42
Cancer survivorship

A cancer survivor is thought of as someone who is living with or beyond cancer, but the term is widely interpreted as meaning someone who is alive in remission of their cancer following treatment. In the United Kingdom more than half of all adults diagnosed with cancer will be alive in remission 10 years later (46% of men and 54% of women). The 10-year overall survival following a diagnosis of cancer in adulthood has doubled in the last 40 years and it is estimated that there are over 1.1 million cancer survivors in the United Kingdom who are alive 10 years after their cancer diagnosis (Table 42.1).

These cancer survivors experience a large number of health-related issues both psychological and physical. The psychological issues encountered include the Damacles, Lazarus and guilt complexes discussed in Chapter 4. The physical health concerns encountered by cancer survivors include the late toxicities of treatment and infertility. These late toxicities are determined by the treatments administered as well as the age of the person when he or she receives the treatment. The late effects of treatment on a developing child are substantial. For example, radiotherapy can retard bone and cartilage growth, impair intellectual development and cognitive function and cause endocrine deficiencies of the thyroid gland and hypothalamus. Similarly, chemotherapy at any age may cause organ-specific damage such as pulmonary fibrosis, cardiomyopathy, peripheral neuropathy and nephrotoxicity that may be irreversible. The late toxicities of treatment include second primary cancers and infertility that are of major concerns to cancer survivors (see Chapter 3).

Cancer survivors face health-related discrimination and disadvantages that can seem as unjust as racial or sexual discrimination. Insurance weighting, mortgage loading and work sick leave questioning are everyday experiences of cancer survivors. It should be noted that it is not just the cancer survivor themselves that may experience psychological problems, but also their spouses and families who have higher levels of anxiety many years after the all-clear has sounded.

Most cancer survivors describe the process of living with cancer and enduring successful treatment as a life-changing experience and it is not uncommon for them to use the opportunity to transform themselves, either spiritually or emotionally. Cancer follow-up clinics are full of marathon running, charity donating vegetarians who foster neglected children. So cancer and its treatments can rarely be a force for good in this evil world. Your beloved authors wonder why it is necessary for a person to have cancer to value their days.