Most employers know they have employees going through cancer treatment. Far fewer realize how many cancer survivors are already in their workforce. 

They’re leading teams, managing projects, supporting customers, and showing up every day while dealing with the long-term effects of cancer and its treatment. Many are managing fatigue that no one can see, cognitive changes they're embarrassed to mention, ever-present anxiety about any possible new symptom, or chronic health issues that persist long after treatment ends. Most do so quietly. 

There are more than 18 million cancer survivors living in the United States today, and that number continues to grow. According to the American Cancer Society, the survivor population is projected to exceed 22 million by 2035, driven by an aging population, earlier detection, and continued advances in cancer treatment, including targeted therapies and immunotherapy. 

This is one of the greatest successes in modern medicine. It is also creating a new challenge that most employers are only beginning to recognize.

The moment treatment ends is not the moment care should end

In my work as a survivorship oncologist, I see this pattern constantly. When a patient completes chemotherapy or radiation, their active treatment team, which followed them closely for months or years, begins to step back. The appointments become less frequent, the check-ins stop, leaving the patient with something that looks like good news but feels, to them, more like limbo.

I've heard this described in nearly identical terms by survivors across cancer types: "I felt lost. Like I'd been dropped."

That feeling isn't unfounded. Roughly 1 in 3 cancer survivors have not seen any healthcare provider for survivorship care within five years of completing therapy. Another 1 in 3 don't see a doctor within a year of finishing treatment. This isn't because survivors don't want support, it's because the clinical infrastructure for survivorship care has simply not kept pace with how many cancer survivors there are today.

Here’s what many don’t understand: cancer care does not end after treatment. Survivors face ongoing risk of recurrence and secondary cancers. They experience long-term side effects that occur during cancer treatment and persist once treatment ends, such as neuropathy (nerve damage), fatigue, brain fog, and osteopenia (loss of bone density). Survivors also experience “late” effects, chronic health conditions that are absent at the end of treatment but can occur months, years, or decades later. These include secondary cancers, thyroid disorders, and cardiovascular disease, among others. The risk of late effects is highest for individuals who were treated at a younger age and generally increases over time. 

Without clinical leadership to guide survivors, these issues go unaddressed, screening gaps accumulate, and chronic conditions go unmanaged.

For employers, the consequences are real and measurable: avoidable emergency visits, missed recurrence, unnecessary disability leave, higher healthcare costs, and employees struggling with symptoms that could have been addressed earlier. The survivor who doesn't know they need a cardiac evaluation after certain chemotherapy regimens. The one managing anxiety without any behavioral health support. The one who wants to come back to work but doesn't have the accommodations they need to do it successfully.

A hidden population with visible costs

Most cancers are diagnosed in people over 60. But a significant and growing number of working-age adults are living with and beyond cancer diagnoses, and they are in your workforce right now. These individuals often don't self-identify, or at the very least don’t voice the challenges they are dealing with post treatment. They may have rung the bell months or years ago and are quietly managing ongoing effects while trying to perform at the level they held before diagnosis. They frequently don't ask for accommodations because they don't know what to ask for, or because they worry about how it will be perceived.

Cancer-related cognitive impact is a perfect example. This can affect attention, short-term memory, and the ability to multi-task. These aren't minor inconveniences for someone in a demanding role. But they're also highly manageable with the right guidance. Something as simple as limiting multitasking, using lists, or working in a quieter environment with fewer distractions can make a meaningful difference. These are reasonable workplace accommodations. Most employers simply don't know to offer them.

What whole-person survivorship care actually looks like

At Color, survivorship care is oncologist-led, whole-person care. That phrase matters. It means clinical accountability, not just a wellness program or a peer support group, but an oncologist who designs personalized screening and follow-up plans, monitors for recurrence and secondary cancers, manages long-term treatment effects, and actually closes care gaps rather than just documenting them.

Our outcomes demonstrate what happens when survivorship care is treated as an ongoing clinical responsibility rather than an occasional check-in: 76% of care gaps closed for survivors enrolled in Color’s program; a 50% higher rate of active recurrence risk monitoring; a 36% reduction in both depression and anxiety; and $6,000 saved per survivor through avoided complications.

Clinical rigor alone isn't enough. Cancer affects the whole person, not just the body. Our program integrates oncology-trained nutritional support, exercise protocols and overall lifestyle support; peer-led emotional support through Color Cancer Connect; coaching on practical challenges like financial pressures; and structured behavioral health support grounded in evidence-based approaches. These are skills-based programs, using a model behind multiple peer-reviewed publications, designed to build resilience, improve emotional regulation, and help survivors stay engaged in their work and lives.

Return to work is a core component of our program, not an afterthought. We work with survivors to understand their current symptoms, identify appropriate workplace accommodations, and partner with employers to make reentry successful. Color goes so far as to give patients a sense of what their costs may look like so they can select an insurance plan and deductible structure that will fit their needs. 

We go directly to employers, training HR teams, educating managers on how to support employees returning from cancer treatment, and helping bridge the gap between clinical reality and workplace expectation.

Virtual care removes the biggest barrier

One of the things I've come to appreciate most about Color's model is something I was reminded of at this year's annual meeting of the American Society of Clinical Oncology (ASCO), the country’s leading oncology organization. I mentioned that our program is 100% virtual, available to patients across all 50 states. The room was genuinely surprised. Most brick-and-mortar survivorship programs require in-person visits. Virtual visits are offered occasionally, in select cases, as an accommodation rather than a design principle.

The implications of this are enormous for employers with distributed workforces. Geographic barriers disappear. A survivor in a rural area gets the same access as one near a major cancer center. A survivor who is managing fatigue doesn't have to factor in the energy cost of travel to a clinic. Proactive outreach, checking in after treatment, following up at three or four months, reaching back out at a year, becomes not just possible but something survivors can count on.

Survivorship care shouldn't require survivors to come to it. It should come to them.

What employers can do now

The 18 million cancer survivors in this country represent one of the most underserved and underrecognized populations in employer health programs. They are in your workforce. They have needs that are specific, manageable, and going largely unmet.

The gap between completing treatment and fully healing is real. It is also closable. With oncologist-led clinical management, whole-person support, and a virtual model that meets survivors where they are, employers have an opportunity to make a genuine difference for a population that has already been through enough.

Survivorship is no longer a small part of the cancer story. It is becoming one of the largest and longest phases of care. As the survivor population continues to grow, employers have an opportunity to rethink how they support employees after treatment ends and ensure survivorship receives the clinical attention it deserves.

Dr. Ashley Speckhart is a survivorship oncologist at Color, where she leads clinical care for cancer survivors across the United States.