From MayoClinic.com
Special to CNN.com

After your cancer treatment, you were eager to nurse your body back to health. But beyond your initial recovery, you might be interested in ways to improve your long-term health so that you can enjoy the years ahead as a cancer survivor.

The advice for cancer survivors is no different than the advice for anyone who wants to improve their health: Exercise and improve your diet. But for cancer survivors these strategies have added benefits — research shows these simple steps can improve your quality of life, smoothing your transition into survivorship. Follow this guide to what you can do to take care of your body after cancer treatment.

Exercise

Regular exercise increases your sense of well-being after cancer treatment and can speed your recovery. Cancer survivors who exercise often experience:

• Increased strength and endurance
• Stronger immune systems
• Fewer signs and symptoms of depression
• Less anxiety
• Reduced fatigue
• Less difficulty sleeping
• Improved mood
• Higher self-esteem

Adding physical activity to your daily routine won’t take a lot of extra work. Focus on small steps to make your life more active. Take the stairs more often or park farther from your destination and walk the rest of the way. Check with your doctor before you begin any exercise program.

With your doctor’s approval, start slowly and work your way up. The American Cancer Society recommends adult cancer survivors exercise for at least 30 minutes five or more days a week. As you recover and adjust, you might find more exercise makes you feel even better.

Sometimes you won’t feel like exercising, and that’s OK. Don’t feel guilty if lingering treatment side effects, such as fatigue, keep you sidelined. When you feel up to it, take a walk around the block. Do what you can, but know that rest is important to your recovery as well.

While exercise has many benefits, there’s no evidence that exercise can keep your cancer from coming back. Many cancer survivors are concerned about cancer recurrence and want to do all they can to avoid it. It’s not clear why cancer recurs in some people but not in others. Exercise won’t stop your cancer from recurring, but it can make you feel better and help prevent other diseases, such as heart disease.

Eat a balanced diet

Vary your diet to include lots of fruits and vegetables, as well as whole grains. When it comes to selecting your entrees, the American Cancer Society recommends that cancer survivors:

• Eat five or more servings of fruits and vegetables every day
• Choose healthy fats, including omega-3 fatty acids, rather than saturated fats or trans fats
• Select proteins that are low in saturated fat, such as fish, lean meats, eggs, nuts, seeds and legumes
• Opt for healthy sources of carbohydrates, such as whole grains, legumes, and fruits and vegetables

This combination of foods will ensure that you’re eating plenty of the vitamins and nutrients you need to help make your body strong.

While it may be tempting to supplement your diet with a host of vitamin and mineral supplements, resist that urge. Some cancer survivors think that if a small amount of vitamins is good, a large amount must be even better. But that isn’t the case. In fact, large amounts of certain nutrients can hurt you. If you’re concerned about getting all the vitamins you need, ask your doctor if taking a daily multivitamin is right for you.

No special diet is known to prevent cancer from recurring. However, some preliminary research in breast cancer survivors indicates that a low-fat diet may reduce the chance of breast cancer recurring. In this study, which has yet to be completed, it isn’t clear whether the slight reduction in breast cancer recurrence was from women eating less fat or from women losing weight on the restricted diet. It also isn’t clear if a low-fat diet has any application to other cancer survivors.

Maintain a healthy weight

You may have gained or lost weight during treatment. Try to get your weight to a healthy level. Talk to your doctor about what a healthy weight is for you and the best way to go about achieving that goal weight.

For cancer survivors who need to gain weight, this will likely involve coming up with ways to make food more appealing and easier to eat. You and your doctor can work together to control nausea, pain or other side effects of cancer treatment that are preventing you from getting the nutrition you need. Losing even more weight can reduce your quality of life and make recovery more difficult.

For cancer survivors who need to lose weight, take steps to lose weight slowly — no more than 2 pounds a week. Control the number of calories you eat and balance this with exercise. If you need to lose a lot of weight, it can seem daunting. Take it slowly and stick to it. Any amount of weight loss can help you feel better about yourself and improve your health.

Stop using tobacco

Kick the habit once and for all. Smoking or using chewing tobacco puts you at risk of several types of cancer. Stopping now could reduce your risk of cancer recurrence and also reduce your risk of developing a second type of cancer (second primary cancer).

If you’ve tried quitting in the past but haven’t had much success, seek help. Talk to your doctor about resources to help you quit.

Drink alcohol in moderation, if at all

If you choose to drink alcohol, keep it to a minimum. At most, women and anyone over 65 should drink no more than one drink a day, and men should drink no more than two drinks a day.

Alcohol does have health benefits in some people — for instance, consuming a drink or two a day can reduce your risk of heart disease. But it also increases the risk of certain cancers, including those of the mouth, throat, liver and breast. While it isn’t clear whether drinking alcohol can cause cancer recurrence, it can increase your risk of a second primary cancer.

Weigh the risks and benefits of drinking alcohol carefully and talk it over with your doctor.

Do what you can

While you may fear it will take an entire overhaul of your lifestyle to achieve all these goals, do what you can and make changes slowly. Easing into a healthy diet or regular exercise will make it more likely that you’ll stick with these changes for the rest of your life.

· Cancer survivors: What to expect with follow-up care

· On the job with cancer: Managing common workplace challenges

· Cancer survivors: Relationships with family and friends after treatment

· Cancer survivors: Late effects of cancer treatment

· Cancer survivors: Managing your emotions after cancer treatment

· Sexuality after cancer treatment: What women can expect

· Sexuality after cancer treatment: What men can expect

· Cancer recurrence: What it means and how to cope

October 05, 2005

Cancer pain: Relief is possible

From MayoClinic.com
Special to CNN.com

Not everyone with cancer experiences cancer pain, but one of out three does. If you have advanced cancer — cancer that has spread or recurred — your chance of experiencing cancer pain is even higher.

Cancer pain strikes in many ways. Your pain may be dull, aching or sharp. It could be constant, intermittent, mild, moderate or severe. Timothy Moynihan, M.D., a cancer specialist at Mayo Clinic, Rochester, Minn., offers some insight into cancer pain, reasons why people might not get the pain treatment they need and what they can do about it.

What causes cancer pain?

Cancer pain can result from the cancer itself. Cancer can cause pain by growing into or destroying tissue anywhere near the cancer. Cancer pain can come from the primary cancer itself — where the cancer started — or from other areas in the body where the cancer has spread (metastases). As a tumor grows, it may put pressure on nerves, bones or other organs, causing pain.

Recent research has shown that cancer pain may not just be from the physical effect of the cancer on a region of the body, but also due to chemicals that the cancer may secrete in the region of the tumor. Treatment of the cancer can help the pain in these situations.

Cancer treatments — such as chemotherapy, radiation and surgery — are another potential source of cancer pain. Surgery can be painful, and it may take time to recover. Radiation may leave behind a burning sensation or painful scars. And chemotherapy can cause many potentially painful side effects, including mouth sores, diarrhea and nerve damage.

How do you treat cancer pain?

There are many different ways to treat cancer pain. The ideal way is to remove the source of the pain, for example, through surgery, chemotherapy, radiation or some other form of treatment. If that cannot be done, pain medications can usually control the pain. These medications include:

• Analgesics, such as aspirin or acetaminophen (Tylenol, others)
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others)
• Weak opioid (derived from opium) medications, such as codeine
• Strong opioid medications, such as morphine, oxycodone, hydromorphone, fentanyl or methadone

These drugs can often be taken orally, so they’re easy to use. However, it you’re unable to take medications orally, they may also be taken intravenously, rectally or through the skin using a patch.

In September 2006 the Food and Drug Administration approved a new form of the opioid fentanyl (Fentora) that dissolves in your mouth. This medication may be particularly effective for intermittent pain episodes, which are sometimes called “incident pain.” These fentanyl tablets dissolve rapidly, and the drug is absorbed through the lining of your mouth.

Specialized treatment, such as nerve blocks, also may be applicable. Nerve blocks are a local anesthetic that is injected around or into a nerve, which prevents pain messages traveling along that nerve pathway from reaching the brain. Other therapies, such as acupuncture, acupressure, massage, physical therapy, relaxation, meditation and humor, may help.

In your experience, what are some reasons for not receiving adequate treatment for cancer pain?

Unfortunately cancer pain is often undertreated. There are many factors behind that, some of which include:

• Physician knowledge. One factor has to do with a physician’s knowledge and ability to treat and recognize pain. Some physicians and other health care professionals may not specifically ask about pain, which should be a normal part of every cancer patient’s visit. Cancer patients should be asked if they are having any pain. If they are, the physician should stop there and deal with the issue. Some doctors don’t know enough about proper pain treatment. If this is the case, your doctor might refer you to a pain specialist.
• Patient reluctance. A second factor might be a patient’s own reluctance. Some people might not want to “bother” their doctors with the information, or they may fear that the pain means that their cancer is getting worse. Some are reluctant to report it or report it as thoroughly as they should because they’re worried about what doctors or other people might think of them if they complain. They might feel that because they have cancer, they’re supposed to have pain and be able to deal with it. That simply isn’t true.
• Fear of addiction. Another factor might be a person’s fear of becoming addicted to the pain medications. This is something that we know doesn’t typically happen if you take medications for pain. If you take them when you’re not in pain or to get high, then, yes, you can get addicted. But the risk of addiction for people who take pain medications in an appropriate fashion — for pain — is very low, so this shouldn’t be a concern.
• Fear of side effects. Some people fear the side effects of pain medications. Many are afraid of being sleepy, unable to communicate with family and friends, acting strangely, or being seen as dependent on medications. People are also sometimes afraid that taking morphine may shorten their life. There is no evidence of any of these happening if the medication is dosed appropriately. And although strong pain medications can cause drowsiness when you first take them, that side effect usually goes away with steady dosing.

What side effects can you expect from cancer pain treatment, and what can you do about them?

Each pain treatment may be accompanied by its own unique side effects. For example, radiation treatments may cause redness and a burning sensation of the skin. And, depending on what part of the body the radiation is applied to, the radiation may cause diarrhea, mouth sores or other problems, such as fatigue. Chemotherapy certainly can cause side effects, such as nausea, fatigue, infection and hair loss, but it can be effective in relieving pain if it shrinks the tumor. There are medications to help with nausea. Relaxation techniques also may help.

Pain medications each have their own unique side effects that should be reviewed with your physician before taking them. One of the common side effects of the stronger pain medicines is constipation — common to opioids. It can be treated with appropriate bowel regimens as prescribed by your doctor, such as adding a stool softener and something to stimulate the bowels. Preventing constipation is much easier than treating it, so anyone who takes these strong pain medications should automatically begin a regimen to keep their bowels moving. Some of the other side effects of the strong pain medications include confusion, lethargy and sleepiness. The severity of these effects varies from person to person and commonly occurs with the first several doses. But once a steady amount of the medicine stays in your body, the side effects usually resolve. Hallucinations and behavior changes are uncommon.

The less potent pain medications actually may have more side effects, which also should be discussed with your physician before taking them. For instance, anti-inflammatory drugs might damage your kidneys, cause ulcers or increase your blood pressure. Aspirin can cause gastrointestinal bleeding, and acetaminophen (Tylenol, others) can cause liver damage if you take too much.

When should you discuss cancer pain with your doctor, and what points should you bring up?

Report any bothersome pain to your physician. If there is a minor pain that goes away, don’t worry about it. But if the pain interferes with your life or is persistent, it needs to be reported and should be treated. Although no one can guarantee that all pain can be completely eliminated, most pain can be lessened to the point where you can be comfortable.

It may help to keep track of your pain by noting how strong it is, where it’s located, what makes it worse, what brings it on, what makes it better and anything else that happens when you have the pain. A pain-rating scale from 0 to 10 — with 0 being no pain and 10 being the worst pain you can imagine — may be helpful in reporting pain to your doctor. In addition, pay attention to what happens when you attempt to relieve your pain. If you take medicine, do you feel any ill effects from it? If it’s a massage or something physical that relieves the pain, those therapies are important to report, too. Note whether they cause any ill effects.

What steps can you take to make sure you’re receiving adequate cancer pain treatment?

First, you need to talk to your doctor or health care provider if you’re having pain. Second, you and your doctor should set a goal for pain management and monitor the success of the treatment against that goal. Your doctor should track the pain with a pain scale, assessing how strong it is. The goal should be to keep the pain at a level with which you’re comfortable. If you aren’t achieving that goal, talk to your physician. If you’re not getting the answers you need, request a referral to a facility more skilled in the care of pain, particularly a major cancer center. All major cancer centers have pain management programs. For the most part, the medications and treatment for pain are covered by standard insurance.

ScienceDaily (Apr. 27, 2007) — A University of Nebraska Medical Center study has found that even before women with breast cancer undergo chemotherapy, they experience fatigue and disruptions in sleep and activity levels. Researchers say their findings suggest health professionals should address fatigue following breast cancer surgery.

Researchers say controlling fatigue after surgery — before starting chemotherapy — is important because fatigue typically increases during chemotherapy. Between 70 to 95 percent of breast cancer patients experience fatigue while undergoing chemotherapy.

The study was published in the current issue of the Journal of Pain and Symptom Management. Having studied 130 women with early stage breast cancer (stage I, II, IIIA), it the largest study to document the prevalence of fatigue associated with altered sleep and activity patterns before chemotherapy treatment. The data confirms what was reported in a previous smaller study funded by the National Institutes of Health.

“We found women are not going into chemotherapy in the best possible shape,” said Ann Berger, Ph.D., Niedfelt Professor of Nursing, UNMC College of Nursing, who has conducted several studies over the past 15 years related to fatigue in cancer patients. “It makes it that much more difficult to reduce the fatigue during treatment. If you start out with some fatigue, it will probably increase.”

“We as health professionals need to address potential fatigue and sleep issues sooner,” said Dr. Berger, principal investigator of the study. “If women are having sleep problems after surgery, we need to address this symptom before women begin chemotherapy. “What we’ve learned might explain why we’re having problems reducing fatigue in breast cancer patients during chemotherapy.”

The published study comes from initial results of a five-year, $1.5 million grant Dr. Berger and her team received in 2003. The purpose of the study, which was funded by the National Institute of Nursing Research, a division of the National Institutes of Health, was to determine the best ways to reduce fatigue during chemotherapy and to prevent chronic fatigue after treatment.

Researchers measured sleep and activity patterns during the 48 hours prior to the first chemotherapy treatment using wristwatch-sized activity monitors called actigraphs.

Fatigue, the most prevalent and distressing symptom for breast cancer patients receiving chemotherapy, has long been accepted by health professionals and patients alike as a side effect of treatment. Researchers say there are ways to intervene, and now they have found it may be important to intervene during the recovery period after breast cancer surgery.

Researchers say disrupted sleep, low daytime activity and/or reduced activity are likely to contribute to mild fatigue before chemotherapy and moderate to severe fatigue after chemo. They say fatigue should be addressed before and after surgery. Women typically begin chemotherapy three to four weeks after surgery.

Dr. Berger said because inactivity contributes to fatigue, she and colleagues say though women need to rest for several days after surgery, they should try to regain activity when they’re able. “We’ve been telling patients for years to rest and take it easy, but in some cases, we’re finding the patients who remain inactive are the one who report higher fatigue.”

Cancer-related fatigue can have a profound impact on an individual’s life, with significant physical, emotional, social, and economic consequences that may persist for months or years after completing treatment. Even after treatment ends, between 30 and 50 percent of patients say their fatigue remains at least six months or doesn’t ever go away.

Fatigue related to cancer treatment is described as a distressing, persistent, sense of tiredness or exhaustion that is not proportional to activity. The factors associated with fatigue are the presence and severity of anxiety, pain, lower sleep quality, physical inactivity, and poor performance status, leaving little desire to work or socialize.

Dr. Berger said the findings provide an important benchmark to begin looking for interventions to reduce cancer-related fatigue.

The study was undertaken to further establish values for sleep, wake, activity, rest, circadian rhythms and fatigue and how they interrelate in women before and during the first year after chemotherapy.

University Of Nebraska (2007, April 27). Fatigue Affects Breast Cancer Patients Even Before First Chemotherapy Treatment, According To Study. ScienceDaily. Retrieved December 4, 2007, from http://www.sciencedaily.com­ /releases/2007/04/070426135536.htm

Nervous System Changes

What they are and why they occur

Chemotherapy can cause damage to your nervous system. Many nervous system problems get better within a year of when you finish chemotherapy, but some may last the rest of your life. Symptoms may include:

• Tingling, burning, weakness, or numbness in your hands or feet
• Feeling colder than normal
• Pain when walking
• Weak, sore, tired, or achy muscles
• Being clumsy and losing your balance
• Trouble picking up objects or buttoning your clothes
• Shaking or trembling
• Hearing loss
• Stomach pain, such as constipation or heartburn
• Fatigue
• Confusion and memory problems
• Dizziness
• Depression

Ways to manage

• Let your doctor or nurse know right away if you notice any nervous system changes. It is important to treat these problems as soon as possible.
• Be careful when handling knives, scissors, and other sharp or dangerous objects.
• Avoid falling. Walk slowly, hold onto handrails when using the stairs, and put no-slip bath mats in your bathtub or shower. Make sure there are no area rugs or cords to trip over.
• Always wear sneakers, tennis shoes, or other footwear with rubber soles.
• Check the temperature of your bath water with a thermometer. This will keep you from getting burned by water that is too hot.
• Be extra careful to avoid burning or cutting yourself while cooking.
• Wear gloves when working in the garden, cooking, or washing dishes.
• Rest when you need to.
• Steady yourself when you walk by using a cane or other device.
• Talk to your doctor or nurse if you notice memory problems, feel confused, or are depressed.
• Ask your doctor for pain medicine if you need it.

ScienceDaily (Apr. 18, 2007) — Using Chinese herbs either alone or in conjunction with chemotherapy may help protect a breast cancer patient’s bone marrow and immune system, as well as improving the woman’s overall quality of life.

Sixty per cent of women undergoing chemotherapy for breast cancer experience a range of significant short term side effects. These include nausea, vomiting and fatigue, as well as inflammation of the gut lining, decreased numbers of red and white blood cells and decreased numbers of blood platelets.

Chinese medicinal herbs include mixtures of herbal compounds or extracts from herbs, and they are prescribed to counteract the side effects of chemotherapy. This Cochrane Systematic Review set out to see if there is conventional evidence indicating that these medicines are safe and whether there is evidence that the medicines are effective.

The researchers identified seven randomised studies involving 542 patients with breast cancer. By analysing these data, the researchers concluded that there was no evidence that the Chinese medicinal herbal treatment caused harm, and some evidence that it might reduce side effects.

“Further trials are needed before the effects of traditional Chinese medicines for people with breast cancer can be evaluated with any real confidence,” says Assistant Professor Jing Li, who works at the Chinese Cochrane Centre in Chengdu, China.