Running head: Cancer Survivors: a vulerable population

Cancer Survivors: A Vulnerable Population

Tyler W. Nickels
Ferris State University

Cancer Survivors: a vulerable population

Cancer Survivors: A Vulnerable Population

What defines a cancer survivor? According to the American Cancer Society (2014), A
cancer survivor is any person who has been diagnosed with cancer, from the time of diagnosis
through the balance of life. The society also defines three phases that are distinct in association
with cancer survival, the time from diagnosis to the end of initial treatment, the transition from
treatment to extended survival, and long-term survival. Cancer is also defined when all traces of
cancer have been removed from a patients body (American Cancer Society, 2014). Surviving
cancer is not an easy task and those who were able to do so are part of a strong, relentless, and
humble population.
Vulnerability of Cancer Patients
Cancer survivors are among some of the toughest people, mentally and physically.
They have overcome a life-threatening illness and continued to live their life. According to the
American Cancer Society, cancer dates back to 3000 BC when Egyptians cauterized tumors or
ulcers but could not treat the individuals (American Cancer Society, 2014). Some cancers can put
patients at risk for infections as their immune system is suppressed; chemotherapy also does this.
This makes patients vulnerable to other infections as their immune system is not strong enough
to fight of an infection. After surviving cancer they have to face the thought that it may come
back at any time, without warning. This can be a mental battle to overcome when trying to get
back to a normal lifestyle. It is difficult to determine the geographic location of cancer survivors
who are at risk. People all over the world have overcome cancer, this is not like a geographical
specific culture where they may be vulnerable to health problems. This makes it hard to identify
where those are at most risk who have survived cancer.

Cancer Survivors: a vulerable population

Those of the cancer survivor population at most risk for mortality and morbidity are at
low income levels. A study on low income cancer survivors in 2011 suggests, those with limited
financial resources experience multiple difficulties, including the financial burden of having a
life-threatening diagnosis, economic impact of treatment, and managing various symptoms from
the disease and its treatment, making it difficult for them to cope effectively (Meraviglia, p.
119). Health care is an expensive industry and it makes it extremely difficult for those of low
income to afford the cost. Having financial hardships generates problems in getting the proper
care and education to maintain a healthy life. After surviving cancer, it is important to continue a
healthy lifestyle when the body has endured the harsh impact from chemotherapy and radiation.
Meraviglia (2011) conducted a study to determine if cancer survivors of low income are using
health promoting decisions. A survey was conducted and found that this population does practice
methods to promote health, some of which included spiritual growth, maintaining a hopeful
outlook and mental attitude, walking, and changing their diet (Meraviglia, 2011).
Establishing a bias for cancer survivors is difficult. They are not a distinct population that
can be easily identified objectively such as race or obesity. We may not know someone has
survived cancer unless we are close to them, such as family or a friend. It is more likely that a
positive stereotype comes from being a cancer survivor rather than a bias. Many look at cancer
survivors as being a strong group of people who can defeat any challenges in life if they can
defeat cancer. There are social media groups that can reflect this, survivors often collaborate to
share their experiences and help each other cope.
Demographics
Nearly 14.5 million children and adults with a history of cancer were alive on January 1,
2014, with an estimation of 19 million to be living by 2024 (American Cancer Society, 2014).

Cancer Survivors: a vulerable population

These numbers are high with more technology developed and diagnosing cancer. According to
the American Cancer Society, The 5 year survival rate for all cancers diagnosed in 2004-2010
was 68%, up from 49% in 1975-1977. This too can be contributed to technology advancements
in treating and diagnosing cancer at an earlier stage. Survival rates for each state can fluctuate
based on population and resources to health care (See Appendix A). It is difficult to determine
the survival rates based on counties in Michigan. Demographics for cancer survivors is limited to
state and national levels. Information on types of cancer, mortality and morbidity per county is
available but does not include the survival rates for each county. Thus, survival rates for
Michigan from 1995 to 2005 can be seen in Appendix B. The table has columns differentiating
the location of cancer, with local being conformed to an organ, regional representing extension to
organs or involvement to lymph nodes and distant representing continuity to non-adjacent
organs, metastasis, or involvement in distant lymph nodes (Statistics and Reports: Cancer
Statistics, 2014).
Health Concerns
Chemotherapy and radiation can have both beneficial and negative impacts to a person
trying to overcome cancer. The benefits are clear to understand, to rid of any tumors or cancer
cells in the body. The negative impacts can be many types of morbidities that may cause
mortality to cancer survivors. Factors that attributed to some morbidities include chronic pain
related to cancer, cancer-related fatigue 42 months post treatment, and some breast cancer
survivors with lymphedema. These all impacted quality of life and health status (Treanor, 2013,
p. 2428). The type and site of cancer, time since diagnosis, and treatment, reflect on the
significance of reported morbidities. Those who received combination therapies compared to
single treatment were over two and a half times more likely to report some long term effects of

Cancer Survivors: a vulerable population

cancer (Treanor, 2013, p. 2428). To better understand the significance of the location and type of
cancer, Appendix C shows a table breaking down the various types of cancer and the mortality
rate associated with it.
Combining treatments to eliminate cancer can also increase the incidence of developing
pulmonary and cardiac complications. The extent of complications is based on the dosage of
chemotherapy and the amount of radiation the patient receives. A patient receiving anthracycline
may develop cardiomyopathy which can lead to CHF when the systolic left ventricular function
decreases (Carver, 2007). A number of factors can lead to this beyond just medication use, it is
also dose-dependent with a higher cumulative dose more likely to cause it. Radiation
pneumonitis is a possibility, occurring in 5 to 15% of lung cancer patients who receive radiation
therapy (Carver, 2007). This can make the recovery of surviving cancer more difficult having to
overcome radiation pneumonitis.
As people age it can be difficult to manage daily activities such as making dinner, getting
groceries, dressing, and showering. With patients who have defeated cancer this can be more
difficult. A study completed in Norway in 2010 involved 911 individuals had survived cancer
with a control group of 10, 988 who were cancer free. The study found that those who had
surpassed cancer were having more difficulty completing daily tasks. The difference was not
marginal but was noticeable, 38% of cancer survivors had difficulty completing daily tasks while
32% of the controls had problems (Grov, 2010). The study also found survivors with comorbidities had a harder time completing ADLs (47%), than survivors without co-morbidities
(39%). It has been difficult to find results for morbidities associated with cancer survival, it is
typically limited to cardiac and pulmonary morbidities, and limitations of ADLs.
Depression

Cancer Survivors: a vulerable population

Depression is a common disease associated with cancer and surviving it. Those who have
cancer are more likely to experience depression compared to individuals who are cancer free.
13.7% of cancer survivors reported having depression in relation to 8.9% of adults who do not
have cancer (Okoro, 2014). Depression in cancer survivors is dependent on the type of cancer.
There is a greater chance of depression in one who has recovered from melanoma. Compared
with those who had no cancer history, women with reproductive cancers were 22% more likely
to report current depression and adults with gastrointestinal cancers and melanoma skin cancer
were 53% and 58% more likely to report so, respectively (Okoro, 2014, p. 760). Cancer can be
difficult for people to handle physically and can be more challenging after overcoming it
emotionally. It has a big impact on their self-image and confidence.
There is a relationship to surviving cancer and psychological morbidity, a study in
Australia confirmed this. In 1323 survivors surveyed, The prevalence of psychological
morbidity was 28%. Specifically, 24% of survivors were identified as cases on anxiety, 14% as
cases on depression and 10% as cases on comorbid anxietydepression (Boyes, 2011, p. 184).
For further detail on prevalence of depression and anxiety refer to Appendix D.
In a separate study mortality was determined in cancer survivors of childhood. A suicide
ideation survey was completed at some point in their lifetime. A follow-up was done years later
to determine the cause of death. 10, 072 survivors were followed up and 10 of them had
committed suicide, see Appendix E (Brinkman, 2014). This was a small percentage (1.6%) of
survivors and of these suicides, 30% reported suicidal ideation. With this study it shows there is a
very small amount of individuals committing suicide after surviving cancer.
Conclusion

Cancer Survivors: a vulerable population

Those diagnosed with cancer have to overcome a long road of chemotherapy and
radiation. Having a history of cancer alone can define someone as being vulnerable as there is
always a chance for relapse. Treatments to defeat cancer have a detrimental impact on the human
body. This too can cause survivors to be vulnerable to morbidities and mortality later in life.
Some resulting morbidities from chemotherapy and radiation can be cardiac and lung
complications, along with difficulty completing ADLs. As technology improves the number of
cancer survivors will continue to increase, this is due to advances in treatment and diagnosing
cancer early on. Information was limited on cancer survivors in the local levels of Michigan, but
national and state levels were identified. Depression is a disease that can derive from surviving
caner. There is a greater chance in developing depression in cancer survivors then those who are
cancer free. Suicide is likely in survivors who are depressed, conversely this is a small
percentage of occurrence in depressed survivors. Overall, cancer survivors are a vulnerable
population since they have endured toxins, and radiation to treat their illness. They can have
mental and physical complications from treatment, which may develop depression, leading to
suicide.

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8
References

American Cancer Society. (2014.) The History of Cancer. Retrieved from

http://www.cancer.org/acs/groups/cid/documents/webcontent/002048-pdf.pdf
American Cancer Society. (2014). Cancer Facts & Figures 2015. Retrieved from
http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc044552.pdf
American Cancer Society. (2014). Cancer Treatment and Survivorship Facts & Figures 20142015. Retrieved from
http://www.cancer.org/acs/groups/content/@research/documents/document/acspc042801.pdf
Boyes, A. W., Girgis, A., d'Este, C., & Zucca, A. (15, July). Flourishing or floundering?
Prevalence and correlates of anxiety and depression among a population-based sample of
adult cancer survivors 6months after diagnosis. Journal of Affective Disorders, 135(1-3),
184-192. doi:http://dx.doi.org/10.1016/j.jad.2011.07.016
Carver, J. R., Shapiro, C. L., Ng, A., Jacobs, L., Schwartz, C., Virgo, K. S., & Hagerty, K. L.
(2007, September). American society of clinical oncology clinical evidence review on the
ongoing care of adult cancer survivors: Cardiac and pulmonary late effects. Journal of
Clinical Oncology, 25(25), 3991-4008. doi:10.1200/JCO.2007.10.9777
Grov, E. K., Fossa, S. D., & Dahl, A. A. (2010, July). Activity of daily living problems in older
cancer survivors: a population-based controlled study. Health & Social Care in the
Community, 18(4), 396-406. doi:10.1111/j.1365-2524.2010.00912.x

Cancer Survivors: a vulerable population

Meraviglia, M. G., & Stuifbergen, A. (2011, May). Health-promoting behaviors of low-income

cancer survivors. Clinical Nurse Specialist, 25(3), 118-124.
doi:10.1097/NUR.0b013e3182157786
Okoro, C. A., Li, J., White, A., & Dhingra, S. (2014, December). Current depression among
caner survivors: Findings from the 2010 behavioral risk factor surveillance system. The
International Journal of Cancer Epidemiology, Detection and Prevention, 38(6), 757764. doi:10.1016/j.canep.2014.10.002
Statistics and Reports: Cancer Statistics. (2014, June). In Michigan Department of Community
Health. Retrieved from http://www.mdch.state.mi.us/pha/osr/Index.asp?
Id=19&MainFile=MAINCAN.HTM&BookMark=RACE#RACE
Treanor, C., Santin, O., Mills, M., & Donnelly, M. (2013, May 16). Cancer survivors with selfreported late effects: their health status, care needs and service utilization. PsychoOncology, 22(11), 2428-2435. doi:10.1002/pon.3304

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Appendix
Appendix A

American Cancer Society. (2014.) The History of Cancer. Retrieved from

http://www.cancer.org/acs/groups/cid/documents/webcontent/002048-pdf.pdf

Appendix B

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American Cancer Society. (2014.) The History of Cancer. Retrieved from

http://www.cancer.org/acs/groups/cid/documents/webcontent/002048-pdf.pdf

Appendix C

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Treanor, C., Santin, O., Mills, M., & Donnelly, M. (2013, May 16). Cancer survivors with selfreported late effects: their health status, care needs and service utilization. PsychoOncology, 22(11), 2428-2435. doi:10.1002/pon.3304

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Appendix D

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Boyes, A. W., Girgis, A., d'Este, C., & Zucca, A. (15, July). Flourishing or floundering?
Prevalence and correlates of anxiety and depression among a population-based sample of
adult cancer survivors 6months after diagnosis. Journal of Affective Disorders, 135(1-3),
184-192. doi:http://dx.doi.org/10.1016/j.jad.2011.07.016

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Appendix E

Brinkman, T. M., Zhang, N., Recklitis, C. J., Kimberg, C., & Zeltzer, L. K. (2014, January).
Suicide ideation and associated mortality in adult survivors of childhood cancer. Cancer,
120(2), 271-277. doi:10.1002/cncr.28385