Tag Archive for: Nicole Normandin Rueda
Survivorship Care: Screening and Lifestyle Strategies to Reduce the Risk of Secondary Cancers
What are key lifestyle changes for cancer patients navigating treatment and recovery? Expert Dr. Amy Comander from Massachusetts General Hospital discusses survivorship care and lifestyle advice for coping with and recovering from cancer treatment.
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Transcript:
Lisa Hatfield:
Navigating cancer treatment and recovery is a journey that involves more than just medical care. Lifestyle choices play a crucial role too. What other factors play into this journey? I’m getting to the bottom of it with a respected oncologist in this Patient Empowerment Network RESTORE program.
Dr. Comander, many patients often worry about secondary cancers. What are key lifestyle changes you recommend for cancer prevention and how do they differ from those recommended for post-cure recovery or post-treatment?
Dr. Amy Comander:
So an important component of survivorship care, which is care of the patient, certainly at the time of diagnosis and beyond, but in that follow-up phase as well, is screening for secondary cancers. And what does that mean? That means that a cancer that can develop after the diagnosis of the primary cancer. And I know to some listening that sounds really overwhelming. “You mean I can get another cancer?” But unfortunately, none of us have a crystal ball and that could happen. So what are strategies we can use to help reduce the risk of someone getting another cancer down the road?
And I first want to emphasize the importance of cancer screening. So we now have all these great tools for cancer screening; mammograms, breast MRIs, colonoscopy, pap smears, pelvic exams, CT scans for detection of lung cancer, and now we’re having these blood tests that we’re going to learn more about in the next few years. So there’s many screening strategies that are super important. So I encourage my patients to talk to their doctor. About making sure they’re staying on top of that because, my patients who I see in breast cancer follow-up, I always ask them, “When was your last colonoscopy?” And nobody loves getting that, but it’s really important as our major strategy for screening for colon cancer.
In terms of lifestyle recommendations, we know that a lot of the lifestyle recommendations that we talk about with our patients to improve their health during the survivorship phase of their care are also associated with a reduced risk of getting another type of cancer. So we know that physical activity is very beneficial to reduce the risk of many cancers, including breast cancer, colon cancer, and others. We know that being at a healthy body weight is really important in terms of thinking about risk for a future cancer. Again, a healthy diet with a focus of lots of whole grains, fruits, and vegetables is also so important.
So I think all the lifestyle strategies that we’ve really emphasized for cancer survivorship are also really important to optimize health, to reduce the risk of a secondary cancer and other chronic diseases, which I do have to mention, such as heart disease, stroke, type 2 diabetes. All of these things can happen too, because they can happen to all of us here. So we need to think about how can we optimize our health to reduce the risk of all of these potential conditions.
Lisa Hatfield:
Thank you. You heard it here from Dr. Amy Comander. Thanks for joining this RESTORE Program. I’m your host, Lisa Hatfield.
How Does Cancer Treatment Impact Nutrition?
What are the impacts of cancer treatment on nutrition? Expert Dr. Amy Comander from Massachusetts General Hospital discusses the impact of chemotherapy and nutrition advice for overcoming the impacts of cancer treatment.
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How Can Wellness Interventions Aid Patients During and After Treatment? |
Transcript:
Lisa Hatfield:
As a patient living with cancer, I’m always thinking about how my treatments might impact my nutrition or vice versa in some cases. Do I need to increase or decrease anything? Should I change my dietary patterns? I’m getting to the bottom of it with a respected oncologist in this Patient Empowerment Network RESTORE Program.
Dr. Comander, can you give us a general overview of cancer treatment and its impact on nutrition?
Dr. Amy Comander:
Cancer treatment certainly has an impact on nutrition. And as I think about that, it kind of really depends where the patient is along his or her treatment journey. When we think about nutrition, certainly we know if an individual is going through active chemotherapy, often the taste buds change and things that used to be delicious don’t taste as good, and things that maybe a person didn’t like to eat all the time is the only thing he or she can tolerate, like a bagel. Nothing wrong with a bagel, but some of my patients tell me, “That’s all I can eat.”
But in general, when we think about a healthy approach to nutrition, I really counsel my patients on the benefits of a whole foods plant-predominant diet. Note I use the term plant-predominant. That just means it is so beneficial to consume a wide variety of fruits and vegetables and whole grains. Of course, it’s okay to incorporate a protein and maybe that’s a plant-based protein or maybe that’s fish or chicken, okay? But just thinking about the concept of half of the plate being full of fruits and vegetables is so important. And you might say, why is that so important?
Fruits and vegetables, the beautiful colors of various fruits and vegetables really reflect all those beneficial nutrients in the food that are also good for our gut microbiome, which is a term a lot of us hear now in the news, this term gut microbiome. And what does that really mean? Really refers to those microorganisms in our GI tract, gastrointestinal tract. And what’s really interesting is emerging research in some cancers is demonstrating that a healthy gut microbiome is really associated with how well certain treatments for cancer work.
So again, eating fruits and vegetables makes our gut microbiome healthy. And so this is so important for our health. Whole grains as well. Limiting red meat, limiting processed foods, limiting sugar-sweetened beverages. These are all the tips and tricks that I talk about with my patients. And if you want to really look this up and read about it and have a good understanding, again, the American Institute of Cancer Research and World Cancer Research Fund, on their website, they kind of have bullet points illustrating each of these points in terms of how we can approach a healthy diet after a cancer diagnosis.
Lisa Hatfield:
Okay, thank you so much for that information. A little shout out to a multiple myeloma doctor that I watch a lot, because that’s the type of cancer I have, her name is Dr. Urvi Shah, and she has done some research on that and recommends getting 30 different plant-based foods per week, not servings, but just the variety helps your gut microbiome. She’s done some research on that that I won’t go into here but, and it’s not that hard because we get to count all different kinds of lettuce in my salad, if I have romaine, spinach, and iceberg, there’s three right there. So thank you for those comments.
Dr. Amy Comander:
Yes, it’s a great tip to think about how can I get 30 different types of fruits and vegetables into my diet in a given week? And actually it’s kind of a fun challenge. So I love incorporating different types of lettuces into my salad. By the way, herbs count. So parsley, cilantro, things like that, those are plants. So it’s a fun game and it’s really a great way to make your gut microbiome happy and healthy.
Lisa Hatfield:
Okay, thank you. Dr. Comander, what are some key nutritional guidelines for cancer patients during and after treatment?
Dr. Amy Comander:
It’s so important to think about guidelines for nutrition because we know out there on the internet, TikTok, Instagram, Facebook, there’s all kinds of people giving nutrition information. And for a cancer patient, it is very confusing and very overwhelming. That’s why I like to stick to the basics. What do research organizations such as the American Cancer Society, American Society of Clinical Oncology, AICR, American Institute of Cancer Research, what are we recommending?
And again, it’s thinking about a healthy diet pattern which includes an emphasis on whole foods, with fruits and vegetables and whole grains, limiting red meats, avoiding processed meats, limiting sugar-sweetened beverages, avoiding processed foods. If you go to the grocery store and you pick up something and it has 35 ingredients and you don’t understand what most of them are, you probably shouldn’t be eating it, okay?
So these are all some of the general themes that we think about when it comes to nutrition. I know it can be very scary and overwhelming, but just if you, again, think of your plate and if half of it is comprised of fruits and vegetables, a quarter is some type of whole grain, when I say whole grain, think about brown rice, whole wheat pasta, and some grains out there like quinoa and farro that maybe you’ve never tried but are really delicious and good for us.
And then a quarter of that plate, some type of protein source, whether that’s a plant-based protein or perhaps fish or chicken or something like that. But that’s really a great approach to thinking about nutrition. Another point I really need to emphasize is limiting alcohol. So, many people don’t really think much of having a glass of wine or two with their dinner each night, but unfortunately we know that for an individual with a diagnosis of cancer, especially if you’re on new medications or going through chemotherapy, in the best case scenario, alcohol really should be avoided or limited really to special occasions.
Lisa Hatfield:
You heard it here from Dr. Amy Comander. Thanks for joining this RESTORE Program. I’m your host, Lisa Hatfield.
How Can Wellness Interventions Aid Patients During and After Treatment?
How can wellness interventions aid cancer patients during and after treatment? Experts Dr. Amy Comander from Massachusetts General Hospital and Nicole Normandin Rueda, LMSW from PEN discuss benefits of different wellness practices, practical wellness strategies, and support resources.
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Transcript:
Lisa Hatfield:
How can wellness interventions help patients during and after cancer treatment? And what specific practices might help? I have many questions. I’m getting to the bottom of it in this Patient Empowerment Network RESTORE program.
Dr. Comander, how can wellness interventions help folks like myself during and after treatment? And while there seems to be only pros here, can you also speak to any risks of certain wellness practices during cancer treatment? And how can patients mitigate these risks?
Dr. Amy Comander:
Such an excellent question. And I do think it’s really important for us to focus on things that a patient can do after his or her diagnosis to take control of one’s health. We know there’s nothing scarier than getting a diagnosis of cancer and going through treatment for cancer. So we want to think about practical strategies that people can employ to feel better, tolerate their treatments better, and ultimately improve their health.
So let’s pick one of my favorites, which is exercise. I know for some people that word exercise sounds intimidating, scary. Maybe they’re not someone who ever really practiced exercise on a regular basis and so when their doctor or nurse practitioner or social worker is talking to them about this, they feel kind of intimidated. Well, I will say a new field emerging is actually called exercise oncology. It’s really fascinating. And we’re really learning about what is actually happening in the body when an individual exercises, what is going on at the cellular level that may actually be fighting the cancer.
And this is really interesting and exciting. And I love reading these scientific papers. But we’re not going to get into that right now. Let’s just talk about, when you talk about practical strategies, if you’re someone who really has not been active, just walking to the mailbox to get the mail. Try to do that each day. Maybe taking a walk in your dining room, a few laps around the dining room table, if you have one, just something basic like that, walking your dog, walking a friend’s dog. Like everyone has to start somewhere.
So when we talk to our patients about exercise, we just meet them where they are and help them get started with something. And I know this sounds very intimidating, but organizations such as the American Cancer Society, American College of Sports Medicine, and my organization, American Society of Clinical Oncology, strongly recommend that individuals going through cancer treatment engage in exercise. And so you just have to start somewhere. So why is this important? Exercise has been shown to help patients tolerate their treatment better, reduce side effects, reduce the need for dose reductions, improve the fatigue that is often associated with cancer, and in many cases, reduce risk of recurrence and improve the outcome. So there are so many reasons to do it.
You also ask about risks. And I can understand that many people are fearful of starting an exercise program if this is not something they’ve been doing on a regular basis. So I would encourage patients to talk to their doctor just to address any particular concerns. Certainly, let’s say an individual has cancer involving their bone and they’re worried that they might be at risk for a fall and a fracture. That’s something they should certainly talk about with their doctor.
As a breast oncologist, I care for many women who are concerned about risk for lymphedema. Lymphedema is swelling of the arm, perhaps on the side of the surgery. And my patients are often worried, will that get worse if she starts a strength training program? Actually, it will not, but that’s a good question for her doctor or her physical therapist. So I think it’s really important to think about exercise as the number one wellness intervention that we want to address.
Lisa Hatfield:
Okay, thank you. And over to you, Nicole, what are some common wellness practices that cancer patients can adopt during treatment? And how can patients be empowered to take an active role in their wellness during and after cancer treatments?
Nicole Normandin Rueda:
Great question. So just like Dr. Comander said, so physical activity, starting somewhere is going to be of the utmost importance. Nutrition, balanced diet, making sure you’re hydrated, you are following all the recommendations from your medical team regarding what you consume, avoiding anything that you probably shouldn’t be consuming. Stress reduction techniques are all, mindfulness, meditation, deep breathing, the things that help you kind of get back to calm is really critical. We want to make sure patients are aware of their sleep. So the sleep cycle is one of those things that people often complain about, but aren’t really informed on how important it is to your actual overall well-being.
And so if that is an issue, we want to make sure that we are referring them to the appropriate specialist in order to help get that resolved. Social connections, again, huge. We want to make sure people understand that there are organizations and people out there that are here to just serve and help as much as we can. Maintaining the relationships, not just with their immediate family and friends, but also making new connections and new relationships with people that are going to support them throughout this journey is important.
For me as a social worker, empowering patients is what I do…it’s why I’m here. We want patients to have an active role in their wellness, both during and after treatment, because we know, as trained individuals, we know that that is going to overall have a positive impact in their quality of life, in their family’s experience throughout the cancer journey. And that’s important. This is a stressful time for a lot of people. So in order to do that, we always want to make sure we’re providing education and that is first and foremost going to come from the medical providers. Follow up to that would then be everything else, all the ancillary services.
So you have organizations, Patient Empowerment Network. We are very focused on providing evidence-based information in an easy to understand way. And so that is one of those organizations that, as a social worker, I would refer everybody to. But there are others that are doing fantastic things providing education on all sorts of topics, anything that you could possibly want. There are organizations that are doing it well. Now that’s the thing, we want to make sure that we are referring patients to get evidence-based, research-backed information for them to consume and digest at their own pace. Next would be advocacy. If you don’t have a strong advocate in your corner, or if you are not comfortable speaking up or asking questions, this is one of those things that is so incredibly important when it comes to empowering patients to really be involved in their care.
And I can tell you firsthand, my mom was my dad’s biggest advocate. It was kind of embarrassing at times, but in hindsight, thank goodness, because had she not been so ferocious and asked so many questions, there’s a lot of things that we wouldn’t have known as a family going through a cancer diagnosis. So that’s really important. And I know working with medical teams, they want somebody to ask questions, they want to be able to provide as much information as they can. That’s a good backbone for people to understand, that their medical teams are going to want to make sure that they walk out of the room feeling like they have the information they need.
And so we want to make sure that we are providing as much information, as many resources as we can. And then it is up to the patient and their care partners or their family members to then take that and run with it. But we want to be able to make sure that we’re giving them what they need in order to ask the right questions at the right time to the right people. And if they have the resources that they need to go and make it happen.
Lisa Hatfield:
Okay, thank you so much, Nicole. You heard it here directly from the experts. Thanks for joining this RESTORE Program. I’m your host, Lisa Hatfield.
How Do Wellness Practices Impact Cancer Care Outcomes?
What are the impacts of wellness practices on cancer care outcomes? Experts Dr. Amy Comander from Massachusetts General Hospital and Nicole Normandin Rueda, LMSW from PEN discuss the field of lifestyle medicine, the six pillars of lifestyle medicine, research results, and wellness resources for cancer patients.
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Transcript:
Lisa Hatfield:
How do wellness practices impact cancer care outcomes? I’m getting to the bottom of it in this RESTORE Program. Dr. Comander, you have a strong interest in cancer survivorship, lifestyle medicine, and improving outcomes of patients facing cancer. Can you speak to the impact of wellness practices on cancer treatment outcomes and what are we learning?
Dr. Amy Comander:
So I’ve gotten very interested in the field of lifestyle medicine over the past few years. And I think it’s really important to define what that is to those who are just learning about that term for the first time. So lifestyle medicine refers to the therapeutic use of evidence-based lifestyle interventions to prevent and treat chronic diseases. In addition, those who are trained in lifestyle medicine work to empower the patient to adopt these tools and make effective behavior changes.
The six pillars of lifestyle medicine include physical activity, attention to diet, social connection, avoidance of risky substances, stress management, and adequate sleep. These are so important for the care of our patients with cancer from the time of diagnosis and beyond. And at our hospital we’ve developed a program where we provide individualized consultations to counsel our patients on each of these pillars to help them optimize their health and well-being, and in many cases, outcome from cancer. There are emerging studies demonstrating the important role of these lifestyle behaviors for improving outcome for our patients.
As a breast oncologist, I can tell you that there are significant studies demonstrating that individuals with a diagnosis of breast cancer who are able to exercise, whether that’s during treatment or after completion of primary treatment, actually have a lower risk of recurrence and improved outcome from their breast cancer. This is very powerful data, and we’re actually seeing this in other cancer types as well. So it’s very important that we in the oncology field provide our patients with these tools so they can engage in these six pillars of lifestyle medicine to improve their health and well-being.
Lisa Hatfield:
Okay, thank you for that. One quick follow-up question, and then I have a question for Nicole. So if a patient does not have a lifestyle medicine specialist, I guess that’s how I think of you, who, what is the resource, like at a local community center, could they ask the social worker there to help me out with these additional aspects of my cancer treatment? Who would they go to for those questions?
Dr. Amy Comander:
Such an excellent question, and I know I’m fortunate that we have this wonderful program that we started. I would say that in terms of exercise, if you have access to a YMCA, many YMCAs have a program called the LIVESTRONG Program, which is a free exercise program for cancer survivors, and many individuals take advantage of that, and that’s a great resource. If you can’t access a YMCA, thankfully, due to technology like this, we now have the opportunity to offer all kinds of exercise programs on YouTube or through an entity called the Maple Tree Cancer Alliance. There’s so many options potentially available online for somebody who wants to take on an exercise program. I’ll pick another important pillar of lifestyle medicine, nutrition.
One, we know there’s so much information out there on the internet, but one organization that does a very good job on conveying important evidence-based nutrition information is the American Institute of Cancer Research, AICR. So I often refer my patients to that site where they can read articles about nutrition, check out recipes, and, again, it’s very evidence-based and based on research that I trust, and so I think that’s a great resource for individuals who might not have access to an oncology-registered dietician at their hospital.
Lisa Hatfield:
Okay, thank you. And Nicole, are there specific wellness practices that have been shown to improve treatment outcomes for patients facing a cancer diagnosis?
Nicole Normandin Rueda:
Yeah, absolutely. So research has shown that adopting certain wellness practices can significantly improve your quality of life and potentially enhance treatment outcomes. Patients that have physical activity, and what that looks like is different for every patient. So regular exercise can mean a lot of different things. At the end of the day, from my perspective, the importance is that you’re moving your body. So if you start with just stretching, yoga, things to get your body start to start moving, it’s better than absolutely nothing, and then you work your way up to as much as you can endure. That’s key, I think, just like Dr. Comander just said.
Second, we have nutrition. So the balanced diet is difficult for everybody, but whenever it comes to a cancer diagnosis, you really want to take into consideration whatever your doctor’s recommending, and that’s specific to your treatment potentially. But as well as just making sure that you are nourishing your body, getting enough water, staying hydrated, all of the basics.
Next, I know that mindfulness and stress reduction techniques are huge. These practices, including like meditation, yoga, just deep breathing exercises to help kind of reduce that stress level, improve your overall clarity and mental health is really important. We want patients to stay as cool, calm, and collected as they can be. And so even just taking some deep breaths in through your nose, out through your mouth, these things are critical. And then I think another big one is the psychological side of things.
So psychosocial is one of those words that doesn’t mean anything to a lot of people, but to those of us who are trained, we understand that psychosocial means everything around you, everything that interacts with you is impacted by this cancer diagnosis. So we want to make sure we are connecting patients with all of the support groups that we can possibly think of. If that’s what they’re looking for. We also want to take into consideration the cultural situation. So if that means that you really don’t want to sit in a room with others, but you want to just read a blog from somebody like an empowerment lead or something like that, that can also be helpful.
And that is what patients are looking for now is easy access to information that is evidence-based, of course, but also that is just testimonial, somebody that’s been there and can guide them through what it’s like to, yeah, it is okay to talk to others, and it is okay to ask for help when you need it. So we really want to encourage that as much as possible. And obviously we want to foster a sense of community. We want everybody to understand you’re not alone. And there’s organizations out there doing fantastic things. Patient Empowerment Network is one of them, but there’s also so many others that are just doing fantastic things to support patients in every aspect of their cancer diagnosis.
Lisa Hatfield:
Thank you, Nicole. You heard it here directly from the experts. Thanks for joining this RESTORE Program. I’m your host, Lisa Hatfield.
What Is Whole Person Care Exactly?
Whole person care is a key part of cancer treatment, but what does it mean exactly? Experts Dr. Amy Comander from Massachusetts General Hospital and Nicole Normandin Rueda, LMSW from PEN discuss the meaning, aspects, and benefits of whole person care for cancer patients.
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Transcript:
Lisa Hatfield:
We hear about the importance of wellness during and after cancer treatment. Some refer to it as whole person care or lifestyle medicine, but what is it really? I’m getting to the bottom of it in this Patient Empowerment Network RESTORE Program.
Dr. Comander, can you explain the concept of whole person care in the context of cancer treatment, and why are these concepts or strategies important for patients and care partners to understand?
Dr. Amy Comander:
Thank you for that excellent question. As an oncologist, I really focus on providing care for the whole patient or really taking what we also refer to as a patient-centered approach, certainly taking into account my patient’s diagnosis, the stage of the cancer, and the appropriate treatments, but also how can I best address all the other needs my patient is facing, whether that’s transportation to appointments, her goals when it comes to her treatment plan, her neighborhood she lives in and how easy it is for her to get to appointments and get outside to get exercise, and really thinking about all of these needs and integrating them as I formulate a treatment plan and also bringing in other members of our team to address the needs that my patient may face so we can really take care of the whole patient. So I’m so glad that you asked about that.
Lisa Hatfield:
Thank you. Nicole, can you share what the meaning of a whole person care is for you as a social worker? As you interact with patients, how do you explain it to them?
Nicole Normandin Rueda:
Sure. So whole person care means you’re addressing not just the physical aspects of cancer, but also the emotional, social, psychological, and spiritual dimensions of the patient’s experience.
The approach recognizes that cancer affects every aspect of a patient’s life and that effective care must go beyond just the traditional medical treatments. It also includes everything from nutrition, physical activity, counseling. It’s very personalized to the patient, meaning we take the time to get to know the patient, figure out how we can help tailor the interventions that we’re going to suggest to their specific needs, including everything that we need to consider, such as their personal, cultural, or social context. And finally, it’s holistic. So we’re addressing emotional, psychological, social challenges that may arise.
In addition to just being diagnosed with cancer, everything else that’s compounded whenever that happens to somebody, we want to make sure that we are addressing as much of that as possible. So whenever I’m interacting with patients, I’m the social worker that comes in and really just gets to explain all of this from A to Z, that we are, as a team, we’re going to take a comprehensive approach that treats them as individuals, rather as just focusing on treating the disease.
I emphasize that we’re looking at their overall well-being, helping them manage their day-to-day life, as well as everything else that comes with a cancer diagnosis, their side effects, the emotional stress, the financial issues that may come about, the change in roles, the cultural things that may come up. All of these things will be addressed in some way or another, depending on what the needs of the patient are.
Lisa Hatfield:
You heard it here directly from the experts. Thanks for joining this RESTORE Program. I’m your host, Lisa Hatfield.
