Cancer Survivorship - A Neglected Aspect in India

By Dr Suresh Rao
Dr Suresh Rao is the chief of Radiation Oncology department at Mangalore Institute of Oncology (MIO) and is an expert in external-beam radiation therapy and brachytherapy.
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June 3, 2019

June is the month commemorated for spreading awareness on cancer survivorship which from a terminological perspective can be termed as living without the disease on completion of his or her treatment. Unlike with other ailments, moving from the period of ‘active treatment’ into survivorship is quite a challenge and is different for every person.

On completion of treatment, some people talk about appreciating life more and gaining a greater acceptance of self, while others become anxious about their health and unsure of how to cope with life’s demands and returning to everyday life while adjusting to the changes that have resulted from the disease and its treatment.

Here with are some of the most commonly faced challenges of survivors:

Psychological challenges

In most survivors the fear of recurrence is very common and minor physical problems, like as an occasional headache or joint stiffness, is assumed to be a sign that the cancer has returned. For some survivors, the feeling of uncertainty leads to struggles with depression and anxiety. Some survivors also suffer from poor body image or low self-esteem because cancer treatment changed the way they look. Studies from around the world have shown that support groups and counseling can help survivors cope with these and other difficult emotions.

Physical challenges

When the treatment is complete some people may have some physical problems like fatigue, hair loss and changes in skin texture. Some survivors may have had a part of their body altered or removed as part of treatment and this can affect their physical functioning. Some side effects are permanent while some decrease with time. Supportive care and rehabilitation services like physiotherapy, regular exercise, and yoga have shown to decrease the side effects and maximize the physical abilities.

Sexual and reproductive challenges

Some treatment of cancer affect a person’s sexual and/or reproductive health. Some find it difficult to be intimate due to physical changes or emotional reasons. Loss of fertility is another issue that bothers a young survivor who is unmarried or has no children. Support groups and counseling can help survivors cope with these and other difficult emotions.

Relationship challenges

When cancer affects an individual their family members are also affected and it can change how you relate to them and how they relate to you. Families may be overprotective, or they may have exhausted their ability to be supportive. Also, some friends may become close and caring, while others move away. To cope with this the survivors and their caregivers have to recognize the issue/s and work through these changes and a counselor can be of immense help.

Work-related challenges

Job is essential for sustenance and returning to work after completion of treatment of cancer is a sign of regaining a normal routine and lifestyle and earning a livelihood. While survivors can be just as productive as they were prior to treatment, some find it difficult due to change in physical appearance or fatigue. Survivors need to know that termination from service or discrimination at work place by the employee or coworkers is against the rule of the land and punishable. For the survivor, lifestyle modification like exercise and psychological counseling on work adjustment is shown to be beneficial.

Financial challenges

When compared to most other ailments, the cost of cancer care can be high. Even patients with health insurance are left with costs that add up quickly. Worse, survivors would have already lost income because they weren’t able to work as much or at all during treatment, making it difficult to pay both medical and household bills. Under these circumstances opting for a life insurance that covers most costs early in life is important. Also it is advisable for the family to be judicious in their spending.

Coping with challenges

Unlike in developed countries, in India focus on cancer survivors is seldom done and is a neglected aspect. Experience at Mangalore Institute of Oncology (MIO), suggest that care after completion of treatment is very important and that at MIO emphasis is placed on importance of follow-up care, managing long-term side effects and late effects, family counseling, occupational therapy, nutritional planning, recreational therapy, tobacco cessation, nutrition, physical activity, stress reduction and complementary therapies like yoga and meditation. Patients who perform yoga are doing much better and have resumed their job early. Yoga is especially useful in survivors who are also afflicted with co-morbidities like diabetes, hypertension, arthritis and asthma as it improves their health and overall quality of life. Additionally, preliminary reports from around the world indicate that yoga is beneficial in preventing regrowth and spread of cancer possibly by reducing obesity which promotes/triggers growth and progression of cancer. MIO has initiated yoga training for regaining better health and the results are very encouraging.

Comment on this article

  • Kusuma Kumari Gunji, Nellore

    Wed, Jun 5 2019

    Yes there need to be progress and support in cancer survivors Only a good programme can save these people and I am sure it will happen soon

    Agree [1]

  • Anthony H Crasta, Granville/Sydney

    Tue, Jun 4 2019

    As Anita Britto said above, this is a well researched and informative article narrated in a simple form, which is quite useful to the cancer sufferers and survivors. Well done Dr. Rao, and keep posting such valuable articles.

    Agree [4]

  • Anita Britto, Mangalore/Auckland

    Tue, Jun 4 2019

    Dear Dr Rao

    Such an informative and well-researched article which provides valuable insight about the challenges faced by Cancer survivors. A Cancer diagnosis can be overwhelming and emotionally draining and your article helps to empower people with knowledge and practical tips to cope with the stress, uncertainty and the need to take control and find out about strategies to stay in a positive space.

    Particularly useful is the emphasis you have placed on Yoga, Meditation and Nutrition which would definitely play a big role in increasing Serotonin and Oxytocin levels, recharge the body and help in visualising healing at a cellular level. As suggested by you, I would strong urge patients and their care givers to stay spiritually connected and turn to Nature to help to put the situation into perspective.
    Have read every article of yours and truly appreciate your time and effort in spreading awareness, dispelling myths and reaching out to support patients and care givers.

    Thank you Dr Rao

    Agree [7]


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