Post-Treatment Transition Can Be Scary for Cancer Survivors

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Post-Treatment Transition Can Be Scary for Cancer Survivors

Postby yowyow » Fri Apr 10, 2009 8:03 am

Post-Treatment Transition Can Be Scary for Cancer Survivors
D McNamara
20090303
2009 Apr 3
Elsevier Global Medical News
Post-Treatment Transition Can Be Scary for Cancer Survivors
Elsevier Global Medical News. 2009 Apr 3, D McNamara

H OLLYWOOD, Fla . (EGMN) — Many people experience fear, anxiety, and depression during the transition from cancer patient to survivor, according to a panel of oncologists, survivors, patient advocates, and others at the annual conference of the National Comprehensive Cancer Network.

Patients should be screened at the very least for anxiety and depression after the acute treatment period, said Mary S. McCabe, R.N., who runs a program for adult cancer survivors at Memorial Sloan-Kettering Cancer Center in New York City. In her experience, many patients can handle their initial treatment psychologically, "but they then run out of gas, and face both anxiety and depression. . . .They tell us that this is often the scariest time after the diagnosis. Up until then, there has been a plan."

Oncologists need to start addressing the gambit of patients' concerns before they transition back to their primary care provider, said Elizabeth Edwards, patient advocate, attorney, and wife of former North Carolina Senator and vice presidential candidate John Edwards. She noted that oncologists are the ideal providers to discuss end-of-life concerns with survivors.

"I have developed trust with this person, I have placed my life in their hands, and I want to hear information from them, even if they refer me," said Ms. Edwards who has breast cancer.

It helps when oncologists address end-of-life early in the course of treatment, said Dr. Douglas W. Blayney, medical director at the University of Michigan Comprehensive Cancer Center, Ann Arbor. He typically tells patients: "We will only talk about the end now, once, and you can bring it up any time you want." Having that conversation proactively and "letting the patient know you're open, that you're not going to talk doom and gloom all the time," helps people feel comfortable talking about their biggest worry. "Working that into your conversation at the second or third visit saves time down the road, and it's the polite thing to do."

Quality of life issues are also important, said Dr. Blayney, who urged oncologists to be open to a discussion of sexual health issues. "Many of us at large institutions have a team who can explore these things . . . but we as doctors need to introduce that to patients," said Dr. Blayney, who is incoming president of the American Society of Clinical Oncology.

"Patients assume we only want to know what happens to them physically, but [sexuality] is a huge area of recovery for patients," agreed Ms. McCabe.

Oncologists need to be proactive about asking survivors about all aspects of their lives, said Dr. Kenneth Miller, medical director, Lance Armstrong Foundation Adult Cancer Survivorship Clinic at the Dana Farber Cancer Institute in Boston. "Often, we ask cancer survivors how they are doing and they say 'fine.' But there is a family member there nodding their heads no."

An automated system that screens survivors for various issues would be ideal, said Catherine M. Alfano, Ph.D., program director, National Cancer Institute Office of Cancer Survivorship. The Institute of Medicine outlined such a systematic process in an October 2007 report called "Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs." The number of issues that some patients want to discuss can be "overwhelming," she said. Addressing these issues in a systematic way is key.

Patients have a tough time transitioning to primary care. "People want to cling to their cancer treatment providers. But clearly the doctors and nurses have to move on to take care of other people," said Sam Donaldson, former ABC News anchor and a survivor of melanoma from a diagnosis in 1995.

Oncologists have a significant role to play in easing that transition. New guidelines from NCCN address Cancer Survivorship Care, and are aimed at guiding this process.

The transition time is also a period of opportunity, when doctors can teach patients how to optimize their time as survivors, and emphasize the importance of healthy nutrition, exercise, bone health, and smoking cessation.

Acute care and long-term survivorship "are both teachable moments," said Dr. Miller.
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