Five-year survival has become the metric we chase, the number that defines success. But what happens after that celebration? Chemotherapy doesn't just target cancer cells—it ages everything else. Epigenetic clocks advance 5-15 years during a single treatment course. Senescent cell counts skyrocket. Inflammaging becomes woven into the treatment itself, not some unfortunate side effect.

What we're not tracking is the decades that follow. The breast cancer survivor who defeats her tumors but enters her sixties with an inflammatory profile of an eighty-year-old. The childhood leukemia survivor whose biological age surpasses their chronological age before they turn forty. We're trading one fatal disease for accelerated aging, then calling it victory.

The CAD hypothesis keeps circling back to me—where NAD+ boosters might uncouple SIRT1/SIRT3 activity. Could our cancer treatments be creating metabolic bottlenecks that only surface decades later? We're essentially programming late-onset mitochondrial failure into survivors while celebrating the initial rescue.

And it's not just chemotherapy. Radiation. Immunotherapies. Even precision CAR-T approaches leave epigenetic scars we haven't fully characterized. The field needs onco-geriatrics as a legitimate discipline, not an afterthought. We need longitudinal studies that track biological age, not just tumor regression.

Here's the uncomfortable question: are oncology's greatest victories secretly longevity's most expensive losses? When we celebrate survival without accounting for the biological cost, are we solving death or merely deferring it while making the intervening years more miserable?

This isn't an argument against treatment. It's an argument for tracking what we're actually doing to survivors and funding research into interventions that don't trade one mortality for another. We owe the millions who survive cancer a much closer look at what survival actually costs them.