Iris Kanera

1 9 INTRODUCTION GENERAL INTRODUCTION Cancer survivorship Cancer represents a big health problem and has a major impact on society. In 2012, 14 million new cases were registered worldwide and it is expected that the number of annual cancer cases will rise to 22 million within the next two decades due to growth and an aging population (DeSantis et al., 2014; The Netherlands Cancer Registry, 2017; Siegel, Miller, & Jemal, 2016). In the Netherlands, the number of new cancer cases increased from 70,608 in 2000 to 108,400 cases in 2016. For Dutch women, the five most common cancers in 2016 were breast (28.1%), skin (14.8%), colon (12.8%), lung (10.4%), and lymphoma and leukemia (7.4%), and among Dutch men, prostate (19.5%), colon (15.5%), skin (14.4%), lung (12.0%), and lymphoma and leukemia (9.3%) are most common (8.9%; The Netherlands Cancer Registry, 2017). Cancer is one of the leading causes of death among the aging population. Fortunately, in recent years, early detection, and treatment improved. In the Netherlands, five-year survival is steadily increasing for all cancers (1994: 51%; 2012: 62%; Meulepas & Kiemeney, 2011; The Netherlands Cancer Registry, 2017). As a result, the number of Dutch cancer survivors increased from 370,000 in 2000 to around 700,000 in 2015 (The Netherlands Cancer Registry, 2017). Cancer survivorship can be defined as the health and life of an individual with cancer post treatment until the end of life (Mayer, Nasso, & Earp, 2017). It covers physical and psychosocial issues of cancer, beyond the diagnosis and treatment. Challenges after cancer treatment Having cancer is a life-threatening event that generates physical and psychosocial distress, possibly resulting in symptoms of anxiety and depression (Jensen et al., 2017; Ng et al., 2017). During curative primary cancer treatment, such as surgery, chemotherapy, and/or radiation therapy, cancer patients are engaged in an intensive medical treatment program that might cause traumatic or toxic tissue damage. After treatment completion, coping with possible residual problems of cancer and its treatment can be a great challenge (Corner, Wagland, Glaser, & Richards, 2013; Given & Given, 2013). Cancer survivors report high levels of psychosocial problems in the first year after treatment completion, such as fear of cancer recurrence, depressive symptoms, fatigue, pain, sleep disruptions, post-traumatic stress, cognitive impairments, and problems with work participation that gradually decrease within the first two years after treatment completion (Given & Given, 2013; Hinnen et al., 2008; Runowicz et al., 2016; Stanton, Rowland, & Ganz, 2015). Dependent on type of cancer and type of treatment, more specific physical residual complaints might occur. For example, after breast cancer surgery, about 20% suffer from arm lymphedema, and 25-60% of breast cancer survivors develop chronic pain. Among colorectal and prostate cancer survivors,