You have finally finished your cancer treatments. The hectic schedule of appointments, follow-ups, chemo and radiation sessions is over and you don't need to see your oncologist again for another three months. You are suddenly free to resume your normal routine, but you're still reeling from the whole cancer experience and you feel a sense of loss?as though the rug has been pulled out from under you.
For many survivors, the phase after treatment can be particularly challenging as they struggle to recover from the many physical and psychological changes wrought by cancer. Although treatment is finished, myriad emotions, including anger, loneliness and fear of recurrence, often linger. Cancer survivors are also at risk for depression (see On the Side in Lifeline, winter 2005), which can be compounded by the residual symptoms presented by both the cancer and ensuing treatments. In a recent survey of 266 women who underwent breast cancer surgery, Erica S. Breslau, Ph.D., and her colleagues at Johns Hopkins University found that approximately one-third of the participants had experienced psychological problems after treatment, with problems becoming most severe four months after surgery.
The cancer experience of Donna Lindsay somewhat mirrors this revelation. Donna, a 44-year-old oncology district sales manager for AstraZeneca in Houston, was diagnosed with multifocal DCIS (non-invasive ductal carcinoma) in 2003. After her biopsy, she underwent a bilateral mastectomy and an oophorectomy (removal of one or both ovaries). As a busy, single working woman who had recently adopted a baby girl, she was very matter-of-fact and "mechanical about the entire situation"?that is, until right after her surgery.
"After surgery it really hit me that I had cancer," says Donna. "I went into such a deep depression that I couldn't get out of bed." Her doctor prescribed an antidepressant, and her treatment protocol included 10 months of regular appointments with her medical team, which was eventually reduced to visits with her oncologist every three months. Donna readily admits to difficulties with the transition.
"I had a lot of issues. I felt abandoned and didn't know what to do," she recalls. "For instance, I had no libido; I had vaginal bleeding and didn't know what to do. I kept worrying that something was wrong with me."
For additional support, Donna turned to her church; the Sister's Network, a national African-American breast-cancer-survivorship organization; and Y-ME, where she joined a support group and underwent training to become a volunteer peer counselor for the 24-hour Y-ME Hotline.
Sue Voorhies, 49, is also an on-call peer counselor for the Y-ME Hotline. In March 2003, she was diagnosed with breast cancer. One month later, Sue underwent a lumpectomy and sentinel node biopsy. In May 2003, she started the first of 33 radiation treatments and started on anastrozole (Arimidex®) two months later. Finally, in July of last year, her oncologist informed Sue that her three-month follow-ups could be tapered down to every six months.
"I was excited about that until I was on the way home, when all of the sudden it hit me that no one would be watching over me for six whole months," Sue relates. "Three months seemed like such a safety net because if I were to have a recurrence, than it would not have gotten too far." Sue currently facilitates a breast cancer support group at her church in Muskegon, Mich.
Marnie McHale, R.N., senior director of the Kellogg Cancer Care Center at Evanston Northwestern Healthcare in Evanston, Ill., offers several coping tips for cancer survivors who need support during this critical stage of the cancer experience:
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Talk realistically with your healthcare team to get an honest appraisal of your recovery time after treatment; in many cases, your recovery may take longer than you anticipate.
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Hold a family meeting to discuss what you might need during your after-therapy recovery period, incorporating your own ideas and information from your healthcare team. Consider having a similar discussion in your workplace, if appropriate.
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Set realistic personal goals for yourself regarding your timelines for resuming activities and responsibilities at home, at work and in the community. Remember, you may need to change or adjust your goals as you go.
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Incorporate a moderate exercise regimen during your after-therapy recovery; with any luck, it will be an extension of the exercises you were doing during your therapy. Exercise is a powerful tool in the fight again fatigue and other symptoms.
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Use your support system?including your oncology nurse?to manage the feelings that occur following the completion of therapy. Sometimes there is a reactivation or escalation of fears of recurrence, especially since you are not seeing your doctor on a regular basis. Seek additional support from trained professionals if you need it.
Y-ME has several resources and services, including breast cancer support groups and the 24/7 National Hotline, that can help you navigate this challenging transition. Call 1-800-221-2141 for more information or to speak to a certified peer counselor who has been in your shoes. Remember, you are not alone!
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