When Cancer Doesn’t Go Away
Cancer isn’t always a one-time event. It can be a chronic (ongoing) illness, much like diabetes or heart disease. Cancer can be closely watched and treated, but sometimes it never completely goes away. This is often the case with certain cancer types, such as ovarian cancer, chronic leukemias, and some lymphomas. Sometimes cancers that have spread or have come back in other parts of the body, like metastatic breast or prostate cancer, also become chronic cancers.
- The cancer may be controlled with treatment, meaning it might seem to go away or stay the same, and it doesn’t grow or spread as long as you are getting maintenance treatment.
- Sometimes when treatment shrinks the cancer, you can take a break until the cancer starts to grow again.
But in either of these cases the cancer is still there – it doesn’t go away and stay away – it’s not cured.
How is chronic cancer described?
A doctor may use the term “controlled” if your tests or scans show that the cancer is not changing over time. Another way of defining control would be calling the disease “stable.” Cancers like this are watched closely to be sure that they don’t start growing.
The cycle of recurrence and remission
Most chronic cancers cannot be cured, but some can be controlled for months or even years. In fact, there’s always a chance that cancer will go into remission. There are different kinds of remission.
- When a treatment completely gets rid of all tumors that could be measured or seen on a test, it’s called a complete response or complete remission.
- A partial response or partial remission means the cancer partly responded to treatment, but still did not go away. A partial response is most often defined as at least a 50% reduction in measurable tumor. Here, when we refer to a remission it will generally mean a partial remission.
To qualify as either type of remission, the reduction in the size of the tumor must last for at least one month. There’s no way to tell how long a remission will last, so neither type of remission means the cancer definitely has been cured.
Some cancers (for example, ovarian), have a natural tendency of recurrence and remission. Often, this repeating cycle of growing, shrinking, and stabilizing can mean survival for many years during which the cancer can be managed as a chronic illness. Treatment can be used to control the cancer, help relieve symptoms, and allow you to live longer.
Cancers that is not changing may be called stable disease. When cancer grows, spreads, or gets worse it’s called cancer progression. When cancer comes out of remission it’s said to have progressed. In the case of chronic cancers, recurrence and progression can mean much the same thing.
Progression may be a sign that you need to start treatment again to get the cancer back into remission. If the cancer progresses during or soon after treatment, it may mean that the cancer has become resistant to the treatment you received. A different treatment may be needed.
Progression and recurrence occur when the treatment doesn’t kill all of the cancer cells. Even if most of the cancer cells were killed, some were either not affected or were able to change enough to survive the treatment. These cancer cells can then grow and divide enough to show up on tests again.
How is chronic cancer treated?
Most people want to do anything possible to treat cancer, whether it’s the first treatment or the second or third one. Your doctor will talk to you about your treatment options. You may also decide to get a second opinion or get treated at a comprehensive cancer center that has more experience with your type of cancer. There may be clinical trials available, too.
Some people get some of the same types of treatment that they had the first time (for instance, surgery or chemo), but some treatments may be less helpful as the cancer progresses. Treatment decisions are based on the type of disease, location of the cancer, amount of cancer, 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 your body because these local treatments can only treat cancer that’s in a limited number of places.
Over the long term, cancers are usually treated with chemotherapy (chemo) in 1 of 2 ways.
- Maintenance chemo is given on a regular schedule to keep the cancer under control. This may help delay progression and prolong survival.
- As another option, chemo may only be given when the cancer becomes active again. The cancer is watched closely with things like imaging tests and blood tests; chemo is started when things change.
Another thing to think about is that cancer cells can become resistant to chemo. The tumors that keep coming back often do not respond to treatment as well as the first tumors did. For example, if the cancer comes back within a year or 2 of getting chemo, it may be resistant to this type of chemo and another drug may be a better option. Sometimes doctors will say, “You’ve already had this drug, so we need to try another one.” This means they think you’ve gotten all the help you can from a certain type of drug and 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 before. For instance, some chemo drugs can cause heart problems or nerve damage in your hands and feet (this is called peripheral neuropathy). To keep giving you that same drug would risk making those problems worse or even lead to long-term damage.
Making treatment choices
Ask your doctor why a certain course of treatment is recommended at this time. Do you have 2 or 3 treatment options? Find out what you can realistically expect to happen with the treatments your doctor offers. Discuss these choices with your nurse or doctor, with members of your support group, and especially with members of your family. Then you can make the best decision for you.
“She may not be able to cure my cancer, but my doctor says she’ll help me buy as much time as possible. I’m good with that—I’ll take each day as it comes.”
-Stan, living with CML
How long can treatment go on?
This is a very normal question to ask, but one that’s very hard to answer. There is no way to answer with an exact time limit. The answer depends entirely on your situation and many different factors. Some of these include
- The type of cancer you have
- The treatment schedule or plan
- The length of time between cancer recurrences
- The aggressiveness of the cancer cell type
- Your age
- Your overall health status
- How well you tolerate treatment
- How well the cancer responds to treatment
- The types of treatment you get
Because there are no guarantees that you can hold on to, chronic cancer is hard to cope with. Talk to your doctor and the rest of your treatment team about any questions or concerns you have. They know your situation best and may be able to give you some idea of what to expect.
How do I know if I should keep getting treatment?
How much is treatment helping?
For some people, getting cancer treatment helps them feel better and stronger. It also helps control the cancer so they can live longer. But for others, being in treatment works the opposite way—they may reach a point where it only makes them feel worse. Side effects might keep you from enjoying the life you have left. Only you can decide how you want to live your life. Of course, you will want to know how your family feels about it, too. Their feelings are important since they are living through the cancer with you. But keep in mind, the final decision is yours.
Do the benefits outweigh the side effects?
When a person has had many different treatments that didn’t help stop the cancer, it may mean that it has become resistant to all treatment. At this time you might want 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. Talk to your cancer care team about what you can expect from treatment. They can help you make the best decision for yourself and your family.
Supportive care can be used with or without aggressive treatment.
Whether or not you want aggressive cancer treatment, there is always the option of supportive care. This is also called palliative care, and you can get it at any time. It’s used along with treatment to control symptoms such as nausea and pain, but it is better known for its role in promoting comfort when aggressive treatment is no longer working.
Palliative care is treatment of symptoms—it’s not expected to treat the cancer. It’s care that focuses on making your life the best it can be throughout cancer treatment. This means that symptoms like nausea, pain, tiredness, or shortness of breath are treated and controlled. Sometimes medicines are used, but other types of treatment may also be used. If you need help finding good palliative care options, call us for more information.
Hospice care can help when aggressive care stops.
If at some point aggressive treatment can no longer control the cancer or the benefits no longer outweigh the side effects, you may feel better with hospice care. The hospice philosophy accepts death as the final stage of life and does not try to stop it or speed it up. The goal of hospice is to help patients live as alertly and comfortably as possible during their last days. Most of the time, hospice care is given at home. It can also be given in hospitals, nursing homes, and hospice houses. Your cancer may cause symptoms or problems that need attention, and hospice focuses on your comfort. If you’d like to learn more about this, please see our document called Hospice Care.
What’s “normal” about living with cancer?
The first few months of cancer treatment are a time of change. But when you’re living with cancer that doesn’t go away you may feel like you’re stuck in this change—you don’t know what to expect or what’s going to happen next.
Living with cancer is not so much about “getting back to normal” as it is learning what’s normal for you now. People often say that life has new meaning or that they look at things differently now. Every day takes on new meaning.
Your new “normal” may include making changes in the way you eat, the things you do, and your sources of support. It may mean fitting cancer treatments into your work and vacation schedule. It will mean making treatment part of your everyday life—treatments that you may be getting for the rest of your life.
“Cancer is just part of my life now, and I always try to have hope.”
-Marisol, living with ovarian cancer
Repeated recurrences, often with shorter time periods in between remissions, can become discouraging and exhausting. It can be even more discouraging if the cancer never goes away at all. The question of whether to keep treating cancer that doesn’t go away or comes back again and again is a valid one. Your choices about continuing 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’s 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. Many families adjust to this kind of treatment schedule.
Having a cancer that cannot be cured does not put you beyond hope or help; you may be living with a disease that can be treated and controlled for a fairly long time.
Living with uncertainty
Here are some ideas that have helped others deal with the uncertainty and fear of cancer that doesn’t go away and feel more hopeful:
- Be informed. Learn what you can do for your health now and about the services available to you and your loved ones. This can give you a greater sense of control.
- Be aware that you do not have control over some aspects of your cancer. It helps to accept this rather than fight it.
- Be aware of your fears, but practice letting them go. It’s normal for these thoughts to enter your mind, but you don’t have to keep them there. Some people picture them floating away, or being vaporized. Others turn them over to a higher power to handle. However you do it, letting them go can free you from wasting time and energy needlessly worrying.
- Express feelings of fear or uncertainty with a trusted friend or counselor. Being open and dealing with emotions helps many people feel less worried and enjoy each day. People have found that when they express strong feelings, like anger and fear, they are better able to let go of these feelings. Thinking and talking about your feelings can be hard. If you find cancer is taking over your life, it may be helpful to find a way to express your feelings.
- Enjoy the present moment rather than thinking of an uncertain future or a difficult past. If you can find a way to be peaceful inside yourself, even for a few minutes a day, you can start to recall that peace when other things are happening—when life is busy, scary, and confusing.
- Make time for what you really want. You may find yourself thinking about all the things you’ve always wanted to do but never made time for. It’s OK to pursue these things, and don’t forget to enjoy everyday pleasures and have fun, too.
- Work toward having a positive attitude, which can help you feel better about life even if a cure is out of reach. Nearly everyone can find things to feel grateful for or hopeful about. But don’t try to be upbeat or positive all the time—no one is! You need to pay attention to your feelings, even the so-called “negative” ones. You’re allowed to have bad days and feel sad, angry, or grieve whenever you need to.
- Use your energy to focus on what you can do now to stay as healthy as possible. Try to make healthy changes in what you eat. If you are a smoker, this is a good time to quit, and encourage others to quit with you.
- Find ways to relax and enjoy time alone and with others.
- Exercise and be as active as you can. Talk with your doctor about what’s realistic for you.
Control what you can. Some people say that putting their lives in order makes them feel less fearful. Being involved in your health care, trying to find your “new normal,” and making changes in your lifestyle are among the things you can control. Even setting a daily schedule can give you more power. And while no one can control every thought, some say they’ve resolved not to dwell on the fearful ones.
Grief and loss
It’s normal to feel sad when you find out that the cancer cannot be cured. This sadness may not go away, even if you know that there’s a good chance you can live a long time with cancer. You now know that your life is likely to be shorter than you expected, and that you may have limits on what you can do. You may find yourself grieving the loss of what you thought would be your future. Cherished dreams and milestones suddenly become unlikely. This is hard for anyone to handle without emotional support.
Grief can affect a person physically, emotionally, and mentally. It can interfere with everyday activities. It takes time and energy to adjust to these major changes in your life. Many people find it helps to have people they can talk to about all these things. If no one comes to mind, you might want to think about finding a counselor or support group (see “Getting support” below).
Dealing with depression
Some degree of depression and anxiety is common in people who are coping with cancer every day. But when a person is emotionally upset for a long time and is having trouble with their day-to-day activities, they may have depression or severe anxiety that needs medical attention. These problems can cause great distress and make it harder for you to enjoy life and follow a treatment schedule.
Even if you are clinically depressed or anxious, you have some things going for you.
- Depression can often be treated and treatment usually works well.
- Improving your physical symptoms and taking action will probably make your mood better.
Anxiety and clinical depression can be treated many ways, including medicine, psychotherapy, or both. These treatments can help a person feel better and improve the quality of their life. Please see our document called Anxiety, Fear, and Depression to learn more about this.
Support in any form allows you to talk about your feelings and develop coping skills. Studies have shown that many people who take part in support groups have a better quality of life, including better sleep and appetite.
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 ideas that might help you from others who have had the same experiences. Contact your American Cancer Society to find out about sources of support in your area.
Types of support
You can find support programs in many different formats, such as one-on-one counseling, group counseling, and support groups.
Counseling. You may enjoy a personal connection with a counselor who can give you one-on-one attention and encouragement. It’s important to find a counselor who has had some training and experience in taking care of people with cancer. Your cancer care team is the best way to get names of counselors in your area. Another resource, the American Psychosocial Oncology Society (APOS), can connect you to a counselor, too. If you see a counselor and do not feel comfortable or safe talking with that person, call APOS and ask for other names. (See the “To learn more” for APOS contact information.)
Support groups. Some support 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 some 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’s very important that you get 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 cancer that can’t be cured. 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 cancer that doesn’t go away.
Online support groups may be another option. 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 http://csn.cancer.org/.) There are many other reputable communities on the Internet that you can join, too.
“Having someone to talk to who knows exactly how I feel is great. The people in my group understand like no one else can.”
-Ed, living with follicular non-Hodgkin lymphoma
Religion and spirituality
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 people with cancer and their families.
Spirituality is important to many people, even those who do not observe a traditional religion. Many people are comforted by recognizing that they are part of something greater than themselves, which can help them find meaning in life. The practice of forgiveness or performing small acts of kindness helps some people. Others meditate, spend time in nature, or practice gratitude—these are just a few of the many ways that people attend to their spiritual needs.
If it’s a struggle to find meaning in your life, or make peace with yourself, you may wish to spend time with a respected counselor or member of the clergy who can help you with this important work.
Family members, loved ones, and caregivers
You may worry about how your illness and care will affect your family and loved ones. This is a very tough journey to travel alone, and everyone needs help and support from those close to them. It can be hard to know how to start—who to talk to and what to say. You may want to read Talking With Friends and Loved Ones About Your Cancer. If there are children in your family, you may also want to read Helping Children With Cancer in the Family: Dealing With Recurrence or Progressive Illness.
You can call us to have free copies mailed to you, or read them online at www.cancer.org.
If you are part of a couple, your partner may step up and offer to help you get back and forth to treatment, go with you to doctor’s appointments, and help you deal with treatment side effects. Singles may need to find a friend or family member who can help in these ways. Whether they are spouse, partner, friend, or other relative, the person who helps you get your cancer treatments and manage side effects is called a caregiver. This is someone who wants to help and support you, but in order to do that they will need their own support and help. They can start by reading What It Takes to Be a Caregiver, and What You Need to Know as a Caregiver, or they can call us for more information at 1-800-227-2345.
Paying for cancer treatment
Finances are often a very real concern for people with cancer. Treatment costs a lot. Hopefully, you have been able to keep your health insurance. Sometimes there are insurance options that people with cancer may not be aware of. Talk to your doctor, your facility’s financial counselors, or a social worker. You can also call us at 1-800-227-2345 for help finding possible sources of financial assistance.
Some questions you may want to ask your doctor
- How long do you think I can live with this cancer? What is the range of survival times for people in my situation?
- How will I know if the cancer is getting worse?
- What do you think I should expect at this point?
- What symptoms do I need to watch for and tell you about?
- How often will I need treatment or need to see the doctor?
- What is the goal of treatment right now? Control of the cancer? Comfort?
- What tests will I need to have to watch for changes in the cancer?
- What can be done for symptoms I have (pain, fatigue, nausea)?
- Are there any support groups I can go to?
- How will I pay for treatment? Will my health insurance cover it?
Most people think of cancer as a disease that people get, have treated, and either are cured of or die from. When cancer is first found, the hope is for a cure. And for some people that hope is possible. But what many people don’t know is that there are a lot of people who have cancer, are treated, and aren’t cured—they live with cancer.
If the cancer has already spread, the hope may be that the cancer can be stopped or slowed down. There is hope for time, for being with loved ones, and finishing important tasks. Some people have cancer that can be controlled with treatment and they can live for a long time.
If treatment stops working, the hope may change again. It may be hope for time to prepare family and loved ones who will be left behind, for telling them what they have meant to you and what you hope for their futures. This can allow a deep closeness to the people you love.
There can also be hope for time to plan the end of your life—where you want to spend your last days and what you do and don’t want. This can ease the burden of uncertainty your loved ones may have about what to do and what you would want. Your clear plans can be a very important gift to them and help them be at peace with the hard choices they may have to make when you can no longer say what you want.
Whatever your hope is, find the support and help you need to try and make it happen. Living with cancer is different from living after cancer. And it’s becoming more common every day.
To learn more
More from your American Cancer Society
We have selected some related information that may also be helpful to you. These materials may be read on our Web site or you can order free copies from our toll-free number.
Coping with cancer and treatment
Anxiety, Fear, and Depression (also in Spanish)
Coping With Cancer in Everyday Life (also in Spanish)
Helping Children With Cancer in the Family: Dealing With Treatment (also in Spanish)
Advanced Cancer (also in Spanish)
Nearing the End of Life (also in Spanish)
Health care and insurance
Health Insurance and Financial Assistance for the Cancer Patient (also in Spanish)
Talking With Friends and Relatives About Your Cancer (also in Spanish)
For loved ones of a person with cancer
Caring for the Patient With Cancer at Home (also in Spanish)
No matter who you are, we can help. Contact us anytime, day or night, for information and support. Call us at 1-800-227-2345 or visit www.cancer.org.
To find a counselor
American Psychosocial Oncology Society (APOS)
Toll-free number 1-866-276-7443
Web site: www.apos-society.org
Leave a message with your name, phone number(s), patient’s city and state of residence, area code of the town where you are searching for a referral, and the patient’s cancer diagnosis. They usually find someone and call back within 24 to 48 hours. The Web site also has a lot of useful information, including books and videos.
Armstrong DK. Relapsed Ovarian Cancer: Challenges and Management Strategies for a Chronic Disease. The Oncologist. 2002;7(suppl 5):20−28.
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.
Markman M. Commentary: Implications of Cancer Managed as a “Chronic Illness.” Curr Oncol Rep. 2011;13:90−91.
Markman M. Maintenance Chemotherapy: An Evolving and Increasingly Acceptable Strategy in Cancer Management. Curr Oncol Rep. 2010;12:349−351.
McCorkle R, Ercolano E, Lazenby M, et al. Self-management: Enabling and empowering patients living with cancer as a chronic illness. CA Cancer J Clin. 2011;61(1):50−62.
Last Revised: 06/05/2012