Survivorship: Life After Treatment

The sound of a bell ringing through a hospital hallway can feel like a period at the end of a very long sentence. 

Treatment. Blood counts. Scans. Hospital stays. Fear. Uncertainty. 

And then, finally: 

We made it. 

But for many childhood cancer survivors, the bell isn’t a period. 

It’s a comma. 

Because surviving cancer doesn’t always mean leaving it behind. 

The physical and emotional effects of childhood cancer—and sometimes the very treatments that made survival possible—can become part of the life that follows. 

What Cancer Can Leave Behind 

Approximately two-thirds of childhood cancer survivors experience at least one “late effect,” a health challenge related to their cancer or treatment that may not appear until years later. 

Late effects can impact nearly every part of a survivor’s health, including their heart, lungs, kidneys, bones, thyroid, fertility, hearing and vision. Treatment can also affect learning and emotional health. 

And sometimes, the challenges of survivorship are harder to see. 

A child who spent formative years navigating cancer may grow into a teenager or adult still processing fear, grief, changes to their body or the experience of having their childhood interrupted by a life-threatening disease. 

For survivors like Corene Parrish, who was diagnosed with Hodgkin lymphoma at 16, those realities didn’t disappear when she became cancer-free. 

“I want to help them deal with the whole experience of having cancer that I didn’t expect—the long-term effects of chemo, the constant checkups, the fear of recurrence,” Corene said years later while describing why she hoped to work in cancer survivorship care. 

It’s exactly the kind of need the Penn State Health Golisano Children’s Hospital Childhood Cancer Survivorship Clinic was created to address. 

Funded by Four Diamonds, the clinic provides long-term, individualized care for childhood cancer survivors who have been off therapy for at least two years. 

But this isn’t simply another doctor’s appointment. 

Caring for the Whole Survivor 

Every childhood cancer journey is different. The care that follows should be, too. 

At the Survivorship Clinic, survivors meet with a multidisciplinary team that includes a physician, survivorship clinic coordinator, social worker, neuropsychologist and cancer genetic counselor. 

Each survivor receives an individualized treatment summary documenting the chemotherapy, radiation, surgeries and other interventions they received, along with a customized plan for long-term follow-up and surveillance based on their individual risks. 

The team monitors the things that can be measured. 

Heart health. Kidney function. Fertility. Hearing. Vision. Learning. 

But they also ask about the things that may never appear on a scan. 

School. Work. Relationships. Finances. Emotional health. 

That’s because caring for someone after childhood cancer means caring for more than whether their cancer returns. It means helping them navigate the life they fought so hard to have. 

Finishing treatment is an incredible milestone, but our responsibility to these children doesn’t end there. Physical and emotional effects of cancer accumulate progressively across the lifespan of childhood cancer survivors, with no plateau even decades after therapy. Furthermore, the burden accelerates as survivors age into midlife and beyond. The Survivorship Clinic exists so they don’t have to navigate those challenges alone. Our goal isn’t simply to help children survive cancer. We want them to have the support and knowledge they need to live full, healthy lives afterward.” — Dr. Smita Dandekar 

That approach has earned national recognition. In 2024, the clinic received the Survivorship Champion’s Prize from The Stewart Initiative for Childhood Cancer Survivors, an annual award recognizing significant advances in lifelong health maintenance for pediatric cancer survivors. 

The program was recognized for its approach to transitioning survivors into long-term care, engaging primary care providers, using telemedicine and reaching survivors throughout a large rural area. 

But the importance of survivorship care isn’t best understood through an award. 

It’s understood through the people living it. 

Growing Up After Childhood Cancer 

Cancer can change a childhood. 

While friends are going to school, playing sports and figuring out who they want to become, a child with cancer may be learning the language of chemotherapy, surgeries, blood counts and hospital stays. 

And when treatment ends, life doesn’t necessarily pick up exactly where it left off. 

Angeles Magana Espinosa was diagnosed with osteosarcoma while she was still in elementary school. Years after treatment, as she entered high school, anxiety and depression surfaced. Through therapy, she realized she had never fully processed what had happened to her as a child. 

“Because I was so young when I got cancer, sometimes it felt like it was a dream,” Angeles said. Talking about the experience helped her accept that what happened was real—and difficult. 

For Kayla Brown, diagnosed with Hodgkin lymphoma at 15, writing became a way to process the loneliness and emotional effects of cancer. What began as a blog during treatment eventually helped shape her career in journalism and gave her a way to connect with other adolescents and young adults affected by cancer. 

Max James, who survived Burkitt lymphoma after coming frighteningly close to death at 16, described survivorship as something that continued to shape him years later. 

“I wanted to take control of the narrative that was my cancer journey and use it to help others,” Max said. 

Different cancers. Different treatments. Different lives afterward. 

That’s the complexity of survivorship. 

There isn’t one way to move forward. 

Giving Survivors Space to Tell the Whole Story 

Sometimes, survivors need medical monitoring. 

Sometimes, they need someone to talk to. 

And sometimes, they need to meet another person who simply understands. 

In 2025, the Survivorship Clinic brought together five adult childhood cancer survivors for the inaugural Photovoice project, supported by Four Diamonds. 

Participants used photography and writing to explore the parts of survivorship that can be difficult to put into words: identity, relationships, chronic pain, grief, survivor’s guilt and the complicated emotions that can exist alongside gratitude for being alive. 

For Monica, a survivor of rhabdomyosarcoma diagnosed at age 2, the project helped put words to something much bigger. 

“Maybe survival isn’t about feeling whole,” she wrote. “Maybe it’s about continuing in pieces anyway.” 

For Lily, who was diagnosed with leukemia at age 6, meeting the other participants revealed a connection she hadn’t experienced before. 

“Tonight is the first time I’ve met these women in person,” she said at the project’s closing reception. “But I feel inextricably connected to them.” 

And for Kayla, Photovoice offered another way to process an experience she had spent years writing about. 

“Photovoice gave me art. It gave me this group. It gave me space to feel understood.” 

The photographs were different. The stories were different. 

But together, they gave a fuller picture of what survivorship can look like when the treatment ends and life continues. 

Photovoice Continues This September 

This Childhood Cancer Awareness Month, another group of survivors will have the opportunity to tell their stories through Photovoice. 

Their work will culminate in the 2026 Photovoice event on Sept. 24 at 5:30 p.m., continuing a program that creates space for survivors to reflect, connect and share the realities of life after childhood cancer. 

For those who have never experienced childhood cancer, their stories offer a chance to understand something a ringing bell alone can’t tell us. 

Survival can be joyful and complicated. 

A survivor can be grateful to be alive and still grieve what cancer took from them. 

They can be cancer-free and still live with its physical effects. 

They can move forward without pretending the past didn’t happen. 

As Lily reflected during the inaugural Photovoice project: “There’s a world where I didn’t live to see moments like this. But I’m here. We’re here. And we’re still becoming.” 

The Story Continues

During Childhood Cancer Awareness Month, we share their stories and raise funds for the care, support and research that can give more children the opportunity to grow up. 

But conquering childhood cancer also means thinking about what happens when they do. 

It means recognizing that a cure doesn’t erase what a child experienced. 

It means monitoring a survivor’s health years after treatment. 

It means creating spaces where they can talk about fear, grief, identity and everything else that may come with growing up after cancer. 

And it means being there as they go to college, build careers, form relationships, start families and create lives much bigger than a diagnosis they received as children. 

That’s why Four Diamonds’ commitment doesn’t end when treatment does. 

By funding the Childhood Cancer Survivorship Clinic and programs that address the physical and emotional realities of life after cancer, Four Diamonds helps survivors navigate what comes next. 

Because the bell isn’t a period. 

It’s a comma. 

A reminder that there is still more life to live, more of the story to tell, more to come,

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