Cancer Survivorship

What is cancer survivorship?

Cancer survivorship is healthcare that supports you throughout your journey with cancer. That journey starts the day you receive a cancer diagnosis. It continues during and after your treatment and for the rest of your life. That support is important because having cancer is a life-changing experience. Cancer survivorship care focuses on your health and well-being. It works to improve your quality of life.

Early detection and new cancer treatments are helping people live longer with cancer. The National Cancer Institute (U.S.) estimates there are more than 18 million cancer survivors in the U.S. An estimated 8 million people are living 10 years or more after diagnosis.

What are the three stages of cancer survivorship?

There are different ways to think about cancer survivorship. Some experts tie cancer survivorship to the cancer stage. Their perspective is that the cancer stage determines cancer survival issues and needs:

• Early-stage cancer, when cancer is diagnosed and treated before it can spread
• Regional cancer, when cancer is in nearby lymph nodes or tissues
• Advanced cancer (metastatic cancer), when cancer has spread to more distant areas of your body

Other experts see survivorship in three phases — acute, extended and permanent:

• Acute survivorship, which starts with diagnosis and ends when cancer treatment ends
• Extended survivorship, which may include the months after treatment ends
• Permanent survivorship, when you’ve been cancer-free for several years

Experts have different points of view about cancer survivorship stages or phases. But they find common ground in the issues that cancer survivors often face.

In general, cancer survivors often experience the following physical and mental health issues.

Common physical issues

Cancer treatment often comes with side effects. They usually become less noticeable when you finish treatment. But some may last for months and years after treatment. Examples of side effects that start with treatment and may continue include:

• Cancer fatigue. This is feeling exhausted, no matter how much rest you get. Cancer fatigue often eases once you finish treatment. But some people have long-term cancer fatigue that makes it hard to get back to daily activities.
• Cancer pain. This can be from cancer or cancer treatments.
• Cognitive dysfunction (chemotherapy brain fog). Cancer treatment may make it difficult for you to make decisions. You may have memory issues.
• Second cancer. This is a new form of cancer. It’s completely different from the cancer for which you received treatment. Second cancers are more common as more people live longer with cancer. Second cancers are different from recurrent cancer or cancer that comes back.

Common mental health issues

Cancer can upend your life and mental health. Some common mental health issues in cancer survivorship include:

• Anxiety disorders. You may have anxiety during or after treatment. That can happen during or after you finish your treatment. Some people develop scan-related anxiety (scanxiety). This is emotional stress and anxiety that spikes when you have cancer tests. Some people with cancer have post-traumatic stress disorder.
• Depression. One in four people with cancer experiences depression. Feeling sad or afraid is a normal reaction to a cancer diagnosis. But depression in cancer is more serious than that. It may interrupt your sleep and keep you from your daily activities.
• Emotional stress. You may experience stress if cancer treatment costs put pressure on your finances or if cancer causes strain on family relationships.
• Fear of cancer recurrence (FCR). This is extreme fear that cancer will come back. An analysis of research shows more than half of cancer survivors experience FCR.

Support for cancer survivors starts the day you receive your cancer diagnosis. Your cancer care team typically includes:

• Healthcare providers who diagnose and treat cancer. This may include medical oncologists and surgical oncologists and other cancer specialists.
• Cancer rehabilitation specialists provide medical care, like physical therapy or occupational therapy. This care may help prepare you for cancer treatment or manage cancer symptoms and treatment side effects.
• Palliative care providers offer specialized treatment to ease symptoms and treatment side effects. Palliative care providers also offer spiritual and emotional support.

Many healthcare organizations offer cancer survivorship programs. Some organizations have cancer survivorship programs tailored to specific kinds of cancer.

What can I expect after I complete cancer treatment?

Cancer survivorship centers on your care plan. This is the plan you and your cancer care team put together. Survivorship care plans vary, but typically include:

• Check-up schedules. You’ll see your care team every two to three months. You’ll have check-ups during the first two or three years after you finish treatment.
• Guidance for lifestyle changes. Your team may discuss avoiding activities that increase cancer risk. They may make suggestions for eating well and being active.
• Resource recommendations. Your care plan may include information about national and regional support groups. These are ways to connect with people living with cancer.

Will I always need cancer survivorship support?

That depends on your situation. You may need ongoing care if you have advanced cancer or a second cancer. But you may finish treatment and feel ready to move on with your life. Either way, you can shape your cancer survivorship to be whatever you need it to be. For example, your cancer survivorship plan could emphasize healthy living after cancer treatment. Or your plan could emphasize ways for you to return to your daily routine.

I have an advanced form of cancer. How does cancer survivorship help me?

If you have advanced cancer, cancer survivorship plans may focus more on managing your symptoms. Cancer survivorship conversations may shift to the kind of care you’d prefer toward the end of your life. For example, you may want to ask about hospice care. This is end-of-life care that helps you live your final days as you choose.