DIAGNOSING AND TREATING
ADULT CANCERS AND
ASSOCIATED IMPAIRMENTS
Committee on Diagnosing and Treating Adult Cancers
Board on Health Care Services
Health and Medicine Division
A Consensus Study Report of
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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This activity was supported by a contract between the National Academy of Sciences and the U.S. Social Security Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-68400-2
International Standard Book Number-10: 0-309-68400-5
Digital Object Identifier: https://doi.org/10.17226/25956
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2021. Diagnosing and treating adult cancers and associated impairments. Washington, DC: The National Academies Press. https://doi.org/10.17226/25956.
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COMMITTEE ON DIAGNOSING AND TREATING ADULT CANCERS
DAN G. BLAZER II (Chair), J.P. Gibbons Professor Emeritus of Psychiatry and Behavioral Sciences, Duke University School of Medicine
ALEX A. ADJEI, Professor of Oncology and Pharmacology, Mayo Clinic
WALLACE AKERLEY, Professor, Huntsman Cancer Institute, The University of Utah
JOSE G. BAZAN, JR., Associate Professor, Radiation Oncology, The Ohio State University
GABRIEL A. BROOKS, Assistant Professor of Medicine, Geisel School of Medicine, Dartmouth College
DEBORAH W. BRUNER, Senior Vice President for Research, Robert W. Woodruff Chair in Nursing, Emory University
GRACE B. CAMPBELL, Assistant Professor, University of Pittsburgh School of Nursing
SUSAN M. DOMCHEK, Basser Professor in Oncology, University of Pennsylvania
PATRICIA A. GANZ, Distinguished Professor, Schools of Medicine and Public Health, University of California, Los Angeles
ROSA HWANG, Professor, MD Anderson Cancer Center, University of Texas
NANCY KEATING, Professor of Health Care Policy and Medicine, Harvard Medical School
ANITA J. KUMAR, Medical Oncologist, Assistant Professor, Tufts University Medical Center
LARISSA NEKHLYUDOV, Professor of Medicine, Brigham and Women’s Hospital, Harvard Medical School
KATHRYN SCHMITZ, Professor, Public Health Sciences, The Pennsylvania State University College of Medicine
DIANE VON AH, Professor, Indiana University School of Nursing
Consultant
HOWARD H. GOLDMAN, Professor of Psychiatry, University of Maryland School of Medicine
Study Staff
ROBERTA WEDGE, Study Director
LAURA AIUPPA, Senior Program Officer
RUTH COOPER, Research Associate
SAMIRA ABBAS, Senior Program Assistant
JULIE WILTSHIRE, Senior Finance Business Partner
SHARYL NASS, Senior Director, Board on Health Care Services
Reviewers
This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.
We thank the following individuals for their review of this report:
DENISE R. ABERLE, University of California, Los Angeles
NANCY DAVIDSON, Fred Hutchinson Cancer Research Center
LORETTA ERHUNMWINSEE, City of Hope, Los Angeles
JESSE R. FANN, Fred Hutchinson Cancer Research Center
CHRISTOPHER R. FLOWERS, MD Anderson Cancer Center
CHRISTOPHER FRIESE, University of Michigan
SHELLEY HWANG, Duke Cancer Center
RANDY JONES, University of Virginia
CHRISTOPHER S. LATHAN, Harvard Medical School
MARYAM B. LUSTBERG, The Ohio State University
DEBORAH MAYER, University of North Carolina
RICHARD I. WHYTE, Beth Israel Deaconess Medical Center
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions
or recommendations of this report, nor did they see the final draft before its release. The review of this report was overseen by ROBERT S. LAWRENCE, Johns Hopkins Bloomberg School of Public Health, and DAVID R. CHALLONER, University of Florida. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.
Acknowledgments
The study committee and the National Academies of Sciences, Engineering, and Medicine’s Health and Medicine Division project staff take this opportunity to recognize and thank the many individuals who shared their time and expertise to support the committee’s work and inform its deliberations.
This study was sponsored by the U.S. Social Security Administration (SSA). We thank Alayna Ness, Vincent Nibali, Mary Beth Rochowiak, and Megan Butson for their guidance and support. The committee also acknowledges SSA for providing data on disability claims. The committee benefited greatly from discussions with individuals who presented at the committee’s open sessions: Cathy Bradley, Michael Feuerstein, Barbara Hoffman, Shelley Fuld Nasso, and Rebecca Nellis. The committee is grateful to these presenters for volunteering to share their expertise, knowledge, data, and opinions not only with the committee but also with members of the public who participated in the committee’s open sessions.
The committee thanks the National Academies staff who provided support for this project, including Roberta Wedge (study director), Laura Aiuppa (senior program officer), Ruth Cooper (research associate), Samira Abbas (senior program assistant), Julie Wiltshire (senior finance business partner), and Sharyl Nass (Board on Health Care Services senior director). Research assistance was provided by Jorge Mendoza-Torres (senior librarian) and Emily Zevon (program officer). Robert Pool provided editorial assistance for the final report.
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4 DIAGNOSIS, STAGING, AND TREATMENT OF CANCER
Staging and Characterization of Cancer
Treatment of Noninvasive Breast Cancer
Treatment of Invasive, Localized Breast Cancer
Treatment of Metastatic Breast Cancer
Life After Breast Cancer Diagnosis
Diagnosis and Staging of Lung Cancer
Summary of Lung Cancer Diagnostic Evaluation and Treatment
Life After Lung Cancer Diagnosis
7 SELECTED TOPICS IN OTHER CANCERS
Long-Term Outcomes of New and Emerging Therapies
9 CANCER-RELATED IMPAIRMENTS LEADING TO FUNCTIONAL LIMITATIONS
Concepts in Impairment and Function
Selected Cancer-Related Impairments
Comorbidities and Symptom Clusters
10 SURVIVORSHIP OUTCOMES AND CARE DELIVERY
Emerging Directions in Cancer Care Delivery
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Acronyms and Abbreviations
| 3-DCRT | 3-D conformal radiation therapy |
| AC-T | adriamycin and cytoxan followed by taxol |
| AJCC | American Joint Committee on Cancer |
| ALK | anaplastic lymphoma kinase |
| ALL | acute lymphoblastic leukemia |
| ALND | axillary lymph node dissection |
| AML | acute myeloid leukemia |
| APBI | accelerated partial breast irradiation |
| ASCO | American Society of Clinical Oncology |
| BCS | breast-conserving surgery |
| CAR | chimeric antigen receptor |
| CBT | cognitive behavioral therapy |
| CDC | Centers for Disease Control and Prevention |
| CDK | cyclin-dependent kinase 4/6 |
| CDKI | cyclin-dependent kinase inhibitor |
| CIPN | chemotherapy-induced peripheral neuropathy |
| CLL | chronic lymphocytic leukemia |
| CML | chronic myeloid leukemia |
| CMS | Centers for Medicare & Medicaid Services |
| COPD | chronic obstructive pulmonary disease |
| CPG | clinical practice guideline |
| CT | computed tomography |
| CTLA4 | cytotoxic T-lymphocyte associated protein 4 |
| DCIS | ductal carcinoma in situ |
| dd AC-T | dose-dense adriamycin and cyclophosphamide followed by taxol |
| DNA | deoxyribonucleic acid |
| DSM | Diagnostic and Statistical Manual of Mental Disorders |
| EBRT | external beam radiation therapy |
| EGFR | epidermal growth factor receptor |
| EHR | electronic health record |
| ER | estrogen receptor |
| ES-SCLC | extensive-stage small-cell lung cancer |
| FDA | U.S. Food and Drug Administration |
| FDG-PET | 2-fluor-2-deoxy-D-glucose positron emission tomography |
| FIT | fecal immunohistochemical testing |
| GI | gastrointestinal |
| GVHD | graft-versus-host disease |
| Gy | gray; unit used to quantify absorbed radiation dose |
| HER2 | human epidermal growth factor receptor 2 |
| HPV | human papillomavirus |
| HR | hormone receptor |
| HSCT | hematopoietic stem cell transplant |
| ICD | International Classification of Diseases |
| ICF | International Classification of Functioning, Disability and Health |
| IMRT | intensity-modulated radiation therapy |
| IORT | intraoperative radiation therapy |
| LHRH | luteinizing hormone-releasing hormone |
| LS-SCLC | limited-stage small-cell lung cancer |
| MBC | metastatic breast cancer |
| MRI | magnetic resonance imaging |
| mTOR | mammalian target of rapamycin |
| NCCN | National Comprehensive Cancer Network |
| NCI | National Cancer Institute |
| NGS | next-generation sequencing |
| NHL | non-Hodgkin lymphoma |
| NSAID | nonsteroidal anti-inflammatory drug |
| NSCLC | non-small-cell lung cancer |
| NTRK | neurotrophic receptor tyrosine kinase |
| OCM | oncology care model |
| OR | odds ratio |
| PARP | poly (ADP-ribose) polymerase |
| pCR | pathological complete response |
| PD | programmed (cell) death |
| PD-1 | programmed cell death-1 |
| PD-L1 | programmed death ligand-1 |
| PET | positron emission tomography |
| PHQ-9 | Patient Health Questionnaire |
| PI3K | phosphoinositide 3-kinases |
| PR | progesterone receptor |
| PRO | patient-reported outcome |
| PROM | patient-reported outcome measure |
| QOL | quality of life |
| RCT | randomized controlled trial |
| RFC | residual functional capacity |
| RT | radiation therapy |
| SABR | stereotactic ablative radiotherapy |
| SBRT | stereotactic body radiation therapy |
| SCLC | small-cell lung cancer |
| SEER | Surveillance, Epidemiology, and End Results Program (NCI) |
| SERM | selective estrogen receptor modulator |
| SLND | sentinel lymph node dissection |
| SNRI | serotonin–norepinephrine reuptake inhibitor |
| SRS | stereotactic radiosurgery |
| SRT | stereotactic radiotherapy |
| SSA | U.S. Social Security Administration |
| SSDI | Social Security Disability Insurance |
| SSI | Supplemental Security Income |
| SSRI | selective serotonin reuptake inhibitor |
| TC | taxotere and cytoxan |
| TNBC | triple-negative breast cancer |
| TNM | tumor, node, and metastases |
| TRK | tropomyosin receptor kinase |
| USPSTF | U.S. Preventive Services Task Force |
| VATS | video-assisted thorascopic surgery |
| VMAT | volumetric-modulated arc radiotherapy |
