Is cancer a chronic disease? Prof. Dace Baltina Riga East University Hospital Ministry of Health

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1 Is cancer a chronic disease? Prof. Dace Baltina Riga East University Hospital Ministry of Health

2 Cancer survival statistics 50% of adult cancer patients diagnosed in in England and Wales are predicted to survive 10 or more years. 46% of men and 54% of women cancer patients diagnosed in in England and Wales are predicted to survive 10 or more years. Cancer survival in the UK has doubled in the last 40 years

3 Cancer survival statistics One-year age-standardised net survival for all cancers combined in England and Wales has increased from 45% during to 67% during in men an absolute survival difference of 22 percentage points In women, one-year survival has increased from 55% to 74% over the same time period (a difference of 19 percentage points). Overall these improvements are most likely to be due to earlier detection and diagnosis, though advances in treatment may also have played a role.

4 All Cancers Excluding Non-Melanoma Skin Cancer (C00-C97 Excl. C44): Age-Standardised One-Year Net Survival, England and Wales Please include the citation provided in our Frequently Asked Questions when reproducing this chart: Prepared by Cancer Research UK Original data sources: Survival estimates were provided on request by the Cancer Research UK Cancer Survival Group at the London School of Hygiene and Tropical Medicine.

5 Cancer survival statistics Types of survival rates include: Disease-free survival rate. This is the number of people with cancer who achieve remission. That means they no longer have signs of cancer in their bodies. Progression-free survival rate. This is the number of people who still have cancer, but their disease isn't progressing. This includes people who may have had some success with treatment, but the cancer hasn't disappeared completely. 80% of those with breast, prostate and skin cancer are living for five years after diagnosis. The figure is 90% for testicular cancer.

6 Cancer survival statistics For people with cancers diagnosed in 2013, the greatest improvement in survival chances will be in men with prostate cancer - from 83.6% to 87.6%. High survival rates for prostate cancer and breast cancer are thought to be due to the increasing number of men and women getting their cancer diagnosed and treated at an early stage. Five-year survival estimates for cancers of the brain, lung, liver, pancreas and stomach are all below 19% for men and 22% for women. Pancreatic cancer for both men and women has a survival rate of just 5.4% - the lowest in both sexes.

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8 Facts Cancer may not be a one-time event. Cancer may come back as second and third time and can even become a chronic (ongoing) illness that never goes away completely. Although recurrent disease may not be cured, it can often be controlled for months or even years.

9 Facts The natural tendency of some cancers is of recurrence and remission (ovarian cancer). Repeating cycles can translate into survival over many years during which the cancer can be managed as a chronic illness. Repeated recurrences can become discouraging and exhausting There is a question of whether to continue treating cancer that keeps coming back - it is a personal decision on how to handle this chronic illness

10 Facts Even those who are not cured of cancer may survive for months or years. For people with controllable cancer, it can be a chronic illness that is mostly controlled with treatment.

11 Psychosocial intervention An important part of coping with cancer diagnosis is recognizing emotions and feelings. So far there is no good evidence to support the idea that psychosocial interventions can reduce the risk of cancer, keep cancer from coming back, or help the persons with cancer live longer. Quality of life is the principal merit of cancer survivorship.

12 What do cancer patient feel? Guilty about their emotional responses to the illness May feel pressure to keep a «good attitude» at all times, which is unrealistic Sadness, depression, fear, anxiety are all normal parts of grieving and learning to cope with major life changes trying to ignore these feelings can make the person with cancer feel lonely Feeling lonely may contribute further marginalization.

13 Cancer survivorship Surviving cancer or survivorship can be defined in different ways. Two common definitions include: Having no disease after the completion of treatment, The process of living with, through, and beyond cancer. By this definition, cancer survivorship begins at diagnosis. It includes people who continue to have treatment to either reduce risk of recurrence or to manage chronic disease.

14 Seasons of cancer survivorship Acute survivorship: describes the time when a person is being diagnosed and/or in treatment for cancer Extended survivorship: describes the time immediately after treatment is completed, usually measured in months Permanent survivorship: describes a longer period, often meaning that the passage of time since treatment is measured in years

15 Cancer survivorship About 68% of today s cancer survivors were diagnosed with cancer five or more years ago. Approximately 15% of all cancer survivors were diagnosed 20 or more years ago. More than half of cancer survivors are 65 or older. And an estimated 1 in 530 adults between the ages of 20 and 39 is a survivor of childhood cancer.

16 Cancer survivorship Most cancer survivors were initially diagnosed with common cancers: 22% of survivors had breast cancer, 20% had prostate cancer, 9% had colorectal cancer, and 8% had cervical, uterine, or ovarian cancers.

17 Cancer survivorship Improved identification of cancers that can sometimes be found early through screening, such as: mammography for breast cancer, PSA test for prostate cancer, Cervical smear for PAP tests for cervical cancer, and Colonoscopy for colorectal cancer Improvements in treatment More effective treatment of side effects, making it possible to give patients the planned doses of cancer drugs The development of new treatments, such as targeted therapies

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19 Cancer survivor Physical symptoms and conditions: Pain, diabetes, loss of appetite, osteoporosis, sleeping difficulties, cardiovascular issue, skin problems, fatigue, infertility, sexual dysfunction, difficulty moving and secondary cancers Psychosocial concerns: Related to both social issues and mental health Anxiety, depression, fear of recurrence, distress, post-traumatic stress and support issues

20 Cancer survivor Health related quality of life: Health impact on peoples well being, including physical, mental, emotional and social functioning Health behaviours: Healthy diet, regular exercise, not smoking and following screening programmes Disease progression, recurrence and survival Cancer treatment outcomes and toxicities, biomarkers of survival and risk prediction models

21 Cancer survivor Patterns and quality of care: How does care follow national guidelines, Survivorship care planning and controlling, Adherence to treatment, insurance coverage, patients copayment, assess to care, risk perception, the use of complementary and alternative treatments. Economic impact of cancer Cancer impact on employment and finances

22 Conclusions Preventing secondary cancers and recurrence of cancer whenever possible Promoting appropriate management following diagnosis and/or treatment to ensure the maximum number of years of healthy life for cancer survivors Minimizing preventable pain, disability and psychosocial distress for those living with, through and beyond cancer Supporting cancer survivors and their families they need to cope with their disease