Survivorship

14,483,830: The number of adults and children with a history of cancer alive in the United States as of Jan. 1.

18,914,670: The predicted size of the U.S. cancer survivor population by the year 2024.

2,975,970: The number of prostate cancer survivors in the United States. Prostate is the most common cancer among male cancer survivors. Colorectal cancer is the second most common, with 621,430 male survivors.

3,131,440: The number of female breast cancer survivors in the U.S. Breast is the most common cancer among women. Uterine cancer is the second most common, with 624,890 survivors, and colorectal cancer is a close third, with 624,340 women previously diagnosed with colorectal cancer alive today.

430,090: The number of lung cancer survivors. Lung cancer is the most common cause of cancer death in both men and women.

64 percent: The percentage of cancer survivors diagnosed five or more years ago.

15 percent: Percentage of survivors diagnosed 20 or more years ago.

747,400: The number of survivors diagnosed 30 or more years ago.

5 percent: The percentage of cancer survivors younger than age 40. Nearly half of survivors are age 70 or older.

60,620: The number of cancer survivors age 14 or younger.

American Cancer Society

Deana Nash is a 14-year survivor of breast cancer and a four-year survivor of melanoma, but while her life has returned to normal, it's definitely the proverbial new normal.

That new normal includes regular visits to her oncologist and dermatologist, taking drugs to offset damage to her thyroid and bones due to cancer treatments, time off from work, going to extremes to avoid the sun, and the stress from the ever-present cloud of potential relapse.

Nash, a 50-year-old Walterboro resident who works as a paralegal in North Charleston, is grateful for both her health and her insurance, Tricare, which she receives via her husband's military retirement.

"It (insurance) has never denied me anything. I tell my parents it would be cheaper for them to hire a hit man and take me out than to pay my medical bills, because of the breast cancer and melanoma. By now, it (the cost) is in the millions (of dollars)."

But another cost cannot be covered by insurance: the stress of the cancer coming back.

Like millions of cancer survivors, they've coined a term for that anxious period of time between a routine scan to the doctor's report on that scan. It's called "scanxiety." Similar worries occur when a survivor finds a questionable lump, or mole, or pain.

"It's the not knowing," says Nash. "Everyone with cancer will tell you this. You're going along fine and then you find something questionable (on your body) and you're instantly transported back to diagnosis and chemo. Over the years since having cancer, I will admit I have had several scares."

Survivorship increases

Life post-cancer continues to become more common in the United States.

In June, reports by the Centers for Disease Control and Prevention, the National Cancer Institute and American Cancer Society indicated that the number of cancer survivors in the United States has increased from three million in 1971 to 13.4 million in 2012, or 4.6 percent of the population.

The reports also estimate the number of survivors, defined as anyone diagnosed with cancer, including patients currently fighting cancer or those who may have become cancer free, to grow to about 18 million during the next decade.

And while that's generally good news, it comes with an array of tangible and intangible costs, from financial to the stress of cancer recurrence.

"Cancer survivors face many challenges with medical care follow-up, managing the long-term and late effects of treatments, monitoring for recurrence and an increased risk for additional cancers," the CDC said in a statement.

"These survivors also face economic challenges, including limitations in work and daily activities, obtaining health insurance coverage and accessing health care, and increasing medical care costs. ... The results indicate that the economic burden of cancer survivorship is substantial among all survivors."

The CDC estimates the average annual medical costs and productivity losses resulting from health problems, during the period of 2008-11, were $4,187 for male survivors and $3,293 for female survivors. By comparison, the costs for persons without a cancer history were $1,459 for males and $1,330 for females.

Ultimately, the CDC says the findings suggest "the need to develop and evaluate health and employment intervention programs aimed at improving outcomes for cancer survivors and their families."

The home front

Dr. Lindsay Peterson, an oncologist specializing in breast cancer and cancer survivorship at the Medical University of South Carolina Hollings Cancer Center, says the medical field is evolving to take into account the increasing numbers of survivors.

Her interest in survivorship stems largely from the fact that medicine has done a better job at curing breast cancer than other cancers, so breast cancer specialists are seeing more survivors. They often suffer from the long-term effects of the treatment, such as fatigue or pain.

Ultimately, those complications should ease as medicine seeks less toxic ways of killing cancer cells. But in the meantime, a large population continues to grapple with issues of living after cancer.

Peterson says both academic medical centers and community hospitals are creating survivor clinics, dedicated to providing patients with "everything they need in an extended survivor phase." MUSC currently has a clinic managed by a nurse practitioner with help from physicians.

"It (creating clinics) is still developing. There are a lot of institutions out there that have really good models and everyone looks to those to see what's working for them - to try to make their survivor care plan and clinic as efficient as possible.

"Giving them a dedicated clinic allows both the provider and the patient a better environment to address some of these things that go beyond the question of 'Is your cancer back or not?' "

Survival stages

While the report in June defined a cancer survivor as anyone who has been diagnosed with cancer, many do define it more specifically, even though cancers vary widely.

Peterson defines the stages as acute, extended and permanent survival. Generally speaking, the acute stage is the time from diagnosis to the end of initial treatment, typically surgery, chemotherapy and radiation. The extended stage involves active follow-up treatment and monitoring. The permanent stage is when the likelihood that cancer returns is low.

Post-cancer issues drop within those stages of cancer, says Peterson.

In the acute stage, Peterson says it's primarily physical challenges, pain, fatigue, nausea, related to treatments. In the extended and permanent stages, it shifts more to the "psycho-social" issue, such as anxiety, work and financial burdens due to either medical bills or not being able to work like they used to do.

"Many survivors feel like they can't keep up physically or mentally with the job they had before (cancer)," says Peterson.

A changed life

Annie Sheehan was a carefree 28-year-old hair stylist at Allure Salon on King Street when she was diagnosed with melanoma on her outer right calf in September 2010. In the months that followed, she had several surgeries to remove the cancer from her calf and lymph nodes.

Like so many cancer survivors, her life changed.

Sheehan, who was uninsured at the time, tried to return to work, but the resulting lymphedema made her leg balloon. She had to go on disability, which eventually qualified her to be on Medicare.

She wouldn't have been able to pay for her follow-up treatments, which include annual PET, CT and MRI scans and the removal of numerous "spots" that tested positive for pre-cancer in the past four years.

"It's very expensive," says Sheehan. "If you don't have insurance, I really don't know how most people can pay for it."

But Sheehan, now 31, admits that her experience has been a mixed blessing. She's been able to spend more time with her son. She and her girlfriend, who stood with Sheehan throughout her cancer battle, bought a house on James Island and are engaged to be married. And Sheehan is studying nursing at Trident Tech.

But the trauma of cancer is never far away.

"Every time my dermatologist removes something or I go in for a scan, it takes you back to the dark days when you were diagnosed," she says.

Reach David Quick at 937-5516.