Worried Sick

Even though new cases of cancer are increasing inexorably, there is some good news about this most feared of diseases.

The success of new technologies, improvements in nursing care and the Cancer Plan measures to speed up access to both diagnosis and treatment are now starting to prolong life for many people with cancer.

For example, almost twice as many women diagnosed with breast cancer today will still be alive in five years, compared with 30 years ago.

Cancer mortality has also stabilised and started to decline. At 1.2 million, there are three times as many people in the population living with cancer as 30 years ago.

Vast NHS resources go into treating the tumour, but as people whose cancer has been cured or is in remission testify, hardly anyone is ever freed from the disease.

It reshapes life totally from the moment the word is uttered, taking away old certainties and the scaffolding of everyday life.

There is little help for people living with cancer after treatment ends, and a survey of almost 1,800 people by Macmillan Cancer Support shows that when their treatment ends, large numbers of people feel abandoned by the system.

Apart from the fear of dying or of uncontrolled pain, cancer causes immense emotional turbulence.

Four in ten people with cancer surveyed by Macmillan said the emotional aspects of cancer are the most difficult to cope with, even compared with the physical effects, and most said they did not receive adequate help.

Half of those surveyed experienced depression, particularly younger people, and the majority said they did not receive any help dealing with it.

The fearful reputation of cancer (which, in spite of treatment advances is fully justified) is reflected in the high levels of anxiety that three quarters of the sample reported, men even more than women.

Everyone close to a person with cancer knows just how corrosive anxiety can be, undermining autonomy just when it is most needed.

With this as a background, it is hardly surprising that cancer puts relationships under enormous strain, with a third of patients reporting exactly this, and a quarter experiencing real difficulties with their partner as a result.

Knowing this, it is perhaps surprising that so few relationships actually break down, though the stresses that people overcome to stay together are immense.

As well as partners, the research also highlights the tremendous reliance cancer patients place on those close friends and family who also act as carers - carers who are there for their myriad practical and emotional support needs.

Nearly all the carers surveyed (95%) said they put the needs of the person with cancer above their own needs, and a third said that their close relationships were put under "enormous strain". A quarter even felt abandoned.

Healthcare focuses on getting the patient well and social services help the most vulnerable; but many cancer patients fall through the gaps in between health and social care provision, and are only kept from falling further by the dedication and selflessness of these carers - carers who all too often get little or no support or recognition.

Only if they come into contact with the likes of Macmillan or Carers UK do they get the help they so desperately need.

So, what is to be done? First and foremost, we must stop treating cancer as if it were simply a tumour to be cut out, irradiated or chemically destroyed.

Cancer affects the whole person and everyone close to them, and those effects ricochet for years.

The immense efforts that have gone in to gaining greater quantity of life need to be matched by improving the quality, so that we do not save life only to condemn patients and carers to untold other misery.

People expect charities to do more, and Macmillan Cancer Support will continue to expand its services to enable people to live better with cancer.

But there is more that the NHS can do too. The Cancer Plan for England pulled in over £500m a year in additional funding, mainly for acute care and medical technologies.

A corresponding effort is required to make sure that the hidden effects of cancer are also treated.

· Peter Cardy is the chief executive of Macmillan Cancer Support

· If you have been affected emotionally by cancer and would like an information pack please call freephone 0800 500 800, or visit www.macmillan.org.uk