By Smita Bhatia, MD, MPH
University of Alabama at Birmingham
Keynote Speaker, 2016 Palliative Care in Oncology Symposium

The number of people living beyond a cancer diagnosis reached nearly 14.5 million in 2014 and is expected to rise to almost 19 million by 2024. This population is growing at a rate of almost 2% per year. As the number of long-term survivors has increased, there has been a growing awareness that many will develop health conditions as a direct or an indirect consequence of their cancer therapy. While some of these conditions occur during therapy and persist well after the therapy has been completed (or become permanent), such as steroid-induced osteonecrosis, many outcomes are not evident until 10 to 20 years later, such as subsequent malignant neoplasms (SMNs) and anthracycline-related late-onset congestive heart failure.

Individuals exposed to radiation and chemotherapy are vulnerable to long-lasting organ toxicity; very young patients because their organs are developing and elderly patients because of organ senescence. Regardless of age at exposure to chemotherapy and radiation, genetic predisposition and its interaction with therapeutic exposures can potentially exacerbate the toxic effect of treatment on normal tissues and organ systems. Thus, it becomes imperative to understand the individual variability in the internal dose of the chemotherapeutic agent, the biologically effective dose, variability in alterations in structure of the tissue or organ, and the consequent development of preclinical disease, in order to understand the mechanistic basis for therapy-related complications.

My Keynote Address at the 2016 Palliative Care in Oncology Symposium will describe an overview of the current knowledge regarding the role of genomic variation in the development of treatment-related late effects. I will focus on key outcomes that are relatively common, have clearly established associations with therapeutic exposures, and are associated with significant long-term morbidity and impact on the quality of life of the survivors. These outcomes include cardiomyopathy and SMNs. Understanding the etiopathogenetic pathways that lead to the morbidity is critical to developing targeted prevention and intervention strategies, minimizing chronic morbidities, optimizing risk-based health care of cancer survivors, and improving quality of life.

Dr. Bhatia is a Professor in Pediatrics and Director of the Institute for Cancer Outcomes and Survivorship at the University of Alabama at Birmingham School of Medicine and a specialist in Cancer Outcomes and Survivorship at UAB and Children’s of Alabama.

Editor's note: Dr. Bhatia is one of two esteemed Keynote Speakers at the 2016 Palliative Care in Oncology Symposium. Playwright Margaret Edson, the author of Wit, will give the other address.