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Cancer treatment and survivorship statistics, 2025: An urgent call to optimize health after cancer
CA: A Cancer Journal for Clinicians ( IF 503.1 ) Pub Date : 2025-05-30 , DOI: 10.3322/caac.70017
Lidia Schapira, Christine M. Duffy

The publication of the American Cancer Society’s “Cancer Treatment and Survivorship Statistics, 2025” report affirms that the number of people living in the United States with a history of cancer is rising because of advances in detection and treatment that have improved survival.1, 2 In our opinion, it also presents a new opportunity to engage all stakeholders in the discourse on cancer survivorship. More cancers have become treatable and controllable, and the sheer number of survivors demands a concerted approach involving a trained health care workforce, accessible referral pathways, and adequate reimbursement for services rendered.

There are reasons to celebrate the findings as we learn that general cancer mortality continues to fall, with an overall incidence decline in men. Yet these improvements are not distributed equally among subpopulations because cancer mortality continues to rise in women, and we are presented with evidence of the persistence of disparities in access to life-saving cancer treatment and receipt of guideline-concordant care. For instance, there is evidence that patients with private insurance are twice as likely to receive recommended treatment for stage II–III colon cancer compared with patients who are uninsured, and Black patients are less likely than White patients to receive surgery for early stage colon and rectal cancers.3, 4 Disparities in receipt of guideline-concordant care have been reported for patients with many solid tumors,5, 6 and this inevitably leads to worse outcomes.

The global disruption caused by the coronavirus disease 2019 pandemic will continue to be studied for years, but some of its consequential effects are beginning to surface. Among them are delays in screening and disruptions in care pathways that contribute to stage migration.7 In addition, the pandemic exposed fault lines across health care systems and exacerbations in disparities in cancer care. Other global events, including wars and famine that lead to massive migration, will undoubtedly have an impact on global cancer statistics in years to come.

Robust data banks are essential to advancing our understanding of long-term outcomes in cancer survivors. Studies like the St Jude Lifetime Cohort and the Childhood Cancer Survivor Study have generated invaluable insights into survivorship in pediatric populations. The National Cancer Institute-funded cancer epidemiology survivor cohorts, which were established to follow survivors over time to capture data on treatment exposures, long-term health outcomes, and social determinants of health, are an important step that will inform future interventions and guidelines for care, but comprehensive population-based surveillance of survivorship outcomes remains limited.8

Growing recognition of the toxicities and long-term burdens associated with cancer treatments has driven efforts to de-escalate therapy, aiming to balance efficacy with improved quality of life for cancer survivors. Major improvements in imaging techniques and genomic assays have made this possible for several cancers. Positron emission tomography-computed tomography scans are now able to guide lymphoma treatment intensity and duration, thus allowing responders to benefit from abbreviated courses of cancer-directed treatment. Genomic testing in early stage, hormonally sensitive breast cancer made it possible for women to avoid chemotherapy without compromising their survival. Sentinel node biopsies in breast cancer and melanoma have resulted in markedly lower rates of lymph node dissections, thus reducing the lifelong risk of lymphedema in these patient groups. Advances in surgical techniques in bladder and rectal cancers have allowed many more individuals to maintain functioning organs, significantly improving health-related quality of life. Similarly, the shift toward watchful waiting in early stage prostate cancer for older men has spared many from experiencing known urinary and sexual complications of surgery.

Survivors of adolescent and young adult cancers, defined as individuals diagnosed with a primary malignancy between ages 15 and 39 years, constitute a population with unique developmental, psychosocial, and health-related needs and are at risk of developing a range of chronic comorbidities. In fact, adolescent and young adult survivors generally experience two times the cumulative burden of severe to life-threatening chronic health conditions compared with peers.9 To complicate matters, adolescent and young adult survivors are often treated in disparate settings (pediatric or adult) on dissimilar protocols that include different recommendations for longitudinal follow-up. Specialized techniques and referral mechanisms are needed to ensure a seamless transition from acute cancer care to survivorship care, and this may include a transition from the pediatric setting to the adult setting, with each transition a risk for discontinuity and subsequent nonadherence to recommended screening guidelines.

The science and practice of survivorship care has flourished as a companion to the development of clinical therapeutics to address the long-term consequences of cancer and its treatment. It includes a thorough and ongoing assessment of the patient with attention to surveillance and management of physical and psychosocial effects of cancer, prevention and surveillance of new cancer/recurring cancers, surveillance and management of chronic medical conditions, general health promotion and disease prevention, and care coordination.10 Cancer survivors may benefit from supportive services, including physical rehabilitation, and nutritional guidance and need access to specialty referrals in cardio-oncology, oncofertility, pyscho-oncology, endocrinology, lymphedema therapy, neurocognitive rehabilitation, pain management, sexual health, and more. Promoting tobacco cessation, exercise, and healthy weight and moderating alcohol consumption, which have been critical to reducing the cancer burden in the public, is essential in survivors given their shared risk factors.

What is neither clear nor standardized is who will care for cancer survivors. Models of care fall into broad categories and include specialist-led care, shared care, primary care-led care, and dedicated survivorship clinics, which offer multidisciplinary services. Advanced practice practitioners could play a key role in delivering survivorship services at cancer centers and clinics, and many have argued that this work is ideally suited for their scope of practice. Innovative practices are testing consultative models for survivorship care as well as fully integrating survivorship care into primary care. Customizing survivorship care based on diagnosis, exposures, as well as future risk (of recurrence or late effects from cancer therapies) allows for better utilization of resources. However, in the long run, most survivors will need to transition to generalist-led care. Ensuring that the medical workforce is adequately prepared requires integrating survivorship education both during medical training and throughout continuing professional development 11-14 Efforts to prepare cancer survivors by boosting self-efficacy and self-advocacy and arming them with concise treatment summaries and care plans have received considerable attention over the past 2 decades.15, 16 In fact, cancer survivors, communities, advocacy groups, and clinicians need more opportunities to co-design models based on individual patient-level characteristics and relevant outcome measures and must have evaluation mechanisms in place.17

What is clear is that we are not yet able to properly care for the 18.6 million cancer survivors in 2025 and that, without coordinated and strategic efforts, we will fall short of meeting the complex care needs of the estimated 26 million projected in the United States by 2030—a gap that poses a significant challenge to both oncology and primary care systems. In a fragmented health care system with survivorship expertise concentrated at major cancer centers and a shortage of primary care clinicians in rural and underserved areas, disparities in the quality of survivorship care and outcomes for cancer survivors are at risk of widening even further. We need innovative approaches that are grounded in high-level evidence, where available, and interventions designed to disseminate best practices and patient-facing interventions that are affordable and scalable.

The US national standards for survivorship care, published in 2024 by the National Cancer Institute, offer a clear blueprint for what cancer survivors and their families can expect after a cancer diagnosis.18 These standards were created to guide health care professionals and health systems in delivering comprehensive, personalized survivorship care that addresses the complex and evolving needs of survivors. They reflect significant advances in the understanding of survivorship but do not address the growing challenge of recognizing and treating toxicities from newer therapies like immunotherapy or drugs a patient may have received through enrollment in a clinical trial. One lesson we have learned is that a proactive approach to supportive care, particularly mental health services, can relieve the symptom burden both during and after the completion of curative-intent treatment. Introducing supportive interventions earlier in the care trajectory can help survivors maintain better physical and emotional health over the long term, rather than waiting to address complications only after treatment ends. This approach aims to ensure that survivors are supported throughout their journey, improving overall quality of life and helping them transition more smoothly from active treatment to survivorship.

We face significant challenges in the years ahead as the number of cancer survivors continues to grow, the survivor population ages, novel treatments introduce new and often unpredictable toxicities, and workforce shortages persist among both oncologists and primary care physicians. To meet the growing needs of cancer survivors, we will need to innovate and explore new models of care. These models should be evaluated not only for their clinical effectiveness but also from the perspectives of survivors, caregivers, health care professionals, and society.



中文翻译:

2025 年癌症治疗和生存率统计:迫切呼吁优化癌症后健康

美国癌症协会的“2025 年癌症治疗和幸存者统计”报告的发布确认,由于检测和治疗的进步提高了生存率,美国有癌症病史的人数正在增加。1、2 在我们看来,它还提供了一个新的机会,让所有利益相关者都参与到关于癌症幸存者的讨论中。更多的癌症已经变得可以治疗和可控,幸存者的绝对数量需要采取协调一致的方法,包括训练有素的医疗保健人员、可及的转诊途径以及对所提供服务的适当报销。

当我们了解到总体癌症死亡率持续下降,男性的总体发病率下降时,我们有理由庆祝这些发现。然而,这些改善在亚群中并未平均分配,因为女性的癌症死亡率持续上升,并且我们得到的证据表明,在获得挽救生命的癌症治疗和接受与指南一致的护理方面存在持续差异。例如,有证据表明,与没有保险的患者相比,拥有私人保险的患者接受 II-III 期结肠癌推荐治疗的可能性是其两倍,而黑人患者接受早期结肠癌和直肠癌手术的可能性比白人患者小。3、4 据报道,许多实体瘤患者在接受指南一致的护理方面存在差异,5, 6 这不可避免地会导致更糟糕的结果。

2019 冠状病毒病大流行造成的全球破坏将继续研究多年,但其一些间接影响开始浮出水面。其中包括筛查延迟和护理路径中断,这些都导致了阶段性迁移。7 此外,大流行暴露了整个医疗保健系统的断层线,并加剧了癌症护理的差距。其他全球事件,包括导致大规模移民的战争和饥荒,无疑将在未来几年对全球癌症统计数据产生影响。

强大的数据库对于促进我们对癌症幸存者长期结果的理解至关重要。St Jude Lifetime Cohort 和 Childhood Cancer Survivor Study 等研究为儿科人群的生存率提供了宝贵的见解。美国国家癌症研究所资助的癌症流行病学幸存者队列旨在随着时间的推移跟踪幸存者,以获取有关治疗暴露、长期健康结果和健康的社会决定因素的数据,这是一个重要的步骤,将为未来的干预措施和护理指南提供信息,但基于人群的全面幸存者监测结果仍然有限。8

人们越来越认识到与癌症治疗相关的毒性和长期负担,这推动了降低治疗水平的努力,旨在平衡癌症幸存者的疗效与改善生活质量。成像技术和基因组检测的重大改进使这成为可能,适用于多种癌症。正电子发射断层扫描-计算机断层扫描现在能够指导淋巴瘤治疗的强度和持续时间,从而使反应者能够从癌症定向治疗的简短疗程中受益。早期激素敏感乳腺癌的基因组检测使女性可以在不影响生存率的情况下避免化疗。乳腺癌和黑色素瘤的前哨淋巴结活检导致淋巴结清扫率显着降低,从而降低了这些患者群体终生患淋巴水肿的风险。膀胱癌和直肠癌手术技术的进步使更多的人能够维持器官功能,从而显着改善与健康相关的生活质量。同样,老年男性在早期前列腺癌中转向观察等待,使许多人免于经历已知的手术泌尿和性并发症。

青少年和年轻成人癌症的幸存者,定义为 15 至 39 岁被诊断患有原发性恶性肿瘤的个体,构成具有独特发育、社会心理和健康相关需求的人群,并有患上一系列慢性合并症的风险。事实上,与同龄人相比,青少年和年轻成人幸存者所经历的严重至危及生命的慢性健康状况的累积负担通常是其两倍。9 更复杂的是,青少年和年轻成年幸存者通常在不同的环境(儿科或成人)中接受不同的治疗,采用不同的方案,其中包括不同的纵向随访建议。需要专门的技术和转诊机制来确保从急性癌症护理到幸存者护理的无缝过渡,这可能包括从儿科到成人的过渡,每次过渡都有不连续和随后不遵守推荐筛查指南的风险。

幸存者护理的科学和实践作为解决癌症及其治疗的长期后果的临床疗法开发的伴侣而蓬勃发展。它包括对患者进行全面和持续的评估,关注监测和管理癌症的身体和社会心理影响、预防和监测新发癌症/复发性癌症、监测和管理慢性疾病、一般健康促进和疾病预防以及护理协调。10 癌症幸存者可能受益于支持性服务,包括身体康复和营养指导,并且需要 获得心脏肿瘤学、肿瘤生育、心理肿瘤学、内分泌学、淋巴水肿治疗、神经认知康复、疼痛管理、性健康等方面的专业转诊。促进戒烟、锻炼、健康体重和适度饮酒对于减轻公众的癌症负担至关重要,鉴于幸存者有共同的风险因素,这对他们来说至关重要。

既不明确也不标准化的是,谁来照顾癌症幸存者。护理模式分为几大类,包括专家主导的护理、共享护理、初级保健主导的护理和专门的幸存者诊所,它们提供多学科服务。高级实践从业者可以在癌症中心和诊所提供幸存者服务方面发挥关键作用,许多人认为这项工作非常适合他们的实践范围。创新实践正在测试幸存者护理的咨询模式,以及将幸存者护理完全整合到初级保健中。根据诊断、暴露以及未来风险(癌症治疗的复发或迟发效应)定制生存者护理可以更好地利用资源。然而,从长远来看,大多数幸存者将需要过渡到全科医生主导的护理。确保医务人员做好充分准备需要在医学培训和整个持续专业发展过程中整合幸存者教育 11-14 在过去的 2 年里,通过提高自我效能和自我宣传以及用简洁的治疗总结和护理计划武装他们来为癌症幸存者做好准备的努力受到了相当大的关注。15、16 元事实上,癌症幸存者、社区、倡导团体和临床医生需要更多机会根据个体患者层面的特征和相关结果测量共同设计模型,并且必须建立评估机制。17

显而易见的是,我们还无法在 2025 年妥善照顾 1860 万癌症幸存者,如果没有协调和战略性的努力,我们将无法满足预计到 2030 年美国估计有 2600 万癌症幸存者的复杂护理需求——这一差距对肿瘤学和初级保健系统都构成了重大挑战。在一个分散的医疗保健系统中,幸存者专业知识集中在主要癌症中心,而农村和服务不足地区缺乏初级保健临床医生,幸存者护理质量和癌症幸存者结果的差异有可能进一步扩大。我们需要以高水平证据为基础的创新方法(如有),以及旨在传播最佳实践和面向患者的干预措施,这些干预措施是负担得起的和可扩展的。

美国国家癌症研究所于 2024 年发布的美国国家幸存者护理标准为癌症幸存者及其家人在诊断癌症后可以期待的情况提供了清晰的蓝图。18 制定这些标准是为了指导医疗保健专业人员和卫生系统提供全面、个性化的幸存者护理,以满足幸存者复杂和不断变化的需求。它们反映了对幸存者理解的重大进展,但并未解决识别和治疗新疗法(如免疫疗法或患者可能通过参加临床试验接受的药物)的毒性的日益严峻挑战。我们学到的一个教训是,积极主动的支持性护理方法,尤其是心理健康服务,可以减轻治愈性治疗期间和之后的症状负担。在护理轨迹的早期引入支持性干预措施可以帮助幸存者长期保持更好的身心健康,而不是等到治疗结束后才解决并发症。这种方法旨在确保幸存者在整个旅程中得到支持,提高整体生活质量并帮助他们更顺利地从积极治疗过渡到幸存者。

随着癌症幸存者人数的持续增长、幸存者人口的老龄化、新疗法引入新的且通常不可预测的毒性,以及肿瘤学家和初级保健医生之间持续存在的劳动力短缺,我们在未来几年将面临重大挑战。为了满足癌症幸存者日益增长的需求,我们需要创新和探索新的护理模式。这些模型不仅应根据其临床有效性进行评估,还应从幸存者、护理人员、医疗保健专业人员和社会的角度进行评估。

更新日期:2025-05-30
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