Bob Underwood, M.D. (Host): There are more than 18 million cancer survivors in the U.S. and there can often be challenges for cancer survivors post treatment. Nonetheless, many folks believe that after completing cancer treatment, the patient's cancer journey is over. Hi, I'm Dr. Bob Underwood, and welcome to the Cancerwise Podcast from the University of Texas MD Anderson Cancer Center. And today we are talking about managing life after cancer with professor of Pediatrics and Medical Director of Cancer Survivorship, Dr. Michael Roth. Dr. Roth, welcome to the program today. How are you? And thank you for being here.

Michael Roth, M.D.: I'm doing great and thanks so much for having me.

Host: You know, this is an often-overlooked component of cancer care. You know, a lot of people think that when they're done with chemotherapy, or radiation, or other treatment, that their cancer journey is over. But that's not right, is it?

Michael Roth, M.D.: Yeah, that is correct. For many, the cancer journey actually just begins after the completion of cancer treatment and new challenges often present. Many patients think that they'll just go back to life as normal pre-cancer and life has changed in many different ways for their, their physical, emotional health, and other goals in life have changed as well.

Host: So, can you explain what do we mean when we say survivorship? What does that mean exactly?

Michael Roth, M.D.: A cancer survivor is someone from the day of diagnosis. So, anyone who is diagnosed right after that initial diagnosis, you are a cancer survivor. For the purposes of this discussion, we're really focusing on after the completion of treatment and what happens in your life once you've completed cancer treatment and for many are trying to get back to the lives they once had.

Host: What kinds of challenges do survivors face in that post-treatment setting? So, tell us about screening and prevention, surveillance for recurrence, side effect management, and other necessary support. What are they going to see?

Michael Roth, M.D.: For those who've gone through cancer treatment themselves or who've had loved ones go through cancer treatment, you know that treatment can be quite challenging and there can be many short-term or acute side effects that come up. Unfortunately, some of those side effects can be long-lasting and can remain long after that the treatment is over. There's also some side effects that can come up after treatment and there's a higher risk of developing chronic health conditions after cancer treatment concludes. We also know that our survivors are at risk for other cancers, which makes it even more important to emphasize screening and prevention, and to always have good quality health care, both during and after cancer treatment concludes.

Host: So, what role does mental health support play in that survivorship journey?

Michael Roth, M.D.: Mental health, psychosocial support, it is hugely important throughout and beyond cancer treatment. Cancer can be life-altering. It can change perspectives, it can alter mood, it can impact fatigue, it can impact relationships. And it's important to acknowledge that the impact of cancer treatment doesn't just end when you stop getting radiation therapy or you complete your surgery or chemotherapy. Mental health is something that really needs to be prioritized. Often patients don't process their cancer experience until after they complete treatment. And things like depression and anxiety can be really challenging after cancer treatment concludes.

Host: Yeah, I think we see that with a lot of different diagnoses that can be pretty major medical issues, and that mental health component is often forgotten about. So, with that, and it's sounding like, you know, maybe a little bit of it is kind of unpredictable. Is there something that people are consistently surprised by during their survivorship? Do they run into a challenge they didn't anticipate or perhaps there's even an unexpected silver lining?

Michael Roth, M.D.: I think both. So, many patients will say after cancer treatment that they have a new perspective on life, or they value things differently. Perhaps they value relationships and family time differently or have a different view of the meaning in their work. Unfortunately, many patients also do experience anxiety, fear of recurrence, fear of other cancers, concerns with their physical activity and how that impacts their ability to do the things that they used to do in life. So those challenges really need to be addressed. They should be addressed early and they need to be continually addressed because unfortunately they don't go away. Cancer is a trauma and we need to acknowledge that and we need to deal with it because our patients deserve to have a life filled with happiness and health and success.

Host: So, it's a plan. It's a journey. So, what does a survivorship plan look like? You know, what questions should patients be asking? Who should they be asking and having these conversations with, especially if they're not able to be at MD Anderson?

Michael Roth, M.D.: The most important thing is to go into survivorship and have a plan. Unfortunately, most of our survivors are never provided a plan, really don't think that far ahead. The goal is to get through cancer treatment. We know that cure is not enough. Life after cancer matters and we need to prepare our patients for what that life looks like. A lot of it is focusing on those things that patients have control over. It's physical health and it's emotional health in terms of exercise and nutrition. It's vocational health, making sure that our survivors have the support they need to get back to the workplace. And then it's about relationships and relationship building. Oftentimes our survivors say others don't understand what they've gone through and there's a need to connect with other survivors to really support them through that post-cancer life. There's a lot of work that needs to be done, a lot of planning, similar to planning for cancer treatment. We need to plan for life after cancer.

Host: Yeah, absolutely. And so, you're a pediatric specialist. Are there particular or extra challenges for young people with cancer?

Michael Roth, M.D.: That's a great question. So, I care for patients who've been treated for cancer as a child, as an adolescent and then as a young adult. And we know those early years are really important in forming many things about our identity. Physically, our organs are growing. Emotionally, we're developing ourselves in terms of how we interact. And then, educationally, we're developing our lives and setting ourselves up for careers. Cancer interrupts all of those things. So, what we try to focus on in survivorship is how does cancer and how has cancer impacted each of those areas of your health and address them by doing risk-based screening for health conditions, by providing vocational and educational support, and also by providing early and frequent mental health support.

Host: Speaking of that, I understand you're a big fan of mentorship. So why is mentoring an important and fulfilling part of your professional life?

Michael Roth, M.D.: Yeah, as I get older and my beard gets a little bit more grey, I've really learned the opportunity to mentor others amplifies your reach and it really expands your ability to impact the care of so many more. I love caring for patients in front of me. It is so rewarding and meaningful, and the ability to impact the careers of others and then have them provide similar, if not better, care than myself; it really is just a great way to expand the reach of what we do. We're all so passionate about caring for our patients and our survivors, and the more patients that we treat, the more patients we care for, we're doing a better job and that's even more meaningful and impactful.

Host: Awesome. It's phenomenal. Great for the patients and great that you believe in it so much. Do you have any final comments, you know, before we close out?

Michael Roth, M.D.: I think the most important thing for our survivors is: be kind to yourself. You've gone through a lot. We care about you. Life after cancer matters. Don't compare yourself to prior to cancer. You're doing a great job. Set goals, set short term goals, set long term goals and be proud of yourself. Chip away, make achievements and celebrate those achievements. We really appreciate the great work that you are doing and the importance of getting back to life and getting back to health and happiness.

Host: Wow. That's awesome. Thanks for being on today. We really appreciate it.

Michael Roth, M.D.: Thank you so much for your time.

Host: If you'd like more information about managing life after cancer, go to MDAnderson.org/Cancerwise to read survivor stories and more insights from our experts. We've reached the end of this episode of the Cancerwise Podcast from the University of Texas, MD Anderson Cancer Center. Remember surviving cancer is a lifelong commitment, but you're not alone.