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Tracy Lautenbach, MSW, LCSW, OSW, is the social work team leader for radiation oncology at Penn. In this article, she discusses what happens when cancer treatment ends.

The time of diagnosis is often a time of shock or described as feeling you’re having an “out of body experience." During treatment you may feel you will never get through it and are often plugging along through the thick of it. Then comes the end of treatment where one can often feel a sense of overall abandonment.

Cancer treatment may have come to an end however the cancer “experience” has not. It is not over. For many patients this is the time there is a resurgence of fear.

You have recuperated and now the recovery stage begins.

Patients are left to pick up the pieces of their lives.

Being around people who listen and validate your fears and not dismiss your fears is the essence of the support that is needed at this time.

In this recent post on her blog, Chemo in Louboutins, by cancer survivor Susan Schwartz, she writes about what it’s like to complete cancer treatment. And the feelings that come with ending this chapter in her life.

No Excuses Now

Susan Schwartz
I don’t know why I am finding this last posting so hard to write. It should be easy. I’m done treatment. The End.

Penn proton therapy came and went without chemo or Louboutins, so I feel kind of like a fraud writing about it. Every day I got up super early, threw on black leggings and white sneakers and went to my session. I did walk back from treatment to my parent’s apartment (almost 2 miles)…still that was no excuse for ugly footware. Mr. Louboutin designs sneakers –of which, sadly, I have none. It would have been RadiationInNewBalance.com.

New Year’s is usually thought of as a time to start anew (thus, the NEW in New Year’s) with projects and plans and resolutions. I just want to go back to April 2012 – home from holiday, kissed by the southwest sun of Arizona and the Grand Canyon, ready to go back to work. A time when I was clueless about what was to come.

I return to London this next week to begin the process of “getting back to normal. This involves trying to convince myself that I look like a middle-aged Jean Seberg and the weight I gained will slough off. After 4 weeks, radiation has only left me with a slight sore throat and some “sun” burned skin around my chest.

“All this will be healed soon,” promised my doctors.

Did wearing Louboutins make me feel and look glamorous? Yes, it did. Am I still filled with fear even now that I am going home? Yes and I am certain I will always feel that way.

Still there is one thing I can guarantee – no more dust covered Louboutins waiting for an invitation to be worn.

The Best of the Goods:

There are some people and things that deserve special recognition:
The SLS Support Team

I could not have gone through this and come out the other side without all of you…the parents, boyfriend, friends, those who read and commented on this blog
The SLS Medical Team
Everyone at HUP (Hospital of U of Penn), especially the chemo nurses, proton 4 ladies, and the doctors who are trying to cure me and their teams.
Steve Jobs and Skype
Without Facetime, Skype and every other software and/or device that let me keep one foot in the UK – allowing me to speak to my friends and watch Strictly Come Dancing at the same time!
Your Prayers, Hopes and Well-Wishes
These I pass along to the people I met at the Proton Center…who are still going through treatment.

June 3 is the National Cancer Survivorship Day - a day on which cancer survivors celebrate life after a cancer diagnosis. Healthy eating after cancer treatment is important for weight control and nutrition.

This video from the Joan Karnell Cancer Center takes a look at nutrition and survivorship after treatment for breast cancer is complete.

Melanie Gaffney is a proud childhood cancer survivor, and a contributor to the Focus On Cancer blog. Today she is cancer-free, but lives with the after effects of her cancer treatments. 

As a cancer survivor, relapse and second cancers are always in the back of your mind. The thought of cancer coming back doesn’t rear its ugly head daily, but sometimes the idea of getting cancer again can stop you dead in your tracks.

I have been cancer free for a very long time. I’ve had a couple of scares, but have always come out on top. Just this past January, during a routine cardiology visit, my incredible physician, Dr. Joseph Carver, discovered a lump on my thyroid. It wasn’t visible to the eye on the outside, but it was there, just under the skin.

I sat there at the end of my exam and stared, listening to him tell me about this lump, and all I could hear was “cancer, cancer, cancer.” As he spoke, all I could think was: “How will I prepare my kids? How will I afford childcare during treatments? Will my 5-year-old son be scared and understand? Will I lose my hair?”

Dr. Carver’s words would penetrate my thoughts every now and then, but for the most part he was just a blur.

Learn more about the Abramson Cancer Center's Living Well After Childhood Cancer program.
Once I mentally came back to the room, I sat and listened. He told me: “Melanie, people find lumps and nodules on their thyroids all the time, and they turn out to be nothing. But, with your personal history, your chances of having cancer again are higher than average.”

He told me I’d need a biopsy, and as he discussed the next steps, I listened intently to every word. I knew that I had to do everything just right to make sure that if it was in fact cancer, I had the knowledge I needed to take care of myself and those around me.

After my appointment it was time to start to make the calls to my family to tell them what was going on. They weren’t easy calls to make - even though I only knew it was a lump –we all knew my chances of what it could be.

Because of my scheduling preferences, my appointment for a biopsy wasn’t for six weeks. I can honestly say, without hesitation, that they were the longest six weeks of my adult life. I went through the motions, work, home, kids, etc. without always focusing on it, but I would break down in tears every day, every single day.
For those six weeks I had cancer, or, I might as well have.

I have incredible people in my life, that change their plans to accommodate my appointments, who are there for me as soon as a I need them, who blindly support me and my family. My friends actually organized a dinner during those six weeks, to just celebrate our friendships and lives together. At that point, I knew that if I did have cancer again, I was going to be just fine regardless of the outcome.

The day came for my biopsy, I was ready; emotional but not scared, strong but humble. I was ready for whatever the results were going to be.

I got my results: 100 percent benign.

I had cancer for six weeks – in my head and in my soul and in my heart, I had cancer. But now, knowing I don’t, I am ready for whatever else being a survivor may throw at me.

I have a feeling this may be just the beginning, that more scares will come and there may be a time where I am not as lucky with the outcome, but until then….
I don’t have cancer.

Lori Smith, MSN, CRNP, is a certified registered nurse practitioner in gynecologic oncology at Penn Medicine. She works with women with cancer and immune therapy clinical trials for ovarian cancer. She is also a co-investigator on many other clinical trials focusing on women’s cancer. Additionally, she leads the Living Well After Cancer™ Program within the Jordan Center for Gynecologic Cancer.

It is important for women who have been treated for a gynecologic cancer to undergo a survivorship visit because the time is completely devoted to addressing your concerns and needs. It is also vital that any other medical providers who participate in your care are aware of your past treatments and current plan of care so that they too can manage your health in a comprehensive manner.

Many women who have been treated for a gynecologic cancer often report significant side effects that they feel affect their quality of life. Those reported side effects include vaginal dryness, painful intercourse, fatigue, lymphedema, urinary and fecal incontinence and pain.

Many women also report psychosocial concerns such as depression, fear/anxiety of their cancer recurring, and concern for family members in cancers with a possible or confirmed genetic mutation.


The Living Well After Cancer™ Program at Penn is a member of the LIVESTRONG TM Survivorship Center of Excellence Network. As part of this network, Penn joins several other LIVESTRONG TM centers nationwide in providing patients and their healthcare providers with the tools necessary to develop a comprehensive cancer survivorship plan.

Penn’s cancer survivorship program offers thorough medical and psychosocial evaluations, follow-up visits, and referrals to other specialists as needed. During this visit, team members discuss any concerns you may have related to your cancer diagnosis and treatment history. A cancer survivorship care plan is developed for you, which includes information about:

• Potential late effects and symptoms
• Recommendations for cancer screening (recurrence or new primary)
• Psychosocial effects (relationships and sexuality)
• Financial issues (work, insurance and employment)
• Recommendations for a healthy lifestyle
• Genetic counseling
• Effective prevention options
• Referrals for follow-up care and a list of supportive resources
• Fertility or reproductive options.

Also during this visit, a complete, personalized care plan and treatment history is created using the LIVESTRONG Care Plan tool. This tool can be found on OncoLink.org and can be completed in the office or anyplace you have computer access. The LIVESTRONG Care Plan provides you with a detailed account of your past diagnosis, treatment history and information about your follow-up care, symptoms to watch for and a report to your healthcare provider. It also provides you with helpful tips to stay healthy.

If you were treated for gynecologic cancer at Penn Medicine and would like to make an appointment for a survivorship visit, please call 215-662-3318 or 800-789-PENN (7366).

Watch the 10th Focus on Gynecologic Cancers Conference.

Learn more about the Jordan Center for Gynecologic Cancers at the Abramson Cancer Center.

Penn's Abramson Cancer Center is a national cancer center in Philadelphia providing comprehensive cancer treatment, clinical trials for cancer and is a cancer research center. The National Cancer Institute has designated the Abramson Cancer Center a Comprehensive Cancer Center, one of only 40 such cancer centers in the United States.