John Keane went through a one-month period of medical examinations to identify the cause of his health concerns, which he initially dismissed as a simple cold. As his health progressively worsened, questions about possible palliative care arose, until finally, a diagnosis was made – John was suffering from non-Hodgkin’s lymphoma.
Keane, an engineer by profession, approached his disease with a practical mindset. He felt relief in knowing there was a structured plan to fight his ailment, set by his medical advisors. Post-diagnosis, an aggressive course of treatment was initiated. Despite the harshness of the process, he maintained his optimism and was relieved when he was capable of emerging victorious over his disease.
In the early months of 2022, Keane resumed his regular lifestyle, following a year full of relentless testing and treatment. His recovery, however, hit an unexpected hurdle in November of the same year when he experienced difficulty breathing on his daily Luas commute. Noticing his deteriorating health, he sought medical help, where it was discovered that he had developed three alarming blood clots – one in his leg and two in his lungs.
The shock of his newfound predicament led him to question the previously disconnected and complex web of his health issues, igniting a deeper sense of fear. The medical team assured him that the new health issue was not related to his former treatment, which set him off on another round of questioning and anxiety.
Cancer diagnosis and treatment garner most attention when people discuss cancer, however, an increasing number of health professionals now recognise the long-lasting effects that come with surviving cancer. For instance, survivors may struggle with enduring fertility issues, mental health problems or physical alterations after being declared as cured from cancer.
In Ireland, the count of cancer survivors has seen an increase of over 50% in the past ten years due to improved survival rates. The latest data available till the end of 2021 shows that there are almost 215,000 people living post making it through an invasive cancer diagnosis.
Professor John Kennedy, the medical director at Trinity St James’s Cancer Institute, attributes the impressive progress in cancer survival rate to significant improvements in therapeutic techniques. For instance, a woman diagnosed with breast cancer in Ireland nowadays has an equal likelihood of surviving 20 years as her mother had of surviving 5 years at the same age. This essentially implies that we have been able to enhance the 5-year survival rate to a 20-year survival rate.
The survival rates for prostate cancer fluctuate around 90% for a period of 5 to 10 years. Furthermore, the survival rates for lung cancer patients have likely doubled in the past 15 to 20 years.
Professor Kennedy emphasises the essential role of a multidisciplinary team, both during and after treatment. Such a team takes into account every aspect of a patient’s care, ensuring higher success rates. He explains that although a surgeon, a medical oncologist and a radiation therapist might individually lean towards their specialities, a collective discussion promotes learning, challenges ideas, and uncovers nuances.
Understanding that issues of survivorship differ among patients, Professor Kennedy points out that younger patients struggle more with the financial burden of treatment, while older patients grapple more with physical side effects. Nevertheless, dealing with side effects has become a strength for the team, in addition to taking preventative steps.
This proactive approach includes Ireland’s first cancer survivorship urologist, Dr John Sullivan. Dr Sullivan’s role is particularly important to help men who have had pelvic cancer and are dealing with regular treatment side effects. He observed that because people are getting diagnosed earlier and treatments are better, there is more awareness of the secondary damage caused by surgery, radiation, or chemotherapy. Therefore, it’s increasingly essential to address these issues than it was in the past.
Pelvic cancer comprises 45 per cent of total male cancer cases. A large majority of men, over 90 per cent, will experience erectile dysfunction post prostate surgery and it may take as long as two years for a complete recovery. Other issues that can arise include problems with continence, especially during orgasm, and fertility, which could be due to surgery hindrance in the flow of sperm and the toxic effects of chemotherapy or radiation.
Nevertheless, these side effects can be ephemeral, given a variety of treatment options available. Depending on the timing and intervention of the patient’s recovery process, it can possibly expedite the recovery time.
However, a common hurdle is the reluctance to confront these side effects among Irish men, as observed by Sullivan during his tenure in the US. There, men were more proactive in seeking treatments like Viagra. He notes a prevalent sense of embarrassment in Ireland, but emphasizes that the goal should not only be survival, but an improved quality of life.
Keane also mentioned that hesitation is not limited to acknowledging physical symptoms but extends to mental health post-treatment. He discussed his coping with unpredictable circumstances after his diagnosis, and an additional health scare despite adhering to everything asked of him. He found himself behaving differently around others – a situation his daughter made him aware of which triggered him to seek help.
He decided to contact St James’s for an appointment with a physiotherapist for his leg rehabilitation, and a counsellor for mental support.
“After undergoing treatment, I promised to be kinder to myself,” he shares. “I realized that withholding my troubles and resisting aid was not self-kindness.” He made an analogy to his counsellors, likening his life to an upside-down jigsaw. While all the pieces were present, he needed assistance to flip it right side up and resume normalcy.
Such sentiments are commonplace amongst cancer survivors. Dr. Sonya Collier, a principal clinical psychologist from St James’s Hospital and an expert in psycho-oncology, suggests that post-treatment life isn’t as glorious as everyone anticipates. Often, the future can be quite intimidating.
For some patients, concluding the treatment course can be the most psychologically challenging part, as they feel deserted at that stage. From the perspective of their family, it’s a sigh of relief followed by a return to routine activities like planning meals. However, for the one who has endured the treatment, questions arise like ‘What have I just gone through?’ ‘What has occurred to me?’ ‘What does the future entail?’
Mental health issues common after a cancer diagnosis include fatigue related to cancer and the fear of its return, she explains. Approximately 20 per cent harbour an intense fear of its return.
“Most people experience mild and temporary distress. But for those wrestling with severe, prolonged distress like depression or an incapacitating fear of cancer’s return, niche psycho-oncology services can be beneficial,” she articulates.
She further elucidates, “For individuals grappling with ongoing physical problems like fatigue stemming from cancer, scarring, pain or infertility, psychological therapy can assist in comprehending and managing these issues, thereby assisting them in adjusting to their ‘new normal’ and leading a satisfying life.”
She concludes with a hopeful note saying, that there is ample cause for optimism, as the immense majority of patients, with suitable help and support, will recover impressively.
Receiving a cancer diagnosis during adolescence can be particularly harsh, according to Collier, given the significant developmental changes taking place at that stage in life. These years are crucial in building self-identity, relationships, and charting educational and career paths. Hence, the impact of a year or two can be profound during adolescence, making it challenging to resume prior life rhythms.
Nevertheless, enduring and overcoming cancer can lead to positive transformations. Some people, in retrospection, recognise an overemphasis on their work lives, leading them to reset their priorities. Others may contemplate altering their living conditions or career paths.
Keane, a cancer survivor, considers himself a changed individual post his ordeal. Prior to his diagnosis, he was indecisive, but he now embraces opportunities that provide him happiness. He has re-discovered his fondness for books, nurtured a keen interest in music— even started learning the guitar—and also developed a liking for golf and podcasts.
Keane candidly admits that these were long-time aspirations, which he either never pursued or gave up due to initial failures. “But now, I persist because these activities give value to my life,” Keane shares. He has learnt to be kinder to himself, continually endeavouring for self-improvement and cherishing personal free time. Having family and friends around is important to him and he avoids dwelling on the past.
Keane’s primary objective each day is to bring a smile to someone’s face. He considers this his daily victory.