A cancer survivor is a person with cancer of any type who is still living. Whether a person becomes a survivor at the time of diagnosis or after completing treatment, whether people who are actively dying are considered survivors, and whether healthy friends and family members of the cancer patient are also considered survivors, varies from group to group. Some people who have been diagnosed with cancer reject the term survivor or disagree with some definitions of it.
How many people are cancer survivors depends on the definition used. About 11 million Americans alive today—one in 30 people–are either currently undergoing treatment for cancer or have done so in the past. Currently nearly 65% of adults diagnosed with cancer in the developed world are expected to live at least five years after the cancer is discovered.
Many cancer survivors describe the process of living with and beating cancer as a life-changing experience. It is not uncommon for survivors to use the experience as opportunities for creative self-transformation into a "better person" or as motivation to meet goals of great personal importance, such as climbing a mountain or reconciling with an estranged family member. This process of posttraumatic growth is called benefit finding. Cancer survivors often have specific medical and non-medical needs related to their cancer experience.
- 1 Definitions and alternatives
- 2 Needs of cancer survivors
- 3 Adolescent and young adult survivors
- 4 Survivorship Care Plan
- 5 Family members
- 6 Notable cancer survivors
- 7 See also
- 8 References
- 9 External links
Definitions and alternatives
Macmillan Cancer Support in the UK defines a cancer survivor as someone who is "living with or beyond cancer", namely someone who:
- has completed initial cancer management and has no apparent evidence of active disease;
- is living with progressive disease and may be receiving cancer treatment, but is not in the terminal phases of illness; or
- has had cancer in the past.
The National Coalition for Cancer Survivorship (NCCS) pioneered the definition of survivor as being any person diagnosed with cancer, from the time of initial diagnosis until his or her death. This expansive definition of "survivor" includes people who are dying from untreatable cancer. NCCS later expanded the definition of survivor even further to include family, friends and voluntary caregivers who are affected by the diagnosis in any way. The US National Cancer Institute's Office of Cancer Survivorship uses a variant of this expanded definition.
The word survivor is a loaded term. Within the breast cancer culture, survivorship is conferred upon women who are perceived as having suffered emotional or physical trauma, even if their breast cancer was a non-life-threatening pre-cancerous condition like LCIS or DCIS. The term tends to erase and degrade people who are dying of incurable cancer. This idea of survivorship emphasizes and values longevity of life after diagnosis, while overlooking issues of quality of life.
Some people reject the term survivor as being a narrow conceptualization of highly variable human experiences. Alternatives include alivers and thrivers, which put emphasis on living as well as possible, despite limitations and disability. A third term, the diers, is used by some terminally ill patients who reject the claim that dying is part of survivorship or should be covered up with inappropriately optimistic language.
The term previvor has been used to describe unaffected carriers. Unaffected carriers, or previvors, are those who have not diagnosed with cancer, but who know that they are likely to develop cancer due to certain genetic mutations that form a known cancer syndrome. They have a survived the predisposition, or higher risk, of cancer. As such, this is the first generation in human history who, armed with information about a predisposition to a cancer after opting into DNA testing, can make informed choices prior to cancer diagnosis. The typical previvor has tested positive for a BRCA mutation and learned that she is at high risk for developing breast cancer and ovarian cancer, and is attempting to manage that risk through a combination of increased surveillance through mammograms, breast MRIs, pelvic ultrasounds, oophorectomy, bilateral mastectomy, and other medical procedures. There has been much controversy over the term previvor, due to the fact that the name compares these healthy women to people have actually been diagnosed with invasive cancer.
Needs of cancer survivors
People who have finished cancer treatment often have psychological and physical medical challenges. These effects can vary from person to person, change over time, and range in intensity from mild and intermittent to fully disabling.
If the treatment is lengthy and disruptive, many patients experience some difficulty in returning to normal daily life. The energy needed to cope with a rigorous treatment program may have caused them to disconnect from previous daily patterns, such as working, normal self-care, and housekeeping. A small number of patients become dependent on the attention and sympathy that they received during their treatment and feel neglected when life returns to normal. There are tremendous implications that cancer has on the relationships that survivors have with their loved ones (particularly their partners) once their cancer has been treated, and social support plays a critical role in their long-term emotional adjustment.
Some survivors, even if the cancer has been permanently cured, struggle emotionally from the trauma of having experienced a life-threatening disease. Cancer survivors suffer from more psychological distress than those who have never experienced cancer (5.6% compared to 3.0%) Serious psychosocial distress was seen 40% more among cancer survivors of five years or more than in those who have never had cancer. About 10% develop major depressive disorder; others experience an adjustment disorder. In young adult cancer survivors, one small study found that 20% of participants met the full clinical diagnosis of post-traumatic stress disorder (PTSD), and 45% to 95% displayed at least one symptom of PTSD. Survivors of adult cancer are at an increased risk of suicidal ideology (having thoughts about suicide), while as many as 13% of childhood cancer survivors experience suicidal ideology. Issues of pain and physical ailments have been hypothesized as major contributing factors in cancer survivors experiencing this suicidal ideology.
Other patients have to adjust to the idea that they will never be cured, or that the cancer could return without warning. After the initial treatment has ended, anxiety is more common among cancer survivors than among other people. The effect is more pronounced among female cancer survivors. Many patients are anxious that any minor symptom indicates that the cancer has returned, with as many as 9 in 10 patients fearful that their cancer will recur. In addition to the appearance of any new aches and pains, common triggers for fear include hearing that someone else has been diagnosed with cancer, annual medical exams to determine whether the cancer recurred and news stories about cancer. This anxiety leads to more medical check ups, which can be measured even after a period of up to ten years.
The cultural ideal of a survivor may add to individual patients' distress if the patient is unable or unwilling to live up to the ideal. The ideal survivor is bravely committed to mainstream medicine and optimistic or even certain of a physical cure. He or she is open about diagnosis and treatment and becomes an educated, empowered medical consumer. The ideal survivor, like a superwoman who simultaneously manages her home, family, and career, struggles valiantly to prevent cancer from affecting loved ones by appearing, behaving, and working as much as possible. Once the immediate crisis is past, the person may feel strongly pressured to donate time, money, and energy to cancer-related organizations. Above all, the ideal survivor does not die of cancer. People who publicly conform to this ideal are given social status and respect.
In terms of medical challenges, some survivors experience cancer-related fatigue, may have long-term side effects from cancer and its treatment, and may need extensive rehabilitation for mobility and function if aggressive surgery was required to remove the cancer. They may experience temporary or persistent post-chemotherapy cognitive impairment. Some young survivors lose their ability to have children.
Cancer survivors frequently need medical monitoring, and some treatments for unrelated diseases in the future may be contraindicated. For example, a patient who has had a significant amount of radiation therapy may not be a good candidate for more radiation treatments in the future. To assist with these needs, "survivor care plans" have been promoted. These are personalized documents that describe the person's diagnosis and treatment in detail, list common known side effects, and specifically outline the steps that the survivor should take in the future, ranging from maintaining a healthy weight to receiving specific medical tests on a stated schedule.
Survivors of childhood cancer have a life expectancy up to 28% shorter than people in the general population. Therefore, there is a need to closely monitor these patients for much longer than usual. The Children's Oncology Group recommends that monitoring should include periodic follow up and screening by a clinician familiar with these patients' risks. Improving these patients' longevity requires recognition and treatment of illnesses associated with late effects in the decades after therapy for childhood cancer. For example, survivors of childhood cancer may have more difficulty than typical with breastfeeding and require more support to undertake this health-promoting activity. Others experience various forms of heart disease. One challenge to achieving this goal is that childhood cancer survivors are both very adaptable and accustomed to denying difficulties; as a result, they tend to minimize their symptoms. Therefore, internists may not give them all the attention they need and thus the actual help they may need. Symptom management, health promotion, specific attention to psychosocial needs, and surveillance for recurrence and specific late effects of treatment are helpful.
Adolescent and young adult survivors
Adolescent and young adult (AYA) survivors, often defined as being between the ages of 15-39, have seen advancements in technology and modern medicine causing a dramatic increase in the number of AYA survivors. Prior to 1970, being diagnosed with cancer during childhood was considered a universally fatal disease. From 1995 to 2000, however, the 5-year survival rate for children diagnosed with cancer was 80%. Significant progress has been built in the last 25 years as there are now approximately 270,000 survivors of pediatric cancer in the U.S., which translates to approximately 1 in every 640 young adults being a survivor of childhood cancer. However, as studies have shown, as patient needs increase, the likelihood of having an unmet need also increases. For the AYA population, 2 out of 3 childhood cancer survivors will develop 1 complication due to the therapy they received and 1 out of 3 will develop serious or life-threatening complications, meaning they will most likely need treatment and follow-up care.
An AYA survivor, faces a variety of issues as a result of their cancer diagnosis and treatment that are unique to their particular age group which differentiate their survivor population from the adult survivor population. For example, AYA survivors report that their education, employment, sexual functioning, marriage, fertility, and other life values are impacted by their cancer. Data show that AYA survivors have a much greater risk of getting a second primary malignancy as a side effect of the treatment for their original diagnosis. It is believed that AYAs have a much higher relative risk of developing a second primary cancer because the intensity of the treatment for their original diagnosis, typically including any combination of chemotherapy, surgery, and radiation, is much higher than the level of intensity given to patients over 40. Furthermore, since AYA survivors are diagnosed and treated at such a young age, their length of time being a survivor is much longer than their adult counterparts, making it more likely they will face a second primary cancer in their lifetime.
Barriers to quality long-term follow-up care
Childhood cancer survivors, in particular, need comprehensive long-term follow-up care to thrive. One way this can be accomplished is through continuous follow-up care with a primary care physician that is trained to identify possible late effects from previous treatments and therapies.
The Children's Oncology Group (COG) has designed a set of survivorship guidelines that hope to aid both health care professionals and survivors themselves, in both the intricacies and basics of long-term follow-up care. The COG has guidelines for how a patient should put together their own “treatment summary”, so they can have their treatment history with them when they visit any health care provider. The COG suggests that a survivor include the following in his/her treatment summary:
- Name of disease, date of diagnosis, stage of disease, contact information of the clinics/hospitals where you received your care
- Names and doses of the chemotherapy and radiation you have received and the area of the body that was radiated
- Names and dates of any surgeries you have had
- If you have received a transplant, the type of transplant and where it was received and whether you developed any chronic Graft-versus-Host Disease
- Names and dates of any significant complications and treatment received for those complications
With the treatment summary, experts hope that survivors will be better equipped to face the significant burden of maintaining quality follow-up care long after their original treatment. This is especially important for the AYA population, in particular, because they are typically facing major social changes regarding their relationship status, employment or education status, their insurance coverage, and even their place of residence, etc. Typically, most of these factors are pretty constant for the adult population and if they experience any changes, it would occur in one or two aspects of their life. However, with the AYA population, the period of time until they are 40 is when they are going to, for the majority of the population, undergo the most change. This reality underscores the importance of a smooth transition from child-centered to adult-focused health care services through which they are consistently managed.
Impact of Affordable Care Act on the AYA survivor population
The US Affordable Care Act (ACA) in 2010 makes it illegal for health insurance providers to deny coverage for a pre-existing condition, such as previously having survived cancer. Young adults will now be required to have insurance coverage and, with a few exceptions, will be able to be covered under their parent's coverage until the age of 26 as a dependent in their parent's plan.
Survivorship Care Plan
Studies among endometrial cancer survivors show that satisfaction with information provided about the disease and treatment increases the quality of life, lowers depression and results in less anxiety. People who receive information on paper, compared to oral, indicate that they receive more information and are more satisfied about the information provided. The American Institute of Medicine and the Dutch Health Council recommend the use of a Survivorship Care Plan; which is a summary of patients' course of treatment, with recommendations for subsequent surveillance, management of late effects, and strategies for health promotion.
Family members are affected by the cancer experience of their loved ones.
In the years after successful treatment, spouses of cancer survivors are more likely than other people to experience anxiety.
Notable cancer survivors
- "Cancer survivors face psychological challenges". Sun-Sentinel (Fort Lauderdale, Florida). 22 January 2009.
- Hart, Jane (August 2007). "Addressing the Psychosocial Needs of Cancer Survivors". Alternative and Complementary Therapies 13 (4): 183–186. doi:10.1089/act.2007.13406.
- Gayle A. Sulik (2010). Pink Ribbon Blues: How Breast Cancer Culture Undermines Women's Health. USA: Oxford University Press. ISBN 0-19-974045-3. OCLC 535493589.
- Carr, Brian I. and Jennifer Steel, ed. (2013). Psychological aspects of cancer a guide to emotion and psychological consequences of cancer, their causes and their management. New York: Springer. p. 167. ISBN 9781461448662.
- "Living with or beyond cancer". Macmillan Cancer Support. Retrieved 2010-11-30.
- "DCCPS: OCS: About Cancer Survivorship Research: Survivorship Definitions". Office of Cancer Survivorship of the US National Cancer Institute. 6 November 2006. Retrieved 30 November 2010.
- Amy Harmon (16 September 2007). "The DNA Age, Cancer Free at Age 33, but Weighing a Mastectomy". The New York Times. Retrieved 2007-09-16.
- "Living with cancer". Macmillan Cancer Support. Retrieved 30 November 2010.
- Jennings, Dana (29 June 2009). "Losing a Comforting Ritual: Treatment". The New York Times.
- Zhou, Eric S.; Kim, Youngmee; Rasheed, Mikal et al. (December 2011). "Marital satisfaction of advanced prostate cancer survivors and their spousal caregivers: the dyadic effects of physical and mental health". Psychooncology 20 (12): 1353–1357. doi:10.1002/pon.1855. PMID 20925137.
- Zhou, Eric S.; Penedo, Frank J.; Bustillo, Natalie E. et al. (2010). "Longitudinal effects of social support and adaptive coping on the emotional well-being of survivors of localized prostate cancer". Journal of Supportive Oncology 8 (5): 196–201. doi:10.1016/j.suponc.2010.09.004. PMID 21086876.
- Smith, Stephen (14 August 2009). "Remy’s woes befall many after cancer: Depression can hit as survivors adjust". Boston Globe.
- Hoffman KE, McCarthy EP, Recklitis CJ, Ng AK (July 2009). "Psychological distress in long-term survivors of adult-onset cancer: results from a national survey". Arch. Intern. Med. 169 (14): 1274–81. doi:10.1001/archinternmed.2009.179. PMID 19636028. Lay summary.
- Twombly R (February 2001). "Post-traumatic stress disorder in childhood cancer survivors: how common is it?". J. Natl. Cancer Inst. 93 (4): 262–3. doi:10.1093/jnci/93.4.262. PMID 11181770.
- Recklitis CJ, Diller LR, Li X, Najita J, Robison LL, Zeltzer L (February 2010). "Suicide ideation in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study". J. Clin. Oncol. 28 (4): 655–61. doi:10.1200/JCO.2009.22.8635. PMC 2816000. PMID 19841325.
- Recklitis CJ, Lockwood RA, Rothwell MA, Diller LR (August 2006). "Suicidal ideation and attempts in adult survivors of childhood cancer". J. Clin. Oncol. 24 (24): 3852–7. doi:10.1200/JCO.2006.06.5409. PMID 16921037. Lay summary.
- Mitchell AJ, Ferguson DW, Gill J, Paul J, Symonds P (July 2013). "Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: a systematic review and meta-analysis". The Lancet Oncology 14 (8): 721–32. doi:10.1016/S1470-2045(13)70244-4. PMID 23759376. Lay summary – Anxiety Lingers Long After Cancer (12 July 2013).
- Gill KM, Mishel M, Belyea M et al. (May 2004). "Triggers of uncertainty about recurrence and long-term treatment side effects in older African American and Caucasian breast cancer survivors". Oncol Nurs Forum 31 (3): 633–9. doi:10.1188/04.ONF.633-639. PMID 15146229.
- Nicolaije K.A. et al. Follow-up practice in endometrial cancer and the association with patient and hospital characteristics: A study from the population-based PROFILES registry, Gynecologic Oncology, 129 (2), May 2013, page 324–331, doi:[//dx.doi.org/10.1016%2Fj.ygyno.2013.02.018 10.1016/j.ygyno.2013.02.018 PMID 23435365].
- Neergaard, Lauran (23 October 2007). "'Survivor plans' a long-term cancer-treatment strategy". Associated Press.
- Yeh JM, Nekhlyudov L, Goldie SJ, Mertens AC, Diller L (April 2010). "A model-based estimate of cumulative excess mortality in survivors of childhood cancer". Ann. Intern. Med. 152 (7): 409–17, W131–8. doi:10.1059/0003-4819-152-7-201004060-00005. PMC 3086591. PMID 20368646. Lay summary – Childhood Cancer Survivors Need Closer Monitoring in Adulthood (7 April 2010).
- Ogg SW, Hudson MM, Randolph ME, Klosky JL (June 2011). "Protective effects of breastfeeding for mothers surviving childhood cancer". J Cancer Surviv 5 (2): 175–81. doi:10.1007/s11764-010-0169-z. PMID 21253880.
- Ries, LA; Eisener, MP; Kosary, CL (2004). "SEER cancer statistics review, 1975-2001". National Cancer Institute.
- Aziz, NM; Oeffinger, KC; Brooks, S & Turoff, AJ. (2009). "Comprehensive long-term follow-up programs for pediatric cancer survivors". Wiley InterScience: 841–848.
- Hewitt, M; Weisner, SL; Simone, JV (2003). Childhood cancer survivorship: Improving care and quality of life. Washington, D.C.: National Academies Press.
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- Bober, Sharon L.; Zhou, Eric S.; Chen, Bing et al. (August 2013). "Sexual Function in Childhood Cancer Survivors: A Report from Project REACH". The Journal of Sexual Medicine 10 (8): 2084–2093. doi:10.1111/jsm.12193. PMID 23679087.
- Zebrack, BJ; Zeitzer, LK (2003). "Quality of life issues and cancer survivorship". Current Problems in Cancer 27: 198–211. doi:10.1016/s0147-0272(03)00027-8.
- Soliman, H; Agresta, SV (January 2008). "Current Issues in Adolescent and Young Adult Cancer Survivorship". Cancer Control 15 (1).
- Bhatia, S; Casillas, J; Hudson, MM; Landier, W (March 2009). "Long-term Follow-up Care for Pediatric Cancer Survivors". American Academy of Pediatrics 123 (3): 906–915. doi:10.1542/peds.2008-3688.
- "Introduction to Long-term Follow-Up after Treatment for Childhood, Adolescent, or Young Adult Cancer". Children's Oncology Group. 2008. Retrieved 1 February 2012.
- Freyer, DR (November 2010). "Transition of Care for Young Adult Survivors of Childhood and Adolescent Cancer: Rationale and Approaches". Journal of Clinical Oncology 28 (32).
- "Summary of New Health Reform Law". Kaiser Family Foundation. Retrieved 2 February 2012.
- Husson O. et al, The relation between information provision and health-related quality of life, anxiety and depression among cancer survivors: a systematic review, Ann Oncol, 22, 2011, page 761–772
- Nicolaije K.A. et al. Endometrial cancer survivors are unsatisfied with received information about diagnosis, treatment and follow-up: A study from the population-based PROFILES registry, Patient education and counseling, 88(3), Sep 2012, page 427–35, doi:[//dx.doi.org/10.1016%2Fj.pec.2012.05.002 10.1016/j.pec.2012.05.002 PMID 22658248]
- Van de Poll-Franse L.V. et al. The impact of a cancer Survivorship Care Plan on gynecological cancer patient and health care provider reported outcomes (ROGY Care): study protocol for a pragmatic cluster randomized controlled trial. Trials, 5 (12). 2011 Dec, page 256, doi:[//dx.doi.org/10.1186%2F1745-6215-12-256 10.1186/1745-6215-12-256 PMID 22141750]
- Information about survivorship at Cancer.Net by the American Society of Clinical Oncology
- National Coalition for Cancer Survivorship
- Cancer survivorship website, NHS Improvement
- Welcome to Cancerland, an essay criticizing the commercialization of survivorship by journalist and breast cancer survivor Barbara Ehrenreich
- Advice for survivors on disclosing their cancer diagnosis from Survivorship A-Z
- Words are inadequate by Dana Jennings, about the language of survivorship, victimhood, and battling cancer