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Facing Forward: How to Move On After Cancer Treatment

When you go through something as stressful, traumatizing, and life-altering as cancer, you may come out on the other end of the tunnel feeling like you were just put through the spin cycle. There’s no “normal” way to respond to a cancer diagnosis, treatment, or remission prognosis, and you should never force yourself into taking on one specific emotion or perspective. You may feel angry, sad, scared, hopeful, or joyous, and all are perfectly acceptable responses to have.

Regardless of how the experience left you feeling, it’s important to work at moving on and processing it in a healthy way. Here are a few ways to help you do it.

Measure Your Mental Health

You’ve spent the last several months or years caring for your body to the point of exhaustion. Now it’s your brain’s turn. Depression, anxiety, post-traumatic stress, and cancer fears are quite common among survivors. In fact, between 18 and 20 percent of adult cancer survivors report symptoms of anxiety[1], while almost 80 percent of survivors experience some level of fear of recurrence. It’s vital that cancer survivors and patients alike are constantly looking inward and taking daily measurements of mood and general well-being. If you experience any persistent, negative feelings, be sure to seek out advice from a licensed mental health professional.

Focus on Daily Self-Care

Because your daily life was thrown completely off track during treatment, it can be hard to settle back into a healthy routine when it’s all over. Implementing certain self-care practices into your day-to-day life can help you stay mindful and prevent you from slipping into prolonged states of anxiety or depression. It will help you immensely to pick up healthy self-care practices, such as yoga, meditation, or long evening baths. Integrating weekly or bi-weekly social time will also help quite a bit, especially if you’re spending time with people who share similar interests or experiences.

Work on Rebuilding Self-Confidence

Though we’re ever-grateful that they exist (and save thousands of lives each year), chemotherapy, surgery, and radiation take a massive toll on our bodies. They leave us looking and feeling burnt out and exhausted, often grinding the last little bit of self-confidence we have into a sad, lifeless pulp. Even if you’ve never been a particularly vain person, your life post-cancer is time to help you regain your self-worth at every turn, and it’s perfectly okay to spend some time making yourself feel beautiful both inside and out! Here are some great ways to do it:

Regrow a Full Head of Hair

If you lost your hair during chemotherapy, there are a few cutting-edge hair loss treatments to consider. Though they’ve only been cleared to treat hair loss due to androgenetic alopecia by the FDA, many people find that low-level laser therapy devices help hair to grow back [2] quicker and healthier after treatment. Luckily, while it takes a little bit of time, most cancer patients are able to fully grow back their hair.

Work on Getting Back to a Healthy Weight

Cancer patients know that the constant barrage of chemicals and harsh treatments can seriously mess with our weight. Weight loss is one of the most common symptoms of both cancer and treatment, with between 40 and 80 percent of patients reporting weight loss [3] and cachexia (wasting) from diagnosis to advanced treatment. Working with your doctor or a dietician will help you return to a healthy weight in a safe way. He or she will design a diet and, if needed, prescribe medication to help you manage your weight.

Treat Your Skin and Nails

Hair isn’t the only physical feature that takes a beating during the treatment process. Chemotherapy and radiation can leave skin red, dry, itchy, or discolored, and it tends to leave nails cracked, infected, or yellow. A full-blown spa day is in order after you’ve recovered from your final treatment. Make sure to also see a dermatologist, especially if you’ve seen any serious changes in your skin since you were diagnosed. 

Connect with Other Survivors

Building up a strong social network is vital to staying happy and positive post-cancer, and nobody will help you get there faster than fellow survivors. Like anything on this list, make sure you ease into it and wait until you’re fully ready. Having to recount your experience before you’ve fully processed it can worsen symptoms of post-traumatic stress, depression, and anxiety. But, after a period of time, it will help you feel stronger and more secure when you have a group of friends or family members to share your experience with. You can use the American Cancer Society’s resources database [4] to find specific support groups in your area.

Get Enough Exercise

Medical experts consistently say that exercise is among the most important components of a healthy life during and after cancer. One of the biggest reasons for this is that, though it sounds counterintuitive, getting physical can help reduce the ever-present cancer fatigue while also helping you get better sleep, reducing symptoms of depression and anxiety, and helping you build back muscle strength that may have deteriorated during treatment. Just be sure to follow all medical advice as you ease back into exercise, especially if you’ve recently had surgery.

Volunteer for a Research Foundation

If you’re experiencing any feelings of sadness, anger, or hopelessness, it can really help you to get involved in cancer-specific organizations that donate to research efforts. Finding a cure or at least more viable treatment options for this devastating disease is certainly on the horizon, but getting there takes a lot of money, resources, and effort. Getting involved can help you connect with other survivors and hopeful people, which will lead you into a deeper state of happiness and optimism.

Let Yourself Experience Loss, Pain, and Joy

Again, there’s no “correct” way to experience cancer, no matter if you’ve just been diagnosed or have just finished your final round of treatment. The most important thing you can do is to constantly take stock of your feelings, being careful not to suppress them, and do everything you can to stay healthy both mentally and physically every step of the way.


References:

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915316/

[2] https://www.capillus.com/blog/a-skeptic%E2%80%99s-guide-to-understanding-how-a-laser-hair-cap-helps-regrow-hair/

[3] https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/managing-physical-side-effects/weight-loss

[4] https://www.cancer.org/treatment/support-programs-and-services/resource-search.html

How to Read and Understand Scientific Research #patientchat Highlights

Last week, we hosted an Empowered #patientchat on how to read and understand scientific research. The #patientchat community came together for an engaging discussion and shared their best advice and tips.

Top Tweets and Advice


Understanding Scientific Research Is Critical


Science should be accessible to all


“The whole of science is nothing more than a refinement of everyday thinking”


Full Chat

Will Cancer Be Cured By 2020?

After cardiac diseases, cancer is the second most leading cause of death worldwide. According to WHO, 20% of deaths are down to cancer while in 2018, there were 18 million new cases, along with 9.6 million deaths were reported. Although the number of surveillance within five years after the diagnosis of cancer is 43 million. In the US alone, 1,688,780 new cases and 600,920 cancer-related deaths were reported in 2017 by National Cancer Institute (NCI).

Researchers have conducted meticulous studies to discover new ways to cure this deadly disease. Currently, the most effective treatment options are radiotherapy, chemotherapy, surgery, and hormonal therapy. But the concern is; how close are experts are in finding more effective treatment options for cancer? Many innovative therapies are beginning to pick up steam to defeat the battle against cancer and ideally having fewer side effects than available options.

Cancer is not just a game of winners and losers [1], these innovations are aimed to address the issues of aggressive treatment, recurrence, irreversible side effects that healthcare providers and patients both face. Below are some updates on the most advanced cancer research breakthroughs that have given us hope for better therapies and prevention methods with less harm.

1.   Immunotherapy

Immunotherapy aims to reinforce existing arsenals in our body to fight against cancer cells. Some types of cancers have the characteristic of duping our immune system. However, with the help of in vivo and in vitro experiments, researchers are exploring new ways to deactivate the protective system of cancer cells.

According to Nature Immunology, macrophages that usually eat up harmful foreign bodies and cellular debris fail to obliterate highly aggressive cancer cells. The reason behind this is the macrophages read out two different signals from cancer cells that are meant to rep-el them for cleaning mechanism. Hence, by blocking the dual signaling pathway, researchers can make white blood cells unable to perform their action.

2.   Therapeutic virus vaccines

Innovative virus vaccines are proven to be a surprising weapon to fight against cancer. In the UK, a team of scientists has succeeded to use reovirus against brain cancer cells [2] while not harming healthy cells. It can pass the blood-brain barrier hence opens up the possibilities towards betterment.

Another milestone is the discovery of dendritic vaccines, in which they are extracted from a person’s body and armed with tumor-specific antigens that make them hunt and smash the cancer cells. Then the dose is injected back to the patient’s body to boost the therapy. Some concerns raise as it may have some pitfalls of damaging healthy tissues.

To address this, researchers from North Carolina have developed a bio-responsive scaffold system to hold on both chemotherapy and immunotherapy with better control on targeting tumor.

3.   Nanoparticle revolution

Stakeholders believe that nanoparticles can be a game-changer in the treatment of cancer.  They are précised and are less invasive to target specific cells without harming the surrounding environment. They can be used to give hyperthermic treatment to make tumors shrink.

Researchers are working on self-regulating nanoparticles to target undifferentiated carcinoma cells without damaging healthy tissues. They can be used to target stem cells to treat the resilience of cancers. They can even be loaded with drugs to prevent recurrence of degenerative diseases [3] and can be beneficial in the treatment of invasive carcinomas such as endometrial and breast cancers.

4.   Starvation strategy for tumors

Starving cancer cells to death is a novel method to kill them. There are many studies onboard that prove multiple ways of cutting off cancer cells nutritional supplies. One effective way is to stop the glutamine supply. It will maximize the oxidative stress and induce cell death. Moreover, blocking the supply of vitamin B2 can halter cancer stem cells. Therefore the strategy can help to avoid the toxic effects of chemotherapeutic agents.

5.   Epigenetics

This refers to the alteration of gene expression to dominate the representative action to affect cells at a biological level. Recent advancements have shown that cancer cells can harbor epigenetic modifications [4] to promote progression and eradication of carcinoma.

Scientists have to channelize the potential without triggering Huntington’s disease, and this is the biggest challenge and concern for them that makes them more hopeful. The knowledge can be utilized to treat stubborn tumors and progress enzyme inhibitors for better success rates.

In a nutshell

Shawn Brad, Research content writer at King Essay [5] believes that researches have given us innovate safe ways to cure cancers and studies are running at a good pace; however, curing every type of cancer is definitely a matter of time. Promising studies immensely give us hope on some technological terms for upcoming years.

It is difficult to say that a single approach is going to work for a variety of needs, while much advanced emerging ways can be useful in treatments. Hence, there are optimistic efforts, that make us claim that cancer can be eradicated quickly, and further depth in knowledge can give us more targeted and précised tools to turn the tables.


Resource Links:

[1] Cancer is not just a game of winners and losers

[2] reovirus against brain cancer cells

[3] prevent recurrence of degenerative diseases

[4] harbor epigenetic modifications

[5] King Essay

How Do You Deal With Cancer Guilt?

It may come as a surprise to those who have not experienced cancer to learn that many cancer survivors suffer a form of “survivor guilt.”  Survivor guilt is most often associated with a reaction to surviving a traumatic event that others have died in, for example, survivors of combat, terrorist attacks, natural disasters, or air crashes. Survivors feel guilty that they have survived the trauma and others – such as their family, friends, and colleagues – did not.

When the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) was published, survivor guilt was removed as a recognized specific diagnosis and redefined as a significant symptom of post-traumatic stress disorder (PTSD).

It seems clear to me that a diagnosis of cancer fits both the description of survivor guilt and PTSD too. Cancer is a traumatic experience and no-one who survives treatment comes out the other side unscathed.    As so many of us know, the end of treatment is not the end of dealing with cancer.  When we’re going through treatment, we are simply trying to survive and don’t really feel the full emotional impact that being diagnosed with cancer involves. It’s often only when treatment ends, that the full impact hits us.

Cancer Related Guilt is a Complex, Multi-Faceted Emotion

We may feel guilt at “surviving” when others have not.  Dee Sparacio writes of her feelings at a time when a friend’s husband died. “How could I face my friend?  How could I, NED [No Evidence of Disease] for 5 years since my recurrence face my friend. Would she look and me and think – why are you still here and my husband is gone?”

Karin Sieger also describes her experience of feeling guilty after a relative died from cancer.  “A few years after my first cancer treatment, the terminal cancer diagnosis of a relative of mine, her gradual and then very quick deterioration and death filled me with the old feeling of guilt,” she writes. “In the presence of the bereaved mother my own mother felt guilty that her child is still alive. Cancer guilt can happen to anyone affected by cancer, including relatives and friends.”

We might feel guilty that our lifestyle choices somehow contributed to a cancer diagnosis. If we have discovered we carry the BRCA1/2 gene, we may feel guilty that we could pass this gene mutation on to our children.  On her blog, Audrey Birt describes how “breast cancer guilt has stalked me. Even when I’ve thought I’d put that beast to rest, up it pops in various guises. My guilt as a parent for causing my family to suffer has been a long term one. Carrying the BRCA2 gene tipped me again into a spiral of grief and guilt but somehow staying with that and recognizing that for what it is has helped me move through it.”

Cancer Guilt May Arise During Any Stage

I have also heard from patients diagnosed with an earlier stage disease, and patients who didn’t have to go through chemotherapy that they felt less “deserving” of sympathy.  One of my blog readers wrote, “I felt like a fraud when diagnosed as in I didn’t need chemo just surgery, radiation and tamoxifen so I didn’t want to make any fuss when so many others had REAL cancer.”

Guilt may also arise from a sense that what I’m doing with my life must have greater meaning if my survival is to be justified. Another of my blog readers commented, “I feel guilty that I am not making more of my life. When I was going through treatment, I made all sorts of plans for what I would do when I finished. I was really going to make the most of my life, now that I’ve been given a second chance…but I am too tired and overwhelmed to do any of those things.”

If any of this sounds familiar to you, you are not alone.  Feeling guilty at surviving cancer is a common experience and a perfectly normal reaction to what you have gone through. When I asked the question of my breast cancer community on Twitter “how you deal with survivor guilt?” I received some great answers.   I hope you will find comfort and practical advice in the quotes below.

“Cancer guilt was related to my family. Years before my diagnosis, my dad died of cancer. So they all had to do it again with me though a different situation. I felt huge guilt about my dad for not understanding. Counseling helped a lot. I would recommend counseling for sure. Or friends who listen and allow you to air the emotion.” Julia

Survivor’s Guilt

“I do feel a certain amount of “survivor’s guilt” since my cancer was stage 0 and no chemo or radiation-just surgery. Volunteering at a cancer support center helps me and inspires me filling me with hope – witnessing patients fortitude and determination to regain their health is so inspiring.” Susan

“The survivor guilt I felt was a sense of discomfort. I was quite possibly picking up someone else’s anger, frustration and despair at their own situation. But it is their situation, not mine. And since my second diagnosis I certainly have nothing to feel guilty about or to apologize for. We have a choice not do guilt, and also do not need anyone else to do guilt for us.” Karin

“As I’ve lost friends and colleagues to breast cancer I’ve grieved for them with an added complexity. What made the difference? Why did I survive and not them? In some ways I’m embarrassed I’m still here, four diagnosis later. It’s a form of madness to feel guilty you haven’t died, to feel guilty your treatment isn’t as bad as others, to feel guilty you’ve survived more than 20 years since your first diagnosis. I know it makes no sense but it’s easy to carry guilt along with everything else. But it serves no purpose and is fueled by a media that feeds a view of the cancer experience which is unrealistic, overly simplistic and laden with judgment.” Audrey

Overcoming Cancer Guilt

In his book, Travelling Light (The Columba Press) Daniel J. O’Leary quotes Bearwatcher, an Apache medicine man. “In the Apache language there is no word for ‘guilt.’ Our lives are like diamonds. When we are born we are pure and uncut. Each thing that happens to us in our lives teaches us how to reflect the light in the world; each experience gives us a new cut, a new facet in our diamond. How brilliantly do those diamonds sparkle whose facets are many, to whom life has given many cuts.”

So when you experience those feelings of guilt, contemplate the brilliant new facet in your diamond and reflect on the way that you can reflect that light in the world. You will best honor the memory of those friends who have died, by looking to the future and pledging to make the best life you can for yourself and those you care about. Life is a precious gift and you have been given the opportunity to recommit yourself to it. Now is your time to live; so armed with the lessons you have learned from your cancer experience, look to the future and shine with the brilliance of your diamond light.

Did you find this blog post useful? If so, please consider donating so that we can continue to provide valuable content.

Donate Here


Resource Links:

 Dee Sparacio

Audrey Birt

Karin Sieger

Is there a hierarchy among cancer survivors?

Twitter Comments:

Julia

Susan

Managing the Emotions of a Chronic Illness #patientchat Highlights

Last week, we hosted an Empowered #patientchat on managing the emotions of a chronic illness. The #patientchat community came together for an engaging discussion and shared their best advice and tips.

Top Tweets and Advice


Step One: Acknowledgement


Emotions Aren’t “Negative” or “Positive”


“We all deserve the freedom to express feelings all the time”


Full Chat

Before You Share Your Cancer Diagnosis at Work

When Marybeth heard the word “cancer” she felt like the floor had fallen out from under her. She had a million questions. So many, in fact, she was too overwhelmed to ask a single one the day she was diagnosed. However, as she absorbed the diagnosis and read the materials her doctor had given her, she began to have non-medical questions.  Such as, what would happen to her job if she needed a lot of time off?  How much of the cost of treatment would be covered by her insurance?

Marybeth debated telling her boss of her diagnosis. She wanted to know her options for taking time off, and if they’d be willing to let her work from home sometimes. However, she was also afraid of how her boss might react. She’d been working at the company for less than a year. And Marybeth was a single mom of a teenage son. She relied on her job to pay the bills and provide medical insurance. She was terrified her employer would cut her hours or even let her go.

Fortunately for Marybeth, people with cancer are protected by the Americans with Disabilities Act (ADA). It is illegal to fire someone because of a cancer diagnosis and employers must provide reasonable accommodations for employees who have cancer. However, even with legal protections in place, it’s important to prepare before telling your employer of your diagnosis.

Know When to Tell Your Employer

Marybeth waited until after she’d met with her oncologist and agreed on a treatment plan before telling her boss.  To her surprise, her boss seemed supportive and offered to work with her on adjusting the work schedule and asked human resources to send Marybeth information on taking FMLA (Family & Medical Leave Act) leave.

However, it’s not enough to know if you’ll have surgery or how many chemotherapy sessions you might need. Before talking to an employer, you should know how the treatment plan might affect you physically and emotionally. Your doctor can provide insight into how most people respond to treatment. It’s also a good idea to read or listen to patient experiences to get an appreciation for how diagnosis and treatment might affect energy level, ability to concentrate, and ability to handle stress or fight off an infection. The Patient Empowerment Network provides numerous resources to equip cancer patients and their caregivers with that kind of robust perspective.

While there’s no guarantee your experience will be like someone else’s, the more you know about the possibilities, the better prepared you are to talk to your boss. There will still be unknowns and you should explain this to your employer. It’s ok to say, “I don’t know.” Ideally telling your employer about your diagnosis is just the first of several discussions. Consider scheduling ongoing conversations with your supervisor to evaluate your needs and adjust.

Know What to Tell Your Employer

Most people find it helpful to write down what they want to say before their first time sharing information about their cancer. When talking to an employer you should cover:

  • The diagnosis
  • How your treatment may possibly affect your work
  • Ways you and your employer can work together to overcome the challenges of working during treatment, or—if you are taking medical or disability leave—the challenges of returning to work after treatment

The more you know, the better you’ll be at communicating what you expect and what adjustments you and your employer might need to make. You needn’t ask for these accommodations immediately. But it’s worth knowing what kinds of accommodations might be available.

The most obvious accommodation during and after treatment is time off. Cancer patients should consider not just the time off for surgery and medical appointments, but time to deal with fatigue or secondary illnesses. Some cancer patients request extra breaks during the day to rest or take medicine. Other common accommodations are temporary or permanent reassignment to less physically demanding roles, or permission to work from home. The federally funded Job Accommodation Network can provide a wealth of suggestions. It is often the employee who identifies the need and the most appropriate accommodation, not the employer, so familiarizing yourself with possible options is helpful.

An employer is not required to grant every requested accommodation. They only need to agree to accommodations that don’t create a hardship for them. They can require essential job duties be fulfilled and they don’t have to lower productivity requirements. Your employer may counter your requested accommodation with an alternative that is easier for them to implement. Most employers are willing to work with their employees to find an arrangement that works. However, the burden for educating them about your needs and accommodations to support your success may fall to you.

Know Who to Tell at Work

You don’t have to tell an employer about your cancer at all.  An employer can’t ask about an employee’s medical situation unless they believe a medical condition is negatively affecting job performance or workplace safety.

However, your employer needs to know you have cancer for you to be protected by the ADA.  It is within your employer’s rights to ask for medical documentation if you request disability or medical leave.

Once you have decided you have enough information about what to expect during and after treatment, start by telling your direct supervisor. He or she may ask you questions you aren’t able to answer and that’s ok. Your goal is to open communication and set expectations.  Don’t expect your supervisor to be familiar with your protections under ADA.  However, your company’s Human Resources department should be.  If your supervisor doesn’t inform HR after you disclose your diagnosis, you should.

After that, it’s up to you who you would like to tell.  Your employer is not allowed to tell other employees about your medical situation, not even if coworkers notice you receiving accommodations and ask about it. It is up to you which coworkers to tell. Some people tell only a trusted coworker. Some people want everyone they work with to know.

Decide how much information you want to share. If you are comfortable sharing your story, this is a great opportunity to educate others.  People will likely make assumptions about your ability to work, or your long-term prognosis. They may comment on changes to your physical appearance or ask personal questions. Most people have beliefs about cancer that are incorrect or based on experiences that have little to do with your diagnosis and treatment.  People are rarely intentionally nosy or hurtful. However, if you feel comments or questions are excessive or constitute harassment, report it to your company’s human resources right away.  This is a form of discrimination and your employer has an obligation to address it.

Keep a Record

Even if your employer responds well to your initial conversation and grants accommodations, it’s a good idea to keep track of discussions you have with your boss or human resources office. Keep copies of emails related to your diagnosis and requests. Also, keep copies performance reviews or other documents related to your job performance. This documentation will be helpful if you feel your cancer diagnosis or accommodations are ever held against you.

Discrimination can sometimes be subtle, such as being excluded from meetings or being disregarded for assignments or promotions. You have 180 days from the date of an incident of discrimination to report it to the EEOC, which is another reason to keep records.

Marybeth wasn’t aware of all the protections of the ADA and that those protections continued even after she’d completed her treatments and returned to work full time.  Six months after her last chemotherapy session, she still found herself struggling to keep up with her workload. She was exhausted and felt frustrated by her coworkers’ lack of understanding. Marybeth says she didn’t want to be known as “the woman with cancer” and she figured asking for more help would be held against her.  She struggled on but her job performance suffered, eventually resulting in a poor performance review and job dissatisfaction.

“I don’t know if things would’ve been different for me if I’d been more willing to talk to my boss about how I was feeling and to ask for more adjustments to my work. I’d like to think so,” said Maryann. “I hope I never have to go through treatment again, but if I do, I know I will be more open to talking to my workplace about it.”

It may be difficult to talk about your diagnosis and expectations with your boss.  However, it is almost always the right thing to do to protect yourself.  Armed with an understanding of your potential needs and rights, you are in a better position to take control of your cancer and your career.

Did you find this blog post useful? If so, please consider donating so that we can continue to provide valuable content.

Donate Here


Resource Links:

Americans with Disabilities Act

Job Accommodation Network

After Cancer, Ambushed By Depression

At some stage in all our lives there comes a time when feelings of sadness, grief or loneliness gets us down. It is part of being human. And after all, what’s more human than feeling down after such a life-changing and stressful event like cancer? Most of the time, we bounce back; but what happens when the blues stick around and start to interfere with our work, our relationships and our enjoyment of life?

Dana Jennings, whose writings in the New York Times about his treatment for prostate cancer, so eloquently captured the mix of feelings which cancer survivors face after treatment ends, wrote that while he was “buoyed by a kind of illness-induced adrenaline” during treatment, once treatment ended, he found himself “ambushed by depression.”

Jennings’ words will have a familiar ring to many of us who have struggled with that unexpected feeling of depression and loneliness that creeps up on us after treatment is finished. For some survivors, depression kicks in shortly after diagnosis or at some stage during treatment; for others it may ambush them weeks, months or even years after treatment ends.

What Causes Depression?

Depression is a word that means different things to each of us; people use it to describe anything from a low mood to a feeling of hopelessness.  However, there is a vast difference between clinical depression and sadness. Sadness is a part of being human; it comes and goes as a natural reaction to painful circumstances, but it passes with time. Depression goes beyond sadness about a cancer diagnosis or concern about the future.

In its mildest form, depression doesn’t stop you leading your normal life, but it does make things harder to do and seem less worthwhile. At its most severe, the symptoms of clinical depression are serious enough to interfere with work, social life, family life, or physical health.

Incidence of Depression in Cancer Survivors

Research shows that cancer survivors are more likely than their healthy peers to suffer psychological distress, such as anxiety and depression, even a decade after treatment ends. Although estimates of the frequency of depression in cancer patients vary, there is broad agreement that patients who face a disruptive life   event like cancer have an increased risk of depression that can persist for many years.  While most people will understand that dealing with a chronic illness like cancer causes depression, not everyone understands that depression can go on for many months (and even years) after cancer treatment has ended.

The Challenge of Identifying Depression in Cancer Patients

Some research has indicated that depression has been underdiagnosed and undertreated in cancer patients.  This may result from several factors, including patients’ reluctance to report depression, physician uncertainty about how best to manage it, and the belief that depression is a normal part of having cancer.

Several of the characteristics of major depression listed below– like fatigue, cognitive impairment, poor sleep, and change of appetite or weight loss—are hard to distinguish from the common side effects of cancer treatment. This makes it harder to tease apart the psychological burden of cancer, the effects of treatment, and the biochemical effects of the disease.

Are You At Risk of Depression?

Depression can occur through a combination of factors, with some of us being more prone to depression than others.  Factors such as a history of depression, a history of alcohol or substance abuse, and a lack of social support can increase the risk of depression in both the general population and among cancer patients.

Even if a person is not in a high-risk category, a diagnosis of cancer is associated with a higher rate of depression, no matter the stage or outcome of the disease.

Distress over a cancer diagnosis is not the same thing as clinical depression – it is important to recognize the signs and get treatment. The first step is to identify if you are experiencing symptoms of depression.

Try answering the following two questions.

Have you, for more than two weeks (1) felt sad, down or miserable most of the time? (2) Lost interest or pleasure in most of your usual activities?

If you answered ‘YES’ to either of these questions, you may have depression (see the symptom checklist below). If you did not answer ‘YES’ to either of these questions, it is unlikely that you have a depressive illness.

Depression Checklist*

(Tick each of the symptoms that apply to you)

  • Trouble sleeping with early waking, sleeping too much, or not being able to sleep
  • On-going sad or “empty” mood for most of the day
  • Finding it hard to concentrate or make decisions
  • Feeling restless and agitated, irritable or impatient
  • Extreme tiredness and lethargy
  • Feeling emotionally empty or numb
  • Not eating properly; losing or putting on weight
  • Loss of interest or pleasure in almost all activities most of the time
  • Crying a lot
  • Losing interest in your sex life
  • Preoccupied with negative thoughts
  • Distancing yourself from others
  • Feeling pessimistic about the future
  • Anger, irritability, and impatience

Add up the number of ticks for your total score: _______

What does your score mean?

  • 4 or less: You are unlikely to be experiencing a depressive illness
  • 5 or more: It is likely that you may be experiencing a depressive illness.

NB This list is not a replacement for medical advice. If you’re concerned that you or someone you know may have symptoms of depression, it’s best to speak to your doctor.

Depression – The Way Forward

It’s common to experience a range of emotions and symptoms after a cancer diagnosis, including feelings of stress, sadness and anger. However, some people experience intense feelings of hopelessness for weeks, months, or even years after diagnosis. If you continue to experience emotional distress from your cancer, it’s very important to know that help is available, and to get the help you need.

The first step on the path to recovery is to accept your depression as a normal reaction to what you have been through –don’t try to fight it, bury it or feel ashamed that it is there.  Think of your depression as just another symptom of cancer. If you were in physical pain, you would seek help, and it’s the same for depression.  There are many people willing to help you but the first step is to let someone know how you are feeling. Finding the courage to talk to just one person, whether that’s a loved one, primary care physician, or specialist nurse will often be the first step towards healing.

The psychological effects of cancer are only beginning to be studied and understood. In time, doctors will not only treat the body to kill the cancer, but will treat the mind which suffers the consequences of the disease long after the body has healed. When you’re depressed it can feel like you are barely existing. By obtaining the correct medical intervention and learning better coping skills, however, you can not only live with depression, but live well.

A Note on Helping a Loved One with Depression

Perhaps you are reading this because you’re concerned about a loved one who might have depression.   You may be wondering how you can help. For people who have never experienced the devastating depths of major clinical depression, it may be difficult to understand what your loved one is going through. Depressed people find it hard to ask for help, so let your friend or family member know that you care, you believe in them and that you’re there for them.

The best thing you can is to listen. Don’t offer preachy platitudes about things never being as bad as you think, or suggesting the person snap out of the depression. Our culture doesn’t encourage people to talk about their emotional pain. We’re taught to suppress our feelings, not to show weakness, to get over things quickly. Most people, when they feel upset, benefit greatly by talking to someone who listens with empathy and without judgment. Most of the time the person who is depressed is not looking for advice, but just knowing that someone cares enough to listen deeply can make all the difference.


*References: American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed (DSM-IV). Washington, DC: APA, 1994; and, International classification of diseases and related health problems, 10th revision. Geneva, World Health Organisation, 1992-1994.

Notable News – June 2019

It’s official! The nation’s cancer mortality rate continues to decline, says cancer.gov. The finding was revealed in this year’s annual report regarding the status of cancer in the country. The report shows that cancer death rates have continued to decline in men, women, and children from 1999 to 2016. Specifically, lung, bladder, and larynx cancers are decreasing, which is attributed to the decline in tobacco use. Conversely, cancers related to obesity are increasing. The highest overall cancer incidence rates occurred in black men and white women. The lowest rates were among Asian/Pacific Islander men and women. In addition, researchers looked specifically at cancer trends among those aged 20 to 49. In this group women had higher cancer and death rates than men, which is the opposite of the data among all age groups. Breast cancer, thyroid cancer, and melanoma were identified as the most common cancers on the rise among 20 to 49 year old women. The report, published last month in the Journal of the National Cancer Institute, is put together by the National Cancer Institute (NCI), the Centers for Disease Control and Prevention (CDC), the American Cancer Society (ACS), and the North American Association of Central Registries (NAACCR). Find more detailed information about the annual report here.

The decline in cancer deaths just may have a lot to do with the amazing strides being made in understanding cancer and its risk factors, ways to diagnose it, and ways to treat it. Researchers at Yale have made a discovery about how metastasis, the spread of cancer, occurs on the molecular level that could lead to new ways of treating cancer, reports medicalexpress.com. While the study focused on renal cancer, understanding metastasis on the molecular level could lead to new testing and treatment for all types of cancer. Find more information about the study and the metastasis process here.

It’s important to know if you are at risk for certain cancers and having children through IVF may be one of them, reports thesun.co.uk. A 21-year study analyzing over 600,000 Danish women suggests that women who have had children using IVF are more likely to develop breast cancer. In addition, women who had their first child through IVF when they were 40 or older, were 65 percent more likely to develop breast cancer than women of the same age who conceived naturally. The drugs given to women during IVF to stimulate the ovaries may be the culprit. They increase levels of estrogen, a known factor in the occurrence of breast cancer. Make sure you are staying on top of your breast cancer screenings if you had children using IVF, and learn more about the study here.

Also reported by thesun.co.uk, is good news about early detection, specifically for prostate cancer. Scientists have developed a simple urine test that could show signs of prostate cancer five years early. The test, which could be available in as few as five years, looks for changes in specific genes. If the changes are noted, further testing is done. The process would mean that some men would not have to have invasive testing procedures and others would know of their prostate cancer risk earlier. Learn more about the promising new test here.

Finally, of interest this month is an article by theatlantic.com regarding the two technologies that are changing the future of cancer treatment, and the way in which oncologists are looking at treating the disease. The article points to immunotherapy and CAR T-cell therapy as kindler, gentler approaches to cancer treatment. Chemotherapy, which is the most successful treatment to date, as the article points out, can make the treatment process brutal. Oncologists are turning to the new therapies to treat cancer without the harsh side effects that come with chemo. The article is a quick read and it provides hope for anyone who is or may be affected by cancer. That means all of us. Check it out here.

Notable News May 2019

Moving into summertime, for many, means increased sun exposure, so it’s pretty good timing that May, the gateway month to summer, is Skin Cancer Awareness Month. Prevention guidelines can be found at skincancer.org and include staying in the shade, avoiding tanning, and protecting your skin with clothing and sunscreen. More guidelines and tips can be found here. However, as noted in washingtonpost.com, prevention guidelines aren’t exactly universal. It turns out that sunscreen is not effective in preventing melanoma in darker-skinned people. While melanoma is a risk for all skin types, those with dark skin or of African descent, usually develop melanoma known as acral lentiginous melanomas which develops in parts of the body that don’t get much sun exposure, such as the palms of the hands or the soles of the feet. Of course, sunscreen use is still recommended for people with all skin types to prevent other sun-related damage, and it’s important to talk to your skincare professional about whether or not sunscreen is the best prevention option for you. Find out more here.

Summertime also tends to include barbecues and picnics, but you might want to think twice about what food you’re packing for the potluck, according to a new study reported in livescience.com. The study researchers estimated that more than 80,000 U.S. cancer cases diagnosed each year might be related to an unhealthy diet. The diets known to be related to cancer risk are low in whole grains, dairy, fruits, and vegetables, and high in processed meats, red meats, and sugary drinks. The cancers most closely-related to diet were colorectal, cancers of the mouth, pharynx and larynx, uterine cancer, and postmenopausal breast cancer. Adults ages 45 to 64 had the highest rate of diet-related cancer. More information about the study can be found here.

There is also increasing evidence that diet can help with cancer treatment, says theatlantic.com. Doctors are starting to look at how the food we eat could affect the cancer cells in our bodies and how what we eat may assist in treatment or preventing cancer cells from growing. Of course, because cancer is a very varied disease, there is no one diet that is best. Different nutrients, or the absence of them, affect different cancers in different ways. The promise is that doctors are starting to uncover the relationship between foods and cancers and how we can best utilize our diets for good health. More information can be found here.

In addition, straitstimes.com further explores the relationship with food and cancer. Researchers in Singapore found a link between a nutrient known as methionine, often in meat, fish and dairy products, and cancer. They discovered that cancer stem cells use methionine as fuel, but when they “starved” lung cancer cells of methionine for 48 hours, they saw a 94 percent reduction in the size of the tumors. The information is promising for the future of cancer treatment. More information can be found here.

No matter what is in your picnic basket or what kind of sunscreen you use, you can enjoy your summer with the knowledge that you are doing your part in being a hero in your own story — much like a young super hero named Wyatt who, during his fourth round of chemo, learned that his dreams would come true in a music video that involved fast cars, battling the bad guys, and pizza. It’s a feel-good story that feels just right for summer. You can read all about Wyatt here. It’s guaranteed to put a smile on your face as bright as the summer sun.

Deceived But Not Defeated

I never felt any symptoms. I mean, I was tired, but what young 20-something who had just started graduate school while maintaining a full time job wouldn’t be? It happened during a physical. A lump towards the top of my throat was felt by my doctor. “I would go and have that scanned,” he said. I wasn’t worried; he had never mentioned cancer. So I went and had the ultrasound. “Well, we see what your doctor was talking about, and it appears to just be a cyst,” the doctor said, “but there’s another spot on the right side of your thyroid. You have two options. You can wait to see if the spot grows or we can perform a biopsy to see if it’s cancer,” he explained. “Now, the chance of it being cancer is anywhere between 10-15%, a very very low chance,” he reassured me. “I want the biopsy,” I said, not wanting to take any chances. The biopsy was performed, and within minutes, the doctor returned saying he had bad news. “Unfortunately, it’s cancer, but the good news is that it’s very treatable. I recommend you having surgery.” And that was it; although, it hadn’t hit me, at least not as hard as I thought it should had – at least not immediately. I went to my car, called my mom, and asked her if she was sitting down. I told her the news, still shocked by the ordeal I was just handed. In an instant, my life had changed forever. I heard those three words no one ever wants to hear, “You have cancer.”

I wasn’t sure how to proceed. How advanced is my cancer? What doctor(s) do I go to? How quickly do I need surgery? I just started school – do I need to drop-out already? What about my job. All of these thoughts raced through my mind. However, the support of my family and, luckily, not having any symptoms kept me going. I was working in a hospital at the time, and I spoke with a few of the doctors I worked with. “Oh, the good type of cancer. You’ll be just fine,” one said. “‘Good type?’” I thought. What is good about having cancer? He gave me the name of a surgeon who specialized in thyroidectomies. It was a five month wait to get in.

When I eventually saw my surgeon, he gave me two options. The first, he explained, was a partial thyroidectomy. “We’ll only remove the lobe of the thyroid where your tumor is. The benefit of that is that the other lobe will continue producing enough of the hormones that your body needs so you don’t have to take a medication for the rest of your life. The second was a total thyroidectomy, rendering me to that medication, literally, for a lifetime. I went with the former, and had a successful surgery. Of course, it didn’t end there.

Two days after my surgery, my doctor called. “We performed pathology on some of the lymph nodes that we removed from your neck, and unfortunately, almost all of them had cancer. What this means is that we need to have you come back and perform another surgery to remove the rest of your thyroid. Then after, you’ll have to undergo radioactive iodine to rid your body of any residual thyroid tissue.” My heart sunk. My world was crushed yet again. Another surgery? What was radioactive iodine? I didn’t how to process the emotions that I was feeling as tears streamed down my face. “It never ends,” I thought.

After my second surgery, I was thyroid-free. Later, I went through the radioactive iodine procedure where I had to be a specific diet for approximately 3 weeks. I could consume very little to no iodine, or salt, which was essentially in every product. As I went up and down the grocery store aisles reading every nutrition label, I found myself frustrated finding almost nothing that I could eat. Don’t get me wrong, this was a very healthy diet, as I was essentially restricted to meats (without seasonings), fruits, and vegetables. But it wasn’t my favorite. I went to a nuclear medicine center where I consumed a pill that would make me radioactive. I was to stay physically away from people for approximately one week, slowly decreasing the amount of feet I could be within others as each day passed. I then had a whole body scan that showed that the cancer hadn’t spread, or metastasized, to any other place in my body, but there was still some residual thyroid tissue that the radioactivity would hopefully kill.

The journey continued. I would need to be on a medication for the rest of my life. I would need to see a specialist, an endocrinologist, for the rest of my life. They would decide the dosage of my medication based on a variety of factors, including how I was feeling emotionally and physically. It wasn’t until after I had my thyroid removed that I realized how much it does for our bodies. “It will take some time before we find the right dosage for you,” my endocrinologist explained. In other words, sometimes I would be hyperthyroid, other times, hypothyroid. My symptoms may be all over the place, including my metabolism rate, my body temperature, and even my mood. As a patient with chronic depression and anxiety, I could only hope that the “right” dosage would be found quickly.

Fast forward two years later from my diagnosis, and I have been deemed “cancer free,” no more thyroid tissue. While I am incredibly thankful for this result, I can’t help but feel survivor’s guilt. I often think, “Why me? Why did I get to survive and others don’t? How did I get by so easily?” Despite this guilt, I have used my cancer diagnosis and journey to become stronger both mentally and emotionally. I have unashamedly shared images on social media and written stories that have been published in the hopes to inspire others and to be an advocate for those who don’t feel like they have a voice. Yet, I don’t pretend to know everything. I still have questions that remain unanswered. How likely is my cancer to come back? Why do I keep losing so much hair? Why am I always so tired? Despite having the “good” type of cancer, there is nothing that great about it. Although I never had symptoms, I still went through two surgeries and a radioactive iodine procedure, which had its own side effects.

As a result of what I went through and my never-ending passion for helping others, I believe that my diagnosis happened for a reason – to lead me to a career in patient advocacy. I have a background in health administration, policy, and communication. I have worked at doctor’s offices and hospitals. I feel I had an advantage in having the knowledge that I did/do, and access to physicians. However, I still get confused when I ask my doctor a question, and I receive an answer that’s in medical jargon. I think, “I can’t be the only one who feels lost, who feels confused.” Plus, I know that there are patients who are going through worse situations than I did. There has to be a way to mend the physician-patient relationship that is currently suffering. There’s not enough time dedicated to each patient, to hear what they’re going through each day. Physicians also need to make sure that what they’re saying/explaining makes sense to the patient, especially when it comes to taking medication(s) (patients with chronic conditions usually have multiple, which can be hard to keep track). There are solutions coming to the forefront, such as pill packs, patient portals, and support groups. But I believe this is just the beginning. Every cancer is different. No two patients are the same – indifference is ignorance. It’s time to combine research, health literacy, and ultimately, compassion for a patient’s story, to provide the best care and create better health outcomes.

Notable News | April 2019

You may want to do some yoga, especially if you are experiencing chronic stress. However, you can breath a sigh of relief about the positive research in bladder and prostate cancers reported this month. There’s even some super cool research that involves containing, rather than killing, cancer cells. Check it out.

Chronic stress is not good for anybody, but as livescience.com reports, it may be even more detrimental for cancer patients. Acute stress is normal on occasion to help us avoid danger, but chronic stress, which weakens the immune system, leads to changes in the body that could then lead to the development and progression of cancer. However, experts say we can’t be so fast to draw a link between stress and cancer because of the ways different people respond to stress. Some people are motivated by it; others sickened by it. Some experts believe it may not be the stress that leads to cancer, but rather the poor habits people adopt to cope with stress. While experts don’t yet agree that there is a clear and definitive line between chronic stress and cancer, there is evidence that taking measures to reduce stress is best for overall health. Find out more here.

Speaking of stress, cancer can be stressful. Many patients turn to alternative forms of healing to manage the affects of cancer or treatment, but medicalnewstoday.com says, that may be doing more harm than good. As many as one third of people living with cancer are using alternative or complementary therapies. The most common form of alternative therapies is the use of herbal supplements, which researchers found could be a problem because the ingredients of herbal supplements are not always known, and there is a concern that supplement ingredients could negatively interact with the medicines they are taking. For example, high levels of antioxidants may make radiation less effective. Yoga, however, is the one complementary method of treatment that seemed to help patients. You can learn more about the research involving alternative and complementary therapies here, and decide whether or not those methods are right for you.

Researchers are starting to decide that maybe killing all the cancer cells isn’t the best option for combating cancer, reports medicalnewstoday.com. Cancer cells evolve really fast, and some studies show that there is no way of killing them all. Researchers are looking at a new approach of treating cancer that involves preventing it from developing and spreading by containing it. They hope to use medication to make the cancer cells dormant and keep them that way, which could be useful in cancers, such as breast cancer, which is now considered a chronic cancer because it can come back many years later with secondary tumors. You can learn more about this unique approach here.

Other findings this month bring good news for bladder cancer patients, reports seekingalpha.com. The FDA has approved the Johnson & Johnson drug, Balversa, for patients with metastatic bladder cancer. The approval was based on a trial that resulted in a 32 percent overall response rate. The patients who are eligible for Balversa, have metastatic bladder cancer with specific genetic alterations, but there is hope that it will eventually be tested on other types of cancers. Learn more here.

More good news comes from British scientists who have discovered 17 genes for diagnosing prostate cancer, reports dailymail.co.uk. Combined with the six genes already known to be linked to prostate cancer, there are now 23 genes that can be screened through a spit or blood test. Find more information about the research and what it means for diagnosis and treatment of prostate cancer here.

The not-so-good news reported this month is the increase in lung cancer among non-smokers — especially women. An in depth look at this growing issue can be found at theguardian.com here.

The ups and downs of cancer research news can be stressful for anyone, so to alleviate that stress, let’s all stay informed, and maybe take to our yoga mats. Until next month, namaste.

Words Matter: Why Cancer Isn’t a Game of Winners or Losers

Are you “battling” cancer? Do you know someone who has “lost their fight” with the disease and died?

It seems whenever we hear a story about someone with cancer, war metaphors are never far behind.  Cancer battles must invariably be bravely fought, won, or lost.  Using this metaphor implies that if a patient fights hard enough and/or long enough, he or she will be able to “win the war.” The trouble with using this particular kind of metaphor to describe cancer is it puts the burden of healing on patients by turning them into winners and losers.  As breast cancer blogger, Nancy Stordahl, writes in What Does Beating Cancer Mean Anyway? ”Struggling to live up to some gold standard of what beating cancer means, adds to the already exhausting burden. We need to stop patronizing and judging cancer patients based on misguided battle talk analogies. Cancer isn’t an opponent in some war game you can stomp out by mindset or determination.”

Besides, the battle metaphor takes no account of the sheer randomness of the disease. Using a statistical model that measures the proportion of cancer risk, across many tissue types, scientists from the Johns Hopkins Kimmel Cancer Center published a study in 2015 which concluded that two-thirds of the variation in adult cancer risk across tissues can be explained primarily by “bad luck.” In other words, a major contributing factor to cancer is in fact beyond anyone’s control. For the most part, we don’t know why one person is alive 10 years after the diagnosis of advanced cancer, whereas another dies within months.

By this reasoning, no amount of fighting or battling cancer can affect its outcome.  Commenting on the study, the researchers said, “Many people have found relief in this research. Cancer has a long history of stigmatization. Patients and family members frequently blame themselves, believing there was something they could have done to prevent their or their family member’s cancer. We have heard from many of these families and are pleased that our analysis could bring comfort and even lift the burden of guilt in those who have suffered the physical and emotional consequences of cancer.”

Cancer is a disease; not a military campaign

Cancer is a disease; not a military campaign. In the words of patient and caregiver Jana Buhlman, “it’s a disease that people manage.”  Cancer is a complex disease. Yet there still exists a prevailing attitude to cancer which treats survival as though it were somehow an act of will.  You’ve got to be strong, remain positive and be courageous to overcome the disease.  Clodagh Loughrey, who was diagnosed with breast cancer nine years ago, explains, “I was absolutely petrified at the time, the opposite of strong or courageous, and to be also made to feel guilty for being scared by well-meaning exhortations to be ‘be positive’….people mean well and I didn’t want to sound ungrateful for the support as it is far worse (and easier for them) to avoid people with cancer, and some people did.”

What other diseases or condition do we say this about? “Do we fight a heart attack or a stroke? Are we told in any other illness to “keep fighting”? asks Jo Taylor, Founder of After Breast Cancer Diagnosis.   The fact is cancer doesn’t care how courageous or positive you are. Patients are in remission because treatment eliminated every cancer cell from their bodies, not because the patient fought courageously or was endlessly positive.  As a patient who is currently NED (i.e. no evidence of disease) I didn’t fight any harder than anyone else with this disease. I haven’t “beaten” cancer. I don’t know for sure that cancer will not come back again.

Cancer isn’t a game of winners and losers

I’ve lost count of the number of times I’ve read about patients who are in remission from cancer, having “won their fight” against the disease. Journalists in particular seem incapable of writing about a person who has died from cancer without resorting to the “lost fight” cliché.  Julia Barnickle, who is living with metastatic breast cancer, points out that while she doesn’t like the term personally, “I have no problem with cancer patients using fighting talk. However, I do object to the media using it, especially in the situation where someone is said to have “lost their battle with cancer.” It’s simply a hackneyed way of grabbing attention.”

Does this imply that patients in remission have somehow done more than those who aren’t in remission?  Or that cancer progression or death from cancer is somehow an indication of failure – of not having had the ability to fight and defeat the enemy?  “It seems,” in the words of breast cancer blogger Maureen Kenny, “if you’ve got cancer you’re almost always seen as battling or fighting it, more often than not bravely. We never hear of anyone dying of the disease after a lacklustre, take or it or leave it, weak-willed tussle.”

Cancer shouldn’t be reduced in this way to a game of winners and losers.  Commenting at the time of the death of film critic Roger Ebert, Michael Wosnick, wrote: “The use of the word, “lose” is like a zero-sum game to me: if someone or something loses then that means that someone or something else wins. You can’t have a loser if you don’t have a winner. We should not so easily give cancer that kind of power over us.”

If someone has lifelong hypertension and dies from a heart attack, do we say in the obituary that they lost their battle with high blood pressure? Then why do so many deaths from cancer get reported this way? While it’s not quite “blaming the victim”, it does have an implicit element of somehow placing the ultimate responsibility for having died in the hands of the deceased.

When words blame

Oncologist, Dr Don Dizon, tells a story about taking care of a young patient with ovarian cancer during his first year as an attending physician at Memorial Sloan Kettering Cancer Center. The patient had just relapsed from first-line treatment and in his discussion with her about the next steps, Dr. Dizon explains that, “despite the failure of first-line treatment, there are many more options for you.”

The doctor was stunned by the patient’s tearful reaction to his words: “You make it sound like this was my fault, like I did something wrong!” she said. “I’m sorry I failed chemotherapy, if that’s what you think, and I’m sorry I disappointed you.”

It’s a lesson Dr. Dizon has never forgotten, as he describes in his own words: “It was never my intention to place ‘blame’ on something so devastating as a cancer recurrence, and I certainly did not mean to imply that she had failed. These many years later, I still consider this encounter a watershed moment in my career as an oncologist.”

The “battle with cancer” may be “only a metaphor” but it stands for a quite destructive attitude that, to the extent it influences doctors as well, distorts the treatment of cancer too.  In a JAMA Oncology article, the authors discuss how “the continuous urge to win the battle extends to oncologists, who actively treat patients for too long. The fact is that 8% of patients receive chemotherapy within 2 weeks of dying of cancer, and 62% within 2 months. Late chemotherapy is associated with decreased use of hospice, greater use of emergency interventions (including resuscitation), and increased risk of dying in an intensive care unit vs at home. This all clearly reflects our society’s need to battle until the end.”

Embracing a fighting spirit can work for some patients

This isn’t to deny that some cancer patients embrace a fighting spirit as a way that helps them feel more in control.  Cancer survivor, nurse and educator, Beth Thompson describes how “identifying as a shorn ‘warrior’ psyched me up for and pushed me through treatment.”  Sara Turle, a 9-year survivor of cancer, also found resonance in the metaphor. “For me I was never battling cancer: it’s a disease, but I was definitely battling how I managed diagnosis and particularly getting through the side effects of treatments,” she explains. “It helped me to look at each stage and at times each day and even hour, at worst points, with a view of getting through, surviving and celebrating with just a simple acknowledgement. It truly helped me feeling that achievement and it helped with knowing that I was going to have to face it again.”

Professor Elena Semino and her colleagues have been studying the use of metaphors in the way we talk about cancer since 2012. As part of their research they have analysed 1.5 million words taken from interviews and online forum discussions involving cancer patients, family carers and health professionals. The team found that the type of metaphors people chose to use when describing their cancer reflected and affected how they viewed and experienced their illness. “For some patients, some of the time, the idea of being engaged in a fight is motivating,” explained Sermino. “Some people say with pride that “I’m such a fighter”, and they find a sense of meaning and purpose and identity in that. The study showed that we are all different, and different metaphors work for different people, and at different times.”

I agree. I’m not criticizing individuals who draw strength from calling themselves fighters.  Everyone is entitled to use whatever language they want to describe their own experiences. As Sara says, “My belief is that the right language is what is right for the individual person and I would hate to think that people who do find this language helps, feel that they can’t openly use for fear of what others may think. Whatever language gets you through is the right language for me. I am very mindful of when speaking to people now to be sensitive to the language they are happy with and these discussions of differing views have helped me with this.”  Beth agrees and asks, “Can we educate while still leaving room for what works for the individual experience of cancer?”

Wrapping Up

If you believe, as many patients do, that the words we use to describe cancer matter, how then should we begin to conceptualize it? Stephanie Sliekers asks a similar question in this HuffPost article, “If cancer really is the ‘enemy’, what’s the best way to beat it?” Her answer? “By studying and understanding it as it is, a disease borne out of human blood, tissues and genes, a disease that lives within us whether it is treatable or fatal.”

Perhaps, rather than speaking of cancer in militaristic terms, it’s better to communicate that we are “living with cancer” for as long and as well as we can. And when a person dies, let’s not say he/she has lost anything, but rather that person has died after living with cancer for a period of time.

Words matter a great deal in life, death, and everything that comes in-between. To quote Dr Dizon “Words are powerful and despite our best intentions, can hurt—this is true in life, and it is true in oncology.”

How to Make the Home a Safe Space for Grief

When a loved one passes away after a battle with cancer, the grief can be nearly impossible to face. Although people react differently to grief, shock, numbness, and sadness are common feelings among those struggling to cope.

As you work through your grief, it’ll be important to have a space where you can feel comfortable and at ease. If you’re like most people, that space will be in the comfort of your own home. Keep reading for some tips on how to make your home a safe space for grief.

Keep Sentimental Items Close

While grieving, you may begin to fear that you’ll forget important details about the person you’ve lost.

Keeping sentimental items that remind you of your loved one nearby can be a useful coping mechanism during this time. These items may be photographs, trinkets, or articles of clothing that promote positive memories and help you feel close.

However, keep in mind that you don’t want to hold on to unnecessary items just because they may have belonged to your loved one. As you decide which sentimental items you’d like to keep, this is also a good time to think about what you can give away. Donating these things is a great option, especially if you’d like to see certain things continue to be put to good use.

Clear Clutter

When dealing with grief, the last thing you want is to feel stressed too. A cluttered home will not only make your space less functional, but it’ll make things more stressful as well.

Even though it might feel like a chore you want to put on the back burner, cleaning your home is the perfect opportunity for you to be productive and shift your focus for a few hours. Once your home is free of clutter you’ll find yourself feeling more relaxed and may notice that you’re able to even sleep better.

Set Boundaries with Guests

When someone close to you passes, other people in your life will probably want to stop by and check on you. Of course, these people mean well, but constantly having guests can get overwhelming. It’s okay to let people know when you’re not in the mood for company.

On the other hand though, it’s important that you find the right balance between solitude and socializing so you don’t isolate yourself.

Let Natural Light Flow Through Your Home

You may think closing yourself in the house all day will help you through your grief, but this could actually make it worse. Instead, you should let as much natural light flow through your home as possible. Research has shown that exposure to natural light can have a positive impact on moods and can help reduce depression and sadness.

Play Music for Your Loved One Throughout the House

This may seem like an odd piece of advice, but research has shown that listening to music can help people deal with grief. One study suggests creating a playlist for your loved one and picking songs meaningful songs that remind you of the person.

Getting Back in the Kitchen

Most of us have an emotional response to food. That’s why friends and family will bring food to their loved ones in bereavement. Plus, cooking for someone in mourning takes one more thing off their plate.

However, cooking may be the ticket to getting back into a semi-normal routine. The act of providing a warm meal to yourself and your family could be rewarding in itself. Cooking meals your loved one had especially liked could be a way to feel somewhat connected still. You might even discover new foods and the kitchen can start to become a source of excitement and it could spark curiosity even in a dark time of your life.

As you grieve, it’s important to remember that the process is a journey that will have its fair share of ups and downs. With self care, patience, and a strong support system you can gather the strength you’ll need to carry on.

The Importance of Sleep for Cancer Patients

Why sleep should be a main priority for those battling cancer

Experiencing trouble sleeping is common in both adults and children. There are many contributing factors as to why it’s difficult to get the sleep we want and need. Perhaps our sleep environment is not conducive, something is weighing on us mentally, or our children are awake at night. Sleep apnea or insomnia could also be playing a role. In addition to other protective factors, like proper nutrition and regular exercise, sleep is extremely important for our overall health. When something else is going on with our body that affects our health, such as a cancer diagnosis, it’s doubly as important in those cases.

About one third to one half of cancer patients report sleep disturbances. Many report having insomnia and feeling as though it is difficult to sleep at all. The percentage of cancer patients who report feeling this way is almost double the general population. For cancer patients, there are unfortunately a slew of reasons at play that are contributing and making sleep very hard to come by. At various points in time, getting the rest your body needs may prove difficult. Understanding the reasons sleep may be nonexistent is the first step in moving towards a solution. Next, implementing strategies to support restful sleep will increase your body’s energy and its ability to heal. Sleep heals us. Many people focus on the cancer treatment itself, followed by things that are known to make us stronger, such as eating protein and going for walks. Often sleep is overlooked as a crucial part of a cancer patients overall treatment plan.

So, why is it that cancer patients struggle to sleep in the first place? There are different reasons and every patient will react differently, physically and emotionally, to the journey of battling cancer. Some common problems include:

Stress/ anxiety about their diagnosis

It’s normal for our mind to race when we are worried or concerned. Throughout different stages of treatment, patients have a variety of stressors that may affect them such as fear of the future, telling their friends and family their diagnosis, as well as financial, work-related and/ or relationship concerns as well.

Interrupted sleep environments

Often when someone is getting cancer treatment, friends and family may offer to come to their home and help. While that is a kind gesture, it can also be problematic as sometimes it’s hard to get adequate sleep if there are guests in one’s home. Keeping this in mind and setting healthy boundaries is important for the patient and whomever they share their home with.

Symptoms, such as nausea and headaches, from treatment

Depending on the intensity of the symptoms and their duration, asking your Doctor/ care team for support on managing those adverse side effects will prove to be helpful. They may have some tips and ideas for how to specifically combat the symptoms, allowing more time for restful sleep.

Pain in one’s body from the cancer

Most cancer patients report the aches and pains in their body interrupt their ability to fall and stay asleep. Stretching, yoga, staying warm/ hydrated, medication, and other forms of pain management/ medication can be used. The more this overall pain is managed, the more the patient will be able to rest and heal.

Excessive sleepiness during the day

Cancer takes a major toll on one’s body. During the day, especially if the person has not slept well at night, they may be extremely fatigued. This pattern throws off the body’s normal sleep cycles and its circadian rhythm. It may be difficult for patients to regain their nighttime sleep in these scenarios.

 

There are a variety of reasons why sleep is vital if you are in any stage of cancer treatment. Many of the drugs used to treat cancer lower and weaken one’s immune system. Chemotherapy, a common cancer treatment, can affect the immune system for quite some time, even after the patient is done with those treatments. According to The National Sleep Foundation, sleep is a major component when it comes to boosting the immune system. “Without sufficient sleep, your body makes fewer cytokines, a type of protein that targets infection and inflammation, effectively creating an immune response. Cytokines are both produced and released during sleep, causing a double whammy if you skimp on shut-eye.”

Targeting inflammation is also especially important for cancer patients, seeing as the body can become inflamed from the cancer itself and/ or the commonly used treatments for it. Reducing the inflammation in the body helps its ability to fight off infection and heal.

Besides building up the immune system, being well rested is also important because it improves our mood and decision-making skills. There are many decisions that need to be made by the patient and family, such as length of treatment, treatments they are willing to try, treatments they are opposed to, etc. Being well-rested helps people to be more energized and have a clearer, calmer ground to make these difficult choices from. Extreme fatigue can lead to (or contribute to pre-existing) mental health disorders such as depression and anxiety. In order to make sound decisions for one’s physical, mental, and emotional health, sleep is an important factor that should always be prioritized.

If someone in your life is suffering from cancer, it’s common to bring a meal or offer a ride to an appointment. These are wonderful ways to support that person. In addition, perhaps consider offering to watch their kids in the afternoons so they can take a nap or take household chores and errands off their plate to lower their stress and hopefully improve their ability to gain extra consistent sleep.

If you are a cancer patient do not be afraid to advocate to the people around you so you can best meet your sleep needs. This could mean asking your Doctor about symptoms that affect your sleep or asking your partner to help you get as much sleep at home as possible. That time while you are resting is crucial for your body as it fights the cancer, as well as your overall health too.