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Stages of Survivorship

Cancer survivorship involves much more than the label “survivor”. Survivorship is an evolving process of living with, through, or beyond cancer.


The concept of cancer survivorship includes everything in life that changes as a result of the diagnosis and its aftermath. Many patients struggle to make sense of these changes and feel a sense of order in their lives.

“Seasons of Survival: Reflections of a Physician with Cancer” written in 1985 by Fitzhugh Mullan, MD, a physician and cancer survivor, suggests the following stages of cancer survivorship.

Acute Stage:

The Acute stage includes the time from diagnosis through the end of treatment when the focus is on the actual disease. Patients and caregivers often struggle to navigate their situations.

Supportive services available through health care professionals and loved ones are especially important to help patients through this journey.

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Although this is often the shortest stage (1 month – 1 year or more depending on your cancer and treatment), it is often the most difficult due to continued emotional stress and the added burden of treatment.


Hang in there, you can get through this stage!

Extended Stage:

Extended stage begins when and if the patient responds to treatment. Patients and caregivers may feel positive, yet uncertain. Fear of recurrence is often present. Recovery focuses on the physical, emotional, and psychological effects of treatment. Emotions can be varied and extreme. Medical services are no longer needed on a regular basis. Patients and their families usually rely on community and peer networks for support.


If you need help during this stage, reach out to your medical team, support team and non-profit organizations specializing in this area. See our resource section.

Permanent Stage:

Permanent stage refers to the long-term stage of survival when a level of confidence for health and life returns to the person affected by cancer. Recovery is celebrated. At the same time, survivors must manage the long-term physical and psychological effects of the disease. Survivors may require continued care by specialists with knowledge about long-term and late effects of their disease and its treatments.


  • For Children who have parents undergoing cancer treatment go to Kids Konnected at:

  • The Wellness Community is a nonprofit that provides free emotional support, education and hope for people with cancer and their loved ones. Go to .

  • CR is a new magazine published by the American Association for Cancer Research (AACR). CR magazine connects all groups of people who are personally affected by cancer, caring for patients and working toward preventing and curing the disease. They also have free podcasts that explore the unique issues facing survivors. Go to .

Chronic Stage:

Is there a Fourth Cancer Survivorship Stage?

Dr. Mullan published his essay about three stages of cancer survivorship in 1985. Since then, there are an increasing number of long-term survivors. This may be a difficult transition period as you are no longer receiving treatment and may feel as if you are not doing anything to keep well. In some of these individuals, cancer has come to be looked upon as a chronic disease. As a result, CISN would like to suggest the inclusion of a fourth survivorship stage.


The chronic stage indicates the disease is present for a long period of time, yet managed. Disease management might include ongoing and perhaps intermittent conventional treatment, and/or the incorporation of major lifestyle changes that support wellness and help to at least control the disease state.

For many patients in this stage, their cancer is viewed as a chronic disease. These survivors, like diabetics, must be treated but their disease can often be controlled for the balance of life.

Relationships may be especially strained during challenging periods in the chronic stage when the survivor feels more like a patient due to episodes of sickness, treatments, or emotional ups and downs.

Loved ones may not understand the consequences of learning to with disease and health for many years. The mainstream medical system may not know how to relate to these survivors or patients.

The physical, mental, emotional, and spiritual toll for those in the chronic stage can be both difficult and rewarding. The difficulty stems from dealing with one's health events for years.

The reward comes from long-term survival and lessons learned along the way.



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