There were an estimated 16.9 million cancer survivors in the U.S. as of January 2019, a number that is expected to increase to 22.2 million by 2030, according to the National Cancer Institute.

Improved cancer treatment and resulting improved survival rates have oncologists thinking about and talking with their patients about survivorship as early as the time of diagnosis, rather than working reactively, Cortes says, with the goals of preventing or at least minimizing collateral problems on the survivors' financial and emotional health.

"You cannot prevent the impact that a diagnosis of cancer can have emotionally on somebody," Cortes says. "We are all humans and it has a big impact, but maybe you can provide the assistance to help the patient navigate the impact that it can have."

An important aspect of these types of published analyses is to increase awareness of the impact of all these factors, Cortes says. "It is an important component to managing cancer. What this analysis, as well as other assessments that Drs. Coughlin and (Jie) Chen and others have done, is bring that to the forefront."

One goal of the All of Us program is to ultimately build a database that reflects the country's diversity, so that good data will be available for groups, like Blacks, women and eventually children, who have historically been underrepresented in medical research.

The uniqueness of this growing national database is that we are able to collect information from people who volunteer to participate, and use data analytics to extract information from the sophisticated database to answer relevant research questions, says coauthor Chen, chief of the MCG Division of Biostatistics and Data Science. More volunteers are needed along with good data science, which enables investigators to extract the insights the data provide, to fully answer questions like those Coughlin and Cortes are asking and to better help patients and families navigate the aftermath of a cancer diagnosis, she says.

Coughlin and his colleagues Cortes and Chen plan to look again at the survivorship data as the 6-year-old database grows and diversifies.

In the current analysis, MCG investigators looked at demographic factors and other personal characteristics like insured and employment status, personal medical history of cancer, health care use and access in the national database. The most common cancers were breast, prostate and colorectal, which are among the top five cancers in the U.S. Patients with skin cancer, the most common cancer, were excluded from their study because their follow up care needs are more often comparatively minor.

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