{"slug":"survivorship","tag":"survivorship","variants":["survivorship"],"description":"Records about life after cancer treatment: late effects, the checks that find them, and what helps recovery.","count":222,"kinds":{"section":1,"person":4,"technology":166,"collection":4,"term":24,"bottleneck":9,"idea":8,"trial":6},"related":[{"slug":"rejuvenation","tag":"rejuvenation","shared":217},{"slug":"late-effects","tag":"late-effects","shared":40},{"slug":"measurement","tag":"measurement","shared":29},{"slug":"paediatric","tag":"paediatric","shared":27},{"slug":"transplant","tag":"transplant","shared":27},{"slug":"rehabilitation","tag":"rehabilitation","shared":25},{"slug":"psychosocial","tag":"psychosocial","shared":24},{"slug":"open-problem","tag":"open-problem","shared":22},{"slug":"second-cancers","tag":"second-cancers","shared":22},{"slug":"instruments","tag":"instruments","shared":14},{"slug":"access","tag":"access","shared":13},{"slug":"biological-ageing","tag":"biological-ageing","shared":9}],"records":[{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/","tldr":"What cancer treatment took, and whether it comes back: hair, hearing, fertility, bone, muscle, nerves, memory, the heart, skin, sexual function and the years afterwards. Recovery begins during treatment rather than after it, and structured exercise has more evidence behind it than everything sold as rejuvenation put together."},{"id":"alexandre-chan","kind":"person","name":"Alexandre Chan","route":"/people/alexandre-chan/","tldr":"Oncology pharmacist-scientist at UC Irvine and President of MASCC, the multinational society for supportive care in cancer, known for research on cancer-related cognitive impairment."},{"id":"kerry-courneya","kind":"person","name":"Kerry S. Courneya","route":"/people/kerry-courneya/","tldr":"Exercise scientist behind CHALLENGE, the first trial to show a structured exercise programme improves survival after colon cancer."},{"id":"exercise-prescription-after-cancer","kind":"technology","name":"The exercise prescription after cancer: the dose the guidelines state","route":"/technologies/exercise-prescription-after-cancer/","status":"established","tldr":"Exercise is the best-evidenced thing a person can do for their own recovery, and the guidelines put a number on it: moderate aerobic exercise at least three times a week for at least thirty minutes, for eight to twelve weeks, plus resistance training twice a week, two sets of eight to fifteen repetitions at sixty per cent or more of the heaviest weight you can lift once."},{"id":"muscle-recovery-after-cancer-treatment","kind":"technology","name":"Muscle and strength after treatment: sarcopenia, cachexia and what rebuilds","route":"/technologies/muscle-recovery-after-cancer-treatment/","status":"established","tldr":"Muscle lost during treatment is usually regained with resistance training and enough protein, over months rather than weeks. Muscle lost to cancer cachexia is different: while the cancer is active, training and food slow the loss but rarely reverse it, and the consensus definition says so plainly."},{"id":"cancer-treatment-bone-loss","kind":"technology","name":"Bone loss caused by cancer treatment, and what rebuilds it","route":"/technologies/cancer-treatment-bone-loss/","status":"standard-of-care","tldr":"Hormone treatments, chemotherapy that stops the ovaries and long courses of steroids all thin the bones, fast enough to measure within a year. Some of it comes back when the treatment stops, and the drugs that prevent fracture while it is going on are well proven."},{"id":"cardiotoxicity-surveillance-recovery","kind":"technology","name":"Heart function after anthracyclines, trastuzumab and chest radiotherapy","route":"/technologies/cardiotoxicity-surveillance-recovery/","status":"standard-of-care","tldr":"Most heart damage from anthracycline chemotherapy appears within the first year after it finishes, and most of it improves at least partly when it is caught and treated. Heart muscle weakened by trastuzumab usually recovers when the drug is stopped. Radiotherapy to the chest raises the risk of coronary disease years later, in proportion to the dose the heart received."},{"id":"anthracycline-cardioprotection","kind":"technology","name":"Protecting the heart during anthracycline treatment: dexrazoxane, beta blockers and ACE inhibitors","route":"/technologies/anthracycline-cardioprotection/","status":"established","tldr":"Dexrazoxane, given with the chemotherapy, cuts clinical heart failure in adults by about four fifths in pooled trials without reducing how well the chemotherapy works. Beta blockers and blood-pressure drugs given preventively protect the ejection fraction by a point or two during treatment, and in the one trial that followed patients for two years that difference had gone."},{"id":"cipn-recovery-and-treatment","kind":"technology","name":"Nerve damage from chemotherapy: what recovers, and what helps","route":"/technologies/cipn-recovery-and-treatment/","status":"established","tldr":"Numbness, tingling and pain in the hands and feet are common on platinum, taxane, vinca and proteasome-inhibitor treatment, and most of it fades. In a meta-analysis of 4,179 patients it was present in 68 per cent in the first month, 60 per cent at three months and 30 per cent at six months or later. Only duloxetine has evidence for the pain, and no drug prevents it."},{"id":"scrambler-therapy","kind":"technology","name":"Scrambler therapy (Calmare) for chemotherapy nerve pain","route":"/technologies/scrambler-therapy/","status":"emerging","tldr":"A surface electrical device that is said to replace pain signals with signals the brain reads as normal. People treated with it often feel better, but in the only trial that compared it with a dummy device there was no difference between the two, so what is being felt may be the attention and the expectation rather than the machine."},{"id":"hearing-after-platinum-chemotherapy","kind":"technology","name":"Hearing and tinnitus after platinum chemotherapy","route":"/technologies/hearing-after-platinum-chemotherapy/","status":"established","tldr":"Cisplatin kills the hair cells of the inner ear, starting at the high frequencies, and the loss does not come back. In children, sodium thiosulfate given six hours after each dose cut hearing loss from 63 to 33 per cent in one randomised trial and from 56.4 to 28.6 per cent in another. Nothing equivalent is licensed for adults."},{"id":"dry-mouth-teeth-after-head-neck-radiotherapy","kind":"technology","name":"Dry mouth, teeth and taste after head and neck radiotherapy","route":"/technologies/dry-mouth-teeth-after-head-neck-radiotherapy/","status":"standard-of-care","tldr":"Radiotherapy to the head and neck damages the salivary glands and, through the dry mouth that follows, the teeth. Planning that steers dose away from the parotid glands roughly halves lasting dryness and lets saliva recover over a year or two. Teeth need a dental assessment before treatment starts, because extractions afterwards risk the jawbone failing to heal."},{"id":"bowel-after-pelvic-radiotherapy","kind":"technology","name":"Bowel function after pelvic radiotherapy","route":"/technologies/bowel-after-pelvic-radiotherapy/","status":"established","tldr":"New bowel symptoms after radiotherapy to the prostate, cervix, womb, bladder or rectum are common and are often treated as something to live with. They usually have several separate and treatable causes, and a trial showed that working through them with a written algorithm, delivered by a nurse or a gastroenterologist, improved symptoms more than a self-help booklet."},{"id":"radiation-skin-recovery","kind":"technology","name":"Skin during and after radiotherapy: dressings, steroids and what lasts","route":"/technologies/radiation-skin-recovery/","status":"established","tldr":"Skin reactions in the treated area peak around the end of radiotherapy and heal. A thin silicone film applied from the first day cut moderate or severe reactions from 45.6 to 15.5 per cent in a randomised trial in breast cancer, and an international guideline recommends it. Permanent changes, such as fine broken veins and firmness, come later and do not reverse."},{"id":"nail-changes-after-chemotherapy","kind":"technology","name":"Nails after chemotherapy: lifting, ridges and discolouration","route":"/technologies/nail-changes-after-chemotherapy/","status":"emerging","tldr":"Taxanes lift the nail from its bed, leave transverse ridges that mark each cycle, and discolour it. Reported rates across studies range from none to forty-four per cent. Cooling the hands during the infusion reduced nail damage in a pooled analysis, but the one properly randomised trial was negative and six in ten participants stopped because the cold was too uncomfortable."},{"id":"lymphoedema-surgery-and-early-detection","kind":"technology","name":"Lymphoedema: catching it early, and the operations for it","route":"/technologies/lymphoedema-surgery-and-early-detection/","status":"emerging","tldr":"Two things have changed. Measuring the limb regularly after surgery, so that a month of compression can start before swelling is obvious, cut progression to full decongestive treatment from 19.2 to 7.9 per cent in a randomised trial. And joining lymphatics to small veins during the node operation cut new lymphoedema from 32 to 9.5 per cent, in a trial not yet finally reported."},{"id":"ovarian-function-after-chemotherapy","kind":"technology","name":"Ovarian function after chemotherapy: who recovers, and when","route":"/technologies/ovarian-function-after-chemotherapy/","status":"established","tldr":"Whether periods return after chemotherapy depends mostly on age and on which drugs were given. In the one study that recorded bleeding daily, about two thirds of women who stopped bleeding for six months after an anthracycline regimen started again, usually within a year. Of those who went two years without a period, one in ten bled again and none regained regular cycles."},{"id":"menopause-after-cancer-treatment","kind":"technology","name":"Menopause brought on by cancer treatment, and the options for it","route":"/technologies/menopause-after-cancer-treatment/","status":"established","tldr":"Treatment can bring on menopause in a week rather than a decade, and the usual answer, hormone replacement, is often unavailable. The non-hormonal options now have real trial evidence: elinzanetant cut moderate to severe hot flushes by three and a half episodes a day more than placebo in women on endocrine therapy, and venlafaxine and oxybutynin also beat placebo."},{"id":"vaginal-oestrogen-after-breast-cancer","kind":"technology","name":"Vaginal oestrogen after breast cancer: what the evidence says, and where it disagrees","route":"/technologies/vaginal-oestrogen-after-breast-cancer/","status":"established","tldr":"Vaginal dryness and painful sex after cancer treatment are common, lasting and under-treated. Low-dose vaginal oestrogen is the usual answer outside cancer, and for women on an aromatase inhibitor the guidance disagrees: American and British bodies read the same cohort studies differently. A reader deserves to be told that rather than given one confident answer."},{"id":"testosterone-after-cancer-treatment","kind":"technology","name":"Testosterone after cancer treatment in men","route":"/technologies/testosterone-after-cancer-treatment/","status":"established","tldr":"Low testosterone is common after cancer treatment and is rarely looked for: it was present in 38.5 per cent of 491 men treated for testicular cancer, in about half of a separate cohort whether or not they had chemotherapy, and in a third of adults given cranial radiotherapy. Replacement is straightforward where it is indicated; men with a prostate cancer history are the uncertain group."},{"id":"sexual-function-after-cancer","kind":"technology","name":"Sexual function and intimacy after cancer, for both sexes","route":"/technologies/sexual-function-after-cancer/","status":"established","tldr":"Sexual difficulty is among the losses people report most after cancer treatment and among the least often asked about. The guideline says a member of the care team should raise it, and that counselling should be offered to everyone. The treatments are real but modest, and the clearest finding is that a tablet taken only when needed does not restore erections after prostate surgery."},{"id":"cognitive-impairment-after-cancer-treatment","kind":"technology","name":"Thinking and memory after cancer treatment: what is measurable, and what helps","route":"/technologies/cognitive-impairment-after-cancer-treatment/","status":"established","tldr":"Trouble with memory, concentration and word-finding after chemotherapy is real and measurable, and what a person reports and what a test shows often do not match. Cognitive rehabilitation is the approach with the best trial evidence, exercise helps on some measures and not others, and every drug tried so far has failed, including a large trial of donepezil."},{"id":"cancer-related-fatigue-management","kind":"technology","name":"Fatigue after cancer treatment: what actually works","route":"/technologies/cancer-related-fatigue-management/","status":"standard-of-care","tldr":"Fatigue is the commonest thing left behind by cancer treatment and the least treated: about a third of women in two large breast cancer cohorts still had severe fatigue years after diagnosis. What works is exercise, cognitive behavioural therapy and mindfulness programmes. What does not is the stimulant tablet people most often ask for, and the 2024 guideline says so."},{"id":"rejuv-age-epigenetic-clocks","kind":"technology","name":"Epigenetic age after cancer treatment","route":"/technologies/rejuv-age-epigenetic-clocks/","status":"emerging","tldr":"An epigenetic clock reads chemical marks on DNA and estimates how old the body looks, which is not always the age on a birth certificate. In survivors of childhood cancer the clock runs ahead of chronological age, and the gap is larger after radiotherapy and after certain chemotherapy drugs. What the gap means for any one person is not yet known, and the clocks do not agree with each other."},{"id":"rejuv-age-clonal-haematopoiesis-after-therapy","kind":"technology","name":"Clonal haematopoiesis after cancer treatment","route":"/technologies/rejuv-age-clonal-haematopoiesis-after-therapy/","status":"established","tldr":"Chemotherapy and radiotherapy do not select blood stem cells at random. They favour the ones carrying mutations in DNA-damage genes, which then expand. Most people with such a clone never develop a blood cancer, but the clone is a measurable mark of what treatment did, and in a minority it is the seed of a later leukaemia."},{"id":"rejuv-age-senescent-cells-after-treatment","kind":"technology","name":"Senescent cells and p16 after chemotherapy","route":"/technologies/rejuv-age-senescent-cells-after-treatment/","status":"emerging","tldr":"Chemotherapy pushes cells into senescence: they stop dividing but stay alive and keep releasing inflammatory signals. The usual marker, p16INK4a in blood T cells, rises sharply during treatment and is still raised a year later. In one study the rise matched about fifteen years of ordinary ageing, in another the gap in survivors was larger still."},{"id":"rejuv-age-frailty-and-late-effects","kind":"technology","name":"Frailty and late effects in survivors","route":"/technologies/rejuv-age-frailty-and-late-effects/","status":"established","tldr":"The clearest evidence that treatment ages people is not a laboratory marker, it is what happens to survivors decades later. In the St Jude Lifetime Cohort, one in eight women who had cancer as a child met the clinical definition of frailty at a mean age of 33, a rate usually seen after 65. Frailty predicted new chronic conditions and death."},{"id":"rejuv-age-telomere-length","kind":"technology","name":"Telomere length after treatment","route":"/technologies/rejuv-age-telomere-length/","status":"emerging","tldr":"Telomeres are the caps on chromosomes that shorten each time a cell divides. They are the oldest and best known measure of cellular ageing, and the one with the least to show for itself in cancer survivors so far: the measurements exist, the associations are inconsistent, and nothing follows from a result."},{"id":"rejuv-frontier-senolytics","kind":"technology","name":"Senolytics after cancer treatment","route":"/technologies/rejuv-frontier-senolytics/","status":"phase-2","tldr":"Senolytics are drugs meant to kill the worn-out cells that chemotherapy leaves behind. The idea is good and the animal work is striking. The human evidence is four small trials in other diseases, none in cancer survivors, and the one properly randomised trial missed its main target. Nobody should be buying these."},{"id":"rejuv-frontier-metformin-ageing","kind":"technology","name":"Metformin as an anti-ageing drug after cancer","route":"/technologies/rejuv-frontier-metformin-ageing/","status":"phase-3","tldr":"Metformin is cheap, old and safe enough that it is the obvious candidate for a drug that slows ageing. The largest cancer trial ever run on it, in 3,649 women with breast cancer, found nothing. The trial designed to test whether it slows ageing itself has not been run."},{"id":"rejuv-frontier-rapamycin-ageing","kind":"technology","name":"Rapamycin and mTOR inhibition for ageing","route":"/technologies/rejuv-frontier-rapamycin-ageing/","status":"phase-2","tldr":"Rapamycin extends life in every species it has been properly tested in, which is why people take it off-label. In humans there are two randomised results worth knowing: a related drug improved the flu vaccine response in older people by about a fifth, and a year of low-dose rapamycin in healthy adults did not change its primary endpoint. That is the whole of it."},{"id":"rejuv-frontier-nad-precursors","kind":"technology","name":"NAD+ precursors taken by mouth","route":"/technologies/rejuv-frontier-nad-precursors/","status":"phase-2","tldr":"NAD+ falls with age, and swallowing a precursor raises it in the blood. That much is established. Whether raising it does anything for a person who has had cancer is not. The one B3 compound with a real cancer result is plain nicotinamide, for preventing skin cancers in people who keep getting them, which is a different claim entirely."},{"id":"rejuv-frontier-immune-reconstitution","kind":"technology","name":"Rebuilding the immune system after treatment","route":"/technologies/rejuv-frontier-immune-reconstitution/","status":"standard-of-care","tldr":"Chemotherapy, a transplant and CAR-T empty out the immune system, and rebuilding it takes months to years. Blood counts come back before protection does: the antibodies built up over a lifetime, from childhood jabs and from infections, are largely lost after a transplant. Re-vaccination puts them back, on a published schedule."},{"id":"rejuv-frontier-mesenchymal-stromal-cells","kind":"technology","name":"Mesenchymal stromal cells for tissue damage","route":"/technologies/rejuv-frontier-mesenchymal-stromal-cells/","status":"approved","tldr":"There is one licensed mesenchymal cell product in oncology and it is for one narrow use: children whose graft-versus-host disease has not responded to steroids. Everything else sold as a mesenchymal or stromal cell infusion for repair or rejuvenation is unlicensed and untested, and it is worth knowing the difference because the clinics rely on it being blurred."},{"id":"rejuv-frontier-fat-grafting","kind":"technology","name":"Fat grafting after cancer surgery","route":"/technologies/rejuv-frontier-fat-grafting/","status":"established","tldr":"Taking fat from one part of the body and injecting it to fill a defect left by surgery is routine reconstructive practice. The question survivors ask is whether it wakes anything up. Matched studies have not found higher recurrence, but they are not randomised trials, and the grafted area can produce changes on a mammogram that need to be told apart from a recurrence."},{"id":"rejuv-frontier-platelet-rich-plasma","kind":"technology","name":"Platelet-rich plasma for survivors","route":"/technologies/rejuv-frontier-platelet-rich-plasma/","status":"phase-2","tldr":"Platelet-rich plasma is the person's own blood, spun down and injected back. It is sold for hair, skin and vaginal dryness after treatment. The two trials that have actually been run in cancer survivors are small, and the better designed of the two found no difference between the treated and untreated side of the same scalp."},{"id":"rejuv-frontier-hyperbaric-oxygen-claims","kind":"technology","name":"Hyperbaric oxygen sold as rejuvenation","route":"/technologies/rejuv-frontier-hyperbaric-oxygen-claims/","status":"emerging","tldr":"Hyperbaric oxygen has real randomised evidence for a short list of late radiation injuries, and none at all for the general claims made for it in wellness clinics. The distinction is worth holding, because the clinics use the real indications to sell the invented ones."},{"id":"rejuv-frontier-stem-cell-tourism","kind":"technology","name":"Stem cell clinics and stem cell tourism","route":"/technologies/rejuv-frontier-stem-cell-tourism/","status":"emerging","tldr":"Clinics at home and abroad sell stem cell infusions and injections to people finishing cancer treatment. The FDA has recorded blindness, tumour formation and infections from these products, and says plainly that if you are being charged for one outside a clinical trial you are likely being deceived. Two of the harms are written up in the New England Journal of Medicine."},{"id":"rejuv-frontier-exosome-injections","kind":"technology","name":"Exosome injections","route":"/technologies/rejuv-frontier-exosome-injections/","status":"preclinical","tldr":"Exosomes are real biology and a serious research field. Exosome injections sold in clinics are neither. There are no approved exosome products anywhere, and the FDA issued a public safety notification after patients in Nebraska were seriously harmed by them."},{"id":"rejuv-frontier-unlicensed-peptides","kind":"technology","name":"Unlicensed peptides sold for recovery","route":"/technologies/rejuv-frontier-unlicensed-peptides/","status":"preclinical","tldr":"BPC-157, ipamorelin, thymosin, CJC-1295 and the rest are sold online and by clinics for healing, energy and recovery after treatment. The FDA has placed several of them on the list of substances that may present significant safety risks in compounding, and names immunogenicity, impurities and, for some, deaths in studies."},{"id":"rejuv-frontier-nad-infusions","kind":"technology","name":"Intravenous NAD+ drips","route":"/technologies/rejuv-frontier-nad-infusions/","status":"emerging","tldr":"An NAD+ drip takes several hours, is sold in courses, and has never been tested against placebo for anything a cancer survivor would recognise. The published human literature on intravenous NAD+ amounts to retrospective series and narrative reviews."},{"id":"rejuv-frontier-ozone-therapy","kind":"technology","name":"Ozone therapy","route":"/technologies/rejuv-frontier-ozone-therapy/","status":"emerging","tldr":"Ozone is sold to survivors as an infusion of ozonated blood, a rectal insufflation or an injection, for immunity, energy and detoxification. The United States regulation on the subject opens with a sentence worth reading in full: \"Ozone is a toxic gas with no known useful medical application in specific, adjunctive, or preventive therapy.\""},{"id":"rejuv-frontier-hormone-pellets","kind":"technology","name":"Compounded hormone pellets","route":"/technologies/rejuv-frontier-hormone-pellets/","status":"emerging","tldr":"Pellets of compounded oestrogen and testosterone are implanted under the skin and sold as a way to feel young again. The National Academies reviewed the evidence and told prescribers to restrict their use: the claim that compounded preparations are safer or more effective than approved hormone products is not supported, and nobody checks what is in them."},{"id":"rejuv-frontier-what-works","kind":"technology","name":"What actually works after treatment","route":"/technologies/rejuv-frontier-what-works/","status":"established","tldr":"Exercise, sleep, not smoking, treating what is treatable and keeping up surveillance outperform everything currently sold as rejuvenation, by a wide margin and with randomised trials behind them. The measurable ageing that treatment causes is real and is a reason for research, not a reason to buy something."},{"id":"sjlife","kind":"collection","name":"St Jude Lifetime Cohort Study (SJLIFE)","route":"/collections/sjlife/","tldr":"The study that brought survivors back to a hospital and tested them, rather than asking them what was wrong. It found that most of what it found had not been diagnosed: by age 45, on clinical testing, 95.5 per cent of survivors had a chronic health condition and 80.5 per cent had a serious, disabling or life-threatening one."},{"id":"bccss","kind":"collection","name":"British Childhood Cancer Survivor Study (BCCSS)","route":"/collections/bccss/","tldr":"Britain's own survivor cohort, built on national registration rather than on hospital volunteers, which is why it can follow people for half a century and count deaths that nobody reported. Its central finding is that what kills survivors changes with time: recurrence early, second cancers and heart disease late."},{"id":"pancaresurfup","kind":"collection","name":"PanCareSurFup and the European survivor cohorts","route":"/collections/pancaresurfup/","tldr":"Europe's answer to the American cohorts: thirteen data providers in twelve countries pooled their records to build what its own authors call the largest cohort of children with cancer to date, 83,333 five-year survivors, so that second cancers and heart disease could be counted on a continent that keeps its data in national pieces."},{"id":"ighg","kind":"collection","name":"International Guideline Harmonization Group for late effects of childhood cancer","route":"/collections/ighg/","tldr":"Three countries wrote three different sets of follow-up rules for the same survivors, and the rules disagreed about who to screen, how and how often. Since 2010 this group has been settling those disagreements one organ at a time, in public, with the evidence graded and the disagreement named."},{"id":"rejuv-paed-chronic-disease-burden","kind":"technology","name":"How much illness childhood cancer survivors carry, and at what age","route":"/technologies/rejuv-paed-chronic-disease-burden/","status":"established","tldr":"The figures, with the cohort and the age attached, because they are misquoted more than any others. On self-report at a mean age of 26, 62.3 per cent of survivors had a chronic condition. On clinical testing, the cumulative prevalence of any chronic condition by age 45 was 95.5 per cent, and by age 50 a survivor had 17.1 conditions against 9.2 in matched controls."},{"id":"rejuv-paed-late-mortality","kind":"technology","name":"Late deaths after childhood cancer, what causes them, and the proof that gentler treatment worked","route":"/technologies/rejuv-paed-late-mortality/","status":"established","tldr":"Five-year survivors still die earlier than their peers, but much less than they did. Fifteen-year mortality among American five-year survivors fell from 12.4 per cent for children treated in the early 1970s to 6.0 per cent for those treated in the 1990s, and the fall tracks the radiotherapy and anthracycline that were taken out of the protocols."},{"id":"rejuv-paed-growth-and-height","kind":"technology","name":"Growth and final height after treatment in childhood, and growth hormone","route":"/technologies/rejuv-paed-growth-and-height/","status":"standard-of-care","tldr":"Radiotherapy that reaches the pituitary stops the growth hormone signal, and radiotherapy to the spine stops the spine growing. In a Dutch cohort of 573 survivors, 8.9 per cent ended up more than two standard deviations below mean adult height, the largest losses after total body irradiation and craniospinal radiotherapy. Replacement restores some height."},{"id":"rejuv-paed-pituitary-and-puberty","kind":"technology","name":"The pituitary, puberty and the hypothalamic axis after cranial radiotherapy in childhood","route":"/technologies/rejuv-paed-pituitary-and-puberty/","status":"standard-of-care","tldr":"Radiotherapy near the base of the brain damages the gland that runs growth, puberty, the thyroid and the stress response, in that order of sensitivity. In 748 survivors treated with cranial radiotherapy, 46.5 per cent had growth hormone deficiency, 10.8 per cent sex hormone deficiency, 7.5 per cent thyroid deficiency and 4 per cent adrenal deficiency, and most of it had not been treated."},{"id":"rejuv-paed-neurocognitive","kind":"technology","name":"Memory, attention and learning after treatment of a childhood cancer","route":"/technologies/rejuv-paed-neurocognitive/","status":"established","tldr":"The commonest pattern after cranial radiotherapy in a young child is not forgetting what was learned but learning more slowly than other children, so the gap widens with every year at school. In 44 children treated for medulloblastoma the measured loss was 2.55 IQ points a year, and raw scores were still rising: they were gaining skills, just more slowly than the test expected for their age."},{"id":"rejuv-paed-hearing","kind":"technology","name":"Hearing after platinum and cranial radiotherapy in a developing child","route":"/technologies/rejuv-paed-hearing/","status":"standard-of-care","tldr":"Hearing loss in a child still learning to speak and read costs more than the same loss in an adult. In the St Jude Lifetime Cohort, severe hearing impairment affected 34.9 per cent of platinum-treated survivors and 38.3 per cent of those irradiated at the cochlea, against 8.8 per cent of unexposed survivors, and tracked deficits in reasoning, fluency and mathematics."},{"id":"rejuv-paed-heart","kind":"technology","name":"The heart after anthracyclines and chest radiotherapy in childhood","route":"/technologies/rejuv-paed-heart/","status":"standard-of-care","tldr":"Heart damage from childhood treatment appears quietly and decades later. When 1,853 adult survivors were examined rather than asked, 7.4 per cent had cardiomyopathy and 28 per cent had valve disease, and most of it was new at that visit: nearly all of them had no symptoms. High blood pressure multiplied the risk of heart failure nineteenfold, which makes it the most treatable thing on the page."},{"id":"rejuv-paed-fertility-female","kind":"technology","name":"Fertility in girls and young women treated for cancer, including ovarian tissue freezing","route":"/technologies/rejuv-paed-fertility-female/","status":"standard-of-care","tldr":"Most female survivors treated with chemotherapy and no radiotherapy to the pelvis or brain can become pregnant: the large cohort that asked found chemotherapy-specific effects were few. The exceptions are busulfan, high-dose lomustine, pelvic and cranial radiotherapy and transplant conditioning. Before puberty, freezing ovarian tissue is the only option."},{"id":"rejuv-paed-fertility-male","kind":"technology","name":"Fertility in boys and young men treated for cancer, including testicular tissue banking","route":"/technologies/rejuv-paed-fertility-male/","status":"established","tldr":"Male survivors were about half as likely as their brothers to father a child, and the causes are specific: testicular radiotherapy above 7.5 gray, and high cumulative cyclophosphamide, ifosfamide, procarbazine or cisplatin. A young man with none of those was no less likely than his brother. Sperm banking works; tissue banking before puberty has produced no births."},{"id":"rejuv-paed-bone","kind":"technology","name":"Bone after childhood cancer: peak bone mass, osteonecrosis and what rebuilds","route":"/technologies/rejuv-paed-bone/","status":"established","tldr":"A child treated during the years in which bone is laid down may never reach the peak bone mass they would have had, which is a different problem from an adult losing bone already built. Thirty per cent of adult survivors of childhood leukaemia had low bone density, most strongly associated with growth hormone deficiency and smoking, both treatable."},{"id":"rejuv-paed-teeth-and-face","kind":"technology","name":"Teeth, jaws and facial growth after treatment in childhood","route":"/technologies/rejuv-paed-teeth-and-face/","status":"established","tldr":"Treatment given while the teeth are forming can stop them forming. In the largest survey, survivors were three times more likely than siblings to report small teeth, three times more likely to report abnormal roots and nearly ten times more likely to report a dry mouth, and the risk was concentrated in children treated with alkylating drugs before the age of five."},{"id":"rejuv-paed-kidneys","kind":"technology","name":"Kidneys after cisplatin, ifosfamide, radiotherapy and nephrectomy in childhood","route":"/technologies/rejuv-paed-kidneys/","status":"established","tldr":"A Cochrane review of 61 studies found reported rates of kidney damage after childhood cancer treatment ranging from nought to 84 per cent, which is a statement about the literature rather than about kidneys. On systematic clinical testing of one large cohort, kidney dysfunction was present in 5 per cent, among the least common of the organ problems measured."},{"id":"rejuv-paed-second-cancers","kind":"technology","name":"Second cancers after childhood cancer: the risk by treatment, and why it is falling","route":"/technologies/rejuv-paed-second-cancers/","status":"established","tldr":"The largest late risk a childhood cancer survivor carries. Thirty years after diagnosis, 20.5 per cent of survivors treated in the 1970s and early 1980s had developed a subsequent neoplasm. The fifteen-year risk of a second malignancy has since fallen from 2.1 to 1.3 per cent across treatment decades, and the fall tracks the radiotherapy taken out."},{"id":"rejuv-paed-breast-after-chest-radiotherapy","kind":"technology","name":"Breast cancer after chest radiotherapy in childhood, and the screening that follows","route":"/technologies/rejuv-paed-breast-after-chest-radiotherapy/","status":"standard-of-care","tldr":"A girl who had radiotherapy to the chest carries a risk of breast cancer by age 50 of about 30 per cent. It is not only about dose: a low dose to the whole lung gave a higher standardised incidence than a high dose to a smaller field, because volume matters. Surveillance is recommended from early adulthood, decades before ordinary screening starts."},{"id":"rejuv-paed-cog-ltfu-guidelines","kind":"technology","name":"The Children's Oncology Group Long-Term Follow-Up Guidelines","route":"/technologies/rejuv-paed-cog-ltfu-guidelines/","status":"standard-of-care","tldr":"The most widely used rulebook in childhood cancer survivorship, and the one that made follow-up exposure-based rather than diagnosis-based: what you were given decides what you are screened for. It comes with Health Links, plain-language sheets written for the survivor rather than the doctor, and it is free to download."},{"id":"rejuv-paed-uk-long-term-follow-up","kind":"technology","name":"Long-term follow-up in the United Kingdom: what a survivor is actually offered","route":"/technologies/rejuv-paed-uk-long-term-follow-up/","status":"standard-of-care","tldr":"Britain sorts survivors into three levels of follow-up by how intensive their treatment was: a postal or telephone review at one end, a specialist late-effects clinic at the other. A Scottish cohort applied the levels retrospectively and found they worked: late effects affected 11.6 per cent of level one survivors and 65.2 per cent of level three."},{"id":"rejuv-paed-transition-to-adult-care","kind":"technology","name":"The handover from children's to adult services, where follow-up falls away","route":"/technologies/rejuv-paed-transition-to-adult-care/","status":"emerging","tldr":"This is where survivorship care is lost. Of 8,522 adult survivors asked, 88.8 per cent had seen a doctor in the previous two years but only 17.8 per cent had received care that addressed their cancer history with risk advice or screening. Among those who should have had an echocardiogram, 28.2 per cent had; among those due a mammogram, 40.8 per cent had."},{"id":"rejuv-ayac-distinct-group","kind":"technology","name":"Adolescents and young adults: a group with its own cancers, its own gap and its own needs","route":"/technologies/rejuv-ayac-distinct-group/","status":"established","tldr":"People diagnosed between 15 and 39 get different cancers from children and from older adults, and for years their survival improved more slowly than either. Since 2000 that has changed: five-year survival gains for this group have paralleled those of childhood cancers. The obstacles that remain are trial enrolment, access and insurance, and support that fits the age."},{"id":"rejuv-ayac-diagnostic-delay","kind":"technology","name":"How long it takes to diagnose cancer in a young person, and what the evidence actually says","route":"/technologies/rejuv-ayac-diagnostic-delay/","status":"established","tldr":"Young people often say their cancer took a long time to diagnose, and the research agrees that time to diagnosis varies widely by tumour type and age. What the research does not support is a single number: a systematic review found the studies used different definitions and skewed data that could not be combined, so no meta-analysis was possible."},{"id":"rejuv-ayac-education-and-work","kind":"technology","name":"Education, work and the years that were interrupted","route":"/technologies/rejuv-ayac-education-and-work/","status":"established","tldr":"Cancer in the years when education and first jobs happen costs more than the time taken. In the largest cohort, 23 per cent of childhood cancer survivors had used special education services against 8 per cent of siblings, and survivors of several cancers were less likely to finish high school. The important finding is that where the educational support was given, the gap closed."},{"id":"rejuv-ayac-services","kind":"technology","name":"Services built for teenagers and young adults, and what the national evaluation found","route":"/technologies/rejuv-ayac-services/","status":"established","tldr":"England built specialist units for 13 to 24 year olds and then evaluated them nationally, which almost no health system does. The results were mixed enough that young people were asked to interpret them, and they pointed out that three years of follow-up was too short and that the study had defined specialist care by how many admissions a person had rather than how long they spent there."},{"id":"rejuv-second-cancers-overview","kind":"term","name":"Second cancers after treatment: what the risk is, and what is done about it","route":"/terms/rejuv-second-cancers-overview/","tldr":"A second cancer is a brand new cancer, not the first one coming back. Most are found by the ordinary routes, and some have a screening programme attached, which is the part worth asking about by name. The risk comes from three things that add together: the treatment, the thing that caused the first cancer and has not gone away, and simply having lived longer."},{"id":"rejuv-second-alkylating-agents-and-myeloid-neoplasms","kind":"term","name":"Alkylating agents and therapy-related myeloid neoplasms","route":"/terms/rejuv-second-alkylating-agents-and-myeloid-neoplasms/","tldr":"Alkylating chemotherapy can damage a blood stem cell in a way that shows up years later as myelodysplastic syndrome or acute myeloid leukaemia. It is uncommon, it depends on the total dose, and the risk falls away after about ten years. Knowing the cumulative dose you were given is the single most useful thing on your treatment summary."},{"id":"rejuv-second-topoisomerase-inhibitors-short-latency","kind":"term","name":"Topoisomerase II inhibitors and the shorter latency","route":"/terms/rejuv-second-topoisomerase-inhibitors-short-latency/","tldr":"Etoposide and the anthracyclines can cause a leukaemia too, but a different one: it arrives after about two years rather than six, it starts as acute leukaemia without a myelodysplastic phase, and it carries a balanced break in a chromosome rather than a missing piece. So the first two or three years after this chemotherapy are when a blood count matters most."},{"id":"rejuv-second-platinum-and-parp-inhibitors","kind":"term","name":"Platinum drugs and PARP inhibitors: the newer leukaemia risk","route":"/terms/rejuv-second-platinum-and-parp-inhibitors/","tldr":"The leukaemia risk after chemotherapy was described in the era of mustards and etoposide, and it did not stay there. Platinum drugs carry it, PARP inhibitors raise it about two and a half times against placebo, and lenalidomide with oral melphalan raises it nearly fivefold against melphalan alone. The absolute numbers are small, but the choice of partner drug is sometimes a real decision."},{"id":"rejuv-second-radiotherapy-dose-field-and-age","kind":"term","name":"Radiotherapy and second cancers: field, dose and age at exposure","route":"/terms/rejuv-second-radiotherapy-dose-field-and-age/","tldr":"A radiation-induced cancer appears in or at the edge of the treated area, usually more than ten years later, and the risk rises with the dose the organ received and falls with the age at which the person was treated. Which organs sat in the field is therefore the question that decides everything that follows, and it is answerable from the radiotherapy record."},{"id":"rejuv-second-age-smoking-and-inherited-risk","kind":"term","name":"Age, smoking and inherited predisposition: what the treatment risk is added to","route":"/terms/rejuv-second-age-smoking-and-inherited-risk/","tldr":"Treatment is rarely the only cause of a second cancer, and in adults it is usually not the main one. Smoking is the clearest example: after chest radiotherapy for Hodgkin lymphoma, the risks from tobacco and from treatment appeared to multiply rather than add, which makes stopping smoking the largest single lever a survivor has over this particular risk."},{"id":"second-primary-breast-after-chest-radiotherapy","kind":"term","name":"Breast cancer after chest radiotherapy given young","route":"/terms/second-primary-breast-after-chest-radiotherapy/","tldr":"This is the second cancer with a real screening programme attached, and the one most worth asking about by name. A woman who had radiotherapy to breast tissue between the ages of 10 and 35, most often for Hodgkin lymphoma, is eligible in England for annual magnetic resonance imaging from age 25 or 30, and being missed from that list has happened often enough that asking is reasonable."},{"id":"second-primary-lung-after-chest-radiotherapy","kind":"term","name":"Lung cancer after chest radiotherapy and after alkylating chemotherapy","route":"/terms/second-primary-lung-after-chest-radiotherapy/","tldr":"Lung cancer is the commonest cause of death among people who develop a second cancer, and chest radiotherapy raises the risk of it for more than twenty years. There is no screening programme aimed at survivors anywhere, although some survivor groups have a measured rate above the threshold at which lung screening was shown to save lives, so this is a gap rather than a settled answer."},{"id":"second-primary-thyroid-after-neck-radiotherapy","kind":"term","name":"Thyroid cancer after neck radiotherapy, and whether to look for it","route":"/terms/second-primary-thyroid-after-neck-radiotherapy/","tldr":"The thyroid is among the most radiation-sensitive tissues there is, and neck or upper chest radiotherapy raises the risk of thyroid cancer for decades. Whether to look for it is genuinely unsettled: the international guideline panel compared ultrasound against feeling the neck, found neither better, and wrote a decision aid instead of a recommendation."},{"id":"second-primary-sarcoma-in-the-treated-field","kind":"term","name":"Sarcoma in the radiotherapy field, and angiosarcoma of the treated breast","route":"/terms/second-primary-sarcoma-in-the-treated-field/","tldr":"A sarcoma arising in tissue that was irradiated is uncommon, appears after about seven years or more, and is recognised by where it is rather than by any test. In the treated breast it most often takes the form of angiosarcoma, and because it can look like a bruise or a cluster of reddish-blue nodules it is the one second cancer a person might reasonably mistake for something harmless."},{"id":"second-primary-bowel-after-abdominal-radiotherapy","kind":"term","name":"Bowel cancer after abdominal and pelvic radiotherapy","route":"/terms/second-primary-bowel-after-abdominal-radiotherapy/","tldr":"Radiotherapy to the abdomen or pelvis raises the risk of cancer in the bowel that sat in the field, and the risk is confined to the irradiated segment. For adults no country runs an organised colonoscopy programme afterwards, so bleeding or a change in bowel habit years later should be investigated rather than put down to the old treatment."},{"id":"second-primary-bladder-after-cyclophosphamide","kind":"term","name":"Bladder cancer after cyclophosphamide","route":"/terms/second-primary-bladder-after-cyclophosphamide/","tldr":"Cyclophosphamide is one of the few cancer drugs that has been shown to cause a specific solid cancer, in the bladder, and the risk depends steeply on the total dose given. Blood in the urine years after treatment with it is a reason to be investigated rather than reassured, and the cumulative dose on your treatment summary is what tells you where you sit."},{"id":"second-primary-skin-cancer-after-cancer-treatment","kind":"term","name":"Skin cancer after cancer treatment","route":"/terms/second-primary-skin-cancer-after-cancer-treatment/","tldr":"Skin cancer is the commonest second cancer after almost any treatment, and the commonest one left out of the counts, because registries record non-melanoma skin cancers inconsistently or not at all. Most are basal cell carcinomas, most are curable when treated, and the practical answer is to look at irradiated skin and to have anything that bleeds, crusts or does not heal in six weeks examined."},{"id":"rejuv-second-uk-very-high-risk-breast-screening","kind":"term","name":"The UK very high risk breast screening protocol after chest radiotherapy","route":"/terms/rejuv-second-uk-very-high-risk-breast-screening/","tldr":"England runs a named screening programme for women who had radiotherapy to breast tissue when young, with exact ages and tests set out in its own documents. Surveillance begins at 25 or 30 depending on your age when irradiated, or eight years after the radiotherapy, whichever is later, and referral runs through a national dataset."},{"id":"rejuv-second-screening-after-treatment-compared","kind":"term","name":"Screening survivors: where the UK, American and European answers differ","route":"/terms/rejuv-second-screening-after-treatment-compared/","tldr":"Three systems have built screening for survivors and they do not agree. England runs an organised programme with fixed ages and automatic referral; the United States issues a guideline and leaves the arranging to the patient; the Netherlands runs a national survivorship clinic network. They differ on when to start and whom to include."},{"id":"rejuv-second-from-clone-to-disease","kind":"term","name":"From a clone in the blood to a leukaemia: what is known, and what is done","route":"/terms/rejuv-second-from-clone-to-disease/","tldr":"Chemotherapy and radiotherapy select for blood stem cells carrying particular mutations, and in a small minority one of those clones becomes a leukaemia. The useful question is not whether a clone is there but whether it will progress: most never do, and nothing has been shown to stop one that does."},{"id":"rejuv-second-what-is-not-a-second-cancer","kind":"term","name":"What is not a second cancer: recurrence, metastasis and field cancerisation","route":"/terms/rejuv-second-what-is-not-a-second-cancer/","tldr":"Four different things get called the same thing in conversation and in the news, and the difference changes what the news means. A second cancer is a new disease with its own stage and its own chance of cure. A recurrence is the first one back. A metastasis is the first one somewhere else. Field cancerisation is a whole area of tissue that was already changed before any of them."},{"id":"rejuv-second-choices-made-at-treatment","kind":"term","name":"Choices made at the time of treatment that change the second cancer risk","route":"/terms/rejuv-second-choices-made-at-treatment/","tldr":"Some of this risk is a decision rather than a fate. Where two treatments cure equally well and one carries less late risk, that is a conversation to have before treatment starts. Trials have settled several: a different partner drug in myeloma, a lower cyclophosphamide dose in breast cancer, brachytherapy rather than external beam."},{"id":"rejuv-mind-fear-of-recurrence","kind":"technology","name":"Fear that the cancer will come back: how common it is, and when it stops being ordinary worry","route":"/technologies/rejuv-mind-fear-of-recurrence/","status":"established","tldr":"Almost everyone who finishes cancer treatment thinks about it coming back, and for about one in five the thought is severe enough to be worth treating. Pooling 9,311 people from 46 studies in 13 countries, 58.8 per cent scored 13 or more on a 36-point questionnaire, 45.1 per cent scored 16 or more and 19.2 per cent reached 22, the clinical threshold."},{"id":"rejuv-mind-fear-of-recurrence-treatment","kind":"technology","name":"Treating fear of recurrence: the randomised trials, their effect sizes, and where the treatment is available","route":"/technologies/rejuv-mind-fear-of-recurrence-treatment/","status":"emerging","tldr":"Treatment aimed specifically at fear of recurrence works, and the effect is small: across 23 controlled trials the pooled difference was 0.33 of a standard deviation afterwards and 0.28 at follow-up. The two largest randomised trials, ConquerFear with 222 people and SWORD with 88, each beat their comparator, and SWORD cost 466 euros a person."},{"id":"rejuv-mind-scan-anxiety","kind":"technology","name":"Anxiety around scans, and what the evidence says about how often to scan","route":"/technologies/rejuv-mind-scan-anxiety/","status":"established","tldr":"Anxiety around a scan has been measured in 57 studies using 81 different instruments, which is why reported rates run from 13 to 83 per cent; moderate to severe anxiety was reported by 4 to 28 per cent. Scanning more often does not lengthen life in breast cancer or in one common lymphoma, and in bowel cancer it found more curable recurrences but no fewer deaths."},{"id":"rejuv-mind-depression-after-cancer","kind":"technology","name":"Depression during and after cancer: the interview-based prevalence, and the care model that works","route":"/technologies/rejuv-mind-depression-after-cancer/","status":"standard-of-care","tldr":"Diagnosed by psychiatric interview rather than questionnaire, depression affects about one in six people being treated for cancer: 16.3 per cent across 70 studies and 10,071 people. Years later the rate is no higher than in people who have not had cancer. The treatment with the largest trial behind it is nurse-delivered collaborative care, which tripled the response rate."},{"id":"rejuv-mind-anxiety-after-cancer","kind":"technology","name":"Anxiety after cancer, in survivors and in their partners","route":"/technologies/rejuv-mind-anxiety-after-cancer/","status":"established","tldr":"Two or more years after diagnosis, anxiety is the mood problem that stays raised: 17.9 per cent of 48,964 people against 13.9 per cent of 226,467 who had not had cancer, a relative risk of 1.27. Depression at that distance is not raised. Where both members of a couple were measured, spouses reported anxiety at 40.1 per cent against 28.0 per cent."},{"id":"rejuv-mind-traumatic-stress-after-cancer","kind":"technology","name":"Post-traumatic stress after cancer: what is measured, and how much of it is measurement","route":"/technologies/rejuv-mind-traumatic-stress-after-cancer/","status":"emerging","tldr":"Post-traumatic stress disorder is commoner after cancer than in matched controls, with a pooled odds ratio of 1.66 across 11 studies, and the meta-analysis authors say some of that may come from publication bias. How much is reported depends on whether a clinician interviewed the person, and on whether the paper's own title mentions post-traumatic stress."},{"id":"rejuv-mind-distress-screening","kind":"technology","name":"Screening for distress: what the thermometer can and cannot do","route":"/technologies/rejuv-mind-distress-screening/","status":"established","tldr":"The one-question distress thermometer is good at ruling depression out and poor at ruling it in: pooled across 38 analyses of 6,414 patients, sensitivity 78.4 per cent, specificity 66.8 per cent, and only 34.2 per cent who screened positive were depressed. Tested as a way of improving outcomes rather than finding cases, the one randomised trial found no improvement."},{"id":"rejuv-mind-post-traumatic-growth","kind":"technology","name":"Post-traumatic growth: what people report, and what the measurement actually captures","route":"/technologies/rejuv-mind-post-traumatic-growth/","status":"established","tldr":"Many people say cancer changed them for the better, and that report is real. What the standard questionnaire measures is less clear: when researchers compared what people said had changed with what had actually changed on the same measures taken before and after the event, the two were largely unrelated, and perceived growth went with more distress while measured growth went with less."},{"id":"rejuv-mind-access-to-psychological-care","kind":"technology","name":"Getting psychological help after cancer: the stepped-care model, and what is actually commissioned","route":"/technologies/rejuv-mind-access-to-psychological-care/","status":"established","tldr":"The guideline answer is stepped care: education for everyone, named talking therapies for moderate symptoms, more intensive therapy for severe ones, and medication after those rather than before. The English four-level model that cancer services were built around, published by NICE in 2004, has been retired and nothing has replaced it in the same form."},{"id":"rejuv-mind-body-image-after-cancer","kind":"technology","name":"Body image after cancer treatment: how it is measured, what drives it, and what helps","route":"/technologies/rejuv-mind-body-image-after-cancer/","status":"established","tldr":"Body image has a validated ten-item questionnaire built for cancer trials and tested in 682 women with breast cancer. It discriminates reliably between people who had a mastectomy and those who had breast-conserving surgery, and the scores do not track age or time since diagnosis, which is the finding most at odds with what people are told."},{"id":"rejuv-mind-visible-difference-head-and-neck","kind":"technology","name":"A changed face and voice: body image after head and neck cancer treatment","route":"/technologies/rejuv-mind-visible-difference-head-and-neck/","status":"emerging","tldr":"Head and neck cancer treatment changes the part of the body a person cannot cover, and the functions, speech and eating, that social life is built on. There is no pooled prevalence figure for body image distress in this group: the first systematic review of the factors behind it was still a published protocol in 2025, which makes this the clearest measurement gap in this part of the corpus."},{"id":"rejuv-mind-body-after-stoma-and-limb-loss","kind":"technology","name":"Living with a stoma, and living after an amputation","route":"/technologies/rejuv-mind-body-after-stoma-and-limb-loss/","status":"established","tldr":"A stoma changes how the body works in public, and the comparisons of quality of life after a stoma against a restored bowel are small and mixed. After bone sarcoma of an arm or leg the finding is the one people least expect: most studies comparing amputation with limb-saving surgery reported no significant difference in quality of life."},{"id":"rejuv-mind-the-word-survivor","kind":"technology","name":"The word survivor, and why the vocabulary is not a detail","route":"/technologies/rejuv-mind-the-word-survivor/","status":"established","tldr":"In the one in-depth British study to ask, most of 40 people interviewed at least five years after a diagnosis of breast, bowel or prostate cancer rejected the word survivor, and the authors recommended descriptive terms instead. A wider review of eight cancer studies found the opposite in five of them, which is the point: there is no single right word."},{"id":"rejuv-life-partners-and-intimacy","kind":"technology","name":"Partners and relationships after cancer: what the divorce data actually show","route":"/technologies/rejuv-life-partners-and-intimacy/","status":"established","tldr":"The widely repeated claim that a marriage is six times more likely to end when the woman is the patient comes from one prospective cohort of 515 people. The largest study of the question, 134,435 married Finnish women followed for a median of 17 married years, found no increase in marital breakdown after early breast cancer, with a hazard ratio of 0.96."},{"id":"rejuv-life-carers","kind":"technology","name":"The carer's own recovery: what is known about the person who is not the patient","route":"/technologies/rejuv-life-carers/","status":"established","tldr":"In studies that measured both halves of a couple, anxiety was reported by 40.1 per cent of spouses against 28.0 per cent of the people they cared for, and the review of fear of recurrence found carers reported more fear than patients. Across 29 randomised trials, interventions aimed at carers reduced burden and improved coping, with small to medium effects."},{"id":"rejuv-life-children-of-a-parent-with-cancer","kind":"technology","name":"Children of a parent treated for cancer","route":"/technologies/rejuv-life-children-of-a-parent-with-cancer/","status":"established","tldr":"An estimated 1.58 million people in the United States living after a cancer diagnosis have a child under 18 at home, about 2.85 million children, and roughly 562,000 of them live with a parent in early treatment. The systematic review found no general excess of serious difficulty against reference groups, a slightly raised risk of internalising problems, and adolescent daughters most affected."},{"id":"rejuv-life-return-to-work","kind":"technology","name":"Going back to work after cancer: the rates, and the programmes that change them","route":"/technologies/rejuv-life-return-to-work/","status":"established","tldr":"Pooled across 36 studies, 20,366 people who had had cancer and 157,603 controls, 33.8 per cent of those who had had cancer were unemployed against 15.2 per cent, a relative risk of 1.37. Of four kinds of return-to-work programme tested in trials, exercise and multidisciplinary ones each raised the proportion returning by about a quarter; education alone did not."},{"id":"rejuv-life-employment-rights-uk","kind":"technology","name":"Employment rights with cancer in the United Kingdom","route":"/technologies/rejuv-life-employment-rights-uk/","status":"standard-of-care","tldr":"Schedule 1 of the Equality Act 2010 says in one sentence that \"Cancer, HIV infection and multiple sclerosis are each a disability\", so protection applies from the moment of diagnosis rather than when the illness starts to limit anything. That brings the employer's duty to make reasonable adjustments, and Statutory Sick Pay of £123.25 a week for up to 28 weeks."},{"id":"rejuv-life-employment-rights-us","kind":"technology","name":"Employment rights with cancer in the United States","route":"/technologies/rejuv-life-employment-rights-us/","status":"standard-of-care","tldr":"Federal regulation states that \"cancer substantially limits normal cell growth\", and the statute counts an impairment in remission if it would substantially limit a major life activity when active. The Americans with Disabilities Act reaches employers with 15 or more employees; unpaid job-protected leave under the Family and Medical Leave Act is 12 workweeks a year."},{"id":"rejuv-life-insurance-loans-and-the-right-to-be-forgotten","kind":"technology","name":"Insurance, mortgages and the right to be forgotten","route":"/technologies/rejuv-life-insurance-loans-and-the-right-to-be-forgotten/","status":"emerging","tldr":"Nine European Union countries have passed laws giving people who have had cancer the right not to declare it when applying for a loan or insurance after a set period, commonly five to ten years for adults and five for a cancer diagnosed young. Where the laws have been in force longest, acceptance rates are high and the strain on insurers is reported as minimal."},{"id":"rejuv-life-money-after-treatment","kind":"technology","name":"Money after treatment: what the cost of cancer does once the treatment has finished","route":"/technologies/rejuv-life-money-after-treatment/","status":"established","tldr":"In a United States cohort covering 231,596 people diagnosed between 1995 and 2009, those who filed for bankruptcy after a cancer diagnosis had a mortality hazard ratio of 1.79 against propensity-matched people who did not. In a national survey of people over 50, 42.4 per cent had depleted their entire assets two years after diagnosis, losing an average of 92,098 dollars."},{"id":"rejuv-mind-sleep-after-cancer","kind":"technology","name":"Sleep after cancer: how common insomnia is, how long it lasts, and the treatment that works","route":"/technologies/rejuv-mind-sleep-after-cancer/","status":"standard-of-care","tldr":"In 962 people interviewed six times over 18 months after surgery for a first non-metastatic cancer, 59 per cent had insomnia symptoms at the start, 28 per cent met criteria for an insomnia syndrome, and 36 per cent still had symptoms at 18 months. A short course of talking therapy for insomnia improved sleep efficiency by 15.5 per cent against 6.1 per cent in controls."},{"id":"rejuv-mind-sleeping-tablets-after-cancer","kind":"technology","name":"Sleeping tablets after cancer: what they do and what they do not","route":"/technologies/rejuv-mind-sleeping-tablets-after-cancer/","status":"established","tldr":"The American Academy of Sleep Medicine's guideline on drugs for chronic insomnia rates every one of its recommendations as weak, suggests eight drugs and suggests against six more, including melatonin, trazodone, diphenhydramine and valerian. In cancer specifically, the only placebo-controlled trial of temazepam and prolonged-release melatonin randomised 21 people."},{"id":"gvhd-chronic-overview","kind":"technology","name":"Chronic graft-versus-host disease","route":"/technologies/gvhd-chronic-overview/","status":"established","tldr":"After a donor transplant the new immune system can treat the body it has landed in as foreign. When that goes on past the first few months it is called chronic graft-versus-host disease, and it affects roughly four in ten adults. It is treatable and often improves, and the same donor immunity also keeps the leukaemia away, so the aim is to control it rather than abolish it."},{"id":"gvhd-nih-consensus-criteria","kind":"technology","name":"How chronic GvHD is diagnosed and scored: the NIH consensus criteria","route":"/technologies/gvhd-nih-consensus-criteria/","status":"established","tldr":"There is an agreed way to say how bad chronic GvHD is, and every trial, drug label and treatment decision uses it. Each affected organ scores 0 to 3, and the pattern gives an overall verdict of mild, moderate or severe. Worth asking: which organs are scored, what each score is, and what the global severity is."},{"id":"gvhd-organ-by-organ","kind":"technology","name":"Chronic GvHD organ by organ: skin, mouth, eyes, gut, liver, joints and genital tract","route":"/technologies/gvhd-organ-by-organ/","status":"established","tldr":"Chronic GvHD is a pattern of injuries that can appear in several places at once: skin that thickens, a dry sore mouth, dry painful eyes, difficulty swallowing, abnormal liver tests, stiff joints, genital narrowing. Several of the best treatments are local rather than systemic. The eye and genital problems are the ones least often raised."},{"id":"gvhd-lung-bronchiolitis-obliterans","kind":"technology","name":"The lungs after transplant: bronchiolitis obliterans syndrome","route":"/technologies/gvhd-lung-bronchiolitis-obliterans/","status":"established","tldr":"The smallest airways in the lung can scar shut after a donor transplant. It is the form of chronic GvHD that changes the outlook most, and it is usually silent until a lot of lung function has gone. It is found by breathing tests on a schedule rather than by waiting for breathlessness, so asking for spirometry is worth doing."},{"id":"gvhd-prophylaxis","kind":"technology","name":"Preventing graft-versus-host disease, and what prevention costs","route":"/technologies/gvhd-prophylaxis/","status":"standard-of-care","tldr":"Every donor transplant includes drugs to stop the new immune system attacking the body. A randomised trial in 2023 changed the usual choice: cyclophosphamide after the transplant, with tacrolimus and mycophenolate, worked better than the older combination. Prevention is not free, because the same drugs hold back the response to infection."},{"id":"gvhd-ruxolitinib-steroid-refractory","kind":"technology","name":"When steroids fail: ruxolitinib for steroid-refractory GvHD","route":"/technologies/gvhd-ruxolitinib-steroid-refractory/","status":"approved","tldr":"First treatment for graft-versus-host disease is steroids, and in about half of people with chronic disease they do not work or cannot be reduced. Ruxolitinib is the only drug that has beaten the alternatives in a randomised trial here, and it has done so twice. About half of people respond; the common problems are low platelets and low haemoglobin."},{"id":"gvhd-belumosudil-axatilimab-ibrutinib","kind":"technology","name":"After ruxolitinib: belumosudil, axatilimab and ibrutinib in chronic GvHD","route":"/technologies/gvhd-belumosudil-axatilimab-ibrutinib/","status":"approved","tldr":"Three more drugs are licensed for chronic GvHD that has not responded to earlier treatment. Their response rates look high, between half and three quarters, but they come from trials with no comparison group. Ibrutinib is the cautionary case: it looked good in a single-arm study and then did not beat prednisone alone when tested against placebo."},{"id":"gvhd-photopheresis","kind":"technology","name":"Extracorporeal photopheresis for graft-versus-host disease","route":"/technologies/gvhd-photopheresis/","status":"established","tldr":"Blood is taken out through a machine, the white cells are treated with a light-sensitive drug and ultraviolet light, and given back. It is used for GvHD that steroids have not controlled, mainly skin and mouth, and it spares people more immunosuppression. Improvement builds over months, so it means two sessions a week for a long time."},{"id":"rejuv-tx-late-effects-overview","kind":"technology","name":"Late effects after a stem cell transplant","route":"/technologies/rejuv-tx-late-effects-overview/","status":"established","tldr":"There are now around half a million people alive worldwide who have had a blood or marrow transplant. Most of them have at least one lasting health problem from it, and many have several. The list is long and reads heavily, but almost every item on it is either preventable or detectable early, which is the reason to know what is on it rather than to avoid knowing."},{"id":"rejuv-tx-survival-after-transplant","kind":"technology","name":"Survival after transplant, and why the curve never quite rejoins the population","route":"/technologies/rejuv-tx-survival-after-transplant/","status":"established","tldr":"If you are alive and free of disease two years after a donor transplant, around nine in ten are alive five years later and 85 per cent at ten years. The death rate among transplant survivors stays higher than in people of the same age who never had one, for many years. The two things that matter most are age and chronic graft-versus-host disease."},{"id":"rejuv-tx-second-cancers","kind":"technology","name":"Second cancers after allogeneic transplant","route":"/technologies/rejuv-tx-second-cancers/","status":"established","tldr":"People who have had a donor transplant develop new, unrelated cancers about twice as often as people of the same age, and by fifteen years about three times as often. Radiation in the conditioning matters most for those irradiated young, and chronic GvHD raises squamous cancers of skin and mouth. Both point at lifelong screening."},{"id":"rejuv-tx-iron-overload","kind":"technology","name":"Iron overload after transplant","route":"/technologies/rejuv-tx-iron-overload/","status":"established","tldr":"Every unit of red cells carries iron the body cannot excrete, and someone who has been through leukaemia treatment may have had dozens. It settles in the liver and sometimes the heart. A blood test finds it and an MRI confirms it, and it can be removed either by a chelating drug or by taking blood off once the marrow is working again."},{"id":"rejuv-tx-bone-eyes-kidneys-lungs","kind":"technology","name":"Bone, eyes, kidneys and lungs after transplant","route":"/technologies/rejuv-tx-bone-eyes-kidneys-lungs/","status":"established","tldr":"Four problems that turn up years later and are easy to miss because each belongs to a different specialty: bone that thins or, less often, dies at the hip; cataract, which is common after total body irradiation and is fixed by an operation; kidney function that drifts down; and lungs that stiffen rather than obstruct. Each has a cheap test."},{"id":"rejuv-tx-endocrine-and-cardiometabolic","kind":"technology","name":"Hormones, metabolism and the heart after transplant","route":"/technologies/rejuv-tx-endocrine-and-cardiometabolic/","status":"established","tldr":"Transplant conditioning can leave the thyroid underactive, the ovaries or testes not working, and the handling of sugar and fat altered in a way that raises heart risk years later. Much of this is treatable with ordinary medicine, and the familiar things about weight, exercise and smoking matter more here than usual, not less."},{"id":"rejuv-tx-immune-reconstitution-timeline","kind":"technology","name":"Rebuilding an immune system: the timeline, lineage by lineage","route":"/technologies/rejuv-tx-immune-reconstitution-timeline/","status":"established","tldr":"After a transplant the immune system comes back in a fixed order, and the order explains most of what follows. Neutrophils in two to four weeks, natural killer cells within a month, B cells over several months to a year, and T cells last and slowest. Adults rebuild a narrower repertoire, because the thymus shrinks with age."},{"id":"rejuv-tx-b-cell-aplasia-and-immunoglobulin","kind":"technology","name":"B-cell aplasia and low antibodies after CAR-T and bispecifics, and immunoglobulin replacement","route":"/technologies/rejuv-tx-b-cell-aplasia-and-immunoglobulin/","status":"standard-of-care","tldr":"Treatments aimed at a protein on B cells cannot tell a cancerous B cell from a healthy one, so they remove both, antibody levels fall and infections become more frequent. The fix is to give the antibodies back every few weeks. In one myeloma study, serious infections were ten times less frequent while people were receiving immunoglobulin."},{"id":"rejuv-tx-infection-by-phase","kind":"technology","name":"Infection risk after transplant and cell therapy, phase by phase, and the prophylaxis that follows it","route":"/technologies/rejuv-tx-infection-by-phase/","status":"standard-of-care","tldr":"Which infections threaten someone after a transplant depends almost entirely on how long it has been, because the immune system returns in a known order: bacteria and fungi first, viruses such as cytomegalovirus in the middle months, encapsulated bacteria later. The preventive medicines are matched to those phases."},{"id":"rejuv-tx-revaccination","kind":"technology","name":"Revaccination after transplant: the schedules, and where the UK and the US differ","route":"/technologies/rejuv-tx-revaccination/","status":"standard-of-care","tldr":"A transplant erases the protection built up by a lifetime of vaccinations, including childhood ones, and it has to be rebuilt. Published schedules exist, the vaccines are free at the point of use in the NHS, and the usual failure is that nobody writes the plan down. If you have had a transplant and have no written schedule, ask for one."},{"id":"rejuv-tx-prolonged-cytopenias","kind":"technology","name":"Blood counts that do not come back after CAR-T: ICAHT","route":"/technologies/rejuv-tx-prolonged-cytopenias/","status":"established","tldr":"After CAR-T the blood counts often take much longer to recover than after ordinary chemotherapy, and in some people they dip again weeks later after appearing to have recovered. Since 2023 this has had a name, ICAHT, and an agreed grading system, which matters because it means it is measured and reported rather than described loosely."},{"id":"rejuv-tx-icans-and-neurocognition","kind":"technology","name":"ICANS, and whether thinking recovers after CAR-T","route":"/technologies/rejuv-tx-icans-and-neurocognition/","status":"established","tldr":"CAR-T can cause a short-lived brain disturbance in the first weeks: confusion, trouble finding words, tremor, sometimes seizures. It almost always resolves. Afterwards, measured outcomes for most people are close to the general population, while a substantial minority report trouble with memory or concentration."},{"id":"rejuv-tx-secondary-t-cell-malignancy","kind":"technology","name":"Secondary T-cell malignancy after CAR-T, and what the FDA's 2024 action actually says","route":"/technologies/rejuv-tx-secondary-t-cell-malignancy/","status":"established","tldr":"In 2024 the US regulator added a warning to every approved CAR-T product about T-cell cancers after treatment. It says the risk applies to the class, that these can appear within weeks, and that patients should be monitored for life. It does not say CAR-T causes most of them, and published series find them very rare."},{"id":"rejuv-tx-gene-modified-follow-up","kind":"technology","name":"Long-term follow-up for gene-modified cell products: fifteen years, and why","route":"/technologies/rejuv-tx-gene-modified-follow-up/","status":"standard-of-care","tldr":"If you were given a treatment in which your own cells were genetically modified, you are expected to be followed up for fifteen years. Not because something is known to go wrong, but because the gene is inserted permanently and the only honest way to find out what happens over a lifetime is to look."},{"id":"rejuv-tx-long-term-follow-up-frameworks","kind":"technology","name":"Who is supposed to be watching: EBMT, CIBMTR, FACT-JACIE, and what a survivor is actually offered","route":"/technologies/rejuv-tx-long-term-follow-up-frameworks/","status":"standard-of-care","tldr":"There is an agreed international list of what should be checked in someone who has had a transplant, and how often, and an accreditation system that centres are inspected against. What there is much less of is a guarantee that any individual survivor is receiving the checks. Knowing the list exists lets a person ask for it."},{"id":"rejuv-tx-fertility-and-growth","kind":"technology","name":"Fertility, growth and what total body irradiation costs","route":"/technologies/rejuv-tx-fertility-and-growth/","status":"established","tldr":"Transplant conditioning, and total body irradiation in particular, usually ends natural fertility and in children slows growth. The decisions that preserve the most are made before conditioning starts. A randomised trial in children with leukaemia tested replacing the radiation with chemotherapy and found the radiation worked better."},{"id":"rejuv-tx-quality-of-life","kind":"technology","name":"Quality of life after transplant and cell therapy","route":"/technologies/rejuv-tx-quality-of-life/","status":"established","tldr":"Most people who come through a transplant or CAR-T report, years later, a quality of life close to that of people who never had one. Underneath that, a substantial minority live with fatigue, anxiety, low mood or trouble concentrating, and the strongest predictor is having had anxiety or depression before treatment, which is treatable."},{"id":"rejuv-tx-what-to-ask-for","kind":"technology","name":"After a transplant or cell therapy: what to ask for","route":"/technologies/rejuv-tx-what-to-ask-for/","status":"standard-of-care","tldr":"The things worth asking a transplant team for, in one place: who follows you up and for how long, which screens are due at which year, what immunisations you need and when, and who to ring when something changes."},{"id":"rejuv-rehab-cancer-rehabilitation","kind":"technology","name":"Cancer rehabilitation: the discipline that puts function back","route":"/technologies/rejuv-rehab-cancer-rehabilitation/","status":"established","tldr":"Cancer rehabilitation is the medical speciality that treats what treatment leaves behind: weakness, a stiff shoulder, a swallow that no longer works, a bladder that leaks, a limb that swells. It is delivered by a named set of professions, it has randomised evidence behind several of its parts, and in the largest study to measure it only three in ten of the impairments that needed it were treated."},{"id":"rejuv-rehab-prospective-surveillance","kind":"technology","name":"Prospective surveillance: looking for the problem before it becomes a disability","route":"/technologies/rejuv-rehab-prospective-surveillance/","status":"emerging","tldr":"The usual model waits for a patient to complain, by which time an arm has been swollen for a year. The prospective surveillance model measures function before treatment starts and again at set points afterwards, so a small problem is found while it is still small. One costing study put the price of managing early arm swelling at 636 dollars a year against 3,125 dollars for late swelling."},{"id":"rejuv-rehab-provision-gap","kind":"technology","name":"The gap between the rehabilitation people need and the rehabilitation they are offered","route":"/technologies/rejuv-rehab-provision-gap/","status":"established","tldr":"This is the measured part. Among 163 women with advanced breast cancer, 92 per cent had at least one physical impairment and 530 impairments were found; 30 per cent of those needing rehabilitation got it. In an Irish cancer centre in 2025, 71 per cent of 660 patients reported at least one specialist rehabilitation need and 36 per cent of those with a need had seen the relevant professional."},{"id":"rejuv-rehab-prehabilitation-evidence","kind":"technology","name":"What the randomised trials of prehabilitation found, operation by operation","route":"/technologies/rejuv-rehab-prehabilitation-evidence/","status":"established","tldr":"Training before an operation reliably makes people fitter for it. Whether it cuts complications depends on the operation and on who was recruited: a trial in high-risk abdominal surgery halved the proportion with complications, the largest colorectal trial cut severe complications from 29.7 to 17.1 per cent, and pooled home-based programmes improved the walking test and nothing else."},{"id":"rejuv-rehab-prehabilitation-programme","kind":"technology","name":"What a prehabilitation programme actually contains, and how long it needs","route":"/technologies/rejuv-rehab-prehabilitation-programme/","status":"established","tldr":"The programme behind the best colorectal result was four weeks long, supervised in hospital, and had four parts: high-intensity exercise three times a week, a nutritional intervention, psychological support, and smoking cessation where it applied. Supervision is the ingredient the trials keep separating out, and the window is what the pathway leaves."},{"id":"rejuv-recon-breast","kind":"technology","name":"Breast reconstruction: implant and autologous, immediate and delayed, and what women report afterwards","route":"/technologies/rejuv-recon-breast/","status":"standard-of-care","tldr":"Two years after surgery, women reconstructed from their own tissue reported more satisfaction with their breasts than women with implants, by about 8 points on a 100-point scale. After radiotherapy the gap widens and so does the complication rate: 38.9 per cent of irradiated implant reconstructions had a complication within two years against 25.6 per cent of tissue ones."},{"id":"rejuv-recon-head-neck","kind":"technology","name":"Head and neck reconstruction: the free flap, and what it gives back","route":"/technologies/rejuv-recon-head-neck/","status":"standard-of-care","tldr":"Removing a tongue, a jaw or a pharynx leaves a hole that will not close, so tissue is moved from the forearm, thigh or lower leg with its own artery and vein and joined under a microscope. In a series of 843 flaps the overall failure rate was 4.0 per cent, and in an older series of 1,000 flaps 7.6 per cent failed wholly or partly. Donor site disability measured years later is small."},{"id":"rejuv-recon-voice-after-laryngectomy","kind":"technology","name":"Voice after the larynx is removed","route":"/technologies/rejuv-recon-voice-after-laryngectomy/","status":"standard-of-care","tldr":"Removing the larynx removes the voice and separates the airway from the mouth permanently. Speech is restored in most people by a one-way valve set in a small hole between the windpipe and the gullet, which lets breath out through the throat so the throat can vibrate. The valve is a consumable that needs replacing, and people who lose contact with the service stop using it."},{"id":"rejuv-recon-stoma-reversal","kind":"technology","name":"Stoma reversal after rectal cancer surgery: who gets the bowel joined up again","route":"/technologies/rejuv-recon-stoma-reversal/","status":"standard-of-care","tldr":"Most temporary stomas made to protect a join in the bowel are reversed, and a meaningful minority are not. In a series of 639 patients having sphincter-sparing surgery, 11.9 per cent still had a stoma two years later; the main reasons were the cancer progressing (52.4 per cent) and the patient deciding against it (19.0 per cent)."},{"id":"rejuv-recon-limb","kind":"technology","name":"Limb salvage, amputation, and the rehabilitation that follows either","route":"/technologies/rejuv-recon-limb/","status":"standard-of-care","tldr":"Saving a limb with a metal endoprosthesis gives better walking efficiency and better return to normal living than an above-knee amputation, and studies that asked patients about overall quality of life found the two closer than expected. On the Toronto Extremity Salvage Score, lower limb amputees scored 72.2 against 85.5 after extended resection."},{"id":"rejuv-recon-facial-prosthetics","kind":"technology","name":"Facial reconstruction and facial prostheses: ears, orbits and noses","route":"/technologies/rejuv-recon-facial-prosthetics/","status":"standard-of-care","tldr":"Where an ear, an eye socket or a nose cannot be rebuilt from the patient's own tissue, a silicone prosthesis is made and held by adhesive or by titanium implants in bone. Implant failure differs sharply by site: across 3,630 implants, 3.5 per cent failed at the ear, 8.8 per cent at the nose and 18.7 per cent at the orbit."},{"id":"rejuv-recon-pelvic-exenteration","kind":"technology","name":"Recovery after pelvic exenteration","route":"/technologies/rejuv-recon-pelvic-exenteration/","status":"standard-of-care","tldr":"Removing the pelvic organs together can cure a recurrence that nothing else will, at the cost of one or two stomas and a long recovery. About half of patients have a major complication within 90 days. Overall quality of life scores recover by six to twelve months in most published series, while sexual function, body image and distress do not, and there are no randomised trials of any of it."},{"id":"rejuv-rehab-swallowing","kind":"technology","name":"Swallowing therapy around head and neck radiotherapy","route":"/technologies/rejuv-rehab-swallowing/","status":"established","tldr":"Keeping food going down the throat during radiotherapy, and doing swallowing exercises through it, both independently predict being back on a normal diet afterwards. In 595 patients, those who kept eating were twice as likely to be on solid food at three to six months and those who exercised were 2.9 times as likely."},{"id":"rejuv-rehab-pelvic-floor","kind":"technology","name":"Pelvic floor rehabilitation after prostate and rectal surgery and after pelvic radiotherapy","route":"/technologies/rejuv-rehab-pelvic-floor/","status":"established","tldr":"Pelvic floor exercises are offered to almost every man after prostate surgery, and the largest randomised trial found formal one-to-one training made no difference at twelve months: 76 per cent of treated men were still leaking against 77 per cent of controls. Training before the operation does speed early recovery."},{"id":"rejuv-rehab-respiratory","kind":"technology","name":"Breathing and exercise capacity after lung resection","route":"/technologies/rejuv-rehab-respiratory/","status":"established","tldr":"Taking out a lobe takes away lung, and breathlessness on stairs is what people notice. Across 18 randomised trials and 1,795 patients, pulmonary rehabilitation after lung resection improved lung function, six-minute walk distance and physical quality of life, with bigger gains from programmes of twelve weeks or more."},{"id":"rejuv-rehab-balance-vestibular","kind":"technology","name":"Balance, dizziness and falls after cancer treatment","route":"/technologies/rejuv-rehab-balance-vestibular/","status":"emerging","tldr":"Surgery for a vestibular schwannoma removes the balance nerve on one side, and the brain has to learn to work without it. Vestibular rehabilitation is the physiotherapy that teaches it, and a systematic review of 23 studies graded every outcome as very low certainty. Referral is also the problem: in one centre 42 per cent of patients were referred and 36 per cent of those completed the programme."},{"id":"rejuv-rehab-scar-contracture","kind":"technology","name":"Scars, stiffness and contracture: shoulders, necks and jaws","route":"/technologies/rejuv-rehab-scar-contracture/","status":"established","tldr":"Scar tissue shortens as it matures, and across a joint that means lost movement: a shoulder that will not reach a shelf, a neck that will not turn, a mouth that will not open. Silicone gel flattens and softens the scar itself in randomised trials, and stretching is what holds the joint."},{"id":"rejuv-rehab-driving-and-exercise-return","kind":"technology","name":"Going back to driving, lifting and exercise","route":"/technologies/rejuv-rehab-driving-and-exercise-return/","status":"established","tldr":"These are the two questions people ask most often after an operation and the two with the least evidence behind the answers. No trial establishes when it is safe to drive after cancer surgery, and in the United Kingdom the licence holder must notify the DVLA of an illness affecting safe driving. For exercise the dose is published."},{"id":"rejuv-rehab-assistive-devices","kind":"technology","name":"The devices that do the restoring, and who pays for them","route":"/technologies/rejuv-rehab-assistive-devices/","status":"standard-of-care","tldr":"A breast prosthesis, a limb prosthesis, a compression garment, a voice valve, a dental implant and a hearing aid are each the difference between a function working and not working, and each is funded differently. In the United States a federal law requires plans that cover mastectomy to cover prostheses and lymphoedema treatment."},{"id":"rejuv-rehab-commissioning-inequity","kind":"technology","name":"Where rehabilitation is commissioned, and who misses out","route":"/technologies/rejuv-rehab-commissioning-inequity/","status":"established","tldr":"Whether a person gets rehabilitation after cancer depends on where the problem was noticed, how far they live from the service, how much money they have and what they were treated for. In the benchmark study a problem found in hospital was 88 times more likely to be treated than the same problem found in clinic."},{"id":"rejuv-recovery-matrix","kind":"technology","name":"What comes back after treatment, treatment by treatment","route":"/technologies/rejuv-recovery-matrix/","status":"established","tldr":"For each treatment and each lasting effect, whether recovery is usual, partial or unlikely, how long it takes and in what proportion of people, with the source for every answer. The grid is mostly empty, because for most pairs nobody has published a recovery figure, and the page says how empty it is rather than hiding it."},{"id":"rejuv-recovery-endocrine-permanence","kind":"technology","name":"Immune endocrine damage is usually permanent, and almost nobody is told","route":"/technologies/rejuv-recovery-endocrine-permanence/","status":"established","tldr":"Most immune side effects of checkpoint inhibitors settle. The hormone glands are the exception: a pituitary, thyroid, adrenal or insulin-making gland destroyed by the immune system does not grow back, and the replacement treatment that follows is usually for life. In the follow-up cohorts 83 per cent of hormone problems were still present three months after the drug stopped."},{"id":"rejuv-recovery-cumulative-dose","kind":"technology","name":"The cumulative dose that decides whether it comes back","route":"/technologies/rejuv-recovery-cumulative-dose/","status":"established","tldr":"For several treatments there is a published number above which lasting damage becomes much likelier: the total anthracycline dose and heart failure, the total cisplatin dose and hearing, the radiation dose to the parotid gland and dry mouth. Twenty-three thresholds are listed with their sources, because the total you have had is a question your team can answer."},{"id":"rejuv-history-cure-is-not-enough","kind":"term","name":"Cure is not enough: when late effects stopped being an afterthought","route":"/terms/rejuv-history-cure-is-not-enough/","tldr":"Children started surviving cancer in the 1960s, and within a decade the doctors who had cured them began writing down what the cure had cost. The phrase that stuck, from a 1975 paper by Giulio D'Angio, is that cure is not enough."},{"id":"rejuv-history-seasons-of-survival","kind":"term","name":"Seasons of Survival: the 1985 essay that named the problem","route":"/terms/rejuv-history-seasons-of-survival/","tldr":"A physician who had been treated for cancer wrote four pages in the New England Journal of Medicine in 1985 saying that the time after treatment was unmapped territory with hazards of its own. It is the paper the whole field dates itself from."},{"id":"rejuv-history-survivorship-movement","kind":"term","name":"The founding of the National Coalition for Cancer Survivorship, and the word survivor","route":"/terms/rejuv-history-survivorship-movement/","tldr":"Twenty-three people met in Albuquerque in October 1986 and set out to replace the phrase \"cancer victim\" with \"cancer survivor\". The definition they chose, a survivor from the day of diagnosis for the rest of life, is the one the National Cancer Institute uses today."},{"id":"rejuv-history-lost-in-transition","kind":"term","name":"Lost in Transition: the 2006 report that defined survivorship care, and the care plan it invented","route":"/terms/rejuv-history-lost-in-transition/","tldr":"The 2006 Institute of Medicine report defined survivorship care, made ten recommendations, and invented the survivorship care plan. The plan became an accreditation standard, and then the randomised trials of it were negative."},{"id":"rejuv-history-ncsi-england","kind":"term","name":"The National Cancer Survivorship Initiative in England, and the Recovery Package","route":"/terms/rejuv-history-ncsi-england/","tldr":"England ran a national programme on life after cancer from 2007. It produced a named bundle of four things every patient should get at the end of treatment, and a 2013 report that measured how rarely they got them."},{"id":"rejuv-history-counting-survivors","kind":"term","name":"Counting the people who live after cancer, and why the number is not a detail","route":"/terms/rejuv-history-counting-survivors/","tldr":"The United States counts its cancer survivors each year and publishes the figure: 18.6 million in May 2025, projected to reach 22.4 million by 2035. Europe cannot produce an equivalent number, and that is a service-planning problem rather than a statistical one."},{"id":"rejuv-agenda-screening-without-a-trial","kind":"bottleneck","name":"No randomised trial shows that any survivorship screening programme reduces death","route":"/bottlenecks/rejuv-agenda-screening-without-a-trial/","tldr":"Survivors are screened for second cancers on the strength of how large their risk is, not on the strength of a trial showing that screening them saves lives. For most organs there is no programme at all."},{"id":"rejuv-agenda-nothing-restores-cognition","kind":"bottleneck","name":"No treatment restores the thinking that cancer treatment takes","route":"/bottlenecks/rejuv-agenda-nothing-restores-cognition/","tldr":"The memory and concentration problems after chemotherapy and cranial radiotherapy are real and measurable. Every drug tested against them has failed, including one tested properly in 276 people, and nothing restores lost processing speed."},{"id":"rejuv-agenda-thymus-does-not-regrow","kind":"bottleneck","name":"Nothing in routine use rebuilds an adult's thymus","route":"/bottlenecks/rejuv-agenda-thymus-does-not-regrow/","tldr":"After a transplant or intensive chemotherapy, the part of the immune system that makes new kinds of T cell recovers slowly in adults and sometimes not at all. The deficit is well described, well measured and currently not correctable."},{"id":"rejuv-agenda-biological-age-as-an-untested-target","kind":"bottleneck","name":"Nobody has tested whether reversing measured biological ageing changes anything","route":"/bottlenecks/rejuv-agenda-biological-age-as-an-untested-target/","tldr":"Cancer treatment measurably accelerates several markers of biological ageing. No trial has ever asked whether moving one of those markers makes any difference to a person, and an entire retail industry rests on the assumption that it would."},{"id":"rejuv-agenda-rehabilitation-not-commissioned","kind":"bottleneck","name":"Rehabilitation is recommended everywhere and commissioned almost nowhere","route":"/bottlenecks/rejuv-agenda-rehabilitation-not-commissioned/","tldr":"The interventions with the best evidence after cancer are supervised exercise, psychological therapy and specialist rehabilitation. The commonest finding across this whole front is that the evidence exists and the service does not."},{"id":"rejuv-agenda-nobody-owns-the-follow-up","kind":"bottleneck","name":"Nobody owns the follow-up once the oncology clinic lets go","route":"/bottlenecks/rejuv-agenda-nobody-owns-the-follow-up/","tldr":"There are guidelines saying what a survivor should have checked and when. There is usually no mechanism that tells an individual survivor, ten years out, which checks they are due this year, or anyone whose job it is to notice they were missed."},{"id":"rejuv-agenda-late-effects-are-not-counted","kind":"bottleneck","name":"Registries count diagnoses and deaths, and not what treatment left behind","route":"/bottlenecks/rejuv-agenda-late-effects-are-not-counted/","tldr":"Cancer registries are good at incidence and mortality and record almost nothing about late effects, so the scale of the problem is estimated from a handful of cohorts rather than counted. Europe cannot say how many survivors it has."},{"id":"rejuv-agenda-no-agreed-outcome-measures","kind":"bottleneck","name":"The field cannot pool its own studies, because it has not agreed what to measure","route":"/bottlenecks/rejuv-agenda-no-agreed-outcome-measures/","tldr":"On subject after subject here, the studies exist and cannot be combined, because each used a different definition, a different questionnaire or a different threshold. A prevalence that ranges from 0 to 84 per cent is a measurement problem, not a biological one."},{"id":"rejuv-agenda-latency-outruns-the-evidence","kind":"bottleneck","name":"The newest treatments have not existed long enough for their late effects to appear","route":"/bottlenecks/rejuv-agenda-latency-outruns-the-evidence/","tldr":"A second cancer after radiotherapy can take forty years to appear. Immunotherapy and antibody-drug conjugates have been in first-line use for a few. Being told a new drug has no late effects usually means nobody has been followed long enough to see one."},{"id":"idea-rejuv-registry-randomised-screening-in-survivors","kind":"idea","name":"Ask whether survivorship screening saves lives, using registry-based randomisation","route":"/ideas/idea-rejuv-registry-randomised-screening-in-survivors/","tldr":"No randomised trial has shown that screening survivors for a second cancer reduces death from it. A registry-based randomised trial, which invites rather than enrols, is the only design that could answer this at an affordable cost."},{"id":"idea-rejuv-biological-age-as-a-randomised-endpoint","kind":"idea","name":"Put a biological-age marker in a trial that also measures something a person would notice","route":"/ideas/idea-rejuv-biological-age-as-a-randomised-endpoint/","tldr":"Epigenetic clocks and senescence markers run fast after cancer treatment, and nobody has shown that moving one matters. The way to find out is to make the clock a secondary endpoint in a trial whose primary endpoint is physical function."},{"id":"idea-rejuv-thymic-regeneration-in-adults","kind":"idea","name":"Find out whether an adult thymus can be made to work again, with an endpoint a clinician would act on","route":"/ideas/idea-rejuv-thymic-regeneration-in-adults/","tldr":"Several agents have been tried for thymic recovery after transplant and none is in routine use. The blocker is as much the missing endpoint as the missing drug."},{"id":"idea-rejuv-core-outcome-set-for-late-effects","kind":"idea","name":"Agree what to measure, so the next systematic review can pool rather than narrate","route":"/ideas/idea-rejuv-core-outcome-set-for-late-effects/","tldr":"A reported prevalence of 0 to 84 per cent for the same late effect is a measurement failure. Core outcome sets are cheap, need no new biology, and would unlock the studies the field has already paid for."},{"id":"idea-rejuv-rehabilitation-prescription-at-discharge","kind":"idea","name":"Write a rehabilitation prescription at the end of treatment, and fund it like a drug","route":"/ideas/idea-rejuv-rehabilitation-prescription-at-discharge/","tldr":"Exercise after colon cancer has a hazard ratio a drug would be licensed on. It is in the guidelines and in almost no budgets, because it is a staffed service rather than a product."},{"id":"idea-rejuv-second-cancer-latency-cohort-for-new-drugs","kind":"idea","name":"Enrol every new systemic therapy into a registry linkage that will still report in thirty years","route":"/ideas/idea-rejuv-second-cancer-latency-cohort-for-new-drugs/","tldr":"A second cancer after radiotherapy can take forty years to appear. Checkpoint inhibitors and antibody-drug conjugates have been in first-line use for a few, so nobody can say anything about their late effects, and nobody is building the thing that could."},{"id":"idea-rejuv-survivorship-platform-trial","kind":"idea","name":"Give survivorship interventions a shared control arm","route":"/ideas/idea-rejuv-survivorship-platform-trial/","tldr":"Every survivorship intervention currently raises its own small trial with its own control arm and its own endpoint. A platform trial with a shared control and a common outcome set would test several at the cost of one and a half."},{"id":"idea-rejuv-exposure-record-a-machine-can-read","kind":"idea","name":"Make the treatment exposure record machine-readable, so surveillance can be computed","route":"/ideas/idea-rejuv-exposure-record-a-machine-can-read/","tldr":"Risk-based follow-up guidelines key surveillance to cumulative dose and radiotherapy field. Survivors frequently cannot obtain either, so the guidelines are unusable even where someone is willing to follow them."},{"id":"rejuv-trial-proffi","kind":"trial","name":"PROFFi: fisetin and exercise to prevent frailty in breast cancer survivors","route":"/trials/rejuv-trial-proffi/","status":"recruiting","tldr":"The first randomised trial to test a senolytic in people who have had cancer. Four arms crossing fisetin against placebo with tailored supervised exercise against a physical activity handout, and the primary endpoint is how far someone can walk in six minutes."},{"id":"rejuv-trial-ex-cipn","kind":"trial","name":"EX-CIPN: virtual exercise-based rehabilitation for persistent chemotherapy nerve damage","route":"/trials/rejuv-trial-ex-cipn/","status":"recruiting","tldr":"Nothing prevents chemotherapy nerve damage and the only drug with guideline support for the established painful form has a benefit the guideline itself calls limited. This pragmatic trial tests ten weeks of individualised remote exercise against usual care."},{"id":"rejuv-trial-amico","kind":"trial","name":"AMICO: aerobic or resistance exercise to improve outcome in metastatic colorectal cancer","route":"/trials/rejuv-trial-amico/","status":"recruiting","tldr":"CHALLENGE showed exercise improves survival after curative treatment for colon cancer. AMICO asks the next question, in advanced disease, with chemotherapy dose modification and progression-free survival as its primary endpoints, and uses an adaptive design to drop an ineffective exercise prescription early."},{"id":"rejuv-trial-allocare","kind":"trial","name":"AlloCare: a stepped-care late-effects service after allogeneic transplant","route":"/trials/rejuv-trial-allocare/","status":"recruiting","tldr":"The gap after a transplant is not that nobody knows what should be checked, it is that no mechanism tells an individual survivor what is due. This trial tests an organised four-step late-effects service against usual care."},{"id":"rejuv-trial-canwork","kind":"trial","name":"CanWork: an occupational therapy programme to help women return to work after breast cancer","route":"/trials/rejuv-trial-canwork/","status":"recruiting","tldr":"Return to work is one of the outcomes most affected by cancer treatment and least provided for. This cluster-randomised trial tests a five-module occupational therapy programme and costs it, so that a commissioner could act on the result."},{"id":"fitzhugh-mullan","kind":"person","name":"Fitzhugh Mullan","route":"/people/fitzhugh-mullan/","tldr":"Wrote the 1985 essay that gave cancer survivorship its name and its first framework, then co-founded the organisation that changed what people treated for cancer are called."},{"id":"ellen-stovall","kind":"person","name":"Ellen L. Stovall","route":"/people/ellen-stovall/","tldr":"Led the survivorship movement's organisation for sixteen years and co-edited the Institute of Medicine report that defined what survivorship care is."},{"id":"rejuv-measure-patient-reported-outcomes","kind":"technology","name":"How recovery is measured: the questionnaires behind the numbers","route":"/technologies/rejuv-measure-patient-reported-outcomes/","status":"standard-of-care","tldr":"Nearly every figure about recovery after cancer, for fatigue, for quality of life, for how a body works after treatment, comes from a questionnaire somebody filled in about themselves. That is a strength, because nobody else can report how a person feels, and a limit, because a questionnaire only measures what it asks about and only from the people who answered it."},{"id":"rejuv-measure-eortc-qlq-c30","kind":"technology","name":"EORTC QLQ-C30: the questionnaire most cancer trials use","route":"/technologies/rejuv-measure-eortc-qlq-c30/","status":"standard-of-care","tldr":"Thirty questions, answered about the past week, that produce separate scores out of 100 for how the body works, how the mind is, and for fatigue, pain and sickness. It is the questionnaire behind most European cancer trial results about quality of life, and there are add-on modules for individual cancers."},{"id":"rejuv-measure-fact-and-facit","kind":"technology","name":"FACT-G and the FACIT family: the other main questionnaire","route":"/technologies/rejuv-measure-fact-and-facit/","status":"standard-of-care","tldr":"Twenty-seven questions about the past week, in four areas: the body, family and friends, feelings, and being able to do ordinary things. Dozens of add-ons exist for particular cancers and particular symptoms, including the fatigue scale used in most anaemia and fatigue trials."},{"id":"rejuv-measure-promis","kind":"technology","name":"PROMIS: the item banks that let a short questionnaire be precise","route":"/technologies/rejuv-measure-promis/","status":"established","tldr":"Instead of a fixed questionnaire, PROMIS is a library of calibrated questions for things like fatigue, pain, anxiety, depression and physical function, built so that a computer can pick the next question based on the last answer and reach a precise score in a handful of items. Scores are set against the general population, not against other cancer patients."},{"id":"rejuv-measure-pro-ctcae","kind":"technology","name":"PRO-CTCAE: side effects graded by the person having them","route":"/technologies/rejuv-measure-pro-ctcae/","status":"established","tldr":"Clinicians have always graded side effects themselves, and they systematically under-record them. PRO-CTCAE is the matching set of questions asked of the patient instead, in plain language, about how often a symptom happened, how bad it was and how much it got in the way."},{"id":"rejuv-measure-eq-5d","kind":"technology","name":"EQ-5D: health reduced to one number, and what that number is for","route":"/technologies/rejuv-measure-eq-5d/","status":"standard-of-care","tldr":"Five questions and a thermometer-style scale from worst to best imaginable health. The five answers are converted into a single index value using a country-specific value set, and that index is what health systems use to decide whether a treatment is worth paying for."},{"id":"rejuv-measure-breast-q","kind":"technology","name":"BREAST-Q and the Q-portfolio: measuring what an operation left behind","route":"/technologies/rejuv-measure-breast-q/","status":"established","tldr":"A questionnaire built from what women actually said matters after breast surgery: satisfaction with how the breasts look and feel, and psychological, physical and sexual well-being, each scored separately. It is the reason reconstruction techniques can be compared on something other than complication rates."},{"id":"rejuv-measure-cognitive-function","kind":"technology","name":"Measuring memory and concentration after treatment","route":"/technologies/rejuv-measure-cognitive-function/","status":"established","tldr":"What a person notices about their own memory and what a formal test measures are two different things, and they agree only weakly. The questionnaire most used for the first is FACT-Cog; the tests used for the second were standardised by an international task force so that studies could be compared."},{"id":"rejuv-measure-fear-of-recurrence-inventory","kind":"technology","name":"Measuring fear of recurrence: the FCRI and its cut-off","route":"/technologies/rejuv-measure-fear-of-recurrence-inventory/","status":"established","tldr":"The most commonly reported unmet need after cancer treatment has a questionnaire of its own. The full version has 42 questions across seven components; the nine-question short form is the one used to screen, and a score of 22 or more marks a level of fear that merits help."},{"id":"rejuv-measure-lymphoedema","kind":"technology","name":"Measuring lymphoedema: tape, bioimpedance and the quality of life scales","route":"/technologies/rejuv-measure-lymphoedema/","status":"established","tldr":"There are two separate questions, how big the limb is and how much it affects the person, and they need different instruments. Limb volume is measured by tape, by water displacement or by a device that passes a small current through the tissue; the effect on living is measured by a questionnaire such as LYMQOL."},{"id":"rejuv-measure-minimally-important-difference","kind":"technology","name":"What a difference has to be before a person would notice it","route":"/technologies/rejuv-measure-minimally-important-difference/","status":"established","tldr":"A trial can report a statistically significant change in a quality of life score that no person would notice. The minimally important difference is the attempt to say how much a score has to move to correspond to something a patient would call a change, and it differs by questionnaire, by scale, by cancer and by direction."},{"id":"rejuv-measure-missing-data-and-who-is-not-asked","kind":"technology","name":"The questionnaires that were never returned, and the people never asked","route":"/technologies/rejuv-measure-missing-data-and-who-is-not-asked/","status":"established","tldr":"In a trial measuring how people feel, the forms go missing exactly when people are most unwell. That makes the remaining scores look better than the truth. The same thing happens on a larger scale when whole groups are not asked at all."},{"id":"rejuv-measure-epro-as-treatment","kind":"technology","name":"Asking people how they are, every week, as a treatment in its own right","route":"/technologies/rejuv-measure-epro-as-treatment/","status":"established","tldr":"Several randomised trials tested asking patients to report symptoms every week, with a nurse alerted when something is bad or getting worse. It reliably improves how people feel and function and cuts emergency visits. Whether it lengthens life did not hold up: two trials found a survival benefit and the largest trial, designed to test exactly that, found none."},{"id":"rejuv-measure-epro-implementation","kind":"technology","name":"What has actually been implemented since those trials, and what has not","route":"/technologies/rejuv-measure-epro-implementation/","status":"emerging","tldr":"The trials finished years ago and most people being treated for cancer are still not asked their symptoms between appointments. The clearest thing that changed is a United States payment model that now requires practices to collect them."},{"id":"rejuv-measure-functional-tests","kind":"technology","name":"Walking, gripping and standing up: the tests that take five minutes","route":"/technologies/rejuv-measure-functional-tests/","status":"standard-of-care","tldr":"How far somebody walks in six minutes, how hard they can squeeze a handle, and how fast they can stand up from a chair five times. These need almost no equipment, they predict what happens to people, and they measure something a questionnaire cannot."},{"id":"rejuv-measure-cardiopulmonary-exercise-testing","kind":"technology","name":"Cardiopulmonary exercise testing: the hardest number in recovery","route":"/technologies/rejuv-measure-cardiopulmonary-exercise-testing/","status":"established","tldr":"A bike or treadmill test to exhaustion with a mask measuring the air breathed in and out, giving peak oxygen uptake. It is the most objective measure of what a body can do, and in breast cancer it showed that survivors sit around a quarter below healthy women of the same age across the whole survivorship continuum."},{"id":"rejuv-measure-body-composition","kind":"technology","name":"Measuring muscle and fat on scans the patient already had","route":"/technologies/rejuv-measure-body-composition/","status":"established","tldr":"A single slice of a CT scan at the third lumbar vertebra measures how much skeletal muscle a person has, and the scan has usually already been taken for staging. Low muscle predicts worse outcomes and more chemotherapy toxicity, including in people whose weight looks normal or high."},{"id":"rejuv-measure-wearables-and-step-counts","kind":"technology","name":"Wearables and step counts: measuring what someone actually does","route":"/technologies/rejuv-measure-wearables-and-step-counts/","status":"emerging","tldr":"A wrist or hip device records steps, activity and sleep continuously, at home, without anyone being asked a question. It measures behaviour rather than capacity, which is the gap a corridor test leaves, and it is the one measurement of recovery that does not stop when the person leaves the hospital."},{"id":"rejuv-measure-consumer-biological-age-tests","kind":"technology","name":"The biological age test you can buy, and whether to buy one","route":"/technologies/rejuv-measure-consumer-biological-age-tests/","status":"emerging","tldr":"You can send saliva or blood to a company and be told your biological age. The underlying science is real and is described in the records on biological ageing after treatment; the test you can buy is not that science. Repeat measurements of the same sample can differ by years, no result changes any treatment, and nothing you can do in response has been shown to change what happens to you."},{"id":"rejuv-access-survivorship-care-uk","kind":"technology","name":"After treatment in the UK: personalised care, and follow-up you lead yourself","route":"/technologies/rejuv-access-survivorship-care-uk/","status":"standard-of-care","tldr":"In England the offer has four named parts: an assessment of what you need and a plan written with you, information and support about living well, a summary of your treatment sent to you and your GP, and a review with your GP. Follow-up is increasingly not a routine clinic appointment but a pathway you manage yourself, with tests at set intervals and a route back in."},{"id":"rejuv-access-survivorship-care-us","kind":"technology","name":"After treatment in the United States: the survivorship care plan, and what the trial found","route":"/technologies/rejuv-access-survivorship-care-us/","status":"established","tldr":"The United States answer to life after treatment was a written survivorship care plan, made an accreditation requirement for cancer centres. The randomised trial of it found no benefit on any patient-reported outcome, and the requirement was later replaced with a broader survivorship programme standard."},{"id":"rejuv-access-survivorship-care-germany","kind":"technology","name":"After treatment in Germany: a rehabilitation entitlement, not a leaflet","route":"/technologies/rejuv-access-survivorship-care-germany/","status":"standard-of-care","tldr":"Germany does something no English-speaking country does: it funds a three-week structured rehabilitation stay after cancer treatment as an entitlement, inpatient or full-day outpatient, through the pension insurance system. Retired people and some non-insured relatives can have it too."},{"id":"rejuv-access-survivorship-care-nordic","kind":"technology","name":"After treatment in the Nordic countries: rehabilitation written into the pathway","route":"/technologies/rejuv-access-survivorship-care-nordic/","status":"established","tldr":"Denmark, Norway and Sweden build rehabilitation and a named contact person into the national cancer pathway rather than leaving them to be requested afterwards. Even in tax-funded systems designed around need, the published work finds that socially disadvantaged people take up less of it."},{"id":"rejuv-access-survivorship-care-australia","kind":"technology","name":"After treatment in Australia: a stated model of survivorship care","route":"/technologies/rejuv-access-survivorship-care-australia/","status":"established","tldr":"Australia published a national model setting out what survivorship care should contain: stratified pathways by need, a treatment summary and care plan, a focus on wellness and prevention as well as surveillance, and timely access without unnecessary appointments. Exercise is recommended as part of routine cancer care by the same body."},{"id":"rejuv-access-survivorship-care-lmic","kind":"technology","name":"After treatment in low and middle income countries: mostly nothing","route":"/technologies/rejuv-access-survivorship-care-lmic/","status":"emerging","tldr":"Most people in the world who survive cancer are offered no survivorship care at all. Specialist centres are rare, follow-up is limited, late effects are poorly documented, and the household pays. This is the largest gap in recovery care anywhere, and the one with the thinnest evidence base."},{"id":"rejuv-access-who-misses-out","kind":"technology","name":"Who misses out on recovery care, measured","route":"/technologies/rejuv-access-who-misses-out/","status":"established","tldr":"Every part of recovery care is unevenly distributed, and the pattern repeats: people with less money, less education, more disability, who live further away or whose cancer is less common get less of it. These are measured gaps with sources, not an impression."},{"id":"rejuv-access-rehabilitation-referral","kind":"technology","name":"Referral to rehabilitation: the service most people who need it never see","route":"/technologies/rejuv-access-rehabilitation-referral/","status":"established","tldr":"Physiotherapy, occupational therapy, speech and swallowing therapy and lymphoedema services are the treatments for most of what cancer treatment leaves behind. The measured use of them after cancer treatment is a small fraction of the measured need, and the people delivering them say they were not trained for it."},{"id":"rejuv-access-fertility-preservation","kind":"technology","name":"Who gets told about fertility before treatment, and who does not","route":"/technologies/rejuv-access-fertility-preservation/","status":"established","tldr":"Fertility preservation has to happen before treatment starts, which makes it the most time-critical part of recovery care and the easiest to miss. Published United States rates of even having the conversation range from 9 per cent to 75 per cent depending on where a young woman is treated."},{"id":"rejuv-access-exercise-programmes","kind":"technology","name":"Exercise is the best-evidenced thing on this front, and most survivors are not doing it","route":"/technologies/rejuv-access-exercise-programmes/","status":"established","tldr":"Structured exercise has the strongest evidence of any recovery intervention, including a randomised survival benefit in colon cancer. In a population survey of blood cancer survivors, 46 per cent met neither the aerobic nor the strength guideline and 22 per cent met both, and meeting both was associated with having been to university."},{"id":"rejuv-access-what-it-costs-uk","kind":"technology","name":"What recovery costs in the UK, and what it does not","route":"/technologies/rejuv-access-what-it-costs-uk/","status":"established","tldr":"Cancer treatment makes prescriptions free in England for five years, but a wig is not a prescription and is charged for unless you qualify for help. A third of UK survivors in one survey still reported financial difficulty, which is lower than the United States and a long way from zero."},{"id":"rejuv-access-what-it-costs-us","kind":"technology","name":"What recovery costs in the United States","route":"/technologies/rejuv-access-what-it-costs-us/","status":"established","tldr":"More than half of United States survivors in a comparative survey reported financial difficulty, against a third in the UK. What a person pays for rehabilitation, psychological care, fertility preservation and a wig depends on their insurance, their state and their employer rather than on their cancer."},{"id":"rejuv-access-what-it-costs-elsewhere","kind":"technology","name":"What recovery costs in the rest of the world","route":"/technologies/rejuv-access-what-it-costs-elsewhere/","status":"emerging","tldr":"In Germany rehabilitation is an entitlement with the outpatient version free to the patient. In most of the world there is no survivorship service to be charged for, and the household pays for whatever follow-up happens. Reliable comparative figures do not exist."},{"id":"ccss","kind":"trial","name":"Childhood Cancer Survivor Study (CCSS)","route":"/trials/ccss/","status":"active","tldr":"The largest study of what happens to children after cancer is cured. Following tens of thousands of survivors for decades, it showed that heart damage, second cancers and other late effects were common after older treatments, and that gentler modern protocols have already halved late deaths."}]}