Cancer Survivorship

Life after cancer can be anything but ordinary.  Survivorship is a broad term that includes not only people who have been diagnosed with cancer at some point in their life, but also the friends and family members of people who have been diagnosed with cancer.  Following the treatment period, during which cancer patients have an abundance of support and helpful information, survivors may feel at a loss for this support, with many unanswered questions. It is important that survivors know it takes time to recover and readjust to life.  It may not be possible to immediately return to their previous version of "normal".  They may need to take some time to determine what is normal for them at the current time.

Quality of life is usually measured with a survey taken by a person about their general situation and feelings. If a cancer patient or survivor is not happy with their condition, they are said to have a low quality of life. This may lead the patient's doctors to change the treatment or follow up program in order to make the patient feel better. Having a high Health Related Quality of Life (HRQoL) is important to cancer patients and survivors because they tend to receive more consistent care and follow through with the suggested treatments. Some recent studies have shown that patients with a higher quality of life may live longer. 12

Because there are so many things that can decrease quality of life, doctors are still working on the best ways to improve this important aspect of cancer care. 13 The topics on the left contain information about some of the different issues related to survivorship and quality of life.

Subjects included on this page:

You may also want to see our information for Caregivers.

 

Click here to watch the full interview with Dr. Michael Burke.

Diet and Exercise

 

Diet
Due to the physical and emotional stresses of cancer treatments, cancer survivors may be at an increased risk for other health problems including obesity, heart problems, osteoporosis, high blood pressure, and diabetes. Because of this, it is imperative that cancer survivors maintain a healthy diet, a regular exercise plan, and work to manage their stress in order to optimize their health. The American Cancer Society recommends eating plant-based foods like fruits, vegetables, grains, and foods low in fat in their Nutrition Guidelines.4

 

Exercise
In addition, exercise may play an important role in controlling fatigue, improving cardiovascular fitness, losing or maintaining weight, improving mood, and stress management. Finding motivation to exercise can be hard due to side effects, like fatigue, that may interfere with a survivor's positive lifestyle decisions; however, it is possible. The American Cancer Society recommends exercising as soon as possible after treatment because of the findings of an association between physical activity and reduced risk of cancer recurrence. 5

Exercise Suggestions:

  • For those who have been inactive for a while, it is helpful to begin with about 10 minutes of walking per day.
  • Combine exercise with other daily activities, i.e. taking the stairs, walking to the store rather than driving, parking further from an entrance, or exercising while watching television.
  • If you suffer from insomnia, consider yoga, which can improve sleep quality.6 Yoga can be a gentle option because individual poses can be tailored to patient abilities. To read more about the role of yoga and Tai Chi in therapy, visit our CAM section.
  • Finding an exercise partner or group can help to provide motivation and friendly support.
  • If you suffer from fatigue, try scheduling exercise during times of the day when you expect your energy levels to be highest.
  • It is important to speak with your doctor before beginning a new exercise routine.

Healthy Lifestyle Suggestions:

  • After treatment, it is important to continue contact with the healthcare team.
  • Don't smoke and avoid secondhand smoke.
  • Taking measurements to manage stress will help the recovery process to move along more quickly.
  • Making more time for fun activities will help improve mood.

Financial Aspects

 

Understanding the Costs Related to Cancer 7

Types of cancer-related cost

  • Medical: medical office visits, tests, treatments, drugs and caregiving
  • Lifestyle: transportation, travel, legal help and financial services

Talk to your health care team

  • While many people are hesitant to ask about their financial concerns, it is vital to talk to your health care team. 
  • One study has shown that while more than half of the patient participants wanted to talk to their doctors about costs, only 19% actually did. 57% of the patients who had conversations with their doctors about financial concerns felt that it helped significantly decrease their costs, and even more felt it decreased their anxiety during the course of treatment

Seek financial assistance

  • Resources that provide financial assistance include child care, personal items (wigs, mastectomy bras, ostomy supplies), counseling services, legal help, transportation.
  • Those who can refer you to helpful organizations include: social workers, advocates, financial counselors, and patient navigators at your medical center.
  • Federal laws offer benefits, health insurance protection, and discrimination protection.

Healthcare Costs

As a cancer survivor, it is very important to be aware of the financial and legal matters related to cancer diagnosis and treatment. Knowing the specifics of healthcare insurance policies is very important. Some types of diagnostic and treatment procedures may not be included in a patient's coverage plan. It is important to speak with hospital financial counselors about hospital bills to determine if reduced rates or monthly payments are available/suitable. The U.S. Federal government has produced guidelines for the treatment of patients.

Pharmaceutical Company Patient Assistance Programs 9

 

If you do not have prescription medication coverage, have limited prescription insurance, or have a number of prescriptions, you may be having a difficult time paying for them. Some of these Patient Assistance Programs, located in the Resources section, may be able to help with the medications they manufacture.

Follow-up Care

 

 

It is important for cancer survivors to see a doctor for regular medical check-ups following treatment. Check-ups typically occur every 3-4 months for several years after treatment, and then once or twice per year after that. At a follow-up appointment, a doctor may look for side effects from treatment and to see if the cancer has returned or spread to other parts of the body. In some cases, blood tests, imaging scans (CT, MRI, PET, etc.) or other tests will be performed.

 

Watch the video to find how sarcoma survivor Ned Crystal is maintaining his health after cancer treatment. Click here to watch the full interview with Ned Crystal.

Choosing Among Recommended Treatments

When selecting a treatment, the goal is to slow the growth or eliminate the cancer in the body. It is also important to also take the patient's physical and emotional well-being into account. If patients or families want to inform themselves about treatment options, a few informative sites include:6

Barriers to Treatment

  • Structural barriers: inadequate health insurance, complexities of the health care system, treatment facility hours of operation, appointment wait times, and access to transportation. 6
  • Physician factors: attitudes, beliefs, preferences, and biases. 6
  • Cost of cancer care is a possible burden for many patients and their families. For information to help compare insurance plan coverage visit the American Cancer Society Cancer Action Network (ACS CAN).

Palliative Care

Palliative care improves the quality of life of patients with cancer. While this service is not yet available to all in need, there are many professionals in this growing specialty area.

To learn about and find palliative care professionals see the Resources section of this page.

Job Discrimination

It is important for a cancer survivor to be aware of their rights under the Americans with Disabilities Act. Employers may be reluctant to hire cancer survivors because they are afraid they may not be able to handle the workload of physically demanding jobs; however, it is unlawful for an employer to discriminate against someone with a disability.

Even though having cancer can be disruptive, it may be possible to continue working. Survivors may find that working provides a sense of normalcy to everyday life. Patients and survivors should talk with their employers about what options are available, whether part-time or full time. Many employers are willing to work out alternative work schedules and locations.

Learn more about the Americans with Disabilities Act

Physical Problems

Cancer can significantly affect the human body on many levels, both physically and emotionally. Problems may arise as a result of the cancer itself or as a result of cancer treatment. The impact can be minor or severe. In the worst cases, side effects can be debilitating for the patient and their healing process. It is important for cancer survivors to speak with their doctors about any changes or concerns.

Some physical changes that a cancer survivor may experience include (Note: these links will take you to the Side Effects section):

Watch an interview with Dr. Michael Burke, a psychiatric oncologist

Learn more about the physical effects faced in cancer survivorship from the Winship Cancer Institute of Emory University.

If you find the material useful, please consider linking to our website.

Survivorship Resources

  • 1. a. b. Roila F, Cortesi E. Quality of life as a primary end point in oncology. Ann Oncol 2001 12(Suppl 3): S3S6 [PUBMED]
  • 2. Moussas B. Quality of life in oncology trials: A clinical guide. Semin Radiat Oncol 2003; 13: 235247 [PUBMED]
  • 3. Constantini M, Musso M, Viterbori P, et al. Detecting psychological distress in cancer patients: Validity of the Italian version of the Hospital Anxiety and Depression Scale. Support Care Cancer 1999; 7: 121127 [PUBMED]
  • 4. Doyle C, Kushi LH, Byers T, Courneya KS, Demark-Wahnefried W, Grant B, McTiernan A, Rock CL, Thompson C, Gansler T, Andrews KS; The 2006 Nutrition, Physical Activity and Cancer Survivorship Advisory Committee; American Cancer Society "Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices." CA(2006) 56(6): 323-53. [http://www.ncbi.nlm.nih.gov/pubmed/17135691?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum] [PUBMED]
  • 5. Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz A, Bandera E, Hamilton K, Grant B, McCullough M, Byers T, Gansler T; American Cancer Society. "Nutrition and Physical Activity Guidelines for Cancer Survivors." CA(2012) 62(4): 243-274. [WILEY]
  • 6. a. b. c. d. Kiecolt-Glaser JK, Bennett JM, Andridge R, Peng J, Shapiro CL, Malarkey WB, Emery CF, Layman R, Mrozek EE, Glaser R. Yoga's impact on inflammation, mood, and fatigue in breast cancer survivors: a randomized controlled trial. J Clin Oncol. 2014 Apr 1;32(10):1040-9. [PUBMED]
  • 7. Patient Resource. Financial Considerations for Patients. Patient Resource Cancer Guide. 2014. [Financial Considerations]
  • 9. Cancer Support Community. Frankly Speaking About Cancer: Coping With the Cost of Care. 2015.