Among a sky of white clouds, a man is overshadowed by a single dark cloud.

Survivorship Has Its Privileges

What happens when you “beat cancer”?  Survivorship is a tricky subject that can leave us with guilt and other mental and emotional challenges in being the “lucky” ones. Often, cancer patients have been treated and then let go, back to a life they don’t have anymore. That is when survivorship becomes not just a word and not even just an achievement, but a way of life.

What happens to a melanoma survivor?

The physical survivorship aspects are challenging enough. Side effects may last long after treatment completion. Scars stay. Complications sometimes do, too. Depending on your age and health, one of these may be more important than the other to you. Both are difficult to deal with. Both impact the well-being of you, the body.

They also bleed into you, the soul. Having physical limitations can wear on the most positive of patients, a keepsake of surgeries and treatments that have no expiration date. Looking in the mirror and seeing blemished skin is difficult for many, particularly in the younger populations that are seeing significant increases in melanoma. These impacts can be felt as strongly as the physical ones, sometimes more so – we know if, when, and how the body heals and can measure that with fairly remarkable accuracy. The well-being of the mind and heart of a person on the road to recovery is much less visible, measurable, and understood.

The daily reminder that you had skin cancer happens every day at sunrise. You get a choice to make to protect yourself from harmful UV rays with the clothes you wear, the sunscreen you apply, and the example you set. That can be both empowering and annoying. The physical act of prevention, the intentional act of detection, and the emotional response of surviving are an intricate, delicate web that layers multiple items on the concept of “survivorship” and what it truly means to live with cancer, AFTER cancer.

Controlling what you can

Most cancers are not so directly behaviorally-linked (with the glaring exception of lung cancer). No diet or exercise drastically lowers the risk of getting, say, breast cancer or colorectal cancer, although a combination of healthy lifestyle choices does offer decreased risk overall for cancer.1 With skin cancer, there are direct links to sun exposure and protection that can elevate or reduce your chances of getting or not getting these cancers. These precise actions can have or give the illusion of having direct benefits (unfortunately, melanoma has a long history of insidiously returning once it takes hold). When you treat cancer, most medical procedures are out of your hands; when you take smart sun safety steps, you regain some of the control that cancer wrestles away in clinical settings.

The black cloud of skin cancer

Not everyone will respond to this empowerment. Some find the reminder frustrating; others would like to avoid it altogether. Having skin cancer comes with those constant reminders the sun tried to kill you once and may do so again. A day in the sunshine is now different than most; worry can override enjoyment each time you pull on a long-sleeve shirt or re-apply sunblock. The black cloud that often hangs over survivorship can figuratively darken the most literally bright day – in this case, giving none of the benefits of clouds in the sky. And one cannot merely rub on sunscreen to block the negative emotions cancer survivors can feel, being saddled with the choice of behavioral change or increased risk of morbidity.

Check ups and reminders

You also get the same reminder with every doctor’s visit. Dermatologist appointments are now standard and seem to be on the calendar constantly. Any new physician – and sometimes the old ones, too – means completing forms and checking off that little “History of cancer” box, and explaining your past brush with the uncontrolled division of abnormal cells, AGAIN, on a few lines. Yearly check-ups go to quarterly calendar items that dredge up the need to check yourself before cancer wrecks yourself.

The survivorship journey

You will not be the same as you were pre-diagnosis; cancer has a way of changing every aspect of your life and threatens your existence. There is no blueprint for how to live the “after” part, much less a guarantee on how to make it “happily ever.” But it exists, and there are plenty of examples of survivorship paths to use as your guide to navigating this journey. Welcome to the wonderful, and wonderfully-complicated, world of cancer survivorship.

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