A cancer survivor refers to any person who has been diagnosed with cancer. Survivorship begins at the time of diagnosis and includes the periods of initial treatment with intent to cure, cancer-free survival, chronic or intermittent disease, and end of life care.

There are millions of survivors worldwide. This number is expected to grow due to improvements in cancer screening, increases in life expectancy following definitive cancer treatment and the aging of the population. For cancer survivors who are no longer in active treatment, health care needs include surveillance for recurrence, screening for the development of subsequent primary cancers, monitoring and intervention for the long-term and late physical and psychological effects of cancer and preventive care.

For some survivors, the consequences of cancer are minimal with many returning back to a normal life after treatment. However, many survivors experience physical and psychosocial effects of cancer and its treatment.

Risk of recurrence:

Following treatment of a primary cancer, survivors are at risk for recurrence. Recurrences may occur where the cancer was originally diagnosed or in a different location. The timing and patterns of recurrence, particularly of distant disease, vary by cancer type and stage at diagnosis. Patients with the highest risk of developing a second (subsequent) primary cancer includes survivors of head and neck cancers and Hodgkin lymphoma.

Subsequent primary cancers in cancer survivors occur due to multiple clinical factors, including prior treatment for the primary cancer (eg, chemotherapy, radiation therapy) lifestyle habits (eg, smoking, obesity) and genetic factors. This data suggests an opportunity for doctors to reduce or prevent the risk of subsequent primary cancers in cancer survivors through lifestyle interventions (eg, cease smoking, alcohol counselling, diet, and physical activity) as well as cancer screening and genetic counselling.

Monitoring for long-term effects of cancer and its treatment

Survivors are at risk for other conditions related to both their disease and its treatment, which are of increasing importance as cancer survival rates improve. Late physical effects of treatment may include pain, fatigue, depression, lymphoedema, urinary and bowel problems, cardiotoxicity, subsequent malignancy, peripheral neuropathy, hearing loss, infection, loss of bone mass, premature menopause in women and sexual dysfunction. Your Oncologist will advise you of the risks and side effects of treatment, as these vary between various treatment approaches.

Psychosocial well-being — Cancer survivors have been shown to experience a number of difficulties that can impact general quality of life, including depression, anxiety, fatigue, cognitive limitations, sleep problems, sexual dysfunction, pain, and opioid dependence.

A number of interventions for cancer survivors have been evaluated, with both psychosocial and exercise interventions reporting beneficial effects on quality of life.

Fertility and parenthood — Cancer therapy may put male and female survivors at risk for infertility. Patients may be concerned about their chances of getting pregnant, suffering a miscarriage, and/or achieving a successful pregnancy outcome. Furthermore, cancer survivors may be fearful that their history of cancer or its treatment will have an adverse impact on offspring conceived after their cancer treatment, such as placing them at risk for malignancy, congenital anomalies, or impaired growth and development. They may also be concerned about the risks of pregnancy on cancer recurrence. For these patients, education regarding reproductive function is an important aspect of their care.

Preventative Care

• Both diet and physical activity can improve the quality of life and can minimize both disease and treatment-related side effects in cancer survivors.
• Smoking — Cancer survivors are at increased risk for subsequent cancers, and the risks are significantly higher among those who continue to smoke.
• Limit alcohol consumption
• Genetic evaluation and testing-genetic factors may have important implications for the survivor's family members

Survivorship Care Plan:  

Cancer survivorship is often a hard transition to a new normal. A cancer survivorship care plan is often formulated between the patient and treatment team. It is a record of your cancer and treatment history. It may list the follow up needed, future tests required, possible long-term side effects and preventative strategies.

Conclusion:

Cancer survivors want health, longevity and quality of life. The road to these outcomes is often riddled with obstacles involving medical uncertainty, treatment outcomes, social expectations and financial burden. An active relationship between Health Practitioners and Patients is important at all levels of care through the cancer journey.

The full referenced article is available on request.

By Dr Nirasha Chiranjan

VIew Profile