatment  vary.  Often,  a  final  common  pathway  is  irreparable  damage  to  DNA.  Surgery  can  create  dysfunction,  including  blind  gut  loops  that  lead  to  absorption  problems  and  loss  of  function  of  removed  body  parts.  Radiation  may  damage  end-organ  function,  for  example,  loss  of  potency  in  prostate  cancer  patients,  pulmonary  fibrosis,  neurocognitive  impairment,  acceleration  of  atherosclerosis,  and  second  cancers.  Cancer  chemotherapy  may  act  as  a  carcinogen  and  has  a  kaleidoscope  of  other  toxicities,  as  discussed  in  this  chapter.  Table  55-1  lists  the  long-term  effects  of  treatment.