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You have completed your cancer treatment and are ready to move
on with your life. You've gotten used to seeing your health care team
less often and things are getting back to normal. Maybe you feel you
are ready to go back to work or to become a more active member of your
household. You may still feel emotionally exhausted and tired from the
treatments you had. Maybe you feel tired in body and spirit and need a
long rest. You've just survived the biggest battle of your life, but
now the doctor tells you it's not over -- you haven't won the battle
yet. Your cancer has returned.
Once treatment is completed, many cancer survivors find they
have issues and concerns that they did not expect. The most significant
and devastating one is cancer recurrence.
What
is cancer recurrence?
A cancer
recurrence is defined as a return of cancer after
treatment and after a period of time during which the cancer cannot be
detected. (The length of time is not clearly defined.) The same cancer
may come back where it first started or in another place in the body.
For example, prostate cancer may return in the area of the prostate
gland (even if the gland has been removed), or it may come back in the
bones. Either situation is a cancer recurrence.
Recurrence or progression
Progression is when cancer spreads or gets worse. Sometimes it
is hard to tell the difference between recurrence and progression. For
example, if the cancer has been gone for only 3 months before it comes
back, was it ever really gone? Is this a recurrence or progression?
Chances are this is not a recurrence. It is likely 1 of 2
things happen in cases like this. One is that, in spite of what the
tests showed, all of the cancer was never completely gone. Sometimes,
even with surgery, small clusters of cancer cells that cannot be seen
or found on scans can be left behind. Over time they grow large enough
to be detected or cause symptoms. These cancers tend to be very
aggressive, or fast-growing.
The second possibility is that the cancer may be resistant or
refractory to treatment. Chemotherapy (chemo) or radiation may have
killed most of the cancer cells, but some of them were not affected or
changed to survive despite the treatment. Any cancer cells left behind
can then grow and show up again.
The shorter the period of time between when the cancer was
gone and the time it came back, the more serious the situation. Most
doctors would agree that 3 months of appearing to be cancer-free is too
short to be considered a recurrence if the cancer does come back. There
is no standard period of time within the definition of recurrence, but
most doctors consider a cancer to be a recurrence if you had no signs
of cancer for at least a year. If your cancer has been gone for only 3
months, this would most likely be a progression of your
disease. In this case, the doctors would assume that the cancer (even
though they could not find it in any of the tests) never totally went
away.
What are the types of recurrence?
There are different types of cancer recurrence:
- Local
recurrence means that the cancer has come back at the same
place where it first started.
- Regional
recurrence means that the cancer has come back in the
lymph nodes near the place where it started.
- Distant
recurrence means the cancer has come back in another part
of the body, some distance from where it started (often the lungs,
liver, bone marrow, or brain).
If you have a cancer recurrence, your doctor can give you the
best information about what type of recurrence you have and what it
means to have that type.
What is the risk of recurrence?
The risk of recurrence (or the chance that cancer will come
back) is different for each person. It depends on many factors,
including the type of cancer, the treatment you had, and how long it
has been since your treatment. Talk with your health care team or
doctor about your specific type of recurrence. You may find this
information reassuring or somewhat unsettling. Whatever information you
get, remember that each person's situation is unique, no matter what
statistics are given. There may be factors in your case that make your
situation different.
Could I have done something to prevent the
recurrence?
Although eating right, exercising, and seeing your doctor for
follow-up visits are important, please understand that there probably
was nothing you could do to keep your cancer from coming back. Many
patients blame themselves for missing a doctor visit, not eating right,
or postponing a CT scan for a family vacation. Yes, there are times
when it is crucial to keep follow-up appointments, especially if you
are having symptoms that you have not had before, because these may be
signs that your cancer is back. But even if you do everything just
right, you can't change the possibility that cancer will come back.
Sometimes people think taking certain vitamins, herbs, or
other dietary supplements will give them an extra edge in preventing
recurrence. But the available research does not support this belief. In
fact, some research has shown that supplements containing high levels
of single nutrients (more than the Dietary Reference Intakes and the
tolerable upper intake limits) may have unexpected harmful effects on
cancer survivors. To learn more about supplements, you may want to read
our document, Dietary Supplements: How to Know
What is Safe.
It would be very satisfying to have something we could use to
keep cancer from coming back after treatment. We want a real weapon to
fight back with -- something that will give us insurance against the
cancer coming back. Both doctors and patients wish that there were such
a magic potion or formula. But at this time there is nothing you could
have done to make sure the cancer would not come back. Even with our
current understanding of the process of cancer development and growth,
this disease is mostly a mystery and not within human control.
Some common questions about cancer
recurrence
Can a person ever be sure the cancer will
never come back?
No, it is not possible to guarantee that a person who has
completed cancer treatment will never have their cancer come back. Even
though your doctor may say, "Your cancer is gone," or "I think I
removed all the cancer," or "I see no evidence of any cancer," the fact
remains that there is always a chance that some cancer cells are left
in your body and survived, even though they cannot be seen or found
with any test used today. Over time, these cells can begin to grow and
cause your cancer to recur.
And while you don't want to ever think about the chance of
having a second cancer, this is also possible. Having one cancer
doesn't make you immune to having a second or even a third different
cancer.
Why is a "no-cancer guarantee" not possible?
A recurrent cancer starts with cancer cells that the first
treatment didn't fully remove or destroy. Some clusters of cancer cells
may have been too small to be found in follow-up tests, scans, or blood
work. This does not mean that you got the wrong treatment. It does not
mean that you did anything wrong after treatment, either. It means that
a small number of cancer cells survived the treatment you had. Over
time, these cells grew into tumors or cancer that your doctor could
finally detect as a recurrence.
Just as it happened the first time, there is also a chance
that some of your normal cells may, for any number of reasons, develop
the same damage in their DNA. (DNA holds genetic information on cell
growth, division, and function.) This damage then causes a gene (a small
segment of DNA) to change (mutate). When genes mutate, they can become oncogenes, which
allow cells to become cancer cells that divide too quickly and out of
control.
There is also something called a tumor suppressor gene,
which tells cells when to repair damaged DNA and when to die (a normal
process called apoptosis,
or programmed cell death). This gene is like the brake pedal on a car.
Just as a brake keeps a car from going too fast, a tumor suppressor
gene keeps the cell from dividing too quickly. When tumor suppressor
genes are mutated or turned off -- that is, when the brakes fail -- the
cells divide very fast, allowing cancer cells to develop. Changes in
tumor suppressor genes can be inherited (you are born with them), or
they can happen during your life. (See our document, Oncogenes and Tumor Suppressor
Genes for more information.)
Not all of the growth factors for cancer cells have been found
yet. Even though treatment may seem to have gotten rid of all of the
cancer, there may be just one tiny cancer cell left someplace in the
body. This cell may be "asleep" and not cause any harm for many years.
Suddenly, something can happen that will change the immune system and
"wake up" the cell. When it becomes active it can grow and make other
cells. The result is a cancer recurrence.
Cancer is not predictable. In some cases it will never come
back, but in some cases it will. No doctor can guarantee cancer will
stay gone forever.
What does it mean when they say "5-year
survival rate"?
The 5-year survival rate refers to the percentage of patients
who are alive at least 5 years after their cancer is diagnosed. Many of
these people live much longer than 5 years after diagnosis. The 5-year
rate is used as a standard way of discussing prognosis or the outlook
for survival.
You may also hear the term 5-year relative survival
rate. Relative survival compares survival among cancer patients to that
of people not diagnosed with cancer, but of the same age, race, and
sex. It is used to adjust for normal life expectancy when cancer is not
present. 5-year relative survival rates are considered to be a more
accurate way to describe the prognosis (long-term outlook) for groups
of patients with a certain type and stage of cancer. But they cannot be
used to predict individual cases.
Keep in mind that 5-year rates are based on patients who were
diagnosed and first treated more than 5 years ago. These statistics may
no longer be accurate because improved treatments often result in a
better outlook for those who were diagnosed more recently.
There is another point to remember when talking about survival
rates. Survival rates look at survival only, not whether the person is
cancer-free 5 years after diagnosis. They are based on a group of
people of all ages and health conditions diagnosed with a certain type
of cancer. These statistics include people diagnosed early and those
diagnosed late. As with any statistics, they should only be used to get
an idea of the overall picture. They cannot be used to predict any one
person's outcome.
Why won't the doctor say "You are cured"?
Most doctors avoid using the word "cure" because it implies
that your cancer is gone forever. As we have discussed, this is almost
impossible to say in any case of cancer. The best a doctor can do is
say that they can find no signs of cancer in your body at this time.
This is most often stated as "No evidence of disease." Your doctor may
continue to follow you closely for many years and do tests to watch for
any signs of cancer recurrence. Be aware that it is still possible for
cancer to come back even after you have been cancer-free for 5 years or
more.
What does it mean if the doctor says "Your
cancer is controlled"?
A doctor may use the term "controlled" if your tests or scans
show that your cancer is not changing over time. Another way of
defining control would be calling the disease "stable." Controlled
means that the tumor does not appear to be growing. Some tumors can
stay the same for a long time, even without any treatment. Some stay
the same size because of the cancer treatment and they are watched by
the doctor to be sure that they don't start growing again.
What does it mean if the doctor says "Your
cancer has progressed"?
If the cancer does grow, the status of your cancer would
change and your doctor might say that your cancer has then progressed.
Most clinical trials define a tumor as progressive when there is a 25%
measured growth in the tumor. (See the section, "What is cancer recurrence?"
for more on the difference between recurrence and progression.)
How is treatment response described?
Doctors describe a complete
response to treatment as that which completely gets rid of
all tumors that were able to be measured or seen on a test in some way.
The decrease in tumor size must last for at least one month to count as
a response.
In general, a partial
response means your cancer partly responded to your cancer
treatment, but still has not gone away. If you are in a clinical trial
this usually is defined more precisely. A partial response is most
often defined as at least a 50% reduction in measurable tumor. The
reduction in tumor size must last for at least one month to qualify as
a response.
How long will I be given treatment before
the doctor can tell if there is a response?
The treatment that is first prescribed is based on the last 20
to 30 years of clinical experience in treating that kind of tumor. But
no 2 cases are exactly alike, and response to treatment cannot always
be predicted.
Standard practice is to wait for 2 full cycles of treatment
before looking for any response to it. This usually takes about 2 to 3
months. Response is checked by repeating the tests that show the
cancer. If the tumor fails to respond to the first treatment, changes
will be made, perhaps to a chemotherapy combination that has shown
promise in similar cases.
Describing the response to treatment
Doctors describe a complete
response to treatment (also called complete remission) as
that which completely gets rid of all tumors that could be measured or
seen on a test. This does not mean the cancer has been cured. The
decrease in tumor size must last for at least 1 month to count as a
response.
A partial
response (or partial
remission) means your cancer partly responded to your
cancer treatment, but still has not gone away. If you are in a clinical
trial this usually is defined more precisely. A partial response is
most often defined as at least 50% reduction in measurable tumor. The
reduction in tumor must last for at least 1 month to qualify as a
response.
When cancer recurs
When cancer comes back it can be devastating for you and the
people closest to you. The medical work-up is difficult and all of the
emotions you had when you were first diagnosed can resurface -- even
stronger this time. You may feel more cautious, guarded, and less
hopeful than ever before. You may be disappointed in your body and your
health care team. Many issues and questions come with cancer
recurrence. We have tried to address the more common ones here.
Is it a recurrence or a new cancer?
"I had breast cancer. Now they say I have
liver cancer? How is that related to breast cancer? Is this a
recurrence?"
It is possible for you to have 2 different types of cancer,
but it is more likely that the first cancer has come back and spread to
a new area of your body, like your liver. When cancer spreads to a new
location in the body, it is said to have metastasized. The
new cancer growths in the new locations are said to be metastases. The
liver is a very common area of spread or metastasis in breast cancer,
along with the lungs, lymph nodes, brain, and bones (usually the ribs
and spine).
Tests will be done to be sure the recurrent cancer is the same
type as you had before. Even when cancer has spread to a new location,
it is still named after the part of the body where it started. For
example, if prostate cancer spreads to the bones, it is still called
prostate cancer, and if breast cancer spreads to the liver it is still
breast cancer. A person with breast cancer that has spread to the liver
is said to have breast cancer with liver metastases.
While it is not possible to predict how likely cancer is to
recur, experience has shown that aggressive cancers (those that are
fast growing), cancers that are more widespread, or those in later
stages are harder to treat and more likely to come back. Most types of
cancer have a typical pattern in which they recur -- your doctor can
tell you more about that if it is something you would like to know.
Treating recurrence
Many people want to do anything possible to treat cancer that
has come back. Your doctor will probably discuss several treatment
options with you. You may also decide to get a second opinion or get
your health care in a national comprehensive cancer center that has
more experience with your type of cancer. There are also usually
clinical trials offered for patients with a cancer recurrence.
It is very important to research your insurance coverage
options along with the medical care options you are thinking about. If
you need information quickly, please contact your American Cancer
Society directly at 1-800-ACS-2345 (1-800-227-2345). Cancer Information
Specialists are there 24 hours a day to answer your questions.
"Why can't I take the same treatment for my
recurrence as I did for my first cancer?"
Some people do end up having some of the same types of
treatment that they had for their first bout with cancer. For example,
a woman with breast cancer that recurs in the area of the original
cancer site may have surgery again to remove the cancerous tumor. She
may also get radiation therapy, especially if it had not been given
before. Next, she and her doctor may consider chemotherapy and/or
hormone therapy.
Treatment decisions are based on the type of disease, timing
of recurrence, location of the recurrence, extent of spread, your
overall health, and your personal wishes. For example, your doctor will
probably not suggest radiation or surgery for cancer that has spread
throughout the body because these local treatments can only treat
cancer that is in a limited number of places.
Another thing to think about is that cancer cells can become
resistant to chemo. Tumors that come back often do not respond to
treatment as well as the first tumors that were found. For example, if
the cancer came back within 2 years of getting chemo, it is possible
the cancer was able to grow despite the chemotherapy. It may be
resistant to this type of chemo and not respond as well as it did the
first time. Sometimes doctors will say, "You've already seen this drug,
so we will try another drug." This means that they feel that you have
gotten all the help you can from a certain drug and that another one
will probably better kill the cancer cells because it works in a
different way.
Sometimes your doctor will not want to use a certain drug
because of the risk of a certain side effect, or because you have had
that drug in the past. For example, certain chemo drugs can cause heart
problems or nerve damage in your hands and feet. To keep giving you
that same drug would risk making those problems worse or even lead to a
long-term side effect.
Ask your doctor why a certain course of treatment is
recommended for your recurrence at this time. Do you have 2 or 3
treatment options? Discuss these choices with your nurse or doctor,
with members of your support group, and especially with members of your
family. Only you can make the best decision for you.
"My doctor has recommended surgery for my
cancer recurrence but we can't schedule the surgery for a month and a
half. I want this thing out like yesterday! How long is too long to
wait -- how much will the cancer spread while I am waiting for the
doctor to work me into his schedule?"
While research is still being done on questions like this, for
most cancers there is some time, certainly a few weeks, before you must
make a decision about your treatment for recurrence. Remember that
cancer cells multiply and divide until they grow enough to form a tumor
or something that can be seen in a blood test or on a scan. This takes
time. Usually there is some time to make a thoughtful decision about
the right treatment option for you. Try not to panic when you learn
about recurrence. Talk to your doctor if you are worried about waiting
to start treatment. You may even want to take the time to get a second
opinion. And be sure to discuss all the available options with your
health care team and your family. You need to be comfortable with your
decision.
"Exactly what are the chances of treatment
working this time? What are the chances of my cancer coming back again
after this treatment? It seems like it will just go on and on and keep
coming back…."
This is a very normal question to ask but one that is very
hard to answer. There is no way to answer with exact percentages. The
answers depend entirely on your situation, and depend on many different
factors. Some of these include the type of cancer you have, the length
of time between the original diagnosis and recurrence, the
aggressiveness of the cancer cell type, your age, your overall health
status, how well you tolerate treatment, the length of time you are
able to take treatment, and the types of treatment you get.
Scientists are studying genetic tests that may predict how
likely it is that cancers such as breast, colon, and melanoma will come
back. For some types of cancer, there are formulas that can help
estimate the chance of recurrence. Prostate cancer is one type of
cancer for which recurrence projections can be made, based on stage and
grade of cancer at the time of diagnosis. For most people facing the
chance of recurrence, the uncertainty of dealing with recurrence cannot
be avoided. This is one reason recurrence is so hard to cope with.
There are no guarantees that you can hold on to.
What happens if treatment is no longer
working?
Sometimes the cancer keeps growing after one kind of
treatment, or it comes back. It is often possible to try another
treatment that might destroy the cancer or shrink the tumors enough to
help you live longer and feel better. When a person has had many
different treatments that did not help stop the cancer, it may mean
that it has become resistant to all treatment. At this time it's
important to weigh the possible limited benefit of a new treatment
against the possible downsides, including the stress of getting
treatment and the side effects that go with it. Everyone has a
different way of looking at this.
This is likely to be the toughest time in your battle with
cancer -- when you have tried everything available and it's just not
working anymore. Your doctor may offer you a new treatment, but you
need to consider that at some point, continuing treatment is not likely
to improve your health or change your survival.
If you want to continue treatment to fight your cancer as long
as you can, you still need to think about the chances that it will
help. In many cases, your doctor can estimate the response rate for the
treatment you are considering. Some people are tempted to try more
chemo or radiation, for example, even when their doctors say that the
odds of benefit are less than 1%. In this case, you need to think about
and understand your reasons for wanting this kind of treatment.
No matter what you decide to do, it is important that you be
as comfortable as possible. Make sure you are asking for and getting
treatment for any symptoms you might have, such as pain. This type of
treatment is called palliative
treatment.
Palliative treatment helps relieve cancer-related symptoms,
but it is not expected to cure the disease. Its main purpose is to
improve your quality of life. Sometimes, the treatments you get to
control your symptoms are much like the treatments used to treat
cancer. For example, radiation therapy might be given to help relieve
bone pain from bone metastasis. Or chemotherapy might be given to help
shrink a tumor and keep it from causing a bowel obstruction. But this
is not the same as getting treatment to try to cure the cancer.
At some point, you may benefit from hospice care. Most of the
time, this can be given at home. It can also be given in hospitals,
nursing homes, and hospice houses. Your cancer may be causing symptoms
or problems that need attention, and hospice is focused on your
comfort. You should know that getting hospice care doesn't mean you
can't have treatment for the problems caused by your cancer or other
health conditions, but you will need to find out in advance what your
hospice will do. Hospice is focused on helping you live your life as
fully as possible and feel as well as you can at this difficult time.
Remember that staying hopeful is also important. Your hope for
a cure may not be as bright, but there is still hope for good times
with family and friends -- times that are filled with happiness and
meaning. In a way, pausing at this time in your cancer treatment gives
you a chance to refocus on the most important things in your life. Now
may be the time to do some of the things you've always wanted to do.
How do people cope emotionally if the cancer
recurs?
Not everyone has the same emotions and thoughts when cancer
comes back. And not everyone has the responses shared here, but many
have concerns and questions like these.
"I am so angry and upset! My cancer was
gone! These are supposed to be my golden retirement years. Now I am
facing more treatment. It's all my doctor's fault."
It is understandable to be very upset when you are expecting
one thing to happen and the opposite does. The last thing anyone
expects is to have to go through more treatment for a cancer that they
thought was gone. It is normal to want to strike out at and blame
someone. A natural choice is your doctor. After all, this is the person
who treated you the first time and said you appeared to be cancer-free.
If you're like most people, you really wanted to believe that you'd be
cancer-free forever. Now you're hearing the bad news about your
recurrence, finding out about a new treatment plan, and here you are
going through this difficult time -- again.
You may feel that your doctor didn't do something right during
your first treatment. Maybe you think your doctor did not follow up
with you closely enough. Or maybe you feel you were not listened to as
closely as you should have been. Whatever your feelings, they must be
dealt with now. There are some things you can do to help resolve any
issues you have at this time. You might try discussing your concerns
with your doctor. See if you can clear up any bad feelings you have
about how your treatment was handled.
It is highly unlikely that any doctor would intentionally not
treat you (or anyone else) as well as possible the first time. When you
think about it that just doesn't make sense. Your doctors want you to
do well; this is what makes the doctor successful, too. But if you feel
it is not possible to work with your current doctor, it may be wise to
find a new one. You may find that a fresh start with a new health care
team will help you improve your attitude and feel better about your
current situation.
Feeling angry and upset about a cancer recurrence is
completely normal, and you might need support and someone to talk to
about these feelings. There are different sources for this type of
support. For some, their support community is their church or
synagogue. For others, a formal support group or online support group
can be helpful. Other cancer survivors in situations like yours can
understand and offer support like no one else. Still, some people
prefer the privacy of one-on-one counseling. Ask your friends, family,
or a trusted doctor for a referral. Just make sure that you are finding
an outlet for your feelings. You deserve to be heard.
Some degree of depression and anxiety is common in people who
are coping with cancer recurrence. But when a person is emotionally
upset for a long time or is having trouble with their day-to-day
activities, they may have a depression or severe anxiety that needs
medical attention. These problems can cause great distress and make it
harder for you to follow a treatment schedule.
Even if you are really upset and depressed about your
recurrence you have some things going for you.
- Depression can often be treated fairly quickly and
treatment usually works well.
- Improving your physical symptoms and taking action will
probably make your mood better.
- You have already been in a battle with cancer once and you
learned a lot along the way. Try the things you that helped you then.
Those same relationships and coping skills may help you now.
Family and friends should be alert for symptoms of distress.
If they notice symptoms of depression or anxiety, they should encourage
the person to seek the help of a health care professional. Anxiety and
clinical depression can be treated many ways, including medicine,
psychotherapy, or a both. These treatments can help the person feel
better and improve the quality of their life.
"I am only 35 years old. How am I supposed
to deal with cancer recurrence? I am too young to die."
Cancer is difficult at any age, but it is especially hard to
cope with when you are young and supposed to have a full, long life
ahead of you. Cancer recurrence may seem even more unfair then. Also,
cancer often is found to be more aggressive in the younger cancer
survivor. This aggressiveness means that it may tend to come back
earlier and be harder to treat.
Having a recurrence does not mean that you will die, but there
is no denying that this is something you must consider. It is a
terribly painful prospect, one that requires much thoughtful processing
and even preparation. First of all, a talk with your doctor can give
you some idea how realistic your fears and concerns are. Even when you
are healthy, it never hurts to be prepared for the chance you could
die. You will want to make provisions for your family if the worst
happens. You also need to get support that works for you so you can
talk about and express your feelings about this recurrence. Sometimes
our lives can have a purpose and meaning that we cannot see clearly. It
can be very helpful to discover that purpose and take pleasure from it
when it seems there is no hope.
Get support
A support group can be a powerful tool for both patients and
families. Talking with others who are in situations like yours can help
ease loneliness. You can also get useful ideas from others that might
help you.
"I tried going to a support group after I
was diagnosed with recurrence. Everyone in there was newly diagnosed. I
felt really out of place and like I was bumming everyone out. Plus I
didn't get any support..."
You can find support programs in many different formats, such
as one-on-one counseling, group counseling, and support groups. Some
groups are formal and focus on learning about cancer or dealing with
feelings. Others are informal and social. Some groups are made up only
of people with cancer or only caregivers while others include spouses,
family members, or friends. Other groups focus on certain types of
cancer or stages of disease. The length of time groups meet can range
from a set number of weeks to an ongoing program. Some programs have
closed membership and others are open to new, drop-in members.
It is very important that you gather information about any
support group you are thinking about joining to make sure that there
are patients in all phases of treatment, including some with recurrence
and disease progression. Ask the group leader or facilitator to tell
you what types of patients are in the group and if anyone in the group
is dealing with recurrence.
Another option for support may be online support groups. The
Cancer Survivors Network, an online support community supported by your
American Cancer Society, is just one example. (You can visit this
community online at www.acscsn.org.) There are many other reputable
communities on the Internet that you can join, too. You may also enjoy
a personal connection with a counselor who can give you one-on-one
attention and encouragement. Your doctor may be able to refer you to a
counselor who works with cancer patients.
Religion can be a source of strength for some people. Some
find new faith during a cancer experience. Others find that cancer
strengthens their existing faith or their faith provides newfound
strength. If you are a religious person, a minister, rabbi, other
leader of your faith, or a trained pastoral counselor can help you
identify your spiritual needs and find spiritual support. Some members
of the clergy are specially trained to help minister to people with
cancer and their families.
Spirituality is important to many people. Many people are
comforted by recognizing that they are part of something greater than
themselves, which helps them find meaning in life. Meditating,
practicing gratitude, and spending time in nature are just a few of the
many ways that people address spiritual needs.
Support in any form allows you to talk about your feelings and
develop coping skills. Studies have found that people who take part in
a support group have an improved quality of life, including better
sleep and appetite. You can contact your American Cancer Society to
find out about sources of support that are available in your area.
"I can't afford to have cancer again. Even
though I have insurance, the coverage is not very good. My deductible
is really high and my medicines cost a lot. I'm already working fewer
hours because my last treatment left me unable to think as quickly as I
could before. I feel really trapped. I can't afford not to have
treatment, but I can't afford to have it either..."
Financial support is often a very real concern for cancer
survivors facing recurrence. For many, as this survivor describes, the
problems began with the first cancer illness.
Hopefully, you have been able to keep your medical coverage.
Sometimes there are insurance options cancer survivors have that they
may not be aware of. Talk to your doctor, your facility's financial
counselors, or a social worker. You can also call 1-800-ACS-2345 for
help finding possible sources of financial assistance.
Treating cancer as a chronic illness
"My cancer has come back 3 times. I just
keep fighting, even though I know there's a good chance that treatment
won't make the cancer go away forever…."
Cancer may not be a one-time event. Cancer can come back a
second and third time. Cancer can even become a chronic (ongoing)
illness that never goes away completely. In some cases, especially with
certain cancer types, this is true. Although recurrent disease may not
be cured, it can often be controlled. In fact, there's always a chance
that your cancer will go back into remission. The natural tendency of
some cancers (for example, ovarian), is one of recurrence and
remission. Often, this repeating cycle of recurrence and remission can
translate into survival over many years during which the cancer can be
managed as a chronic illness.
Repeated recurrences, often with shorter time periods in
between disease-free intervals, can become discouraging and exhausting.
The question of whether to continue treating cancer that keeps coming
back is a valid one. Your choices about ongoing treatment are personal
and based on your needs, wishes, and abilities. There is no right or
wrong decision on how to handle this phase of the illness.
Still, it is important to know that even those who are not
cured of cancer may go on living for months or years, even though there
may be changes in their lives. For these people, cancer can be much
like diabetes -- a chronic illness that is mostly controlled with
treatment.
Having a recurrence does not put you beyond hope or help; you
may be living with a disease that can be treated or controlled. Keep in
mind that you can learn to live with cancer and remember the good news:
there are nearly 11 million Americans alive today who have had cancer
and the survival rate is improving all the time.
Additional resources
We have selected some related information that may also be
helpful to you. These materials may be viewed on our Web site or
ordered from our toll-free number.
- Financial Guidance for Cancer Survivors and Their Families:
No matter who you are, we can help. Contact us anytime, day or
night, for information and support. Call us at 1-800-ACS-2345 (1-800-227-2345) or
visit www.cancer.org.
References
Baker, F, Denniston, M, Smith, T, West, M. Adult Cancer
Survivors: How Are They Faring? Cancer
2005;104: 2565-2576.
Balboni TA, Vanderwerker LC, Block SD, et al. Religiousness
and Spiritual Support Among Advanced Cancer Patients and Associations
With End-of-Life Treatment Preferences and Quality of Life. J Clin Oncol.
2007;25:555-560.
Brussat F, Brussat MA. Spiritual
Literacy: Reading the Sacred in Everyday Life. New York,
NY; Simon and Shuster: 1996.
Hewitt, M, Greenfield, S, Stovall, E, eds. From Cancer Patient to Cancer
Survivor: Lost in Transition. Washington, D.C. The
National Academies Press; 2006.
Weissman, D. Fast Fact and Concept #14: Palliative
Chemotherapy. End of Life/Palliative Education Resource Center.
Accessed at
www.mywhatever.com/cifwriter/library/eperc/fastfact/ff14.html on
February 6, 2009.
Last Medical Review: 02/19/2009
Last Revised: 02/19/2009
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