Cancer affects more than 1.7 million people in the US today. More than 15.5 million Americans will be living beyond cancer. The American Cancer Society reports a majority of cancer survivors (67%) were diagnosed 5 or more years ago, and 17% were diagnosed 20 or more years ago. Prostate, breast and colorectal cancers are the most common diagnoses among survivors. The increase in survival rates over the last 5 years can be attributed to early detection methods for cancer screening, and advancements in identifying new targeted cancer therapies. As cancer detection and treatment continue to improve on disease free survival, it is estimated that there will be 20.3 million survivors by 2026.
Who is a survivor?
There are many definitions of a cancer survivor but most agree that an individual is considered a cancer survivor from the time of diagnosis through the balance of his or her life. The cancer patient generally moves through three distinct phases.
- The first phase, often the shortest, is from diagnosis to the completion of initial cancer treatments. To cure cancer or to extend quality of life requires intensive oversight of the patient and accompanying symptoms and side effects. This phase is frequently the most physically and emotionally distressing for patients to navigate and results in heavy reliance on healthcare professionals and one’s support network.
- The second phase transitions the patient from treatment to extended survival with evidence that the disease is responding to treatment. During this phase, cancer survivors may worry, fear a recurrence, or develop a feeling of isolation as they transition out of active cancer therapy and into surveillance. Imaging, laboratory studies and appointments become less frequent and patients may be prescribed additional therapies to prevent the recurrence or spread of the cancer.
- The final phase constitutes long term survival. Patients may see their oncologist annually or be followed by their primary care physician. Patients may or may not continue to take medications to minimize recurrence.
Most cancer patients are ecstatic when they complete active treatment. Patients were educated about what to expect during chemotherapy, after surgery or with radiation. They were reassured that all efforts would be made to minimize side effects during treatment. Unfortunately, as a health profession, we haven’t done a great job in preparing the patient about what to expect once this phase is completed.
In 2005, the Institute of Medicine and the National Research Council released the report “From Cancer Patient to Cancer Survivor: Lost in Transition” which highlighted gaps in the care for cancer survivors and recommendations for survivor- ship care. Many survivors experience physical, emotional, and psychosocial effects of cancer and it treatment. Fortunately, oncology practices have started responding to the unique needs of survivors and are now focusing on survivorship as a distinct entity of cancer care.
It is imperative that survivors continue to follow cancer screening recommendations, practice healthy habits, and meet regularly with their primary care physician.
As a cancer patient moves further away from active treatment, it’s difficult to remember all the treatments and studies one has undergone. Patients completing primary treatment are provided a comprehensive care summary and follow-up plan with healthy maintenance recommendations written by the primary oncology provider(s). It is a useful tool that patients can refer to throughout the remainder of their lives and provide to their providers.
Cancer survivors are at risk for side effects from treatment that linger such as neuropathy, fatigue and memory problems. Survivors are also at risk of effects that can develop months to years after treatment such as osteoporosis, infertility, heart problems, and second cancers. Each patient’s risk profile is unique and directly related to their health status, family history and the types, as well as duration of treatments.
Survivors need to focus on wellness, diminish the effects of cancer and control any personal comorbidities such as diabetes, obesity and heart disease. It is imperative that survivors continue to follow cancer screening recommendations, practice healthy habits, and meet regularly with their primary care physician.
Being a cancer survivor is a lifetime commitment to living well and minimizing risks. Many survivors, their families and friends thought that once treatment was over, life would revert back to the way it was before a cancer diagnosis. Survivors find that there is now a new normal which involves negotiating roles with families, friends and employers, making lifestyle modifications and coping with fluctuating emotions. Cancer survivors, empowered and partnered with their providers, are emerging from their cancer journey more resilient than ever.
Authors: Rachel Swart, MD, PhD is a medical oncologist/hematologist at Arizona Oncology’s Orange Grove office.