Recovery & Rejuvenation

Head and neck cancer treatment changes the part of the body a person cannot cover, and the functions, speech and eating, that social life is built on. There is no pooled prevalence figure for body image distress in this group: the first systematic review of the factors behind it was still a published protocol in 2025, which makes this the clearest measurement gap in this part of the corpus.

Numb, tingling or painful hands and feet after taxanes, platinum or bortezomib have no proven preventive treatment. Small trials suggest acupuncture may ease the symptoms, but they are too small and inconsistent to be sure, so it is an option to try inside a trial or with careful tracking rather than an established treatment.

Radiotherapy to the head and neck can permanently dry the mouth. A randomised trial in the United States and China found that acupuncture given during radiotherapy reduced dry mouth a year later compared with standard care, an effect that needs confirming.

People diagnosed between 15 and 39 get different cancers from children and from older adults, and for years their survival improved more slowly than either. Since 2000 that has changed: five-year survival gains for this group have paralleled those of childhood cancers. The obstacles that remain are trial enrolment, access and insurance, and support that fits the age.

The things worth asking a transplant team for, in one place: who follows you up and for how long, which screens are due at which year, what immunisations you need and when, and who to ring when something changes.

Three more drugs are licensed for chronic GvHD that has not responded to earlier treatment. Their response rates look high, between half and three quarters, but they come from trials with no comparison group. Ibrutinib is the cautionary case: it looked good in a single-arm study and then did not beat prednisone alone when tested against placebo.

Australia published a national model setting out what survivorship care should contain: stratified pathways by need, a treatment summary and care plan, a focus on wellness and prevention as well as surveillance, and timely access without unnecessary appointments. Exercise is recommended as part of routine cancer care by the same body.

Germany does something no English-speaking country does: it funds a three-week structured rehabilitation stay after cancer treatment as an entitlement, inpatient or full-day outpatient, through the pension insurance system. Retired people and some non-insured relatives can have it too.

Most people in the world who survive cancer are offered no survivorship care at all. Specialist centres are rare, follow-up is limited, late effects are poorly documented, and the household pays. This is the largest gap in recovery care anywhere, and the one with the thinnest evidence base.

Denmark, Norway and Sweden build rehabilitation and a named contact person into the national cancer pathway rather than leaving them to be requested afterwards. Even in tax-funded systems designed around need, the published work finds that socially disadvantaged people take up less of it.

In England the offer has four named parts: an assessment of what you need and a plan written with you, information and support about living well, a summary of your treatment sent to you and your GP, and a review with your GP. Follow-up is increasingly not a routine clinic appointment but a pathway you manage yourself, with tests at set intervals and a route back in.

The United States answer to life after treatment was a written survivorship care plan, made an accreditation requirement for cancer centres. The randomised trial of it found no benefit on any patient-reported outcome, and the requirement was later replaced with a broader survivorship programme standard.

In a randomised placebo-controlled trial of 364 people, eight weeks of Wisconsin American ginseng modestly improved cancer-related fatigue, mainly in those still on treatment. The 2024 fatigue guideline says it may be offered during treatment; quality of the product matters.

Because hair thinning on endocrine therapy follows the pattern of androgenetic alopecia, the drugs used for that pattern are sometimes added. The evidence in cancer survivors cannot separate them from minoxidil, the one guideline that addresses spironolactone says not to use it routinely, and an expert panel advised against finasteride and dutasteride in breast cancer.

Two or more years after diagnosis, anxiety is the mood problem that stays raised: 17.9 per cent of 48,964 people against 13.9 per cent of 226,467 who had not had cancer, a relative risk of 1.27. Depression at that distance is not raised. Where both members of a couple were measured, spouses reported anxiety at 40.1 per cent against 28.0 per cent.

Anxiety around a scan has been measured in 57 studies using 81 different instruments, which is why reported rates run from 13 to 83 per cent; moderate to severe anxiety was reported by 4 to 28 per cent. Scanning more often does not lengthen life in breast cancer or in one common lymphoma, and in bowel cancer it found more curable recurrences but no fewer deaths.

Several randomised trials tested asking patients to report symptoms every week, with a nurse alerted when something is bad or getting worse. It reliably improves how people feel and function and cuts emergency visits. Whether it lengthens life did not hold up: two trials found a survival benefit and the largest trial, designed to test exactly that, found none.

Treatments aimed at a protein on B cells cannot tell a cancerous B cell from a healthy one, so they remove both, antibody levels fall and infections become more frequent. The fix is to give the antibodies back every few weeks. In one myeloma study, serious infections were ten times less frequent while people were receiving immunoglobulin.

Surgery for a vestibular schwannoma removes the balance nerve on one side, and the brain has to learn to work without it. Vestibular rehabilitation is the physiotherapy that teaches it, and a systematic review of 23 studies graded every outcome as very low certainty. Referral is also the problem: in one centre 42 per cent of patients were referred and 36 per cent of those completed the programme.

Eyelashes and eyebrows often fall out with chemotherapy and can be slow to return. Bimatoprost, a glaucoma eye drop approved for thin lashes, applied along the lash line each night increased lash length and thickness in a randomised trial that included people after chemotherapy.

After CAR-T the blood counts often take much longer to recover than after ordinary chemotherapy, and in some people they dip again weeks later after appearing to have recovered. Since 2023 this has had a name, ICAHT, and an agreed grading system, which matters because it means it is measured and reported rather than described loosely.

Body image has a validated ten-item questionnaire built for cancer trials and tested in 682 women with breast cancer. It discriminates reliably between people who had a mastectomy and those who had breast-conserving surgery, and the scores do not track age or time since diagnosis, which is the finding most at odds with what people are told.

A child treated during the years in which bone is laid down may never reach the peak bone mass they would have had, which is a different problem from an adult losing bone already built. Thirty per cent of adult survivors of childhood leukaemia had low bone density, most strongly associated with growth hormone deficiency and smoking, both treatable.

Hormone treatments, chemotherapy that stops the ovaries and long courses of steroids all thin the bones, fast enough to measure within a year. Some of it comes back when the treatment stops, and the drugs that prevent fracture while it is going on are well proven.

Zoledronic acid and denosumab reduce fractures, spinal cord compression and bone pain from bone metastases and myeloma, prevent treatment-induced bone loss, and in postmenopausal breast cancer modestly reduce recurrence in bone.

Four problems that turn up years later and are easy to miss because each belongs to a different specialty: bone that thins or, less often, dies at the hip; cataract, which is common after total body irradiation and is fixed by an operation; kidney function that drifts down; and lungs that stiffen rather than obstruct. Each has a cheap test.

New bowel symptoms after radiotherapy to the prostate, cervix, womb, bladder or rectum are common and are often treated as something to live with. They usually have several separate and treatable causes, and a trial showed that working through them with a written algorithm, delivered by a nurse or a gastroenterologist, improved symptoms more than a self-help booklet.

A girl who had radiotherapy to the chest carries a risk of breast cancer by age 50 of about 30 per cent. It is not only about dose: a low dose to the whole lung gave a higher standardised incidence than a high dose to a smaller field, because volume matters. Surveillance is recommended from early adulthood, decades before ordinary screening starts.

Two years after surgery, women reconstructed from their own tissue reported more satisfaction with their breasts than women with implants, by about 8 points on a 100-point scale. After radiotherapy the gap widens and so does the complication rate: 38.9 per cent of irradiated implant reconstructions had a complication within two years against 25.6 per cent of tissue ones.

A questionnaire built from what women actually said matters after breast surgery: satisfaction with how the breasts look and feel, and psychological, physical and sexual well-being, each scored separately. It is the reason reconstruction techniques can be compared on something other than complication rates.

Taking out a lobe takes away lung, and breathlessness on stairs is what people notice. Across 18 randomised trials and 1,795 patients, pulmonary rehabilitation after lung resection improved lung function, six-minute walk distance and physical quality of life, with bigger gains from programmes of twelve weeks or more.

When density has not come back, the options are to hide the gap or to move hair into it. Keratin fibres and scalp micropigmentation are cheap, immediate and reversible; hair transplantation and surgical reconstruction have been reported in cancer survivors only in small numbers, and no trial compares any of them.

Cancer rehabilitation is the medical speciality that treats what treatment leaves behind: weakness, a stiff shoulder, a swallow that no longer works, a bladder that leaks, a limb that swells. It is delivered by a named set of professions, it has randomised evidence behind several of its parts, and in the largest study to measure it only three in ten of the impairments that needed it were treated.

Cardio-oncology builds heart risk assessment, monitoring and prevention into cancer care so patients can finish curative treatment without trading cancer for heart failure. It targets anthracycline and trastuzumab damage, checkpoint-inhibitor myocarditis and radiation heart disease using echocardiography, troponin tests and protective drugs; specialist clinics are concentrated in large centres.

A bike or treadmill test to exhaustion with a mask measuring the air breathed in and out, giving peak oxygen uptake. It is the most objective measure of what a body can do, and in breast cancer it showed that survivors sit around a quarter below healthy women of the same age across the whole survivorship continuum.

An estimated 1.58 million people in the United States living after a cancer diagnosis have a child under 18 at home, about 2.85 million children, and roughly 562,000 of them live with a parent in early treatment. The systematic review found no general excess of serious difficulty against reference groups, a slightly raised risk of internalising problems, and adolescent daughters most affected.

After a donor transplant the new immune system can treat the body it has landed in as foreign. When that goes on past the first few months it is called chronic graft-versus-host disease, and it affects roughly four in ten adults. It is treatable and often improves, and the same donor immunity also keeps the leukaemia away, so the aim is to control it rather than abolish it.

Chronic GvHD is a pattern of injuries that can appear in several places at once: skin that thickens, a dry sore mouth, dry painful eyes, difficulty swallowing, abnormal liver tests, stiff joints, genital narrowing. Several of the best treatments are local rather than systemic. The eye and genital problems are the ones least often raised.

Chemotherapy and radiotherapy do not select blood stem cells at random. They favour the ones carrying mutations in DNA-damage genes, which then expand. Most people with such a clone never develop a blood cancer, but the clone is a measurable mark of what treatment did, and in a minority it is the seed of a later leukaemia.

Cancer-related fatigue and anxiety respond to structured talking therapy that targets the thoughts and habits that keep them going. Randomised trials show benefits during treatment and, for persistent fatigue, years afterwards; guidelines recommend it.

Insomnia is one of the most persistent problems after cancer treatment. A short structured talking therapy that retrains sleep habits works better and for longer than sleeping tablets, and digital versions bring it to people who cannot reach a therapist.

Pellets of compounded oestrogen and testosterone are implanted under the skin and sold as a way to feel young again. The National Academies reviewed the evidence and told prescribers to restrict their use: the claim that compounded preparations are safer or more effective than approved hormone products is not supported, and nobody checks what is in them.

Arm or leg swelling after lymph node surgery or radiotherapy is managed with compression garments, specialised massage, skin care and exercise. Weight lifting, once forbidden, was shown in a randomised trial to reduce flare-ups rather than cause them.

Several drugs have been put on the scalp to stop chemotherapy hair loss before it starts: minoxidil lotion, vitamin D analogues, and others. The trials were done and they did not work. Scalp cooling remains the only method cleared by a regulator to prevent it.

The staging CT scan every cancer patient already has can be measured for muscle and fat at the level of the third lumbar vertebra; low muscle predicts chemotherapy toxicity and shorter survival across cancers, and software now does the measuring automatically.

Diagnosed by psychiatric interview rather than questionnaire, depression affects about one in six people being treated for cancer: 16.3 per cent across 70 studies and 10,071 people. Years later the rate is no higher than in people who have not had cancer. The treatment with the largest trial behind it is nurse-delivered collaborative care, which tripled the response rate.

Radiotherapy to the head and neck damages the salivary glands and, through the dry mouth that follows, the teeth. Planning that steers dose away from the parotid glands roughly halves lasting dryness and lets saliva recover over a year or two. Teeth need a dental assessment before treatment starts, because extractions afterwards risk the jawbone failing to heal.

Cancer in the years when education and first jobs happen costs more than the time taken. In the largest cohort, 23 per cent of childhood cancer survivors had used special education services against 8 per cent of siblings, and survivors of several cancers were less likely to finish high school. The important finding is that where the educational support was given, the gap closed.

Schedule 1 of the Equality Act 2010 says in one sentence that "Cancer, HIV infection and multiple sclerosis are each a disability", so protection applies from the moment of diagnosis rather than when the illness starts to limit anything. That brings the employer's duty to make reasonable adjustments, and Statutory Sick Pay of £123.25 a week for up to 28 weeks.

Federal regulation states that "cancer substantially limits normal cell growth", and the statute counts an impairment in remission if it would substantially limit a major life activity when active. The Americans with Disabilities Act reaches employers with 15 or more employees; unpaid job-protected leave under the Family and Medical Leave Act is 12 workweeks a year.

Instead of starving patients before and after an operation, modern surgical pathways feed them early, give carbohydrate drinks the night before, and get them walking the next day. Complications and hospital stays fall.

Thirty questions, answered about the past week, that produce separate scores out of 100 for how the body works, how the mind is, and for fatigue, pain and sickness. It is the questionnaire behind most European cancer trial results about quality of life, and there are add-on modules for individual cancers.

An epigenetic clock reads chemical marks on DNA and estimates how old the body looks, which is not always the age on a birth certificate. In survivors of childhood cancer the clock runs ahead of chronological age, and the gap is larger after radiotherapy and after certain chemotherapy drugs. What the gap means for any one person is not yet known, and the clocks do not agree with each other.

Five questions and a thermometer-style scale from worst to best imaginable health. The five answers are converted into a single index value using a country-specific value set, and that index is what health systems use to decide whether a treatment is worth paying for.

Structured exercise during and after treatment, which the CHALLENGE trial showed improves survival in colon cancer.

Moderate exercise while on chemotherapy is safe and reduces fatigue, helps people finish their planned doses, and may protect the heart and nerves.

Structured exercise has the strongest evidence of any recovery intervention, including a randomised survival benefit in colon cancer. In a population survey of blood cancer survivors, 46 per cent met neither the aerobic nor the strength guideline and 22 per cent met both, and meeting both was associated with having been to university.

Exosomes are real biology and a serious research field. Exosome injections sold in clinics are neither. There are no approved exosome products anywhere, and the FDA issued a public safety notification after patients in Nebraska were seriously harmed by them.

Blood is taken out through a machine, the white cells are treated with a light-sensitive drug and ultraviolet light, and given back. It is used for GvHD that steroids have not controlled, mainly skin and mouth, and it spares people more immunosuppression. Improvement builds over months, so it means two sessions a week for a long time.

Where an ear, an eye socket or a nose cannot be rebuilt from the patient's own tissue, a silicone prosthesis is made and held by adhesive or by titanium implants in bone. Implant failure differs sharply by site: across 3,630 implants, 3.5 per cent failed at the ear, 8.8 per cent at the nose and 18.7 per cent at the orbit.

Twenty-seven questions about the past week, in four areas: the body, family and friends, feelings, and being able to do ordinary things. Dozens of add-ons exist for particular cancers and particular symptoms, including the fatigue scale used in most anaemia and fatigue trials.

Taking fat from one part of the body and injecting it to fill a defect left by surgery is routine reconstructive practice. The question survivors ask is whether it wakes anything up. Matched studies have not found higher recurrence, but they are not randomised trials, and the grafted area can produce changes on a mammogram that need to be told apart from a recurrence.

Fatigue is the commonest thing left behind by cancer treatment and the least treated: about a third of women in two large breast cancer cohorts still had severe fatigue years after diagnosis. What works is exercise, cognitive behavioural therapy and mindfulness programmes. What does not is the stimulant tablet people most often ask for, and the 2024 guideline says so.

Almost everyone who finishes cancer treatment thinks about it coming back, and for about one in five the thought is severe enough to be worth treating. Pooling 9,311 people from 46 studies in 13 countries, 58.8 per cent scored 13 or more on a 36-point questionnaire, 45.1 per cent scored 16 or more and 19.2 per cent reached 22, the clinical threshold.

Male survivors were about half as likely as their brothers to father a child, and the causes are specific: testicular radiotherapy above 7.5 gray, and high cumulative cyclophosphamide, ifosfamide, procarbazine or cisplatin. A young man with none of those was no less likely than his brother. Sperm banking works; tissue banking before puberty has produced no births.

Most female survivors treated with chemotherapy and no radiotherapy to the pelvis or brain can become pregnant: the large cohort that asked found chemotherapy-specific effects were few. The exceptions are busulfan, high-dose lomustine, pelvic and cranial radiotherapy and transplant conditioning. Before puberty, freezing ovarian tissue is the only option.

For young women with the earliest, low-grade endometrial cancers, progestin pills or a hormonal IUD can clear the cancer and allow pregnancy before a later hysterectomy.

Transplant conditioning, and total body irradiation in particular, usually ends natural fertility and in children slows growth. The decisions that preserve the most are made before conditioning starts. A randomised trial in children with leukaemia tested replacing the radiation with chemotherapy and found the radiation worked better.

Cancer treatment can bankrupt patients even with insurance. Financial navigation programmes screen for money problems and connect patients to assistance, insurance optimisation and legal help, and trials show they reduce distress and debt.

The clearest evidence that treatment ages people is not a laboratory marker, it is what happens to survivors decades later. In the St Jude Lifetime Cohort, one in eight women who had cancer as a child met the clinical definition of frailty at a mean age of 33, a rate usually seen after 65. Frailty predicted new chronic conditions and death.

Wearing frozen gloves and socks, or tight surgical gloves, during taxane infusions reduces nail damage and may reduce numbness in the hands and feet, by narrowing the blood vessels while the drug is at its peak. Trials are small but consistent, and it is cheap.

The guideline answer is stepped care: education for everyone, named talking therapies for moderate symptoms, more intensive therapy for severe ones, and medication after those rather than before. The English four-level model that cancer services were built around, published by NICE in 2004, has been retired and nothing has replaced it in the same form.

Oral glutamine, an amino acid that gut and mouth lining cells use for fuel, may reduce the severity of mouth ulcers during head and neck chemoradiation; mucositis guidelines suggest it for that use. Intravenous glutamine in transplant patients is not recommended, and evidence for preventing nerve damage is thin.

These are the two questions people ask most often after an operation and the two with the least evidence behind the answers. No trial establishes when it is safe to drive after cancer surgery, and in the United Kingdom the licence holder must notify the DVLA of an illness affecting safe driving. For exercise the dose is published.

Pooled across 36 studies, 20,366 people who had had cancer and 157,603 controls, 33.8 per cent of those who had had cancer were unemployed against 15.2 per cent, a relative risk of 1.37. Of four kinds of return-to-work programme tested in trials, exercise and multidisciplinary ones each raised the proportion returning by about a quarter; education alone did not.

Radiotherapy that reaches the pituitary stops the growth hormone signal, and radiotherapy to the spine stops the spine growing. In a Dutch cohort of 573 survivors, 8.9 per cent ended up more than two standard deviations below mean adult height, the largest losses after total body irradiation and craniospinal radiotherapy. Replacement restores some height.

Removing a tongue, a jaw or a pharynx leaves a hole that will not close, so tissue is moved from the forearm, thigh or lower leg with its own artery and vein and joined under a microscope. In a series of 843 flaps the overall failure rate was 4.0 per cent, and in an older series of 1,000 flaps 7.6 per cent failed wholly or partly. Donor site disability measured years later is small.

Hearing loss in a child still learning to speak and read costs more than the same loss in an adult. In the St Jude Lifetime Cohort, severe hearing impairment affected 34.9 per cent of platinum-treated survivors and 38.3 per cent of those irradiated at the cochlea, against 8.8 per cent of unexposed survivors, and tracked deficits in reasoning, fluency and mathematics.

Cisplatin kills the hair cells of the inner ear, starting at the high frequencies, and the loss does not come back. In children, sodium thiosulfate given six hours after each dose cut hearing loss from 63 to 33 per cent in one randomised trial and from 56.4 to 28.6 per cent in another. Nothing equivalent is licensed for adults.

Most heart damage from anthracycline chemotherapy appears within the first year after it finishes, and most of it improves at least partly when it is caught and treated. Heart muscle weakened by trastuzumab usually recovers when the drug is stopped. Radiotherapy to the chest raises the risk of coronary disease years later, in proportion to the dose the heart received.

Transplant conditioning can leave the thyroid underactive, the ovaries or testes not working, and the handling of sugar and fat altered in a way that raises heart risk years later. Much of this is treatable with ordinary medicine, and the familiar things about weight, exercise and smoking matter more here than usual, not less.

There is an agreed way to say how bad chronic GvHD is, and every trial, drug label and treatment decision uses it. Each affected organ scores 0 to 3, and the pattern gives an overall verdict of mild, moderate or severe. Worth asking: which organs are scored, what each score is, and what the global severity is.

Young people often say their cancer took a long time to diagnose, and the research agrees that time to diagnosis varies widely by tumour type and age. What the research does not support is a single number: a systematic review found the studies used different definitions and skewed data that could not be combined, so no meta-analysis was possible.

The figures, with the cohort and the age attached, because they are misquoted more than any others. On self-report at a mean age of 26, 62.3 per cent of survivors had a chronic condition. On clinical testing, the cumulative prevalence of any chronic condition by age 45 was 95.5 per cent, and by age 50 a survivor had 17.1 conditions against 9.2 in matched controls.

Nearly every figure about recovery after cancer, for fatigue, for quality of life, for how a body works after treatment, comes from a questionnaire somebody filled in about themselves. That is a strength, because nobody else can report how a person feels, and a limit, because a questionnaire only measures what it asks about and only from the people who answered it.

Breathing pure oxygen in a pressurised chamber, over 30 to 40 sessions, helps heal radiation damage to the jaw, bladder and bowel that appears years after treatment. A Cochrane review found moderate-quality evidence of benefit for these sites, and little for others.

Hyperbaric oxygen has real randomised evidence for a short list of late radiation injuries, and none at all for the general claims made for it in wellness clinics. The distinction is worth holding, because the clinics use the real indications to sell the invented ones.

CAR-T can cause a short-lived brain disturbance in the first weeks: confusion, trouble finding words, tremor, sometimes seizures. It almost always resolves. Afterwards, measured outcomes for most people are close to the general population, while a substantial minority report trouble with memory or concentration.

Most immune side effects of checkpoint inhibitors settle. The hormone glands are the exception: a pituitary, thyroid, adrenal or insulin-making gland destroyed by the immune system does not grow back, and the replacement treatment that follows is usually for life. In the follow-up cohorts 83 per cent of hormone problems were still present three months after the drug stopped.

Which infections threaten someone after a transplant depends almost entirely on how long it has been, because the immune system returns in a known order: bacteria and fungi first, viruses such as cytomegalovirus in the middle months, encapsulated bacteria later. The preventive medicines are matched to those phases.

Nine European Union countries have passed laws giving people who have had cancer the right not to declare it when applying for a loan or insurance after a set period, commonly five to ten years for adults and five for a cancer diagnosed young. Where the laws have been in force longest, acceptance rates are high and the strain on insurers is reported as minimal.

An NAD+ drip takes several hours, is sold in courses, and has never been tested against placebo for anything a cancer survivor would recognise. The published human literature on intravenous NAD+ amounts to retrospective series and narrative reviews.

Every unit of red cells carries iron the body cannot excrete, and someone who has been through leukaemia treatment may have had dozens. It settles in the liver and sometimes the heart. A blood test finds it and an MRI confirms it, and it can be removed either by a chelating drug or by taking blood off once the marrow is working again.

A Cochrane review of 61 studies found reported rates of kidney damage after childhood cancer treatment ranging from nought to 84 per cent, which is a statement about the literature rather than about kidneys. On systematic clinical testing of one large cohort, kidney dysfunction was present in 5 per cent, among the least common of the organ problems measured.

Five-year survivors still die earlier than their peers, but much less than they did. Fifteen-year mortality among American five-year survivors fell from 12.4 per cent for children treated in the early 1970s to 6.0 per cent for those treated in the 1990s, and the fall tracks the radiotherapy and anthracycline that were taken out of the protocols.

There are now around half a million people alive worldwide who have had a blood or marrow transplant. Most of them have at least one lasting health problem from it, and many have several. The list is long and reads heavily, but almost every item on it is either preventable or detectable early, which is the reason to know what is on it rather than to avoid knowing.

Saving a limb with a metal endoprosthesis gives better walking efficiency and better return to normal living than an above-knee amputation, and studies that asked patients about overall quality of life found the two closer than expected. On the Toronto Extremity Salvage Score, lower limb amputees scored 72.2 against 85.5 after extended resection.

A stoma changes how the body works in public, and the comparisons of quality of life after a stoma against a restored bowel are small and mixed. After bone sarcoma of an arm or leg the finding is the one people least expect: most studies comparing amputation with limb-saving surgery reported no significant difference in quality of life.

If you were given a treatment in which your own cells were genetically modified, you are expected to be followed up for fifteen years. Not because something is known to go wrong, but because the gene is inserted permanently and the only honest way to find out what happens over a lifetime is to look.

Britain sorts survivors into three levels of follow-up by how intensive their treatment was: a postal or telephone review at one end, a specialist late-effects clinic at the other. A Scottish cohort applied the levels retrospectively and found they worked: late effects affected 11.6 per cent of level one survivors and 65.2 per cent of level three.

Red and near-infrared light from a cap, comb or in-clinic device, sold for hair growth and tested twice in breast cancer. Adding it to scalp cooling did not improve on scalp cooling alone, and a separate caution applies to shining light at tissue where a tumour may be.

Two things have changed. Measuring the limb regularly after surgery, so that a month of compression can start before swelling is obvious, cut progression to full decongestive treatment from 19.2 to 7.9 per cent in a randomised trial. And joining lymphatics to small veins during the node operation cut new lymphoedema from 32 to 9.5 per cent, in a trial not yet finally reported.

The most commonly reported unmet need after cancer treatment has a questionnaire of its own. The full version has 42 questions across seven components; the nine-question short form is the one used to screen, and a score of 22 or more marks a level of fear that merits help.

There are two separate questions, how big the limb is and how much it affects the person, and they need different instruments. Limb volume is measured by tape, by water displacement or by a device that passes a small current through the tissue; the effect on living is measured by a questionnaire such as LYMQOL.

What a person notices about their own memory and what a formal test measures are two different things, and they agree only weakly. The questionnaire most used for the first is FACT-Cog; the tests used for the second were standardised by an international task force so that studies could be compared.

A single slice of a CT scan at the third lumbar vertebra measures how much skeletal muscle a person has, and the scan has usually already been taken for staging. Low muscle predicts worse outcomes and more chemotherapy toxicity, including in people whose weight looks normal or high.

The commonest pattern after cranial radiotherapy in a young child is not forgetting what was learned but learning more slowly than other children, so the gap widens with every year at school. In 44 children treated for medulloblastoma the measured loss was 2.55 IQ points a year, and raw scores were still rising: they were gaining skills, just more slowly than the test expected for their age.

Treatment can bring on menopause in a week rather than a decade, and the usual answer, hormone replacement, is often unavailable. The non-hormonal options now have real trial evidence: elinzanetant cut moderate to severe hot flushes by three and a half episodes a day more than placebo in women on endocrine therapy, and venlafaxine and oxybutynin also beat placebo.

There is one licensed mesenchymal cell product in oncology and it is for one narrow use: children whose graft-versus-host disease has not responded to steroids. Everything else sold as a mesenchymal or stromal cell infusion for repair or rejuvenation is unlicensed and untested, and it is worth knowing the difference because the clinics rely on it being blurred.

Metformin is cheap, old and safe enough that it is the obvious candidate for a drug that slows ageing. The largest cancer trial ever run on it, in 3,649 women with breast cancer, found nothing. The trial designed to test whether it slows ageing itself has not been run.

Structured eight-week mindfulness courses reduce anxiety and low mood during and after cancer treatment, with dozens of randomised trials behind them. Guidelines from ASCO and the Society for Integrative Oncology recommend them as a first option alongside, not instead of, psychological care.

Most hair grows back after chemotherapy, but a minority, especially after docetaxel, are left with thin hair, and tamoxifen and aromatase inhibitors cause gradual thinning. Minoxidil lotion or low-dose tablets, the same treatment used for pattern hair loss, improved regrowth in most patients in dermatology series and shortened regrowth time in an early randomised trial.

In a United States cohort covering 231,596 people diagnosed between 1995 and 2009, those who filed for bankruptcy after a cancer diagnosis had a mortality hazard ratio of 1.79 against propensity-matched people who did not. In a national survey of people over 50, 42.4 per cent had depleted their entire assets two years after diagnosis, losing an average of 92,098 dollars.

Muscle lost during treatment is usually regained with resistance training and enough protein, over months rather than weeks. Muscle lost to cancer cachexia is different: while the cancer is active, training and food slow the loss but rarely reverse it, and the consensus definition says so plainly.

NAD+ falls with age, and swallowing a precursor raises it in the blood. That much is established. Whether raising it does anything for a person who has had cancer is not. The one B3 compound with a real cancer result is plain nicotinamide, for preventing skin cancers in people who keep getting them, which is a different claim entirely.

Taxanes lift the nail from its bed, leave transverse ridges that mark each cycle, and discolour it. Reported rates across studies range from none to forty-four per cent. Cooling the hands during the infusion reduced nail damage in a pooled analysis, but the one properly randomised trial was negative and six in ten participants stopped because the cold was too uncomfortable.

Numbness, tingling and pain in the hands and feet are common on platinum, taxane, vinca and proteasome-inhibitor treatment, and most of it fades. In a meta-analysis of 4,179 patients it was present in 68 per cent in the first month, 60 per cent at three months and 30 per cent at six months or later. Only duloxetine has evidence for the pain, and no drug prevents it.

Protecting the ability to have children before cancer treatment that damages eggs, sperm or the womb: sperm and egg or embryo freezing, ovarian tissue freezing, ovarian shielding and, for some breast cancers, temporary ovarian suppression.

Sucking ice chips for half an hour around a bolus dose of fluorouracil or high-dose melphalan roughly halves the risk of painful mouth ulcers. It costs nothing and is recommended in international mucositis guidelines.

Whether periods return after chemotherapy depends mostly on age and on which drugs were given. In the one study that recorded bleeding daily, about two thirds of women who stopped bleeding for six months after an anthracycline regimen started again, usually within a year. Of those who went two years without a period, one in ten bled again and none regained regular cycles.

Ozone is sold to survivors as an infusion of ozonated blood, a rectal insufflation or an injection, for immunity, energy and detoxification. The United States regulation on the subject opens with a sentence worth reading in full: "Ozone is a toxic gas with no known useful medical application in specific, adjunctive, or preventive therapy."

The widely repeated claim that a marriage is six times more likely to end when the woman is the patient comes from one prospective cohort of 515 people. The largest study of the question, 134,435 married Finnish women followed for a median of 17 married years, found no increase in marital breakdown after early breast cancer, with a hazard ratio of 0.96.

Pelvic floor exercises are offered to almost every man after prostate surgery, and the largest randomised trial found formal one-to-one training made no difference at twelve months: 76 per cent of treated men were still leaking against 77 per cent of controls. Training before the operation does speed early recovery.

Shining low-power red or near-infrared light on the inside of the mouth before and during treatment prevents severe mouth ulcers in people having head and neck radiotherapy or high-dose chemotherapy for transplant. Mucositis guidelines recommend it, though few centres yet have the equipment.

Blood is spun to concentrate platelets and injected into the scalp. It is sold widely for hair loss and is expensive. The one randomised study in people treated for cancer injected one half of the scalp and left the other half alone: both halves improved by the same amount.

Platelet-rich plasma is the person's own blood, spun down and injected back. It is sold for hair, skin and vaginal dryness after treatment. The two trials that have actually been run in cancer survivors are small, and the better designed of the two found no difference between the treated and untreated side of the same scalp.

Many people say cancer changed them for the better, and that report is real. What the standard questionnaire measures is less clear: when researchers compared what people said had changed with what had actually changed on the same measures taken before and after the event, the two were largely unrelated, and perceived growth went with more distress while measured growth went with less.

Post-traumatic stress disorder is commoner after cancer than in matched controls, with a pooled odds ratio of 1.66 across 11 studies, and the meta-analysis authors say some of that may come from publication bias. How much is reported depends on whether a clinician interviewed the person, and on whether the paper's own title mentions post-traumatic stress.

Prehabilitation is a few weeks of structured exercise, nutrition and psychological preparation between diagnosis and surgery to make patients fitter for the operation and speed recovery.

Every donor transplant includes drugs to stop the new immune system attacking the body. A randomised trial in 2023 changed the usual choice: cyclophosphamide after the transplant, with tacrolimus and mycophenolate, worked better than the older combination. Prevention is not free, because the same drugs hold back the response to infection.

Clinicians have always graded side effects themselves, and they systematically under-record them. PRO-CTCAE is the matching set of questions asked of the patient instead, in plain language, about how often a symptom happened, how bad it was and how much it got in the way.

Instead of a fixed questionnaire, PROMIS is a library of calibrated questions for things like fatigue, pain, anxiety, depression and physical function, built so that a computer can pick the next question based on the last answer and reach a precise score in a handful of items. Scores are set against the general population, not against other cancer patients.

The usual model waits for a patient to complain, by which time an arm has been swollen for a year. The prospective surveillance model measures function before treatment starts and again at set points afterwards, so a small problem is found while it is still small. One costing study put the price of managing early arm swelling at 636 dollars a year against 3,125 dollars for late swelling.

Dexrazoxane, given with the chemotherapy, cuts clinical heart failure in adults by about four fifths in pooled trials without reducing how well the chemotherapy works. Beta blockers and blood-pressure drugs given preventively protect the ejection fraction by a point or two during treatment, and in the one trial that followed patients for two years that difference had gone.

Psycho-oncology recognises and treats the anxiety, depression, fear of recurrence and existential distress that affect a third of people with cancer, using screening, psychotherapy adapted to cancer, and medication.

Most people who come through a transplant or CAR-T report, years later, a quality of life close to that of people who never had one. Underneath that, a substantial minority live with fatigue, anxiety, low mood or trouble concentrating, and the strongest predictor is having had anxiety or depression before treatment, which is treatable.

Rapamycin extends life in every species it has been properly tested in, which is why people take it off-label. In humans there are two randomised results worth knowing: a related drug improved the flu vaccine response in older people by about a fifth, and a year of low-dose rapamycin in healthy adults did not change its primary endpoint. That is the whole of it.

After a transplant the immune system comes back in a fixed order, and the order explains most of what follows. Neutrophils in two to four weeks, natural killer cells within a month, B cells over several months to a year, and T cells last and slowest. Adults rebuild a narrower repertoire, because the thymus shrinks with age.

Chemotherapy, a transplant and CAR-T empty out the immune system, and rebuilding it takes months to years. Blood counts come back before protection does: the antibodies built up over a lifetime, from childhood jabs and from infections, are largely lost after a transplant. Re-vaccination puts them back, on a published schedule.

Removing the pelvic organs together can cure a recurrence that nothing else will, at the cost of one or two stomas and a long recovery. About half of patients have a major complication within 90 days. Overall quality of life scores recover by six to twelve months in most published series, while sexual function, body image and distress do not, and there are no randomised trials of any of it.

Physiotherapy, occupational therapy, speech and swallowing therapy and lymphoedema services are the treatments for most of what cancer treatment leaves behind. The measured use of them after cancer treatment is a small fraction of the measured need, and the people delivering them say they were not trained for it.

Progressive muscle relaxation, breathing exercises and guided imagery are simple techniques that reduce anxiety and treatment-related distress during chemotherapy and radiotherapy. Guidelines say they may be offered, and audio versions cost nothing.

Lifting weights and eating enough protein is the only treatment shown to build muscle in people with cancer wasting, but most are too unwell to do it alone and the trials are small.

A transplant erases the protection built up by a lifetime of vaccinations, including childhood ones, and it has to be rebuilt. Published schedules exist, the vaccines are free at the point of use in the NHS, and the usual failure is that nobody writes the plan down. If you have had a transplant and have no written schedule, ask for one.

A bare scalp burns in sun it has never met, loses heat fast in cold, and is more easily irritated while treatment is going on. The measures are small and free, and they are the part of hair loss a person can act on from the first week.

A tightly fitted cap chilled to a few degrees above freezing, worn before, during and after each chemotherapy infusion, narrows the blood vessels of the scalp so less drug reaches the hair roots. In a randomised trial about half of women on taxane-based chemotherapy kept most of their hair, compared with none who went without.

Scar tissue shortens as it matures, and across a joint that means lost movement: a shoulder that will not reach a shelf, a neck that will not turn, a mouth that will not open. Silicone gel flattens and softens the scar itself in randomised trials, and stretching is what holds the joint.

A surface electrical device that is said to replace pain signals with signals the brain reads as normal. People treated with it often feel better, but in the only trial that compared it with a dummy device there was no difference between the two, so what is being felt may be the attention and the expectation rather than the machine.

The one-question distress thermometer is good at ruling depression out and poor at ruling it in: pooled across 38 analyses of 6,414 patients, sensitivity 78.4 per cent, specificity 66.8 per cent, and only 34.2 per cent who screened positive were depressed. Tested as a way of improving outcomes rather than finding cases, the one randomised trial found no improvement.

People who have had a donor transplant develop new, unrelated cancers about twice as often as people of the same age, and by fifteen years about three times as often. Radiation in the conditioning matters most for those irradiated young, and chronic GvHD raises squamous cancers of skin and mouth. Both point at lifelong screening.

The largest late risk a childhood cancer survivor carries. Thirty years after diagnosis, 20.5 per cent of survivors treated in the 1970s and early 1980s had developed a subsequent neoplasm. The fifteen-year risk of a second malignancy has since fallen from 2.1 to 1.3 per cent across treatment decades, and the fall tracks the radiotherapy taken out.

In 2024 the US regulator added a warning to every approved CAR-T product about T-cell cancers after treatment. It says the risk applies to the class, that these can appear within weeks, and that patients should be monitored for life. It does not say CAR-T causes most of them, and published series find them very rare.

Chemotherapy pushes cells into senescence: they stop dividing but stay alive and keep releasing inflammatory signals. The usual marker, p16INK4a in blood T cells, rises sharply during treatment and is still raised a year later. In one study the rise matched about fifteen years of ordinary ageing, in another the gap in survivors was larger still.

Senolytics are drugs meant to kill the worn-out cells that chemotherapy leaves behind. The idea is good and the animal work is striking. The human evidence is four small trials in other diseases, none in cancer survivors, and the one properly randomised trial missed its main target. Nobody should be buying these.

Chemotherapy leaves behind zombie cells that will not divide but poison their neighbours. Senolytics aim to clear them.

England built specialist units for 13 to 24 year olds and then evaluated them nationally, which almost no health system does. The results were mixed enough that young people were asked to interpret them, and they pointed out that three years of follow-up was too short and that the study had defined specialist care by how many admissions a person had rather than how long they spent there.

Sexual difficulty is among the losses people report most after cancer treatment and among the least often asked about. The guideline says a member of the care team should raise it, and that counselling should be offered to everyone. The treatments are real but modest, and the clearest finding is that a tablet taken only when needed does not restore erections after prostate surgery.

Skin reactions in the treated area peak around the end of radiotherapy and heal. A thin silicone film applied from the first day cut moderate or severe reactions from 45.6 to 15.5 per cent in a randomised trial in breast cancer, and an international guideline recommends it. Permanent changes, such as fine broken veins and firmness, come later and do not reverse.

In 962 people interviewed six times over 18 months after surgery for a first non-metastatic cancer, 59 per cent had insomnia symptoms at the start, 28 per cent met criteria for an insomnia syndrome, and 36 per cent still had symptoms at 18 months. A short course of talking therapy for insomnia improved sleep efficiency by 15.5 per cent against 6.1 per cent in controls.

Half of people with cancer sleep badly, so sleep and body-clock interventions matter. Talking therapy for insomnia works well and is under-used; whether fixing sleep or body-clock disruption changes the cancer itself is unproven.

The American Academy of Sleep Medicine's guideline on drugs for chronic insomnia rates every one of its recommendations as weak, suggests eight drugs and suggests against six more, including melatonin, trazodone, diphenhydramine and valerian. In cancer specifically, the only placebo-controlled trial of temazepam and prolonged-release melatonin randomised 21 people.

Clinics at home and abroad sell stem cell infusions and injections to people finishing cancer treatment. The FDA has recorded blindness, tumour formation and infections from these products, and says plainly that if you are being charged for one outside a clinical trial you are likely being deceived. Two of the harms are written up in the New England Journal of Medicine.

Most temporary stomas made to protect a join in the bowel are reversed, and a meaningful minority are not. In a series of 639 patients having sphincter-sparing surgery, 11.9 per cent still had a stoma two years later; the main reasons were the cancer progressing (52.4 per cent) and the patient deciding against it (19.0 per cent).

An ordinary heart ultrasound analysed by software that tracks how far each segment of heart muscle shortens with every beat; a fall of more than about fifteen per cent from baseline warns of chemotherapy heart damage months before the usual ejection fraction measurement moves.

A supervised, coached exercise programme for three years after bowel cancer treatment cut recurrence and death in a large randomised trial. It is the first lifestyle intervention proven to work like an adjuvant drug.

Biotin, marine-protein and multi-ingredient capsules are advertised directly to people whose hair has thinned after treatment. No randomised trial of any of them has been run in chemotherapy or endocrine-therapy hair loss. High-dose biotin also distorts hospital blood tests, including the one used to diagnose a heart attack.

If you are alive and free of disease two years after a donor transplant, around nine in ten are alive five years later and 85 per cent at ten years. The death rate among transplant survivors stays higher than in people of the same age who never had one, for many years. The two things that matter most are age and chronic graft-versus-host disease.

Organised follow-up for the 18 million US and 50+ million global cancer survivors: watching for recurrence and second cancers, managing long-term side effects such as heart damage, infertility, neuropathy and fatigue, and helping people return to work and life.

Keeping food going down the throat during radiotherapy, and doing swallowing exercises through it, both independently predict being back on a normal diet afterwards. In 595 patients, those who kept eating were twice as likely to be on solid food at three to six months and those who exercised were 2.9 times as likely.

Slow, low-impact movement practices from Chinese tradition improve fatigue, sleep and balance in people with cancer. Randomised trials are moderately sized and positive, and the 2024 fatigue guideline recommends them during treatment.

Treatment given while the teeth are forming can stop them forming. In the largest survey, survivors were three times more likely than siblings to report small teeth, three times more likely to report abnormal roots and nearly ten times more likely to report a dry mouth, and the risk was concentrated in children treated with alkylating drugs before the age of five.

Telomeres are the caps on chromosomes that shorten each time a cell divides. They are the oldest and best known measure of cellular ageing, and the one with the least to show for itself in cancer survivors so far: the measurements exist, the associations are inconsistent, and nothing follows from a result.

Low testosterone is common after cancer treatment and is rarely looked for: it was present in 38.5 per cent of 491 men treated for testicular cancer, in about half of a separate cohort whether or not they had chemotherapy, and in a third of adults given cranial radiotherapy. Replacement is straightforward where it is indicated; men with a prostate cancer history are the uncertain group.

You can send saliva or blood to a company and be told your biological age. The underlying science is real and is described in the records on biological ageing after treatment; the test you can buy is not that science. Repeat measurements of the same sample can differ by years, no result changes any treatment, and nothing you can do in response has been shown to change what happens to you.

In studies that measured both halves of a couple, anxiety was reported by 40.1 per cent of spouses against 28.0 per cent of the people they cared for, and the review of fear of recurrence found carers reported more fear than patients. Across 29 randomised trials, interventions aimed at carers reduced burden and improved coping, with small to medium effects.

The most widely used rulebook in childhood cancer survivorship, and the one that made follow-up exposure-based rather than diagnosis-based: what you were given decides what you are screened for. It comes with Health Links, plain-language sheets written for the survivor rather than the doctor, and it is free to download.

For several treatments there is a published number above which lasting damage becomes much likelier: the total anthracycline dose and heart failure, the total cisplatin dose and hearing, the radiation dose to the parotid gland and dry mouth. Twenty-three thresholds are listed with their sources, because the total you have had is a question your team can answer.

A breast prosthesis, a limb prosthesis, a compression garment, a voice valve, a dental implant and a hearing aid are each the difference between a function working and not working, and each is funded differently. In the United States a federal law requires plans that cover mastectomy to cover prostheses and lymphoedema treatment.

Exercise is the best-evidenced thing a person can do for their own recovery, and the guidelines put a number on it: moderate aerobic exercise at least three times a week for at least thirty minutes, for eight to twelve weeks, plus resistance training twice a week, two sets of eight to fifteen repetitions at sixty per cent or more of the heaviest weight you can lift once.

This is the measured part. Among 163 women with advanced breast cancer, 92 per cent had at least one physical impairment and 530 impairments were found; 30 per cent of those needing rehabilitation got it. In an Irish cancer centre in 2025, 71 per cent of 660 patients reported at least one specialist rehabilitation need and 36 per cent of those with a need had seen the relevant professional.

This is where survivorship care is lost. Of 8,522 adult survivors asked, 88.8 per cent had seen a doctor in the previous two years but only 17.8 per cent had received care that addressed their cancer history with risk advice or screening. Among those who should have had an echocardiogram, 28.2 per cent had; among those due a mammogram, 40.8 per cent had.

Heart damage from childhood treatment appears quietly and decades later. When 1,853 adult survivors were examined rather than asked, 7.4 per cent had cardiomyopathy and 28 per cent had valve disease, and most of it was new at that visit: nearly all of them had no symptoms. High blood pressure multiplied the risk of heart failure nineteenfold, which makes it the most treatable thing on the page.

The smallest airways in the lung can scar shut after a donor transplant. It is the form of chronic GvHD that changes the outlook most, and it is usually silent until a lot of lung function has gone. It is found by breathing tests on a schedule rather than by waiting for breathlessness, so asking for spirometry is worth doing.

Radiotherapy near the base of the brain damages the gland that runs growth, puberty, the thyroid and the stress response, in that order of sensitivity. In 748 survivors treated with cranial radiotherapy, 46.5 per cent had growth hormone deficiency, 10.8 per cent sex hormone deficiency, 7.5 per cent thyroid deficiency and 4 per cent adrenal deficiency, and most of it had not been treated.

In a trial measuring how people feel, the forms go missing exactly when people are most unwell. That makes the remaining scores look better than the truth. The same thing happens on a larger scale when whole groups are not asked at all.

In the one in-depth British study to ask, most of 40 people interviewed at least five years after a diagnosis of breast, bowel or prostate cancer rejected the word survivor, and the authors recommended descriptive terms instead. A wider review of eight cancer studies found the opposite in five of them, which is the point: there is no single right word.

Trouble with memory, concentration and word-finding after chemotherapy is real and measurable, and what a person reports and what a test shows often do not match. Cognitive rehabilitation is the approach with the best trial evidence, exercise helps on some measures and not others, and every drug tried so far has failed, including a large trial of donepezil.

Treatment aimed specifically at fear of recurrence works, and the effect is small: across 23 controlled trials the pooled difference was 0.33 of a standard deviation afterwards and 0.28 at follow-up. The two largest randomised trials, ConquerFear with 222 people and SWORD with 88, each beat their comparator, and SWORD cost 466 euros a person.

Two routine blood tests, troponin for heart muscle injury and natriuretic peptides for heart strain, taken before and during heart-toxic cancer drugs so that damage is caught weeks or months before the heart's pumping falls on a scan.

BPC-157, ipamorelin, thymosin, CJC-1295 and the rest are sold online and by clinics for healing, energy and recovery after treatment. The FDA has placed several of them on the list of substances that may present significant safety risks in compounding, and names immunogenicity, impurities and, for some, deaths in studies.

Vaginal dryness and painful sex after cancer treatment are common, lasting and under-treated. Low-dose vaginal oestrogen is the usual answer outside cancer, and for women on an aromatase inhibitor the guidance disagrees: American and British bodies read the same cohort studies differently. A reader deserves to be told that rather than given one confident answer.

Removing the larynx removes the voice and separates the airway from the mouth permanently. Speech is restored in most people by a one-way valve set in a small hole between the windpipe and the gullet, which lets breath out through the throat so the throat can vibrate. The valve is a consumable that needs replacing, and people who lose contact with the service stop using it.

How far somebody walks in six minutes, how hard they can squeeze a handle, and how fast they can stand up from a chair five times. These need almost no equipment, they predict what happens to people, and they measure something a questionnaire cannot.

A wrist or hip device records steps, activity and sleep continuously, at home, without anyone being asked a question. It measures behaviour rather than capacity, which is the gap a corridor test leaves, and it is the one measurement of recovery that does not stop when the person leaves the hospital.

A trial can report a statistically significant change in a quality of life score that no person would notice. The minimally important difference is the attempt to say how much a score has to move to correspond to something a patient would call a change, and it differs by questionnaire, by scale, by cancer and by direction.

The programme behind the best colorectal result was four weeks long, supervised in hospital, and had four parts: high-intensity exercise three times a week, a nutritional intervention, psychological support, and smoking cessation where it applied. Supervision is the ingredient the trials keep separating out, and the window is what the pathway leaves.

Exercise, sleep, not smoking, treating what is treatable and keeping up surveillance outperform everything currently sold as rejuvenation, by a wide margin and with randomised trials behind them. The measurable ageing that treatment causes is real and is a reason for research, not a reason to buy something.

For each treatment and each lasting effect, whether recovery is usual, partial or unlikely, how long it takes and in what proportion of people, with the source for every answer. The grid is mostly empty, because for most pairs nobody has published a recovery figure, and the page says how empty it is rather than hiding it.

The trials finished years ago and most people being treated for cancer are still not asked their symptoms between appointments. The clearest thing that changed is a United States payment model that now requires practices to collect them.

In Germany rehabilitation is an entitlement with the outpatient version free to the patient. In most of the world there is no survivorship service to be charged for, and the household pays for whatever follow-up happens. Reliable comparative figures do not exist.

Cancer treatment makes prescriptions free in England for five years, but a wig is not a prescription and is charged for unless you qualify for help. A third of UK survivors in one survey still reported financial difficulty, which is lower than the United States and a long way from zero.

More than half of United States survivors in a comparative survey reported financial difficulty, against a third in the UK. What a person pays for rehabilitation, psychological care, fertility preservation and a wig depends on their insurance, their state and their employer rather than on their cancer.

Training before an operation reliably makes people fitter for it. Whether it cuts complications depends on the operation and on who was recruited: a trial in high-risk abdominal surgery halved the proportion with complications, the largest colorectal trial cut severe complications from 29.7 to 17.1 per cent, and pooled home-based programmes improved the walking test and nothing else.

First treatment for graft-versus-host disease is steroids, and in about half of people with chronic disease they do not work or cannot be reduced. Ruxolitinib is the only drug that has beaten the alternatives in a randomised trial here, and it has done so twice. About half of people respond; the common problems are low platelets and low haemoglobin.

Whether a person gets rehabilitation after cancer depends on where the problem was noticed, how far they live from the service, how much money they have and what they were treated for. In the benchmark study a problem found in hospital was 88 times more likely to be treated than the same problem found in clinic.

Fertility preservation has to happen before treatment starts, which makes it the most time-critical part of recovery care and the easiest to miss. Published United States rates of even having the conversation range from 9 per cent to 75 per cent depending on where a young woman is treated.

There is an agreed international list of what should be checked in someone who has had a transplant, and how often, and an accreditation system that centres are inspected against. What there is much less of is a guarantee that any individual survivor is receiving the checks. Knowing the list exists lets a person ask for it.

Every part of recovery care is unevenly distributed, and the pattern repeats: people with less money, less education, more disability, who live further away or whose cancer is less common get less of it. These are measured gaps with sources, not an impression.

A wig, scarf or cap restores privacy and confidence during hair loss. In the UK wigs come on NHS prescription, free in Scotland, Wales and Northern Ireland and in England for children, students under 19 and people on qualifying benefits; in the US a prescription for a 'cranial prosthesis' lets some insurers reimburse one, and charities give wigs free.