By Dr Mastura Mohd Sopian
On the day cancer treatment ends, many patients expect life to finally return to normal. The scans are clear, the appointments become less frequent, and family members breathe a collective sigh of relief. After months or years of fear and uncertainty, the word “survivor” feels like a finish line. But for a growing number of people, it is not the end of the journey; it is the start of a quieter, more complicated chapter.
For many years, cancer care focused on one overriding goal which is survival. Patients and doctors alike asked the same urgent question: can we beat the disease? Every test, every drug, and every difficult decision revolved around that single aim. Today, the answer is increasingly hopeful. Advances in early detection, chemotherapy, targeted treatments and radiotherapy mean more Malaysians are surviving cancer than ever before. This is one of modern medicine’s greatest achievements, transforming cancer from a fatal diagnosis into a chronic, often manageable condition.
Yet this success has revealed a new challenge, one that rarely makes headlines: what happens after cancer treatment ends? As survival improves, doctors are seeing more cancer survivors develop other serious health problems years later. Heart disease, diabetes, high blood pressure and abnormal cholesterol levels are appearing with surprising frequency. These conditions can limit independence, increase hospital visits and, in some cases, pose a greater long-term threat than the cancer itself. For survivors, this reality can be deeply unsettling. After enduring surgery, chemotherapy or radiotherapy, many expect their health to steadily improve. Instead, some find themselves breathless after short walks, struggling with rising blood sugar, or facing lifelong medication for heart conditions they never had before.
Cancer and heart disease are often treated as separate worlds, managed by different specialists in different clinics. In reality, they are closely connected. Both share common risk factors such as obesity, diabetes, smoking, physical inactivity, chronic inflammation and ageing, conditions that are increasingly common in Malaysia. Cancer treatments themselves can also strain the body. Some chemotherapy drugs may weaken the heart muscle. Radiotherapy involving the chest can affect blood vessels years later. Hormonal therapies and prolonged steroid use can disrupt metabolism, leading to weight gain, insulin resistance and abnormal cholesterol levels. This does not mean cancer treatments are unsafe or should be avoided; rather, it means survivorship care must evolve to reflect the realities of longer life after cancer.
Traditionally, healthcare has been organised around individual diseases. Cancer is treated in oncology centres. Heart disease is managed by cardiologists. Diabetes and metabolic disorders are addressed elsewhere. While this structure works for short-term treatment, it struggles when conditions overlap over time. A patient may complete cancer therapy, be discharged from oncology follow-up, and return to routine care. Years later, heart failure or diabetes develops, often without clear links being made to past cancer treatment. By the time symptoms appear, damage may already be significant.
This is why experts are increasingly calling for a more integrated approach to survivorship care, one that recognises cancer as part of a broader health journey rather than an isolated episode. Cancer centres are uniquely positioned to lead this shift. They already follow patients closely, collect detailed treatment histories and manage complex care plans. By embedding heart and metabolic health monitoring into cancer care, risks can be identified early rather than discovered late. This means assessing cardiovascular and metabolic health before treatment begins, monitoring changes during therapy, and continuing follow-up long after remission. Simple measures such as regular blood pressure checks, blood sugar monitoring, heart function screening and lifestyle counselling can make a meaningful difference.
Family medicine specialists play a vital coordinating role in this model. Working alongside oncologists, cardiologists and endocrinologists, they help ensure continuity of care across years, not just treatment cycles. This team-based approach reduces the risk of survivors falling through the cracks once active cancer treatment ends. Prevention is another powerful benefit of integrated survivorship care. Many heart and metabolic complications can be delayed, reduced or avoided entirely with early intervention. Encouraging physical activity, supporting healthy weight management, addressing smoking and improving diet may seem basic, but for cancer survivors they are essential tools for long-term recovery.
Early treatment of high blood pressure, abnormal cholesterol or rising blood sugar can prevent serious disease later. For survivors, these measures are not optional add-ons; they are a necessary extension of cancer care itself. This approach is particularly relevant for Malaysia. Cancer incidence continues to rise as the population ages, while cardiovascular disease and diabetes remain leading causes of illness and death. Treating these conditions separately places increasing strain on healthcare resources and patients alike.
An integrated survivorship model makes both medical and practical sense. It shifts care from crisis response to early prevention and recognises patients as whole individuals rather than a collection of separate diagnoses. Helping cancer survivors live longer should go hand in hand with helping them live better. Survival alone is not enough if it is accompanied by preventable chronic disease. Beating cancer is no longer the end of the story.
For many, it marks the beginning of a new chapter that deserves protection, planning and care. As cancer care continues to advance, our approach to survivorship must advance with it, ensuring that life after cancer is not only longer, but healthier and fuller.
Dr. Mastura Mohd Sopian is a Senior Lecturer at the Department of Clinical Medicine, Pusat Kanser Tun Abdullah Ahmad Badawi, Universiti Sains Malaysia (USM)
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