Stages of survivorship: life after cancer

According to the US Centers for Disease Control and Prevention, the word 'survivor' was used to describe anyone surviving the loss of a loved one to cancer back in the days when cancer was pretty much regarded as incurable.

Over the years, oncologists started using a five-year timeframe to define survivorship: if your cancer didn't recur during the five years after either diagnosis or treatment, you were regarded as a 'survivor'. Regardless of your frame of reference, being a survivor is a unique experience for every cancer patient. There's only one thing in common: life will never be the same.

Stages of survivorship

Learning how to live as a survivor is an essential part of every cancer journey and your medical team will be able to guide you through all the possible emotional upheaval you may go through - and any other physical or mental challenges you may have.

Listen to Dr Inge Kriel share fascinating insights into cancer survivorship and the unique support she provides to patients in this phase of life, here.

Survivorship has become a highly specialized field and you'll be regularly monitored as you progress through the three acknowledged stages, first described in 1985 in “Seasons of Survival: Reflections of a Physician with Cancer,” by Dr Fitzhugh Mullan, a cancer survivor and physician. The stages are 'acute', 'extended' and 'permanent':

• Acute survivorship begins at diagnosis and extends to the end of your initial treatment. Dr Mullan describes fear, anxiety and pain resulting from both illness and treatment as 'important and constant elements of this phase'
• Extended survivorship begins at the end of your initial treatment (when you go into remission) and goes through the months after treatment. The effects of cancer and treatment are now the focus here:
  • Psychologically this stage is a time of watchful waiting, as you wonder if any symptoms may be signs of recurrence or just a part of your everyday life. When treatment is complete, diminished contact with your healthcare team can also cause great anxiety
  • Physically you may be learning to live with chronic side effects and accompanying anxieties right now
• Permanent survivorship is the period when years have passed since your treatment ended and recurrence seems less likely. Dr Mullan acknowledges that this stage is more complex than simply the status of your condition as you may still face social and economic challenges such as problems with employment and insurance, psychological challenges, the fear of recurrence, and secondary effects from previous cancer treatment.

Facing end-of-life care and dynamics

End-of-life dynamics might be relevant during any of the three above survivorship stages. End-of-life care affirms life and regards dying as a normal process. The goal of end-of-life care is to achieve the best possible quality of life for cancer survivors by controlling pain and other symptoms and addressing psychological and spiritual needs here.

Listen to our experts share fascinating insights into Palliative Care and the unique support that this form of care provides to cancer patients at any stage of their journey, here.