When Mary Ann was diagnosed with breast cancer, she quit her job to wage a full-time battle. Later, when she was told that she was cancer-free, she did a little dance in her living room.
About half of American males and one-third of females will battle cancer at some time in their lives; for most, it will be the toughest battle of their lives. After undergoing considerable stress, pain, fatigue and worry, about 64 percent of these persons will be alive five years after diagnosis–the official mark of victory.
Nearly 10 million Americans today can call themselves cancer survivors, and they deserve to feel proud. Yet, we can not afford to become complacent.
In addition to a higher than average risk of developing a second cancer or other health problems later in life, a survivor is likely to face a number of non-medical problems. Because of her cancer diagnosis, Mary Ann has not been able to get another permanent job or health insurance she can afford. Her treatment was expensive, and she struggles to make payments on the debt she incurred.
Cancer survivors have complex needs–physical, mental, emotional and financial–that frequently go unmet. What is needed is a coordinated effort on the part of health care professionals, insurers, advocates and the government to ensure that the victors get the long-term care and support they need.
Among the minimum requirements is a written follow-up care plan for each patient, telling the primary care physician precisely what treatments have been given and how they might affect the patient’s health now and in the future. Doctors and patients should know and be alert for the signs of recurrence, a second cancer or a late effect of treatment. And regular screening tests are crucial.
As for preventive measures, a diagnosis of lung cancer is a pretty definitive signal to quit smoking. For other cancers, the importance of positive health behaviors–diet, exercise, weight control, sunscreen use–may not be as obvious.
A 2005 study found that breast cancer patients who switched to a low-fat diet had a 24 percent reduced risk of having a recurrence within five years. Exercise has also been found to be beneficial to breast cancer patients.
About 61 percent of cancer survivors are over age 65. They and their doctors must find ways of integrating cancer care with the treatment of chronic medical problems such as heart disease, high blood pressure, diabetes, osteoporosis and arthritis.
Survivors of childhood cancers also make up a large group, and they have substantial risks that are not always apparent right away. By age 45, according to results of a long-term study, two thirds of childhood cancer survivors have at least one chronic medical problem. And in about half of these cases, the illness is severe and life-threatening.
About half of cancer survivors have been treated for either breast, prostate or colorectal cancers. Screening and early detection have greatly improved survival for these cancers, but treatment can and often does cause lingering effects to health, sexual function and self image.
One study found that 60 percent of prostate cancer survivors were dissatisfied with their sexual lives following treatment. Nearly one third of women successfully treated for breast cancer reported problems with sexual function. Doctors must be alert for signs that the patient may need psychosocial support or therapy.
Financial matters, which may take a back seat when a person’s life is on the line, add to the stress load. One survey found that nine percent of cancer survivors had debts of $25,000 or more and 11 percent of adult survivors under age 65 were going without health insurance. (Older survivors are protected somewhat by Medicare.)
Younger patients who quit their full-time jobs or lose them because of cancer-related disabilities may find it impossible to obtain affordable health insurance.
Once the celebration dance is over, the cancer survivor faces some difficult emotional and financial realities. With some assistance and the same determination that conquered cancer, this battle too can be won.
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