What happens after cancer treatment?

Dr Sarita Retief talks us through some of the emotions you will feel after cancer treatment.

When you have cancer therapy (chemotherapy, radiotherapy and surgery), at some stage it might feel that it will never end. Then suddenly, you have reached the end of your treatment. That great day, you’ve anticipated for months, have arrived. All your friends and family celebrate with you. Though, for some strange reason, it’s not all just joy, but a strange, eerie feeling is also there, a ‘So, what happens now?’ feeling.

You are not alone. Everybody who undergoes treatment feels like that. While you were busy with treatment, you felt that you were actively fighting the cancer, but afterwards it almost feels like you are a sitting duck, waiting for something to happen now, perhaps for the cancer to return.

The worry of recurrence

Is it justified to worry, and will it help in any way to worry? The short answers are no and no.

The first question to ask is whether it helps to do regular tests to catch a recurrence early. Scientific evidence shows us that for most cancers it doesn’t really make a difference in survival if you catch a recurrence very early or if you wait until you have symptoms.

Most recurrences aren’t picked up by routine follow-up scans, but by symptoms that patients develop in between follow-ups.

Survival after recurrence also depends more on the aggressiveness of the returning cancer cells, and not so much on the amount of cancer cells. You can do nothing about the type of cells that are returning. So, don’t worry about it.

Furthermore, all the stress that you experience if you worry about a recurrence, is not good for your quality of life or your immune system.

Last day of treatment

My advice to all patients on their last day of treatment therefore is:

1. You have done all the required treatment to try and cure your cancer. Be proud of that. It wasn’t that easy and you have done it.
2. Now go on, forget about the cancer and live as if it will never come back. Chances are much better that you are cured than that the cancer will come back.
3. Go for regular follow-up. This is to monitor for long-term side effects of previous treatment and to see if you develop any symptoms suggestive of recurrence. It’s also to do standard screening for other cancers. It further helps to motivate you to follow a healthy lifestyle.
4. Every person develops cancer cells in their body every day. You will too. You must keep your immune system as strong as possible to destroy them. To do this, you must do a few simple things:

• Sleep about 7-8 hours a night. Go to bed early to have melatonin secretion. Exercise daily. Eat healthy. Promote gut health as 70% of your immunity comes from your gut bacteria. Stay away from unhealthy habits, like smoking and using excess alcohol. Keep a healthy weight by limiting empty calories. Laugh often and practise intermittent fasting.

5. Look after your bone health. Keep your bone density strong by doing weight bearing exercises, getting in enough calcium and maintaining vitamin D levels with enough exposure to sunlight.
6. Remember that you are living for a reason. Make it worth it. Do something wonderful every day for yourself and to make someone else’s life better.
7. Develop a habit to be thankful for everything.

Be patient and empathise with yourself

Most people experience some degree of anxiety every time they come for follow-up, especially if it’s time for special tests. You will feel worried about every ache, pain and cough. Give it a week or so to see what the symptom is doing. If it gets worse, contact your doctor. Most of the time it will be nothing and go away.

Have patience and empathy towards yourself. You are just a human being, having normal emotions and fears. It takes time to learn how to life with a previous cancer diagnosis.