The dramatic gains in survival for cancer patients has challenged the medical and scientific community to think about the long-term and late effects of cancer treatments and how they might be mitigated. During that latter half of the 20th century, much effort was focused on increasing survival, through earlier diagnosis and improvements in treatment. Little thought was given to the post-treatment sequelae of cancer treatments and their impacts on the lives of survivors. Studies in long-term survivors of childhood cancer have led the way in helping us to conceptualize how to frame the research agenda. In adult survivors of childhood cancer we see accelerated aging, premature failing of organ systems, functional declines, and second malignancies. Will this be the fate of long-term adult cancer survivors?
The challenge today is to construct a survivorship research agenda for adult cancer survivors, who span young adulthood to the oldest old, and to determine what are the most pressing medical, functional, and psychosocial issues that need our attention. We have limited understanding of the late effects of specific cancer treatments in adults, with some exceptions, and how they interact with normal age related organ changes e.g., anthracycline toxicity and atherosclerotic heart disease; cognitive effects of cancer treatment and age-related cognitive decline. Preventing the late effects of treatments, particularly for younger adults who can expect extended survival after cancer treatments, may be increasingly important. Management of persistent symptoms (e.g., fatigue, insomnia, neuropathy, depression, pain, cognitive changes) can best be addressed through development of treatment strategies based on an understanding their biological mechanisms. No single institution can take on this challenge; global effort is required. This will include basic and clinical research, as well as well as implementation and evaluation of new models of care.