Info For Cancer Survivors

In my practice I care for a large number of cancer survivors.  Breast cancer, colon cancer, bladder and prostate cancer, even appendiceal and esophageal cancer survivors are among my patients.

This week I am attending an adult medicine conference and one of the talks was about caring for cancer survivors.  Today I want to review my big two take-home points from that lecture.

First of all, let’s talk about our definitions.  What is a cancer survivor.  Well, if you have been diagnosed with cancer, from that day for the rest of your life you are a cancer survivor.  That’s a LOT of people.  In fact there were estimated to be almost 15 million people in the US and over 500,000 Ohioans (as of January 2014) living as cancer survivors.

Many people don’t realize that once you are a cancer survivor, one one hand you are very different from a medical standpoint from those who have never experienced cancer.  And on the other hand, you are no different at all.

Let’s review the differences first.  Once you have received treatment for cancer you have specific needs and health risks related to your cancer and its treatment.  If you received chemotherapy, radiation or surgery you may have aftercare needs related to those treatments.  For instance, some chemotherapy agents can damage your nerves or cause other long-term side effects.  Radiation to certain parts of the body can increase the risk of damage to healthy tissue in the radiation field.  Colon cancer patients may wind up with a permanent colostomy which obviously requires care long-term.

Survivors of childhood cancers have special needs that will have to be monitored by their physicians.  Learning difficulties, future fertility concerns, and other considerations will need to be addressed.

Any cancer survivor should have a complete survivorship plan developed by their oncologist within 6 months of finishing treatment.  The patient, the oncologist, AND the primary care physician need to have copies of the survivorship plan.  The patient should clearly understand what they will need to have done in the future, how often, and why.  Any long-term effects of treatment should be explained thoroughly with descriptions of symptoms to watch for.

This was my first take-home point.  Cancer survivors have unique needs that depend on the type of cancer they had and what treatments they received to address it.  This makes every survivor different and their survivorship plan must reflect this.

The second take-home point was actually the direct opposite.  Cancer survivors are no different from anyone else in that they need their routine screening exams performed on-time.

Many cancer survivors (including one in particular that I know very well) are content to use their oncologist as their primary care doctor, even years after their treatment is complete.  Oncologists are NOT primary care doctors.  They will not assess your cardiovascular risk and check your cholesterol.  They won’t discuss contraception and STD screening.  They may or may not check hepatitis C and bone density.

Also, many cancer survivors don’t feel they need to be screened for OTHER cancers.  They believe (incorrectly) that they have used up all their bad luck in having one cancer.  Cancer survivors should be aware that their risk of all other cancers is the same as or higher than those who have never had cancer – it will NEVER be lower.  And in many cases the treatment for their first cancer INCREASES their risk of developing a second cancer (so-called secondary malignancy).

This is my advice for cancer survivors.  By all means focus intensely on surviving your cancer.  Get through your surgery, chemo, radiation, all the treatments prescribed by your oncology team.

However, when your treatment is finished, make sure to sit down with your oncologist and get a comprehensive survivorship plan.  This document (and it will probably be a long one full of words you may not understand) should be explained to you in language familiar to you.  It should contain all the details of the treatments you received, including amounts of radiation and chemo drugs delivered.

Your survivorship plan should also detail follow-up testing you will need, how often, and for how long.  For instance, certain chemo drugs (like Adriamycin and Herceptin which are used in breast cancer) can harm the heart muscle and testing should be done periodically to make sure the heart is functioning well after treatment.  As another example, those who received radiation therapy to the chest for Hodgkin’s lymphoma are at higher risk for breast cancer.

If you have survived cancer, it is even more important that you take good care of your body.  Eat healthy and avoid smoking, using drugs and drinking alcohol to excess.  This means limiting alcohol to an average of two drinks per day for men and one for women.  Get plenty of exercise, drink clean water and avoid toxic exposures like industrial chemicals and heavy metals.  Make sure you are up-to-date on appropriate vaccines.  Get good sleep, manage your stress, and maintain a healthy weight.

God willing, you will have many years of life as a cancer survivor.  Your survivorship plan will spell out the road map for you and your primary care doctor to keep you healthy for many years to come.

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