Late Effects After Cancer
“Beyond the Oncologist’s Office: A Comprehensive Health Program for Cancer Survivors” a personal reflection by Kate Murphy
Advocate, Hereditary Colon Cancer Association
“I feel like I’m out there without a safety net,” a woman writes to the Colon Cancer Discussion e-mail list.
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She has reached the 5-year mark after her colorectal cancer diagnosis, and her oncologist has told her that annual visits are no longer necessary. She does need a colonoscopy every 3 to 5 years because a second primary colon tumor is more likely for her than the general public. But there is no evidence that routine blood tests or scans will benefit her. Like most long-term cancer survivors, she will probably die of something other than cancer.1
Although she, like many cancer survivors, worries about her cancer returning, she probably should be watching for cardiovascular disease and working to prevent it. She also needs to be alert for other cancers and be screened regularly for them.
“The evidence that cancer patients die of non-cancer causes at a higher rate than persons in the general population is overwhelming,” a researcher studying mortality data for cancer survivors writes. 2
My friend’s safety net is changing. A family physician or internist will probably care for her. That doctor will need to know the details of her cancer treatment but will also focus on healthy body weight, hypertension, and cholesterol levels.
Maintaining a healthy body weight may not be easy. Many cancer survivors reduce the amount of exercise they get during treatment and don’t return to their earlier levels of physical activity afterwards.3 A study of pre-menopausal women who received chemotherapy showed that they gained a large amount of body fat during the year following diagnosis. In fact, the fat gained and lean body mass lost was equal to 10 years of normal aging.
The President’s Cancer Panel, in their 2003 Annual Report, Living Beyond Cancer, Finding a New Balance, recommends that upon discharge from cancer treatment every patient
- Should be given a record of all treatment received and important disease characteristics
- S hould receive a follow-up care plan incorporating evidence-based standards of care
Patients can take this information to future physicians alerting them to follow-up care and to risks that might be present due to late effects of treatment, including higher risk of cardiovascular disease.
How can my friend build her new safety net?
- She can make sure that she receives a complete record of her cancer treatment and follow-up recommendations from her oncologist.
- She can follow standard recommendations for cancer screenings including Pap tests, mammograms, and colonoscopy.
- She can find a skilled and experienced primary care physician who will recognize her higher risk for cardiovascular disease and other late effects of treatment.
- She can try to maintain a healthy body weight and decrease risk for heart attack and stroke by
- I ncreasing her physical activity
- Increasing the amount of fruits and vegetables she eats every day
- Reducing the amount of red meat and fat in her diet
Increased physical activity will not only decrease risk of heart attack, stroke, and some cancers, it may also help with depression and other emotional issues that she may have as a cancer survivor.
Still she worries, out there without a safety net. I understand that. It’s been 10 years since my last cancer treatment, 21 years since my first cancer diagnosis. And I still worry more about cancer than my very real hypertension, overweight, and type 2 diabetes. Cancer terrifies! But information soothes and empowers!
As I wrote several years ago when a new, fortunately benign, lump appeared in my breast:
I walked five years
without stumbling over
that particular stone,
that particular scar.
Five years, you realize
is very strong magic,
an oak door to slip through,
turn and slam.
The promised door in sight,
the old scar bloomed, rose
on my mauled breast, hard,
round, a familiar terror.
From deep in fog, doors creaked,
banged in the wind, sent magic
Machines, knives, noise.
No doors, only passages,
dark, iron, smelling of wolves.
1 PA Wingo et al., Long-term cancer patient survival in the United States, Cancer Epidemiol Biomarkers Prev. 1998 Apr; 7(4): 271-82
2 Kerry S.Courneya, PhD, Promoting Behavior Change After Cancer: Physical Activity
3 Wendy Demark-Wahnefried PhD, RN, LDN, Cancer Survivors: Hungry and Need of Dietary Change