Policies and Practices to Address Cancer's Long-Term Adverse Consequences

Cathy J. Bradley, PhD; Sara Kitchen, MPH; Smita Bhatia, MD, MPH; Julie Bynum, MD, MPH; Gwen Darien, BA; J. Leonard Lichtenfeld, MD, MACP; Randall Oyer, MD; Lawrence N. Shulman, MD, MACP, FASCO; Lisa Kennedy Sheldon, PhD, ANP-BC, AOCNP, CGNC, FAAN


J Natl Cancer Inst. 2022;114(8):1065-1071. 

In This Article

Abstract and Introduction


As cancer detection and treatment improve, the number of long-term survivors will continue to grow, as will the need to improve their survivorship experience and health outcomes. We need to better understand cancer and its treatment's short- and long-term adverse consequences and to prevent, detect, and treat these consequences effectively. Delivering care through a collaborative care model; standardizing information offered to and collected from patients; standardizing approaches to documenting, treating, and reducing adverse effects; and creating a data infrastructure to make population-based information widely available are all actions that can improve survivors' outcomes. National policies that address gaps in insurance coverage, the cost and value of treatment and survivorship care, and worker benefits such as paid sick leave can also concurrently reduce cancer burden. The National Cancer Policy Forum and the Forum on Aging, Disability, and Independence at the National Academies of Sciences, Engineering, and Medicine sponsored a virtual workshop on "Addressing the Adverse Consequences of Cancer Treatment," November 9–10, 2020, to examine long-term adverse consequences of cancer treatment and to identify practices and policies to reduce treatment's negative impact on survivors. This commentary discusses high-priority issues raised during the workshop and offers a path forward.


With approximately 17 million cancer survivors living in the United States, a population that is expected to grow to 20 million by 2030, more people are living with the aftermath of cancer and its treatment.[1] Advancements in early detection and treatment and the resulting improvement in long-term survival for many cancers are cause for celebration. Several cancers, even some that are diagnosed at late stage, are moving toward becoming chronic. With this newfound longevity comes the need to understand the sequelae of treatment so that cancer survivors, who comprise nearly 5% of the United States population.[2] have the best possible outcomes and support.

The National Cancer Policy Forum, along with the Forum on Aging, Disability, and Independence, held a 2-day virtual workshop with experts in cancer treatment and survivorship to examine critical long-term adverse consequences and to identify practices and policies to reduce the negative impact of treatment on survivors.[3] These consequences span physical, social, psychological, emotional, and financial outcomes for adults and children. People with cancer require immediate actions that can be taken to prevent, mitigate, and treat adverse consequences and improve their quality of life. In addition, new strategies are needed to address emerging treatments such as oral therapies, where the home is the site of care and their unique impacts during and after treatment.

This commentary summarizes high-priority problems, potential solutions, and research needs that will improve outcomes for people with cancer, including those with metastatic disease, highlighting the many opportunities to reduce cancer's burden. We discuss care delivery approaches and emphasize the data infrastructure requirements to better detect, track, and treat immediate and long-term adverse effects. We suggest practice and policy changes that will mitigate the challenges that survivors face, with the goal of preventing adverse consequences before they disrupt the lives of millions of survivors and their families. For this commentary, we prioritized problems and solutions that can be immediately addressed; however, the workshop proceedings contain the full set of presentations, including those that are beyond the scope of this commentary.[3]