Are you a cancer survivor?
Due in part to an aging population and advances in early detection and treatment, more people are.
By 2035, more than 22 million people are expected to be living with cancer, up from about 18.6 million people as of January 1, 2025, says this report.
But cancer survivorship is a sensitive term that carries different meanings for different people.
And regardless of when someone starts thinking of themselves as a survivor, many have to live with the challenges that can occur as a result of diagnosis and treatment.
“Getting people the high‐quality care they need after active treatment is so important,” says Jennifer A. Tabiri, MSN, APRN, who works together with Michael L. Pearl, MD and Ilana Cass, MD, in the Gynecological Cancer (Gyn-Onc) Program.
Below are their answers to questions about how survivorship care programs can help you deal with the challenges you may face as someone living with cancer.
1. What is cancer survivorship?
There is no consensus about when survivorship starts.
According to one study, close to 40% of respondents defined survivorship as beginning on the day of diagnosis, while 34% believed the period of survivorship begins after patients have completed active therapy and are in remission.
What matters is not when survivorship starts but addressing the challenges that can come as a result of cancer diagnosis and treatment.
2. What are these challenges and how can a cancer survivorship care program help?
Challenges that may occur with diagnosis, treatment, and long afterward can be medical, emotional, psychological, and even social. Many patients also have co-morbid or simultaneous conditions that cancer and treatment can make worse. Lifestyle and relationships can also be impacted, and family members can feel that impact, too.
A survivorship care program can help address these challenges when structured correctly, says this report. The report also suggests that because survivors are at risk for recurrence and developing other cancers, surveillance and prevention can be an important part of survivorship programs. So, too, may be coordinated care for both survivors and their families.
Tabiri, Pearl, Cass, and others stress that treatments can affect survivors of adult-onset cancer in the longer term in other ways. Complications and conditions may include premature mortality, chronic illness, and a lower quality of life. A well-structured, comprehensive survivorship care program can help identify, manage and sometimes prevent these longer-term effects, as well as provide support.
Once more, in rural areas, challenges can be harder to address due to age of population, lower socioeconomic status, transportation challenges, and education, reports this study.
A survivorship care program can assist here, too.
3. How exactly is survivorship care different from active treatment?
Active treatment refers to any intervention aimed at directly treating the cancer itself. This treatment includes therapeutic approaches such as surgery, chemotherapy, radiation therapy, and immunotherapy. The goal is to eliminate cancer cells, reduce tumor size, and control the spread of the disease, according to Cancer Science.
Survivor care, says The National Cancer Institute, focuses on the health and well-being of a person with cancer from the time of diagnosis until the end of life. Or put another way, this care, says the Institute, includes managing the physical, mental, emotional, social, and financial effects of cancer. It also includes issues related to follow-up care (including regular health and wellness checkups), later effects of treatment, cancer recurrence, second cancers, and quality of life. Family members, friends, and caregivers are also considered part of the survivorship experience.
4. What are some of the specific emotional challenges and social-emotional needs of survivors and can a survivorship care plan address those?
Emotional challenges can include fear of recurrence, anxiety, depression, loss of control, and changes in body image. You might also experience a change in sense of worth or purpose, grief, survivor’s guilt, and difficulty with relationships, personal and professional. A survivorship care plan can provide the resources and support that can help you manage and address these challenges.
5. How is a survivorship care plan structured?
A survivorship care plan includes a comprehensive record of your cancer history and follow-up care recommendations. This record may include:
- Contact information for providers
- Diagnosis and identification of stage of cancer
- Details about treatment type — such as surgery, chemotherapy, radiation, transplantation, hormone therapy, or others — with beginning and ending dates
- A listing of potential emotional effects and available support services
- Possible long-term effects of treatment and symptoms
- Recommended cancer screenings and other recommended testing and follow-up appointments
- Wellness advice around diet, exercise, self-care, and smoking cessation, when applicable.
The record will help identify specific care needs and the resources to best meet them.
6. What are the benefits of being in this survivorship care program?
Survivorship care at Dartmouth Cancer Center is individualized based on your health and wellness needs, type and stage of cancer, treatment received, and national guidelines. Our goal is to assist your return to wellness and to transition your care, as a cancer survivor, to your primary care provider.
More specifically, we can help address:
- Late and long-term effects of cancer and treatment, such as neuropathy, fatigue, cognitive changes, menopausal symptoms, and sexuality
- Psychosocial issues, such as fear of recurrence, body image, transportation, and finance
- Wellness issues, such as nutrition, exercise, smoking/alcohol/drug use, and health screening
- Emotional challenges
7. Are there specific issues that are addressed in your Gyn-Onc survivorship care program?
Studies suggest common issues for all cancer survivors may include anxiety, fatigue, cognitive changes, changes in bowel patterns, peripheral neuropathy, skin changes, and psychosocial issues.
More specific issues common to gynecologic cancer survivors include sexual side effects, menopausal effects, and fertility issues. The Gyn-Onc survivorship program strives to address those.
8. What resources and services are available?
Our survivorship care program includes:
- Complementary self-care options include chair massage, creative writing, healthy eating, Reiki, acupressure, therapeutic harp, visual arts, gentle chair yoga, healthy steps for women, Qigong, and self-hypnosis.
- Exercise options
- Financial services
- Neurocognition, under our Neurocognition Program, helps patients overcome difficulties in cognitive function that may result from cancer treatment
- Oncology nutrition, including Healing Harvest, which is a program that provides a nutritious bag of groceries to patients navigating treatment, and in-person cooking demonstrations
- Palliative care
- Psychosocial oncology
- Research
- Spiritual health
- Thriving Thursdays program, offered in partnership with the American Cancer Society, provides a variety of services related to the challenges and opportunities of cancer survivorship.
- Tobacco cessation
- Physical therapy, such as pelvic floor therapy
- Reproductive endocrinologist and infertility specialist care
9. Is there more information you can provide about your Gyn-Onc Survivor Care Program?
How it works
Ideally, we strive to blend surveillance for the specific cancer diagnosis with comprehensive care targeted to optimize gynecologic health and wellness. Cancer treatments can impact gynecologic health and lead to intimacy or pelvic floor side effects that we strive to seek to improve. This can mean partnering with patients to create a safe space to discuss issues, ask the right questions, and normalize topics that women may feel uncomfortable exploring with providers who do not understand cancer diagnoses and treatments.
How often
The frequency of visits depends on the individual’s issues. It may be one consultative visit with us and a patient’s local provider. It could include additional follow-up. It also could entail more problem-solving and further discussion.
How long does the program last
Duration is determined by cancer surveillance guidelines and symptoms, and the Gyn-Onc team serves as your advocate for care and wellness. For patients with non-gynecologic cancers but with gynecologic issues (such as breast, colon, and genitourinary cancers), we work in partnership with your existing care team to make suggestions, discuss possible appropriate referrals, and serve as an intermittent resource.