What Cancer Survivors Can Do To Help Themselves
An increased understanding of the biology of cancer, improvements in cancer screening techniques and use, and the development of more effective cancer therapies have contributed to significant improvements in quality of life and survival for cancer patients. Due to these reasons, there are approximately 12 million cancer survivors living in the United States currently. Sixty-five percent (65%) of survivors will live at least five years and 10% will live at least 25 years after their cancer diagnosis. The majority of survivors have had breast, prostate, or colorectal cancer; are over the age of 65; and have at least one other medical problem or condition. The number of cancer survivors is growing, and many want to know what changes in their behavior and lifestyle can contribute to keeping them healthy after cancer and what they can do to help themselves recover after diagnosis and treatment.
Survivorship is a distinct component of cancer treatment and care. It involves follow-up and surveillance for recurrence and residual or late side effects of treatment, rehabilitation and recovery after treatment, management of other health conditions, psychological coping with the diagnosis and treatment, and adoption or continuation of healthy behaviors after treatment. A cancer diagnosis can be associated with limits in functional abilities and lower quality of life. Lifestyle behaviors that contributed to cancer risk can continue to threaten quality of life and survival after the diagnosis. Cancer survivors are at increased risk for recurrence of their initial cancer as well as for the development of new primary cancers and other medical problems such as diabetes, high blood pressure, cardiovascular disease, osteoporosis, functional decline, and premature death. As a survivor, it is important that you become your own health advocate to help make a difference in your health. You need to take an active role in your survivorship care.
Know Your Cancer History and Surveillance Plan
As a cancer survivor, you have different health risks and health care needs after completing your treatment. You and your oncology providers should develop a survivorship care plan that summarizes the treatment you received, the potential effects of the treatment, and the surveillance plan to monitor for cancer recurrence and effects of treatment. You should know the type of surgery you had, the type and length of chemotherapy you received, and the dose and location of radiation therapy you may have received. If you are a breast or prostate cancer survivor, you should also know about the type, side effects, and length of treatment of any hormonal therapy you may have received. Finally, you should know the possible long-term side effects of your treatments and understand the symptoms that may signal a recurrence or late treatment effect.
Your surveillance plan depends upon your type of cancer. Breast cancer survivors require regular doctor visits and annual mammograms throughout their lifetime. Routine use of bone scans, CT scans, breast MRI, or blood work is not recommended. Colorectal cancer survivors should undergo routine monitoring of the carcinoembryonic antigen (CEA) blood test and doctor visits for a total of five years. Colonoscopy should be performed one year after diagnosis in most patients, then at three years and every five years thereafter. The detection of polyps or other risk factors for colorectal cancer may alter this schedule. CT scans may be recommended for certain survivors. Prostate cancer survivors require a doctor visit, digital rectal exam, and a prostate-specific antigen (PSA) blood test at least annually throughout life. Lung cancer survivors should have a doctor visit and chest CT scan at least annually after their treatment. Other cancer survivors may require a combination of medical history, physical exam, blood tests, and imaging studies. You should talk with your oncologist about your specific follow-up plan and follow it closely.
Be Proactive About Your Health: Cancer Screening
In addition to monitoring for recurrence, it is important to undergo screening for other types of cancers. Your specific screening program may depend upon your prior therapy, various risk factors, family history, and age.
Generally, women without a history of breast or cervical cancer should undergo routine screening for these cancers. Breast cancer screening should begin in women over the age of 20 with a clinical breast exam by your doctor or gynecologist every one to three years. Women age 40 and older should undergo clinical breast exam and mammograms annually. Those women with a higher lifetime risk of breast cancer may require more intensive screening. Cervical cancer screening in the form of a pelvic exam and Pap test should begin no later than age 21 and occur annually or every two years, depending on the test your doctor uses. Talk to your gynecologist about when this schedule may change or when you may stop screening tests.
Survivors without a history of polyps, inflammatory bowel disease, or colorectal cancer should undergo colorectal cancer screening, usually beginning at age 50. This screening can be done by a colonoscopy every ten years (or sooner if polyps are found), flexible sigmoidoscopy every five years, or stool testing for blood with or without flexible sigmoidoscopy. Talk with your doctor about your screening options and preferences.
Prostate cancer screening in men without a history of prostate cancer is controversial, and men age 50 and older should talk with their doctors about whether to undergo screening. If you are African American or have a father or brother with a history of prostate cancer before age 65, you may have a higher risk of prostate cancer and should talk with your doctor about the risks and benefits of prostate cancer screening at age 45.
Be Proactive About Your Health: Care for Non-Cancer Conditions
Routine care for non-cancer medical conditions is important during and after a cancer diagnosis. Cancer survivors die of non-cancer causes at higher rates than the general population, with half of these deaths related to cardiovascular disease. In order to ensure the best outcome after a cancer diagnosis, it is important to maintain regular follow-up with your primary care and other physicians.
The US Preventive Services Task Force has guidelines for the necessary preventive care of adult men and adult women. You should discuss these recommendations with your doctors to decide which screening tests are right for you. In general, you should undergo routine monitoring of your blood pressure and cholesterol and routine screening for diabetes. Postmenopausal women should undergo bone density monitoring at regular intervals and ensure adequate calcium and vitamin D intake. If you already have these conditions, your monitoring should be based on your treatment. Regular vaccination against influenza is recommended for all adults, and vaccination against pneumonia, shingles, or chicken pox may be appropriate for certain survivors. If you are currently smoking, quitting is important for your health, regardless of where you are in your survivorship journey. Talk with your doctor about the preventive care you require and what programs or help is available if you want to stop smoking.
Engage in a Healthy Lifestyle
Although a cancer diagnosis may be a time in which survivors are motivated to make lifestyle changes, the majority of cancer survivors have health behaviors similar to the general population. These behaviors include being sedentary; remaining overweight; eating less than optimal amounts of fruits, vegetables, and fiber; and eating high amounts of saturated fats. Meeting diet and activity recommendations has been shown to be associated with improvements in outcomes such as recurrence, mortality, and quality of life. Given that energy balance (the balance between caloric intake and caloric output) and increased weight or obesity are concerns in a significant number of cancer survivors, recommendations regarding healthy behaviors have been issued by the American Cancer Society, the American College of Sports Medicine, and the American Dietetic Association.
Maintaining a healthy weight throughout your life is an important component of a post-cancer lifestyle. A healthy weight is based on your height and is often expressed in terms of body mass index, or BMI. BMI is calculated as body weight in kilograms divided by height in meters squared. A BMI of 18.5 to 25.0 kg/m2 is considered to be ideal, while a BMI of 25.0 to 29.9 kg/m2 is considered overweight and 30.0 kg/m2 and over is considered obese. For help in calculating your BMI, check out this website.
In the US, obesity contributes to an estimated 14-20% of cancer-related mortality. Excess body weight has been associated with higher rates of death from all cancers, as well as from specific cancers such as breast, colorectal, and prostate cancers. Survivors who are overweight or obese should attempt to lose weight, while their health care providers and caregivers should encourage and support their efforts. The best way to achieve a healthy body weight is to balance the amount of calories you consume in food and drink with the calories you burn through physical activity and exercise. Even modest decreases in caloric intake (50-100 calories per day) or modest increases in physical activity (30 minutes per day) can result in maintenance of a healthy body weight or gradual weight loss in many survivors. Minimizing added sugars, saturated and trans fat, and alcohol intake are healthy ways to lower caloric intake. Smaller portion sizes and smarter food choices (such as limiting refined sugar intake and high calorie foods and drinks) can also help.
Consume a healthy diet with an emphasis on plant sources, including five or more servings of a variety of fruits and vegetables each day, and limited consumption of processed and red meats. Choose whole grain products over refined starches (i.e. pastries, sweetened cereals), and poultry, fish, or beans over beef, pork, or lamb for protein sources. Consuming a variety of plant-based foods that replace calorie-dense processed foods is also important. Knowing the amount of a standard serving size for a given food is needed to make intelligent choices when selecting the type and size of your portions. Limiting alcohol intake to no more than two drinks per day for men and one drink per day for women is also recommended. (A drink of alcohol is defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof hard liquor.) Total alcohol intake, not type, is the most important factor when evaluating alcohol consumption. Drinking at least eight cups of liquid (water and other fluids excluding soda) is also recommended.
Supplement use is necessary only if you are unable to maintain adequate nutritional intake through your diet. In general, food is the best source of vitamins and minerals. Antioxidants and folate should be consumed through food sources such as fruits and vegetables. Calcium and vitamin D intake is important for bone and general health and may be found in dairy products, vegetables, and fish. The use of a multivitamin that contains no more than 100% of the “Daily Value” of most nutrients is recommended for those who cannot meet their nutritional needs through diet alone or who have specific deficiencies.
Exercise and physical activity are generally safe for cancer survivors during and after cancer treatment. Exercise and physical activity improve quality of life, physical functioning, and fatigue. Physical activity may also improve recurrence risk and survival in certain cancers. Thus, the American Cancer Society and American College of Sport Medicine recommend regular physical activity for cancer survivors. These organizations endorse the US Department of Health and Human Services recommendation for at least 30 minutes of moderate to vigorous intensity physical activity, in addition to usual activity, on five or more days of the week, or an overall volume of 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity exercise weekly. Strength training for major muscle groups should be performed with appropriate supervision two to three weekly sessions with stretching of major muscle groups on days when other exercise is performed. Supervised slowly progressing weight training is considered safe in breast cancer survivors, but may require the use of compression garments for those women who have or who are at risk for lymphedema. The avoidance of activities that increase pressure within the abdomen may be necessary colorectal cancer survivors with ostomies. People with chronic medical conditions or physical effects of treatment should consult their health care providers before starting an exercise program.
Ways to increase physical activity include using the stairs rather than the elevator, walking to a destination rather than using the car, using a treadmill or stationary bike while watching TV, or visiting a coworker to discuss a topic rather than sending an e-mail. Planning active vacations, joining a sports team, or playing with your kids in a physically active way are also fun ways to increase activity. In general, returning to your normal physical activity routine as soon as possible after any component of your treatment is important to maintain lean muscle mass and ward off weight gain.
You are a cancer survivor from the time of your diagnosis and throughout your life. You have been through an experience that forever changes you, from a health perspective and in many other ways. Survivorship is an arena in which you can advocate for your best health outcome. While following surveillance, preventive care, and medical recommendations and maintaining a healthy weight, diet, and level of activity may not guarantee that your cancer will not return, working with your health care team and practicing healthy behaviors can maximize your chances that you will live your life to its fullest. It is something you can do.
The information found here is not intended to provide nor should it be interpreted to provide professional medical, legal or financial advice. You should consult a trained professional for more information.
Category: Experts Speak
Tags: cancer screening, diet, exercise, Healthy Lifestyle, recurrence, residual or late side effects, Surveillance Plan, Survivorship