Print

Email story

Comment

Email editor

Cancer-free doesn't mean carefree

After facing down cancer, patients still need support and education to overcome the challenges ahead.

By DAVID LIPSCHITZ, M.D., Special to the Times
Published October 31, 2006

Due to early detection and patient education, the world of medicine has reduced dramatically the number of deaths from many illnesses and diseases.

It seems this is most prevalent with cancer. Enhanced detection as well as improved radiation, surgery and chemotherapy have greatly increased the number of cancer survivors, currently estimated to be 10-million.

In the past 30 years, the chance of surviving cancer for more than five years has increased from 50 percent to 64 percent. But now that we see so many more survivors, new issues are arising.

Earlier this year, the Institute of Medicine issued a series of reports about problems facing cancer survivors. Many patients fall through the cracks and do not receive comprehensive and coordinated follow-up care.

Additionally, the report states that these survivors "have moved from an orderly system of care to a 'non-system' in which there are few guidelines to assist them through the next stage of their lives."

Cancer survivors and health-care providers receive little education about follow-up care. Of even greater concern, often patients do not understand the nature of their disease, the potential long-term effects of therapy, how they should be screened and the signs and symptoms to look for in order to detect a recurrence.

This lack of patient education is a common reason for needless anxiety. Frequently, cancer survivors come to see me complaining of a symptom such as chest, back, abdominal or breast pain, constipation, diarrhea or an inconsequential lump. Most cancer survivors do not understand that, in general, pain is a rare symptom of recurrent cancer.

Seldom does the patient state that he is worried his cancer has recurred. Yet the good physician will realize this is a concern and conduct the necessary tests in order to provide reassurance.

These unstated anxieties are the reason the Institute of Medicine recommends that upon completion of treatment, every cancer patient receive a complete record that summarizes his illness, the treatment given, the potential short-term and long-term effects of treatment some therapies, for example, increase the risk of other cancers, and the symptoms that may suggest a recurrence or the development of a second cancer.

The patient must be given clear and definite instructions on the frequency of required cancer screening as well as the needed tests and examinations to make certain that the tumor has not recurred.

The patient should be responsible for assuring that these needed tests are scheduled.

Just as important is the impact of being a cancer survivor on marriage, sex, family relationships and the need for psychological support. The patient also must be made aware of potential benefits for which he may be eligible as well as the financial, employment, insurance and legal implications of being a cancer survivor.

He should receive education on nutrition, exercise and strategies to reduce the risk of recurrent cancer and many other diseases. Cancer survivors must be made aware of community resources (such as the American Cancer Society) as well as appropriate Web sites that provide information and education.

Physicians, too, must be trained to understand the unique needs of cancer survivors. These include the risks of recurrence, how frequently screening should occur and the impact that surviving cancer has on quality of life, anxieties about recurrence and the high prevalence of depression and family conflicts.

The doctors, too, must be made aware of community support services that can be of value to them and their patients.

Here, team care is essential, with nurses, pharmacists and social workers playing key roles in providing appropriate support for cancer survivors.

If you or someone you know has survived cancer, make sure that you are educated about what to expect. As an empowered consumer of health care, you can assure that chances of recurrence are reduced and that you have the highest possible quality of life.

Gerontologist David Lipschitz, M.D., Ph.D., is the author of "Breaking the Rules of Aging." Write to him at askdrdavid@msn.com or go to www.drdavidhealth.com.

[Last modified October 30, 2006, 19:21:33]