by Zahra Muse, M.S.
The completion of active cancer treatment is often associated with anticipated relief for most individuals and families. Appointments are fewer, side effects subside, and crisis-related language is eased. However, for many survivors and loved ones, this phase is characterized by less finality and more ambiguity. Although treatment has ended, the psychological, relational, and identity impacts of cancer can persist (Kolsteren et al., 2022). Survivorship is not a return to life before cancer; instead, it is a shift to a new relational terrain. The entire family system faces the challenges of reorganization, renegotiation, and meaning-making.
Marriage and family therapists (MFTs) are well-positioned to address the needs of individuals and families during this stage of care. From the perspective of systems and medical family therapy, oncology survivorship is not considered an individual adaptation but a relational process constructed through illness narratives, changing roles, fear of recurrence, and continued medical system contact. As the healthcare system increasingly emphasizes survivorship as an essential stage of the cancer journey, MFTs are poised to be significant contributors to this field.
Survivorship as a systemic transition
Cancer treatment frequently reorganizes families around the struggle to survive (Christensen & Carlsen, 2021). Roles may become more defined by what needs to be done, communication may become more focused on logistics and symptoms, and expression of emotion may be limited in the interests of just getting through. When treatment ends, families are often expected to return to previous patterns without recognition or guidance about how much those patterns have been altered (Emery et al., 2022). Survivorship, therefore, is a systemic transition, not a destination.
Survivorship is now more broadly understood at the national level as a complex experience of late physical effects, psychological distress, social role changes, and medical uncertainty. As the transition may expose fissures in family relationships that were obscured by the more salient evidence of illness, survivors may feel pressured to be grateful or strong, caregivers may be challenged by their need to continue watching so vigilantly, and other family members may have different beliefs about how much cancer should continue to affect day-to-day living. From a systemic perspective, these symptoms are not indications of pathology, but rather manifestations of the family system’s struggle to reorganize. MFTs have been trained to evaluate symptomatic patterns and intervene at the interactional level rather than target individual symptoms (Rajaei, 2021).
Fear of recurrence as a relational process
Fear of cancer recurrence (FCR) is one of the most prevalent concerns among cancer survivors, and it remains prevalent long after treatment is over (Simard et al., 2019). Although FCR is often understood as an individual, anxiety-related phenomenon, evidence is building for the relational nature of this fear. Partners and caregivers may share or hold even greater fear, and efforts to manage this fear affect communication patterns within couples and families (Lebel et al., 2018).
FCR typically presents less directly in clinical work. For example, a family may avoid discussing medical issues with each other in a bid to protect each other, or they may repeatedly reassure each other in a way that only increases the level of anxiety within the relationship. From a systemic perspective, the therapist can examine who in the family holds which fears, who takes on which responsibilities for monitoring bodily changes, and so on. Fear can be given a voice or silenced in different ways within the family. Such a reframing of FCR as a systemic issue can reduce blame and move the family towards a shared coping strategy (Mardadni et al., 2025).
Role renegotiation after treatment
Caregiving roles can become fixed during treatment out of necessity. Partners, parents, or adult children may take on a significant role in managing the survivor’s medical treatment and daily functioning (Cetin, 2022). These roles often do not reverse automatically once treatment is completed. Survivors may have difficulty assuming control again, and caregivers may feel anxious when no longer monitoring behaviors that have become routine.
Intimacy, identity, and connection in survivorship
Sexuality and intimacy are aspects of survivorship around which people can experience common problems (Walker et al., 2019). This may be due to physical changes, pain, fatigue, and body image issues, which affect sexual function or sexual and emotional intimacy. Psychological distress and post-traumatic stress symptoms can also affect the connection with self and others. Survivorship care practice guidelines recommend that sexual health and relational functioning be addressed as fundamental to quality of life.
From a systemic perspective, problems with intimacy are not merely individual dysfunctions, but couple-level adaptations to the change induced by illness. MFTs can help couples construct new narratives around intimacy that are more congruent with their current realities than with an idealized vision of “returning to normal” (Rajaei, 2021). Emotionally focused and relational approaches have been shown to enhance relationship satisfaction and emotional connection in couples where one or both partners are cancer survivors (Traa et al., 2015).
Family Dynamics Essential Reads
Meaning-making and the reconstruction of family narratives
Survivorship can beget existential questions about who we are and what we are to do and be. Survivors may have a hard time assimilating the experience of cancer into their identity; family members may have different ideas about how the family may or may not want to remember the illness or move past it (Rashidi et al., 2020). Family members may be struggling with each other over how best to recognize or make meaning of the illness, with some wanting to close the chapter on cancer and others feeling like the experience must be ever-present to be remembered.
MFTs have training in guiding shared meaning-making efforts so that families can hold two truths at once. Gratitude for the survivorship experience can coexist with grieving what was lost. Guiding the family in co-constructing a narrative of the cancer experience so that it can be assimilated into the family story, while not overpowering other aspects of the future, is an intervention in relational resilience and coherence.
The role of medical family therapy in survivorship care
As MFTs have a specific focus on using a biopsychosocial lens and integrating with healthcare systems (McDaniel et al., 2014), survivorship offers a key opportunity for MFTs to connect relational work with ongoing medical care. As survivors may continue to have follow-up and medical care with an oncology team, primary care provider, or specialty clinic, family dynamics may play an important role in adherence, symptom reporting, and medical decision-making.
MFTs may collaborate with medical teams in several ways, including providing relational assessments, supporting patient-provider communication, and advocating for the adoption of family-centered survivorship models. Teamwork models also align with broader calls for psychosocial integration across the cancer continuum.
Survivorship is more than extending time. It’s about reuniting after cancer changes bodies, relationships, and expectations. The systemic orientation of MFTs uniquely positions them to view survivorship as an inherently relational process that demands explicit attention, flexibility, and meaning-making.
Zahra Muse, M.S., is a clinician and researcher whose work centers on culturally grounded behavioral health, trauma, and family systems within underserved communities. Muse’s scholarly interests have consistently emphasized health psychology, trauma recovery, and culturally responsive family-based interventions.
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