Cancer Survivorship Presents Host of New Financial, Emotional Challenges

When Mary Craige found a lump on her breast during a self-exam in the shower nearly six years ago, she wasn’t immediately concerned.

She was a new mother with a six-month old son at home, and in relatively good health. Because of her age, then 34, she said her breast surgeon didn’t think it was likely that the lump would be cancerous either. Indeed, fewer than 5 percent of new female breast cancer diagnoses occur in women under 40.

Unfortunately, a biopsy and further tests revealed that Craige had Stage 1 invasive ductal carcinoma, a common type of breast cancer that afflicts more than 180,000 women in the United States each year, according to the American Cancer Society. Nine months later, after six rounds of chemotherapy, 34 rounds of radiation, and one lumpectomy, Craige was a cancer survivor.

Nationwide, there are more than 14 million men, women, and children just like Craige – people living after being diagnosed with cancer. And that number is only expected to grow over the next several decades, ballooning to more than 24 million people by 2025, due to advances in early detection methods and treatment options, according to the Centers for Disease Control and Prevention.

The number of cancer survivors isn’t just now beginning to increase – it’s been on the rise for decades, and has grown four-fold since the War on Cancer in the United States began in 1971, according to Dr. Natasha Buchanan, a behavioral scientist with the CDC. People in general are living longer lives nowadays, but Buchanan said advances in early detection, treatment, and clinical trials have also helped push the numbers up.

Those advances have come continuously over the last several decades. Paul Marks, a 1991 recipient of the National Medal of Science, developed a way to control cancer cell proliferation. Harold Varmus, a 2001 recipient of the National Medal of Science and former director of the National Cancer Institute, with Michael Bishop discovered the growth-controlling oncogenes in normal cells, which informed researchers’ knowledge about how tumors develop. And in 2012, Arthur Levinson received the National Medal of Technology and Innovation for his work with another researcher that led to the creation of Herceptin, a type of antibody that is now used to treat breast cancer and other types of cancer.

Today, some companies are even exploring the development of chimeric antigen receptor T-cells, or CAR T-cells, which can be altered and introduced back into patients’ blood streams to seek out and kill cancer cells.

“Prior to 1970, if you were a child and you were diagnosed with leukemia or another type of cancer, your hope of survival was really low,” Buchanan says.

But cancer survival also brings a host of new challenges for both individual survivors and the public health community to address, ranging from financial hardships and higher medical costs, to issues with memory loss and other long-term physical problems.

For Craige, some challenges are almost minute, while others will impact how she lives the rest of her life. Being a cancer survivor means taking more time filling out paperwork on her medical history each time she sees a new doctor – a dentist, or a dermatologist, for example.

But it also means she’s dealing with issues that 60- to 65-year-old women face, but at the age of 40. Craige says she’s now living with early-onset and permanent menopause, a condition that has also caused osteoporosis.

And there’s a growing body of research that brings to light the unique obstacles cancer survivors face, as well as important health concerns that can help or hinder their long-term treatment.

One study found that breast cancer survivors, for example, have reported cognitive concerns, such as problems with memory, thinking, or attention. Colorectal cancer survivors need to alter their diets to focus on low-fat foods, and limit their alcohol consumption to reduce the risk of recurrence. Some also experience depression or anxiety after treatment, according to the CDC’s Buchanan.

“We have found that a majority of survivors are not having conversations with their doctors about these concerns, and very few are receiving treatment for their emotional concerns or difficulty with memory and attention,” Buchanan says.

For Craige, an important concern is access to mental health services and psychological support. Through her work with the Young Survival Coalition, a group that provides support for young women diagnosed with breast cancer, Craige says she’s learned that mental health support can vary widely across the country.

“When you’re in active treatment, you’re seeing a doctor pretty much every week, and then all of a sudden when active treatment stops, you’re sort of like the baby chick kicked out of the nest,” Craige says. “People think that you’re done and you’re long-term and you’re going to be fine. But your perspective on life and health and everything just changes completely. I think a lot of people still need help processing what they went through.”

Cancer survivorship can also introduce several financial hardships, Buchanan says, including higher-than-average medical costs, problems with work, and a loss of income during and sometimes after treatment. One recent study from Penn State University also found cancer survivors may face some form of job discrimination, and are less likely to receive a callback from potential employers.

“[Cancer survivors] might have to make difficult decisions about working with regard to the amount of paid leave they receive, or insurance benefits. They might have fears about losing their job,” Buchanan says. “All these would tie into that and it might then lead to them not getting the necessary medical care, or delaying them going to get medical care.”

Moving forward, Buchanan says it’s important for the public health community as a whole – including government and non-governmental agencies, advocacy groups, and state health departments – to address the unique needs of cancer survivors through research, communication, and support programs.

The CDC, for example, operates a number of public health interventions that encourage cancer survivors to maintain their health by quitting smoking, exercising, and reducing their exposure to alcohol, UVA radiation, and certain chemicals. And agencies like the American Cancer Society provide resources for patients to cope with cancer during and after treatment, as well as a network to connect survivors with support groups.