As people continue to live longer and the survival rate of cancer diagnoses increases, researchers from VCU Massey Comprehensive Cancer Center led a multi-decade analysis studying the rates of subsequent primary cancers (SPCs), which are new cancers unrelated to the original diagnosis. The study, which was recently published in PLOS Medicine , provides understanding for how these cancer risks change over time and across generations, helping guide future prevention and monitoring measures.
A team of Massey researchers used cancer registry data from over three million cancer survivors in the United States from 1975-2021 to study patterns of SPCs, examining age, calendar period and birth cohort effects on SPC risk.
Expert quote: "Cancer survivors are surviving longer, and that gives them a higher chance of developing a subsequent primary cancer, but literature in that area is limited," said Hui Cheng, Ph.D., a member of Massey's Cancer Prevention and Survivorship Outcomes Research Lab and the article's primary author.
Why this research matters
Cancer survivorship is up 34% since 1991, meaning patients are living longer, which also allows for a higher risk of SPCs.
Understanding how cancer survivors are at risk for SPCs can help guide future strategies for cancer prevention and risk reduction.
Massey's cancer survivorship program is unique in that it provides a holistic approach that focuses on both a patient's cancer predispositions to guide personalized medical and treatment strategies alongside providing resources related to stress reduction, nutrition, sleep improvement, and other lifestyle factors that can influence cancer risk.
Expert quote: "Whether it be our work in germline genetic testing, stress reduction, or general lifestyle improvements, our program is incredibly impactful," said Susan Hong, M.D., director of the cancer survivorship program at Massey and co-author of the study.
"For example, our program is one of the few that has an embedded food as medicine program. Plenty of cancer centers have food pantries, per se, but ours is one of the few that targets every single person in the cancer center who reports food insecurity because we have studies that demonstrate that cancer patients with food insecurity have higher rates of mortality, anxiety and depression, and are less likely to complete treatment."
Massey's survivorship program is actively engaged in research to improve patient care and outcomes and to inform how cancer care will be delivered across cancer centers in the United States. One example of Massey's impact across the country is its three-year grant from the McKesson Foundation to examine how food access affects cancer patients receiving active treatment.
The research findings
Researchers found that SPC risks varied by cancer type, sex, and generation. Generally, the risk of developing a subsequent primary cancer increased in those who were older when first diagnosed; however, breast cancer survivors showed stable risks across ages.
In recent decades, SPC risks have declined among cancer survivors, with notable exceptions in female lung cancer and male bladder cancer survivors. Additionally, survivors diagnosed at older ages continued to face persistent or rising risks.
Overall, these findings highlight the importance of long-term monitoring of cancer survivors, as risks of SPCs remain substantial. Additionally, these findings can inform prevention strategies, survivorship care and public health planning.
Expert quote: "This is an opportunity to really evaluate your risk factors, your lifestyle and really become a survivorship warrior," said Oxana Palesh, Ph.D., MPH, Massey Cancer Center Chair in Cancer Research, co-leader of Massey's Cancer Prevention and Control research program and co-author of the study. "It is important to remind people that they have a lot of control over their individual cancer risk and prevention."
What's next?
Researchers will seek a supplemental grant to collect data from outside the clinic, specifically allowing for home monitoring of patients to increase the amount of data available to researchers.
Collaborators
Livingstone Aduse-Poku, M.D., Cancer Prevention and Survivorship Research Lab, VCU Massey Comprehensive Cancer Center
Chelsey McGill, Ph.D., NIH T32 Postdoctoral Fellow, VCU Massey Comprehensive Cancer Center and Department of Psychiatry
This research was funded by:
US National Cancer Institute (R01CA239714, R01CA172145, and R01CA226080 to OP)
National Cancer Institute (P30CA016059 to the Massey Comprehensive Cancer Center)
