Caring for the survivors

MEDICAL MATTERS: One of the best medical "good news" stories of the past couple of decades is the steady increase in the number of people who are surviving cancer.

In the United States, those living with a past history of cancer have tripled since 1971, and the number of survivors there is increasing by 2 per cent each year. Some 2.5 per cent of the Canadian population are cancer survivors, while in the Republic, more than 100,000 people have successfully put a diagnosis of cancer behind them.

If we include all cancer types, two-thirds of individuals diagnosed today will survive for at least five years. For those with breast and prostate cancer, more than 80 per cent will be long-term survivors. Clearly, cancer is no longer an automatic death sentence.

Better chemotherapy and more focused radiotherapy, combined with surgery, can take the lion's share of the credit for these satisfying results.

Early detection is also vital: the earlier the cancer is picked up, the greater the treatment options and the higher the chance of long-term survival.

Even the treatment, in many cases, is less toxic or its side effects can be better controlled. With the latest anti-nausea drugs, 60-70 per cent of people undergoing chemotherapy will have no nausea.

Radiotherapy that is targeted exactly at the tumour means fewer side effects due to the inadvertent "burning" of healthy tissue.

But there are a different set of challenges facing the many survivors of cancer. They may not be life-threatening, but they have a huge impact on the person's quality of life.

Some people who have finished their chemotherapy complain of memory problems, difficulty concentrating and fatigue.

Labelled "chemobrain" in North America, one breast cancer survivor said: "I couldn't concentrate or focus long enough to finish most tasks. I wouldn't be able to think of a key word in a sentence when talking on the phone."

In one study at the University of Cincinnati, presented at the annual meeting of the American Society of Oncology, some 60 per cent of patients with breast and ovarian cancer continued to experience fatigue and memory problems two months after chemotherapy.

The research team is now investigating whether a drug called dexmethyphenidate (d-MPH) may help in relieving the symptoms of "chemobrain".

A survey of cancer survivors carried out by the Lance Armstrong Foundation in the US found that a half of those surveyed had continuing unmet needs.

They reported that the non-medical aspects of having cancer, including depression and fear of recurrence, the physical side effects of treatment and financial worries often posed a greater challenge than dealing with the cancer itself.

Some of the physical side effects of treatment they identified were chronic pain, infertility and sexual dysfunction.

Sexual issues were also highlighted at last week's European Cancer Conference in Paris. In one Canadian study, patients experiencing sexual difficulties said they had encountered problems broaching the subject with health professionals.

"The implications of these study results direct us towards education for healthcare professionals and towards how we can create the type of environment for communication that is comfortable for patients to discuss sensitive topics," the author of the study, Dr Margaret Fitch, noted.

A Greek study presented at the same conference found that post-chemotherapy patients experienced varying levels of anxiety and depression. The authors called for the routine screening of emotional distress during all phases of cancer.

At St James's Hospital in Dublin, one of the biggest cancer treatment centres in the State, Dr Ann Marie O'Dwyer, a consultant psychiatrist, and Sonya Collier, a clinical psychologist, run a pyscho-oncology service.

"Cancer survivors have to learn to live with the fear of recurrence," Dr O'Dwyer says.

For some people, there is a constant fear of the cancer coming back, which brings on disabling symptoms such as avoiding particular activities. For others, according to Dr O'Dwyer, hair loss or the scars from surgery cause social anxiety which interferes with the person's quality of life.

The good news for patients of St James's is the ready availability there of counselling, in the form of cognitive behavioural therapy (CBT), for those experiencing emotional difficulties even after they have been given the "all clear".

And while a small number of people develop clinical depression secondary to cancer, this too responds well to CBT and anti-depressant therapy.

We have come a long way from the sentence of death long associated with "the big C". Happily for the many people who now survive cancer, the health system faces a new challenge: how to provide a service, both at primary care and hospital level, that will ensure the high quality of life cancer survivors surely deserve.

Dr Muiris Houston is pleased to hear from readers at mhouston@irish-times.ie but regrets he cannot answer individual queries.