It took my own bout with leukemia for me to understand the long-term consequences that result from poisoning your body with cancer treatments. These enduring symptoms have been termed “late effects,” which seems a bit euphemistic to me. I prefer calling them collateral damage. It is not unlike being involved in a car accident. You can repair your car, but it never drives the same again.
The good news is that researchers have finally begun paying attention to this collateral damage and the persistent changes in our bodies and brains that many of us know all too well. How many? A recent paper stated that “up to 85% of adult cancer survivors and 99% of adult survivors of childhood cancer live with an accumulation of chronic conditions, frailty, and/or cognitive impairments resulting from cancer and its treatment.”
One current idea is that treatments cause an accelerated aging process. The National Cancer Institute recently convened two think tanks on this topic: Cancer and Accelerated Aging: Advancing Research for Healthy Survivors Initiative. Experts assembled to share evidence of promising strategies to prevent, slow, or reverse the aging consequences of both cancer and its treatment. They explained that many approaches we use to cure or control cancer also seem to accelerate or accentuate the aging process, resulting in health conditions like fragility, muscle loss, chemo brain, and even second cancers. One study that compared signs of premature aging in women who had undergone treatment for breast cancer and healthy women found that the survivors who had undergone surgery, chemotherapy, and radiation had higher cytokines in their blood and more symptoms associated with premature aging than the control group. Unfortunately, lifestyle changes such as eating a healthy diet and engaging in regular exercise don’t seem to have much effect on these age-related conditions that develop due to cancer treatments.
The main premature-aging problem appears to be heart disease. A recent study that compared all-cause and cardiovascular deaths breast cancer survivors and women without breast cancer, found that after 25 years, breast cancer survivors had a 79% higher risk of death from any cause relative to women who had never been diagnosed with the disease. This overall higher risk of dying was seen even when the time since diagnosis, tumor stage, estrogen receptor status, and age at diagnosis were taken into account. Interestingly, cardiovascular disease was the leading cause of death in the women who didn’t have cancer and the second leading cause of death among the survivors. Similarly, the Women’s Health Initiative also found that women with localized breast cancer had a higher overall mortality rate than women who had not had breast cancer.
These findings have led to a new interest in using the approaches applied to age-related conditions to better understand post-cancer treatment consequences. Exercise is a good example, with data suggesting that “prehabilitation” or short-term exercise and nutrition therapy before cancer surgery, adjuvant chemo, or radiation can help lower subsequent complications and support recovery. It also suggests that rehabilitation post-treatment is key to improving quality of life.
Clearly, this area of research is critical. It’s not enough to cure cancer. We have to mitigate the side effects of the treatments. Even better, of course, will be learning how to prevent breast cancer — which has always been my goal.