There is an increase in the numbers of patients being successfully treated for cancer, with almost one half being alive and well after 5 years. Nevertheless, although this is a remarkable change in the outlook for some cancers, ‘alive and well’ may reflect an objective assessment rather than what patients feel about now and the future. It may also reflect the notion of well-ness. Is that freedom from a disease or is it a much broader concept?

We can all celebrate the considerable advances in cancer treatment and care with the subsequent increase in survival, but this situation brings a different imperative to those of us working in cancer care. It also represents a significant health burden to any economy. Cancer survivors have very different needs from those actively being treated for cancer. For example, a young middle-aged woman having been successfully treated for breast cancer, may have a variety of issues to deal with. ‘Life’ as it was known when this ‘silent assassin’ came along, stopped, as she dealt with a bizarre array of toxic treatments, new jargon, a disruption to her normal life and perhaps broken relationships. Her own role in life may have been fractured with ambitions curtailed and the need to develop a new approach to life. Then, five or so years on, all is back to ‘normal’. However, ‘normal’ is changed. She has to reconstruct her life; may need ongoing help for body image changes, impairment or disability. She may have to start a new occupation or profession, having lost the threads of the original one. Her family – dependent upon her at the time of cancer, have moved away, become adults and have their own lives. Surviving and coping has taken its toll. But she is alive.

Another example, a teenager recovered from acute lymphoblastic leukaemia following gruelling treatment, uncertainty, tension and disruption, is declared cured. He tries to pick up the threads of his life – study, career, social status, particularly relationships. Then, as a result of the toxic and intensive treatment he has discovered a new cancer and is anticipating starting all over again . . . A whole 5 or 6 years of his life just gone. He is alive but what now?

Finally, an older man who has had treatment for bowel cancer. He is ‘alive and well’ at 6 years after diagnosis and much investigation and treatment. He was a successful business man and he has tried to pick up those threads and re-establish himself. However, he has disabling faecal incontinence which may occur at any time – in a business meeting, in the Board Room, as he negotiates a deal. His wife has been unable to accept his illness and its treatment and his two young-twenties children have moved away. He cannot enjoy a pint of beer with his friends and colleagues. Remaining successful is difficult.

Cancer health professionals need to look ahead, to try and help these people they have supported in their treatment and recovery. New strategies and health policy needs to be developed to take account of a growing number who fall into a ‘black hole’ with no support. If they have been cured in order to live a better quality of life without cancer, then they may need very different support and help from health and social care professionals. They may need psychological help to re-think their lives. They may need rehabilitation help to adjust to impairments and disabilities caused by the cancer. They may need family therapy or more practical help to deal with significant financial losses or needs to re-establish themselves and move on. Who now is providing for these needs and what can we all do in research, policy, re-allocation of resources and re-education to meet these needs? We have to do something and we have to do it soon.