Survivorship
Experts use the word "survivor" for any person who has been diagnosed with cancer at any . Survivorship refers to the short- and long-term health and wellness concerns of people who have been diagnosed with cancer.
The effects of cancer and treatment begin at diagnosis but they can last long after treatment ends.
Follow-up care after treatment
Even after treatment ends, it is important for cancer survivors to receive ongoing follow-up care from a doctor who can address the issues listed above.
The National Comprehensive Cancer Network guidelines for cancer survivors recommend that they be checked annually by their oncologist or primary care doctor for special health issues, including:
- cardiovascular (heart) disease
- emotional distress
- (memory and thinking) issues and fatigue
- menopause symptoms
- pain
- sexual dysfunction
- sleep disorders
For many of the health issues listed above, exercising regularly, eating a balanced diet and maintaining an ideal body weight can improve health outcomes. Research on ways to improve health and quality of life in cancer survivors is ongoing.
After treatment, some oncologists provide their patients with a "survivorship care plan" that outlines the treatment the patient received and provides a list of recommended follow-up visits and care. It is very important that you speak with your doctor and have a plan for care after treatment ends, including:
- which doctors should you see, and how often?
- which tests should you have done, and when?
- who should you contact between appointments to report any symptoms or side effects?
Heart disease
People diagnosed with cancer have a greater risk for heart disease than people who have never been diagnosed. Some cancer treatments, including chest radiation, and certain chemotherapy and agents can cause heart damage. Other risk factors include early-onset menopause from treatment or surgery and a family history of heart disease. Researchers are also studying whether inherited mutations, including and , may affect the risk for heart disease.
NCCN survivorship guidelines recommend that cancer survivors be regularly checked for heart disease:
- Doctors should review patients' medical history and note any treatments that increase risk for heart disease.
- Doctors should check patients for other heart disease risk factors, including high cholesterol, diabetes, smoking, obesity and a family history of heart disease.
- Doctors should examine patients for signs of heart disease.
- Patients showing evidence of heart disease should have a complete cardiac exam, including imaging (e.g., echocardiogram), EKG and blood tests.
Because heart disease that is caught early is more treatable, it's important for cancer survivors to receive follow-up care for heart disease and to report to their doctor any shortness of breath, abnormal heart rhythm, chest pains or other symptoms.
function and fatigue
People diagnosed with cancer often report trouble with their memory and abilty to think clearly, also known as cognition. This change can persist even years after treatment ends. Chemotherapy and other treatments may effect memory; patients sometimes refer to this as "chemo-brain." Other factors, like early-onset menopause, stress and anxiety may also affect memory. In many cases, memory changes associated with cancer improve over time.
Like memory issues, fatigue is common in cancer survivors and can persist years after treatment. Many of the causes and approaches to fatigue are similar to those for memory.
NCCN guidelines recommend that doctors ask cancer survivors about changes in memory and thinking and their experience and level of fatigue as part of their regular visits. Patients who report changes or fatigue should be checked and treated for underlying causes including depression, sleep disturbance and medication side effects. The guidelines recommend that survivors limit alcohol and drugs that can affect memory, sleep quality and energy level.
Some research has shown a benefit from yoga, exercise, mindfulness, meditation and training. Research has shown some benefit from the medication Modafinil, a drug used to treat sleep disorders.
is fluid buildup and swelling that develops in the arms, legs or other part of the body, usually as a result of surgery that removes or radiation therapy. The swelling and fluid may be mild to severe and can cause pain, infection and loss of mobility.
Although symptoms of may not always be obvious, it is important for survivors, especially those who have had surgery, radiation or removed to report any persistent feeling of heaviness, pain or discomfort, muscle weakness, tightness or swelling to their doctor.
is usually managed with special massage and compression garments. This is most effective when it is caught early. In some circumstances, that progresses can be managed with surgery. The right type of weight training under supervision and physical activity do not worsen and in fact, may help to lower risk.
Sleep
Sleep is important to overall wellness. The NCCN recommends that doctors ask survivors about their quality of sleep and check for underlying medical causes of sleep disturbances. Sleep experts can help develop plans for treating sleep disorders, which may include behavioral therapy, strategies for improving sleep habits and medication.
Many cancer centers offer survivorship expertise and services, including fatigue clinics, sleep centers, experts, and pain management experts. Ask your doctor to refer you to experts who can address your symptoms and concerns. The following resources can help you find experts:
- The American Academy of Sleep Medicine's website SleepEducation.org includes a section on finding a sleep center by location.
- The American Physical Therapy Association's ChoosePT.com website allows you to search for a physical therapist in your area.
- Eatright.org, the website for the Academy of Nutrition and Dietetics, has an online tool to find a nutritionist in your area. You can search for nutritionists by specialty, including "cancer," "weight management" and "heart health."
- The National Certification Commission for Acupuncture and Oriental Medicine has a searchable directory of licensed acupuncturists.
- The Lymphatic Education & Resource Network has tips and tools for finding experts.
- The North American Menopause Society is an organization for menopause experts. Their website has a tool to help you find a qualified menopause expert in your area.
updated: 08/06/2022
The following studies are looking at management of side effects:
Multiple cancers
- NCT03581357: Mobile Mindfulness Meditation to Improve Neuropathy in Cancer Survivors. The studies a mobile app for cancer-related neuropathy in people with breast, colorectal, endometrial, pancreatic, and other cancers, who have finished treatment and are experiencing neuropathy.
- NCT02296450: Quality of Life (QoL) Assessment in Cancer Patients and Survivors With Dermatologic Conditions Using Dermatologic QoL Instruments. This large study is designed to see how skin conditions that are related to different kinds of cancer or cancer treatments affect a patient's overall well-being.
- NCT04262180: Physical Activity Promotion for Breast and Endometrial Cancer Survivors. This study is looking at whether messaging and coaching can increase activity level and how moderate-to-vigorous activity improves symptoms and quality-of-life in women diagnosed with breast or endometrial cancer.
- EnergyPoints: A Mobile App Guiding Use of Acupressure for Cancer-related Fatigue and Sleep Disturbances. This study is looking at the use of acupressure to manage cancer-related fatigue and sleep disturbances.
Breast cancer
- NCT04621721: Physical Activity at Home for Relief from Neuropathy Caused by Taxanes in People with Breast Cancer. This study will look at the effects of gain and balance training and resistance exercise (using bands) on gait, balance, and lower extremity muscle strength after a 16-week home-based exercise program compared to educational materials without an exercise program.
- NCT04586530: Telehealth and Memory Study (TAMS). The overall purpose of this trial is to confirm the effectiveness of Memory and Attention Adaptation Training (a cognitive-behavioral therapy) as a treatment for chemotherapy-related dysfunction among breast cancer survivors.
- NCT02290834: Chemotherapy-induced and brain changes in older adults with breast cancer. The study will investigate abilities and brain images before and after chemotherapy to identify people at risk for side effects and to better understand the effects of treatment on brain structure and function.
- NCT04906200: Web-Based Symptom Monitoring and Self-Management Portal for Adolescent and Young Adult Breast Cancer Survivors. This compares a web-based patient-reported symptom-monitoring and self-management portal to standard therapy in young breast cancer survivors.
- NCT04049695: Improving Cognition After Cancer (ICAN). This study will test whether physical activity can improve cognition in breast cancer survivors and help the development of physical activity guidelines for cognition in breast cancer survivors.
- NCT04086875: A Text-based Tool to Improve Adherence to Hormone Therapy in Patients With Hormone Positive Breast Cancer. This trial studies how well text messaging works to improve adherence to hormone therapy in people with breast cancer.
- NCT04837820: The Effect of Acupuncture on Cancer-Related Difficulties. This study will test whether acupuncture can improve thinking and insomnia in breast cancer survivors. This study will also look at insomnia's link to difficulties.
- NCT03996265: Bupropion in Reducing Cancer Related Fatigue in I-III Breast Cancer Survivors. This will study how well the drug bupropion (welbutrin) reduces cancer-related fatigue in I-III breast cancer survivors.
- NCT02831582: Omega-3 Supplementation to Prevent Aromatase Inhibitor-Induced in Patients With I-III Breast Cancer. This study looks at omega-3 fatty acid supplementation to prevent aromatase inhibitor-induced side effects in patients with I-III breast cancer.
- NCT03879629: TrAstuzumab Cardiomyopathy Therapeutic Intervention With Carvedilol (TACTIC). Breast cancer patients receiving Herceptin or other HER2-directed therapy are at risk of heart damage. This study is looking at whether beta-blocker drugs could help prevent this from happening.
- NCT01802346: Low Calorie Diet to Reduce Side Effects and Increase Response to Chemo in People With Breast or Cancer. This studies a low calorie diet to reduce side effects and increase response to chemotherapy in patients with breast or cancer.
Colorectal cancer
- NCT04763174: An mHealth Symptom Management Intervention for Colorectal Cancer Patients (mCOPE). The study will look at a mobile health tool to meet the multiple symptom needs and stage-of-life challenges faced by colorectal cancer survivors.
Endometrial cancer
- NCT04713618: Changes in Pelvic Health, Sexual Function, and Quality of Life in Women With Pelvic Cancer Undergoing Radiation Therapy. This study looks at changes in physical measures and patient-reported outcomes of sexual function, intimacy and quality of life.
- NCT04298827: Gyn Onc Prehab Study. This study will compare physical therapy, nutritional counseling and behavioral therapy with physical therapy alone as part of a prehabilitation program. Return of function after surgery, quality of life, patient satisfaction and compliance will be measured.
Ovarian cancer
- NCT04533763: Living WELL: A Web-Based Program for Ovarian Cancer Survivors. This studies a group-based and web-delivered tool for ovarian cancer survivors in increasing quality of life and decreasing stress, depressive mood, anxiety, and fatigue across a 12-month period.
- NCT05047926: Prehabilitation for Advanced Ovarian Cancer Patients. Prehabilitation may improve peri-operative outcomes in patients undergoing cancer surgery. This study will look at structured activity for women undergoing chemotherapy to improve their physical state prior to surgical intervention and thus improve outcomes.
cancer
- NCT03971591: Men Moving Forward: A Lifestyle Program for African-American Cancer Survivors (MMF). This study will look at Men Moving Forward (MMF), a community-based lifestyle intervention that supports adherence to nutrition and physical activity guidelines to promote improved body composition and lessen the side effects of treatment.
- NCT05155501: Pelvic Fascia spARing Radical Prostatectomy TrIAL (PARTIAL). This clinical trial is studying whether pelvic fascia-sparing radical prostatectomy has similar cancer control and sexual function outcomes; and significantly better urinary function, less penile deformity and inguinal hernia risks as compared to radical prostatectomy.
- NCT01802346: Low Calorie Diet to Reduce Side Effects and Increase Response to Chemo in People With Breast or Cancer. This studies a low calorie diet to reduce side effects and increase response to chemotherapy in patients with breast or cancer.
updated: 02/15/2023