Жизнь после рака: опыт и вызовы выживания.

Person with cancer who is still alive

A cancer survivor is a person with cancer of any type who is still living. Whether a person becomes a survivor at the time of diagnosis or after completing treatment, whether people who are actively dying are considered survivors, and whether healthy friends and family members of the cancer patient are also considered survivors, varies from group to group. Some people who have been diagnosed with cancer reject the term survivor or disagree with some definitions of it. How many people are cancer survivors depends on the definition used. Nearly 65% of adults diagnosed with cancer in the developed world are expected to live at least five years after the cancer is discovered. In the U. S. for example, about 11 million Americans alive today—one in 30 people–are either currently undergoing treatment for cancer or have done so in the past. For many people, surviving cancer can be highly traumatic and it is not uncommon for people to experience psychological distress such as post traumatic stress disorder or symptoms of post traumatic stress. Some cancer survivors describe the process of living with and beating cancer as a life changing experience Cancer survivors often have specific medical and non medical needs related to their cancer experience.

People who have finished cancer treatment often have psychological and physical medical challenges. These effects can vary from person to person, change over time, and range in intensity from mild and intermittent to fully disabling. They commonly include fatigue, pain, physical side effects like lymphoedema, weight gain, anxiety and depression, fear of cancer recurrence, and impaired quality of life.

If the treatment is lengthy and disruptive, many patients experience some difficulty in returning to normal daily life. The energy needed to cope with a rigorous treatment program may have caused them to disconnect from previous daily patterns, such as working, normal self care, and housekeeping. Some survivors become dependent on the attention and sympathy that they received during their treatment and feel neglected when life returns to normal. There are tremendous implications that cancer has on the relationships that survivors have with their loved ones (particularly their partners) once their cancer has been treated, and social support plays a critical role in their long term emotional adjustment. Cancer survivors tend to be more resilient than the general population.

Some survivors have to adjust to the idea that they will never be cured. Some survivors, even if the cancer has been permanently cured, struggle emotionally from the trauma of having experienced a life threatening disease. Cancer survivors experience more psychological distress than those who have never had cancer (5.6% compared to 3.0%) Serious psychological distress was seen 40% more among cancer survivors of five years or more than in those who have never had cancer. Survivors of adult cancer are at an increased risk of suicidal ideation (having thoughts about suicide), while as many as 13% of childhood cancer survivors experience suicidal ideation. Issues of pain and physical ailments have been hypothesized as major contributing factors in cancer survivors experiencing this suicidal ideation.

Patients whose cancer is in remission may still have to cope with the uncertainty that at any time their cancer could return without warning. After the initial treatment has ended, anxiety is more common among cancer survivors than among other people. Many patients are anxious that any minor symptom indicates that the cancer has returned, with as many as 9 in 10 patients fearful that their cancer will recur or spread. This anxiety leads to more medical check ups, which can be measured even after a period of up to ten years. This fear can have a significant effect on individuals' lives, resulting in difficulties in their daily life such as work and socialising, and difficulties planning for the future. Overall, fear of cancer recurrence is related to a reduced quality of life in cancer survivors. Treatments that are being investigated include: cognitive behavioural therapy, meta cognitive therapy, cognitive existential group therapy, mindfulness based interventions, and physical exercise.

The cultural ideal of a survivor may add to individual patients' distress if the patient is unable or unwilling to live up to the ideal. is open about diagnosis and treatment and become an educated, empowered medical consumer. The ideal survivor, like a superwoman who simultaneously manages her home, family, and career, struggles valiantly to prevent cancer from affecting loved ones by appearing, behaving, and working as much as possible. Once the immediate crisis is past, the person may feel strongly pressured to donate time, money, and energy to cancer related organizations. Above all, the ideal survivor does not die of cancer. People who publicly conform to this ideal are given social status and respect. Medical tests to determine whether the cancer has returned commonly provoke fears. Informally, this is called scanxiety, a portmanteau of scan and anxiety. A desire to avoid feeling this fear can prompt survivors to postpone or refuse tests. This may be able to be helped by the follow up of people who have had cancer post treatment being undertaken via self reported patient related outcome measures rather than follow up visits, but there is not enough controlled research looking into this. Survivors of childhood cancer have a life expectancy up to 28% shorter than people in the general population. Therefore, there is a need to closely monitor these patients for much longer than usual. The Children's Oncology Group recommends that monitoring should include periodic follow up and screening by a clinician familiar with these patients' risks. Improving these patients' longevity requires recognition and treatment of illnesses associated with late effects in the decades after therapy for childhood cancer. For example, survivors of childhood cancer may have more difficulty than typical with breastfeeding and require more support to undertake this health promoting activity. Childhood cancer survivors are also at risk for developing kidney diseases. Others experience various forms of heart disease, particularly those exposed to anthracyclines or chest radiotherapy. One challenge to achieving this goal is that childhood cancer survivors are both very adaptable and accustomed to denying difficulties; as a result, they tend to minimize their symptoms. Therefore, internists may not give them all the attention they need and thus the actual help they may need. Symptom management, health promotion, specific attention to psychosocial needs, and surveillance for recurrence and specific late effects of treatment are helpful. Likewise, physical exercise training interventions may have positive effects on physical fitness, including cardio respiratory fitness, muscle strength and health related quality of life.

The US Affordable Care Act (ACA) in 2010 makes it illegal for health insurance providers to deny coverage for a pre existing condition, such as previously having survived cancer. Young adults are required to have health insurance coverage and, with a few exceptions, will be able to be covered under their parent's coverage until the age of 26 as a dependent in their parent's plan. People who receive information on paper, compared to oral, indicate that they receive more information and are more satisfied about the information provided. The US Institute of Medicine and the Dutch Health Council recommend the use of a written "survivorship care plan", which is a summary of a patient's course of treatment, with recommendations for subsequent surveillance, management of late effects, and strategies for health promotion. Cancer survivors are encouraged to meet the same guidelines for physical activity as the rest of the population. However, less than one third of US cancer survivors met the Physical Activity Guideline for Americans. Increased physical activity reduces both all cause and cancer specific mortality in breast and colorectal cancer survivors as well as all cancer survivors. and may also assist with cancer related fatigue and common co morbidities. Diet can also impact long term mortality, with evidence across various cancer types. However, adherence to diet and exercise recommendations among cancer survivors is often poor. Digital behaviour change interventions can be successful at increasing physical activity and may also help with diet in cancer survivors. In breast cancer survivors, home based multidimensional survivorship programmes have short term beneficial impacts on quality of life and can reduce anxiety, fatigue and insomnia. Mindfulness based survivorship programs may be an effective way to improve the mental health of cancer survivors.

Family members can be significantly affected by the cancer experience of their loved ones. For parents of children with cancer, finishing treatment can be a particularly vulnerable time. In the post treatment period, some parents may experience increases in anxiety, depression and feelings of helplessness. A sub group of parents report post traumatic stress symptoms up to years after treatment completion. Evidence based psychological interventions tailored to the needs of parents of childhood cancer survivors may assist parents in resuming their normal lives after their child has finished treatment. Spouses of cancer survivors are more likely than other people to experience anxiety in the years after their partner's successful treatment. Being married reduces the cancer survivor's risk of developing post traumatic stress disorder or other psychological difficulties, but it increases the risk of the spouse developing mental health symptoms.