BEHAVIORAL AND BIO-PSYCHO-SOCIAL FACTORS IN CANCER SURVIVORSHIP

The incidence of cancer continues to rise, with over 26 million cancer survivors projected by 2040. As survival rates improve, attention must shift toward comprehensively addressing the needs of cancer survivors, not only including prevention of cancer recurrence, but also extending to surveillance and management of physical and psychosocial effects. However, current practices reveal suboptimal engagement in key survivorship services such as health promotion as well as in management of long-term treatment-related symptoms, which can signifcantly impact survivors' quality of life, and also affect medication adherence and, ultimately, clinical outcomes. Predisposition to clinically meaningful symptom burden after cancer and cancer-related frailty represents signifcant risks for a substantial portion of cancer survivors and such risks seem to be driven by multiple individual factors such as age, comorbidities, lifestyle, psycho-social traits, baseline symptom burden pre-treatment, and type of treatment received. An additional important role seem to be played by susceptibility to cancer- induced infammation and accelerated aging. Emerging bio-behavioral models can now help identify patients at higher risk of long-term effects. Interventions targeting modifable factors, like excess weight, poor diet, inactivity, and stress, can address risk factors, and some of them act through mitigation of systemic infammation. Many of these behavioral interventions are multi-target and can also be delivered digitally and/or self-administered. Moving forward, by leveraging knowledge of behavioral and bio-psycho-social risk factors, and capitalizing on the continuum between risk stratifcation and early, personalized supportive care delivery, innovative models of cancer survivorship care have great potential to enhance survivors' health outcomes and quality of life.