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Morgan Newman, a survivor of cervical cancer, at the Des Moines Public Library last December. Natalie Krebs/Iowa Public Radio hide caption
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Natalie Krebs/Iowa Public Radio
The cancer diagnosis came as a shock, disrupting Morgan Newman's carefully laid plans for launching her life. It was 2015, and she was working as a dental assistant in Des Moines, Iowa, while studying to become a social worker.
After an abnormal result on her Pap smear, her doctor brought her back in to check for abnormal tissue.
Newman wasn't that concerned at first. She was only 24.
"I didn't think anything of it, because, you know, all my friends have had some sort of [abnormal result] like that, and they turned out to be okay," she said.
But during the follow-up exam, she started bleeding so heavily that they couldn't continue, she said.
"And so they had to stop, and they referred me to a gynecologic oncologist at that point."
Newman soon learned she had cervical cancer. She had just moved into her own apartment for the first time.
An increasing number of Iowans are getting — and surviving — cancer.
Nationally, there were more than 18 million cancer survivors in 2025, and it's projected to grow to 22 million by 2035, according to the National Cancer Institute. But long after completing treatment, many survivors face lingering mental health challenges that go unaddressed.
Newman underwent six weeks of radiation and chemotherapy. Her scans were clear until the three-month mark, when her doctors found suspicious nodules in her lungs.
Newman endured additional chemotherapy, which had more side effects.
It was physically exhausting. But she was also struggling psychologically, as she watched her friends hit significant adult milestones.
"My friends were getting married, they were having children, you know, progressing in their lives and their careers, and I just felt stuck," she said.
Newman had done therapy before, for anxiety and depression.
But after she got sick, she had to quit.
Therapy was just too expensive, now that she had her medical bills. And between the doctor's appointments, college courses, and her full-time job, she just didn't have the time.
Newman's treatment ended, and the scans remained clear.
By 2017, she had a new job with better health benefits. So she decided she could go back to therapy.
She still worried that every ache and pain could be the cancer coming back.
At times, it was emotionally difficult to spend time with her friends who had kids, because the radiation treatment had damaged her reproductive system, leaving unable to have her own children.
Now, almost 10 years later, Newman remains cancer free, and cancer prevention has become her passion. She recently started a new job as the Iowa grassroots manager for the lobbying arm of the American Cancer Society and has served on the boards of other cancer organizations in Iowa.
But she continues to go to therapy to deal with lingering anxiety she has about the cancer reoccurring and for support for lingering effects of treatment, like her infertility.
"The fear of the unknown really takes over and can physically impact your body, as well as your mind, of what if the cancer is back," she said.
Cancer's 'silent' impacts can linger
Studies show cancer survivors are more likely to experience anxiety and depression that can last years after they finish treatment.
Cancer Nation, an advocacy group, did a national survey of patients who were finished with their treatment. It found that about a third of them reported anxiety about their cancer coming back, and problems with "not feeling like their old self."
Only 1 in 5 of the surveyed survivors had seen a mental health professional.
"Part of it is, I don't think we have enough. I think some people need mental health professionals who really understand cancer," said Shelley Fuld Nasso, CEO of Cancer Nation.
But finding therapists who understand how cancer can affect people physically and emotionally can be a challenge, especially in Iowa.
Iowa's growing cancer rate
Iowa has the second-highest rate of new cancer diagnoses, according to the Iowa Cancer Registry. Researchers aren't sure why, but University of Iowa scientists, who run the registry, are taking a deep dive into the issue.
Iowa is also largely rural. Some of the counties that have the highest cancer rates also have the fewest mental health workers.
Dr. Richard Deming is the medical director of the MercyOne Richard Deming Cancer Center in Des Moines, Iowa. The center has recently added services like yoga and counseling to help cancer patients and survivors deal with mental health issues. Natalie Krebs/Iowa Public Radio hide caption
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Natalie Krebs/Iowa Public Radio
Newman went through several therapists before she was able to get an appointment with Julie Larson, a Des Moines-based therapist who works with a lot of cancer survivors.
"I just felt like I needed something more specific to what I was going through," she said.
In Larson's practice, it's common for clients like Newman to start therapy months or even a year after finishing treatment, when they realize they just aren't feeling how they expected to feel.
"Physically, people's bodies have changed, and they are reconciling loss and grief, and those experiences are a little bit more silent, a little more invisible, and friends and family don't often fully understand or grasp that," Larson said.
Larson started her career as a therapist working with a cancer non-profit before going into private practice where she continued to work with cancer patients. She now writes and speaks publicly about her work to raise awareness.
"Just to help normalize the intensity — mentally and emotionally — of dealing with cancer," she said.
Larson understands cancer and the different forms of treatment people may have experienced, which is why she said cancer survivors often seek her out.
"I'm not a doctor, but I've done this a long time, so I know what happens when people have Adriamycin. I know the treatment protocol for carboplatin. I know what happens for lung cancer patients as they're moving through the treatment decision making process."
The role of oncology in mental health
When it comes to treating cancer, the field of oncology often neglects mental health, said Patricia Ganz, an oncologist and professor at the UCLA School of Public Health, who has spent decades doing research on cancer survivors and their lingering challenges.
"We know how to give pills. We know how to give pain medicine, sleep medicines, but we're not really schooled in the antidepressants," she said.
There's an increasing awareness about the need to screen for psychological distress in cancer patients, and the need to provide mental health services for both cancer patients and survivors, Ganz said, but expert-recommended screenings and referrals don't always happen to the extent they should.
"If you screen, that means you have to be able to provide services. That's not always available if you don't have access to a mental health professional. So that has not been done as rigorously as it should be in general practice," she said.
The Richard Deming Cancer Center at MercyOne hospital in Des Moines, is trying to do more to to address the mental health of patients and survivors
It has started offering services like counseling, music therapy and mindfulness to reduce stress to those in – and out -- of treatment.
"You get cared for intensely when you're getting treated for cancer," said Dr. Richard Deming, the medical director of the clinic. "When you're done with cancer treatment and you are cancer free, we don't say this — but the way that we manage those types of patients, it's almost like: 'You should feel fortunate that you're cancer free, and just get on with your life.'"
In order to treat cancer comprehensively, doctors need to pay attention to far more than just physical symptoms. That requires a shift in the way doctors treat patients, he said.
"Every step along the way, whether it's through diagnosis or treatment or follow up, we have to ask, 'What are the issues you're experiencing?' Not just, 'Do you have cancer? Did we get rid of the cancer?'" Deming said.
This story comes from NPR's health reporting partnership with Iowa Public Radio and KFF Health News.
