|Year : 2016 | Volume
| Issue : 1 | Page : 1-4
The Challenges of Cancer Survivors
Ashok K Vikey1, Deepali Gupta Vikey2
1 Department of Oral and Maxillofacial Pathology and Microbiology, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India
2 Department of Prosthodontics, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India
|Date of Web Publication||27-Jun-2016|
Ashok K Vikey
Department of Oral and Maxillofacial Pathology and Microbiology, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
The cancer is a major health threat, which is considered as the third major cause of death. In old days, childhood cancer was a mortal threat. However, a revolution in medical technology and research work; life expectation is improved. Hence, from 1995 onward, there is increased 5-year survival rate particularly, in children treated with cancer and around 80% attain adulthood. Even in other cancers, recent treatment advances have increased survival rate. However; still there is a lack of awareness and consideration toward long-term consequences in increasing survivors. Hence, merely elimination of cancer from the body is not enough; there is a call to work collectively for the betterment of rest of the life for the survivors. The survivorship project considers the need of time, but narrow work force (8%) of qualified group is the main concern.
Keywords: Cancer survivors, health-related quality of life, psychosocial stress, survivorship
|How to cite this article:|
Vikey AK, Vikey DG. The Challenges of Cancer Survivors. Indian J Oral Health Res 2016;2:1-4
| Historical background|| |
Today cancer has become major health menace, and the entire world is skirmishing against it. The united efforts from scientists, researchers, engineers, biological workers, and masters of technology, contributed to confine mortality. Simply cure of cancer is not a complete solution, but what about the prospect of survivors; who conquered on death?
What is cancer survivor? The issue appears to be very simple, but only inadequate people know the actuality. In 1985, Mullan coined the term "cancer survivor." He defined it as "cancer survivor, is the person, who has diagnosed as fatal form of cancer and is therefore forced to face his or her mortality."  With due course of time the National Coalition for Cancer Survivorship (NCCS) defined it as, "from the time of diagnosis and for the balance of life, a person diagnosed with cancer is a survivor."  The substitute term for survivor includes alivers or thrivers. In 2000, the term "previvor" was introduced by an organization called Facing Our Risk of Cancer Empowered. This term is used for persons those who have not been diagnosed with cancer but have an inclination toward cancer.  Increased survival goes together with the routine needs of livelihood which leads to the development of facilities. This calls for identification of cancer survivors with affected health-related quality of life (HRQOL).  Efforts of National Cancer Survivorship agencies have doubled the survival rate of cancer patients. , The mutual data of cancer patients living at least 5 years postdiagnosis has increased from 50% in 1976 to over 64% in 2001. This attributes around one of every 640 adults between the ages of 20 and 39 years and is anticipated to continue to rise.  Despite increased longevity, the effectiveness of various approaches is not well understood. Hence, it is important to explore more information which enables individuals to revisit to energetic lives. In the majority of developed world, such as the USA, Australia, and European countries; the survival rates are variable from 1.5 to 5.2 per million persons per year.  Literature states that both adult and childhood cancer survivors have increased suicidal tendency.  Despite increased longevity, the effectiveness of various approaches to improve the quality of life is insufficient, so still survivors and survivorship is not well understood. Hence, it is important to explore more information regarding ill consequences of cancer, and at the same time, there is a need to motivate to lead energetic lives following the completion of cancer treatment. Because even after proper treatment, the survivors have various concerns such as psychosocial, physical, loss of self-confidence, employment problems, pain, and family as well as a sexual imbalance. To get rid of from these ailments, there are suicidal attempts. Hence, more the literatures, more will be information for the survivors and will help in understanding the specifics of life so as to set their minds. This will focus light on nonsurvivors, various organizations, health providers, and society to get nearer to work for the betterment of the survivors.
| Discussion|| |
The aim of survivorship project is to show the path to the cancer survivors toward healthy and active life. The National Cancer Survivorship Initiative (NCSI) agency is encouraging to provide proper services and solutions for the betterment of survivors. Following points must be taken into account while considering the improvement of life of cancer survivors:
The above features may be solved, but before that, we have to search for related after effects of the survivors. Researchers worked in this direction and found concerning problems to the survivors such as psychosocial, physical, lack of confidence, relationship, employment. The frenetic treatment program changes their daily routine, such as normal self-care, housekeeping, and other works. Sympathy and feeling of being neglected are some concern of the survivor. Few of them overcome these hurdles, but few still have the psychological impairments, known as posttraumatic stress disorder (PTSD).  The studies showed PTSD is a major problem in the young population.  Cancer treatment along with cure of cancer, affects sexual life of patients, further leading to ovarian, or testicular failure leading to infertility. , Although there is an introduction of neoadjuvant chemotherapy (NAC) but at the same time, it has some proven significant side effects, including physical fitness, mild weakness, and HRQOL , which simply cannot be overlooked. However, again this is the topic of discussion because some studies advocate that; there is a positive correlation between physical activity and NAC indicating that NAC is not responsible for decrease physical activity.  But eventually, over a period, many survivors lose their employments leading to financial and social trauma. To overcome this burden, in spite of cancer-related disabilities; some survivors work to fulfill their expenses. However, complete recovery of financial loss is very difficult because physical as well as psychological factors affect on working hours and productivity by survivors. 
- Data of survivors each year
- Pre- and post-treatment health-related issues
- Economic and social impairments
- Risks factors
- Well-planned scientific approach toward the future of survivors
- Encourage the researchers for better interventions
- To develop a general guideline for clinicians.
Earlier to 1970, childhood cancer was considered as universally fatal disease accompanied with other issues such as education, employment, marriage, and fertility. 
Adolescent and young adult survivors
This group is placed between the ages of 15 and 39 years, which is continuously increasing and is a major part of survivors. This group has different issues as compared to adult survivors and nowadays due to increasing medical facilities; around 80% children treated with cancer attain adulthood. Therefore, it is important to put more collective efforts to work on this group. 
| Interventions|| |
The historical background of survivorship program is quiet old, which began with the foundation of the New York Cancer Hospital in1884. Later on, in 1948, this was renamed as Memorial Hospital for Cancer and Allied Diseases and recently called as Memorial Sloan-Kettering Cancer Center. So far, the period between1974 and 1976 is considered a turning point in the field of survivorship when people started thinking about consequences cancers on lives of survivors.  However, a worldwide message regarding this issue was raised by a young pediatrician, Fitzhugh Mullan, when he published an article, "Seasons of Survival" in 1985 and introduced term survivorship.  Later on, in 1996, the executive director for NCCS, formulated the quarries for logical and legal issues for easy approach, legal action plan, and accountability. For this, it is important to consider patient's complete history, including name, detail address with contact, date, and stage of diagnosis of disease. Further, there should be the maintenance of record in the hospital which includes when and how the treatment modality was given to the patient, including surgeries and radiation therapy. In case of any complications or reaction during the intervention and corrective procedure for the same should be initiated and record must be maintained. Survivor care is not restricted up to improved longevity of life, but it should also consider the quality of life of survivors. Presently, we see appreciable work in this direction such as Children's Oncology Group; which included overall intervention details so that patient may visit any health center without any difficulty. This will help clinician and patient both during follow-up.  The NCSI has formulated its guidelines to generate newer approaches during research, which will be helpful for better planning and care of survivors.  There are some guidelines such as the history of survivorship to identify the risk factors, ongoing problems of patients, research targeting to health and psychosocial aspects of survivors and to expand literatures toward awareness, and regaining smooth life. There is a demand to explore parameters which are supposed to monitor pre- and post-treatment outcomes and their after effects, which may disturb the personal and social life of survivors.  The major issue of young survivors is infertility and is supported by sperm banking which relieved the stress and acted as an emotional battle against cancer. , There are many options for males and females such as freezing mature oocytes, ovarian tissues and protection of ovaries from gonadotoxic effects in women and testicular biopsy, semen collection, and freezing spermatozoa in males. , Researchers tried to manage infertility by various means such as prioritizing normality and marginalizing fertility ongoing infertility-related matters, and fertility concerns dominating the cancer legacy.  In addition, "survivor care plans" are helpful for the survivors to lead a healthy life. Along with this cognitive behavior therapy is effective to minimize stress and other problems.  To encourage cancer survivors, the National Cancer Survivor Day Foundation organizes meaningful events since 1987 in the United States, Canada, and rest of countries. The basic concept being to show the world, how life is meaningful and productive. This event is organized on the 1 st Sunday of every June preferably. Cancer survivor and survivorship have become a global agenda and need the attention of government and nongovernmental organizations. Increasing graph of survivors is alarming toward the development of health-related needs, maintenance of infrastructure, financial, and social burdens. A synchronized agenda for research and practice is needed which will address cancer survivors' long-term medical, psychosocial, and practical needs across the survivorship path and may involve a new way of working in hospitals for providing follow-up and holistic support.
| Conclusion|| |
Time demands the need to think for in-depth examination of survivors with psychological distress and poor HRQOL. Because of lack of systematic follow-up, we need to learn about the positive and negative aspects of treatments. Today, a question arises that who will take responsibility to monitor the health of survivors and assist in their recovery. There must be a commitment for the continued care, rehabilitation, and psychosocial fallout after treatment.
The presented work could not have been accomplished without dedication and invaluable help of my students. My special thanks to Dr. Trupti Chordia and Dr. Anjali Shujalpurkar for their help in editing the manuscript.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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