Life After Cancer Harvard Health

A HARVARD MEDICAL SCHOOL
SPECIAL HEALTH REPORT
Life After Cancer

Preserving your health and well-being after treatment
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LIFE AFTER CANCER
SPECI A L HE A LT H REPORT
Medical Editor
Contents
Ann Partridge, MD, MPH What does it mean to be a cancer survivor? . . . . . . . . . . . . 2
Director, Adult Survivorship Program,
Dana-Farber Cancer Institute Long-term and late effects of treatment. . . . . . . . . . . . . . . . 5
Professor of Medicine, Harvard Medical School Cardiovascular disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Executive Editor Lung disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Anne Underwood Infertility, early menopause, and sexual issues . . . . . . . . . . . . . . 7
Writer Fatigue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Stephanie Watson Sleep problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Copy Editor Brain fog . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Robin Netherton Diabetes and other endocrine issues . . . . . . . . . . . . . . . . . . . . 12
Creative Director Nerve damage (neuropathy) . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Judi Crouse Hearing loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Production/Design Manager Bladder and urinary issues . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Susan Dellenbaugh Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Scars and body image issues. . . . . . . . . . . . . . . . . . . . . . . . . . 15
Published by Harvard Medical School
Gregory D. Curfman, MD, Editor in Chief Creating a survivorship care plan. . . . . . . . . . . . . . . . . . . . 16
Urmila R. Parlikar, Senior Content Editor
Keeping track of your medical records. . . . . . . . . . . . . . . . . . . . 16
IN ASSOCIATION WITH Your survivorship care plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Belvoir Media Group, LLC, 535 Connecticut Avenue,
Norwalk, CT 06854-1713. Robert Englander, Chairman Cancer’s aftermath—emotions, work, finances. . . . . . . . . . 19
and CEO; Timothy H. Cole, Executive Vice President, Anxiety and depression. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Editorial Director; Philip L. Penny, Chief Operating
Officer; Greg King, Executive Vice President, Marketing Director; How to deal with your emotions. . . . . . . . . . . . . . . . . . . . . . . . . 20
Ron Goldberg, Chief Financial Officer; Tom Canfield, Vice Financial and work issues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
President, Circulation. Health insurance concerns. . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Copyright © 2017 by Harvard University. Permission is Effects on your family and relationships. . . . . . . . . . . . . . . . . . . 24
required to reproduce, in any manner, in whole, or in part, Will the cancer come back? Living with uncertainty. . . . . . . . . . . 25
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The goal of materials provided by Harvard Health Publications Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
is to interpret medical information for the general reader.
This report is not intended as a substitute for personal medical
advice, which should be obtained directly from a physician. Cover Image: © Ridofranz | Thinkstock
Dear Reader,
If you are reading this report, chances are you are among the 15.5 million people in the United
States who currently consider themselves cancer survivors. Or you are the spouse, child, parent,
or concerned friend of someone who is a cancer survivor.
“Survivor” is a powerful word. As defined by some medical groups, it refers to anyone who has
ever been diagnosed with cancer, from the earliest stages of treatment through the final days of
hospice care—and applies to their loved ones and caregivers as well. Others define it more nar-
rowly, as we do in this report. It means that you have survived the first active phase of treatment
and have been able to resume your life. Perhaps treatment has slowed or stopped your cancer
growth, and you need only monitoring for the time being. Or perhaps you’ve reached a plateau
that you can maintain with long-term treatment. Or maybe you have conquered your disease and
received a clean bill of health from your doctor. All of these meet the definition.
No matter where you are in your cancer journey, you have undoubtedly faced some of the most
difficult challenges you’ve ever experienced. You’ve had to come to terms with the frightening
reality of your own mortality. You’ve undergone treatments that took a great toll on your emo-
tional and physical well-being. And you likely had to step away—at least temporarily—from
your day-to-day life to deal with this imminent threat.
Now that you are a survivor, your challenges have shifted, but they have not disappeared. As
you enter this next phase of your journey, you will encounter more obstacles ahead. The same
treatments that likely saved your life might have left residual effects that could threaten your
health again one day. Your cancer may have left physical—and emotional—scars that have yet
to heal. And your experience as a cancer patient may have put strain on your relationships that
will require time and effort to fix.
This Special Health Report was designed to guide you through the next stage of your cancer
journey. It will walk you through many of the issues you’ll face in the upcoming months and
years—the long-term and late effects of your cancer and treatment; the potential for a recurrence
or new cancer; the emotional, occupational, and financial issues you’ll potentially face; and the im-
plications for your family and friends. You’ll learn how to readjust to the life you may have put on
hold during your treatment, transitioning back to your full work and home life. And you’ll learn
ways to maintain your health to prevent new problems, including cancer, from taking hold again.
Sincerely,
Ann Partridge, M.D., M.P.H.

Medical Editor
Harvard Health Publications | Harvard Medical School | 4 Blackfan Circle, 4th Floor | Boston, MA 02115
What does it mean to be a cancer survivor?
I n 2016, more than 15.5 million people in the United

States could call themselves cancer survivors. That is,
more than 15.5 million people had heard their doctor
Counter to an overly simplistic cured-or-not-
cured scenario, cancer survival extends across a large
spectrum of physical states. Often, we consider in our
say three of the most foreboding words in the Eng- definition of survivors people who’ve been treated for
lish language—“You have cancer”—and lived to tell cancer and who don’t currently have evidence of dis-
the tale. This army of millions survived breast cancer, ease, but are being monitored and possibly treated to
prostate cancer, lymphoma, melanoma, kidney can- ensure the cancer doesn’t return. It can also include
cer, colorectal cancer, leukemia, and dozens of other people whose cancer is proceeding at a slow enough
malignancies. pace to warrant surveillance over active treatment.
However, the word “survivor” can be somewhat And it can encompass those who are on lifelong
misleading, because the designation doesn’t neces- therapy for a long-term but manageable cancer like
sarily mean that you’re cancer-free. “Although the chronic myeloid leukemia.
binary notion of cure versus non-cure is understand-
ably appealing to everyone concerned with cancer,
most agree that it is not an accurate characterization The need for a broader definition
of the experience,” wrote physician and cancer sur- Cancer experts began searching for a new lexicon to
vivor Fitzhugh Mullan in The New England Journal describe patients in the 1980s, when treatments had
of Medicine in 1985. “The vagaries, phases, and syn- improved to the point where more and more people
dromes of survival are far more complex than that were surviving their cancer and treatments (see Fig-
simple idea suggests.” ure 1, page 3). Pulling through, however, did not mean
that everything went back to the
way it had been before. Once the
initial cancer had been subdued,
people found themselves with a
whole new range of issues to con-
tend with. There were late-appear-
ing effects of cancer treatment,
from heart and lung problems to
infertility, fatigue, and memory
complaints. There were also emo-
© Monkey Business Images | Thinkstock
tional challenges to overcome,

including fears of a recurrence.
And there were interrupted lives to
restart—returns to husbands and
wives, children, and careers.
In 1986, an advocacy organiza-
More and more Americans are living past their initial cancer diagnoses. Survivorship, tion called the National Coalition
however, brings new sets of challenges—from the aftereffects of treatment to potential for Cancer Survivorship (NCCS)
problems with work, finances, relationships, and the emotional fallout of the disease. put forth a broad definition that
2 Life After Cancer w w w.h ealt h .ha r va r d.e du
changed the description of the cancer patient from your treatment to ensure that you have the best pos-
“victim” to “survivor.” In the category of survivor, it sible outcome.
also included the people who surround and support Once your primary treatment ends, the map—
the person with cancer. The NCCS’s definition has now and your guides—can suddenly vanish. You may be
been incorporated into the National Cancer Institute’s left without a clear medical coordinator to help you
website: “An individual is considered a cancer survi- navigate the vital follow-up care you’ll need in the
vor from the time of diagnosis, through the balance of months and years ahead. “Lost in transition” is how
his or her life. Family members, friends, and caregiv- the Institute of Medicine of the National Academies
ers are also impacted by the survivorship experience of Science, Engineering, and Medicine describes the
and are therefore included in this definition.” way people often feel as they encounter the convoluted
Many other institutions use the term “survivor” passage from cancer patient to survivor.
more narrowly. At Harvard-affiliated Dana-Farber Historically, this transition has been so often
Cancer Institute, it is used to describe people who undirected because doctors themselves had few guide-
have completed the first phase of treatment, which has posts to help them chart their patients’ paths forward.
slowed or stopped the growth of their cancer or effec- While medical students learned the latest cancer treat-
tively removed all traces of the disease. This report ment breakthroughs, they didn’t get any training on
also uses the more narrow definition of survivor. how to steer patients through follow-up care. Cancer
Either way, the new concept of survivorship has organizations similarly didn’t offer any guidelines on
served an important function. As the idea took root, the transition process. As a result, many people were
cancer organizations began to devote more time and thrust back into the hands of a primary care physician
resources to addressing survivors’ needs and helping who was only tangentially aware of their treatment
them address the issues that loom after treatment, as and its potential consequences. Many were forced to
they transition beyond the realm
of full-time cancer patient. In
1996, the National Cancer Insti- Figure 1: Cancer survivors—yesterday and today
tute launched its Office of Cancer 30
2040
Survivorship. Many cancer cen- Projections 26.1 million
ters around the country, includ- 25
ing Dana-Farber, have started
their own survivorship programs. 20
2016
15.5 million
Millions
The transition from 15
patient to survivor 10
Cancer treatment is an all-con- 1975
3.6 million
suming journey that follows a
5
very specific and detailed road
map. Your doctor charts your
treatment protocol, and then 0
1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040
a team of oncologists, nurses,
surgeons, radiation therapists, Advances in screening and treatment have dramatically improved the outlook for cancer
psychologists, social workers, patients and the likelihood of surviving cancer. In the 1970s, fewer than four million people
in the United States were considered survivors. Today that number exceeds 15 million. By
and other specialists guide you
the year 2040, it is projected to reach more than 26 million.
every step of the way. They plan, Adapted from Bluethmann SM, et al. “Anticipating the ‘Silver Tsunami,’” Cancer Epidemiology, Biomarkers &
administer, and then monitor Prevention (July 2016), Vol. 25, No. 7, pp. 1029–36.
ww w. h ealt h . h ar v ar d . e du Life After Cancer 3

oversee their own care, coordinating the efforts of • monitoring for cancer recurrence and new cancers
their cancer specialists and other providers to ensure • screening for late and long-term side effects of
they received all the medical visits and screening tests your cancer treatments
they needed. • implementing lifestyle changes to help you stay
The good news is that survivorship care is healthy
improving, and the remaining gaps in care are being • coordinating care from your various providers
addressed. Today, universities are conducting research • addressing your financial, insurance, and employ-
on how best to care for survivors, and cancer orga- ment concerns
nizations like the American Cancer Society and the • deciding whether family members should be
National Comprehensive Care Network are releasing screened for cancer-causing genetic mutations, if
guidelines to steer survivorship care. you have an inherited form of cancer.
To meet all of these needs, you’ll need guidance
Your continuing care needs from, and coordination among, a multidisciplinary
In your transition from cancer patient to survivor— team of experts. You may want to work with your doc-
and over the long term—you’ll have many physical, tor to create a personalized survivorship care plan that
emotional, and practical needs that have to be met. details specifically what kind of care you’ll receive,
These include when you’ll get it, and who will provide it.
• getting counseling and support to deal with the You will find information about all these topics in
emotional effects of your cancer and its treatment the following chapters.
Long-term and late effects of treatment
I n the early part of the 20th century, a cancer diag-

nosis often resulted in a dire prognosis. Even when
tumors could be removed surgically, they often
live longer than ever before, often remaining cancer-
free over the long term. Yet there is also a downside.
Many of these treatments cause side effects that can
returned. Then in the late 1940s, Harvard Medi- manifest months or years later. Some of these side
cal School pediatric pathologist Sidney Farber dis- effects are minor, but others can be life-altering, or
covered that a vitamin D–related compound called even life-threatening. Here are two terms you will
aminopterin killed leukemia cells and put children need to know:
with the disease into remission. Dr. Farber’s discov- • Long-term effects are side effects or complications
ery helped usher in a new age of cancer treatment. that start during treatment and continue after it is
Today, the oncologist’s armamentarium includes completed. Nerve damage (neuropathy), fatigue,
chemotherapy, hormonal therapy, radiation, immu- and sexual dysfunction are examples of possible
notherapy, targeted treatments, and a number of long-term effects.
experimental therapies that are currently being tested • Late effects don’t become evident until months or
in clinical trials. even years after treatment ends. These can include a
These advances have enabled cancer patients to secondary cancer or heart disease.
Monitoring for long-term and late
effects of cancer treatment is a lifelong
Table 1: Types of heart disease linked to cancer treatment endeavor that involves a team of spe-
Cancer treatments can cause or increase your risk for these heart conditions,
cialists (see “Specialists who treat health
among others.
problems in cancer survivors,” page 6).
TREATMENT HEART CONDITION
As your treatment is drawing to a close,
Radiation Atherosclerosis (hardening of the arteries) sit down with your oncologist and ask
Coronary artery disease which long-term and late side effects you
Heart valve damage are likely to experience, when you might
Myocarditis (inflammation of the heart muscle) encounter them, and which specialist you
Pericarditis (inflammation of the membrane around the heart) should see if you do have these effects.
Also find out who will make the referrals
Chemotherapy Blood clots
to specialists—your oncologist or your
High blood pressure
primary care provider? Or will you have
Irregular heartbeat
to make the calls yourself?
Myocardial ischemia (reduced blood flow to the heart)
Pulmonary hypertension (high blood pressure in the lungs)
Immunotherapy Myocarditis (inflammation of the heart muscle) Cardiovascular disease
Hormone therapy Blood clots Chemotherapy and radiation use power-
Heart attack ful doses of medicine and x-rays, respec-
Stroke tively, to kill cancer cells. When these
treatments are delivered directly to your
Targeted therapy Atherosclerosis (hardening of the arteries)
chest—for example, in the treatment of
Cardiomyopathy (heart muscle disease)
breast or lung cancer—they can cause

Specialists who treat health problems in
cancer survivors
A s you move from cancer patient to survivor, you’ll still need

a team of health care providers to manage the long-term
and late side effects of your treatment and keep watch for a
recurrence. Here are some of the specialists you might see:
Oncologist: The specialist who originally treated your cancer
and who will follow you for many months or years to check
for side effects and cancer recurrence.
Oncology nurse: A health care professional who monitors
your health and serves as the main line of communication
It takes a team of doctors to get you through your initial
© Cathy Yeulet | Thinkstock

with your oncologist.
treatment. But as a survivor, you will also consult a variety of
Primary care provider: Your family doctor, who oversees
specialists to help monitor your condition.
your general health care and works in coordination with your
oncologist to manage your cancer follow-ups.
Pain specialist: A doctor or nurse who can help you manage
Survivorship care provider: A medical doctor (M.D.), nurse the pain of your cancer or its treatments.
practitioner (N.P.), or physician assistant (P.A.) who focuses on
Palliative care specialist: A medical professional who can
caring for cancer survivors, usually at specialized cancer centers.
help you manage cancer side effects like nausea, pain, and
Psychologist or psychiatrist: A mental health provider who fatigue.
can help you deal with the emotional impact of your cancer
Wound care nurse or enterostomal therapist: A nurse
and its treatment.
or other health care professional who will teach you how to
Cardiologist: A specialist who treats problems related to care for your wounds or for an ostomy (a surgically created
the heart and blood vessels, some of which may be caused opening through which wastes are removed from your body
by cancer treatment (see “Cardiovascular disease,” page 5). into a bag).
Some larger hospitals have cardio-oncology programs that
In addition, you may also encounter a number of other health
partner oncologists with cardiologists to treat short- and
care providers, including these:
long-term cardiovascular issues stemming from chemothera-
py and radiation treatments. Dietitian: An expert in nutrition who can help you plan a
healthy diet and manage any food aversions you experience
Endocrinologist: A specialist who can help you manage
as a result of your treatment.
hormonal conditions related to your treatment, such as
diabetes and hypothyroidism. Some larger centers have onco- Genetic counselor: A professional who can help you under-
endocrinology centers to address the specific hormonal needs stand your personal and family risk of cancer.
of cancer patients. Occupational therapist: A therapist who can help you
Neurologist: A specialist who can help with issues related recover the skills you need to manage in daily life, such as
to your brain and spinal cord, including memory loss, nerve balance and fine motor skills.
damage, and lingering cognitive issues that may result from Physical therapist: A professional who uses exercises and
treatment (see “Brain fog,” page 10, and “Nerve damage,” other therapies to help you regain mobility and function
page 13). you’ve lost from cancer and its treatments.
Otolaryngologist: A doctor who treats hearing loss and Sex therapist: A mental health professional who can counsel
other conditions that affect the ear, nose, and throat, includ- you on issues that are interfering with your sex life.
ing those related to cancer treatment.
Another person who may be an important part of the process
Pulmonologist: A specialist who treats lung conditions, in- in some centers is a patient navigator—someone who can
cluding lung damage caused by chemotherapy and radiation help you understand your condition and your doctor’s recom-
therapy. mendations so that you can make more informed decisions.
Urologist: A doctor who treats the urinary system, including The navigator will also help you coordinate tests and other
incontinence in both men and women, as well as the repro- medical appointments, connect you with the resources you
ductive system in men. Both systems can suffer long-term and need, and deal with health insurance and other issues that
late effects from cancer and its treatment. could be barriers to your care.
lasting damage to your heart (see Table 1, page 5). ent, your doctor might suggest that you undergo one
And if you already had heart disease before your can- or more of these tests:
cer diagnosis, cancer treatments could make certain • an echocardiogram, which uses sound waves to cre-
drugs you use to treat it, like clopidogrel (Plavix) or ate pictures of your heart
warfarin (Coumadin), less effective. • an electrocardiogram (ECG), which checks the
Types of heart disease that have been linked to electrical activity of your heart
cancer treatment include the following: • a multigated acquisition (MUGA) scan of the
Coronary artery disease is a narrowing and heart’s lower chambers to make sure they’re pump-
hardening of the arteries that supply blood to your ing properly
heart. Narrowed arteries don’t allow as much blood • blood tests to measure levels of substances like
through, which means your heart can’t get the oxygen brain natriuretic peptide (BNP) or troponin, which
it needs to keep pumping soundly. Untreated coronary can show how well your heart is working.
artery disease can lead to a heart attack, which causes
permanent damage to the heart muscle.
Irregular heartbeat (arrhythmia) is an uncoordi- Lung disease
nated heart rhythm. Normally, the heart pumps in a Chemotherapy and radiation to the chest can also
familiar lub-dub pattern. Electrical signals cause the damage the lungs (a problem called pulmonary toxic-
upper chambers (atria) to contract, followed by the ity), particularly if you received both treatments or if
bottom chambers (ventricles). An irregular heartbeat you already had lung disease before your cancer diag-
occurs when these signals happen too quickly, too nosis. Cancer treatment can cause the lungs to swell
slowly, or at an abnormal pace. An arrhythmia can and thicken, making it harder for them to take in oxy-
prevent your heart from pumping enough blood out gen—and harder for you to breathe. The cancer drugs
to your body. most likely to cause lung damage are
Heart failure means your heart is too weak to • arsenic trioxide (Trisenox)
pump out enough blood to meet your body’s needs, • bleomycin (Blenoxane)
making you feel dizzy and short of breath. Some che- • carmustine (BiCNU)
motherapy drugs can cause heart failure soon after • idarubicin (Idamycin)
you start on them. • methotrexate (Trexall).
High blood pressure is an increase in the force If you have symptoms like shortness of breath,
of your blood pushing against your artery walls as it cough, fatigue, or discomfort when you exercise or
pumps through your body. Cancer drugs called angio- lie on your back, tell your doctor. A chest x-ray, lung
genesis inhibitors, which prevent the formation of function tests, and tests to measure the oxygen levels
blood vessels that feed a tumor, can cause dramatic in your blood can reveal a lung problem. Lung toxicity
increases in blood pressure. is treated with steroids to bring down swelling; oxygen
You’re more likely to have heart problems after therapy; and pulmonary rehabilitation, a program that
cancer treatment if incorporates breathing techniques, exercise, diet, edu-
• you’re age 65 or older cation, and support.
• you received high doses of chemotherapy
• you received radiation to the chest
• you took one of these cancer drugs: cyclophospha- Infertility, early menopause, and
mide (Neosar), daunorubicin (Cerubidine), doxo- sexual issues
rubicin (Adriamycin, Doxil), epirubicin (Ellence), If you’re treated for cancer before or during your
pertuzumab (Perjeta), or trastuzumab (Herceptin). reproductive years, one important consideration is
If you have symptoms of a heart problem, or to what effect those treatments will have on your ability
check for problems before symptoms become appar- to have children in the future.

Infertility tect the ovaries from damage during chemotherapy.
Cancer treatment can affect fertility in both men and Estrogen production should resume once you stop
women. In men, radiation to the pelvis and testicles or these medicines.
the use of chemotherapy drugs can damage the cells
that develop into sperm. Surgery or radiation for pros- Early menopause
tate or testicular cancer may affect your ability to pro- Women who have treatment that permanently dam-
duce sperm, ejaculate, or have erections. And radiation ages their ovaries—whether surgery, radiation, or
or surgery to some parts of your brain may reduce or chemotherapy—will enter menopause immediately,
block hormones that control sperm production. meaning their ovaries no longer produce estrogen.
In women, surgery to remove both ovaries or the Not only does this mean they can no longer conceive
uterus will prevent a future pregnancy. Women who a child naturally, but they may also have to contend
have surgery to remove their ovaries will immediately with menopausal symptoms like hot flashes, night
go into menopause (see “Early menopause,” at right). sweats, vaginal dryness, and mood changes.
If you have radiation to your pelvis, it can damage Your gynecologist can help you combat these
your uterus in a way that prevents it from supporting symptoms with treatments like hormone replace-
a growing baby and may also damage your ovaries. ment therapy, vaginal estrogen cream, nonhormonal
Radiation or surgery to certain parts of your brain can vaginal lubricants and moisturizers, or antidepressant
disrupt hormones that trigger your ovaries to release drugs, as well as behavioral strategies (dressing in lay-
an egg each month. Chemotherapy can also damage ers, using fans, exercises, meditating). Women with a
the ovaries because it destroys rapidly growing cells, history of hormone-sensitive cancer (e.g., estrogen or
such as the cells that produce eggs. progesterone receptor–positive breast cancer) are gen-
The chemotherapy drugs most likely to affect erally advised to avoid using hormone replacement
fertility in either men or women are and stick with nonhormonal strategies.
• busulfan (Busulfex, Myleran)
• carmustine (BiCNU) Sexual issues
• chlorambucil (Leukeran) Cancer treatment can also erase your desire for sex,
• cisplatin (Platinol) which can have significant effects on your relationship
• cyclophosphamide (Neosar) with your partner and on your self-esteem. Many can-
• doxorubicin (Adriamycin) cer patients say that of all the treatment side effects
• lomustine (CeeNU) they experienced, they were most blindsided by the
• mechlorethamine (Mustargen) changes to their sex life. Breast, prostate, and gyneco-
• melphalan (Alkeran) logic (uterine, ovarian) cancer treatments can be par-
• procarbazine (Matulane). ticularly devastating to sexual desire and intimacy.
There are methods to preserve your fertility, but Men may not be able to get an erection or achieve
they generally work best if you start them before your orgasm because of surgery or radiation that dam-
treatment. Men can bank their sperm or use protective ages the nerves that control erection or ejaculation.
measures to guard their testes from radiation damage. Women may experience vaginal dryness that makes
Women can freeze their unfertilized eggs or fertilized sex painful. People of either sex might have little inter-
embryos. Depending on the stage and type of your est in sex because of the stress associated with their
cancer, you may opt for surgery that preserves one of treatment; side effects like nausea, pain, or fatigue; or
your ovaries and your uterus or strategies that shield body changes (such as weight gain, breast removal, or
your ovaries from the harmful effects of radiation. hair loss) that make them feel less attractive.
Some hormone-based therapies like goserelin Although talking about sex—even with your doc-
(Zoladex) and leuprolide (Lupron) temporarily block tor—can be embarrassing, it’s an important conversa-
the ovaries from producing estrogen and may pro- tion to have. Your doctor can address the issues that
are coming between you and your partner—including see “A survivor’s story: William J. Trainer,” below.)
erectile dysfunction, menopause, fatigue, pain, and Cancer fatigue can reflect several factors, includ-
body changes. Women who experience pain during ing the treatments you received as well as stress, sleep
sex might try vaginal estrogens, nonhormonal lubri- problems, medications, pain, poor nutrition, and other
cants and moisturizers, or dilation therapies to widen factors related to your disease. The fatigue that accom-
the vaginal opening. Men with erectile dysfunction panies cancer isn’t your average, everyday tiredness. It
can try medications like tadalafil (Cialis) or sildenafil drains you of energy, makes your arms and legs feel
(Viagra) or a pump device to help them achieve erec- like lead, and doesn’t relent, no matter how many hours
tions. You might also try couples therapy with a thera- you sleep. Cancer fatigue can disrupt your daily life,
pist who specializes in treating sex and relationship making it impossible for you to work or spend time
issues in people who’ve had cancer. with friends and family. What’s worse, the fatigue can
Also remember that you can stay close to your continue many years after your treatment has ended.
partner though other forms of intimacy, like cud- Try these strategies to manage fatigue:
dling and kissing. Be open and honest with each • Take short naps or rest breaks during the day.
other about your desire to be intimate. • Prioritize the things you need to do, and take care
of the most important ones first.
• Conserve energy by breaking big tasks (such as
Fatigue cleaning your house) into smaller ones (dust one day,
Fatigue is one of the most common and debilitating sweep the floors the next). Ask friends and family for
aftereffects of cancer and its treatment. (For example, help getting through your daily responsibilities.
A survivor’s story: William J. Trainer
W illiam J. Trainer, a mechanical contractor in Cranston,

R.I., awoke one morning in 2010 to find a pea-sized
lump on his left collarbone. He assumed he’d picked up a bug
three kids, and my wife was a stay-at-home mom. My income
stopped when I was unable to work. That added the stress of
worrying about money and paying bills.”
from one of his three children, but within a couple of days, the To relieve his side effects, Trainer turned to a variety of thera-
lump had doubled in size. A visit to his doctor confirmed his pies. He tried several different medications to bring down the
worst fears—he had Hodgkin’s lymphoma. swelling, and he had both hips replaced. To ease his fatigue,
He subsequently underwent a battery of treat- he used massage, acupuncture, and nutritional therapy,
Cancer ments—chemotherapy, radiation, surgery, including drinking a lot of water. Gradually, the inflammation
survivor rituximab (Rituxan), and a stem cell trans- and fatigue began to recede. Exercise, particularly swimming,
plant. The treatments were grueling, and so was especially helpful. “I would swim in the ocean a lot
were many of their side effects. “Some time because it was no-impact, and there was a lot of buoyancy,”
after getting the rituximab, the joints in my knuckles, hands, he says. “That gave me so much relief.” It took some time, but
toes, ankles, hips, and spine started to experience extreme today he’s back to work and free from the side effects that
inflammation,” he recalls. “By the end of an eight-hour work- plagued him during treatment.
day I would struggle to step into my vehicle and struggle to In 2013, Trainer was officially declared a survivor, and he
walk up the four steps to my house.” He also had to address transferred to follow-up care in the Cancer Survivorship Pro-
fatigue, which was severe enough to disrupt his work. “I’d gram at Dana-Farber Cancer Institute, where he had received
have to find a place to rest and close my eyes. I would feel his treatment. Now 52, he returns to Dana-Farber every six
like everything in my body was shutting down,” he says. months for blood tests and to check in with his nurse practi-
A workaholic by nature, Trainer had to take three separate tioner in the Survivorship Program.
leaves of absence from his job to accommodate his treat- Despite the ordeals of his cancer and its treatment, Trainer has
ments and their associated side effects. The longest period he been able to see a positive side to his experience. “I met amaz-
was out—when he had his stem cell transplant—lasted nine ing people who I wouldn’t have otherwise met—an amazing
months. The time off (and the resulting loss of income) took a hospital staff, medical team, and a community that came out
serious toll on his family’s finances. “I was married with to support me,” he says. “It showed me the best in people.”

• Exercise. Though you might feel too tired to drag diazepam (Valium) short-term. Just be mindful that
yourself out of bed, a brisk walk, game of tennis, or these drugs can give you a hangover feeling the next
swim will give you more energy to face the day and day, and some of them can be addictive. Sleep medi-
help you sleep better at night. cines should be used only for a few weeks and only
• Eat foods that give you energy. Fresh fruits, vegeta- under your doctor’s care. Over-the-counter sleep aids
bles, whole grains, and lean protein (fish, chicken, can also cause grogginess and other side effects. Ask
eggs, tofu) will give you the right mix of nutrients. your doctor before trying any sleep medicine, even a
Drinking plenty of water throughout the day can supplement like melatonin.
also fight fatigue. You’ll be less reliant on sleep aids and more likely
• Tell your cancer team that you’re tired. You might to have restful nights if you adopt better sleep habits
have an underlying condition, like anemia, that’s like these:
treatable. Your doctor can prescribe medicine to • Try to establish a sleep schedule. Go to bed at the
help you sleep better or give you more energy, if same time each night and wake up at the same time
you need it. each morning, even on weekends.
• Exercise. Thirty to 60 minutes of aerobic exercise
daily can improve the quality of your sleep and give
Sleep problems you more energy during the day. Just don’t work
Up to half of cancer patients report insomnia, which out too close to bedtime, because the activity could
can last for two to five years after their treatment ends. wind you up too much to fall asleep. Morning exer-
The treatments themselves can cause sleep problems, cise offers the greatest benefit to sleep.
as can the pain, nausea, and anxiety that accompany • Before bed, do something relaxing, like reading a
many treatments. Drugs to help manage side effects book or listening to soft music.
can also make you toss and turn throughout the night. • Keep your bedroom cool, dark, and quiet.
Poor sleep isn’t normal, and it’s not healthy. With- • Dress for bed in light, loose fabrics. Layer sheets
out a solid seven to nine hours of slumber nightly, and blankets so you can remove them if you’re hot.
your body won’t get the downtime it needs to heal • Avoid stimulants like caffeine close to bedtime.
from the effects of your cancer and treatment. If sleep • Don’t eat a heavy meal before bed.
issues keep you awake three or more nights a week,
talk to your doctor. Disrupted sleep might be a mani-
festation of a larger cognitive issue (see “Brain fog,” Brain fog
at right) that needs to be addressed. Your doctor can If you feel mentally “fuzzy” these days, it’s not your
identify problems like pain that could be keeping you imagination. Up to 75% of cancer patients have
awake and help you find ways to improve your sleep. cognitive issues during their treatment, and 35%
One method used to foster better sleep in cancer continue to struggle with memory, attention, and
survivors is cognitive behavioral therapy, which helps thinking afterward (see “A survivor’s story: Daniel
you change your sleep habits and reverse negative Platte,” page 11).
thoughts that are contributing to your insomnia. You Cognitive issues can manifest in many ways. You
can also try a relaxation technique like meditation, might be unable to remember words, names, or phone
deep breathing, guided imagery (picturing a calming numbers you could once recall easily. You could have
scene), or progressive muscle relaxation (alternately trouble concentrating on your work and difficulty
tensing and then relaxing the muscles from your head remembering what you’ve just read. It could take you
to your feet). much longer to complete tasks that involve a multi-
You could try a sleep aid such as zolpidem step process, like cooking dinner or organizing your
(Ambien) or an antihistamine that causes drowsi- taxes. Your judgment, reasoning, organizational, and
ness. Or you could go on a benzodiazepine drug like language skills can all suffer.
You might have heard the term “chemo brain” fatigue, insomnia, anxiety, depression, and stress can
to describe the fog that descends after cancer also contribute to mental fogginess.
treatment. Chemotherapy can contribute to these Your doctor can do a number of tests to evaluate
symptoms, but so can radiation, hormone therapy, your cognitive function and look for any declines in
surgery to the brain, anesthesia (in older people), your memory or thinking abilities. One way to treat
and some of the medications you took to relieve can- these issues is with a program called cognitive reha-
cer side effects. Cancer treatments disrupt the activi- bilitation. This consists of a series of mental exercises,
ties of nerve cells in your brain that are responsible which you might do on a computer to improve your
for tasks like memory, attention, processing, and memory, attention, and concentration skills.
executive functions such as planning and organiz- Another technique used to treat chemo brain is
ing. Vitamin and nutrient deficiencies and the stress called electroencephalography biofeedback, or neu-
of living with cancer can also take their toll on your rofeedback. A device called an electroencephalogram
ability to think clearly. And cancer side effects like lets you see a readout of your brain activity. Over time,
A survivor’s story: Daniel Platte
I n 2015, Daniel Platte was a 55-year-old, highly successful

director of sales for Micron Semiconductor living in New
Hampshire. He’d always been athletic and healthy, but while
forced to take a break from work and had to go on disability
to support his family.
His relationships also suffered. “I ignored friends. I ignored
he was on a business trip to Boise, Idaho, he suddenly fell ill.
family. I wasn’t returning calls,” he says. The physical stamina
“People told me I looked like I was having a heart attack. My
that had made him an avid runner, biker, and skier took a hit.
skin had turned gray. I was short of breath. They said, ‘You
“I’m probably half the guy I was mentally and half the guy I
should really go to the hospital,’” he recalls. It wasn’t a heart
was physically prior to this bout of acute AML,” he says.
attack. Doctors at St. Luke’s Boise Medical Center told Platte
he had acute myeloid leukemia (AML) and that his outlook was Now 58, Platte is working hard to regain both his physical
grim. “The head oncologist walked in and said, ‘Dan, you are and mental agility. He walks and does power yoga daily to
way down the road with this leukemia. There’s not much we retrain his muscles. “Physically, my goal is to be able to ride
can do for you.’ He said, ‘You have three to four days to live.’” 100 miles again,” he says. “I want to be able to ride around
the perimeter of Yellowstone National Park with my son.”
Refusing to accept this death sentence, Platte
Cancer returned home and started treatment at To improve his mental skills, he regularly sees a psychologist,
survivor Harvard-affiliated Dana-Farber Cancer Institute and he’s started taking part in a cognitive rehabilitation ther-
and Brigham and Women’s Hospital in Boston. apy program at Massachusetts General Hospital. The program
While he was in the hospital, Platte did is designed to help patients like Platte develop strategies to
everything he could to stay healthy and strengthen his body’s improve or compensate for skills they’ve lost, such as atten-
defenses against the cancer. “I’ve been a very physical person tion, learning, memory, planning, organization, and problem
all my life,” he says. “I wrestled for 12 years. I played hockey. solving. “We’re going to hopefully get my brain to ‘light up’ a
I’ve skied, hiked, and ridden my bike. I refused to give up on my little better. And the skills I’ve lost, hopefully I can learn other
body.” So there, in his hospital room, he devised an exercise ways to get to the same end,” he says.
plan. “I was in this little space at Brigham and Women’s Hos- Some of his intellectual skills are already beginning to reap-
pital—37 steps to one door and 37 steps to the other door,” pear. Where he once found it difficult to sustain the give-and-
he says. “I would walk 7,000 to 10,000 steps a day that way. I take required to engage in phone conversations, he’s starting
focused on getting healthy and fighting the cancer with walk- to feel mentally agile enough to return his friends’ and
ing and yoga.” After several rounds of chemotherapy and a co-workers’ calls. “After a 15-minute conversation, I would
bone marrow transplant, he defied his original prognosis, going literally have to rest for 45 minutes,” he says. “Now I can
into full remission. have a conversation and just take a breather and do some-
While Platte gained a new lease on life, things did not return thing else.” He’s not content to remain at this level, though.
to normal. As a result of “chemo brain” and post-traumatic “My goal is to get back to the cognitive level I was at, where
stress disorder (see “Cancer’s aftermath—emotions, work, I could run a $500- to $750-million territory; manage 50
finances,” page 19), he lost many of the cognitive skills that salespeople, 50 engineers, and all the customer relations; and
had enabled him to become a top sales professional. He was negotiate contracts.”

you learn how to gain control over cancer treatment can disrupt the
and change that activity to boost your normal transmission of hormones
mental function. and interrupt their various func-
A couple of medications have tions. This hormone disruption
been investigated for improving can lead to conditions like hypo-
mental function in people with can- thyroidism, diabetes, metabolic
cer. The neurostimulants methyl- syndrome, and osteoporosis.
phenidate (Concerta, Ritalin) and
modafinil (Provigil) are both used to Hypothyroidism
© Wavebreakmedia Ltd | Thinkstock

treat problems with focus and atten- A number of cancer treatments—
tion in people with attention deficit including radiation to the neck,
hyperactivity disorder. Small studies tyrosine kinase inhibitor drugs,
have suggested they might improve thyroid surgery, and stem cell
these and other mental functions in transplants—can disrupt the func-
cancer patients, but the research con- tion of the thyroid gland in the
Up to 35% of cancer survivors continue
ducted so far hasn’t proved they work neck. Because thyroid hormone
to struggle with cognitive problems after
for cancer-related cognitive issues. treatment is over. Cognitive rehabilitation is responsible for keeping your
To combat cognitive issues on a programs can help. More informal mental metabolism running at a healthy
day-to-day basis, try these tips: challenges like crosswords may help, too. pace, many of your body’s pro-
• Focus on only one task at a time. cesses slow down if your thyroid
• Use tools like a digital calendar, to-do list, daily can’t produce enough of its hormone. This condition
organizer, or sticky notes to help you remember is called hypothyroidism. Symptoms include fatigue,
upcoming tasks. dry skin, weight gain, increased sensitivity to cold,
• Do brain-training activities like crossword puzzles forgetfulness, and constipation. Your doctor can check
or Sudoku, learn a new language, or play an instru- your thyroid hormone level with a simple blood test
ment to strengthen your brain’s connections. and treat the problem with a synthetic form of the thy-
• Get plenty of rest. roid hormone levothyroxine (Levothroid, Synthroid).
• Exercise. Aerobic exercise, whether it’s riding a bike
or taking a walk, sends more oxygen-rich blood to Diabetes
fuel your brain. When you’re active, you’ll feel more Diabetes is a problem with your body’s blood sugar
alert and less fatigued. regulation. Normally when you eat, your blood sugar
rises; this signals your pancreas to release insulin,
which ferries sugar from the blood into your cells to
Diabetes and other endocrine issues be used as energy or stored. In diabetes, either your
Hormones are the chemical messengers that con- pancreas doesn’t produce enough insulin (type 1 dia-
trol a variety of functions throughout your body. For betes), or your body’s cells become resistant to insu-
instance, growth hormone regulates growth and cell lin’s effects (type 2 diabetes). As a result, your blood
reproduction. Thyroid hormone oversees metabolism. sugar stays too high for too long, which can damage
Insulin and glucagon regulate blood sugar levels. your eyes, kidneys, nerves, and other organs.
The release of these hormones is directed by a Several cancers, including those of the pancreas,
feedback system overseen by the hypothalamus in the liver, and colon, may increase your risk for both types
brain. The hypothalamus directs the actions of the of diabetes. Radiation, chemotherapy, and steroid
pituitary gland, which instructs the various glands medicines can also cause treatment-induced diabe-
throughout your body to release their hormones. But tes. Dietary changes, exercise, and insulin therapy can
damage to these and other endocrine glands during treat diabetes triggered by your cancer or its treatment.
Metabolic syndrome Nerve damage (neuropathy)
Metabolic syndrome isn’t one disease, but a cluster of Chemotherapy drugs, in their haste to destroy quickly
disorders—high blood pressure, abdominal obesity, dividing cells, can damage the nerves that carry sen-
high triglycerides, high cholesterol, and high blood sory messages from your brain and spinal cord to your
sugar—that together put you at increased risk for heart body. Radiation and surgery can also leave behind
disease and diabetes. Having metabolic syndrome also nerve damage. Symptoms include numbness or tin-
increases your risk for cancer, but the inverse is true as gling in your hands, feet, or both. You may also expe-
well. After cancer treatment, you’re more likely to get rience burning or shooting pains, muscle weakness,
metabolic syndrome. This rise in risk stems from sev- and loss of balance.
eral factors, including weight gain, hormonal changes, Whether you develop neuropathy during or after
increased inflammation, and changes in lipid (fat) chemotherapy depends on the drug you took and the
metabolism that can be caused by cancer and its treat- dose you received. Chemotherapy drugs that are most
ments. To reduce your odds of developing metabolic likely to cause neuropathy include
syndrome, keep your weight in check, get more active, • epothilones—ixabepilone (Ixempra)
eat a well-balanced diet, and manage blood sugar, • immunomodulatory drugs—lenalidomide (Rev-
blood pressure, and cholesterol levels with lifestyle limid), pomalidomide (Pomalyst), thalidomide
changes and medication. (Thalomid)
• microtubule dynamics inhibitors—eribulin
Osteoporosis (Halaven)
Your bones naturally weaken with age, as the pro- • plant alkaloids—etoposide (Toposar, VePesid; also
cess of bone breakdown begins to outpace the pro- known as VP-16), vinblastine (Velban), vincristine
cess of rebuilding. The bones become more porous (Vincasar), vinorelbine (Navelbine)
and weaker. Some cancers (such as breast, prostate, • platinum drugs—carboplatin (Paraplatin), cisplatin
and lung cancers and multiple myeloma), as well as (Platinol), oxaliplatin (Eloxatin)
treatments like chemotherapy, hormone therapy, • proteasome inhibitors—bortezomib (Velcade),
and steroids, can accelerate this process of bone loss. carfilzomib (Kyprolis)
Weakened bones make you more susceptible to frac- • taxanes—cabazitaxel (Jevtana), docetaxel (Tax-
tures if you fall. otere), paclitaxel (Taxol).
Often, bone loss comes without any symptoms. If If you notice symptoms of nerve damage, report
you’ve had a treatment that might affect your bones, them to your doctor right away. Your doctor will do
your doctor will recommend a dual energy x-ray tests like electromyography and nerve conduction stud-
absorptiometry (DEXA) scan to measure your bone ies to check your nerve function. Medicines like anti-
density. Osteoporosis treatment involves drugs like depressants, antiseizure drugs, and steroids can relieve
bisphosphonates—such as alendronate (Fosamax), the pain of nerve damage. Physical and occupational
ibandronate (Boniva), and risedronate (Actonel)— therapy, along with an exercise program, can help you
which prevent further bone loss. Other ways to shore up regain movement, balance, and fine motor skills.
your bones are to get enough calcium (1,000 mg daily, or
1,200 mg for women 51 and older, from a combination
of food and supplements) and vitamin D (800 IU daily). Hearing loss
Weight-bearing exercises also help. A well-rounded Chemotherapy, radiation, and surgery can all damage
strength training program that works all your muscles the structures inside your ear that help you hear clearly.
is best, but other forms of exercise where you’re simply In some people, this damage manifests as trouble hear-
supporting your own body weight (such as running or ing conversations in situations, such as at a party, where
walking) also help reinforce bone—though only those there is a lot of background noise. In other people, it
bones that are attached to the muscles you’re exercising. takes the form of ringing in the ear (tinnitus).

Cancer treatments that cause hearing loss include • Hormone therapies can dry out the urethra.
the following: • Surgery to the pelvic organs—the prostate, blad-
• Platinum chemotherapy drugs, such as cisplatin der, or uterus and cervix—can damage muscles and
and carboplatin, damage sensory hair cells in the nerves that control urination.
inner ear. Damage to these hair cells prevents sound To diagnose urinary issues, your doctor might
from reaching the brain. have you keep a journal of your symptoms. You can
• High doses of radiation to the head or brain also also have tests to see how well your bladder is work-
damage these hair cells. In addition, radiation can ing, or imaging scans to look for functional problems
cause inflammation in the ear, fluid buildup in the with your urinary system.
middle ear, or stiffness of the eardrum. Treatment for urinary problems can involve
• Surgery can damage structures in the ear and brain • bladder training (learning to delay the time between
that are responsible for transmitting, receiving, and bathroom visits)
interpreting sound. • Kegel exercises to strengthen the muscles you use to
Other drugs you take during the course of your hold and release urine
treatment, such as pain medicines, antibiotics, and • medicines such as oxybutynin (Ditropan) and tolt-
antinausea medications, can also cause hearing prob- erodine (Detrol) to relieve an overactive bladder
lems. Hearing loss from chemotherapy should lessen • devices such as a urethral insert or pessary to sup-
once you’ve finished your treatment. Issues due to sur- port the bladder muscles so you don’t leak
gery might be permanent. See your doctor for a hear- • catheterization, the use of a thin tube to drain urine.
ing evaluation. Hearing aids can be an option to treat You can manage urinary problems by limiting
more severe hearing loss. the amount of fluids you drink, especially before
bedtime, and by going to the bathroom at regular
intervals throughout the day. If you often leak, wear-
Bladder and urinary issues ing an absorbent pad or undergarment can prevent
Urination might seem like a simple process, but really wetness and odor.
it involves the complex, coordinated effort of several
organs. Your kidneys filter waste products and excess
water from your bloodstream, creating urine. Urine Pain
passes down tubes called ureters into your bladder. Pain can remain an issue long after your cancer treat-
Your bladder stores urine until you’re ready to use ment is completed. Cancer-related pain can be persis-
the bathroom, and then it contracts to expel the urine tent, or it can come and go. It can be mild, moderate,
down your urethra and out of your body. or severe. And it can go away after a short period of
After cancer treatment, parts of this system might time, or stay with you for many years. The pain can
not work as well as usual. As a result, you could have take a variety of forms:
trouble emptying your bladder, or you might feel a • burning or stabbing pain in your hands and feet
constant urge to go and then leak urine. Cancer treat- from nerve damage
ments can also increase your risk for a urinary tract • residual pain from surgery or its scars
infection, which can cause pain and burning when • phantom pain in a missing limb or breast
you urinate. • pain from tissue damage caused by radiation and
The following treatments can affect your urinary other cancer treatments.
system in a variety of ways: Regardless of what type of cancer or treatment
• Radiation therapy to the pelvis can irritate the you’ve had, pain isn’t normal, and you don’t need to
bladder. suffer through it silently. To help your doctor under-
• Chemotherapy can damage nerves that control stand what you’re experiencing, rate your pain on a
urination. scale from one to 10 (see Figure 2, page 15). Describe
tos showed Marianne DuQuette
Figure 2: Pain rating scale Cuozzo, with her arms uplifted
in victory—and dark purple
scars running across her chest
where her breasts used to be.
0 2 44 66 8 10
10 “This is what we now look like
NO HURT
NO HURT HURTS A
HURTS HURTS A
HURTS HURTS
HURTS HURTSA
HURTS HURTS
HURTS
LITTLE BIT LITTLE MORE EVEN MORE WHOLE LOT WORST
from cancer,” she said. “I loved
LITTLE BIT LITTLE MORE EVEN MORE WHOLE LOT WORST
my breasts. Now I’m finding new
Use this visual guide to help explain your level of pain to your doctor. Rate the pain on a scale parts of my body to love. I want
of 0 to 10, where 0 is no pain and 10 is the most unbearable pain you’ve ever felt. to feel beautiful and sexy again,
but it will take time.”
where the pain is in your body, what it feels like In fact, Cuozzo had tried breast reconstruction,
(sharp, stabbing, throbbing, dull), what seems to trig- but after four infections in five months, she decided to
ger it, and how it affects your daily life. “go flat.” The other women in the article cited a vari-
Treatments for pain can take many forms, ety of issues with implants, ranging from their weight
including to the unnatural feel of their reconstructed breasts.
• non-narcotic pain relievers, such as ibuprofen “The nerves are cut, so they’re not receptive to feel
(Advil, Motrin), acetaminophen (Tylenol), and or touch,” said Rebecca Pine, another of the women.
naproxen (Aleve) Research suggests that women who opt against breast
• opioids, such as morphine, codeine, and oxycodone reconstruction are no worse off than women who
(OxyContin) choose it. A review of 28 studies in the Journal of the
• antidepressants such as tricyclics and duloxetine American College of Surgeons found that some women
(Cymbalta) who declined breast reconstruction even did better in
• antiseizure drugs such as gabapentin (Neurontin) terms of body image, quality of life, and sexual out-
or pregabalin (Lyrica) to treat nerve pain comes. In some cases, these women choose tattoos
• nerve blocks (procedures to permanently numb to cover the remaining scars and help define a new
nerves) self-image.
• physical therapy No matter what type of cancer surgery you’ve
• complementary and alternative therapies like acu- had, if scars from your treatment are affecting your
puncture, meditation, or yoga self-image, talk to your doctor about ways to mini-
• relaxation techniques such as deep breathing or mize their appearance. One of the simplest and
meditation. lowest-cost solutions is to conceal your scars with
makeup. Another solution is steroid injections,
which flatten, soften, and smooth scars. For espe-
Scars and body image issues cially stubborn or disfiguring scars, your doctor
Any surgery can leave behind scars—flat or raised might recommend surgery. Though the procedure
marks that form indelible reminders of a cancer long might not fully erase the scar, it should minimize its
after the disease has been eradicated. Scars are signs of appearance.
healing, but they can be unsightly, painful, and itchy. Scars are more than just physical. They can lay
In October 2016, The New York Times ran pho- waste to your confidence and undermine your rela-
tographs of five breast cancer survivors for an arti- tionships. If you’re struggling with the emotional
cle called “‘Going Flat’ After Breast Cancer,” about effects of cancer-related scars, see a counselor or
women who had either chosen not to reconstruct therapist who specializes in treating body image
their breasts after mastectomy or else had repeat sur- issues in cancer survivors. Ask your oncologist for a
gery to have the implants removed. One of the pho- recommendation.

Creating a survivorship care plan
O nce you transition from cancer patient to survivor,

your care needs will shift. Rather than focusing on
eradicating your cancer, your doctors’ efforts will cen-
health care provider(s) you will see for each check-up.
The fact that many doctors aren’t well trained in
survivorship issues complicates follow-up care, and
ter on three main areas: medical organizations historically have offered lit-
• preventing, identifying, and managing long-term tle in the way of recommendations to help doctors
and late effects of your treatment (such as pain, steer their patients through the post-treatment phase
fatigue, and emotional and sexual issues) (although this is changing). Getting care in different
• preventing and checking for a recurrence or a new places may also be a barrier to adequate coordination.
cancer (see “What happens if your cancer returns,” Your doctors may not have access to your electronic
page 41) medical records containing your test results and the
• ensuring that all of your health care needs are met treatments you received. As a result, you may have
(for example, vaccinations, screening for both can- to take more of an active role in managing your own
cer and noncancerous conditions, and caring for care—including maintaining and sharing your medi-
other health conditions). cal records with every health professional you see.
You’ll continue to see your oncologist for follow-
ups, which may at first be every few months and then
step down to once a year. Your primary care provider Keeping track of your medical records
may take over the majority of your care, referring you An electronic medical record (EMR) is an expanded,
to specialists when necessary. Depending on what type digital version of the chart in which your doctors
of cancer you had and what side effects its treatment record your health information. It contains compre-
caused, you also might see a variety of other medical hensive information about your
professionals, including a cardiologist, neurologist, • medical history
endocrinologist, and psychiatrist (see “Specialists who • vital signs
treat health problems in cancer survivors,” page 6). • diagnoses
Some cancer centers now have their own survivorship • medications
clinics that coordinate every aspect of your care. If you • immunization dates
don’t have access to one of these programs, request • allergies
that one medical professional oversee your care and • progress
facilitate communication and collaboration between • lab reports, imaging scans, and other test results.
all of your other providers. Each doctor you visit should have access to your
Which doctor or doctors you see is ultimately complete EMR. Yet because EMRs aren’t standardized,
less important than how much each one knows about each doctor might use his or her own system, which
your cancer and its treatment. Your primary care pro- may or may not be compatible with other doctors’
vider needs clear communication from your oncolo- systems. This can lead to incomplete information and
gist to know what treatments you’ve had and what fragmented care. Efforts are under way to streamline
kinds of follow-up you’ll need to prevent a recur- the sharing of EMRs.
rence. Every other doctor needs to know his or her To prevent your providers from missing infor-
specific role in your care. You should also receive, mation that’s essential to your care, you should know
in writing, a schedule of follow-up visits and which how to access your medical record or keep a copy of
it so you can share it with any new doctors you see. • a record of all the treatments you received, includ-
You can ask for a copy of your medical record each ing surgery, chemotherapy, radiation, hormone
time you visit a doctor. You can store your own ver- therapy, and gene therapies, with a description of
sion of the EMR, called your personal health record the drugs you took, the dosage, your response, and
(PHR), on your home computer. View and update any side effects you experienced
an electronic PHR using an e-health tool like Blue • dietary advice, psychological counseling, and other
Button, or use a manual system like a filing cabinet support you received during the course of your
or three-ring binder for paper copies. You can also treatment
include records of your benefits—including your • contact information for every doctor involved in
company benefits package, health plan, life insur- your cancer treatment, including your oncologist,
ance, and disability. Back up your files, and give a surgeon, radiation therapist, and primary care phy-
copy to a family member or friend in case you lose sician, as well as the laboratories and imaging facili-
yours or have an emergency. ties where your tests (such as x-rays, CT scans, and
MRI scans) were performed.
In addition to a summary of your medical record,
Your survivorship care plan the document should also include a follow-up care
In 2005, the Institute of Medicine (IOM) released a plan that details
report offering guidance to anyone making the tran- • the type of maintenance therapy you’ll need
sition from cancer patient to survivor. “Too many • how you will likely recover from treatment side
survivors are lost in transition once they finish treat- effects
ment,” the report read. “They move from an orderly • cancer screenings and other tests you’ll need, along
system of care to a ‘non-system’ in which there are with the dates when they should be performed
few guidelines to assist them through the next stage • possible late and long-term effects of your treat-
of their life or help them overcome the medical and ment, and their symptoms
psychosocial problems that may arise.” To ease the • signs of a recurrence or new cancer
transition, the IOM recommended that each cancer • possible effects of cancer on your relationships, sex-
survivor be given a comprehensive care summary ual functioning, work, and parenting ability
and follow-up plan containing everything he or she • information on insurance, employment, and finan-
will need to know moving forward. The Commis- cial consequences of cancer, and referrals to coun-
sion on Cancer (CoC), a program of the American seling, legal aid, and financial assistance
College of Surgeons, has requested that its accredited • recommendations for a healthy lifestyle, including
cancer programs provide survivorship care plans to diet, exercise, weight control, sunscreen use, virus
50% of eligible patients by 2017, and to 75% of eli- prevention, smoking cessation, and osteoporosis
gible patients by 2018. However, not all hospitals are prevention
CoC-accredited, and not all accredited hospitals will • recommendations on genetic counseling and test-
achieve this goal. ing for yourself and your relatives
A survivorship care plan is a comprehensive doc- • referrals to follow-up care providers, support
ument that should contain a full record of informa- groups, and your primary care provider
tion related to your cancer treatment, including the • cancer-related organizations and other resources
following: you might turn to for support.
• your tumor type, location, stage and grade, hor- The health care team at your cancer center might
monal status, and marker information give you a survivorship care plan when you’re dis-
• copies of your diagnostic test results and pathology charged. If they don’t offer this plan, you can print one
reports out from the Internet and fill it out with the help of
• treatment start and end dates your doctors and nurses. Several organizations have

developed model survivorship care plans to help you of studies published in the British Journal of Cancer
structure this information, including found that people who were given survivorship care
• American Society of Clinical Oncology (go to plans were generally happy with them, although the
www.cancer.net, click on “Survivorship,” then on plans didn’t have an effect on their distress levels, can-
“Follow-up Care After Cancer Treatment”) cer care coordination, or overall satisfaction with care.
• Journey Forward (www.journeyforward.org) Because the implementation of these plans can
• Penn Medicine (https://oncolife.oncolink.org). vary greatly by institution, experts say there is room
Following the IOM’s recommendation that each for improvement. But even if cancer survivorship
survivor receive a survivorship care plan, a number of plans aren’t perfect, they at least provide a concise
studies have sought to learn what kind of impact these guideline for survivors and their providers to follow as
plans have on cancer patients’ follow-up care. A review they move forward into the next phase of their care.
Cancer’s aftermath—emotions, work, finances
C ancer is a life-changing experience. Learning that

you have the disease, grappling with the treat-
ments and their side effects, and coming to face-to-
after their diagnosis. The younger you were when you
were diagnosed, the more advanced your cancer was,
and the more symptoms you experienced from your
face with your own mortality can be difficult—even cancer and its treatment, the more profound these
life-shattering—and the psychological turmoil doesn’t emotional challenges can be.
necessarily end once your doctor declares you a sur- The psychological impact of cancer and its treat-
vivor. You may have problems with depression, the ments can be so severe that some survivors develop
lingering uncertainty that the cancer may return, post-traumatic stress disorder (PTSD), the same con-
financial and work issues to solve, and insurance condition that affects survivors of life-threatening events
cerns—all of which can be major sources of stress. like military combat, rape, and natural disasters.
While life after cancer is unquestionably difficult, PTSD causes nightmares and flashbacks of the devas-
it doesn’t have to be entirely negative. Many people are tating event. It can keep you up at night and fill your
surprised at how their disease changes them for the waking hours with fear, anger, anxiety, and a sense of
better, by helping them focus on what’s meaningful hopelessness.
and important in their lives. Some use the time—par- Depression, anxiety, and PTSD can have a pro-
ticularly after the active phase of treatment—to renew foundly negative impact on your quality of life, as well
friendships, mend relationships with family members, as on your treatment outcome. Survivors who can’t
and do things they’ve put off for years. Some use the rein in the anger and depression sometimes contem-
time as an opportunity to look inward, harnessing plate killing themselves. Some succeed in carrying out
mind-body techniques like meditation and prayer to the act. A study in the Journal of Clinical Oncology
help them gain a new understanding of, and apprecia- found that cancer patients were almost twice as likely
tion for, themselves and their lives. to commit suicide as people in the general population,
No matter how your cancer affects you emotion- and those risks continued decades after the diagno-
ally, it’s important to get emotional support. Lean on sis. The highest suicide risks were among people with
friends, family, and co-workers. Turn to your medical lung, stomach, oral, and laryngeal cancers. Nearly
team, and—if you need it—get assistance from mental half of people who consider committing suicide never
health professionals. show signs of depression, which is why it’s so impor-
tant that you get screened for any mental health issues
that might be simmering under the surface.
Anxiety and depression Just as you cared for your body during treatment,
Cancer isn’t solely a physical disease. The stress focus on caring for your mind after treatment. Learn-
of undergoing cancer treatments, the fear of the ing to identify the signs of depression (see “Spotting
unknown, and the distress of seeing your body the signs of depression,” page 20) and getting help if
change—possibly in ways you never expected—can you need it can help you overcome these feelings—
take their toll on you emotionally, too. That’s why and might even save your life.
cancer survivors are more likely to experience depres-
sion, anxiety, and other emotional problems than their Screening for psychological issues
peers. Up to 25% of survivors report feeling depressed, A cancer diagnosis can bring up a rush of emotions—
and many continue to feel this way five years or more including anger, sadness, grief, denial, fear, frustra-

screening tests, such as the Personal Health Question-
Spotting the signs of depression naire Nine-Symptom Depression Scale, Beck Depres-
A s many as a quarter of cancer survivors report

feeling depressed. See a doctor, psychologist,
psychiatrist, or counselor for advice if you have
sion Inventory, Hamilton Rating Scale for Depression,
or Penn State Worry Questionnaire.
experienced these symptoms: Your doctor might also use a printout of the “dis-
• You feel hopeless, helpless, guilty, worthless, irritable, tress thermometer,” a gauge developed by the National
or angry. Comprehensive Cancer Network to assess the emotional
• You lose interest in things you once loved, like sex, your effects of cancer and its treatments. On an image resem-
social life, or hobbies. bling a thermometer, you indicate how much distress
• You sleep too much or too little. you’ve experienced in the past week ranging from zero
• You cry all the time. (no distress) to 10 (extreme distress). In an accompany-
• You lose your appetite or eat too much. ing problem list, you also check off “Yes” or “No” to indi-
• You withdraw from friends or family. cate whether you’ve had problems dealing with everyday
• You feel like you have no energy. tasks in the past week, such as work and child care, and
• You lose your concentration. if you’ve had any emotional problems or physical symp-
• You have recurring thoughts about death or suicide.
toms like fatigue or tingling in your hands or feet.
Once your doctor has a better idea of how depres-
If you have at least five of these nine symptoms for
more than a couple weeks (and one of them is either the sion and anxiety are affecting your life, he or she
first or second symptom listed here), your doctor may should offer treatment strategies and information on
diagnose clinical depression. If you’ve thought about supportive resources (see “Finding support,” page 26).
committing suicide or you feel that your life isn’t worth
Depending on the extent of your emotional distress,
living, get help right away. Call your doctor, go to an
emergency room, or call the National Suicide Prevention you might get a referral to a psychologist, psychiatrist,
Lifeline at 800-273-8255 (toll-free). or other mental health professional. Even if you don’t
qualify for a depression diagnosis, you might want to
consider seeing a counselor or therapist for guidance.
tion, loneliness, and guilt. All of these feelings are Schedule regular follow-up visits with the doctor who
normal considering the gravity of the condition. Only is overseeing your mental health care to check that any
when these feelings become persistent or life-altering treatments you’ve implemented are helping you man-
do they cross the line into clinical depression. But age your psychological issues.
even less severe emotional symptoms deserve care
and attention.
Your oncologist and primary care provider might How to deal with your emotions
not ask about your emotional health as often as they If you’ve felt like you’ve been on an emotional roller
inquire about your physical health. If your doctor coaster since your diagnosis, it’s time to get off the ride
doesn’t initiate the discussion, bring it up yourself so and regain control of your life. Dealing with your emo-
you can get the proper screening and treatment, if tions starts with a visit to your oncologist, psychologist,
necessary. psychiatrist, or therapist. Be open about symptoms like
In 2014, the American Society of Clinical Oncol- anger, fear, and sadness and how they’ve affected your
ogy released anxiety and depression screening life, so you can get the right treatment.
guidelines for adults with cancer. These guidelines rec- For depression, often the most effective treatment
ommend psychological screening throughout the can- strategy combines antidepressant or anti-anxiety
cer treatment process, as well as after treatment and in drugs (or both) with one-on-one or group therapy.
the event of any progression or recurrence. Your doc- Here are a few other techniques that may help:
tor should ask about your history of depression and • Exercise. An hour of walking in the fresh air every
anxiety and assess your symptoms with one or more day can help relieve mild to moderate depression
and may even play a supporting role in treating able to answer your needs, reach out for support
severe depression. When you exercise, your body (see “Support groups,” page 27). Today, many can-
releases feel-good chemicals called endorphins cer support groups are available online, which is
that boost your mood and reduce your stress lev- especially helpful if you live in a rural area, if you’re
els. Simply being in nature has a calming effect, so unable to travel, or if you have a rare kind of cancer.
if you can walk in a place with grass and trees, so • Get creative. Give your emotions a creative outlet
much the better. by writing in a journal, painting, photographing, or
• Try mindfulness. Mindfulness is a heightened state creating a short video. Expressing yourself in this
of awareness. It involves focusing your mind on the way can be a cathartic experience that allows you
present. When worries and concerns enter your to work out feelings like sadness or anger. Creative
mind, you acknowledge them and then let them go. expression can also be soothing, if you choose an
There are formal and informal approaches to mind- art form you truly enjoy.
fulness, but one essential feature is living “in the • Start a support network. Prepare a list of phone
moment.” You have survived the initial bout of can- numbers you can call when you feel down. Your
cer. No one knows what the future will bring. But network might include friends, family, your treat-
you now have an opportunity to live each moment ment team, other cancer survivors, or members of
to the fullest. Appreciate the small pleasures. your religious organization.
Engage your senses fully, so that you savor every Not everyone experiences a rash of negative emo-
joyful sensation. People with cancer often find that tions after a cancer diagnosis. Some cancer survivors
the heightened awareness of mortality makes them emerge with a profound new appreciation for life.
appreciate life more. Joann Totten, who was diagnosed in 2015 with stage
• Relax. Try a relaxation technique like deep breath- 4 lung cancer, vowed to stay positive and make the
ing or meditation to calm and refocus your mind. most of the time she had with her family. “There is
If you’re not good at sitting still, try walking medi- still happiness in our lives—taking a family trip to my
tation, yoga, or qigong. A technique called mind- girls’ birthplace in China, watching them play vol-
fulness-based cognitive therapy—which combines leyball and skate, walking our dogs, and sharing a
mindfulness techniques with cognitive behavioral laugh—and these memories can never be taken away,”
therapy—seems particularly useful for helping to she wrote in a blog post on the website of Dana-Farber
prevent recurrences of depres- Cancer Institute. “Despite my ill-
sion. Like any meditation ness, I know that I am blessed,
practice, it takes time to yield and I remain positive and hope-
results—and is more effective ful that there is a treatment that
the longer you do it. will work effectively to fight my
• Join a support group. Shar- cancer and provide me with time,
ing stories with other can- time, and more time.”
cer survivors can give you a
sense of fellowship and help
you overcome some of the Financial and work
loneliness and isolation your issues
© Mike Watson Images | Thinkstock
diagnosis might have caused. Today’s cancer treatments can

No one can understand what prolong your life and potentially
you’re going through better cure your cancer. Yet they come
Exercise is like an all-purpose tonic. Not only is
than someone who’s experi- it good for your overall health, but it also boosts at a steep cost—both in terms
enced the same problems, so your mood. Studies indicate that it can even play of dollars and in the amount of
if friends and family aren’t a supporting role in treating severe depression. stress these financial burdens

place on you. The average cancer surgery ranges help you stay employed—or provide assistance if you
from $14,161 to $56,587, according to one survey. have to leave your job. Under the Americans with Dis-
Six months of chemotherapy in a hospital outpatient abilities Act, companies with more than 15 employees
department can exceed $61,000. And three months of are required to provide accommodations—includ-
radiation can cost more than $35,000. ing flexible work schedules—to help people with dis-
Health insurance can offset treatment costs, but abling health conditions keep their jobs. The Family
it doesn’t necessarily eliminate them. A 2016 study and Medical Leave Act allows you to take 12 weeks
from researchers at Johns Hopkins University found a year of unpaid leave, provided you have worked at
that Medicare beneficiaries with cancer who didn’t your company for at least a year. And if your job will
have supplemental health coverage paid an average prevent you from working for at least 12 months, you
of $2,116 to $8,115 a year out of pocket. Some spent may qualify for disability through the Social Security
as much as 63% of their annual income on their can- Administration, which can help pay for your living
cer treatment. With some cancer drugs costing more and health care expenses.
than $5,000 a month, co-insurance payments can You can also take steps to ease the financial bur-
reach into the hundreds or thousands of dollars per den of your cancer treatment. First, consult with a
year. financial counselor, social worker, and care manager.
The high cost of treating your cancer can quickly These professionals can help you navigate insurance
eat through your savings and leave you struggling to coverage and overcome any financial barriers to care
pay your mortgage and other bills. Nearly one-third you might face.
of cancer patients say they’ve experienced finan- Several organizations, such as the following, offer
cial hardship as a result of their treatment. Many financial and copay assistance to help cover the costs
have had to delay or forgo necessary medical care of your treatment:
or stop taking their medication, simply because they • CancerCare Co-Payment Assistance Foundation
couldn’t afford it. You might have to borrow money (www.cancercarecopay.org)
just to stay afloat. Or you could go under entirely. • Cancer Financial Assistance Coalition
Cancer patients are two-and-a-half times more likely (www.cancerfac.org)
to declare bankruptcy than people without cancer, • HealthWell Foundation
according to a study at the Fred Hutchinson Cancer (www.healthwellfoundation.org)
Center in Seattle. • NeedyMeds, Inc. (www.needymeds.org)
Just as your financial obligations are increas- • Partnership for Prescription Assistance
ing exponentially, you could be unable to maintain (www.pparx.org)
employment. Cancer survivors miss an average of • Patient Access Network (www.panfoundation.org)
151 workdays, research finds (see “A survivor’s story: • Patient Services, Inc. (www.patientservicesinc.org)
Katherine Walsh,” page 23). Up to half of them end up • Rx Outreach (www.rxoutreach.org).
quitting or losing their jobs in the six years following
their diagnosis. Even if you are able to return to work,
you might find that the effects of your cancer and its Health insurance concerns
treatment hamper your performance, reducing your With the annual cost of cancer treatments averag-
productivity and making it harder to concentrate. And ing in the thousands—or even tens of thousands—of
if you lose your job, you risk losing your health cover- dollars, the only thing protecting you from finan-
age, too. cial ruin may be your health insurance coverage. Yet
You’ll be more likely to keep your job if your even a sound insurance plan may not entirely buffer
employer is accommodating enough to let you take you from cancer care costs, and the resulting toll on
time off when you need it and work a flexible schedule your bank account and sense of control over your life.
when you return. A few government protections can Over the past two decades, premiums for employer-
sponsored health plans have risen by 191%. In 2016, for a family (as of 2017). The ACA also guarantees
the average premium was $6,435 for an individual and health insurance coverage for people with pre-exist-
$18,142 for family coverage, according to the Kaiser ing conditions, and abolishes lifetime health care
Family Foundation. On top of premiums, more than limits. Yet a potential repeal and replacement of the
80% of covered workers must pay a deductible, which ACA, which been approved by the House of Repre-
averages nearly $1,500 for each individual covered sentatives and is under discussion in the Senate as
(in high-deductible plans, individuals can pay nearly of this writing, could overturn guaranteed coverage
$2,300 and families about $4,300 before their insur- and spending caps, putting even more of a financial
ance starts to pay). burden on cancer patients. If the ACA is ultimately
The Affordable Care Act (ACA), also known as overturned, insurers might be able to refuse coverage
Obamacare, has offered some financial protection to cancer patients or charge them significantly more
to cancer patients and others with significant health for coverage.
care costs. The ACA capped out-of-pocket spend- Even if you are covered by an ACA or employer
ing at $7,150 annually per individual and $13,700 plan today, your insurance company can refuse to
A survivor’s story: Katherine Walsh
I n the fall of 2010, Katherine Walsh was a 23-year-old Ph.D.

candidate at Harvard Medical School and Dana-Farber Can-
cer Institute, where she was completing her doctoral research
pist helped her deal with the extreme anxiety and PTSD she
experienced after being diagnosed. The therapist’s office also
provided a safe place to discuss the strain the cancer was put-
on rare pediatric cancers. A bout of flu-like symptoms along ting on her relationships with friends and family. She found
with a few bruises of unknown origin sent her to her primary a shared understanding through friends she met at support
care provider’s office for blood tests. “In the middle of the groups. While Walsh’s experience brought her closer to some
night I was awakened by my cellphone ringing,” she recalls. of the people in her life, it distanced her from others. “You
“They said, ‘Please don’t be alarmed, but you need to go to have some friends who really rise to the occasion, and some
the emergency room right away.’” friends who really disappoint you. I had both,” she says. “I
learned who I could count on in a crisis.”
In a moment, Walsh went from cancer re-
Cancer searcher to cancer patient. Her oncologist told Her last chemotherapy infusion was in November 2012. Five
survivor her she had acute lymphoblastic leukemia. It years later, she’s fully regained her energy, and her career
was a difficult diagnosis, but one with a silver is back on track. “I got my Ph.D. and finished my graduate
lining. “My doctor said to me, ‘This is going work,” she says. Today, she’s a research scientist at the Broad
to be a speed bump on a long and normal life,’” she says. Institute—a joint research venture between Harvard and the
“He said, ‘This is going to be really hard, but we’re going to Massachusetts Institute of Technology—where she’s on a
get you through this and we’re going to get you to the other team investigating cancer drug targets.
side.’ And he did.”
Sometimes just being in the hospital environment—little
Walsh checked into the hospital for several rounds of inten- things, like the smell of surgical soap in the air—brings back
sive chemotherapy, which left her extremely tired, sick to her the anxiety of her treatment. But she’s learned how to over-
stomach, and coping with severe mouth sores. The treatment come these negative emotions. “I just have to feel what I’m
and its side effects forced her to temporarily sideline her feeling and think about where I am now,” she says. “It turns
education. “I had to take a leave of absence from school,” into feelings of intense gratitude more than anything else.”
she says.
Along with work, Walsh is focused on staying healthy. “I’ve
A year later, Walsh was able to return to her program while taken up yoga. I like to go jogging. I like going to the gym. I’m
finishing her treatment, but side effects prevented her from not a great cook, but I like trying to cook and make relatively
going back full-time. “I had a lot of fatigue,” she says. “I healthy recipes,” she says. She also tries to ensure that she
would work from nine to three or four and then go home and devotes more of her days to what really matters—her friends
take a nap. My boss, given that he was an oncologist, was and family. “I’m very cognizant of work-life balance,” she
very understanding.” says. “As much as I’m passionate about cancer research, it’s
There were also emotional issues to contend with. A thera also important for me to live my life.”

cover the cost of a test or treatment you need—for
example, if it’s a noncovered procedure under your
Effects on your family and
plan or if you used an out-of-network provider. Some relationships
insurers will refuse to cover the cost of your treatment Cancer doesn’t affect only you, although it can seem
in a clinical trial. that way when you’re in the thick of diagnosis and
If your insurer does deny a claim, you have the treatment. The effects of cancer are like a wave that
right to appeal it. First, ask your insurance company overcomes and engulfs everyone around you. Cancer
for a full explanation as to why the claim was denied. can be a real test for your friendships and romantic
Also check with your state’s insurance department relationships. Some of them won’t survive this test.
to make sure the denial was appropriate. Then, get a Others will grow stronger.
letter from your doctor, along with supporting docu- Even the most solid relationships can feel the
mentation, explaining why you need the service cov- strain of a cancer diagnosis. Conflicts and frustration
ered. If that doesn’t work, you may need to request arise when you expect more than your partner, family,
an internal appeal by the insurance company, and or friends are willing to provide. Some will not under-
eventually an external review conducted by an out- stand what you’re going through, or simply won’t
side agency. know what to say, so they may distance themselves
To ensure that you don’t pay more than you should from you. Others may pull back when they find that
for your care, carefully review and manage the health you can no longer give back to them in the way you
insurance coverage you have. Here’s a checklist: once could (see “A survivor’s story: Katherine Walsh,”
• If you are enrolled in a public health insurance plan page 23). Friends and family may cycle through many
through the ACA marketplace or you’re changing of the same emotions you have experienced—includ-
jobs, make sure your plan does not expire. ing anger, resentment, anxiety, and depression—along
• Pay your premiums and other health insurance with the guilt of not being able to help enough, or of
costs in full so you don’t lose coverage. remaining healthy while you have cancer.
• Know exactly what your plan covers by reading Your children, depending on their age, may not
through your insurance company’s Summary of understand what you’re going through or how they
Benefits. should respond. And your siblings, parents, and
• Before you see a new doctor, undergo surgery, or friends might not fully comprehend their new roles in
start on a new cancer medicine, call your insurance your life.
carrier to find out what costs it will cover and to Having cancer can put a significant strain on your
make sure it doesn’t require prior authorization. If marriage, introducing uncertainty about your finan-
preauthorization is needed, work with your treat- cial future, disrupting your sex life, and forcing both
ment team to make sure you can get approval. you and your partner to take on new and sometimes
• Keep copies of all paperwork related to your care unexpected roles—including that of the primary wage
and health insurance, including medical bills, let- earner. Men in particular may have a harder time
ters of medical necessity from your doctor, claim dealing with their partner’s diagnosis and treatment.
forms, and explanations of benefits. Although the divorce rate isn’t generally higher among
• If you’re confused about your health insurance cov- people with cancer, one study found that women who
erage, get a hospital-affiliated patient navigator or are diagnosed with cancer are 12 times more likely to
financial counselor to help. Or ask for assistance separate or get divorced than men with the condition.
from a group like the American Cancer Society. Conversely, some friends and relatives will draw
If you’re struggling to afford health insurance, you even closer to you during this trying time. They’ll be
might look to a government-sponsored program like right by your side as you undergo tests and treatments.
Medicaid, but these programs do have certain maxi- They’ll be at your door with a casserole for dinner
mum income requirements. or a pick-me-up bouquet of flowers at just the right
moment. You might also forge new alliances with can- cancer will eventually return. Fear of recurrence is
cer survivors you meet during your treatments or at common in cancer survivors, and it can continue for
support groups. These new friends will identify with many years after treatment ends, giving people a sense
your experience in a way no one else can. of constantly waiting for the other shoe to drop.
How you and your loved ones cope with these Though you can’t entirely eliminate your fear of a
challenges can help determine the future course of recurrence, you can learn to manage and live with it.
your relationships. Holding in anger and other feelings The first step in coping with fear is to acknowledge it
will only make tensions grow. That’s why it’s important and be open about it. Express your worries in the safe
to be open and honest with your partner, your chil- space of a therapist’s office. Then you can discuss strat-
dren, and everyone else who is close to you. Let them egies for addressing them. For instance:
know what you’re experiencing, what you need from • Join a support group for cancer survivors.
them, and what you are able to give back. • Engage in activities that distract you from your con-
If you can’t discuss these and other issues on your cerns. Exercise, read a book, or talk with friends.
own, enlist the help of a psychologist or family coun- • Work with your oncologist to develop a survivor-
selor. Take special care with young children, who may ship plan, to include follow-up visits and tests (see
be especially frightened and need reassurance during “Screening tests,” page 43) and steps for reducing
this uncertain time. And be conscious of your loved your risk of recurrence. If possible, participate in
ones’ needs, too. Remember that the people in your a clinical trial testing approaches to further reduce
life who’ve been caring for you also deserve time and risk of recurrence.
space to care for themselves. • Learn to spot the signs that your cancer has
returned, so you can report them to your doctor
quickly (see “Warning signs,” page 42). Also learn
Will the cancer come back? Living which signs aren’t likely cancer, so you don’t live in
with uncertainty a state of perpetual panic. Most symptoms in sur-
Survivors feel a sense of relief when their treatment vivors are not related to a cancer recurrence, so it’s
works. Yet that relief can be short-lived, as they have important to know the difference. Knowledge can
to endure the constant worry and anxiety that their be a powerful tool.

Finding support
D uring cancer treatment, you

might find yourself con-
stantly surrounded by doctors,
and social workers. They offer
services such as
• nutrition and exercise guidance
nurses, imaging technicians, and • psychological counseling and
well-meaning friends and family emotional support
members. Once you’re finished • genetic counseling
with treatment, your treatment • symptom management or pal-
team, friends, and family become liative care
less present in your day-to-day • rehabilitation and exercise
life, which can leave you feeling • integrative therapies like medi-
isolated, lonely, and sad. tation, yoga, tai chi, massage,
Even if support remains and acupuncture
close by, you may be reluctant • fertility counseling
to take advantage of it. When • screening services
© lilly3 | Thinkstock
you’re exhausted and ill from • seminars and workshops on
the stress of your cancer and its topics relevant to survivors,
treatment, it might seem easi- such as insurance, employ-
est to retreat into your shell and ment, legal rights, and care-
Some survivorship programs include integrative
hide from everyone who wants to therapies like tai chi, yoga, meditation, massage, giver issues.
help. Don’t let this happen. While and acupuncture that can help to nurture both Some cancer centers in
some family and friends will your body and your soul. major metropolitan areas offer
distance themselves, others will outpatient treatment centers in
want to be part of your journey. Reach out to them for the suburbs as well as in the city. Cancer survivor-
support. ship resources are also available online; for example,
You can also turn to professional resources to help from the National Cancer Institute’s Office of Cancer
you cope with the repercussions of your cancer. Survivorship (https://cancercontrol.cancer.gov/ocs),
the National Cancer Survivorship Resource Center
(https://smhs.gwu.edu/gwci/survivorship/ncsrc), and
Survivorship programs OncoLink (https://oncolife.oncolink.org).
Many of the major cancer centers—including Dana-
Farber Cancer Institute in Boston, Stanford Cancer
Center in Palo Alto, Memorial Sloan Kettering Can- Counseling
cer Center in New York, Hospital of the University If stress and sadness have become inescapable parts of
of Pennsylvania in Philadelphia, and MD Anderson your daily life and you just can’t shake them, it’s time
Cancer Center in Houston—have cancer survivor- to see a therapist, psychologist, psychiatrist, social
ship programs that address survivors’ ongoing care worker, counselor, or other mental health professional
needs. (see “Screening for psychological issues,” page 19).
These programs are staffed by a team of doctors, Asking for help doesn’t mean you’ve failed. It simply
nurse practitioners, integrative medical specialists, provides a place for you to deal with the issues you
face and get any persistent worries off your chest. tion and support at times when you feel most alone.
A counselor or other mental health professional You don’t need to attend a church, synagogue,
can help you come to terms with the implications of mosque, or temple to feel a spiritual connection.
your diagnosis and help you gain more control over a Many people find spirituality in nature, or in a gen-
condition that often seems out of your control (see “A eral sense that there is a world beyond our own.
survivor’s story: Katherine Walsh,” page 23). Together, Spirituality is different for each person. If you don’t
you can address issues with relationships and work need it in your life, you can find other sources of
and explore the ways in which cancer has left its mark comfort. If you do need it, you can try one of these
on your life. You can also learn practical techniques to practices:
manage fatigue, loss of sexual interest, and other treat- • prayer—alone, or with members of your religious
ment side effects. And you can discuss ways to com- organization
municate more effectively with your treatment team. • meditation
You might even bring in members of your family to • reading the Bible, Koran, or other religious works
help them understand how to adjust to your new real- • listening to spiritual music
ity as a cancer survivor. • talking with a priest, rabbi, imam, chaplain, or
Counseling can be done in several ways—one-on- other religious leader.
one, with your partner or other family members, or If religion is an integral part of your life, discuss it
as part of a group of other cancer survivors. To find with your treatment team as well. Your hospital might
a counselor, start by asking at your cancer treatment have a pastoral care department that can help inte-
center. Often, these hospitals provide counseling ser- grate spirituality into your care.
vices to their patients. You can also check with your
health insurance company to see which providers are
covered under your plan. Ideally, you want to seek Support groups
out a counselor who has experience treating cancer Your loved ones might have been entirely empathetic
patients. Before you make an appointment, ask about and kind throughout your treatment, but no one truly
his or her approach, and make sure it fits with your understands what you’ve gone through like another
expectations and goals. survivor. A cancer support group is a place where you
can feel free to express your feelings in a safe, sup-
portive environment.
Spirituality and religion Many cancer hospitals and centers offer their own
If you consider yourself to be a spiritual or religious support groups. Or you might find a group (local, tele-
person, then prayer might have played a significant phone, or online) through one of these organizations:
part in your treatment. According to the CDC, 69% • American Cancer Society (go to www.cancer.org;
of cancer patients say they’ve prayed for their health. click on “Treatment & Support,” then “Support in
And a 2015 study of more than 32,000 cancer patients Your Area”)
found that those who described themselves as spiritual • CancerCare (www.cancercare.org, under “Our
reported better physical health. In other studies, spiri- Services”)
tuality has been linked to reduced anxiety, depression, • Cancer Support Community (call 202-659-9709 or
and loneliness and better control of treatment side go to www.cancersupportcommunity.org)
effects like pain and nausea. • Susan G. Komen foundation (for breast cancer; call
Depending on your beliefs, spirituality can mean 877-GO-KOMEN or go to https://ww5.komen.org).
many things. You might look to a higher being for com- Before joining a support group, call its leader and
fort and guidance. You might look to your faith to help ask who attends the groups and what they discuss.
you find a deeper meaning in your cancer journey. Or Also consider whether you’re comfortable discussing
you might lean on your religious institution for connec- personal issues among people you may not know.

SPECIAL SECTION
Guidelines for a healthy

lifestyle after cancer
W
hen you were first diagnosed with cancer, your over-
riding goal was to eliminate your disease. When
you transition to survivorship, your priorities
shift to prevention—ensuring that your cancer never comes
back, and that a different cancer doesn’t come along to
replace it. Because lifestyle plays a significant role in the
development of cancer, healthier habits are integral to
cancer prevention.
Strategies such as diet, exercise, In general, your

weight loss, and smoking cessation diet should include
will not only reduce your risks of a mix of lean protein,
a future cancer, but also help ease complex carbohydrates,
the effects of your cancer treatment and unsaturated fats. Here’s
and ward off other chronic condi- a guide:
tions like diabetes and heart dis- • Eat at least five servings of A healthy diet should include lean protein
ease in the future. fruits and vegetables every day. sources, such as fish or legumes, along with
Include a variety of colorful plenty of colorful vegetables and fruits.
Eat a healthy diet produce—especially green leafy
A healthy diet is always essential, vegetables, tomatoes, berries, Try to avoid or limit the fol-
but even more so now that you’ve and citrus fruits. lowing unhealthy foods:
had cancer. Studies suggest that • Choose lean protein sources, • refined grains found in white
good nutrition lowers the chances such as skinless chicken breast, bread, crackers, and baked goods
that your cancer will progress or beans, peas, and fish. • sugary foods, such as cookies,
come back and improves your • Get your fiber from whole-grain cake, soda, and candy
odds of surviving over all. No sources, such as whole-wheat • red meat and processed meats,
© Elena Danileiko | Thinkstock
specific diet has been identified bread, quinoa, and oatmeal. such as hot dogs and bacon
as protective, but certain eating • Eat healthy fats, such as vegeta- • high-fat dairy products like
patterns have been linked to a ble oil (canola, olive, safflower) whole milk and ice cream
reduced risk of dying after a can- and the omega-3 fatty acids • fried foods
cer diagnosis. found in fish and walnuts. • alcohol.
28 Life After Cancer www.health.har vard.edu
Guidelines for a healthy lifestyle after cancer | SPECIAL SECTION
A good way to start overhaul-

ing your diet is by getting a nutri- When you just can’t eat
tional assessment. Work with a
dietitian—preferably one who
specializes in oncology nutri-
C ancer treatments can erode your appetite, damage your ability to taste and
smell, and plague you with gastrointestinal issues like nausea and diarrhea,
leaving you with little desire to eat. If these problems continue, you can end up
tion (you can find them at many with nutritional deficiencies, and you might lose enough weight to cause muscle
cancer centers)—who can assess wasting. A dietitian can help make sure you’re getting adequate nutrients, de-
you for issues common to cancer spite a reduced appetite. In addition, the following may help you compensate for
a diminished desire to eat:
and its treatment, including appe-
• If you can’t stomach big meals, turn into a grazer. Eat small meals throughout
tite changes, nutrient absorption
the day, rather than three large ones. Snack on nutrient- and calorie-dense
issues, and vitamin and mineral foods like peanut butter, trail mix, and cheese to ensure that you reach the daily
deficiencies (see “When you just calorie count your doctor and dietitian recommend.
can’t eat,” at right). • Drink fluids between meals instead of during them, so you don’t get filled up
too quickly.
Should you take a daily • If mouth sores make eating too painful, puree fruits and vegetables. Or drink
supplement? high-calorie, nutrient-dense beverages like Boost or Ensure. Avoid acidic and
spicy foods, which can be painful to eat.
A multivitamin-multimineral
• Suck on mints or chew gum to get rid of a metallic taste in your mouth that
supplement could make up for
some cancer treatments can cause. You can also try brushing your teeth before
nutrient shortfalls in your diet. you eat.
Yet the use of supplements in If you still have trouble eating after trying these measures, ask your doctor about
cancer survivors is controver- taking an appetite stimulant.
sial. Many supplements contain
far more than the recommended
daily amount of certain nutri- supplement, and make sure that it was associated with a 34% lower
ents. That’s worrisome because contains no more than 100% of the risk of breast cancer death, a 24%
the role of antioxidants like vita- Daily Value for each nutrient. lower risk for recurrence, and a
mins C and E can be problematic 41% lower risk of death from any
in the high doses you often find Exercise cause.
in supplements. While they pro- Staying active is another highly Guidelines from the American
tect healthy cells, they also shield effective way to reduce the risk College of Sports Medicine recom-
cancer cells from certain types of that your cancer will return. mend that you start exercising as
damage—and in very high doses, Exercise improves the outlook soon as you can, even if you haven’t
antioxidants can actually acceler- for people with breast, colorec- yet finished your treatment. As
ate cancer growth. tal, ovarian, and prostate cancers, for quantity, aim for the govern-
Supplements might still be an among other cancer types, accord- ment’s recommendation—150
option if you’re deficient in par- ing to a variety of studies. For minutes of moderate-intensity
ticular nutrients, or to prevent example, a meta-analysis in the aerobic exercise (walking, biking,
specific conditions—for example, journal Medical Oncology exam- gardening, tennis, hiking), or 75
taking calcium and vitamin D to ined six studies of breast cancer minutes of high-intensity exer-
shield your bones against osteo- survivors. Among the more than cise each week. But don’t worry if
porosis. Check with your doctor 12,000 participants in the analysis, you can’t do it all. Any exercise is
and dietitian before taking any physical activity after diagnosis better than none, so be respectful
www.health.har vard.edu Life After Cancer 29

SPECIAL SECTION | Guidelines for a healthy lifestyle after cancer
Table 2: Exercise precautions Control your weight

Before you begin to exercise, check with your doctor to make sure it’s safe for you to start The stereotypical image of a can-
and to ensure you’re doing the right types of exercises. Keep these condition-specific and cer patient is of someone who has
treatment-specific precautions in mind as you begin a new fitness program.
become thin and wasted by disease.
CONDITION OR TREATMENT EXERCISE PRECAUTION Although some cancer patients do
Breast cancer Avoid exercising your arms and shoulders until your lose weight, more and more people
doctor gives you the okay. are entering treatment overweight,
Compromised immune system—for Avoid public pools and gyms until your blood cell and that poses some serious chal-
example, because of a bone marrow count returns to normal. lenges. Being overweight is linked
transplant to both a greater risk of develop-
Current radiation treatment Avoid the pool, lake, and ocean to prevent bacterial ing cancer in the first place and
exposure on raw skin. also an increased risk for cancer
Indwelling catheter or feeding tube Avoid the pool, lake, and ocean to prevent bacterial recurrence, particularly for can-
exposure. cers of the breast, prostate, colon,
Lymphedema Wear a compression garment while you work out. esophagus, pancreas, gallbladder,
Nerve damage (neuropathy) Exercise in a way that doesn’t put you at risk for a
and kidney.
fall. For example, pedal a recumbent bicycle rather Some research suggests that
than walking on a treadmill. losing weight if you’re overweight
Recent surgery Allow time to heal before starting an exercise or obese could improve your out-
program. Ask your doctor how long you need to look and survival odds. In the
wait.
Women’s Intervention Nutri-
Severe anemia Wait to start exercising until your blood count is tion Study, women who lost 6
back up to normal.
pounds—about 4% of their body
weight—were less likely to have
of your energy level and do what that combine fitness with deep a recurrence of postmenopausal
you can do. You can break the breathing offer an added stress breast cancer. Losing weight will
total down into 10-minute peri- relief bonus. also improve your quality of life
ods spaced at intervals, if shorter Whether you are getting active and general health.
sessions are easier for you. Add in again after a period of inactivity or You can start on a weight-loss
strength training exercises (lifting starting on an exercise program plan while you’re still in treatment,
light weights) twice a week and for the very first time, be mind- but keep it sensible. Try limiting
stretches for flexibility. ful of your abilities. Ask your your portion sizes; avoiding high-
Exercising regularly can doctor how to start safely, so you fat, high-calorie foods and drinks;
improve your physical state, help- don’t injure yourself. Be aware and exercising more often. (For
ing you regain strength and condi- that there may be certain limita- more detailed information, Har-
tioning you might have lost during tions on your workouts based on vard’s Special Health Report Lose
your cancer treatment (see “A sur- the type of cancer or the specific Weight and Keep It Off includes a
vivor’s story: Daniel Platte,” page treatment you’ve had (see Table broad range of advice for everyone
11). Staying active is also good 2, above). Work with a physical who needs to lose weight, whether
for your state of mind. It reduces therapist to create a program that 5 pounds or 200; for ordering
depression and fatigue while accommodates both your fitness information, see the “Resources”
improving self-esteem. Programs level and your overall health. section, page 46).
Guidelines for a healthy lifestyle after cancer | SPECIAL SECTION
Losing just 5% to 10% of your the cancer once it starts. After linked to smoking. A 2016 study
body weight can make a big dif- you’ve been diagnosed with cancer, in the Journal of Clinical Oncol-
ference to your health. Have your smoking can interfere with your ogy found that breast cancer sur-
oncologist and dietitian oversee treatment and worsen side effects vivors who smoke are more likely
your weight-loss plan to make from chemotherapy, radiation, and to die from breast cancer, as well
sure it’s safe for you. If you’re sig- surgery. as from lung cancer, respiratory
nificantly overweight, your doctor Despite volumes of evidence disease, or cardiovascular disease,
might recommend weight-loss sur- highlighting the cancer-tobacco compared with those who don’t
gery to get you back into a healthy connection, nearly 10% of survi- smoke. Your survivor status puts
range. vors continue to smoke years after you at even higher risk of getting
On the other hand, if cancer their diagnosis. In many cases, a smoking-related cancer than
caused you to lose weight, you may their strong physical and men- people who’ve never been diag-
want to increase your daily calo- tal dependence on this addictive nosed with cancer.
rie count once you feel up to eat- substance prevents them from Quitting smoking isn’t easy, but
ing again. High-calorie foods and quitting. it is possible. And you’ll not only
nutritional shakes can help you If you don’t stop smoking, lower your risk of a future cancer,
regain some of the weight you’ve you increase the chance that your but also protect yourself against
lost (see “When you just can’t eat,” original cancer will return or a heart disease, chronic obstructive
page 29). new cancer will begin. You might pulmonary disease (COPD), dia-
also develop another disease betes, cataracts, gum disease, and
Quit smoking many other chronic conditions.
No habit is more deeply connected As a first step, try making an
to cancer than smoking. Doctors appointment with your doctor to
have long known that tobacco discuss smoking cessation strate-
smoking contributes to most cases gies. Or call the American Cancer
of lung cancer, but research shows Society’s Quitline at 800-ACS-2345
that it’s also responsible for nearly (toll-free) to find a program in
half of the deaths from 12 differ- your area. Then, set a date to quit.
ent types of cancer, including liver, A number of tools are available to
colorectal, oral, esophageal, stom- help you, including
ach, bladder, kidney, and pancre- • counseling, in person or by
atic cancers. phone
Every time you take a puff • nicotine replacement products,
© Creatas Images | Thinkstock
from a cigarette—or breathe in the in patch, gum, lozenge, inhaler,

smoke from someone else’s—you and nasal spray forms
inhale about 250 harmful chemi- • medicines like varenicline
cals, nearly 70 of which are known (Chantix) and buproprion SR
to cause cancer. These poisons can (Zyban), which reduce nicotine
If you’re overweight, losing weight could
damage your DNA to the point help improve your long-term survival odds.
withdrawal symptoms.
where your cells start to grow out It will also improve your quality of life and If the first method you try
of control, and they weaken your general health. Losing just 5% to 10% of doesn’t work, don’t give up. It can
body’s immune response to fight your body weight can make a difference. take several attempts to finally
www.health.har vard.edu Life After Cancer 31

SPECIAL SECTION | Guidelines for a healthy lifestyle after cancer
kick the habit, but with the right • Practice safe sex. A few sexually When you do have to go out-
support you can be successful. transmitted infections, includ- doors, cover all exposed areas
ing hepatitis B, HIV, and human with sunscreen that has an SPF
Change other papillomavirus (HPV), can of 15 or higher and protects
cancer-prone behaviors increase your risk for cancer. against both UVA and UVB
Diet, exercise, weight control, and If you’re not in a monogamous rays. Also wear sun-protective
smoking cessation are the founda- relationship, use a condom clothing, a wide-brimmed hat,
tions of a cancer prevention strat- every time you have sex. and wraparound sunglasses.
egy. Here are some other lifestyle • Shield yourself from the sun. Avoid tanning beds.
changes that will help reduce your Stay indoors when the sun’s • Don’t share needles, which can
risk of progression, recurrence, or ultraviolet (UV) rays are stron- increase the risk of hepatitis B
secondary cancer: gest—from 10 a.m. to 4 p.m. and hepatitis C.
Survivors of childhood cancer
E ach year, 15,700 American children are diagnosed

with cancer. Their outlook is far more optimistic
than it once was, thanks to dramatic improvements
in childhood cancer treatments and survival rates
over the last half-century. Fifty years ago, only 10%
of children survived their diagnosis. Today, the five-
year survival rate exceeds 80%. By the year 2020, a
half-million adults will count themselves as childhood
© Michael Jung | Thinkstock
cancer survivors.
For a child, overcoming cancer is only the first
hurdle. The effects of powerful radiation and chemo-
therapy drugs are even more profound on growing
bodies than they are on adults. Children who survive Fifty years ago, only 10% of children with cancer survived. Today the
their cancer potentially face decades of long-term and rate exceeds 80%. But the effects of radiation and chemotherapy
late effects (see “A survivor’s story: Meredith Dona- are even tougher on developing bodies than on adult bodies.
hue,” page 34). Sometimes even when the cancer is
survivable, the side effects of treatment are not. A Impact on growth and development
2010 study by researchers from Dana-Farber Cancer Cancer treatments can affect the hormone-produc-
Institute found that childhood survivors live an aver- ing endocrine glands that control a child’s growth
age of four to 17 fewer years than their peers. Their and physical development. Radiation therapy to the
premature deaths are due to recurrences of their origi- head can damage the pituitary gland, stunting growth
nal cancer, new cancers caused by radiation and che- and delaying puberty. Chemotherapy can interrupt
motherapy, and long-term complications like heart puberty, too. Many children catch up on growth once
and lung damage from cancer treatment. their treatment ends, but some chemotherapy drugs,
Today, doctors are aware of the long-term effects especially when given in very high doses, have per-
childhood cancer survivors face, and they take steps manent effects. The bones and muscles are particu-
during treatment and afterward to reduce those risks. larly vulnerable to cancer treatments, because they go
through a period of very rapid growth during child-
hood and adolescence.
Long-term effects of cancer Cancer drugs—including corticosteroids and
Cancer treatment can affect every part of a child’s body. methotrexate—can also weaken bones, increasing the
These effects can develop weeks, months, or even years risk for osteoporosis and fractures. Steroids can lead
after treatment is finished. And because children are to osteonecrosis, reduced blood flow to bones that
still growing, long-term cancer treatment effects are causes part of the bone to die.
magnified and therefore potentially more life-altering
than they are in adults. The emotional issues, too, can Effects on fertility and reproduction
be amplified—not only because a person has more Children aren’t generally concerned about the impact
years to cope with the aftermath, but because the ill- of cancer treatment on their fertility, but once they
ness strikes before mature coping skills are developed. reach reproductive age, they might find that they

are unable to have children. In boys, radiation to the to the chest, spine, or upper abdomen can weaken the
lower abdomen or genitals, or chemotherapy with heart muscle and lead to heart failure. Anthracyclines
alkylating agents such as cyclophosphamide (Neosar) can also interrupt the heart’s normal rhythm, causing
or ifosfamide (Ifex) can cause infertility. These treat- an irregular heartbeat. And radiation can damage the
ments can also lower testosterone levels, affecting sex- blood vessels that supply the heart with oxygen.
ual function. In girls, chemotherapy and radiation to Lungs. Chemotherapy drugs such as bleomycin
the abdomen or pelvis can cause infertility, irregular (Blenoxane), carmustine (BiCNU), and lomustine
periods, or early menopause. In people of either sex, (CeeNU) can damage the lungs, as can radiation and
radiation to the head can interrupt the production of surgery to the chest. The risk is highest among chil-
hormones necessary for puberty, fertility, and healthy dren who were treated at a young age. Children with
sexual function. lung damage may experience shortness of breath,
cough, and an increased risk for lung infections later
Organ damage in life.
Cancer treatment can damage virtually every organ in Digestive system. Surgery to the abdomen or
a child’s body. While steps can be taken to avoid or pelvis and radiation to the chest, abdomen, or pelvis
minimize the damage, a certain amount of damage is can affect the gastrointestinal system. Survivors may
usually inevitable. Following are some common types. have long-term problems with stomach pain, consti-
Heart. Anthracycline drugs such as daunorubicin pation, diarrhea, heartburn, nausea, and vomiting.
(Cerubidine, DaunoXome), doxorubicin (Adriamy- Eyes. High doses of radiation to the eyes can
cin, Doxil), and idarubicin (Idamycin) and radiation damage the inside of the eye, leading to long-term
A survivor’s story: Meredith Donahue
M eredith Donahue, who lives in the Boston suburbs, was

14 years old and about to return to high school after
winter break when she awoke with a huge lump on her neck.
procedure left her with a temporary feeding tube and trouble
swallowing, but again, she survived.
At her pediatrician’s office for tests, it became clear to her Doctors warned her that cancer might not be through with
that something was very wrong. “I remember seeing the look her yet, so when the third diagnosis came in 2014, she was
of panic on his face,” she says. When tests confirmed she had almost expecting it. Still, the news was hard to take. “I found
Hodgkin’s lymphoma, she says, “I was worried I might die.” out I had breast cancer right after I got engaged. I was like,
‘Oh my God, now I have to deal with this, too.’” This time the
Donahue didn’t die. She had surgery to treatment was a mastectomy, followed by breast reconstruc-
Cancer remove her spleen (a procedure that’s some- tion and hormonal therapy.
survivor times used to diagnose or treat Hodgkin’s
lymphoma), followed by radiation to her neck Each of Donahue’s three cancers requires its own separate set
and chest. The treatment worked—but it also of follow-up appointments with different specialists, who moni-
left its mark on her body. “The radiation burns your skin,” she tor her for long-term effects and recurrence. “I spend a lot of
says. “I was going to school in February with a sunburned time at Dana-Farber,” she says. Cancer has forced her to make
neck. It affected my taste buds and my throat. Some of my many accommodations and concessions in her life—including
hair fell out. That was all very hard on me because I was a abandoning her hope of having children, because of the tamox-
freshman in high school.” ifen she takes to prevent her breast cancer from returning.
She recovered from her cancer and its side effects and Despite having to manage side effects from her treatment
resumed her life, finishing school and embarking on a career. and deal with the ever-present worry of another cancer on the
More than two decades passed. Then in 2012, Donahue was horizon, Donahue says she lives “a pretty normal life.” Now
hit with another devastating diagnosis. She had tonsil cancer, 42, she’s married and working full-time as a practice manager
which may have been caused by the radiation treatment that for a health care company. “It’s hard, but I just do the best I
previously saved her life. This time she had surgery to remove can,” she says. “I’ve never let anything stop me, but I do have
her tonsils and several lymph nodes surrounding them. The my difficult days.”
vision problems. Radiation can also cause cataracts— development. Accommodations might include one-
a clouding of the lens. Chemotherapy drugs can con- on-one assistance from a classroom aide, modified
tribute to eye problems like double vision, blurred deadlines, help with reading and other subjects, and
vision, and glaucoma—a sight-threatening increase in extra time for tests.
eye pressure. Radioiodine treatment for thyroid can-
cer can increase tear production, while a bone marrow Emotional issues
stem cell transplant can have the opposite effect, caus- At any age, a cancer diagnosis and treatment are
ing dry eyes. frightening propositions. Children are especially vul-
Ears. Radiation to the head or chemotherapy nerable to feelings of fear and anxiety, because they
drugs like cisplatin (Platinol) can damage hearing, may not understand what is happening to them or
especially in younger children who undergo these know what to expect. As they get older, fear from the
treatments. Symptoms include difficulty hearing con- original cancer subsides, but it can be replaced by fear
versations in noisy environments, ringing in the ears, of a recurrence or new cancer. Childhood cancer sur-
and dizziness if treatment affects parts of the inner ear vivors are at greater risk than their peers for depres-
that control balance. Hearing loss that starts early in sion and other mood disorders, as well as for PTSD.
life can affect a child’s speech development. They’re also vulnerable to body image issues as a result
Mouth and teeth. Radiation therapy to the head, of weight loss or gain, hair loss, or unsightly scars.
neck, and mouth can lead to long-term dental prob-
lems, including missing or small teeth, gum disease, Life issues
cavities, and dry mouth. Chemotherapy can slow Cancer’s effects extend far beyond physical health.
tooth development in children whose first teeth have This disease can intrude on virtually every aspect of
not yet emerged. life, leaving a survivor of childhood cancer vulnerable
to all of these issues:
Learning and memory problems • difficulty completing school
Radiation to the brain or high doses of cancer drugs • trouble finding and holding down a job
like methotrexate can lead to long-term cognitive • reduced access to health care because of the pre-
impairments, including lower I.Q. scores, poorer existing condition
academic performance, and problems with mem- • disrupted relationships with family and friends
ory and attention. A 2013 study in the Journal of • loneliness and isolation
the National Cancer Institute looked at survivors of • relationship and intimacy issues
acute lymphoblastic leukemia in their mid-30s who • cancer-related stigma.
had been treated with radiation during childhood.
Those who had received high doses of radiation had
memory loss similar to that of people in their late Reducing long-term effects of
60s. Very young children are especially vulnerable to childhood cancers
cognitive issues following cancer treatment, because Increasingly mindful of the lifelong effects cancer
brain cells develop most rapidly in the first few years treatments can have, pediatric oncologists today take
of life. great care to minimize long-term damage from treat-
To identify possible learning delays, children ment, while still eliminating the cancer as efficiently
who’ve been treated for cancer can undergo an evalu- as possible. In children, radiation therapy is now
ation by a pediatric psychologist. Once the prob- delivered much more precisely than it was in the past.
lem has been identified, parents can request special Doctors try to avoid or limit the use of radiation in
accommodations from the school—possibly in children younger than 3 years old. In older children,
the form of an Individualized Education Program they prescribe radiation in smaller or more focused
(IEP)—to accommodate problems with thinking and doses to destroy the cancer while sparing healthy

surrounding tissues. Oncologists also try to limit or treatment, you’re also at risk for the same cancers any
avoid using the most damaging chemotherapy drugs adult can get, including those of the prostate, breast,
in young patients. When doctors do need to treat a and colon. You can reduce your risks of getting a
child with potentially harmful drugs, they prescribe future cancer by addressing factors you can control,
them together with medicines that protect vulnerable such as body weight, diet, sun exposure, tobacco use,
organs. and activity level. And make sure you get an annual
Research suggests that these efforts to minimize check-up, as well as regular cancer screenings. Report
treatment side effects in children are working. A 2016 any cancer symptoms (see “Warning signs,” page 42)
study in The New England Journal of Medicine found to your doctor right away.
that the rate of deaths from late effects of childhood
cancer treatment—including secondary cancers and
heart and lung damage—dropped from 3.1% in the Long-term screening, treatment, and
1970s to 1.9% in the late 1990s. counseling
While you might want to put your cancer behind you
and stop thinking about medical treatment, the fact is
Secondary cancers that continuing to see your doctor for follow-up vis-
If you had cancer in childhood, the relief you might its will give you the best chance at a healthy future.
have experienced after learning your cancer was suc- A variety of specialists will check you for long-term
cessfully treated could be short-lived. Childhood can- and late treatment effects, as well as for signs that your
cer survivors have to be ever vigilant for new cancers cancer has come back or that you’ve developed a new
and need to be aware of both their risks and what to cancer. Depending on the type of cancer and treat-
watch or screen for. ment received, the follow-up routine for childhood
Several factors affect your future cancer risk, cancer survivors should include periodic visits to one
including the following: or more of these specialists (also see “Screening tests,”
• The kind of cancer you had the first time. page 43):
• The types of treatments you received. You may • a cardiologist for evaluation of heart health, includ-
be more likely to develop acute myeloid leukemia ing an ECG, an echocardiogram, and other tests of
(AML) if you received high doses of certain che- heart function
motherapy drugs. These include alkylating agents • a dermatologist for skin changes that could signal a
such as cyclophosphamide (Neosar) or nitrogen new or recurring cancer
mustard, epipodophyllotoxins such as etoposide • a neurologist for cognitive and sensory problems,
(Toposar, VePesid) and teniposide (Vumon), and as well as for numbness, tingling, and other issues
anthracycline drugs such as daunorubicin (Ceru- related to nerve damage
bidine) and doxorubicin (Adriamycin). High- • a pulmonologist for lung function tests
dose radiation therapy at a young age can increase • an ophthalmologist for eye exams
your risk of skin, breast, brain, thyroid, and bone • an otolaryngologist or audiologist for hearing tests
cancers. • a dentist every six months to monitor for tooth and
• How old you were when you were diagnosed. The gum problems
earlier you get treated for cancer, the higher your • a neuropsychologist to evaluate and treat for educa-
risk for another malignancy. tional and work issues
• Your genetic history. A genetic mutation that runs • a therapist at least once a year to discuss depression,
in your family could increase your chance of getting anxiety, post-traumatic stress, and other long-term
another cancer (see Table 3, page 38). emotional impacts of cancer.
In addition to your increased odds of getting a If you have a child who is a cancer survivor, the
cancer that’s related to your original cancer and its care team would also include the following:
• a pediatrician, to coordinate care and communi- undergone treatment should receive a treatment sum-
cation between specialists, monitor growth, and mary and survivorship care plan to inform their pedia-
discuss health and disease prevention strategies trician and other specialists during the care transition.
(eventually transitioning to a primary care physi- Childhood cancer survivors can also protect their
cian in adulthood) future health by taking good care of themselves as they
• a pediatric oncologist (and later, survivorship pro- age. A study in the Journal of Clinical Oncology found
vider) to check for late effects of cancer treatment, that Hodgkin’s lymphoma survivors who did regu-
recurrence, or secondary cancer lar high-intensity exercise were less likely to develop
• an endocrinologist or a urologist or gynecologist heart problems than those who were less active. Fol-
to identify and treat hormonal issues, including low the diet, exercise, and other lifestyle tips outlined
delayed puberty, problems with sexual function, in “Guidelines for a healthy lifestyle after cancer” (see
and infertility, as well as bone loss. page 28) to minimize long-term side effects and help
Just as with adult survivors, children who have you remain healthy in the years to come.

What your genes tell you (and your family)
J ust as family members often have certain features • An acquired mutation is one you’ve picked up
in common—like dark hair or blue eyes—they may
also share a susceptibility to diseases like cancer. You
during your lifetime—for example, because you
smoked or were exposed to UV radiation. Most
might have noticed that several of your relatives devel- cancers are caused by acquired mutations.
oped the same or related types of cancer. These family Mutations can alter the orderly cell reproduction
cancer syndromes stem from a combination of inher- process, potentially leading to cancer. Three types of
ited genes and shared environmental exposures (see genes are often involved in cancer development:
Table 3, below right). • Tumor suppressor genes regulate the process of cell
Genes—the segments of code packed inside each division. They control how quickly cells multiply
of our 37 trillion or so cells—provide the instructions and ensure that cells die when they’re supposed to,
that make each one of us who we are. If you have your so cells don’t overproliferate. If tumor suppressor
mother’s blue eyes or your father’s curly hair, those genes are mutated, cells can multiply unfettered
traits are manifestations of the genes you’ve inherited. and form tumors. P53 is an example of a tumor
Genes are made up of segments of DNA—
sequences of varying patterns of four
Table 3: Family cancer syndromes
chemical bases: adenine (A), guanine (G),
Here are examples of a few inherited cancer types and the genes that increase
cytosine (C), and thymine (T). Strands of your risk. Genetic tests are available for these mutations.
DNA are wound up into threadlike struc- GENE(S) TYPES OF CANCER IT CAUSES
tures called chromosomes. You have two
APC Colorectal, brain, stomach, bone, skin
sets of chromosomes—23 from each of
your parents. BRCA1, BRCA2 Breast (male and female), ovarian, prostate, pancreatic,
melanoma
Each gene codes for the production of
a protein, and each protein is responsible CDKN2A Melanoma
for a different function in your body. Any CHEK2 Breast, ovarian, prostate, lung, colon, kidney, thyroid
alteration to the genetic code—no matter
MEN1 Pancreatic, parathyroid, pituitary gland
how small—may change how your body
functions, and often not for the better. MLH1, MSH2, MSH6, Colorectal, ovarian, endometrial, uterine, pancreatic,
PMS2, EPCAM liver, stomach, brain, breast
Changes in your DNA sequence are called
mutations, and they can give rise to can- MYH Colorectal
cers. You can get mutations in one of two PTEN Breast, endometrial, thyroid
ways: RB1 Eye, pineal gland, bones, melanoma, soft tissue sarcoma
• An inherited mutation is passed down
RET Thyroid
from your parents. It can be autosomal
dominant (meaning that you need to STK11 Colorectal
inherit only one copy of the mutated gene TP53 Bone and soft tissue sarcoma, leukemia, brain, breast,
to have an increased cancer risk) or auto- adrenal, colon, adenocarcinoma
somal recessive (meaning that you need TSC1, TSC2 Kidney
two copies of the mutated gene—one
VHL Kidney
from each parent—to have a higher risk).
suppressor gene. Mutations in this gene are fortu- makes you more susceptible to colorectal cancer, a
nately very rare, but they can lead to a number of high-fat, meat-heavy diet and lack of exercise could
cancers, including sarcoma, leukemia, brain can- tip the balance toward developing cancer rather than
cer, and breast cancer. remaining cancer-free. In other words, you inherit a
• DNA repair genes fix mistakes in the DNA code. predisposition or susceptibility to a particular cancer,
When they are mutated, mistakes don’t get cor- but whether you actually get the cancer is not prede-
rected, which could lead to cancer. BRCA1 and termined. Many people live with gene mutations and
BRCA2 are examples of DNA repair genes. Muta- never show any harmful effects from them.
tions in these genes lead to hereditary breast, ovar-
ian, prostate, and pancreatic cancers, as well as
melanoma. Should you and your family get
• Oncogenes are genes that turn healthy cells can- tested?
cerous. An example is MYC, which contributes to During cancer treatment, a pathologist may do
B-cell leukemia, Burkitt’s lymphoma, and some genomic testing on a sample of your tumor to get a
types of lung cancer. better sense of what treatments may help you most—
If a certain type of cancer—say, breast or pros- for example, if you have a particular subtype of a
tate cancer—runs in your family, genes you’ve inher- given cancer. This is different from the genetic muta-
ited may be to blame, but usually only partly so. Only tion testing to determine why you might have got-
about 5% to 10% of these family cancer syndromes ten cancer and whether you may have an inherited
are the direct result of an inherited gene mutation. predisposition.
The rest are due to a complex interplay of genetics and Getting tested for genetic mutations that cause
environmental triggers. cancer can help you learn whether your cancer was
These cancers can also be influenced by the fam- related to genes—and therefore if other family mem-
ily you grew up in, since families have a tendency to bers might also be at risk. It may be worthwhile for
share other cancer risks—like a poor diet, obesity, or them to get tested if there is a strong history of a par-
smoking. So though you might inherit a gene that ticular cancer in your family, especially if two or more
of your relatives were diagnosed at a young age (see
“Criteria for genetic testing,” at left). If they opt for
Criteria for genetic testing testing and turn out to have a cancer-related muta-
tion, knowing their risks in advance will encourage
E xperts recommend that you and other members of
your family undergo genetic testing for cancer if you
meet these any of these criteria:
them to have regular cancer screenings, thus improv-
ing their chances of finding cancer early, when it is
• You have several close relatives with the same type of easiest to treat.
cancer. Even if you’ve already had cancer, testing can
• One or more family members have had two or more
give you a window into your future cancer risks. For
related cancers, such as breast and ovarian cancer, or
colorectal and endometrial cancer. example, if you’ve had breast cancer and you learn
• Your family members developed cancer at a young age
that you carry the BRCA1 or BRCA2 gene muta-
(before age 50). tion, you’ll know that you’re also at risk for ovarian
• A family member developed several different types of cancer and cancer in the other breast. Then you can
cancer, or got cancer in two paired organs (such as both decide whether to have regular surveillance, undergo
kidneys or both breasts). preventive surgery, or take chemopreventive drugs
• You’re a member of an ethnic group that is known like tamoxifen (Nolvadex). Family members who test
to develop certain hereditary cancer syndromes (for
positive can make similar decisions. You’ll also learn
example, Ashkenazi Jews are more likely to inherit BRCA
mutations). whether you could pass cancer susceptibility to your
children.

Getting tested has undeniable benefits, yet it has how significant that increased risk might be.
downsides as well. Learning the existence of a can- By the same token, a negative result (meaning that
cer risk gene can be a heavy burden for both you and the test didn’t identify any genetic change) doesn’t
your relatives. You—and they—could carry the weight guarantee that you’re off the hook. It’s possible that
of worry about a cancer that might or might not ever the test missed or wasn’t able to pick up the particular
emerge. Not everyone with a genetic mutation will gene variant you have. And even if you don’t carry a
ultimately develop cancer. You might also feel a sense genetic variation, you could still be at risk for cancer—
of guilt about passing a cancer-causing mutation for example, because of your environmental exposures.
down to your children. Conversely, a negative result In a third scenario, the test doesn’t give you any
may give you a false sense of security because no test information about your genetic risk for cancer at all.
can definitively prove that you won’t get cancer in the This vague result is called inconclusive or uninforma-
future. Sometimes genetic test results are unclear, and tive. Everyone carries normal genetic variations, called
you will have to live with uncertainty. polymorphisms. Sometimes it can be hard for genetic
Another issue is cost. Genetic testing is expensive. tests to differentiate between these benign variations
The cost of testing for the BRCA genes can range from and the variations that cause cancer.
$300 to $5,000, depending on whether your doctor In all three of these situations, you might need
is testing only one part of a gene or multiple genes. additional genetic tests to get a more conclusive
Medicare will cover the cost if you’ve already been answer. This is where a genetic counselor can be
diagnosed with cancer and you meet certain family invaluable in helping you interpret your results. Your
history requirements. Many private insurers will also doctor and genetic counselor can help you determine
pay, but you must meet specific criteria that specify whether you need to take additional steps.
your age at diagnosis and the number of family mem-
bers who are affected.
The decision to get tested is a complicated and Your legal rights
very personal one. To help you weigh your options, If you plan to have genetic tests, you might worry
make an appointment with a genetic counselor, who about your privacy or the potential for your employer
can help you decide whether to get tested, help inter- and other companies to discriminate against you
pret your results, and decide how to act on the infor- based on your results. Under the Health Information
mation. To find a genetic counselor in your area, ask Portability and Accountability Act (HIPAA), your
your oncologist or visit the National Society of Genetic health care provider is required to protect the pri-
Counselors website (https://nsgc.socious.com). vacy of your medical information—including your
genetic test result—and restrict access to it. Yet certain
groups—such as your health insurance company and
What do your genetic test results your employer—may have the legal right to access this
mean? information in your medical record.
Gene tests can answer some questions about your fam- Under the Genetic Information Nondiscrimina-
ily’s cancer risks, but they can also create new question Act (GINA), your employer can’t discriminate
tions. The results aren’t always straightforward. Say against you based on your genetic history. However,
you or a family member tests positive. In other words, there are no federal protections to prevent companies
the lab has found a change to one or more genes, chro- that provide life insurance and long-term care insur-
mosomes, or proteins. This result could mean that ance from using your genetic test results to deny you
you’re at risk for that cancer, but it can’t determine coverage or charge you higher premiums.
What happens if your cancer returns
H earing the words “You’re in remission” or “You’re

cured” can bring a huge sense of relief after a long
and difficult treatment journey. Yet these words don’t
so breast cancer that spreads to the bone will still be
called breast cancer.
• Progression means your existing cancer has spread.
necessarily mean you can look forward to a cancer- If your doctor finds cancer within a few months
free future. Once you’ve had cancer, a recurrence or of your treatment, it’s likely because your can-
new cancer is an ever-present risk. In what might cer wasn’t completely eradicated to begin with, or
seem a cruel twist of fate, having cancer once makes because it has become resistant to your treatment.
you more likely to get cancer again. • Secondary cancer means you’ve developed a new
Cancer can re-emerge months or years later in one cancer. Sometimes cancer treatments like radia-
of three ways: tion and chemotherapy can alter your cells to
• Recurrence means your original cancer has come the point that they later turn cancerous. Or you
back after it was previously undetectable. Surgery, might be at increased risk for a secondary can-
chemotherapy, and other treatments don’t always cer because of your previous cancer (see Table 4,
remove or destroy all of the cancer cells. Some cells, below left). Another possibility is that a new can-
not detectable on tests, might have been left behind cer developed that was unrelated to the first one.
and continued growing. Others might have lain In much the same way that cancer developed the
dormant, only to wake up later. Cancer can return first time, normal cells simply turned cancerous.
in the same place where it started (local recur- It can be disheartening to learn that you have
rence), travel to lymph nodes close to its original cancer after you thought you were free and clear. You
site (regional recurrence), or appear in another part might cycle through the same emotions you expe-
of your body (distant recurrence). The cancer keeps rienced when you were first diagnosed—including
its original name, regardless of where it has spread, anger, fear, and anxiety. Just as you did before, you’ll
work with your oncology team to find the best treat-
ments to combat the latest cancer.
Table 4: Secondary cancers, by cancer type
Here is a look at the types of secondary cancer for which you’re at
increased risk, based on your original cancer type.
Factors that increase your risk for a
PRIMARY CANCER
TYPE
SECONDARY CANCERS ASSOCIATED
WITH IT secondary cancer
Several factors can make you more likely to develop
Breast cancer Breast, colorectal, leukemia, lung,
ovarian, uterine a secondary cancer. Some are under your control.
Others aren’t. Most of these risk factors have already
Colorectal cancer Breast, lung, prostate, uterine
been discussed in this report, but we repeat them
Head or neck cancer Breast, colorectal, lung, prostate here because it’s important for you to discuss your
Hodgkin’s disease Breast, leukemia, lung risks with your doctor and find out what you can
Lung cancer Breast, colorectal, esophageal, head or do to lower your odds of developing cancer again.
neck, leukemia, prostate Equally important, discuss how often you need to get
Prostate cancer Bladder, colorectal, leukemia, lung screened, so you can catch any new cancers early.
Childhood cancer. If you developed can-
Uterine cancer Breast, colorectal
cer before age 15, you’ll need to stay on top of your

health in the years to • Exercise for at least 30
come. Some childhood minutes a day, five days
tumors are caused by a week.
inherited syndromes • Keep your body mass
that contribute to a life- index (BMI) within a
long increased risk for healthy range.
cancer. For example, • If you smoke, ask your
© Wavebreakmedia Ltd | Thinkstock

Li-Fraumeni syndrome doctor for help quitting.
can lead to sarcoma, leu- Also avoid secondhand
kemia, and brain and smoke.
breast cancers. The treat- • Limit alcohol intake
ments you received to to no more than one
combat childhood can- If you have fair skin or any suspicious moles, you should get a skin 6-ounce glass of wine
cer can also make you cancer check. Suspicious moles are irregularly shaped, unevenly col- (or the equivalent) a
more vulnerable to future ored, and larger than a pencil eraser, and they change over time. day for women and one
malignancies. or two glasses for men.
Family history. When you have multiple close • Wear UVA/UVB–protective sunscreen whenever
relatives who all developed a particular cancer, that’s you go outside.
a very strong indication that your family carries a
genetic susceptibility. Though you can’t change your
genes, you can get tested for genetic changes that are Warning signs
associated with increased cancer risk and—if you are If your original cancer returns or you develop a new
at higher risk—be screened for those cancers and take cancer, finding it early may give you the best chance
other preventive measures. of successfully treating it, or at least protect you from
Cancer treatment. Radiation, chemotherapy, and experiencing more symptoms. Survival rates are high-
other cancer therapies, while necessary to cure your est in early-stage cancers that haven’t yet spread to
disease, can also trigger cellular changes that make other organs.
you more vulnerable to a secondary cancer. Your doc- To catch a cancer early, you need to be vigilant for
tor will make every possible effort to structure your symptoms. If your earlier cancer returns, you might
initial treatment—for example, fine-tuning the drug easily recognize the symptoms, but you might not be
and dose—to destroy the cancer, while minimizing as familiar with the signs of a new cancer. Here are a
your future cancer risks. few general warning signs to watch out for:
Age. The older you are, the higher your cancer risk. • a lump under your skin that is new and appears to
Each passing year brings more chronic conditions, be growing
more exposure to environmental factors that increase • fatigue
your risk, and a lower ability of cells to repair damage. • unexplained pain
Lifestyle. Lifestyle is one cancer risk you can • a new or changing sore or growth on your skin
control. Many of the choices you make each day can that doesn’t heal
influence—sometimes significantly—your chances of • a cough that doesn’t go away
getting a future cancer. Here are a few things you can • unexplained night sweats (unrelated to menopause)
do to reduce your risks: or fevers
• Eat a nutritious diet that’s heavy in cancer-fight- • unexplained bleeding or bruising
ing foods, like broccoli and other cruciferous veg- • trouble swallowing, hoarseness
etables, dark leafy greens, beans and peas, berries, • unintended weight loss
cherries, tomatoes, and nuts. • change in bowel or bladder habits.
Screening tests urethra and up into the bladder, so your doctor can
Once you’ve been treated for cancer, you’ll set up a monitor for bladder cancer.
schedule of exams and screenings to verify that you Blood or urine tests for tumor markers. Some
are still cancer-free and to catch any new cancers cancers release substances that can alert your doc-
early (see “A survivor’s story: Jeff Sirlin,” below). Your tor to their presence. For example, carcinoembryonic
oncologist or primary care provider will oversee a fol- antigen (CEA) is used to detect colon cancer recur-
low-up care plan that includes regular exams and tests rence. Bladder tumor antigen (BTA) identifies cancer
in the upcoming months and years. These visits usu- of the bladder, kidneys, or ureters. PSA for prostate
ally follow a stepwise pattern, starting at intervals of cancer (next entry) is also a type of tumor marker.
every few months, then stepping down to once a year, Prostate-specific antigen (PSA) test. The PSA
and then possibly to longer intervals between visits. test measures levels of a protein that rise when you
Depending on the cancer you had and your risks for have prostate cancer or any other abnormal activity
other cancers, you might need one or more of these in your prostate. Although this blood test is contro-
tests. Some of them are useful screening tests that are versial for diagnosing an initial prostate cancer, it is
recommended at regular intervals anyway: recommended during treatment. Prostatectomy and
Bone scan. This test uses a small amount of a androgen deprivation therapy—two common treat-
radioactive tracer injected into a vein to find cancer ments for prostate cancer—should both lower PSA
that has started in or has spread to your bones. levels substantially. If levels rise, it could mean these
Chest x-ray. A chest x-ray uses a low dose of interventions haven’t been successful.
radiation to produce images of your lungs. It can help Digital rectal exam. During this exam, the doctor
your doctor find cancer that has started in or spread inserts a gloved, lubricated finger into a man’s rectum
to your lungs. to check for abnormalities in the prostate gland. This
Cystoscopy. This procedure involves inserting a exam cannot, however, detect small cancers or those
thin tube with a camera and light on it through the in the front portion of the prostate gland.
A survivor’s story: Jeff Sirlin
J eff Sirlin of Needham, Mass., was just 37 years old and

owner of an online fundraising company when he was
diagnosed with stage 3 colon cancer in 2010. The news
Since late 2013, Sirlin has been cancer-free. Doctors have
told him that if he hits the five-year mark without a recur-
rence, his chances of it returning are slim. Yet no matter how
came as a complete shock. He had no family history of colon many clean scans he has, the fear of another positive diag-
cancer or risk factors for the disease. In fact, he was so much nosis continues to haunt him. “Once you have a recurrence,
younger than the typical patient (90% of colorectal cancers you’re always on edge for another one,” he says. “Every time
start in people older than 50) that his doctor initially figured you go in for a scan, your anxiety level goes through the
the blood in his stools had to be from hemorrhoids. When it roof.” To cope with the stress, Sirlin has adopted a program of
proved to be cancer, Sirlin opted for colon resection surgery, mindfulness-based stress reduction. “On a daily basis I do tai
followed by six months of chemotherapy that wiped out any chi, qigong, and the deep stretching type of yoga,” he says.
remaining trace of the tumor. He’s even launched a website, called Cancer Wellness TV
(www.cwellness.com), to share mind-body techniques with
That might have been the end of his cancer
other cancer patients and survivors.
Cancer story, but it turned out to be only the beginning.
survivor About three years later, while Sirlin was under- With all the worries and challenges cancer has brought to Sir-
going periodic blood work and scans, his doctor lin’s life, the experience has also given him a new perspective
found a mass in his chest. The cancer had not and made him a stronger, more centered person. “This has
only returned—it had migrated. Again he went through surgery, really opened my eyes to how things can turn so quickly in
this time followed by six months of chemotherapy and 30 rounds life,” he says. “I don’t focus on the small things—I’m grateful
of radiation. Once again, the treatment was successful. for the things that are important to me.”

Mammogram. This test uses x-rays to create Follow-up recommendations
images of the breasts, which can reveal breast cancer. The earlier you catch a new cancer, the better your
Tomosynthesis, also known as 3D mammography, is a chances are of surviving it, so you need to stay vigi-
newer technique that takes three-dimensional images lant. Your oncologist will set up a series of follow-up
of the breasts. A 3D mammogram can help prevent appointments, during which he or she will monitor
false positives and detect cancer more accurately in you for cancer progression or return and check for
women with dense breasts. The U.S. Preventive Ser- any long-term or late effects of your treatment. These
vices Task Force recommends a mammogram every follow-ups will be tailored to your cancer type and
two years from ages 50 through 74 for all women. personal risks, but in general, here are the recommen-
Colonoscopy. The doctor uses a thin, flexible tube dations you can expect to follow for these common
with a tiny camera to relay an image of the inside of cancer types.
your colon and rectum—the lower part of your large
intestine. During this test, your doctor can find and Lung cancer
remove growths called polyps, which can grow into The frequency of your visits depends on your type
colorectal cancer. Colonoscopies at regular intervals of lung cancer. With small cell lung cancer, you’ll see
are recommended for everyone beginning at age 50. your doctor about once every three months for the
Mole checks. A dermatologist examines your first couple of years after your treatment. Then you’ll
entire body for signs of suspicious moles or lesions. stretch out the visits to once every six months. After
Cancers can appear in places you might not see, five years with no signs of cancer, you can extend your
like on your scalp or in areas that do not regularly appointments to once a year. With non–small cell lung
get sun exposure (under the breasts, for example). cancer, doctors often recommend follow-up visits
every six to 12 months for two years, and then yearly
Imaging methods visits. These appointments can include CT scans and
These are some of the technologies used for testing: blood tests.
CT scan. A computed tomography (CT) scan uses
x-rays to take a series of pictures from inside your Breast cancer
body. Each picture represents a “slice” of an organ. You’ll start by seeing your doctor every few months.
When put together, the pictures create a three-dimen- After five years, your follow-up visits will stretch out
sional image. Your doctor might do a chest CT scan to to once a year, unless you’re still on endocrine therapy,
look for lung cancer. in which case you might be seen more frequently. If
PET scan. Positron emission tomography (PET) you had breast-conserving surgery, you’ll still need to
uses a radioactive material to find cancer in your body. have regular mammograms. Most experts recommend
This tracer is either injected into a vein or put into a that women who have had a partial mastectomy or
drink for you to swallow. The scanner then detects lumpectomy get a mammogram of the treated breast
where in your body the tracer goes, helping your doc- six months after radiation treatment ends. If you’ve
tor spot cancer, if it exists. had a complete mastectomy, have regular mammo-
MRI scan. Magnetic resonance imaging (MRI) grams on the other breast. You’ll also need an annual
uses a powerful magnet and radio waves to look at pelvic exam if you take the drug tamoxifen (Nolva-
organs and other structures inside your body. It can dex), because this medicine can increase your risk
help your doctor distinguish between normal tissue for uterine cancer. If you have signs of a recurrence,
and cancer. your doctor might send you for an x-ray, CT scan,
Ultrasound. An ultrasound uses sound waves to bone scan, MRI or other imaging test, or blood tumor
produce images of your organs. Sound waves bounce marker test. You’ll also want to keep up with screen-
differently off cancerous tissue than they do off nor- ing for colon and cervical cancers, for which you’re at
mal tissue, thus helping your doctor find any tumors. higher risk because of your breast cancer.
Prostate cancer Bladder cancer
You’ll see your doctor every six months or so for PSA Most bladder cancer survivors see their doctor once
tests and digital rectal exams (if your prostate is still every three to six months for blood, imaging, and
intact). After five years, you can switch to a once- urine cytology tests (to look for abnormal cells in the
yearly schedule. You might also need imaging scans, urine). If you still have your bladder, you’ll also need
depending on your risks and symptoms. regular cystoscopy. If you have no signs of cancer, your
doctor will let you extend the time between visits.
Colorectal cancer
For the first couple of years after your treatment, you’ll
get an exam every three to six months. Then you’ll go Treatment for a recurrence
back once every six months for the next few years. Sometimes, despite the best care and vigilance, your
Within a year after your surgery, you’ll have a colonos- cancer will come back. If you do get cancer again, your
copy. If the result is normal, you can wait three years doctor will talk you through your treatment options.
to have another one. If you’re at high risk for a recur- As you might have done the first time you were diag-
rence or your first cancer spread to your liver or lungs, nosed, you can ask for a second opinion. You might
you’ll also have regular CT scans. During your follow- need to consult with another oncology specialist if
up visits, your doctor might test your blood for the you have cancer in a different part of your body.
marker CEA, which will rise if your cancer returns. To treat a recurrence of the same cancer, you
might try the same regimen you were on previously.
Leukemia Or your doctor might give you a new therapy if you
You’ll see your oncologist every three to four months didn’t respond well the first time or you had a reaction
at first, and then taper off to once or twice a year. Dur- to the drug you were on. Sometimes your cancer can
ing your visits, you may have blood tests to check your become resistant to the effects of one chemotherapy
white and red blood cell counts, bone marrow tests to drug regimen, and you’ll need to try another drug or
look for cancerous cells, and possibly imaging scans. type of treatment that works in a different way.
Don’t let a recurrence leave you disheartened. You
Skin cancer overcame your cancer once, and you can do it again.
For basal cell cancers, your doctor will see you once Sometimes the second cancer is curable. In other
every six to 12 months. Squamous cell cancer fol- cases, it becomes a chronic condition that is manage-
low-ups are done once every three to six months. able. The danger is that individual cancer cells may
The frequency of melanoma visits depends on the have survived the initial treatment and spread to mul-
extent of your cancer. If you had an early-stage mel- tiple areas of the body, seeding new cancers there.
anoma that your doctor completely removed, you’ll Even if treatments don’t stop the cancer right away,
come back every six to 12 months. For a thicker you can look into clinical trials of new therapies that
melanoma that wasn’t completely removed, or one might be effective for your type of cancer.
that spread, you’ll visit your doctor every three to If you didn’t join a support group after your first
six months. cancer, you may want to join one now. No one has
During your visits, the doctor will examine your a better understanding of what you’re going through
skin for signs that the cancer has returned. If your can- than others with similar circumstances. Also, lean on
cer was more aggressive, you might also have imaging family and friends, and let them know what you need.
tests, such as a CT scan. Your doctor will likely recom- Many will want to help but may be at a loss for what
mend that you also check your own skin once a month. to say or do. Only you can tell them.

Resources
Organizations community programs, and financial assistance to cancer patients.
American Cancer Society Cancer Financial Assistance Coalition

250 Williams St. NW www.cancerfac.org
Atlanta, GA 30303 This coalition of organizations helps cancer patients fund the high
404-320-3333; 800-227-2345 (toll-free) cost of care.
www.cancer.org
American Cancer Society Cancer Survivors Network Cancer Legal Resource Center
https://csn.cancer.org 213-736-1031; 866-THE-CLRC (866-843-2572) (toll-free)
This leading national organization conducts cancer research and www.cancerlegalresources.org
supports patients through their diagnosis and treatment. It also This legal aid organization helps cancer patients with issues like
offers a Cancer Survivors Network—a community for people access to health care and government benefits, employment
whose lives have been touched by cancer. rights, and insurance appeals.
American Psychosocial Oncology Society Cancer Support Community

5034A Thoroughbred Lane 734 15th St. NW, Suite 300
Brentwood, TN 37064 Washington, DC 20005
615-432-0090 202-659-9709; 888-793-9355 (toll-free)
Helpline: 866-APOS-4-HELP (866-276-7443) (toll-free) www.cancersupportcommunity.org
https://apos-society.org
This nonprofit organization provides emotional and social support
APOS is an organization of professionals who work to address for people who are affected by cancer.
the psychological and social aspects of cancer. It offers a toll-free
helpline to cancer patients and caregivers, along with a directory Fertile Action
of resources. P.O. Box 3526
Manhattan Beach, CA 90266
American Society of Clinical Oncology www.fertileaction.org
2318 Mill Road, Suite 800
Fertile Action helps women who have been treated for cancer
Alexandria, VA 22314
become mothers.
888-651-3038 (toll-free)
www.cancer.net/survivorship Friend For Life
ASCO, which has more than 40,000 members involved in caring 4003 Kresge Way, Suite 100
for cancer patients, offers a section of its website to help survivors Louisville, KY 40207
and their families. 866-374-3634 (toll-free)
www.friend4life.org
Association of Cancer Online Resources
Friend for Life is a network of cancer survivors and caregivers who
173 Duane St., Suite 3A
provide support to current cancer patients and their loved ones.
New York, NY 10013
212-226-5525 Leukemia and Lymphoma Society
www.acor.org 3 International Drive, Suite 200
ACOR provides information and support to cancer patients Rye Brook, NY 10573
through email lists and Web-based resources. 914-949-5213
www.lls.org
Association of Oncology Social Work
The Leukemia and Lymphoma Society promotes research and
1 Parkview Plaza, Suite 800
provides support for patients, survivors, and families dealing with
Oakbrook Terrace, IL 60181
leukemia, lymphoma, Hodgkin’s disease, and myeloma.
847-686-2233
www.aosw.org Livestrong
AOSW is an organization of professionals who provide 2201 E. Sixth St.
psychosocial services to people with cancer, as well as their Austin, TX 78702
families and caregivers. 855-220-7777 (toll-free)
www.livestrong.org
CancerCare
This organization helps connect the more than 32.6 million
275 Seventh Ave.
people worldwide with cancer to the services they need.
New York, NY 10001
800-813-HOPE (4673) (toll-free) Movember Foundation
www.cancercare.org P.O. Box 1595
This organization offers counseling, support groups, education, Culver City, CA 90232
Resources continued
310-450-3399 Adult cancer survivorship programs
https://us.movember.com
This organization is devoted to saving the lives of men diagnosed Dana-Farber Cancer Institute
with prostate and testicular cancers. 450 Brookline Ave.
Boston, MA 02216
National Cancer Institute 617-632-4523
BG 9609 MSC 9760 www.dana-farber.org/For-Adult-Cancer-Survivors.aspx
9609 Medical Center Drive
Bethesda, MD 20892 Fred Hutchinson Cancer Research Center
800-4-CANCER (800-422-6237) (toll-free) 1100 Fairview Ave. N.
www.cancer.gov Seattle, WA 98109
Office of Cancer Survivorship 206-288-1024
http://cancercontrol.cancer.gov/ocs www.fredhutch.org/en/treatment/survivorship.html
The National Cancer Institute is the federal government’s main
cancer research agency. It offers information to the general public MD Anderson Cancer Center
on cancer diagnosis and treatment. 1515 Holcombe Blvd.
Houston, TX 77030
NeedyMeds, Inc. 855-728-7094 (toll-free)
800-503-6897 (toll-free) www.mdanderson.org/patients-family/life-after-cancer.html
www.needymeds.org
Memorial Sloan Kettering Cancer Center
This nonprofit organization provides information on programs to 1275 York Ave.
help consumers who can’t afford their medication. New York, NY 10065
800-525-2225 (toll-free)
OncoLink
www.mskcc.org/experience/living-beyond-cancer/survivorship
www.oncolink.org
https://oncolife.oncolink.org
Stanford Health Care
This website from Penn Medicine at the University of Pennsylvania 875 Blake Wilbur Drive
offers a variety of resources for those at various stages of the Palo Alto, CA 94304
cancer journey. The OncoLife section of the site helps you draw up 650-498-6000
a survivorship care plan. http://stanfordhealthcare.org/medical-clinics/cancer-survivorship-
program.html
Patient Access Network
P.O. Box 221858
Charlotte, NC 28222 Childhood cancer survivorship programs
866-316-7263 (toll-free)
www.panfoundation.org Children’s Hospital of Philadelphia
The Patient Access Network helps people with life-threatening Cancer Survivorship Program
and chronic diseases cover out-of-pocket health care costs. 3401 Civic Center Blvd.
Philadelphia, PA 19104
Patient Advocate Foundation 267-426-0210
421 Butler Farm Road www.chop.edu/centers-programs/cancer-survivorship-program
Hampton, VA 23666
800-532-5274 (toll-free) Dana-Farber Cancer Institute
www.patientadvocate.org David B. Perini, Jr. Quality of Life Clinic
450 Brookline Ave.
The Patient Advocate Foundation helps patients settle medical
Boston, MA 02216
and care access issues through arbitration, mediation, and
617-632-5124
negotiation.
www.dana-farber.org/For-Survivors-of-Childhood-Cancer.aspx
Susan G. Komen
5005 LBJ Freeway, Suite 250 St. Jude Children’s Hospital
Dallas, TX 75244 Division of Cancer Survivorship
877-GO-KOMEN (877-465-6636) (toll-free) MS 735, Room S6014
https://ww5.komen.org 262 Danny Thomas Place
Memphis, TN 38105
This organization funds medical research and provides support to 901-595-3384
breast cancer patients. www.stjude.org/treatment/survivorship.html

Resources continued
Publications Sat Bir Singh Khalsa, Ph.D., and Lauren E. Elson, M.D., Medical
Editors
The following Special Health Reports from Harvard Medical
(Harvard Medical School, 2016)
School can provide additional information to supplement the
advice given in this report. To order, go to www.health.harvard.
Lose Weight and Keep It Off: Smart approaches to achiev-
edu or call 877-649-9457 (toll-free).
ing and maintaining a healthy weight
Advance Care Planning: A guide to advance directives, liv- W. Scott Butch, M.D., M.S.C., Medical Editor
ing wills, and other strategies for communicating health Karen Ansel, R.D., R.D.N., C.D.N., Nutrition Editor
care preferences (Harvard Medical School, 2017)
Muriel Gillick, M.D., Medical Editor
Charles P. Sabatino, Legal Editor Understanding Depression: The many faces of depres-
(Harvard Medical School, 2016) sion—and how to find relief
Michael Craig Miller, M.D., Medical Editor
The Harvard Medical School 6-Week Plan for Healthy Eating (Harvard Medical School, 2017)
Teresa Fung, Sc.D., R.D., L.D.N., Faculty Editor
Kathy McManus, M.S., R.D., L.D.N., Nutrition Editor Walking for Health: Why this simple form of activity could
(Harvard Medical School, 2015) be your best health insurance
Lauren E. Elson, M.D., Medical Editor
An Introduction to Yoga: Improve your strength, balance, Michele Stanten, Fitness Consultant
flexibility, and well-being (Harvard Medical School, 2015)
Glossary
acquired mutation: A gene change that you pick up during your myocardial ischemia: A reduction in blood flow to the heart,
lifetime—for example, because you smoked or you were exposed usually because of a blockage in one of the arteries that carries
to ultraviolet radiation. Most cancers are caused by acquired blood to the heart.
mutations. neurofeedback: A technique that uses an electroencephalogram
arrhythmia: An abnormal heart rhythm in which the heart beats (EEG) to display your brain activity so that you can learn how to
too fast, too slowly, or irregularly. gain more control over certain mental functions.
atherosclerosis: Hardening and narrowing of the arteries caused neurologist: A specialist who treats conditions of the brain and
by fatty deposits called plaques. spinal cord, including memory loss and nerve damage.
autosomal dominant: In the context of gene mutations, a type neuropathy: Nerve damage that can be a result of certain cancer
of gene change in which you only need to inherit one copy of the treatments.
mutated gene to have an increased cancer risk. oncogene: A type of gene that can turn healthy cells cancerous.
autosomal recessive: In the context of gene mutations, a type oncologist: A specialist who treats cancer and who follows
of gene change in which you need to inherit two copies of the survivors for side effects and cancer recurrence.
gene—one from each parent—to have an increased cancer risk.
oncology nurse: A health care professional who monitors the
cardiomyopathy: Disease of the heart muscle. health of cancer patients and serves as the main line of communi-
cognitive rehabilitation: A program of mental exercises that’s cation between them and the oncologist.
designed to help overcome treatment-related cognitive impair- ostomy: A surgically created opening through which wastes are
ment and improve memory, attention, and concentration. removed from your body into a bag.
colonoscopy: A test that uses a camera mounted on a thin, flex- palliative care specialists: Medical professionals who help
ible tube to show the inside of your colon and rectum—the lower manage cancer side effects like nausea, pain, and fatigue.
part of your large intestine. During this test, your doctor can find
and remove growths called polyps, which can grow into colorectal pericarditis: Swelling of the membrane surrounding the heart.
tumors positron emission tomography (PET) scan: A test that tracks
computed tomography (CT) scan: A test that takes a series of a radioactive material (which is injected or swallowed) to find
x-rays of the inside your body and combines them into a three- cancer in your body.
dimensional image. post-traumatic stress disorder (PTSD): A disorder in which
coronary artery disease: A condition in which the blood vessels people who’ve survived a traumatic event, such as war, violence,
that supply the heart become stiff and narrow, impairing blood or a life-threatening disease, relive the event over and over again
flow to the heart. in their minds.
digital rectal exam: A test for prostate cancer in which the doc- prostate-specific antigen (PSA) test: A blood test that mea-
tor inserts a gloved, lubricated finger into a man’s rectum to check sures levels of a protein that rise when a man has prostate cancer
for abnormalities in the prostate gland. or any other abnormal activity in the prostate.
DNA repair gene: A type of gene that fixes mistakes in the DNA pulmonary hypertension: Increased blood pressure in the
code. arteries of the lungs.
endocrinologist: A specialist who treats hormonal conditions, pulmonologist: A specialist who treats lung conditions.
such as diabetes and hypothyroidism. recurrence: When your original cancer returns, either in the same
heart failure: A condition in which damage to the heart prevents place it started (for example, your breast or lung) or in another
it from pumping enough blood to the body. part of your body.
hypothyroidism: A condition in which the thyroid gland in the secondary cancer: A new cancer that is unrelated to your
neck can’t produce enough of its hormones, leading to a slowed original cancer.
metabolism and symptoms like fatigue, cold intolerance, and sigmoidoscopy: A screening test for colorectal cancer that
weight gain. enables the doctor to see the lower part of your colon and rectum.
inherited mutation: A change to a gene that is passed down tinnitus: Hearing damage marked by ringing in the ears.
from parents to their children. tumor suppressor genes: Genes that regulate how quickly cells
magnetic resonance imaging (MRI) scan: A test that uses a multiply and ensure that cells die when they’re supposed to, so
powerful magnet and radio waves to look at organs and other cells don’t overproliferate. If tumor suppressor genes are mutated,
structures inside your body. It can help distinguish between normal cells can multiply unfettered and form tumors.
tissue and cancer. ultrasound: A test that uses sound waves to produce images of
mammogram: A test that uses x-rays to create images of the your organs. Sound waves bounce differently off cancerous tissue
breasts to identify breast cancer. than they do off normal tissue.

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A HARVARD MEDICAL SCHOOL

SPECIAL HEALTH REPORT

Life After Cancer

Here’s what you CAN do Here’s what you CAN’T do

For more information

Ann Partridge, M.D., M.P.H.

I n 2016, more than 15.5 million people in the United

tional challenges to overcome,

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The transition from 15

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I n the early part of the 20th century, a cancer diag-

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A s you move from cancer patient to survivor, you’ll still need

© Cathy Yeulet | Thinkstock

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A survivor’s story: William J. Trainer

W illiam J. Trainer, a mechanical contractor in Cranston,

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A survivor’s story: Daniel Platte

I n 2015, Daniel Platte was a 55-year-old, highly successful

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© Wavebreakmedia Ltd | Thinkstock

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O nce you transition from cancer patient to survivor,

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C ancer is a life-changing experience. Learning that

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A s many as a quarter of cancer survivors report

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diagnosis might have caused. Today’s cancer treatments can

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A survivor’s story: Katherine Walsh

I n the fall of 2010, Katherine Walsh was a 23-year-old Ph.D.

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D uring cancer treatment, you

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Guidelines for a healthy

Strategies such as diet, exercise, In general, your

28 Life After Cancer www.health.har vard.edu

A good way to start overhaul-

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Table 2: Exercise precautions Control your weight

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from a cigarette—or breathe in the in patch, gum, lozenge, inhaler,

www.health.har vard.edu Life After Cancer 31

32 Life After Cancer www.health.har vard.edu

E ach year, 15,700 American children are diagnosed

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A survivor’s story: Meredith Donahue

M eredith Donahue, who lives in the Boston suburbs, was

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