Ask an expert: I've finished my cancer treatment. Now what?
Q: “I finally completed my cancer treatment, and I thought I would be elated, but instead I feel a little bit lost. I'm so used to focusing on the fight – what should I be doing now that it's over?”
Answered by Jennifer Moore, RN, BSN, OCN, oncology nurse navigator, Providence Cancer Survivor Program
When active treatment for cancer ends, many people expect to feel happy, relieved and ready to get back to “life as usual.” It can take you by surprise, then, when your feelings are actually quite different. The side effects from your treatment may linger longer than you expected. You may feel different, emotionally and physically, than you did before cancer. You may miss the close interaction with and guidance of your care team. And you may find yourself wondering: What now?
A lot of cancer survivors find themselves with the same feelings and questions after completing treatment. So many, in fact, that in 2005, the Institute of Medicine issued Lost in Transition, an important report calling on hospitals to address the gap between cancer care and survivor care for the nation's 8 million survivors. As a result of that report, beginning in 2015, all hospitals certified by the American College of Surgeons will be required to provide cancer patients with survivorship care plans after their treatment ends.
If you are a patient of Providence Health & Services, a survivorship care plan is already available to you through the Providence Cancer Survivor Program. The program can provide you with a personalized assessment of your potential long-term risks, plus a comprehensive care plan and recommendations to help you manage the long-term effects of your cancer diagnosis and treatment. For answers to your question – “What now?” – asking your oncologist about this program, or similar programs at other hospitals, would be a great first step.
Meanwhile, here are some additional steps you can take to nurture your physical and emotional health in the days to come and keep moving forward.
Give it some time. Let me assure you that everything you are feeling is completely normal – and it does get better. Over the next several months, your energy will improve, your appetite will return and you will begin to feel more like yourself. But it took time – and some pretty powerful weapons – to treat your cancer, and it will take time to recover from everything you've been through.
Be proactive. The most common fear after completing cancer treatment is the fear of recurrence. One of the best ways to fight that fear is to be proactive about maintaining your health. Staying physically active, eating a healthy, balanced diet and avoiding smoking all can reduce your risk of recurrence – and will make you feel better, too. Learn more about evidence-based nutrition and lifestyle choices that can reduce cancer recurrence.
Talk to someone who understands. After the immediacy of dealing with cancer, you're left with a lot of questions and a lot to process. Talking with your friends, your family members or a counselor can help, but one of the most comforting, helpful and reassuring things you can do is to talk to someone who is going through the same thing. Support groups are different from any other kind of therapy. There's something very special about being in a room full of people to whom you don't have to explain anything – they just get it.
Pay attention to your emotions. Beyond its physical toll, working your way through cancer treatment can cause financial strains, parenting concerns, social isolation and a host of other concerns that would be stressful for a healthy person, not to mention someone who's just spent the better part of a year – or more – fighting for life. It's no wonder so many people come out of it with depression and anxiety. If you're feeling down or taking little interest or pleasure in anything, and the feeling continues for more than a couple of weeks without letting up, contact your physician. This is especially important if you're feeling hopeless or worthless, or if you are considering harming yourself. Don't wait for the feelings to pass – depression can and should be treated.
Stay connected with your oncologist. Your oncologist will determine when follow-up appointments are needed to monitor your recovery. If troublesome symptoms persist – such as a nagging cough after chest radiation, residual pain from scar tissue or lymphedema issues – be sure to mention them at your follow-up appointment. The drugs used to fight cancer can cause a constellation of long-term side effects, but many of them can be relieved very effectively with medication or physical therapy. Any new, worrisome symptoms, such as pain that doesn't go away within a couple of weeks, should be reported to your oncologist.
Don't forget your other doctors. Just because you had one type of cancer doesn't mean that you get a free pass on the rest of the cancers and ills of the world. You still need to get your colonoscopy, your mammogram or lung test if those risks apply, your blood pressure and cholesterol measurements and other age-appropriate screenings.
Tired? Take a walk. Cancer-related fatigue affects almost all patients, and it can last long after treatment is over. Unlike regular fatigue, you can't make it go away with a cup of coffee or a nap. The only proven treatment for cancer-related fatigue is moderate activity. I know – it may sound impossible to take a walk when you're feeling exhausted, but multiple studies show that moderate activity really does reduce fatigue and improve energy. In fact, physical activity reduces just about every side effect of cancer treatment, so it's really important to give it a try.
Taste changes? Try something new. I've never met anybody whose relationship with food was the same after cancer therapy. Dry mouth, swallowing difficulties or taste changes can take anywhere from a few months to a year to completely go away. In the meantime, the key to working through these changes is to keep an open mind and try new things. You may find that you can never eat a green pepper again, but suddenly, for the first time, you like beets. Listen to your body and see what it will accept.
Digestive difficulties? Eat natural foods. If you find that you're still having a little mild nausea, diarrhea or constipation, sticking with natural foods will be easier for your body to sort out. Eat mostly plant foods in a wide variety of colors. Choose whole grains (whole wheat, brown rice, quinoa) if you can tolerate them instead of refined grains (white flour, white rice, white bread). Think of meat and dairy foods as small side dishes rather than the main event, and stay away from red meat and processed meats (deli meat, salami, jerky). These changes will do your digestion a big favor.
Combat chemo brain – even if you didn't have chemo. Chemo brain is a very real and very common phenomenon after cancer treatment. You don't even have to go through chemo to get it – the problems with memory, word finding and attention span collectively known as “chemo brain” can be caused by radiation to the head, endocrine therapies for breast cancer, and certain hormone therapies for prostate cancer as well. While dealing with this long-lasting side effect, it's important to remember that, as slow as you feel, you have not lost any intelligence. And it does get better with time. Until then, take some of the pressure off by adopting some new habits. Put your keys and your phone in the same place every time you come home. Carry a notebook and write things down. Don't think you're going to remember something and then beat yourself up later when you can't. Give yourself a break – you are not stupid. You just had cancer.
Take control where you can, and let the rest go. The active part of your treatment is done. From today forward, try to be at peace with the things you can't control, and proactive about the things that you can control. The next steps may be uncomfortable, but take them anyway: Change your diet. Get up and go for a walk. See your doctor for your follow-up appointments. Schedule that colonoscopy. Join a support group and talk to people honestly about your experience. You had a deadly disease, and you lived to talk about it. That's a pretty powerful statement. Remembering that will give you a strength that you didn't know you had.