Surviving and thriving?

Prior to the last decade, cancer epidemiologists presented incidence figures for cancer, but never provided prevalence figures (Feldman et al., 1986). This was because the diagnosis of cancer was a death sentence for most people. For instance, five year survival for cancer was approximately one in five in 1930 (Gotay and Muraoka, 1998). By the end of the last century, this figure had increased to 59% (Greenlee et al., 2001). The advent of earlier diagnosis and better treatment has been primarily responsible for the increased number of people surviving cancer. In fact, in the United States alone, the number of people surviving cancer is now estimated at >8.2 million (Greenlee et al., 2001). Improved survival varies by both cancer site and by socio-demographic factors such as income and race/ethnicity. For example, the most common cause of cancer in the US is lung cancer where five year survival is 14% for whites and has not changed over the last 20 years. Survival from other cancers is more favorable. Today, 520% of Hodgkin’s disease survivors die from their disease, while 80% or more of persons diagnosed with cancer of the prostate, testis or thyroid can expected to be alive five year later (Greenlee et al., 2001). In the United States, cancer mortality for breast cancer has been falling by almost 2% per year. In a current study of women diagnosed with breast cancer at age 50 or younger, 90% are alive five years later (Bloom et al., 2000). However, survival statistics in the US still favor the more affluent and white population; the survival rate of non-whites has been estimated to be 5–15% lower (Greenlee et al., 2001; Freeman, 1989). Thus, it is not only appropriate, but also timely to consider how cancer affects the lives of cancer survivors. Perhaps, because of the recentness of the changes in cancer survival rates, less attention was focused on quality of life issues in the past. As length of life following cancer has been extended, greater attention has been paid to the sequelae of cancer and its treatment on the individual’s evaluation of these effects, i.e. the individual’s quality of life. While a large number of quality of life domains can be assessed, most agree that the physical, psychological, and social dimensions are among the most important (Aaronson et al., 1985; Cella and Tusky, 1990; Ferrell and Dow, 1997). The physical dimension captures the potentially debilitating consequences from treatment that has enabled long-term survival. The physical disruptions range from day-to-day effects such as loss of energy to life threatening sequelae such as second cancers. These physical disruptions can also have consequences for return to work and insurability which along with inter-personal relationships, broadly defined, are among the social aspects of quality of life. Among the most commonly studied psychological effects of a cancer diagnosis, especially soon after treatment, are depression, anxiety, self-image, and fear of recurrence. Finally, a focus of new interest has been study of the spiritual dimension of quality of life. The eight papers in this special issue have as a common theme the impact of cancer on quality of life for cancer survivors. The papers, however, focus on different cancer sites, different populations, and different times post diagnosis. And they can be described in terms of three stages on a life trajectory as described by Mullin (1990). The first stage is the period from the diagnosis through the first year, which generally includes treatment, is referred to as acute survival. There has been considerable research in this area. Some of the earliest systematic work on breast cancer was conducted by Morris et al. (1977) and by Maguire et al. (1978), on Hodgkin’s disease by Fobair et al. (1986), and on prostate cancer by Litwin et al.