Women's Cancer Survivorship Program: "I Am"
Information for Patients
The Women's Cancer Survivorship Program has put together several documents to give our patients more information about their screening questions, treatment plans, and advice on a number of topics. Click on each topic to expand the section and learn more.
There are many types of pain, including:
- Chronic post-operative syndromes.
- Lymphedema (localized fluid retention and tissue swelling).
- Myalgias (muscle pain).
- Arthralgias (joint pain).
- Myofascial (muscle pain due to inflammation in the body’s soft tissues).
- Neuropathic (pain resulting from injury to the nervous system).
As part of your treatment plan, it may be suggested that you try:
- Physical therapy.
- Medications, such as:
- Medication to treat neuropathic pain.
- Anti-inflammatory medication.
- Pain medication.
- Myofascial release/massage.
- Nerve blocks.
Cancer-related fatigue is a distressing sense of physical, emotional or cognitive tiredness or exhaustion related to cancer or cancer treatment. The fatigue is often greater than you would expect from your recent activity and interferes with your usual functioning.
Treatment plan suggestions include:
- Self-monitoring your fatigue levels. (A diary of your fatigue levels with time of day and activity you attempted is helpful.)
- Conserving your energy.
- Setting realistic expectations and priorities for your day.
- Being aware of the pace you are keeping.
- Scheduling your activities when you have the most energy.
- Increasing your physical activity. (Physical therapy or exercise professionals can assist with this.)
As part of your treatment plan, it might be suggested that you try cognitive behavioral therapy for sleep.
Examples of cognitive behavioral therapy include:
- Stimulus control (The bed/bedroom should be a place for sleep or sex only.)
- Sleep restriction (Improve sleep continuity by limiting time spent in bed and maintaining a regular sleep schedule.)
- Cognitive therapy (Use positive thoughts: you will get to sleep, it will be okay in the morning.)
- Relaxation training
- Reduce physiologic and cognitive arousal at bedtime.
- Progressive muscle relaxation, meditation, yoga, biofeedback.
- Sleep hygiene
- Exercise regularly, in the morning or afternoon.
- Increase exposure to bright light during the day and avoid bright light at night.
- Avoid heavy meals and drinking within 3 hours of bedtime.
- Avoid alcohol, caffeine, and nicotine 2 to 4 hours before bedtime.
- Enhance your sleep environment (dark, quiet room, and comfortable temperature).
- Set aside another time for worry.
- Avoid looking at the clock.
Anxiety and Depression
Survivors of cancer are at higher risk for anxiety and depression due to the additional stressors and challenges they face. Many people fear that the cancer might return, and this leads to anxiety related to surveillance and any physical symptoms that may or may not be related to the cancer diagnosis. Unpredictable events and outcomes can lead to anxiety and depression, especially at times of transition, self-monitoring, significant loss, major life events, and social isolation.
Some social factors can contribute to anxiety and depression, including:
- Social isolation.
- Family and caregiver conflicts.
- Financial burden, such as limited insurance coverage.
- Younger age/lack of peers.
- History of abuse.
- Limited access to medical care.
- Employment concerns.
Anxiety and depression are treatable conditions. As part of your treatment plan, it may be suggested you try:
- Social work counseling.
- Cognitive behavioral therapy.
Cognitive dysfunction is often reported in association with cancer diagnosis and treatment, especially in patients treated with central nervous system radiation or intra-thecal chemotherapy. Our goal is to support you, and we will screen you for any underlying disorders.
Here are some tips and suggestions:
- Some patients find it helpful to use specific organization strategies, such as memory aids like notebooks and planners, maps, keeping items in the same place (your keys, your cell phone), and using reminder notes.
- Avoid multitasking and minimize distraction, especially at work. Give yourself permission to focus on one thing at a time.
- Get enough rest.
- Be mindful of your cognitive strengths. For example, is there a better time of the day to accomplish certain tasks?
- Limit alcohol and other substances that can alter your ability to think clearly.
- Be aware of the potential side effects and cautions with medications you are taking.
- Try relaxation training to help focus your attention. For example, yoga meditation or simple yoga poses are mentally and physically calming and can help focus your concentration.
- Routine exercise that increases your breathing and heart rate helps elevate your mood (for example, walking, lifting 1- to 3-pound hand weights, or going up a staircase).
- Some patients find occupational therapy helpful.
- Write in a journal to see what influences your memory problems.
Or create your own sleep diary with spaces for:
- The time you went to bed and woke up.
- How long and how well you slept.
- When you were awake during the night.
- How much caffeine or alcohol you consumed, and when.
- What and when you ate and drank.
- What emotion or stress you had.
- What drugs or medications you took.
Sexual health is an important part of an individual’s overall physical and emotional well-being.
Types of problems that patients often report related to sexual function:
- Little or no interest in sex.
- Decreased genital sensation (feeling).
- Decreased vaginal lubrication (dryness).
- Inability to reach orgasm.
- Pain during sex.
It may be suggested that you try:
- Lubricants (water, oil, silicone-based) or nonhormonal, vaginal moisturizers for dryness.
- Topical lidocaine for pain.
- Vaginal dilators/vibrators.
- Relaxation techniques and exercises.
- Pelvic floor physical therapy.
- Topical estrogen therapy.
- Communication with partner through psychotherapy/couples counseling.
- Treatment for men can be found at the Men’s Health Center at The Miriam Hospital.
Preventive Care and Well-Being
Vaccines are recommended for all cancer and transplant survivors. Vaccination is recommended 3 months after completion of chemotherapy or 2 weeks before starting chemo, and some vaccines can be given during cancer treatment.
Some vaccination recommendations are:
- Flu vaccine every year in the usual dose.
- Pneumococcal vaccine [Pneumovax or pneumococcal polysaccharide vaccine (PPSV)] in the usual dose and time-frame.
- Tetanus, diphtheria, and pertussis (TDaP) vaccine every 10 years, usual dose, to protect against tetanus, diphtheria, and pertussis (whooping cough).
- HPV vaccine for women 26 years old and under to protect against infection of the most harmful cancer types caused by HPV and genital warts.
- Also available to and encouraged for males from age 13 through 21 years old, or 22 to 26 years old for men with certain immunocompromising conditions.
- Hepatitis B, usual dose and schedule of three doses.
There are many steps you can take to maintain a healthy diet during your treatment. You can:
- Maintain a healthy weight by getting regular exercise and limiting intake of high-calorie food and drinks.
- Enjoy a diet rich in fruits and vegetables, and aim for at least 5 servings per day.
- Choose whole grains instead of refined grains.
- Avoid processed meat and red meat; try experimenting with beans and lentils.
- Kepe to healthy plate proportions: one-half fruits and vegetables, one-quarter whole grains and one-quarter healthy proteins.
- Choose healthier fat sources in moderation.
- Drink plenty of water.
- Limit your intake of alcohol and sugar.
- Choose whole soy foods like edamame, tofu and soy milk to help lower the risk of some cancers.
- Avoid products with high levels of soy isoflavone, such as in protein powder and supplements.