Surviving cancer: You're not alone

Surviving cancer: You're not alone

By Lisa M. Mayers

Tremendous progress has been made over the past two decades in diagnosing, treating, and even curing many cancers. While it remains a very serious and life-threatening disease, many of those who are diagnosed with cancer now go on to live a healthy, cancer-free life. In fact, according to the American Cancer Society there are more than 13 million cancer survivors living in the United States (as of January 1, 2012) and it is estimated that by the year 2020, that number will increase to as many as 18 million survivors.

Cancer survivors do face some special needs however, to recover and stay healthy, particularly in the first year or two following active treatment.

"As our patients complete their treatment, we work with them individually to provide a plan of care going forward that is tailored specifically to their needs," explains Laura Balmer, ANP, AOCNP a Radiation Nurse Practitioner with the Falck Cancer Center at Arnot Ogden Medical Center, in Elmira, NY. "Not only does the care plan ensure ongoing support and monitoring, but knowing that there is a plan in place can be very reassuring to the patient."

Many survivors find that from the point of diagnosis, through much of their treatment they are so focused on doing what they need to do to heal - often a combination of tests, surgeries, chemo and radiation - that it is only after those treatments end that they begin really processing the emotional aspects of their disease.

"For months, sometimes longer, cancer patients are undergoing active treatment and seeing their health care providers on a constant basis. Then, treatment ends and there may be months that pass without a doctor's visit. Survivors can suddenly feel vulnerable and alone," cautions Balmer.

Fear of recurrence, anxiety about getting back out into the world, coping with the unknowns of a "new normal" and what to expect going forward, as well as issues such as financial stress due to the cost of treatment or going an extended period without income can catch survivors off guard when treatment ends.

"Strong emotions are to be expected when a person's treatment ends. We always do our best to reassure patients that it is completely normal, and to let them know that we are still here for them," says Balmer. "An oncology social worker is available to patients during and after treatment for emotional support, as well as practical needs such as finding resources to help with insurance co-payments and the cost of medications."

When you are part of a survivors personal support network, it is also important to understand that they will need your support long after treatment ends. Often survivors feel like the support they received so generously and abundantly during treatment evaporates the day treatment ends - just when they often need it the most. Understanding that this is the case will help you stay present and available for those you love.

In addition to the emotional issues survivors must deal with once treatment ends, there are often lingering or long term physical side effects as a result of cancer treatments. Fatigue can last for more than a year after treatment is complete, as the body heals from all it has been through. The fatigue can be minimal and resolve in weeks or months, or linger in a more profound way impacting a survivor's quality of life for much longer, depending on the individual and their specific circumstances.

De-conditioning of muscles contributes to the fatigue, reducing physical stamina. Depending on the age and physical condition of the individual when they began treatment and the course of treatment they received, restoring muscle health and strength can take time.

"Proper nutrition is essential when recovering from cancer and the associated treatments. Your body needs quality nutrients, particularly protein, to rebuild itself. A higher calorie, higher protein diet is generally recommended for at least six months following treatment. If a patient's appetite lags we can prescribe appetite stimulants," says Balmer.

Exercise is also important in alleviating fatigue and rebuilding muscle strength and stamina. Simple things like walking and stretching can be a good way to start getting back to your normal activities and lifestyle. Physical activity also contributes to a positive outlook and helps to keep worry and stress at bay.

While fatigue can be a normal side effect of cancer treatments, it's important to let your health care provider know if it becomes extreme during or after treatment, making it impossible for you to maintain the normal activities of daily life.

Many survivorship issues are very specific to the age, condition, and treatment an individual receives - whether that's radiation therapy, chemo therapy, or surgery. The younger a person is when they are diagnosed and treated, the longer and more closely they will be followed by their medical team for long term side-effects and possible recurrences.

It's important that survivors play an active role in their post-treatment care plan. Laurie Balmer offers these tips:

• Listen and make sure you understand your care plan, as outlined by your medical team at the end of treatment.
• Ask questions - write them down before your visit and make sure they are answered so that you feel comfortable in your understanding of them.
• Follow the advice of your care providers - keep all of your follow up appointments and continue with any prescribed medications or dietary recommendations.
• Make any necessary lifestyle changes - smokers have a much higher rate of recurrence than non-smokers. Assistance is available to help smokers quit.
• Maintain a healthy weight and a healthy level of fitness, through proper diet and exercise.
• Stay aware of issues related to your own individual situation - if you experience symptoms that concern you, it's better to ask about it than to worry about it.
"Often patients and survivors have such a myriad of specialists that it can be overwhelming just knowing which one to call when a question arises, but the most important thing is to simply reach out. Any one of your providers will be happy to assist you and connect you to the most appropriate resource," advises Balmer.

Additional Resources for cancer patients, survivors, and care givers:

Laura Balmer, ANP, AOCNP
Radiation Nurse Practitioner
Falck Cancer Center
Arnot-Ogden Medical Center
Elmira, NY