Even after cancer is defeated, it can cast a lifelong shadow. “Cancer survivorship represents a very critical phase,” said Smita Bhatia, M.D., M.P.H., a pediatric oncologist and director of the new Institute for Cancer Outcomes and Survivorship in the UAB School of Medicine and associate director for cancer outcomes research at the UAB Comprehensive Cancer Center. “We and others have shown in our research studies that our cancer survivors are a vulnerable population,” she said. “When you follow them long-term, you find that they have a very high burden of chronic health conditions.”

Often, these health problems can be linked back to cancer treatments, including chemotherapy, radiation and even surgeries, Bhatia said. Because these complications can occur “many years after the completion of treatment,” they are called “late effects.” One example involves a particular class of chemotherapy drug known as anthracyclines. “We use these agents often because they are highly effective in a large variety of cancers,” Bhatia said. But research shows that patients who take these drugs have a high risk of developing congestive heart failure many years later.

Girls who have “received radiation to the chest around puberty for lymphoma,” have “an increased risk of breast cancer,” Bhatia added. And this breast cancer “occurs at a much younger age than would be anticipated in the general population. So these girls are developing breast cancer at age 30 and 40, whereas in the general population you’d be anticipating breast cancer at age 60.”

Results from a survey have shown that only a third of patients realize they are at risk for these late effects, and because the family practitioners and internists who are seeing these patients do not encounter cancer survivors very often, “it is not in the forefront in terms of their understanding, in terms of their knowledge base and in terms of their experience of what they should anticipate,” Bhatia said. Addressing this situation becomes even more urgent as the number of survivors grows, she adds. “The number of cancer survivors is growing at the rate of about 2 percent every year,” Bhatia said. “We will, by about 2022, have 18 million cancer survivors.”