Seasons of survivorship revisited.

Several decades ago the chance of a cancer survivor enjoying long-term survival was limited. At that time the terms cancer survivor and cancer survivorship were new. A cancer survivor was defined as a person from the moment of diagnosis onward for as long as they live. Cancer survivorship was also described in several "seasons" including; acute survivorship (the experience of diagnosis and treatment), extended survivorship (a time for "watchful waiting"), and then permanent survivorship (long-term remission). Today, acute cancer survivorship is still a time of intense emotion and medical activity surrounding the diagnosis, staging, and actual treatment. We then propose that after the intense initial therapy is completed the survivors enter a "season" that can be called "transitional cancer survivorship" reflecting the transition from active treatment to careful observation and the emotional, social, and medical adaptations that occur. Next, there are a growing number of cancer survivors who are (1) alive and "living with cancer" but requiring ongoing treatment for recurrent, active, and often advanced disease; (2) in a complete remission that requires ongoing therapy; or (3) in a complete remission and with a favorable prognosis. Collectively, this is a diverse group in "extended survivorship" and some later go on to obtain a permanent remission although others experience disease progression. Finally, there are millions of long-term or "permanent survivors." This group is also very heterogeneous and is comprised of 4 subgroups including (1) survivors who are "cancer-free but not free of cancer," (2) survivors who are cancer-free but continue to have significant "fall-out" from cancer and its treatment including psychosocial, medical, financial, or legal sequelae, (3) survivors who go on to develop second cancers which may be unrelated to the first cancer or its treatment, or may be more likely due to genetic or environmental factors, and also (4) survivors who later develop cancers that are secondary to the initial treatment.