Appendix D.2
Recommendations for Health Behavior and Wellness Following Primary Tr eatment for Cancer

Lee W. Jones, PhD*

Wendy Demark-Wahnefried, PhD, RD, LDN**


Every 23 seconds, an American is diagnosed with cancer.1 Given advances in early detection and treatment, 64% of those diagnosed with this disease can expect to be alive in 5 years.1 These individuals will join the ever-expanding numbers of cancer survivors who now number over 10 million and constitute 3-4% of the U.S. population.2,3 While these numbers are encouraging, it is important to acknowledge that the impact of cancer is significant and associated with several long-term health and psychosocial sequelae.2-15 Indeed, cancer survivors constitute a vulnerable population who have distinct health care needs.7,16 Data clearly show that compared to general age- and race-matched populations, cancer survivors are at greater risk for developing second malignancies and other diseases, such as cardiovascular disease (CVD), diabetes, and osteoporosis.2-16 An early comparison by Brown et al.6 of over 1.2 million patient records obtained from the SEER database with those obtained from the National Center for Health Statistics found a significantly higher noncancer relative hazards ratio for cancer patients of 1.37 and concluded that “the evidence that cancer patients die of noncancer causes at a higher rate than persons in the general population is overwhelming.” Data collected over the past decade confirm these findings.2-4,8,17 These competing causes of death and comorbid conditions are believed to result from cancer treatment, genetic predisposition, and/or common lifestyle factors.2,4,13-15


Department of Surgery, Duke University Medical Center


Department of Surgery and School of Nursing, Duke University Medical Center

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