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  Yale-New Haven Hospital, New Haven, Connecticut, USA HealthLINK: Cancer

July 2007

News this month
Researchers looking
at programs to help
cancer survivors

Cancer survivorship is being more intensely studied in the United States as the number of cancer survivors grows. Doctors are finding that cancer survivorship programs are helping the burgeoning number of patients cope with after-effects of the disease. The fact is, everyone has some side effects from cancer – whether it’s noticing slight hair loss to experiencing pain. For some, depression and living in fear of reoccurrence is their complication.

Patricia Ganz, MD, professor, University of California Schools of Medicine and Public Health, Los Angeles, and director of the Jonsson Comprehensive Cancer Center Patients and Survivors Program, and her colleagues are studying the effects of surviving cancer.

There are 10.1 million survivors Innovative new treatments and targeted therapies are helping to cure more and more cancer patients and are providing hope for patients living with cancer. These exciting developments are leading to the growing number of cancer survivors, now estimated to be 10.1 million people, in the United States. Cancer survivors have unique health concerns resulting from the treatments they were given to fight their cancer and should be monitored by physicians and supportive care professionals specializing in side effects of treatment.

Researchers are exploring fatigue, sleep and cognitive functions of cancer survivors, and they are studying the immunologic and physiologic causes of side effects. In addition, they’re testing therapies such as yoga, and studying whether some drugs can block symptoms of fatigue.

Side effects can involve the entire body
Writing in Supportive Oncology in February 2007, Dr. Ganz and her fellow researchers indicated that late effects of chemotherapy and radiation can affect almost every body system.

For example, breast cancer survivors seem to have better emotional health but decreased physical function when compared to other women.

This can be attributed to use of adjuvant chemotherapy or the drug tamoxifen, according to the researchers. They reported in Supportive Oncology, “Breast cancer survivors, in general, are doing very well, but having adjuvant chemotherapy or tamoxifen leads to subtle changes in function.”

In addition, fatigue is common among survivors and can be associated with insomnia, forgetfulness, distractibility, diminished activity and other issues.

According to the researchers, there’s a biologic reason for fatigue. Cancer treatments cause the release of pro-inflammatory cytokines that lead to fatigue. Cytokines are proteins and peptides that are chemical signals similar to hormones and neurotransmitters that allow cells to communicate.

Survivorship programs recommended
To combat cancer complications, Dr. Ganz and her associates recommend programs like the Connecticut Challenge Survivorship Clinic at Yale Cancer Center, which is the first program of its kind in Connecticut. Programs like this can help people address pain, alternative therapies, diet, exercise and wellness concerns, all of which can help assure a better quality of life.

They recommend that survivor clinics and registries be launched to contribute to a better understanding of the late effects of cancer and the needs of cancer survivors. Patients should be given checklists of what to expect, including weight guidelines, changes in organs, and how menopause and sexual function can be affected.

The researchers wrote: “We should give patients a treatment summary and survivorship care plan. We should send them forward based on the kind of treatment they had and expect them to become participants in their lifetime care.”


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We would be happy to assist you in scheduling an appointment with a member of the hospital’s medical staff. Use the link above or call:

203-688-2000
or toll free
1-888-700-6543
to talk with a referral coordinator.



Kenneth D. Miller, MD

Offering hope and healing

Cancer death rates have been dropping since 2003. That’s great news, but it suggests another issue: cancer survivorship.

There are more than 10 million cancer survivors in this country, a number so significant that cancer survivorship programs are opening. There are 12 programs around the country, one of which is here at Yale Cancer Center.

Multidisciplinary support and follow-up care programs are needed because as the prognosis improves, the number of people cured or living with the disease will reach critical mass.

While most cancer survivors have a special appreciation for life, they may fail to talk about residual issues.

Special needs of cancer survivors
Each cancer survivor experiences unique health concerns. It is estimated that 10-15 percent of survivors experience side effects such as pain, chronic fatigue, cognition changes or depression. Cancer survivorship programs help survivors deal with these issues. They address three common areas: the medical side effects of treatment, psycho-social concerns and body image.

Many of the medical issues affecting cancer survivors are the after-effects of chemotherapy and radiation. What is called late toxicity can affect the brain, bone and soft tissue, and it can cause nausea, vomiting, hair loss and low blood counts.

Chronic pain can also result, especially after a mastectomy for breast cancer. Chemotherapy can also cause neuropathy, which is nerve damage.

Typically, pain problems develop soon after treatment. In some cases, pain will resolve, but in others it lingers.

Side effects can be controlled
Many times, patients don’t tell their doctors about pain and live with it. They say they keep it from their doctors because:

  • they feel a sense of profound joy just to be alive.
  • they fear that pain means the cancer is back.
  • they fear their doctor will give up on them.
  • they think that pain is expected after cancer treatment.
  • they fear that they’ll get hooked on narcotics and have medication side effects.
  • they think that there’s nothing the doctor can do.

And some doctors may not ask cancer patients if they have pain. As a cancer pain specialist, I find that taking a good pain history means using the acronym WILMA. Words, Intensity, Location, Medication, Aggravate.

I ask patients to first describe the type of pain they have in their own words, its intensity on a numerical scale, and the location of the pain. Then I ask them what medications help and what tends to aggravate or relieve the pain.

Survivors should realize that pain can be treated, so it’s important for them to tell their doctor what they’re feeling.

How Yale Cancer Center’s program can help
At the Connecticut Challenge Survivorship Clinic at Yale Cancer Center, we encourage patients to share everything with their doctor. We also counsel them on diet and exercise, and how complementary medicine responses like Reiki, meditation, yoga and massage can help.

We have a social worker and nurse on staff who understand the long-term side effects of cancer and who can help guide patients through the recovery journey. Patients come to the program for just one visit or for ongoing transitional management of symptoms, especially for those with pain.

At the Survivorship Clinic, we tell cancer survivors that hope is free and has no side effects. We let them know that they are not their cancer diagnosis, and that the experience of cancer and its related issues are different for all patients.

If you are a cancer patient, I recommend talking to your doctor, sharing your feelings with friends, and understanding that most symptoms can be treated effectively.

Kenneth D. Miller, MD, is assistant professor of medicine, medical oncology for Yale School of Medicine, and medical director of the Connecticut Challenge Survivorship Clinic at Yale Cancer Center.



For more information about the Connecticut Challenge Survivorship Clinic at Yale Cancer Center, call (203) 785-CARE (2273)



best_hospitals_2007

Yale-New Haven Hospital was ranked among the very best in the nation in cancer treatment by U.S. News & World Report in 2007.

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