• Paths of Progress Spring/Summer 2010

    Cancer's 'Seasons of Survivorship'

    Editor's note: This is an online-only supplement to the article "Making Progress for Cancer Survivors" that appears in the Spring/Summer 2010 print issue of Paths of Progress.

    He knew in middle school that he wanted to be a cancer doctor, but it wasn't until his own wife, Joan, developed acute leukemia decades later that Kenneth Miller, MD, fully understood the toll this disease can have on a family.

    The couple's three children were ages 7, 11, and 15, when Joan went through the trials of treatment and started reclaiming her full life as a mother, wife, and writer.

    The experience, combined with insights gained from talking to his own patients, and changes in cancer care over the past 20 years, prompted Miller to expand on the idea of 'seasons' of survivorship, a concept first developed in 1986 by Fitzhugh Mullen, MD.

    Miller, now co-director of the Perini Family Survivors' Center at Dana-Farber, says there are four such seasons, to which health care providers should give specific attention:

    • Acute survivorship, including the time of diagnosis (shock) and treatment.
    • Transitional survivorship, when treatment has ended, but survivors may still feel anxious, depressed, and isolated as they engage in 'watchful waiting' to see if cancer will return.
    • Extended survivorship, which comes in three forms: cancer-free (treatment-free remission); maintained remission (staying cancer-free due to ongoing therapy); or living with cancer (as a chronic, advanced disease that requires continued treatment).
    • Permanent survivorship, which has four subgroups, including survivors who are cancer-free and asymptomatic; are cancer free but with long-term/late problems (such as fatigue or depression); develop second cancers (unrelated to earlier treatment); or have secondary cancers (related to earlier treatment).

    "For years, we probably talked about Joan's leukemia two or three times a day," Miller explains. "Finally we stopped and moved on to a time when hope and a sense of permanence returned."

    Reflecting back, he believes that anticipating and understanding each stage of cancer survivorship can help a patient experience a better quality of life.

    Paths of Progress Spring/Summer 2010 Table of Contents 

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