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Feel Your Best After Cancer

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How to get the care you need…

You beat cancer. Now what? For the 14 million cancer survivors in the US, this is no small question.

Once you’ve given that sigh of relief for having survived a possibly life-threatening illness, you’re immediately confronted with a new set of concerns: How should you protect yourself against the dangerous aftereffects of cancer treatments? What about nagging emotional issues, including depression? And what can be done to keep cancer from coming back?

Latest development: Cancer survivors have traditionally lacked coordinated follow-up care by their physicians after completing their treatments. But there’s now a new option for getting specialized aftercare. Hospitals and cancer centers across the US are offering survivorship-care programs that give patients state-of-the-art methods for keeping tabs on their health and reclaiming their emotional equilibrium after battling cancer.*

GETTING ON WITH YOUR LIFE

At a cancer-survivorship program, a team of medical doctors, physical therapists, psychologists, nutritionists and other health professionals focus exclusively on the individual needs of each cancer patient. This includes monitoring for complications that can result from cancer treatment. Among the most important to watch for…

 

  • Heart damage.

Chemotherapy and radiation can harm any organ, notably the heart. It doesn’t necessarily happen right away—a potent class of drugs called anthracyclines, commonly used to treat some lymphomas, breast cancer and certain rare types of cancer like sarcoma, can cause cardiomyopathy (weakening of the heart) decades after treatment is completed.

 

Radiation that reaches the heart, as often occurs, for example, with lung cancer, can cause damage, too. Similarly, a study appearing in the Journal of Clinical Oncology attri­buted up to 25% of the deaths of former Hodgkin’s disease patients to heart disease caused in some part by ­radiation.

Best self-defense: Depending on the treatment you received, your doctor may recommend one or more tests, such as MRI, ultrasound and/or electrocardiogram, to closely monitor your heart health.

 

  • Infection.

Chemo, radiation and stem cell transplants used to treat cancer suppress the immune system, increasing risk for infection.

 

Best self-defense: Vaccines must be used carefully in cancer survivors. For example, “live” vaccines (such as Zostavax for shingles) should not be used in cancer patients with weakened immunity—they are at increased risk of contracting the infectious disease from the live organism in the vaccine. Cancer patients should talk to their doctors about the vaccines they need.

 

  • Fatigue.

Up to 82% of cancer survivors are affected by persistent fatigue, brought on by chemo and/or radiation or as a result of stress or chronic pain.

 

Best self-defense: It’s common for individuals who have received chemo and/or radiation to suffer mild-to-moderate fatigue for up to a year. However, other conditions not directly related to the cancer itself—for example, an underactive thyroid, anemia, arthritis or insomnia—or even the use of pain medication may be partially to blame.

If these possibilities are ruled out, the best defense is often a carefully designed exercise program. A physical therapist on staff at a cancer-survivorship program will be knowledgeable about the issues that cancer survivors confront.

For best results: Pace yourself! Start with just 20 minutes of brisk walking and/or resistance training one to three days a week…and gradually increase to 20 to 60 minutes up to five days a week.

 

  • Pain.

More than one-third of cancer survivors experience chronic pain—often due to chemotherapy, radiation or surgery.

 

Best self-defense: Don’t rely on just one pain-fighting strategy. A combination of approaches, such as physical therapy, exercise, oral painkillers, lidocaine (injections, creams or patches) and massage, may be recommended.

 

  • Depression.

This is also common after cancer treatment.

 

Best self-defense: Don’t shrug off worrisome symptoms, such as trouble sleeping, an inability to focus, lingering feelings of sadness and anger or an overwhelming sense of isolation or fear. These are all red flags that depression may have taken hold.

The psychologists, social workers and other mental health professionals at survivorship programs are trained to identify and treat cancer-related complications, such as fatigue and pain, that may contribute to depression. In addition, therapy and/or medication may be needed to treat the depression.

 

  • Additional postcancer issues.

Cancer-survivorship programs also treat sexual dysfunction…cognitive decline…and sleep problems.

 

RISKS FOR RECURRENCE

Up to 70% of cancer survivors report having significant fear of a cancer recurrence. If you have survived cancer, the best way to catch a recurrence early—when the malignancy would be most treatable—is to stay on top of follow-up visits to your doctors.

How often? Follow-up visits are­ generally recommended every three to four months for the first few years following treatment and once or twice annually after that. However, the exact schedule depends on such factors as the type of cancer you had, the treatments you received and your age.

Which tests? It’s crucial to have an after-cancer screening plan that may include specific tests (such as blood tests and MRI and/or CT scans) that are sometimes used to help detect cancer recurrences.

Best resource: Guidelines from the National Comprehensive Cancer Network. Go to NCCN.org/default.aspx. Under “NCCN Guidelines,” click on “NCCN Guidelines for Patients.”

*To find a cancer-survivorship program near you, go to the National Cancer Institute (NCI) website, CancerCenters.Cancer.gov. Cancer-survivor programs are often used in conjunction with care from one’s primary care doctor and are covered by most health insurers.

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Source: Sheetal Kircher, MD, an oncologist and clinical director of the Cancer Survivorship Institute at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University in Chicago. Dr. Kircher’s research interests are focused on improving the quality of cancer care and cancer ­survivorship.

Date: July 1, 2014 Publication: Bottom Line Health
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