After being diagnosed with breast cancer a year ago Sandra Calleja mustered up every ounce of courage she had and underwent surgery followed by much-dreaded chemotherapy.

Now that the treatment is over she sometimes catches herself wondering if the cancer will return.

“This fear can take over when you hear of another patient who got it again. It affects you. But you have to fight to remain positive. If it does come back, I will fight it again,” the 41-year-old said in a determined tone.

These thoughts and fears are very common among cancer survivors who, after having made it through one of the toughest challenges in their lives, often need support getting back into their pre-cancer lifestyle.

For this reason a new Cancer Care Pathways Directorate was set up to understand what survivors need, among various things.

Whenever something was upsetting me I’d write it on a piece of toilet paper, then flush it down the toilet

With survival rates increasing – also through screening that was leading to early detection – the need for such services was becoming more evident.

Malta sees 2,000 new cancer cases per year, explained Danika Marmara who heads the directorate. She explained that the directorate was reviewing the systems in place to ensure that all people diagnosed navigated seamlessly through it.

It was also working to improve communication and networking between various organisations and hospitals, improving palliative care and patient information.

Cancer treatments booklets for breast, colorectal, early prostate and primary lung cancers were developed as the first set of written resources in the treatment stage of the cancer journey, she said adding that the directorate was working closely with the newly launched National Cancer Platform to identify patients’ needs.

Health Parliamentary Secretary Chris Fearne said that, even though cancer survival was on the increase, going through cancer therapy was a rollercoaster ride.

“It is not enough to just provide the most advanced cancer care. We must also make this unavoidable experience as non-traumatic and as human as possible,” he said.

Support played a vital role in Ms Calleja’s battle against cancer. Apart from the backing of her husband, Dennis, and their daughter Shirley, she also found the strong backing of doctors, nurses, relatives, friends, and other patients. Patients who she met during treatment set up the closed Facebook group Never Give Up to offer support to one another and share experiences.

Ms Calleja often shares a “trick” she was taught by a nurse: “Whenever something was upsetting me I’d write it on a piece of toilet paper, then flush it down the toilet. I found this really helped.”

Ms Calleja never expected to go through the cancer experience since no one in her family was diagnosed before her. Last year, she realised she had a lump on her left breast while doing her routine breast self-examination at home. A biopsy revealed the lump was cancerous and had to be removed.

“I wanted to do the operation as soon as possible as I wanted to be alright by my daughter’s Confirmation,” she said.

I started chemotherapy on Monday and, on Wednesday, I asked my hairdresser home. I shaved it all off

After the lumpectomy she was told she needed to undergo chemotherapy.

“The word chemotherapy choked me up. I cried for the first time. The first thing I asked was: Will I lose my hair? But I had to make an effort and accept it.

“I started chemotherapy on Monday and, on Wednesday, I asked my hairdresser home. Yes. I shaved it all off. I didn’t want to wake up in the morning and find that strands of hair had fallen,” she said.

Throughout the therapy she tried to make it a point to live life as normally as possible. Ms Calleja urged people to be aware of their health and to educate their daughters to do the same – as she is going with her 13-year-old.

“You have to fight for life,” she stressed.

Employer support

The support that employers offer to a worker who has cancer plays a huge role in that person’s attitude towards recovery, according to a 30-year-old woman who just completed treatment.

“I was lucky that my employer supported me and allowed me to take the sick leave I needed. Even my boyfriend and sister had support from their bosses to come with me when necessary. But not everyone is so lucky. Some people can lose their jobs and this affects them psychologically, not to mention financially,” she said.

The woman, who preferred to remain anonymous, was diagnosed last March. Two months earlier she was running her hand over her chest when she noticed a lump on the top part of her left breast. Tests showed it was cancerous.

Two weeks after the diagnosis, she had a mastectomy and a lymph node was removed. The hardest part was telling her parents, which she did together with her boyfriend and sister who were with her when she was told she had cancer.

After the operation she started chemotherapy. Like Ms Calleja, she too was scared of the word as she imagined her hair and nails falling off.

“The fear of chemotherapy was worse than the actual experience. I expected worse. It’s just something you have to face,” said the woman, whose treatment was completed in September.

“At that point you think: I did what I had to do, now what becomes of me? You have to re-enter your normal routine. You feel a bit lost,” she said, adding she agreed with the need for support for survivors.

Throughout the experience, she said, hospital staff were immensely supportive and helpful. Two things, however, bothered her and she was glad to see action was being taken after she spoke about them.

First, she said, she pointed out that cancer patients who had to go to the emergency department should not have to stay in the same waiting area as other sick patients due to their low immune system.

Secondly, she said, she was annoyed that staff at Mater Dei Hospital were not trained to use the port-a-cath which is catheter connected to a port that is surgically inserted under the skin.

Like Ms Calleja, she had one thing to add: “Life is beautiful. It is worth fighting for. So don’t give up.”