Cancer Survivorship
Cancer is a disease that impacts nearly everyone in some way. In fact, it is predicted by the American Society of Clinical Oncology (ASCO) that in 2030 there will be 22.1 million cancer survivors in the United States or about 15% of the entire population.
As treatments improve, patients with cancer will live longer. Therefore, understanding cancer survivorship is becoming increasingly important.
Survivorship programs at the CU Cancer Center
The University of Colorado Cancer Center provides survivorship care plans (SCP) for its patients. A SCP is a document that summarizes a patient’s diagnosis, treatment, and reasons to contact their health care teams. This document describes the recommended follow-up plan and contains wellness tips and resources. It is designed to be shared with your primary care team and may be reviewed in person or via telehealth.
CU Cancer Center also providers electronic consults to health care professionals with specific questions.
Additional resources:
- Tactic Clinic: The Thriving After Cancer Treatment is Complete (TACTIC) Clinic strives to help those who experienced cancer during childhood receive health care as young adults. The TACTIC Clinic is located within the Internal Medicine Clinic, Anschutz Outpatient Pavilion, 5th Floor. For more information, please call 720-848-2300.
- Hope Survivorship Clinic: The Hope Survivorship Clinic is available for pediatric survivors. For more information, please call 720-777-5441 or 720-777-6688.
- National Coalition for Cancer Survivorship: Cancer survivorship checklist for transitioning from active treatment into survivorship.
For general information about survivorship, please contact Carlin Callaway, DNP, at carlin.callaway@cuanschutz.edu, 720-848-3931, or 720-848-4870.
The term “cancer survivorship” generally has two meanings. According to cancer.Net, the first, more traditional, definition of cancer survivorship is “having no signs of cancer after finishing treatment.” The second definition that is more commonly used today is “living with, through, and beyond cancer. This means that cancer survivorship starts at diagnosis. It includes people who receive treatment over a longer time. Their treatment can lower the chance of cancer coming back or help to keep the cancer from spreading.”
Survivorship phases
Cancer survivorship has three phases:
Acute survivorship: This phase of survivorship starts at the diagnosis and finishes when treatment is completed. Treating the cancer is the focus during this phase.
Extended survivorship: This phase begins after the patient finishes treatment and continues for the months to follow. The focus during this phase is on the side-effects of cancer and treatment.
Permanent survivorship: The last phase of survivorship focuses on the long-term side-effects of cancer and treatment. This phase begins years after the final treatment when the cancer is less likely to return.
As treatments and therapies for cancer are improving, the number of cancer survivors is increasing each year. According to the American Cancer Society, it is estimated that there are nearly 17 million cancer survivors in the United States alone. By 2030 that number is set to increase to more than 22 million.
As of 2019:
- 67% of survivors are living five or more years.
- 45% of survivors are living 10 years or more.
- 18% of survivors are living 20 years or more.
- 64% of survivors are 65 years or older.
Improvements in cancer prevention initiatives, such as increased screening, maybe a reason behind higher survival rates. Screening tests include:
- Mammography for breast cancer
- Colonoscopies for colon and rectal cancer
- Pap smears for cervical cancer
- Prostate-Specific Antigen (PSA) tests for prostate cancer
Cancer researchers all across the country, including at the University of Colorado Cancer Center, are working to develop screening tests for other cancer types such as lung or ovarian cancer.
Many times, cancer survivors deal with mental health challenges they had not experienced before the diagnosis.
Some of these challenges include:
- During active treatment
- Anxiety
- Depression
- Uncontrolled worry
- Angry outbursts
- Irritability
- Feelings of hopelessness
- Feeling like a burden
- Post-traumatic stress syndrome (PTSD)
- Chemo-brain
After completing treatment:
- Fear/anxiety of disease recurring
- Survivors guilt (wondering why they survived when so many others have died)
- Relief that treatment is over
- Sexual and fertility problems
- Work discrimination
- Feeling like no one can relate to them
- Relationship problems
- Loss
- Feeling abandoned
Often times mental health problems arise after treatment is completed and patients are returning to their “normal” lives. This transition often is accompanied by feelings of anxiety about recurrence or other side-effects from treatment. Additionally, transitioning to regular visits with a PCP can cause anxiety as visits with the oncologist to become less frequent. Patients may worry that their usual doctor will not catch signs of recurrence or may not be familiar with their cancer.
It is important that cancer survivors take care of their mental health. A few practices to maintain and improve the quality of life include:
- Exercising
- Engaging in hobbies/interests that bring joy
- Asking for and accepting social support
- Getting enough sleep
- Eating a healthy diet
- Limiting alcohol and other substances
- Meditating
The importance of maintaining good mental health while going through cancer was once not considered a priority as it was assumed depression was a normal response to the diagnosis. However, there has recently been a push by researchers to increase the funding of mental health research in cancer survivors as more studies show that mental health problems are not only common but also can affect the quality and quantity of life of those survivors. Mental health screenings during and after cancer treatment are increasingly becoming the standard when it comes to cancer survivorship. If you are struggling be sure to talk to your doctor and get the support you need.
While relief is a common emotion after completing treatments, so is uncertainty and worry about the future. Some cancer survivors find that it is hard to return to “normal” and instead call their life after cancer treatment a “new normal”. The “new normal” may be defined by:
- Changing dietary habits
- Permanent scars on the body
- Having to change your routine
- New or different sources of support (IE: support groups)
- Finding it is harder to do things that came easy before the cancer diagnosis
- Emotional trauma
Dealing with a “new normal” can be hard for cancer survivors. Emotional concerns include:
- Fear that cancer will return
- Worry that they will not catch the cancer in time if it returns
- Feeling disconnected from their loved ones
- Loss of identity
- Low body image
- Low self-esteem
- Concerns of secondary cancers/long term side effects from treatment
It is important to note that feeling unsettled after completing treatment is normal and almost expected. Be sure to talk to your health care team about the concerns you are having.
Life-changing experience
Many cancer survivors agree that their experience with the disease did have some positive impact on their life in some form. This often includes:
- A greater appreciation for life
- Enjoying life more than before the diagnosis
- Being accepting of themselves
- Taking better care of their health
- Not sweating the small stuff