Anthony Jewell went through bouts of anxiety and utter hopelessness between the moment doctors found a tumor in his esophagus in January 2011 and when his treatment ended earlier this year.

But one of the hardest challenges came two months ago, after he’d joined the ranks of cancer survivors. His doctor encouraged him to quit his longtime job in the wine industry, which was about to become more demanding and require international travel three weeks a month. It was a prospect that caused great anxiety.

“He told me to stop working and apply for disability,” said Jewell, 59, of Hallandale Beach. “I’ve always stood on my own and not relied on anyone to pay my bills. That was incredibly hard.”

Life after cancer has its own series of challenges, including mental and emotional difficulties that come with adjusting to “the new normal,” as many survivors call it. Psychological issues range from depression and anxiety to cognitive impairments and stress about body image.

There are more than 12 million cancer survivors in the United States and, with ongoing treatments and early detection, that number is expected to increase, said Dr. Maria B. Currier, who directs the Courtelis Center for Psychosocial Oncology at the University of Miami Sylvester Comprehensive Cancer Center.

“That’s why we need to target the non-oncology needs,” she said. “There’s a spectrum of symptoms that arise in cancer patients during as well as after treatment — from psychological to physical and even spiritual and social issues.”

More than two dozen independent studies have shown that mortality rates are 25 percent higher in cancer survivors experiencing depressive symptoms and 39 percent higher in those diagnosed with clinical depression, Currier said.

“Depression may be an independent predictor of mortality rates in cancer patients,” she said. “That’s why it’s important to screen patients with depression and encourage survivors to seek treatment.”

Along with depression, anxiety is another common psychological issue, taking the form of the fear of recurrence. Survivors often report a constant anxiety of the cancer returning.

“Every little pain, every little blotch on my skin, every time my fingernail hurts, I think it’s cancer,” said Angela Lara, 34, of Miami. “I’m not like a normal person anymore.”

It became a very real anxiety for Lara, who was diagnosed with breast cancer in December 2010. She had a mastectomy the following July and spent the fall in chemotherapy. Up until six weeks ago, she thought everything was going to be OK.

Then doctors found cancerous cells in her spine. She’s back in chemotherapy.

“ ‘Why does this have to happen to me?’ ” Lara said she asks herself.

For the first time since she was diagnosed, she thinks she’s depressed and is considering therapy.

Sameet Kumar, a clinical psychologist at Memorial Cancer Institute, at Memorial Regional Hospital in Hollywood, said the cancer survivors he counsels often ask him how they’ll ever know they’ll be OK.

A third of his patients report having a harder time emotionally after the cancer treatment is over than at any other point.

“Their emotions are suddenly catching up to them, and they ask that question, ‘What is this life I’ve been fighting for?’ ” he said. “Underlying it all is a double whammy of vulnerability and uncertainty. For some people it feels like depression; for some it feels like anxiety.”