Surviving Cancer

When treatment ends, people often expect life to return to the way it was before they were diagnosed with cancer. This rarely happens. You may have permanent scars on your body, or you may not be able to do some things you once did easily. Others may think of you--or you may view yourself--as being somehow different.

After you've finished your cancer treatment

This information designed mainly for cancer survivors who have recently completed their cancer treatment, but you may find the information helpful even if you were treated a long time ago. The purpose of this information is to give cancer survivors and their loved ones a better idea of what to expect during the first few months after treatment ends. It covers what may happen with:

• Your medical care
• Your body
• Your mind and your feelings
• Your social relationships
• Practical matters such as job and insurance issues

As you'll see, this information talks about many concerns of those who have been through cancer treatment and offers suggestions that have helped others move forward. As you read, you may find yourself saying, "That's just how I feel."

Although this information describes issues that are important to many survivors, each person has a unique response to having cancer. While some of the issues covered may reflect your experience well, other issues may not concern you. Focus on finding what works for you. The information is not intended to be all-inclusive. Resources are provided at the end of the article if you need more information on a given topic or one that is not included. We encourage you to be active in getting the information and support you need.

It is natural for anyone who has finished cancer treatment to be concerned about what the future holds. Many people worry about the way they look and feel and about whether the cancer will come back. Others wonder what they can do to keep cancer from coming back. Understanding what to expect after cancer treatment can help survivors and their families plan for follow-up care, make lifestyle changes, stay hopeful, and make important decisions.

All cancer survivors should have follow-up care. But you may have a lot of questions about getting the care you need now, such as:

• Whether to tell the doctor about symptoms that worry you
• Which doctors to see after treatment
• How often to see the doctor
• What specific tests you need
• What you can do to relieve pain and other problems after treatment
• How long it will take for you to recover from treatment and feel more like yourself

Dealing with these issues can be a challenge. Yet many say that getting involved in decisions about their future medical care and lifestyle was a good way for them to regain some of the control they felt they lost during cancer treatment. Research has shown that people who feel more in control feel and function better than those who do not. Being an active partner with your doctor and getting help from other members of your health care team is the first step.

This next section offers some guidance on working with the people who provide care after treatment. It describes the kinds of help you may need and provides tips for getting what you want out of your medical visits. Reading this section can also help you create a plan of action for your recovery and future health.

The main purpose of follow-up care is to check if your cancer has returned (recurrence) or if it has spread to another part of your body (metastasis). Follow-up care can also help in:

• Finding other types of cancer
• Spotting side effects from treatment now or that can develop years after treatment

Follow-up care means seeing a doctor to get regular medical checkups. At these visits, your doctor will:

• Review your medical history
• Examine your body

Your doctor may run follow-up tests:

• Imaging procedures (ways of producing pictures of areas inside the body)
• Endoscopy (the use of a thin, lighted tube to examine organs inside the body)
• Blood tests

Follow-up care can also include home care, occupational or vocational therapy, pain management, physical therapy, and support groups.

Which Doctor Should I See and How Often?

You will need to decide which doctor will provide your cancer follow-up care and which one(s) will provide other medical care. For follow-up cancer care, this may be the same doctor who provided your cancer treatment. For other medical care, you can continue to see your family doctor or medical specialist as needed.

Depending on where you live, it may make more sense to get cancer follow-up care from your family doctor than to travel long distances to see an oncologist. No matter whom you choose as a doctor, try to find doctors you feel comfortable with.

At your first follow-up visit, ask your doctor to recommend a follow-up schedule. In general, people who have been treated for cancer return to the doctor every 3 to 4 months during the first 2 to 3 years after treatment, and once or twice a year after that for follow-up appointments. Some medical organizations also have follow-up guidelines for certain cancers and update this information as researchers develop new approaches to follow-up care.

Follow-up care will be different for each person who has been treated for cancer, depending on the type of cancer and treatment he or she had and the person's general health. Researchers are still learning about the best approaches to follow-up care. This is why it is important that your doctor help determine what follow-up care plan is right for you. Lastly, it is important to note that some insurance plans pay for follow-up care only with certain doctors and for a set number of visits. In planning your follow-up care schedule, you may want to check your health insurance plan to see what restrictions, if any, apply to your follow-up care after cancer treatment.

Keep in Mind

Some people may suspect that their cancer has returned, or they notice other changes in their bodies. It is important for you to be aware of any changes in your health and report any problems to your doctor. Your doctor can find out whether these problems are related to the cancer, the treatment you had, or another health problem. Even if you learn that your cancer has returned, there is no reason to lose hope. Many people live good lives for many years with cancer that has returned.

Do You Have Trouble Talking to Your Doctor

It is not always easy to talk with your doctor. Sometimes, he or she uses terms you do not know. When this happens, it is important to stop and ask the doctor to explain what the words mean. You may be afraid of how you will sound to the doctor, but having questions is perfectly normal.

Talking with your doctor is important. Both of you need information to manage your care. Telling the doctor about your health and asking questions helps both of you do your "jobs" well. Here are some points to cover.

At your first follow-up visit, ask your doctor/health care team about:

• The tests and follow-up care you need, and how often you will need them.
• The kinds of physical problems you may have from your cancer treatment and what you can do to prevent, reduce, or solve them. T
• he potential long-term effects of treatment and the warning signs that you might have them.
• The warning signs that cancer may be coming back and what to do if you see them.
• Fears you may have about follow-up care.

Keep in Mind

Many survivors want to learn about symptoms that may indicate their cancer has come back, or recurred.

There are many types of symptoms that may show if cancer has returned, and it depends on each person, the kind of cancer she/he was treated for, and the kind of treatment he/she had.

It is for this reason that you should talk to your doctor about the signs or symptoms that you should watch for and what you should do about them.

At each visit, tell your doctor/health care team about:

• Symptoms that you think may be a sign of cancer's return.
• Any pain that troubles you.
• Any physical problems that get in the way of your daily life or that bother you, such as fatigue, trouble sleeping, loss of sex drive, or weight gain or loss.
• Other health problems you have, such as heart disease, diabetes, or arthritis.
• Any medicines, vitamins, or herbs you are taking and any other treatments you are using.
• Any emotional problems you may have, and any anxiety or depression you have had in the past.
• Any changes in your family medical history.
• Things you want to know more about (such as new research or side effects).

Your health care team should be able to help you or refer you to someone who can help with any side effects or problems you may have. You have a right to get the help you need.

Complementary and alternative medicine includes many different healing approaches that people use to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. An approach is generally called complementary when it is used in addition to treatments prescribed by a doctor. An approach is often called alternative when it is used instead of treatments prescribed by a doctor. Research has shown that more than half of all people with cancer use one or more of these approaches.

Some common approaches include: visualization or relaxation; acupressure and massage; homeopathy; vitamins or herbal products; special diets; psychotherapy; spiritual practices; and acupuncture.

Even though you have finished your cancer treatment, if you are thinking about using these methods, discuss this decision with your doctor or nurse. Some complementary and alternative therapies may interfere or be harmful when used with treatments normally prescribed by a doctor.

After cancer treatment, many survivors want to find ways to reduce the chances of their cancer coming back. Some worry that the way they eat, the stress in their lives, or their exposure to chemicals may put them at risk. Cancer survivors also find that this is a time when they take a good look at how they take care of themselves and their health. This is an important start to living a healthy life after cancer.

When you meet with your doctor about follow-up care, you should ask about developing a wellness plan that includes ways you can take care of your physical, emotional, social, and spiritual needs. You may not be used to talking with your doctor as a partner in planning for your health, so it may be hard for you at first, but it is very important that you do it. The more you do it, the easier it will become.

Research is just beginning to show what people can do to lower their risk of getting certain cancers. But we don't yet know why cancer comes back in some people and not others.

Making changes in the way you eat, exercise, and live your life may not prevent your cancer from coming back. However, making these changes can help you feel better and may also lower your chances of developing other health problems.

Changes you may want to think about:

• Quitting smoking. Research shows that smoking can increase the chances of developing cancer at the same site or another site. For more, please read the Smoking and Quitting Smoking article.
• Cutting down on how much alcohol you drink. Research shows that drinking alcohol can increase your chances of developing certain cancers.
• Eating well and exercising.

Eating Well After Cancer Treatment

1. Eat a variety of healthful foods, with an emphasis on foods from plant sources.

• Eat five or more servings of vegetables and fruits each day.
• Choose whole grains--rather than processed (refined) grains and sugars.
• Limit eating red meats, especially high fat or processed meats.
• Choose foods that help you maintain a healthy weight.

2. Adopt a physically active lifestyle.
3. Maintain a healthy weight throughout the rest of your life.
4. Limit drinking alcohol, if you drink at all.

Source: American Cancer Society Recommendations for Nutrition and Physical Activity for Cancer Prevention, 2002

Exercise After Cancer Treatment

Few studies have been done to find out whether physical activity affects survival after cancer treatment. More research is needed to answer this question, but studies have shown that moderate exercise (walking, biking, swimming) for about 30 minutes every--or almost every--day can:

• Reduce anxiety and depression
• Improve mood
• Boost self-esteem
• Reduce symptoms of fatigue, nausea, pain, and diarrhea

During recovery, it is important to start an exercise program slowly and increase activity over time, working with your doctor or a specialist (such as a physical therapist) if needed. If you need to stay in bed during your recovery, even small activities--like moving your arms or legs around--can help you stay flexible, relieve muscle tension, and help you feel better. Some survivors may need to take special care in exercising. Talk with your doctor before you begin any exercise program.

For additional information, please visit the Cancer Center.