Cancer survivor

A cancer survivor is a person with

How many people are cancer survivors depends on the definition used. Nearly 65% of adults diagnosed with cancer in the developed world are expected to live at least five years after the cancer is discovered.^[1] In the U.S. for example, about 11 million Americans alive today—one in 30 people–are either currently undergoing treatment for cancer or have done so in the past.^[2]

For many people, surviving cancer can be highly traumatic and it is not uncommon for people to experience psychological distress such as

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.^[6]

The

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.^[4] 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.^[4]

The term previvor has been used to describe

Needs of cancer survivors

People who have finished cancer treatment often have psychological and physical medical challenges.

Cancer survivors tend to be more resilient than the general population.^[24]

Ongoing effects

Some survivors have to adjust to the idea that they will never be cured.

Some survivors, even if the cancer has been permanently cured, struggle emotionally from the trauma of having experienced a life-threatening disease.

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.^[41]

Medical tests to determine whether the cancer has returned commonly provoke fears. Informally, this is called scanxiety, a portmanteau of scan and anxiety. A desire to avoid feeling this fear can prompt survivors to postpone or refuse tests.^[42][43] This may be able to be helped by the follow-up of people who have had cancer post-treatment being undertaken via self-reported patient-related outcome measures rather than follow-up visits, but there is not enough controlled research looking into this.^[44]

Survivors of childhood cancer have a

Adolescent and young adult (AYA) survivors, often defined as being between the ages of 15 and 39, have seen advancements in technology and modern medicine causing a dramatic increase in the number of AYA survivors. Prior to 1970, childhood cancer was considered a universally fatal disease. From 1995 to 2000, however, the 5-year survival rate for children diagnosed with cancer was 80%.^[51] 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.^[52][53] However, as studies have shown, as patient needs increase, the likelihood of having an unmet need also increases.^[54] For the AYA population, 2 out of 3 childhood cancer survivors will develop a complication due to the therapy they received, and 1 out of 3 will develop serious or life-threatening complications, meaning they will need treatment and follow-up care.^[55] In addition, AYAs may experience greater difficulties adhering to treatment, which may negatively impact future outcomes.^[56]

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,

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 who is trained to identify possible late effects from previous treatments and therapies.^[61]

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 recommends that patients or their families 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 all survivors include the following in their treatment summaries:

• Name of disease, date of diagnosis, stage of disease, contact information of all clinics and hospitals where care was received
• Names and doses of any chemotherapy received
• Names and doses of any radiation received, and the area of the body that was radiated
• Names and dates of all surgeries
• For people receiving a transplant, the type of transplant, where it was received, and whether chronic graft-versus-host disease developed
• Names and dates of any significant complications and treatment received for those complications^[62]

With the treatment summary, experts hope that survivors will be better equipped to maintain 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

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.^[64] Young adults are required to have health 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.^[64]

Care

Studies among

Diet can also impact long-term mortality, with evidence across various cancer types.[76]^[77][78][79]

However, adherence to diet and exercise recommendations among cancer survivors is often poor.^[80][81][82]

Digital behaviour change interventions can be successful at increasing physical activity and may also help with diet in cancer survivors.^[83]

In breast cancer survivors, home-based multidimensional survivorship programmes have short-term beneficial impacts on quality of life and can reduce anxiety, fatigue and insomnia.^[84] Mindfulness-based survivorship programs may be an effective way to improve the mental health of cancer survivors.^[85][86]

Family members

Family members can be significantly affected by the cancer experience of their loved ones.^[87][88] For parents of children with cancer, finishing treatment can be a particularly vulnerable time. In the post-treatment period, some parents may experience increases in anxiety, depression and feelings of helplessness.^[89] A sub-group of parents report post-traumatic stress symptoms up to years after treatment completion.^[90] Evidence-based psychological interventions tailored to the needs of parents of childhood cancer survivors may assist parents in resuming their normal lives after their child has finished treatment.^[91]

Spouses of cancer survivors are more likely than other people to experience anxiety in the years after their partner's successful treatment.^[30] Being married reduces the cancer survivor's risk of developing post-traumatic stress disorder or other psychological difficulties, but it increases the risk of the spouse developing mental health symptoms.^[24]

See also

• Learning problems in childhood cancer
• Psycho-oncology

Notes

References