I've finished treatment. Now what?

You are a survivor

In medicine, a survivor is anyone who has had cancer, from the day of diagnosis and for the rest of their life. The word is not only about those who "beat" the disease. It describes a stage of life that deserves its own care.

The emptiness after treatment

Many people imagine the last day of treatment will be pure celebration. For many patients, however, that is when an unexpected emptiness sets in. For months, life revolved around sessions, tests and appointments. There was a team close by, a plan to follow and the feeling of doing something against the disease. Suddenly, it all stops. Appointments become further apart, and it is common to feel "cut loose" or that you have lost your safety net.

At the same time, the people around you expect you to be happy and "back to normal." But your body is still recovering, and so is your mind. This is when many people finally feel the weight of everything they went through, something there was no time to feel during treatment. That is why sadness, fatigue, irritability, fear or a sense of not recognizing yourself can appear.

Finding it hard to "get back to life" is very common, and it is neither ingratitude nor weakness. There is no "old normal" to snap back to all at once. There is a new normal, which you build little by little, at your own pace.

What usually helps:

• Naming what you feel. Knowing that this emptiness is expected already lightens the load a little.
• Having a plan for afterwards. Knowing when your next appointments are, and whom to contact if a question comes up, restores a sense of security.
• Easing back in. Resume work, activities and plans in stages, without expecting yourself to keep your old pace.
• Talking with people who understand. Support groups and others who have been through the same thing help you feel less alone.
• Seeking professional help if sadness, anxiety or low mood last for weeks or get in the way of daily life. Psychologists and psychiatrists are part of care after cancer.
• Telling your care team. The end of treatment is not the end of care. We are still here.

Ask for a summary of your treatment

When you finish, ask your team for a care plan: a simple document you can take to any appointment, with any doctor. It should include:

• your diagnosis and the stage of the cancer;
• the treatments you received, such as surgery, chemotherapy and radiation therapy, with the dates;
• when your next appointments and tests will be;
• the effects that may appear over time and the warning signs that call for an earlier visit;
• who looks after each part: the oncologist, the family doctor or other specialists.

Appointments and tests: more is not always better

Follow-up depends on the type of cancer, its stage and the treatment you received. That is why each person has their own schedule. In the first few years, appointments are usually more frequent. After that, they become further apart.

Having lots of tests may seem safer, but it isn't always. Imaging tests only help when finding something earlier would change the treatment. Too many CT scans add up radiation over the years. Follow the plan agreed with your team, and always ask what each test is for.

Also keep up with the routine screening tests for your age, such as colonoscopy, mammography and Pap smears, unless your team advises otherwise. People who have had cancer have a slightly higher risk of developing another type in the future.

Effects that may appear later

Some treatment effects last for months. Others appear only years later. Knowing about them helps you treat them early:

• Fatigue that doesn't go away with rest. It may sound odd, but physical exercise is what helps most.
• Tingling or numbness in the hands and feet. There is treatment for it: let your team know.
• Slower memory and attention. This usually improves with time, exercise and memory training.
• Heart and blood pressure. Some treatments call for closer attention to the heart. Controlling blood pressure, cholesterol and blood sugar becomes even more important.
• Weaker bones, from some hormone treatments or early menopause. Exercise, calcium and vitamin D help. In some cases, your care team may recommend other measures to strengthen your bones.
• Sex life and having children. There may be less desire, pain during sex, early menopause or difficulty getting pregnant. These are health issues like any other, and specialized help is available.
• Weight. Some people gain fat and lose muscle, even if the number on the scale stays the same.

The fear of the cancer coming back

Almost everyone who has had cancer feels, at some point, afraid that it will come back. This fear tends to grow around the time of tests and can last for years, even when the odds are very good. A little fear is normal and can even help you keep taking care of yourself.

Ask for help when the fear disrupts your sleep, your work or your relationships, or when the sadness won't lift. Therapy, exercise and meditation work well. Bringing it up with your team is not an overreaction: it is part of your care.

Keep moving: it's one of the best medicines

The recommendation is at least 150 minutes a week of moderate activity, such as brisk walking, cycling or swimming, plus strength exercises on two or more days a week. Start slowly and respect your limits.

In bowel cancer, this has been tested in a large study: people who followed an exercise program after chemotherapy had fewer recurrences than those who received only advice.

Other habits that make a difference

• Don't smoke. If you do, ask for help to quit. It's never too late.
• Keep alcohol to a minimum.
• Watch your weight and eat a balanced diet, with fruit, vegetables and whole grains.
• Manage other conditions, such as high blood pressure and diabetes, with your family doctor.

Work and daily routine

Returning to work, activities and plans is an important step, and it can happen gradually. At first, fatigue and trouble concentrating may call for adjustments. It is also common for the people close to you to expect everything to "go back to normal" quickly. Explain how you are doing. You don't have to pretend you're fine.

When to contact your team before your scheduled appointment

• A new symptom that doesn't go away within two to three weeks, such as pain, cough, shortness of breath or a change in bowel habits.
• Unexplained weight loss.
• Unusual bleeding.
• Tingling, fatigue or sadness that is getting worse or interfering with your life.

No question is too small. Write down your questions and bring them to your next appointment.

For information only. Your follow-up plan should be agreed with your care team.