Cancer Treatment Is Over, So What's Next? Breast Cancer Survivorship Cancer Treatment Is Over, So What's Next? The end of cancer treatment can be a relief for patients and their families, but it also can be a time of new concerns. Listen to this interview with Hannah Wright, Hannah Wright, ANP-BC, GNP, from the REACH for Cancer Survivorship Clinic at Vanderbilt.
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Laura Osterman: Welcome to this edition of the Vanderbilt University Health and Wellness Wellcast. I am Laura Osterman with Health Plus. October is breast cancer awareness month, and I am here today with Hannah Wright, nurse practitioner with the REACH for Survivorship Clinic at Vanderbilt. Thanks for joining us today. Hannah Wright: You are very welcome. Thanks for having me. Laura Osterman: People are very interested in survivorship as it relates to breast cancer. What does survivorship mean and can you tell us a little bit more about the clinic? Hannah Wright: The definition of a survivor is anyone who has been diagnosed with cancer from time of diagnosis on, so anyone who is living with the cancer diagnosis whether they are in remission or whether they are cured in the survivorship time. So, survivorship we kind of focus on is life after cancer after active treatment, so there has been a big push or long-term follow-up of cancer survivors and that is why there has been a big focus on survivorship so we know that when they are in treatment and they are getting treatment on a regular basis, seeing their oncologist, and then they finish, and we send them back out to the world after a cancer treatment experience. We know that there is a lot that changes. For some people, the life goes back to the way it was before, but we know for a lot of people there are late effects that can occur from the cancer treatment and that is psychological and physical, so our hope is to try to support patients in that transition from someone undergoing active treatment to someone in the life after cancer-type phase. Laura Osterman: Can you tell us more about some of the late effects of treatment and what do survivors need to be aware of? Hannah Wright: For breast cancer patients specifically, there are many potential late effects, not everyone is going to have these effects, but we want people to be aware. We think by educating people it is empowering them essentially. So, some late effects, one of the most common ones that you will hear about from breast cancer patients is lymphedema which is a swelling in the arms after removal of lymph nodes during surgery that can affect people long term, so that is a late effect as well as neuropathy is numbness or tingling in the arms or legs and that could be from the chemotherapy, and like I said, not everyone gets that, but it can be a long-term side effect that you might have the rest of your life, so we know that even though you finish your cancer treatment, you might have effects that are going to be with you for several years. And of course also, late effects like depression is a big one and just anxiety after you finish the treatment like that as well as fatigue is probably number one thing that are seen most commonly with patients, what we call chemo brain, you kind of feel like in a chemo fog. So, it depends on the patient, depends on the treatment they receive, and every patient is different. Some patients finish treatment and their life goes back to the way it was and even they might even be better than it was before, and in some people, there are some new challenges that they have to be deal with. Laura Osterman: And that is something that the clinic can help them with managing and monitoring some of these late affects? Hannah Wright: Exactly. So, big a part is education. So, you want to educate them on potential late effects so they know what to be aware of and also what not to be aware of. If you did not have the anthracycline-type chemo, we are not as worried about long term effects on your heart. So, it is educating them and then it is also treating in terms if I do identify patients who have neuropathy. I can get them involved in our pain clinic here or talk about the treatments that we have. If I have patients who have sexual health as an another big issue, lot of patients have especially after breast cancer treatment where we are suppressing their estrogen, so we have a lot of resources and clinics that we can get them involved in, so meeting their needs in terms of trying to treat that but also monitoring. Laura Osterman: Can you tell us more about what a visit at the clinic would entail, is a referral needed, and what is that process going to look like? Hannah Wright: The good news of our clinic is referral is not needed, so anyone can self-refer. What we do is we give them a treatment summary, so it is a two-page document that includes all of their treatment, any chemotherapy, their dosages, radiation, the radiation dosages, all their surgeries, pathology, a list of their providers, and also it is a treatment summary, but it is also a survivorship care plan. We would like to see patients right after treatment, but some patients we see 20 years after treatment for the first time and we go over the treatment summary, and they do not have to have been treated at Vanderbilt. We see patients no matter the age, no matter where they are treated, and no matter what their diagnosis was. I see all of them, but some patients say they are 5 to 10 years out of diagnosis. Their oncologist might say congratulations, you graduated. You are doing really well. You do not necessarily need to be seen by an oncologist, but if you still want to be plugged into oncology, you can now transition to our Survivorship Clinic, so I also see those patients who can be followed just by survivorship. So, in that case, we do mammograms, screening, we do surveillance imaging, so all that care is transitioned to survivorship. Laura Osterman: After treatment, what do patients find most challenging in resuming normal activities? Hannah Wright: I feel like the number one complaint I hear is fatigue and it is multifactorial. There are lots of reasons for fatigue. It might be the treatment itself, just the chemotherapy, whether it is recovering from surgery, and age-related changes too. It might be harder for someone to recover from this in older age whereas 10 years ago it might have been easier. So, with fatigue, I think it is also the expectation that is tough. A lot of patients think they would be say 5 months off treatment and they think they would have had more energy now than they actually do. I think also chemo brain, a lot of our patients complain of that and they will also described as a brain fog and what that really is we do not know exactly what causes it, but a lot of patients will say I do not feel like as sharp as I used to, I am having trouble with remembering certain words, the words will be on the tip of my tongue, or they have to make lists and write things down now, they did not before, and most patients finds ways to compensate. And usually that improves over time as does the fatigue, but it can take months sometimes for that to improve. I would say another issue is sexual health especially with our breast cancer patients, and again that is multifactorial. There are lots of different things that could be contributing to that. The fatigue could be contributing. If there is depression, that could be contributing, and so we have got a lot of resources for that that we encourage patients to let us know if they are having decreased libido, any vaginal dryness, hot flashes, all these things that go along with some of the medications that our breast cancer patients have to take or going to premature menopause. Laura Osterman: You mentioned healthy lifestyle, can you talk a little more about how does healthy lifestyle play a role in survivorship and what kind of things that you are talking with patients about? Hannah Wright: Lifestyle is a huge issue that we talk about kind of answering that, what next life after cancer type question, and so one of the hardest things is getting back into routine, and it takes time when you have been out of it, you maybe had to take off work for your treatment for several months, so now your stamina is different, you might get tired more easily, so it is taking out time to get back into that. One thing I always tell patients I say start slow. We can start slowly, we do not want to try to get back in exercising too fast, but we know that with survivorship the things that are really important are physical exercise and diet. We know that obesity is linked to decreased survival for cancer patients, and also studies have shown that women who participate in moderate amount of physical activity after diagnosis have significantly better outcomes as compared with women who are less active, and moderate activity might even be something along mowing a lawn or gardening, so what we encourage the patient to do is try to have about 30 minutes of moderate-to-vigorous activity 5 days a week or more., Another thing is diet. There is no specific data for breast cancer focusing on. There is not one thing that they say to avoid, and there is evidence that suggest that decreasing a dietary fat intake after a cancer diagnosis can improve outcomes, but there is no specific data on what things to avoid or consume, so we really should encourage healthy eating, five servings of fruit or vegetable a day, and these are the recommendation by the American Cancer Society. Laura Osterman: Great. Thank you so much for your time here today. Hannah Wright: Great. Thank you so much for having me. Laura Osterman: Thank you. Thanks for listening. Please feel free to leave us any comments on this Wellcast on the form at the bottom of this page. If you have a story suggestion, please email it to us at email@example.com or you can use the “Contact Us” page on our website at healthandwellness.vanderbilt.edu. -- end of recording --