As part of World Cancer Day (4th Feb), the journal Molecular Oncology invited researchers to take part in a writing competition focused on inequity in cancer therapy and access to treatment. This entry, by Ines Martic (Leopold Franzens Universität Innsbruck, Austria), received an honourable mention.

Despite the incredible progress in cancer treatments, the long-term consequences of therapy are often neglected, particularly in young survivors. Chemotherapy, radiation, and targeted therapies are essential for eliminating tumors. However, they also accelerate aging and induce therapy-induced senescence (TIS), a state where cells cease to divide but remain metabolically active. These senescent cells secrete a set of proinflammatory molecules and extracellular vesicles (EVs)—small, bilayered particles that act as messengers—collectively known as the senescence-associated secretory phenotype (SASP). The SASP reshapes the tumor microenvironment, potentially driving therapy resistance, relapse, and secondary malignancies (López-Otín et al., 2023; Prasanna et al., 2021).

In addition, TIS contributes to chronic inflammation, tissue dysfunction, and increased risks of secondary cancers and age-related diseases (Prasanna et al., 2021). However, post-cancer care systems rarely address these consequences. This creates an inequity in survivorship care, where patients, especially those from resource-limited regions, face long-term health burdens due to limited access to senescence-targeting interventions. In young survivors, this senescence accumulation leads to premature aging, causing long-term side effects such as cardiovascular disease, metabolic dysfunction, neurodegeneration, and immune system decline. Consequently, many survivors face a higher risk of preventable health issues, as cancer treatment policies do not provide systematic monitoring or therapies for treatment-related complications, including therapy-induced senescence.

To improve these disparities, cancer care policies must prioritize long-term health outcomes, especially in young and socioeconomically disadvantaged survivors. To detect complications early, post-treatment follow-up programs should integrate biomarkers for senescence, SASP-related inflammation, and EV-based diagnostics. Expanding research and access to senolytic drugs and SASP inhibitors could help mitigate therapy-induced aging. These innovations should remain cost-effective and equally distributed to avoid inequalities in post-cancer treatment. Another groundbreaking policy that should be implemented in cancer care is the incorporation of care models adapted to different age groups and acknowledge that young cancer survivors require specific interventions to prevent (or ameliorate) premature aging. For the elderly survivors, the reinforcement of geriatric oncology programs is necessary. Finally, long-term post-cancer care should be covered by insurance and healthcare policies, preventing financial barriers that impact unprivileged populations. Implementing these policies will ensure that follow-up care, screenings, and survivorship support are not a luxury but a necessary part of cancer therapy!

No cancer survivor should bear the burden of accelerated aging and lasting health disparities. Therefore, the integration of policies for therapy-induced senescence and its consequences in cancer care is paramount, requiring immediate action to close the gap between cancer treatment and equitable survivorship care. By integrating biological insights with survivor-centered healthcare policies, we can ensure that every patient—regardless of age or socioeconomic status—has access to a healthy life beyond cancer.

References:

López-Otín, C., Blasco, M. A., Partridge, L., Serrano, M., & Kroemer, G. (2023). Hallmarks of aging: An expanding universe. Cell, 186(2), 243–278. https://doi.org/10.1016/J.CELL.2022.11.001 

Prasanna, P. G., Citrin, D. E., Hildesheim, J., Ahmed, M. M., Venkatachalam, S., Riscuta, G., Xi, D., Zheng, G., Deursen, J. van, Goronzy, J., Kron, S. J., Anscher, M. S., Sharpless, N. E., Campisi, J., Brown, S. L., Niedernhofer, L. J., O’Loghlen, A., Georgakilas, A. G., Paris, F., … Coleman, C. N. (2021). Therapy-Induced Senescence: Opportunities to Improve Anticancer Therapy. JNCI: Journal of the National Cancer Institute, 113(10), 1285–1298. https://doi.org/10.1093/jnci/djab064