FIGURE 1-1 Cancer care trajectories.

SOURCE: Adapted from IOM and NRC, 2006.

disability, fatigue, and pain that can result, even when there are no longer any signs of the disease. These effects contribute to emotional distress and mental health problems among cancer patients, and together can lead to substantial social problems, such as the inability to work and reduced income. These effects are magnified in the presence of any psychological and social stressors that predate the onset of cancer, such as low income, lack of health insurance, and weak or absent social supports. Indeed, physical, psychological, and social stressors are often intertwined, both resulting from and contributing to each other.

These effects of cancer and its treatment are also influenced by the physical and developmental age of patients and their caregivers. More than half (approximately 60 percent) of individuals who have ever been diagnosed with cancer are age 65 or older; 39 percent are young and middle-aged adults aged 20–64; and 1 percent are age 19 or younger (NCI, undated). Among the large portion of older adults within the population living with cancer, experts in cancer care and aging note that there is great heterogeneity. Although “health and well-being, social circumstances, living arrangements, and age-related changes resulting in diminished psychologic

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