LIVING AND COPING
WITH CANCER
ELSHAMI M. ELAMIN, MD
Medical Oncologist
CENTRAL CARE CANCER CENTER
INTRODUCTION
 When doctor says the word “cancer”:
 People can be overwhelmed
 Cancer diagnosis often brings:
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Disbelief
Sadness
Anxiety
Anger
Feelings of fear
Confusion
Feelings of helplessness
INTRODUCTION
 Cancer diagnosis may lead to a change in:
 Person's priorities:
 Relationships
 Career
 Lifestyle
COPING WITH CANCER
 WHAT CANCER PATIENT NEEDS?
 Help to answer common questions about cancer.
 Help to feel more in control of his/her health.
WHO ARE THE MAIN
PLAYERS TO HELP IN
COPING WITH CANCER?
Patient
Caregiver
Health
care
provider
ROLE OF THE PATIENT
“FIGHTING”
FIRST DOCTOR
VISIT
When you meet your health
care team:
 Learn the medical terms
 Will help making informed decisions about cancer
treatment
 Ask for a simpler explanation when don’t
understand something
 Ask to see:
 Drawings
 Pictures
 X-Rays
Seeking information
 Understand your disease
 Process of diagnosis
 Treatment options
REMEMBER:
During the initial visit, absorbing
the news of the cancer and its
unfamiliar medical language may
be difficult and overwhelming
SOME PATIENTS WANT TO KNOW
MORE INFORMATION WHILE
OTHERS LESS
When you get home:
 Try to take care of yourself while coping with
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this news
Start learning about your disease
Seek the support of family, friends, and
others
Find other ways to express your feelings
Write down your questions for the next
doctor visits
GET ORGANIZED
 Because:
 In a short period:
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Various doctors’ visits
Gather a large amount of paperwork
Test results
Personal notes
Talking to insurance
Create a
system
Back again to see your
health care team:
 Ask your questions again
 May bring a family/friend
 Not only be supportive, but can also
help listen to and remember
information
 Being an informed, involved patient is
helpful to you and your health care team
in forming a partnership in your care.
 Tell them how you prefer to be given
information about your diagnosis,
treatment, and prognosis.
 Don't be afraid to ask questions or to let
your doctor know that you don't know
what questions to ask.
The following questions may be
appropriate to ask your health care team:
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What is the exact type and name of the cancer I have?
How was it diagnosed?
What tests were taken and what did they show?
Will I need additional tests?
What stage is the cancer and what does that mean?
What are my treatment options?
What are the possible side effects of this treatment option, both in the
short term and the long term?
What clinical trials are open to me?
Who will be coordinating my overall treatment and follow-up care?
Who will be part of my health care team, and what does each member
does?
If I’m worried about managing the costs related to my cancer care, who
can help me with these concerns?
What support services are available to me and my family?
Second opinion
 A second opinion is standard practice in
medical care
Understanding your emotions
 Illness changes our relationship to the world.
 Remember:
 There will be days when you cannot make
yourself feel hopeful.
 That is normal, especially if you feel physically sick
or tired.
Get support
 Sharing fears and anxieties with family or friends,
counselors, support groups:
 Strengthen patients emotionally, and perhaps even
physically.
 However, some may express their feelings in other
ways:
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Writing
Reading
Painting
Praying
 Anxiety and depression:
 If you find yourself not interested in normal activities for
more than a few weeks, talk to your doctor.
Fear of recurrence
 Maintain your schedule of follow-up visits
 Many cancer survivors describe feeling scared and
nervous
 These feelings may ease with time
 To reduce a anxiety:
 Discuss with your doctor:
 The actual risk of recurrence
 The symptoms to report
Health care
provider
ROLE OF HEALTH
CARE PROVIDER
FIRST PATIENT
VISIT
“Doctor’s most difficult duties”
 Breaking Bad News:
 Confirm medical facts
 Review relevant clinical data
 Arrange adequate time
 Privacy
 Allow for Questions
 Allow for silence and tears
 Emotionally prepare for the encounter
 offer realistic hope
Breaking Bad News
 Keep in mind:
1. Socio-cultural differences:
 Family barrier
 What and how much information is provided
 Participation in medical decision-making
 Asian pts prefer:
 Relatives be present more than Westerners do
 To discuss their life expectancy less than Westerners
2. Religion and believes
Breaking Bad News
 Patients' preferences for
communication:
 Differ based on:
 Gender
 Age
 Level of education
 Younger, female, highly educated
patients desire to receive:
 As much detailed information as possible
 Emotional support
After the bad news
Doctors first focus on:
1. The physical effects of the disease
2. Treatment
 Treatment options:
 Help patients make more
informed decisions about their
health care
 Patients also should know the
short-term and long-term side
effects of their treatment to
anticipate how their needs may
change in the future.
Treatment Side Effects
Anemia
Appetite Loss
Bleeding Problems
Bowel Obstruction
Clotting Problems
Cognitive Problems
Constipation
Diarrhea
Difficulty Chewing
Difficulty Swallowing
Dry Mouth
Fluid Retention
Fatigue
Fluid Around the Lungs
Hormone Deprivation Symptoms
Menopausal Symptoms
Infection
Confusion
Mouth Sores
Nausea and Vomiting
Nervous System Side Effects
Neutropenia
Pain
Sexual Dysfunction
Shortness of Breath
Skin Changes
Skin Reactions to Targeted Therapies
Sleeping Problems or Insomnia
Fluid in the Abdomen
Fluid in the Arms or Legs or Lymphedema
Hair Loss or Alopecia
Hand-Foot Syndrome
Hypersomnia or Somnolence Syndrome or Nightmares
Superior Vena Cava Syndrome
Taste Changes
Thrombocytopenia
Weight Gain
Headaches
Weight Loss
Caring for the Whole Patient
 The health care team should address the
psychosocial effects of the cancer:
 Lack of information and support
 Emotional difficulties
 Depression and anxiety
 Lack of transportation
 Disruptions to work, school, and family life
 Paying for medical bills
Emotional support
 Patients with untreated depression
or anxiety:
 Less likely to take their medication
 More likely to withdraw from family
and others offering support
Emotional support
 Resources and services:
 Peer support groups (Victory in the Valley)
 Individual or group counseling
 Medication
Lifestyle changes
 Part of cancer treatment plan may
includes:
1.
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Change in lifestyle and habits
Change in physical activity levels
Change in diet
Quit smoking
Managing life disruptions
 Change in work schedules or stop working
 The Americans with Disabilities Act and the Family
and Medical Leave Act provide legal protection for
disruptions in work due to cancer treatment
 Trouble performing daily activities
 Home care
What to expect after
completing treatment
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What treatment patient received
Schedule for follow-up
Learn the definitions of medical terms
Keep a complete record of medical care
 Manage Side Effects
Late Effects
 Problems from surgery
 Vision problems
 Problems from
radiation
 Heart problems
 Bone, joint, and
muscle problems
 Endocrine system
problems
 Nerve problems
 Digestive problems
 Memory difficulties
 Secondary Cancers
 Dental problems
 Lung problems
Late Effects
 Emotional difficulties
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Coping with interpersonal relationships
Changes to body image
Sexuality
Returning to the workplace
Obtaining health insurance
 Fatigue
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Anemia
Pain
Sluggish thyroid gland
Lack of physical strength
Depression
Making Positive Lifestyle Changes
 Improve diet:
 More fruits and vegetables
 Quitting smoking
 Establishing better sleeping habits
 Reevaluate lifestyle and make positive
changes:
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Reduce stress
Gain confidence
Discover new interests
Find greater meaning in life
Feel more in control
!!Talking With Someone
Who Has Cancer!!
 Sometimes it may be difficult to know:
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What to say
What not to say
How to be sensitive
How to remain supportive at all times
 Sometimes it's best to just listen …… OR
 Talk about the usual and familiar topics; not
every conversation needs to be about cancer
WAYS TO SHOW YOUR SUPPORT
Be Respectful
 Respect patient need to be alone at times.
 He or she may need to vent frustrations
or anger, which is normal.
 Try not to take it personal.
Choose your words carefully
 It's impossible to truly know what it's like to
be diagnosed with cancer unless you have
been diagnosed
 Avoid phrases, such as:
 I know what you’re going through …
 I know how you must feel …
At the Time of Bad News
 Avoid making statements, such as
 Everything will be fine …
 It's okay …
 Statements like this may not only prove to be false
 May also make the patient withdraw from accepting
your support because they cannot express their true
concerns
Show support with your
body language
 Keep eye contact
 Listen attentively, and avoid
distractions
 Allow for periods of silence
 Smile and touch appropriately
Help the patient stay involved
 Keep the balance between being
supportive and keeping things the same
as before cancer diagnosis.
 Some people with cancer cope best by
staying involved and continuing old
routines as much as possible.
CANCER SURVIVORS
Defining survivorship
 Two common definitions:
 Having no disease after the completion of treatment
 The process of living with, through, and beyond cancer
 Other definition:
 Acute survivorship:
 The time when a person is diagnosed and/or in treatment
 Extended survivorship:
 The time immediately after treatment is completed
 Permanent survivorship:
 A longer-term period
Survivorship is a unique
journey for each person
 Survivors appreciate life more and gain a
greater acceptance of self
 Some survivors become anxious about their
health and uncertain of how to cope with life
after treatment
Survival statistics
 Cancer survivors in USA:
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3 million in 1971  12 million today
15% of survivors were diagnosed >20 years ago
Most cancer survivors today are age 65 or older
68% of cancer patients today are expected to live at
least five years
 Survivors’ cancers:
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Breast 22%
Prostate 20%
CRC 9%
GYN 8%
Increase in survival rates
 Improved screening and early detection:
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Mammography
Colonoscopy
PSA
Pap smear
 Improvements in treatment:
 More effective treatment of side effects
 Anti-emetics
 Growth factors
 Antibiotics
 The development of targeted therapies
REHABILITATION
Rehabilitation
 Cancer rehabilitation
 Obtain the best physical, social, psychological, and
work-related functioning during and after cancer
treatment.
 The goal of rehabilitation:
 Regain control over many aspects of live
 Remain as independent and productive as
possible
How cancer rehabilitation help?
 Improve the quality of life for patient and
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family
Patient become more independent and less
reliant on caregivers
Helping patient adjust to actual, perceived,
and potential losses due to cancer and cancer
treatment
Reducing sleep problems
Lowering the number of hospitalizations
Cancer rehabilitation services
 Patient and family education and counseling
 Pain management techniques and medications
 Nutritional counseling
 Exercise programs to help to build strength, endurance,
and mobility
 Smoking cessation education and support programs
 Assistance with activities of daily living (ADLs)