Although cancer survivors are living longer, cancer and its treatment can result in lasting or late-onset impairments that may affect their ability to work, according to a new report from the National Academies of Sciences, Engineering and Medicine.
The report, written by a committee of experts including a faculty member of Emory University and Winship Cancer Institute, was commissioned by the U.S. Social Security Administration (SSA) to inform disability determinations for cancer survivors.
“Diagnosing and Treating Adult Cancers and Associated Impairments” examines advances in the prognosis, diagnosis and treatment of cancer, and the growing number of survivors living with impairments and functional limitations. The report focuses on the impairments and functional limitations associated with the treatment of breast cancer and lung cancer, which make up almost 30 percent of disability claims, as well as other common cancers, including colorectal cancers, which account for 12 percent of claims.
The authoring committee found that SSA’s assessments of adult patients with cancer largely focus on terminal and metastatic cancers with a high likelihood of death, rather than those with a high likelihood of survival.
The report says that of the estimated 16.9 million cancer survivors in the United States, about a third are below 65 years in age. If survivors experience long periods of impairment that preclude them from working, they may need SSA disability benefits for longer than expected. Conversely, those who return to work may need reasonable accommodations, such as job modification or a flexible work schedule.
Currently, cancer survivors who are younger than 65 and unable to work because of cancer-related impairments may apply for disability benefits from the SSA.
Pain, fatigue, abnormal swelling, depression and anxiety, peripheral nerve damage and cognitive limitations (sometimes called “chemo brain”) are among the most common impairments that may impact those whose goal is returning to work, the report found. These impairments may occur during treatment and persist afterwards, or emerge months or even years after treatment ends.
Deborah Watkins Bruner, RN, FAAN, PhD, senior vice president for research at Emory University, served on the committee. Bruner points out that earlier detection has led to growing numbers of cancer survivors.
“While the increasing number of people surviving cancer is good news, most people treated for cancer have to live with the side effects of cancer treatments. Some working adults will need to go on disability,” she says. “The information in this report will help the SSA better understand what cancer survivors experience and what constitute cancer or treatment-related functional side effects when considering disability claims. It will also help patients, their caregivers and physicians provide clear information when filing disability claims.”
The report also examines how new and emerging cancer treatments — including immunotherapies and other targeted therapies, minimally invasive surgeries and new radiation techniques — have significantly improved survival for some patients. But little is known about the long-term and late-onset toxicities of these treatments, particularly immunotherapies, for different cancers and populations, says the report. It emphasizes the need for more research on persistent toxicities among long-term survivors, and among those with comorbidities such as diabetes or cardiovascular diseases.
In addition to drug and surgical interventions, there are a number of evidence-based nonpharmacologic interventions to address cancer-related impairments. These include exercise and physical activity, rehabilitation (physical and occupational therapy, and speech and language therapy) and psychological and emotional interventions. Although these interventions are evidence-based and have been shown to improve outcomes, they are often underused and under prescribed for cancer-related impairments, the report concludes.
Survivorship care, a fundamental part of the care continuum, provides cancer-related and supportive interventions that address the individual needs of each survivor. However, the report finds that care team members may lack the resources to assess patients for impairments or provide the necessary interventions. Education efforts, including certification programs, are underway to expand training opportunities for health care providers to ensure they are able to meet the long-term needs of cancer survivors during and after treatment.
About the National Academies
The National Academies are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.