AGING IN CANCER SURVIVORS Accelerated Aging among Cancer Survivors: From Pediatrics to Geriatrics Tara O. Henderson, MD, MPH, Kirsten K. Ness, PT, PhD, Harvey Jay Cohen, MD OVERVIEW There are almost 14-million cancer survivors in the United States and the population is growing. Almost two-thirds of these survivors are age 65 or older. Given this, it is imperative to understand the impact of cancer and its therapies on the aging process. Childhood cancer survivors, diagnosed with cancer at age 21 or younger, particularly females, have rates of frailty similar to rates in older adults. This phenomenon appears to start early, suggesting an aging phenotype. Frailty among childhood cancer survivors increases risk for chronic disease and mortality. Adults diagnosed with cancer are faced with the effects of cancer and its therapies compounded by the issues of multiple morbidities that occur with the typical aging process. Intervention studies to date have focused on smoking cessation, diet, and exercise, as well as improving rates of late effects surveillance in childhood cancer survivors. No intervention studies have specifically addressed the issue of frailty or multiple morbidities in cancer survivors. Concerted efforts must continue to create and disseminate survivorship care plans to all cancer survivors. I t is currently estimated that there are over 13.7 million can- cer survivors in the United States. The National Cancer Institute defınes cancer survivors from the time of diagnosis until time of death. This population is steadily increasing in size 1 as a result of improvements in treatment as well as early detection. Furthermore, the general population is living lon- ger and cancer rates tend to increase with age. It is estimated that two-thirds of all cancer survivors will be aged 65 or older by 2020. 2 Research in survivors of both pediatric and adult cancer has shown that success in the cure of cancer has come with a cost. Cancer and its therapies are associated with sec- ond malignancies and late effects that can affect any organ system. Given that older survivors are more likely to have multiple chronic health problems than younger survivors, it is imperative to understand the influence of cancer, its treat- ments, and associated late effects on the aging process. This understanding will enable health care providers to deliver appropriate risk-based care and interventions to minimize morbidities and maximize quality of life in this growing high-risk population. CHILDHOOD CANCER SURVIVORS, CHRONIC DISEASE, AND AGING Most large cohorts of childhood cancer survivors, such as the North American Childhood Cancer Survivor Study (CCSS), defıne survivors diagnosed at age 21 years or younger with a cancer as survivors if they are alive 5 years after initial diag- nosis. The proportion of children diagnosed with cancer who survive 5 years after their original cancer diagnosis has im- proved from 57.9% in 1975 to over 83.1% in 2009. 3 There are nearly 380,000 survivors of childhood cancer living in the United States today. 3 Over 270,000 of these individuals are younger than age 40, with years of potential to actively and signifıcantly contribute to family life, their communities, and society. 3 Unfortunately, treatment for childhood cancer, al- though curative, does not come without risk of late effects (Table 1). Surgical intervention, therapeutic radiation, and administration of chemotherapy do not always spare normal tissue, in some cases leaving the young survivor with less than optimal organ system structure and function. 4-6 Although most young adult cancer survivors do not have clinically sig- nifıcant chronic disease, some experience symptoms that in- terfere with or subtly limit their abilities to participate fully in life roles at home, at work, and in the community or during recreational activities. These symptoms may include fa- tigue, 7,8 shortness of breath, 9 or an inability to fully engage in activities that require exertion. 10 Such symptoms are all markers of reduced physiologic capacity, and may indicate an increased risk for developing early onset of chronic dis- eases, hospitalization, and death. Accumulating evidence indicates that impairment of phys- iologic health early in life 11 may make childhood cancer sur- vivors more vulnerable than the rest of the population to conditions and diseases often associated with aging, such as heart disease, 12,13 diminished pulmonary function, 14 and sec- From the University of Chicago Comer Children’s Hospital, Chicago, IL; St. Jude Children’s Research Hospital, Memphis, TN; Duke University, Durham, NC. Disclosures of potential conflicts of interest are found at the end of this article. Corresponding author: Tara O. Henderson, MD, MPH, Assistant Professor of Pediatrics, University of Chicago, Comer Children’s Hospital, 5841 S. Maryland Ave. MC 4060, Chicago, IL 60615; email: thenderson@peds.bsd.uchicago.edu. © 2014 by American Society of Clinical Oncology. asco.org/edbook | 2014 ASCO EDUCATIONAL BOOK e423