In the Spotlight

Cancer Survivorship

Submitted by: Paulette Mehta MD, MPH, April 1, 2008
Central Arkansas Veterans Healthcare System, Little Rock, AR

There are now many more cancer survivors than ever before, with more than 10 million Americans who have battled cancer and won. But many more people are also actual cancer survivors, since cancer also affects family members and close friends.

Cancer survivorship is a new concept, made possible through many technological advances in the field, better medications, better supportive care, and earlier diagnosis for many people. These days most people who present with early stage breast, prostate, colorectal, gynecological, and other cancers have a good chance of being cured of their disease; people with other cancers or later stages of disease also have increasingly better chances of doing well.

There are several stages of cancer survivorship. Early cancer survivorship is often accompanied by dealing with fear of dying and is often accompanied by fear, anxiety and depression. Late cancer survivors have to deal with limitations from their disease and treatment including organ dysfunction, fatigue, depression, and fears of recurrence. Many cancer survivors however have a much heightened appreciation of life, knowing that each day is a special gift that they almost didn't have.

People who survive cancer still have health and social issues which may persist for a lifetime. The problems depend on their type of cancer and type of treatment. Based on that, there may be organ damage, changes in bone health, higher risk for atherosclerosis, decreased fertility, and decreased sexual activity. For example, patients who received certain drugs such as anthracyclines, steroids, and HER-2 receptor antagonists have a higher risk for heart disease. People treated for testicular cancer or other patients treated with steroids have a higher risk for early atherosclerosis and pre-diabetes (metabolic syndrome). Patients with prostate, breast, and lung cancer or multiple myeloma have a higher risk for skeletal problems like osteoporosis and bone fractures.

Many cancer survivors also have less ability to keep jobs than before they had before they developed cancer either because of discrimination form employers or because they no longer have the stamina to keep their jobs.

Psychological problems are very common including depression, anxiety and these can be helped with psychotherapy, group therapy, medications and exercise.

There are some additional potential side effects after stem cell transplantation including graft-versus-host disease; however it can usually be well controlled with steroids and other medicines. Finally, for cancer survivors there is always a chance that the disease will come back although this risk gets less with each passing year. There is also the chance of developing a second cancer.

For all of these reasons, cancer survivors need to maintain good lifelong medical care. For all cancer survivors here are some precautions to remember.

• First, exercise can help to overcome limitations, to improve mood, and to reduce the risk of second cancers.
• Smoking cessation is essential - tobacco smoke is a carcinogen and will increase the chances of relapse and of second cancers, so stopping smoking is one of the best things to do to recover.
• Avoiding excessive body weight and obesity is also important, since obesity is related to cancer and excess body weight can predispose to a second cancer. Exercise is important to maintain weight and also reduce physical limitation, improve stamina and flexibility and to feel good. Eating well with daily vegetables and fruits is also important.
• Cancer survivors also need to maintain their connections to the health center and may need to have more preventive screening than most other people who have not had cancer.

There are many organizations that can help answer questions and provide encouragement. The American Cancer Society, the National Cancer Institute, and the American Society for Clinical Oncology all have very helpful Websites and each is developing a survivorship education and navigation program. The Cancer Information Service sponsored by the National Cancer Institute has vast resources to help cancer survivors get more information. They have an active, up-to-date Website and also have a 24-hour helpline, 1-800-4-CANCER.

Cancer survivorship is becoming common and is a very special gift of a true second chance for healthy life. It should be cherished and celebrated everyday.

Related Links

A Cancer Survivorship: Basic Information (Centers for Disease Control and Prevention (CDC))

Supervivencia del cancer: Información básica (Centros para el Control y la Prevencíon de Enfermedades (CDC)) (en Español)

Information for Survivors/Caregivers/Advocates (National Cancer Institute)

National Organizations That Offer Services to People with Cancer and Their Families (National Cancer Institute)

Organizaciones nacionales que brindan servicios a las personas con cáncer y a sus familias (Instituto Nacional del Cáncer)

The Road to Survivorship: Living after Cancer Treatment (PDF)

Sharing: A Story of Faith and Hope (People Living Through Cancer)

Paulette Mehta MD MPH
Professor, Hematology/Oncology, UAMS, LR, AR
Staff Hematologist/Oncologist, CAVHS, LR, AR
Director, Field Advisory Committee H/O, VACO, DC
Director, HOPE* Unit, CAVHS, LR, AR

Updated/Reviewed: May 31, 2008