What does it mean to be in remission?
Cancer is said to be in remission when the signs and symptoms of the disease have decreased or resolved. If the cancer is a solid mass — such as a tumor in the lung or breast — remission means the mass has shrunk. If it is a hematologic (blood-related) cancer, such as leukemia or lymphoma, remission notes a drop in the number of cancer cells throughout the body.
Generally, a decrease in cancer has to last for at least a month to be considered a clinical remission.
It’s important to note that the term “remission” is typically used only when referring to blood cancers. In the case of solid tumors, oncologists often note what type of “response” the patient has had to treatment. If the treatment has worked entirely, the patient will be told they had a “complete response” or there is “no evidence of disease.” If the treatment has worked partially, the patient will be told they had a “partial response.”
Is there more than one type of remission?
Cancer remissions are often classified as either “partial” or “complete.” A partial remission or partial response signifies a reduction of at least 30% of a measurable tumor within the body. By contrast, a complete remission or complete response indicates all detectable evidence of cancer is gone.
Not every patient will be told they’re in remission. Some may be informed their disease is “stable,” meaning it hasn’t progressed, or that it has shrank, or grown, by only a small amount. A few millimeters on a scan is typically considered not to be clinically significant.
If a patient is told they have “disease progression,” that means the cancer has grown, either in one area or multiple areas.
Is remission the same as being cancer-free?
Remission is not the same as being cancer-free. While a complete remission or complete response indicates that all clinical signs of cancer are undetectable, there may still be microscopic cancer cells in the body. Cancer cells that remain in the body after treatment may have the ability, after a time, to resume their growth — leading to a recurrence of the cancer. This is why some patients, specifically those with advanced, solid tumors, will often continue treatment even after they have achieved a complete response.
How long does remission typically last?
Every patient’s response to treatment is different, and what works for one person may not be the same for another. The goal of cancer therapy is to produce remissions that are as deep and long-lasting as possible. If or when the cancer does return, your oncology team will walk you through your available options. Patients will often have multiple treatment options available to them, even if they are on their 3rd, 4th, or 5th line of therapy, or beyond.
Furthermore, as targeted therapies — drugs that target specific genes or proteins — continue to advance, oncologists now have the ability to return to previously successful treatments and pair them with new drugs, depending on the specific case. This is often done with the hope of recreating or even extending the previous result.
“Treatment is constantly advancing, and the list of what’s available continues to grow,” says Caroline Block, MD, clinical director of the Breast Oncology Program at the Susan F. Smith Center for Women’s Cancers at Dana-Farber. “We’re always looking for a long-term goal, whether that’s achieved through a single therapy or many.”
Are there ways to stop cancer from reoccurring?
As previously noted, it may be recommended for some patients to continue treatment even after they have achieved a complete response. Because there is potential for cancer to return after remission, it’s important for patients to continue to see their cancer care team for follow-up care. These ongoing visits offer an opportunity to check on a patient’s overall health, monitor them for late- or long-term side effects of treatment, and assess any signs of disease recurrence. They also allow patients to have ongoing conversations with their care team and alert them of any concerning symptoms or developments.
Can metastatic cancer go into remission?
Metastatic cancer patients can achieve a complete response or remission. However, the likelihood of that happening depends on their cancer. Many hematologic cancer patients can achieve complete and long-lasting remission.
While this is less likely in advanced, solid tumors, it is not impossible. In instances where remission isn’t achievable, there are still things that can be done to extend and improve a patient’s life. Following each appointment, your oncologist will be able to walk you through all available options and develop a plan that is right for you.
Mentally transitioning to survivorship
Transitioning from active patient to survivor is an achievement worth celebrating. However, many patients will experience mixed emotions at this milestone. It’s perfectly OK and normal to be overwhelmed, anxious, frustrated, or even scared following what many perceive as a joyous moment: the end of treatment.
According to Ashley Boyd Fermin, LICSW, a clinical social worker at Dana-Farber, the number one thing patients transitioning into survivorship can do is reach out for support. You are not alone at the conclusion of treatment, and it’s OK to continue to ask for help.
That help can come in many forms. Perhaps it’s attending a support group(s), talking with someone you trust, or working with a social worker or therapist. Your oncologist will be able to connect you with someone who is clinically trained to help you work through your emotions.
[Dana-Farber’s Adult Survivorship Program, part of the Perini Family Survivors’ Center at Dana-Farber, can help patients find expertise, education, and support in helping manage issues related to surviving cancer.]
Emotional side effects
The conclusion of treatment is often the first-time patients have a chance to truly process what they’ve been through. Cancer can impact every aspect of a person’s life, so coming to grips with what has happened can quickly become overwhelming.
Anxiety following treatment is a common side effect, but patients can undergo a whole range of emotions. Again, do not be afraid to ask for help, especially if these side effects are interfering with your daily life. Speaking with a licensed professional can help you process what happened and allow you to move on.
“We need to be kind to ourselves, and work on accepting life is going to be different,” says Boyd Fermin. “It’s OK to struggle but know things will get better and you will feel better.”
Practicing good self-care (exercising regularly and eating healthfully), as well as a regular mindfulness practice, can also be helpful when working through these emotions.
It’s important to remember it takes time for the body and mind to heal. Most people may not feel entirely like themselves following treatment, and it can take weeks, months, or even years to start feeling like “yourself” again.
During this transition be sure to find a balance when returning to your “normal” life, whether that’s going to work, exercising, or even acting as the family caregiver. It’s going to be a gradual process and you shouldn’t feel guilty asking for help.
Having a conversation with your team prior to completing treatment can often help prepare you for what to expect, set realistic expectations, and avoid some future frustrations.
Prepare for the hard days
Anniversaries surrounding your diagnosis or reoccurrences can be incredibly stressful. These dates may bring back complex emotions, some you might not have even known you had. It’s important to recognize what you’re experiencing, and to reach out for help if you feel you are struggling.
Planning ahead is a great way to prepare for the days that might carry difficult moments. Whether it’s watching a movie, enjoying the day with loved ones, or going for a hike, organizing a fun distraction can be incredibly helpful.
Reestablishing your identity
Many patients struggle with redefining who they are following treatment, according to Stephanie Tung, MD, a psychiatrist in Psychosocial Oncology and Palliative Care at Dana-Farber. Many feel their whole identity has been consumed by their diagnosis. It’s important to find what drives you, identify what’s important to you, and ultimately reconnect with other aspects of yourself that are not your disease.
To help do this, Tung suggests taking time to reflect on what you’ve gone through and develop a plan to get where you want to be. This should include both long- and short-term goals and can even be as simple as going for a walk or returning to a hobby you’ve put down for a while.
Fear of recurrence
Being away from your care team can make you feel vulnerable or afraid that you’re giving the cancer a chance to return. These feelings of fear or anxiety are completely normal, and something many cancer survivors will face.
As treatment begins to wind down, be sure to ask your team what the “roadmap” for your survivorship looks like. They’ll be able to tell you what to expect three, five, or even 10 years out. This will include both the mental and physical side effects; knowing what to expect can greatly help lessen feelings of anxiety.
Even with this roadmap, you’ll likely notice you’re more acutely aware of new aches and pains and may worry they are signs the cancer has returned. Before finishing treatment, be sure to have a conversation with your team about what side effects are a normal part of the healing process and which are a cause for concern. While you will likely still have concerns or fears about recurrence, education is a valuable tool to help provide some structure and context.