Editor’s note: Cancer Q&A is a monthly column in which health professionals from Baystate Regional Cancer Program, based in Springfield, address issues related to cancer in a question and answer format.
No one likes to hear the word cancer from the doctor. What follows can be a physically and emotionally tough journey that often doesn’t end with your last treatment.
For some, the physical and emotional struggle continues with late effects, such as nerve injury, fatigue, weight gain and loss; returning to work, or not for those who lost their job; financial challenges, as well as the worry that their cancer might return.
Q: What role do follow-up plans play after cancer treatment ends?
A: Surveillance after cancer treatment with the intent of cure is increasingly controversial.
Some patients with specific cancers, such as colon cancer, benefit with improved survival from blood tests and a CT scan once a year.
For most cancers, frequent imaging and blood testing to find a recurrence “earlier” either does not improve survival, or does not detect recurrence earlier. The cancer treatment community is working to reduce this type of testing which is costly and of minimal, if any, value for certain cancers.
For many patients, cancer treatment can lead to persistent side effects that have to be managed, and this forms a significant part of follow-up plans.
Q: What type of late-effects can patients expect after treatment?
A: The types of symptoms vary depending on the treatment received. Post-surgical pain, lymphedema or swelling after radiation or surgery, fatigue after chemotherapy, and anemia are common. Some aggressive treatments, such as radiation to the head and neck area, can result in alterations in taste and mouth and throat dryness. While it isn’t the norm, occasionally some patients require intensive rehabilitation.
Q: Just as cancer affects physical health, it can also affect mental health. In what ways does that happen and how can these feelings be dealt with?
A: After intensive treatment for cancer, patients occasionally feel a let-down, depression or even abandonment as they enter into post-treatment survivorship. There is often a sense of combating cancer that disappears once treatment is complete to be replaced with the uneasy feeling that the patient is left alone to deal with the disease, which in his or her mind can now recur as the individual is not “actively” engaged in treatment.
Appropriate counseling and, occasionally, medical therapy can help relieve these feelings, leading to a more balanced and appropriate viewpoint of one’s health and cancer recurrence risk.
Q: What role does diet and exercise play when recovering from cancer?
A: For various diseases, but particularly in early-stage breast and colorectal cancer patients, exercise has been shown to improve quality of life, as well as overall survival. These studies demonstrate that exercise has a very important role to play in patients’ survivorship plans.
The role of diet is more controversial, with conflicting data on the ability of diet change to reduce the likelihood of cancer development, and even less on recurrence rates for patients with a diagnosis of cancer.
A reasonable recommendation to strive for is the National Cancer Institute’s Eating Hints (downloadable from http://www.cancer.gov/publications/patient-education/eatinghints.pdf). The booklet addresses eating issues and makes suggestions, including recipes.
While there is limited research supporting dietary treatment, these recommendations appear prudent.
Q: There are many stresses associated with a cancer diagnosis. Once the bills start coming in after treatment, finding a way to pay them can be troubling. How financially draining is the cost of cancer for patients and how are they being helped to address their financial burden?
A: Cancer costs are increasing significantly, primarily due to the high price of new therapies (some of which are very effective, others less so).
These high prices are coupled with the increasing frequency of high-deductable health plans, resulting in more costs born directly by the patient and his or her family.
It is important to have an open conversation with your cancer care providers to clarify what your health insurance will pay for, what it will not cover, and what you and your family may be responsible for.
Options regarding cost, payment plans and patient assistance programs should be sought at your cancer care center by talking with your physicians or the nurses there. Oncology social workers are helpful, too. There also are discount coupons available on some pharmaceutical websites which substantially reduce your out-of-pocket expenses for the many newer, high-priced cancer drugs. It pays to do your homework.
Breakthrough cancer treatments will help no one if patients and their families are placed in the challenging position of foregoing treatment due to costs.
Q: Are support groups helpful? How can patients find others to talk with during recovery?
A: Support groups may be helpful to some people, but the experience of others is not likely to be your experience, either in terms of side effects or treatment results. That said, there is some solace to be had in appreciating that you are not alone, that many have had similar challenges and have overcome them, and that there is healing regardless.
We are fortunate to have outstanding community resources in the Pioneer Valley, such as Florence’s Cancer Connection, and Hampden County’s Cancer House of Hope, that offer a number of support groups and other programs to help patients and their families.
Dr. Wilson C. Mertens is vice president and medical director of Cancer Services Baystate Regional Cancer Program is Springfield.