You completed the chemotherapy, surgery, and/or radiation years ago. Months and years of follow-up visits prove that you have beaten cancer. However, you find it difficult to regain the life you had before your diagnosis of cancer.

Over the last two decades, major advances have been made in cancer research. This progress has led to improvements in diagnosis, screening and treatments for many types of cancer. As a result, many people are surviving and living longer with the disease. Approximately 66 percent of people diagnosed with cancer are expected to live at least five years beyond their diagnosis.

A cancer survivor is a person who has lived with, through and beyond cancer. In the United States, there are an estimated 11 million cancer survivors. For those not previously diagnosed with cancer, there are many people who know or care for someone with cancer. A cancer diagnosis can change a person's lifestyle, career, and priorities. Health care providers often place emphasis on treating the disease, but many of us are unaware of the struggles encountered by patients to regain normalcy to their lives.

After the treatment and the surveillance follow-up visits have ended, cancer survivors face a wide array of physiological and psychological issues. Survivors begin to live with uncertainty, and many anxieties start to surface. Fear of cancer recurrence is very common. Any symptom, such as a headache, may be interpreted as a return of disease. Late effects of cancer treatment such as fatigue and chronic pain also may heighten anxieties and alter one's quality of life.

Cancer treatment often results in financial debt from medical and non-medical expenses. Medical insurance does not pay for all expenses. Lost income from not working, eldercare expenses and medical bills can add up quickly. Financial concerns can be overwhelming for cancer survivors and their families. These financial challenges are magnified for cancer survivors from disadvantaged or minority communities. It is important to seek financial counseling and community resources to cope with these issues early.

Returning to work can help a cancer survivor start to obtain normalcy. More than 80 percent of cancer survivors return to work after a cancer diagnosis. Since health insurance is tied to employment, many survivors need to work to maintain medical coverage.

Co-workers and managers are often concerned about a survivor's ability to handle their workload. However, studies have shown that there is no difference in the work performance of cancer survivors. When returning to work, it is very important for the survivor to expect questions from colleagues and think about how to best answer these questions in advance.

Most survivors benefit from counseling and support programs to regain their lives. The UNC Lineberger Comprehensive Cancer Center provides these services through the Carolina Well survivorship program.

UNC is one of only eight members nationally of the Lance Armstrong Foundation's LIVESTRONG Survivorship Center of Excellence Network. The Carolina Well program at the new North Carolina Cancer Hospital was developed to address the problems faced by cancer survivors across North Carolina.

Several services are available:

Cancer Transitions: Moving Toward Wellness is a six week program for survivors focusing on life after cancer. Survivors learn nutrition, stress and coping skills, exercises to increase physical activity and techniques to regain normalcy in a group setting.

Survivorship Consultations and Clinic will provide individualized treatment summaries and care plans to survivors. Each evaluation will address post-cancer diagnosis and treatment issues. The goal of this clinic will be to assist the cancer survivor move toward wellness through physical and nutritional assessments, counseling, as well as stress reduction and coping skills.

Integrative Medicine programs including massage, yoga and movement.

A Breast Cancer Survivorship Clinic. This clinic will be oriented specifically to problems encountered by women who are survivors of breast cancer.

"Coming To The End of Treatment: Now What?" is a new class to be offered at the North Carolina Cancer Hospital monthly to prepare patients ending their cancer treatment to face survivorship issues.

A full time lymphedema clinic. Lymphedema is localized tissue swelling and fluid retention in an arm or leg that can occur after a lymph node operation and/or radiation.

Psychosocial services.

For more information on the Carolina Well survivorship program, please contact Elizabeth Sherwood, at 843-5069 or go to www.carolinawell.org.

Better understanding of the hardships faced by cancer survivors and the development of resources for support can help bring reform that can improve the quality of life for survivors and their loved ones.