Transcription:
Surviving Cancer: What Do I Do Now?

Melanie Cole (Host):  Life after cancer treatment can sometimes present both physical and emotional challenges, and that’s why City of Hope developed the Center for Cancer Survivorship, a long-term followup program that’s designed to create a bridge between cancer treatment and community medical care. My guest today is Dr. Elizabeth Lynn Meyering. She’s an assistant clinical professor in the department of medical oncology and therapeutic research at City of Hope. Welcome to the show, Dr. Meyering. Tell us a little bit about life after cancer. How does it affect the survivors and also their families? 

Dr. Elizabeth Lynn Meyering (Guest):  That’s such a great question, and it comes up all the time in my office. When people are treated for cancer, there are so many issues that come up. Their first task is to be cured from their cancer. They are goal oriented. They want to get through it. But then what happens when they’re done? They feel very lost. Sometimes they have a lot of fear. They don’t know if the cancer is coming back. They have all kinds of issues that come up, and it’s not just physical issues. They have so many emotional problems that come up as well, including grief. And like I said, the statistics are a little bit terrifying because when we think about the statistics of cancer, there are about 12 million people surviving with a history of either chronic cancer or cancer that they have faced in the past in the United States today. A lot of those people are concerned that their cancer is going to come back. 

Melanie:  I would think that’s one of the biggest fears. How do you deal with that? Some of us think we’re going to get cancer. But if you’ve already had it, then that fear of recurrence would seem to be even greater. 

Dr. Meyering:  Well, that’s interesting. I think that’s very true. It is a greater fear. And I think I was a little naïve when I was a young fellow and I thought, well, shoot, if you get your cancer, maybe that’s it. You pull that card out and you’re done. As it turns out, there is an increased risk for another cancer when you have cancer in the first place. A lot of that has everything to do with whether or not you are carrying a genetic mutation, which truly, that is the minority. Most people do not have a mutation. However, we know there is more than mutations that cause us to have increased risk for cancer. It’s just everybody has different coping skills and trying to help patients find how to put cancer in the rear-view mirror is a different journey for every person and it’s not a simple one, certainly. 

Melanie:  When you think of the side effects of treatment, chemotherapy, losing your hair, fatigue, general weakness, and you think, “Oh, I’m not even gonna be able to work. What am I gonna do for money?” all these fears and stress start building up, Dr. Meyering. What about after the fact and maybe you can go back to work? What are some of the after side effects that might limit your ability to do the things you always want to do? 

Dr. Meyering:  That’s a great question. I usually characterize this for my patients in two different ways. One, I explain there’s going to be temporary side effects, just like you mentioned—the hair loss and all of those different side effects. Then the long-term things, which I think the biggest problem that people have is a problem with short-term memory and focus as well as self-esteem. These things are very, very difficult to combat, and they happen to all patients with cancer, and not only if they’ve had chemotherapy. We certainly have seen patients, particularly breast cancer patients, who never even had chemotherapy. Maybe they had surgery. Maybe they did or did not have radiation. However, they have the same cognitive problems that we see in patients who have received chemotherapy. We know there is a lot more to this than just the medications we’re providing and strategies to do these. I sometimes try to help my patients by exploring what exactly is their problem. Is it memory issues? Because there are go-rounds for everything. Sometimes I have them keep little notebooks where they can put buzz words and things in there to just sort of help them feel like they’ve got control and to reassure them that there is life after cancer. They can do whatever strategies we need to do to help get back into the workforce because they’re going to survive and we know with our five-year survival now approaching 70 percent, that they really are going to have an improved quality of life if they’re able to go back to work. 

Melanie:  If they are and that improved quality of life you’re talking about, what can they do to promote more of a healthy lifestyle at home? And when we talk about that fear of recurrence, do you need to keep checking again? I would think that some cancer survivors would want to go have scans every three months, make sure it’s not coming back. What do you recommend for healthy lifestyle, things they can do, and followup care? 

Dr. Meyering:  For healthy lifestyle, the most important things that I recommend is a very well-balanced diet. And I do not recommend fad diets for anybody. Lots of fruits and vegetables, must have fatty acids, must have healthy fats and enough protein. Exercise has been shown time and time again to help with the physical and the mental effects of cancer treatment. It seems to improve mental acuity. It improves reduced joint pain. There are a million and one reasons that exercise is beneficial. A lot of times my patients come to me and they say, “Oh, I am just way too tired.” The truth of the matter is that moving your body, just your strength and your stamina is improved by exercise in general. You’re right. A lot of patients do come in and want scans because they’re so concerned about their cancer coming back. There’s a lot of different reasons that we don’t do these things. For one thing, repeated scans is not good for us. This increases our risk to have exposure to ionizing radiation, plus it finds a lot of incidental things that really have no bearing on our health whatsoever, and that can result in many unnecessary procedures and surgeries and biopsies that we don’t really need. The other thing that’s important is that in most cases, a scan is going to find cancer in which it’s already past the point where we can cure it. Honestly, really what we need to be focused on is the ones that we can do something about, and that means continuing to do the routine screening. For breast cancer patients, that’s going to be histories and physicals and breast exams and looking for local recurrence, which we can do an awful lot for. If there is something that is outside of the breast, it presents with a symptom. People will have a pain related to wherever it is. Doing multiple scans doesn’t typically find that sooner. In some of my patients, however, in those patients we often do heightened surveillance because we can often do things to interact with it or to change the cure rate. I have to explain these things to the patients, and they’re usually very amenable once they understand what the limitations of the imaging is and how it can offer a negative impact on their health. 

Melanie:  Now, what about family relationships? As we talked so much about that fear of recurrence, the family must be terrified as well—children, spouses, parents, anybody who is dealing with cancer in a loved one. How do you work with, and what do you recommend for family relationships so that people can live a little bit less stressed life when they’re dealing with someone who’s surviving cancer? 

Dr. Meyering:  That is such a good question and it is so tricky because it depends on which relationships we’re talking about. The first concern is when there are children involved, and the age of the child certainly has a lot to do with it. Very often parents are afraid to let their children know that they are fighting a cancer battle because they’re afraid that their child will have fear. What we do see is that children have a remarkable ability to be understanding, and they feel rejected if they are not told what’s going on. “Why is dad feeling sick all the time?” or, “Why is mom losing her hair?” Most of the time, it is a better strategy to have the child part of the process in the beginning so that they have that ability to ask questions and to feel that they are not being kept in the dark from this. That is actually probably easier than some of the other problems that I come across in my office. A lot of times, this puts an unusual amount of strain on marriages. A lot of this is because of changes in body morphology. Sometimes people have had surgeries. Maybe they have ostomies where they have a bag for going to the bathroom. Sometimes they’ve had breast reconstruction, and all of these things cause problems both in the spouse but also in the patient themselves, because they look at themselves and they’re like, “Well, I’m not the person I was. I’m never gonna be the person I was. I’m something different. I have a new normal,” and it’s sometimes very difficult to accept that and that itself puts strain on it. The healthy relationship typically will survive a cancer diagnosis, but if the relationship is already strained, often it results in a failure in the relationship, which is adding additional problems to the patient who already is struggling to feel like they can move forward. The other thing that comes up is parents who have not children but adult children who have a diagnosis of cancer. No one feels that they want to see their child go through cancer treatments, but typically these relationships are preserved and supportive, and I don’t see nearly the problems for those. I think the body image is huge in a relationship, and the problem is often within the patients themselves. Counseling is often very helpful for those, and I usually recommend this for most of my patients. 

Melanie:  In just the last minute or so, Dr. Meyering, your best advice for families and loved ones and the people going through cancer and surviving it. 

Dr. Meyering:  Well, my best advice is cancer is not the definition of the person. It is something that happens to someone. It does not define you. It is only something that has happened. To move forward and be yourself and start the whole trip anew and turn the page and look forward, we now have to accept the new normal and to do it with gusto. I think that’s my best advice. 

Melanie:  Thank you so much. That’s great information. You’re listening to City of Hope Radio. For more information on the Center For Cancer Survivorship at City of Hope, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.