About one million Americans are diagnosed with cancer each year, according to the American Cancer Society. About half that number will be cancer-free after five years. They are cancer survivors, and their numbers continue to swell each year.

It is estimated that there are now 10 million cancer survivors in the United States. Ten million who have lived through the shock and turmoil of a cancer diagnosis, the pain and trauma of treatment and the relief that their cancer has either been eradicated or is in remission.

Being a survivor means they can have hope and make plans for the future. They have their lives back. But for most it’s a life that has changed dramatically.

A diagnosis of cancer forces most people to confront their mortality, to reconsider basic questions about family, work and health. For some it makes it possible to focus on the essentials in life and lose much of the clutter that had seemed important before. Friendships and marriages can be strengthened by the depth of support and caring; or they can be torn apart by the stress and fear that so often accompany cancer.

Cancer may express itself as a physical disease, but its aftermath can be far-reaching, affecting an individual’s psychological and emotional being, work environment, social roles, intimate relationships and insurance status.

Patrick, a middle-aged, divorced man treated six years ago for colon cancer is physically well but has to deal with the inconvenience of a colostomy and the altered self-image that goes with it. A salesman who worked mainly on commission, Patrick was unable to work for an extended period after his diagnosis and initial treatment that required two surgeries and chemotherapy. He now works for his brother who owns a mid-sized company and wanted to ensure that Patrick had good health insurance and a flexible schedule that would allow him to recover fully.

The bond between the brothers has strengthened; they now go fishing together regularly and Patrick, always an attentive father, has made it a priority to spend even more time with his young daughter.

“I feel like I have my life back,” Patrick said, “even though the colostomy is a hassle. At first I was afraid of dying and I felt bitter, but mostly I worried about not being there for my daughter, Annie. She’s a big priority for me now.”

Facing the Fear
Cancer survivors have to cope with fear. They have faced the fear of death and most experience an ongoing fear of recurrence. With some types of cancers, survivors are given a clean bill of health after three to five years. Others, like breast cancer, can recur many years later. And treatment with radiation and chemotherapy create some risk of secondary cancers in future years.

Advances in treating childhood cancers mean that 70 percent of children with cancer will survive into adulthood. The pediatric cancer centers that follow these children in the years after treatment are not geared to treat them as they reach adulthood and often move away. These young adults need to establish a relationship with a primary care physician in their area and ensure that the doctor is aware of their cancer and treatment history.

Many issues follow adult survivors of childhood cancers including fertility problems, damage to organs, the risk of a secondary cancer and problems with insurance and employment.

The aches and pains that most of us accept as part of daily life can have frightening implications for a cancer survivor who worries that any new pain may signal a return of cancer. A positive way to channel anxiety about health is to make healthy lifestyle changes–getting regular exercise (check with your doctor to find out what is right for you) and eating a healthy diet.

Ellen Stovall, 55, of Gaithersburg, MD has faced Hodgkin’s disease twice in the past and has been cancer-free now for 20 years. The president of the National Coalition of Cancer Survivors, Ms. Stovall recognizes the fear that follows survivors but asserts the need to continue with life. One way of coming to terms with fears about recurrence is to be vigilant about health.

A small percentage of cancer survivors have a high level of continued anxiety, a symptom of post-traumatic stress. Psychological therapy, relaxation therapy or a support group can help deal with the distress.

Regaining Control
Loss of control can be one of the most devastating aspects of a cancer diagnosis. Mentally drained and often physically ill, most patients expend their energy on just getting through treatment in the early months. But after treatment ends, survivors have a chance to regain control in their lives. This might be expressed as cooking meals again, planting a garden, returning to work, taking up new interests or making major changes in lifestyle, personal relations or philosophy.

Some cancers–breast cancer, for example–have a public mechanism for recognizing and bringing survivors together. Annual Run and Walk for the Cure events are held in communities across the country, raising money for awareness and research and forging a bond between women who have survived breast cancer, their families, friends and the wider community.

Most cancers don’t have that level of organized support but there are a number of organizations devoted to cancer survivorship, some headed by cancer survivors seeking to meet a perceived need for communication, information and support, and others headed by official health agencies or local hospitals.

Survivor groups include the National Coalition of Cancer Survivors and Y-Me, a national support group for survivors.

The National Cancer Institute established the Office of Cancer Survivorship website in 1996. The website provides lists of resources for cancer survivors and links to articles on pediatric and adult cancer incidence and survival.

The site is set up so that researchers, physicians, cancer survivors and their families are able to communicate directly with office staff. Survivors can get an overview of current research, funding and new research directions for different forms of cancer.

The site can be accessed at http://dccps.nci.nih.gov. Click on “Survivorship Research.”

Being a cancer survivor is a lifelong mission. There is no right or wrong way to go about it. Some walk away from treatment and don’t look back; others experience a profound change in the way they see the world and their place in it. While a certain amount of fear and anxiety is probably normal and can be channeled into vigilance concerning health issues, anxiety that interferes with life and its fulfillment can be helped by counseling or joining a survivor support group.

REFERENCES:
Jean Brown et al, “Nutrition During and After Cancer Treatment: a Guide for Informed Choices by Cancer Survivors,” Ca, May 2001. (This article is also available online at www.cancer.org)
Martin J. Edelman, “Follow-Up Testing After Cancer Treatment: Is It Indicated?” The Western Journal of Medicine, June 1998.
Barbara Ehrenreich, “Welcome to Cancerland,” Harper’s Magazine, November 2001.
Harmon J. Eyre, “Nutritional Advice for Cancer Survivors,” Ca, May 2001.
Karen G. Goff, “Surviving Cancer,” Insight On the News, November 5, 2001.
Kevin Oeffinger, “Childhood Cancer Survivors and Primary Care Physicians,” Journal of Family Practice, August 2000.
“Patients Living Longer, Better with Cancer,” Cancer Weekly Plus, November 10, 1997.
“Researchers Study Life After Cancer for Older Americans,” Health and Medicine Week, August 20, 2001.
Tony Sheldon, “Cancer Survival Rates Continue to Rise in the Netherlands,” British Medical Journal, June 23, 2001.
“Some Survivors Feel Discriminated Against,” Women’s Health Weekly, May 17, 2001.
Rebecca Voelker, “Cancer Stress Continues,” JAMA, January 24, 2001.
“Women Facing Cancer Treatment May Still Have Fertility Options,” Health and Medicine Week, July 23, 2001.