Five years on: What does survival mean?

December 31, 2014, was not just the last day of last year. For me, it was a significant point in my cancer journey – that landmark day that marks 5 years since the end of chemotherapy, the point at which my oncologist started the survivorship clock.

Those 5 years have brought me from a place of terror to one, I hope, of realistic adjustment to the idea that I won’t live forever and that, regardless of appearances, the only real control I have over my life is within my small realm of influence – what I choose to do or not do. I still think about having had cancer every day, sometimes throughout the day, but these thoughts echo from the back of my mind; they rarely take a position in the front.

I still occasionally wonder what I did to bring on the disease, though a recent study suggests what I’ve ultimately come to believe — that in many cases, cancer develops simply as a matter of “bad luck.” Still, although I’ve changed habits that might have led to my developing cancer, I can be prone to that same panic I felt at my initial diagnosis when some new pain shows up.

Why do the cancer gurus set the critical point to determine survival at 5 years and not some other time? After all, I know a few people who were given a clean bill of health at the 5-year mark, but later were taken from us by a recurrence of the very cancer they thought had been conquered.

Here’s what the Mayo Clinic has to say about those 5-year survival statistics, which clarifies the factors influencing survival about as much as they can be. If you want even more details, especially about those long tails in the survival curves, take a look here. And as noted in this chain of posts, lots of factors influence the choice of a 5-year time point for analyzing survival.

Whatever the reason, it’s a date to acknowledge. In my own case of triple negative breast cancer, the more critical time point seems to be 2 to 3 years after diagnosis when (statistically speaking) the cancer is more likely to recur. Although I passed that mark a while ago, the 5-year point is equally important. Besides being the cut-off for the data, this is the point when oncologists tend to turn the care of cancer patients back to their primary care doctor. So the 5-year time point also marks the end of a long-term relationship with the doctor who served as a guide and security blanket during a harrowing time of life.

Besides the legion of thoughts about survival, my diagnosis of cancer left me with the feeling that I should be doing greater things with my life — establishing a non-profit foundation, for instance, or helping to solve world hunger. But here I am, going about my days much as I did before – getting the kids to and from school, teaching writing classes, walking the dog (sometimes).

Outwardly, my life looks very much like it did before my diagnosis, and even my hair has returned to its normal state (albeit with a few more gray hairs). Inwardly, the course of my thoughts is very different. I worry more about possible health risks for my family, yes, but I am also better at recognizing the value of my work, my relationships, and even the boring minutes of the day.

In his book Man’s Search for Meaning, Viktor Frankl notes that “What matters, therefore, is not the meaning of life in general but rather the specific meaning of a person’s life at a given moment . . . Man does not simply exist but always decides what his existence will be, what he will become in the next moment.” In other words, I can decide that, at this moment, what I’m doing has meaning simply because I have decided that it is meaningful. I may not be in a position to solve world hunger, but I can do what I can where I am.