RE: Prevalence of cancer survivors in the United States

Tonorezos et al. (2024)¹ provide a critical update to the state of cancer survivors in the United States, in describing the population at large and providing an overview of key gaps in knowledge that impede further improvement in cancer survivorship generally. One limitation the authors mentioned was not including the stage at diagnosis. Hopefully, they intend to incorporate the stage at diagnosis in an upcoming survivorship report, because it could reveal important benefits of early detection or the burden and loss resulting from cancer detection at a late stage by age or length of survivorship. When coupled with race, ethnicity, or other demographic factors, further illumination of health disparities among cancer survivors may also surface. Such reports can provide significant insight into understanding the economic impact of cancer survivorship, considering the large numbers of working adults diagnosed with cancer. They might even detect populations of extra long-term survivors, including individuals not expected to survive long-term (eg, stage IV lung cancer patients²). Studying such individuals may lead to new directions for improving survival.

Projections of survivor numbers are important, but meeting their needs is better informed when we know the status of their cancer at diagnosis, given differences in cancer-related morbidity by stage. Preparing our health-care system—its workforce and system capacity—for a growing population of survivors benefits from knowing the scale of their health-care needs. For example, if those diagnosed at an early stage have fewer long-term cancer-related symptoms over time but greater opportunity to develop other cancers from longer survival, then strategies can be tailored for surveillance and targeted training provided for clinicians outside oncology. Anticipating the diverse needs of survivors and planning for the capacity to meet them must be undertaken in advance and shaped by the untenable model of oncologist-led care, the deficit of expertise for survivorship care among primary care providers the authors describe, and the potential for electronic health records as tools to improve survivorship care.

Of course, the usefulness of such reports is limited to those described in the data available for characterizing the problems facing survivors. Domogauer et al. (2024)³ raise important points about the invisibility of individuals identifying as sexual and gender minorities within these data systems, leaving unrecognized disparities and suffering unaddressed. This is especially problematic at a time when anti-DEI and anti-LGBTQIA+ policies are barreling across the country but numbers of individuals who self-identify as sexual and gender minorities are growing.⁴

Note from the Editor: We provided a copy of this Correspondence to the authors of the article that prompted this work and offered them the opportunity to respond. They declined to write a response.

Author contributions

Shine Chang, PhD (Conceptualization; Writing—original draft; Writing—review & editing).

Funding

Dr Chang is supported by funds from the National Institutes of Health (U54CA280804, R01GM147064, R25CA056452, R25CA265802, P30CA016672) and institutional funds.

Conflicts of interest

None declared.

Data availability

Not applicable to this correspondence.