An increasing number of Americans are getting—and surviving—cancer. There were more than 18 million cancer survivors in the U.S. in 2025, and the National Cancer Institute estimates that number will grow to 22 million by 2035. But long after completing treatment, many survivors face lingering mental health challenges that go unaddressed.
Cancer’s ‘silent’ impacts
Studies show cancer survivors experience anxiety and depression that can last years after they finish treatment.
The advocacy group Cancer Nation surveyed patients nationwide last year. It found that about a third of those who had finished treatment reported anxiety about their cancer potentially coming back, as well as problems with not feeling like their “old self.” Only 1 in 5 of the surveyed survivors reported seeing a mental health professional.
Finding therapists who understand how cancer can affect people physically and emotionally can be a challenge, especially in states like Iowa.
The Iowa Cancer Registry notes that the number of Iowans living five years after their diagnosis has increased about 0.4% each year since 2000, and the state has the second-highest rate of new cancer diagnoses. Researchers aren’t sure why, but the University of Iowa scientists who run the registry are taking a deep dive into the issue in a two-year project.
Iowa is also largely rural. Some of the counties that have the highest cancer rates also have the fewest mental health workers. Julie Larson is a Des Moines-based therapist who works with a lot of cancer survivors.
In Larson’s practice, it’s common for clients to start therapy months or even a year after finishing treatment, when they realize they aren’t feeling how they expected to feel.
“Physically, people’s bodies have changed,” Larson said. “And they are reconciling loss and grief. And those experiences are a little bit more silent, a little more invisible, and friends and family don’t often fully understand or grasp that.”
Larson said cancer survivors often seek her out because she understands cancer and the different forms of treatment people may have experienced.
“I’m not a doctor, but I’ve done this a long time. So I know what happens when people have Adriamycin. I know the treatment protocol for carboplatin,” she said, citing chemotherapy drugs.
Oncology and mental health
When it comes to treating cancer, the field of oncology often neglects mental health, said Dr. Patricia Ganz, an oncologist and professor at the UCLA School of Public Health who has spent decades doing research on cancer survivors and their lingering challenges.
“We know how to give pills. We know how to give pain medicine, sleep medicine. But we’re not really schooled in the antidepressants,” she said.
There’s an increasing awareness about the need to screen for psychological distress in cancer patients and the need to provide mental health services for cancer patients and survivors, Ganz said, but expert-recommended screenings and referrals don’t always happen to the extent they should.
The MercyOne Richard Deming Cancer Center in Des Moines has started offering services such as counseling, music therapy and mindfulness sessions to reduce stress for those in and out of treatment.
“You get cared for intensely when you’re getting treated for cancer,” said Richard Deming, medical director at the clinic named for him. By contrast, he said, when people complete treatment, the care typically shifts: “It’s almost like, ‘You should feel fortunate that you’re cancer-free and just get on with your life.'”
To treat cancer comprehensively, Deming said, doctors need to pay attention to far more than just physical symptoms. That requires a shift in the way doctors treat patients, he said.
“Every step along the way, whether it’s through diagnosis or treatment or follow-up, we have to ask, ‘What are the issues you’re experiencing?'” Deming said. “Not just: ‘Do you have cancer? Did we get rid of the cancer?'”
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