502 Adult Development and Aging
with cancer will be alive in “ve years. For those diag-
nosed with early stage or localized prostate, breast, or colon
cancer, “ve-year survival is even higher (92%, 77%, and
65%, respectively). Currently in the United States, more than
10 million persons have survived a diagnosis of cancer, ap-
proximately 8 million of whom have survived “ve or more
years (Hewitt, Breen, & Devesa, 1999). Some of the success
in treating these cancers is attributable to the growing use of
effective screening methods and, hence, diagnosis of earlier,
more treatable forms of the disease. More effective adjuvant
treatments have also contributed to better prognoses.
While more patients are living longer after being treated
for cancer, and with the increased number of older adults, an
area of research that has received limited attention is cancer
survivorship. Concurrent with an increased vulnerability to
cancer, increasing age also confers high risks for a number of
other health problems (Guralnik, 1996; Yancik et al., 2001).
Despite the broad impact of survivorship throughout the lives
of patients and their families and caregivers, relatively little
research has been directed at problems of survivorship be-
yond the immediate posttreatment phase.
Lingering emotional distress from the •traumaŽ of cancer
diagnosis, treatment, and the life threat associated with the
cancer is similar to distress experienced by individuals who
have experienced other traumatic events (e.g., physical
assault, natural disasters; Alter et al., 1996). The residual dis-
tress associated with the diagnosis and treatment of a life-
threatening disease like cancer is now included as one of the
circumstances that may precipitate posttraumatic stress disor-
der (PTSD). Although it is unlikely that a PTSD diagnosis
would be made for the •averageŽ cancer patient, Cordova and
colleagues (1995) documented PTSD rates in a breast cancer
sample ranging from 5% to 10% and suggested that this may
be comparable, if not an underestimate, to other cancer sur-
vivor populations. Van•t Spijker et al. (1997) conducted a
meta-analytic review of 58 studies performed from 1980 to
1994 of psychological sequelae of cancer diagnosis. Focus-
ing on studies that included validated instruments, the
authors found that from 0% to 46% of patients quali“ed for
depressive disorder; and from 0.9% to 49% quali“ed for
anxiety disorder across the various studies. Compared to
published reference norms for the general population, cancer
patients were signi“cantly more depressed. Despite the in-
creased risk of distress, longitudinal data indicate that if the
cancer is controlled, by one-year posttreatment, the severe
distress of diagnosis will have dissipated for most patients
(Andersen, Anderson, & deProsse 1989; Brown, 1987).
One life area that undergoes disruption for cancer sur-
vivors is sexuality. All cancer patients with solid tumors
(approximately 85% of adult patients) and many treated for
hematologic malignancies are vulnerable to sexual dysfunc-
tion. Across sites, estimates range from 10% (e.g., breast can-
cer patients treated with lumpectomy), 70% to 90% (e.g.,
women with vulva cancer treated with modi“ed radical vul-
vectomy) to 100% (e.g., men with prostate cancer treated
with radical prostatectomy), with the distribution skewed to-
ward greater levels of disruption; among the hematologic
malignancies, estimates are in the range of 20% (Andersen &
Lamb, 1995).
Once cancer treatment ends, cancer survivors need to be
carefully followed for potential late effects of disease.
Because of their treatments, many are at increased risk of de-
veloping secondary tumors. For example, within 25 years of
diagnosis of childhood cancer in Britain, about 4% of sur-
vivors develop a secondary primary cancer„about six times
the expected number of cancers (Hawkins, Draper, &
Kingston, 1987). This excess risk among survivors is attribut-
able to the carcinogenic effects of treatments for the original
childhood cancer as well as to genetic predisposition (Harnish
et al., 2001). Treatment is also related to other chronic condi-
tions, such as osteoporosis, diabetes, and cardiovascular dis-
eases. Most cardiovascular disease, for example, is the result
of a direct effect by radiation and chemotherapeutic agents,
but injury to other organs can contribute indirectly.
There is limited information about the health behaviors of
patients beyond the active cancer treatment period. Demark-
Wahnefried, Peterson, McBride, Lipkus, and Clipp (2000)
found that 55% of their sample of 978 survivors ate fewer
than “ve daily servings of fruits and vegetables. Prostate can-
cer survivors ate even fewer servings than breast cancer sur-
vivors. Over 30% indicated they did not adhere to a low-fat
diet, with prostate cancer patients again indicating worse
practice than breast cancer survivors in this area. Also, 42%
of survivors did not engage in routine exercise and 8% were
current smokers. In this study, receptivity of the survivors to
interventions to promote lifestyle changes was stated to be
high.FUTURE DIRECTIONSA major contribution of health psychology to the study
of aging is to deal with diseases and how they impact indi-
viduals as they age and to incorporate the best of epidemiol-
ogy into our work. This should lead to the appearance of
more health psychology-aging papers in medical and
epidemiological journals, where they will be read by physi-
cians and persons working in epidemiology and other areas
of public health, and a more informed use of behavioral
outcome measures in medical research.