More people are living with and surviving cancer than ever before. Driven by advances in earlier detection, better treatments, and an aging population, the number of cancer survivors in the United States is projected to grow from 18.6 million to 22 million by 2035.
"Since 1991, overall cancer mortality has declined by more than a third, translating to nearly 5 million lives saved," says Dawn Hershman, MD, MS, FASCO, an expert in cancer outcomes and survivorship and deputy director of the Herbert Irving Comprehensive Cancer Center (HICCC) at Columbia University Irving Medical Center (CUIMC) and NewYork-Presbyterian Hospital. "This steady progress reflects decades of investment in research, prevention, screening, and treatment."
There are now more cancer survivors with unique health needs after they've faced cancer diagnosis and treatment. Columbia researchers are working to better understand these survivorship challenges and develop innovative solutions that help people thrive long after treatment ends.
Long-term effects of cancer treatment
While advances in cancer therapies mean more people are surviving cancer, treatments can have long-lasting - or even delayed - side effects.
Cardio cancer care
Certain chemotherapy drugs, targeted therapies, immunotherapies, and radiation treatments can affect the cardiovascular system during treatment or increase the risk of heart disease later in life. Cardio-oncology is a growing field geared to help patients navigate these risks before, during, and after cancer treatment. "As cancer treatments have evolved, we have also learned that some cancer therapies can affect the heart," says Jayant K. Raikhelkar, MD, a cardio-oncologist at CUIMC. "We know now that patients receiving certain treatments may need to be monitored differently to protect both their cancer outcomes and their long-term heart health."
Combating neurological and "late" effects
For many survivors, the most immediate, and severe, challenges are the day-to-day physical effects that can stick around for years after their treatment ends. These "late" effects include fatigue, cognitive changes often described as "chemo brain," hormonal disruption, infertility, and peripheral neuropathy, a form of nerve damage that causes numbness, tingling, or pain in the hands and feet.
Melissa Accordino, MD, sees firsthand how peripheral neuropathy can shape a cancer survivor's life , from difficulty walking to chronic discomfort that never fully goes away. Her research focuses on testing different preventative measures, such as using cooling and compression techniques applied to patients' hands and feet during chemotherapy, to reduce nerve damage while ensuring they are practical and tolerable for patients.
Hershman is a leader in the field whose work has helped define the broader scope of treatment-related nerve damage. She studies taxane-induced peripheral neuropathy, mapping exactly how and when symptoms develop, and why they persist in some patients after therapy ends.
More recently, Hershman and her colleagues developed a clinical risk prediction model to help identify patients most likely to develop severe neuropathy before they begin chemotherapy. The goal is not only to better prepare patients for what lies ahead, but to guide treatment decisions in ways that reduce long-term harm without compromising survival outcomes.
Beyond neuropathy, lifestyle-related factors can also influence long-term health after cancer. Weight gain and obesity after a cancer diagnosis-particularly breast cancer-are common and can increase the risk of recurrence, worsen treatment side effects, and reduce quality of life. Results presented at the 2026 ASCO Annual Meeting from the Breast Cancer Weight Loss (BWEL) Trial, led by Hershman and colleagues at Dana-Farber, point to a potential solution to support weight loss in survivors, which led to significant improvements in physical function, fatigue, and overall quality of life.
The emotional and psychological side of survivorship
Nearly half of all people diagnosed with cancer experience a diagnosable mental health condition, yet many do not seek out or receive adequate psychological care. Fear of cancer returning can also be a persistent source of distress long after treatment ends.
At Columbia, clinical health psychologists like Ian Sadler, MD work within the psychosocial oncology program to support patients through survivorship - which he describes as one of the most under-recognized stages of cancer care.
The field of psycho-oncology examines how psychological, behavioral, and social factors interact with cancer. Clinicians in this specialty provide support across the entire cancer continuum, including helping patients adjust to life after diagnosis, address trauma from prior cancer experiences, support family members and caregivers, and navigate identity changes such as shifts in body image, independence, or sexual health.
"A cancer diagnosis is a profoundly isolating experience," he said in a recent interview with Cure, "even when someone has strong support systems in place."
For Sadler, a substantial share of his patients -more than 40% - come to him only after treatment has concluded, a period when many expect emotional recovery to come easier.
He adds that emotional and psychological challenges often continue or even emerge after treatment ends, and stresses that experiencing difficulty during survivorship is a common and understandable response, not a personal shortcoming.
Unique challenges for adolescents and young adults (AYAs)
For younger patients, often termed adolescents and young adults (AYAs), a cancer diagnosis comes at a particularly complex moment in life. Many are building careers, pursuing education, or starting families when they are diagnosed. While survival rates are improving overall, this group has not seen the same benefits as children or older adults, prompting researchers to look beyond treatment alone and toward the financial, emotional, and practical barriers causing this gap in better outcomes.
Maintaining stability at a critical life stage
Melissa Beauchemin, PhD, MSN, focuses on the "financial toxicity," or the burden of medical costs that can accumulate during and after cancer care, as well as what she describes as "time toxicity," or the cost of time away from work, school, and daily life required to get treatment. For many AYAs, these disruptions can lead to lost income, insurance instability, and long-term medical bills that change their life trajectory for years. In clinical trials, Beauchemin is evaluating new ways to connect young survivors with financial resources and support to help reduce these burdens during and after treatment.
Workplace and financial stability are part of the financial toxicity puzzle. Claire Sathe, MD, supported by a Susan G. Komen Career Catalyst Research Grant, is studying how a diagnosis of metastatic breast cancer affects patients' ability to remain employed as they manage long-term disease. Her research examines how treatment type, side effects, and lack of workplace accommodations influence job stability, with the goal of identifying practical, evidence-based tools to allow patients to continue working when possible.
Fertility and planning for the future
Fertility, relationships, and long-term family planning often urgently become part of survivorship care discussions for AYAs. However, many barriers exist that prevent young people from ever getting proper fertility guidance before they begin treatment. Young female cancer patients, in particular, are offered fertility preservation procedures at a lower rate than male patients.
In a recently published article in Cancer, Beauchemin and team, including Marcela Algave, BSN, RN PhD, found that there is wide variability in how frequently fertility preservation is discussed for AYAs, with racial and ethnic minority patients less likely to receive fertility counseling, referrals, or fertility preservation services and that young female cancer patients face unique oncofertility challenges. She and her team are now working to help oncologists bring fertility preservation conversations and referrals into care earlier.
Many questions remain about the long-term needs of adolescent and young adult (AYA) cancer survivors. Jeanine Genkinger, PhD, is working to understand the full picture through a $5 million National Cancer Institute-funded multi-center grant with Weill Cornell Medicine and Memorial Sloan Kettering Cancer Center. The study is examining issues including fertility, sexual health, and financial stress, providing researchers with a more complete picture of survivorship over time.
