According with stage II is about 93% with

According to the Centers for Disease Control and Prevention (CDC), the term “cancer survivor” refers to a person who has been diagnosed with cancer, from the time of diagnosis throughout his or her life.25 According to the American Cancer Society (ACS), a long-term cancer survivor is defined as an individual who has survived five or more years since the diagnosis of cancer.10,11 The concept of cancer survivorship itself as a distinct phase of cancer treatment is relatively new, and the awareness of long-term issues affecting cancer survivors is low, especially in less developed countries.26In the USA, the 5-year relative survival rate for women with stage 0 or stage 1 is close to 100% with stage II is about 93% with stage III is about 72% and with metastatic or stage IV is about 22%.27 Globally, breast cancer 5-year relative survival rates range from 80% to 90% in high income (North America, Sweden, and Japan) to 60% in middle income, to below 40% in lower income countries.26 These differences have been attributed to disparities in early detection, type of breast cancer, access to treatment, type of treatment, and social and cultural barriers.26Three phases or seasons of survivorship have been described as comprising the cancer trajectory, each with its own unique set of concerns.28,29 The first season referred to as “Acute Survivorship” is dominated by the time of diagnosis and the treatment of cancer.28 The second season called “Extended Survivorship” can be thought of as the period of remission and waiting for follow-up examinations.28 The final season, “Permanent Survivor” describes the subsequent period when a gradual sense of confidence develops when the risk of recurrence diminishes and the chances of long-term survival are great.28,30In developed world breast cancer survival improvement can be variously ascribed to early detection through the use of mammography, high-quality surgery, increasing use of effective adjuvant therapies including chemotherapy, targeted therapies, hormonal therapy, more recently the HER2-directed agent trastuzumab.31The National Comprehensive Cancer Network (NCCN) has established survivorship care guidelines which are symptom-specific and aim to tackle anthracycline-induced cardiac toxicity, healthy lifestyles, pain, cognitive function, sexual function, anxiety and depression, fatigue, sleep disorders and immunizations and infections in cancer survivors.32 In addition, the American Cancer Society (ACS) and the American Society of Clinical Oncology (ASCO) have published similar guidelines on the long-term survivorship care of breast cancer survivors which are used in developed word.32–34 Guidelines help oncology and primary care providers pinpoint and manage possible psychosocial and physical late and long-term after-effects of cancer and its treatment in addition to other features of post-treatment survivorship care.32–34 Moreover, these guidelines ensure an effective management of BCSs; by assisting health care providers(HCPs) in decision making and therefore provide prompt and appropriate screening and surveillance leading to improved patient outcomes including reduced morbidity and mortality, improved quality of life (QoL), psychosocial well-being, and overall satisfaction.32–34 Extending follow-up and supportive care efforts across the survivorship continuum help to identify and develop interventions that address the apprehensions and needs of this population and help to discern consequent illnesses and recurrences.35 For instance, in Australia supportive care provides  services to meet physical, practical, informational, psychosocial, and spiritual needs encountered during the diagnostic, treatment, and follow-up phases of cancer.30Breast cancer survivors in developing countries may experience greater effects of chemotherapy-induced early menopause, infertility, and impairments in sexual function and body image.26 It may bring an increased risk of recurrence as well as a sense of isolation due to social and cultural conditions.26 Unfortunately, supportive care services are often limited and program development for appropriate survivorship care and long-term follow-up has not been well addressed in developing countries.26