what follow-up for the four million people who have survived cancer in France?

In France, thanks to new treatments, four million people are survivors of. But they are not necessarily healthy. Both the illness and the treatments have physical and moral consequences. There are now structures dedicated to these former cancer patients.

At Léon-Bérard cancer center in Lyon, we take care of these former cancer patients who are often very alone at the end of their treatments. This is what motivated hematologist Mauricette Michallet to follow more than 500 cancer survivors as part of a study: “All the patients say that at this moment, they feel abandoned, although they have completely structured oncological follow-up. And so, there, they are left to their own devices.”

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Up to five years after the end of their treatments, Professor Michallet’s team receives at regular intervals the patients followed as part of this scientific study of health pathways during cancer (Pasca). “We’re six months post-treatment and we’re going to see how you feel?explains a caregiver to a patient. If there is anything that has appeared since the end of the treatments? What if there is something that is bothering you and if we can help you in a particular area?”

Reassuring support

The assessment is very thorough each time with a blood test, urine tests, an electroencephalogram, and x-rays. Nathalie had surgery for breast cancer. She underwent chemotherapy. Today, she is on hormonal therapy, and this very detailed monitoring reassures her: “I find it reassuring, even if we feel that everything is fine, sometimes we can have cancer and not know it. So having follow-up allows us to become more objective.”

“What worries the most and which reassures the most, are mammograms. Obviously, when you have had cancer, each time you do one, you say to yourself as long as nothing is found. Before, I didn’t think about it, now I think about it.”

All survivors face anxiety related to the fear of relapse, and sometimes it turns into depression. It is one of the consequences of cancer in addition to the after-effects caused by chemotherapy or immunotherapy. “Fatigue is scaryobserved Professor Michallet in his patients. The problem of pain is also everyone’s problem. We realize that there is significant hypercholesterolemia. High blood pressure is extremely common. But it’s mostly about the side effects of drugs. What interests us is also knowing what happens to the patient. Is he still depressed? Is he panicked by a relapse?”
Professor Michallet wants to demonstrate through his study that monitoring cancer survivors makes it possible to prevent diseases such as hypertension, heart problems, depression or kidney disease.

Sports activity and return to work

In the journey of these former cancer patients, there is also sport, because physical activity is essential for these survivors because after cancer, we often gain weight. Sport can also help fight depression. At the Gustave Roussy Institute, in Val-de-Marne, a transition day is organized for women who have had breast cancer. On the program: tips for eating well and an adapted sports session led by Hajer Chaouachi. “Many oncology studies have shown that physical activity will improve muscle strength, joint pain, and the risk of infection”explains the specialist.

“At the psychological level, it improves the patient’s quality of life and self-esteem. Patients will better accept their treatment.”

Hajer Chaouachi, adapted physical activity teacher, at Gustave Roussy

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After breast cancer, there are medications to take every day for years. Compliance with treatments is one of the challenges after cancer. Cancer has an impact on the physical and psychological level but it also has consequences on social life. For example, not all survivors return to work, far from it. According to a study carried out by the National Institute of Health and Medical Research (Inserm), one in five people have still not returned to work five years after cancer.

Florian Scotté is an oncologist at the Gustave Roussy Institute and head of the patient journey department, he is trying to lift this taboo in the company. “Being able to discuss one’s illness in the workplace is still very taboo today. We must take into account this return to work with people who are still receiving treatment. We must therefore, indeed, arrange the workstation, consider that the person can be absent to receive treatment for a period of fatigue linked to the treatment and that however they can keep their place within society.”

The Gustave Roussy anti-cancer center regularly organizes training in companies to change the way human resources managers view cancer survivors.