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Biology of premature ageing in survivors of cancer
  1. Margaret C Cupit-Link1,
  2. James L Kirkland2,
  3. Kirsten K Ness3,
  4. Gregory T Armstrong3,
  5. Tamar Tchkonia2,
  6. Nathan K LeBrasseur2,
  7. Saro H Armenian4,
  8. Kathryn J Ruddy5,
  9. Shahrukh K Hashmi6
  1. 1 College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota, USA
  3. 3 Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
  4. 4 Department of Population Sciences, City of Hope National Medical Center, Duarte, California, USA
  5. 5 Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
  6. 6 Cancer Center, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Shahrukh K Hashmi; Hashmi.Shahrukh{at}


Over 30 million cancer survivors exist worldwide. Survivors have an earlier onset and higher incidence of chronic comorbidities, including endocrinopathies, cardiac dysfunction, osteoporosis, pulmonary fibrosis, secondary cancers and frailty than the general population; however, the fundamental basis of these changes at the cellular level is unknown. An electronic search was performed on Embase, Medline In-Process & Other Non-Indexed Citations, and the Cochrane Central Register of Controlled Trials. Original articles addressing the cellular biology of ageing and/or the mechanisms of cancer therapies similar to ageing mechanisms were included, and references of these articles were reviewed for further search. We found multiple biological process of ageing at the cellular level and their association with cancer therapies, as well as with clinical effects. The direct effects of various chemotherapies and radiation on telomere length, senescent cells, epigenetic modifications and microRNA were found. We review the effects of cancer therapies on recognised hallmarks of ageing. Long-term comorbidities seen in cancer survivors mimic the phenotypes of ageing and likely result from the interaction between therapeutic exposures and the underlying biology of ageing. Long-term follow-up of cancer survivors and research on prevention strategies should be pursued to increase the length and quality of life among the growing population of cancer survivors.

  • aging
  • anticancer therapeutics
  • long term side effects

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  • Contributors MCC-L and SKH wrote the manuscript. All authors contributed substantially to the conception, acquisition, analysis and interpretation of data for the work and approved the final approval of the version to be published.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Unpublished data are not available for this study.

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