Not long ago, cancer was considered an incurable disease.
Fortunately, despite the increasing number of people diagnosed with cancer, mortality rates have dropped significantly over the past three decades. This is mostly thanks to early detection through screening, and more effective treatments. Today, on average, two-thirds of cancer patients can expect long-term survival, though this varies by the type of cancer and the stage at which it was diagnosed. For example, the majority of women with breast cancer are diagnosed at early stage, which is now associated with a five-year survival rate of 96 per cent. Testicular cancer, even when fairly advanced at diagnosis, has a relative survival rate of more than 95 per cent.
While the growing number of cancer survivors is something to be celebrated, patients transitioning to the post-treatment phase of their cancer journey still face a number of health challenges.
Almost all major types of cancer treatment – surgery, radiotherapy, chemotherapy, hormone therapy – can result in side effects including fatigue, pain, sleep disturbances, sexual dysfunction and limitations to mobility. Certain treatments can also increase the risk of developing other conditions such as osteoporosis or heart disease, or can result in increased risk of a second cancer.
For most people, side effects slowly go away over the first few months after treatment ends. For some, however, they may continue, or new side effects may develop months or years later.
In addition to physical side effects, a cancer diagnosis can result in significant emotional and economic consequences. Survivors commonly experience the fear of cancer recurrence, anxiety, sadness and issues related to sexual dysfunction and altered body image. Many people also worry about going back to work and finances.
Over the past decade, health-care providers, patient advocates and other stakeholders have established cancer survivorship – the period after cancer treatments end – as a distinct phase in the cancer journey. They have raised awareness of and legitimized the needs of cancer survivors. They have also advocated for a shift in the care of cancer survivors from purely a disease-focused approach to a wellness-centred approach that provides co-ordinated comprehensive care.
Yet there remains wide variation in the clinical care and organization of services for cancer survivors, with limited experience and evidence to inform the best ways to deliver care. National and provincial strategies and funding models for survivorship services are urgently needed.
It takes time to recover from a cancer diagnosis and treatment, but there are many things that survivors and their health-care providers should do. To start, all survivors should be routinely followed by either their cancer specialist or family doctor to monitor for cancer recurrence and side effects.
The reality, however, is that for the majority of their lives, cancer survivors live and function outside the formal cancer system, and so must take responsibility to help get their lives back on track after treatment ends. The most important thing cancer survivors and their families can do is become informed about follow-up care, the expected course of recovery, chances of recurrence, symptoms to look out for and available resources.
It is also important for cancer survivors to accept and talk about their feelings and understand that it will take time to recover and adjust. Cancer survivors can access a number of programs for information and support on the day-to-day issues they face, including the Canadian Cancer Society's web, print and telephone-based resources on managing life after cancer. And more cancer centres have begun to develop and offer cancer survivorship programs and clinics.
Finally, a growing and convincing body of evidence demonstrates that healthy lifestyle behaviours – notably diet and physical activity – can be powerful tools to manage the many side effects and health risks resulting from cancer treatments, and can also reduce the risk of recurrence and overall mortality.
Guidelines for cancer survivors recommend eating healthy foods with an emphasis on plant sources, and getting 150 minutes of moderate-intensity physical activity each week. Healthy lifestyle programs designed for cancer survivors are increasingly being offered within cancer programs, such as the ELLICSR Health, Wellness and Cancer Survivorship Centre at Princess Margaret in Toronto, or the community-based Wellspring, which is available in many Canadian cities.
For most people diagnosed today, cancer can be viewed as a chronic rather than a life-limiting condition. Every person's experience will be different and the journey to recovery challenging. Cancer survivors need time to adjust to life after cancer and should become informed and empowered partners in their follow-up care – for the rest of their lives.
Health Advisor contributors share their knowledge in fields ranging from fitness to psychology, pediatrics to aging.
Dr. Jennifer M. Jones is the Director of Research for the Cancer Survivorship Program at Princess Margaret Cancer Centre, University Health Network.