A diagnosis of breast cancer often leads to a treatment plan that includes surgery, chemotherapy and/or radiation and frequent check-ups. As the treatment takes place over time, a routine develops. But what happens — and what should a patient do —– once the treatment ends?
"There is the common misconception by someone who hasn't dealt with breast cancer that you go out to the parking lot and pop open the champagne," says Lisa Graziano, manager of the Breast Cancer Survivorship Patient Navigator Program at the Helen & Harry Gray Cancer Center at Hartford Hospital. "It should be a happy day, but now there's anxiety —– I still don't feel well, I still have scars, I'm depressed, I'm afraid that the cancer will come back."
For some, the future can seem bewildering and, in some cases, frightening. "When people go through surgery and chemotherapy and radiation, they come to the center every day and attach themselves to a team," says Dr. Andrew Salner, director of the Helen & Harry Gray Cancer Center at Hartford Hospital. "Then, we pull the rug out and say, 'See you in six months.'"
"Those people have needs," Salner says of the two-thirds of patients who survive cancer. The hospital has found a way to help patients deal with life after treatment for breast cancer. In 2008, the care center received a grant from the Lance Armstrong Foundation to develop a Patient Survivorship program. Through the program, breast cancer patients who were treated at Hartford Hospital can get a coordinated, personalized after-care plan. Participation in the program is voluntary, but every breast cancer patient is invited to meet with a nurse practitioner and receive a treatment summary and a wellness plan.
"There is no magic pill to prevent cancer, but we can teach [patients] some really good strategies" for good health, Graziano says. Among the important lifestyle habits are a healthy diet (see related story, page ???), 150 minutes of exercise a week, weight management and stress reduction. "These are things that are proven," she says. "We don't just say, 'Go and eat some vegetables.' We will hook [the patient] up with a nutritionist, or a smoking cessation counselor.
We have a whole network of people" such as financial counselors and social workers.
Lucinda Von Duntz of Storrs, who was diagnosed with breast cancer in May, 2011, and took advantage of the survivorship resources at Hartford Hospital, can attest to the benefit of diet and exercise. Through the program, she found out about the LIVESTRONG at the YMCA, a 12-week exercise course for cancer survivors. Von Duntz and her husband, who had also undergone cancer treatment, joined the program.
"I'm not a joiner type of person, but we needed to get exercise," she says. "These people were wonderful. It made all the difference in my life. It gave me an outlet to meet people who were in different stages of their treatment. It gave us all a place to be ourselves and to be positive. Everyone encouraged one another."
Von Duntz found that going to a support group, even while she was still in the hospital, was beneficial. "It gives you a place to get some perspective," she says. She also took advantage of the one-on-one appointment through the survivorship program to go over her treatment summary and wellness plan. "You're confused, and you don't know why [the cancer] happened," says Von Duntz, who is a nurse. "[The health professionals] have so much knowledge to pass on. Why not take advantage of it and learn everything you can?"
For any breast cancer patient, certain lifestyle changes and programs can help a person move forward. Support groups are a place where the participants share common experiences and feelings. Physical activity, eating right, losing – or gaining – weight, if necessary, and stress reduction can improve both a person's physical health and outlook, Salner says.
The kind of treatment summary that the survivorship program supplies contains valuable information. "The treatment summary is big help to the patient; it empowers them," Salner says. "It lets them know what was been done and can offer some strategies for how to stay well, including exercise, proper body weight, diet, what kind of screening they need for monitoring their disease, and what screenings they may need for other types of cancer. The primary care doctors really appreciate [the summary] because they feel they receive bits and pieces [of information]. Here, they receive it in one fell swoop."
By 2015, the National Institutes of Health will require all accredited cancer centers in the United States to offer survivorship programs, Graziano says. With funding from the state, Hartford Hospital will lead a mentorship program for hospitals in Connecticut that are setting up such programs.
While the survivorship program at Hartford serves patients who received treatment at the hospital, Salner suggests that a patient ask her oncologist or team of doctors to put together a treatment summary. The team of surgeons and oncologists treating a patient also are likely to recommend strategies to live by once treatment ends. Salner also offers these tips:
>>Take advantage of support groups and seminars sponsored by area hospitals. Knowledge is power, and "support is such an important part of getting through this whole thing."
>>If you find new lumps or have a persistent pain or other health problem, see your doctor. Schedule regular visits with your primary care physicians after treatment. Most patients continue to see their oncologist intermittently for several years.
>>Exercise a minimum of five days a week, and aim for a goal of 150 minutes of aerobic exercise a week. "That can reduce the reoccurrence of cancer and the risk of new tumors," he says.
>>Strive for optimum body weight. "There is very good evidence that obese women have a greater risk of reoccurrence of breast cancer," Salner says.