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Long-term Toxicity of Cancer Treatment in Older Patients

Armin Shahrokni, Abraham J. Wu, Jeanne Carter, Stuart M. Lichtman

Clinics in Geriatric Medicine, Volume 32, Issue 1, February 2016, Pages 63-80

Key points

  • ​The number of older cancer survivors is expected to increase in the next few decades because of the aging population, earlier cancer stage diagnosis, and proper cancer treatment.
  • Although effective on cancer treatment, both chemotherapy and radiation therapy may have long-lasting negative impacts on older cancer survivors’ quality of life.
  • Long-term toxicities of breast and prostate cancer treatment on cognition, cardiac function, emotional wellbeing, muscle and bone health, balance and coordination, and sexual health are well known.
  • In order to maintain older cancer survivors’ quality of life, it is critical that primary care providers screen, diagnose, and properly manage long-term toxicities of cancer treatment.


The number of cancer survivors is increasing in the United States. In 2014, there were 14.5 million cancer survivors. By 2024, this number is expected to increase to 19 million, with the significant portion of them being older than age 65 years.1 Because more patients are diagnosed with earlier stages of cancer, the likelihood of cancer survivors living beyond 5 years after the initial cancer diagnosis has increased.2 The role of primary care providers in the immediate and long-term follow-up of patients with cancer is still being defined, because there are significant differences between primary care providers’ and oncologists’ preferences toward follow-up care of the cancer survivors. Although 38% of primary care providers prefer shared care of the cancer survivors with the oncologists, only 16% of oncologists were in agreement with this model of care. More than half of primary care providers thought they had the necessary skills to take care of the cancer survivors, whereas this was agreed to by only 23% of the oncologists.3 The primary care providers who were more confident in their skills to provide follow-up care for patients with cancer were more involved in the care of patients with cancer.4

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