Forum: Cancer survivorship must be recognised as an ongoing phase of care

Dr Wong Seng Weng’s commentary on cancer survivorship highlighted an issue that many survivors in Singapore quietly struggle with: Treatment may end, but recovery does not (Cancer rates are rising among the young. Singapore healthcare system needs to address this, May 15).

As a breast cancer survivor, I related to his observation that the transition into long-term care remains poorly defined. Much attention is understandably placed on diagnosis, surgery and treatment. 

Yet, survivorship – the months and years after – is often where patients are left to navigate the greatest uncertainty.

Many younger survivors today (and many more are being diagnosed, at increasingly younger ages) are expected to return quickly to work, family responsibilities and daily life as though they have simply “recovered”.

But survivorship is rarely linear. Fatigue, fear of recurrence, cognitive changes, anxiety, altered identity, fertility concerns and difficulties reintegrating into the workplace can persist long after treatment ends; meaning, the journey is more layered and nuanced than often thought. 

If we define success narrowly and continue to put national resources only into survival statistics and treatment options, we sadly fail to address the quality of the life that follows.

Cancer care should not stop at “no evidence of disease”. Survivorship must be recognised as an ongoing phase of care requiring greater medical, psychological, financial and workplace support. This includes clearer pathways into long-term primary care, stronger psychosocial services and more national tracking of survivorship outcomes such as mental health, return-to-work experiences and long-term quality of life.

Insurance and healthcare frameworks should evolve as well. MediSave and MediShield coverage remain largely focused on acute treatment, yet many survivors continue to require rehabilitation, therapy, counselling and supportive care long after hospital visits become less frequent.

I was diagnosed with breast cancer four years ago at age 43, and have poured many personal resources into my aftercare. I feel survivorship issues should be better recognised and supported, as survivorship is not a completed medical episode but a long-term health reality that deserves sustained support and ought to merit national attention. 

Today, I work with cancer survivors through wellness and coaching programmes focused on nervous system regulation, movement, sound therapy and rebuilding confidence after treatment. Through this work, I see how many survivors are quietly trying to hold themselves together while appearing “fine” externally. 

Dr Wong’s piece was important because it recognised something survivors already know: As he astutely put it, treatment is one chapter. Survivorship is the rest of the book.

Jill Alphonso