Lessons Learned from Cancer Survivors
Once cancer treatment has been completed and your medical team offers congratulations and tells you to return in three months for your next follow-up appointment, many survivors wonder what is next for them and how to keep this from happening to them again. While this period of time is filled with feelings of gratitude and relief, it can also be a time of solemn reflection and challenging transition. Survivors may be re-entering the work force, re-establishing routines with family and friends, coping with lingering effects of treatment, and beginning to reckon with the experience of cancer and its impact on their future.
Every June we celebrate National Cancer Survivors Day, and many hospital systems honor their cancer survivors and caregivers with special celebrations and educational opportunities. It’s very fitting that I have the opportunity to contribute an article at this time. I have learned so much from cancer survivors and the scientific community over the last six years and would like to share some of these lessons with you.
Be an active participant in your care. Throughout your cancer treatment, you probably have experienced the importance of communicating with your healthcare providers. This communication is a vital part of your care after treatment as well. Attend your follow-up appointments with a list of questions/concerns. Report any symptoms you are having that concern you for cancer recurrence or potential side effects of current treatments.
If you have not re-connected with your primary care provider (PCP), now is an excellent time to do so. There are a myriad of health issues your cancer team will not necessarily address, such as routine chronic disease screenings for and management of such conditions as diabetes, high cholesterol, and thyroid dysfunction. One study has also demonstrated that those cancer survivors who have both a PCP and medical oncologist involved in their ongoing care have higher rates of cancer detection and non-cancer screenings than those who see only a medical oncologist due to the PCP’s continuation of “both preventive and surveillance cancer screening.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4294578/
Small health behavior changes make a big difference. “You don’t have to be a marathon runner to consider yourself physically active. Walking at about 3 mph (or 20 minutes per mile) is considered activity of moderate intensity. The American Cancer Society recommends that adults engage in at least 150 minutes of moderately intense activity or 75 minutes of vigorous activity each week (or a combination of these). You can get in the recommended activity levels by just walking on your lunch break for 30 minutes, 5 days a week.” https://www.cancer.org/latest-news/exercise-linked-with-lower-risk-of-13-types-of-cancer.html Exercise is now linked to lower risk of thirteen different cancers: colon, breast, endometrial, esophageal, liver, stomach, kidney, head and neck, rectal, and bladder as well as myeloid leukemia and multiple myeloma—two types of blood cancer—and lung cancer in current and former smokers.
Fruits and vegetables are part of a healthy diet, but did you know that certain key nutrients found in whole foods can pack a punch in the fight against cancer and chronic disease? According to findings from the American Institute for Cancer Research (AICR), seven key nutrients in cancer-fighting foods have demonstrated usefulness in this fight. Fiber, found in dry beans, whole grain breads, and other plant sources, reduces risk for colorectal cancer as well as diabetes and cholesterol. Vitamin A, present in yellow and orange vegetables, is important for immunity and may help to inhibit cancer cells. Folate can be found in green vegetables such as spinach, asparagus, avocado, and Brussels sprouts, and works to keep our DNA healthy and our cancer-protective genes turned on. Vitamin C, found largely in peppers, citrus, strawberries, and kiwi, protects DNA from damage and may protect against the formation of cancer-causing compounds found in processed meats. Magnesium, present in almonds, cashews, spinach, soy milk, and edamame, helps to repair DNA and control cell growth. Vitamin K, as found in green leafy vegetables, is helpful for blood clotting and bone strength. However, due to the food-drug interaction, those individuals taking warfarin, a common blood thinner, should talk to their healthcare provider before incorporating these leafy vegetables into their diet. Potassium, found in sweet potatoes, bananas, spinach, tomatoes, and oranges, plays a role in building muscle, controlling the body’s acid-base balance, and regulating sodium. http://www.aicr.org/enews/2017/03-march/enews-7-key-nutrients-found-in-foods.html
Acknowledge and accept your emotions. Many cancer survivors tell me they are surprised to experience feelings of loss, sadness, anxiety, and disequilibrium at the end of treatment. While these emotions are commonly experienced to some degree at this time, it is also important to understand that they are usually transient. What is especially helpful is to acknowledge these emotions without judgment and without heaping guilt on top of these difficult feelings. It doesn’t mean one is any less grateful for having “beat cancer,” if he/she is also experiencing some of these harder emotions. I have observed that those individuals who find peers with whom to share these feelings or other ways of expressing their experience, such as journaling, are able to more quickly come to terms with these emotions and move on. For those who may be experiencing more profound feelings of loss, depression, and grief, finding a counselor can be very beneficial. It is also important to let your health care team know if you are struggling in these ways. The most appropriate intervention for you may be an evaluation for clinical depression and management with medication combined with counseling.
Utilize your resources. Hospital systems with cancer programs usually have cancer resource centers. These centers may be staffed with cancer experts or designed to help you search for resources on your own. Often computer access for online searching as well as lists of reputable, relevant websites are provided. Resources for both cancer treatment and survivorship issues are available. Additionally, many cancer centers will employ staff with special expertise in cancer survivorship who can easily direct individuals to helpful and reliable community and online resources. Feel free to use any or all of these resources as you navigate this new terrain of life after treatment. They are there for you!
Mary F. Baker, MSN, RN, FNP-C, AOCNP, CBCN
Cancer Survivorship, Bon Secours Richmond
Bon Secours Virginia Health System – Medical Oncology