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Background

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Improvements in cancer survival have been marked over the last 40 years due to screening, earlier diagnosis and improvements in and access to treatment. It is predicted that half of people diagnosed with cancer in England and Wales in 2010-2011 will survive for at least 10 years.1 This rate has doubled since the 1970s.1 The current UK 10 year survival rates are around 80% for breast cancer and 84% for prostate cancer.2

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Cancer is still a leading cause of morbidity and mortality. In England and Wales 40% of all preventable deaths are caused by cancer.3 The poor survival in some cancers has changed little since the 1970s. For example, lung cancer survival remains very poor, with only 10% of patients surviving 5 years and 5% surviving 10 years.1 More than a quarter of all people with lung cancer die within a year of diagnosis.4 It has been estimated that 2.5 million people were living with and beyond cancer in the UK in 2015 and this number is set to increase to an estimated 4 million by 2030.5

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In response to the growing number of people surviving cancer there has been increasing focus over the last few decades on the quality of survival as well as on the number of disease-free years. Survivorship has various definitions and can include anyone diagnosed with cancer, from diagnosis to end of life.6

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Impact of cancer and its treatment on everyday life

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Cancer and its treatment can have a considerable and long-term impact on everyday life.7-9 Cancer survivors may face a range of challenges including physical problems, poorer quality of life (QOL), psychological distress, sexual problems, problems with social relationships and financial concerns.9 An estimated 625,000 cancer survivors in the UK are facing poor health or disability.10 At least 350,000 are living with chronic fatigue, 240,000 with mental health problems, 200,000 with severe pain after curative treatment, 150,000 with urinary problems such as incontinence and 90,000 with gastrointestinal problems, including faecal incontinence, diarrhoea and bleeding.10 Some consequences may emerge 5 or 10 years after treatment (late effects) and can have a significant impact. For example, some chemotherapy can increase the risk of heart disease, and long-term hormone therapy is related to osteoporosis.10

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Important elements of survivorship

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Cancer survivorship is broader than length of survival or detection of recurrence and symptoms. It includes psychosocial aspects such as coping with disruption to one's life, confidence to manage consequences of treatment, living with uncertainty, lifestyle changes and so on.11 It can also include disruption to one's social role and identity.12 Foster and Fenlon's conceptual model of recovery of health and well-being following cancer treatment attempts to draw these elements together from empirical research findings (Figure 8.1).13 They hypothesize that health and well-being ...

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