One of the classes offered at the Stephen and Barbara Slaggie Cancer Education Center, located in Rochester, Minnesota, is Moving Forward: Life After Cancer Treatment.  The ideal participant is one who is nearing the end of cancer treatment or is post-treatment and transitioning into the next phase of survivorship.  Key topics covered in class are available below for you to review at a time that is convenient.  You are invited to stop by the center for additional class offerings, Monday through Friday, 8 a.m. to 5 p.m, Gonda Building, lobby level.  All classes are free and do not require a provider referral.  We look forward to seeing you!

• Nutrition
• Sleep
• Exercise
• Emotions
• Fear of Recurrence
• Communication with Others
• Sexuality
• Late Effects of Cancer Treatment
• Follow-up Medical Care
• Defining the "New Normal"

 

 

Nutrition

The foods you choose can make a difference in your health and survivorship.  Eating right may help you regain your strength, rebuild tissue and feel well.  Eating right starts with selecting a variety of foods every day because no one food contains all the nutrients you need.  Here are some ways to eat a healthy and varied diet: focus on plant-based foods; aim for color with fruits and vegetables; emphasize whole grains and legumes; go easy on fat, salt, sugar, alcohol, and smoked and pickled foods; select low-fat dairy products and small portions of meat, fish and poultry; and maintain hydration with water consumption.

Dr. Shin podcast on Diet and Cancer (Coming soon!)

Oncology Nutrition

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Sleep

Good sleep habits or "sleep hygiene" can help you establish and maintain healthy sleep patterns.

• Create a pleasant, comfortable pace to sleep - think about lighting, temperature, noise and clutter.
• Go to bed and wake-up at consistent times - even when it is a day off.
  • • • • • Avoid heavy and/or spicy meals before bed.
          • Exercise during to help you to sleep better at night.
          • Limit naps to 30 minutes and at least 6-8 hours prior to bed time.
          • Avoid caffeine after 12 noon.

If you have a lot on your mind before bed, whether it be worries or to do's, it may be helpful to write them down so you can release the thoughts.  Keep a pen and paper on your nightstand for this purpose.  Another technique to quiet a busy mind is to practice gratitude.  Think of 3 to 5 things you are grateful allowing for positive thoughts which may be more conducive to sleep.

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Exercise

Emerging evidence in several cancer types is revealing regular to moderate exercise may play a role in reducing the risk of cancer recurrence.  Exercise will need to be tailored to your medical condition and energy level.  Ask your provider for guidelines that would be safe for you.  Exercise of any level is a powerful tool that can help you take control of your physical and mental health.  Maintaining exercise programs can be difficult for anyone.  Three steps have helped many people stick with changing exercise habits:

1. Set realistic goals.
2. Reward yourself.
3. Establish a support system.

Adam Schultz podcast on Physical Activity and Cancer (coming soon!)

Cancer Treatment and Exercise article

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Emotions

Your cancer experience affects the way you feel, think and act.  Just as you need to care for your body after treatment, you also need to care for your emotions.  Shock, guilt, anger, fear, sadness and depression can all be a part of the roller coaster ride of emotions you may feel.

Help in Stressful times video

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Fear of Recurrence

One of the most common feelings reported by survivors is the fear their cancer will return and that can interfere with different aspects of life.  If you are finding this to be true here are some tips for coping with fear:

• Learn signs of recurrence from your doctor.
• Follow through with recommended test and appointments.
• Talk about it.  Express your feelings.  You do not have to be upbeat all the time, but do try to look for the positive.
• Take control of what you can, make a plan, let go of what you cannot control.
• It is normal to have fears enter our minds, don't judge them, but try positive self-talk to help address and re-frame the fear.
• Try mind and body relaxation techniques - they may help you to remain calm.
• Spend time with people you feel are most supportive.
• Do not be afraid to seek professional help to assist with sorting out your emotions.  Psychological distress screening should be a part of your ongoing care.  You may need to seek professional help if you have feelings of depression or anxiety.
• Connect with other survivors for support, you are not alone - utilize online support groups such as Mayo Clinic Connect or in-person support groups.

Living with Uncertainty: The Fear of Cancer Recurrence by American Cancer Society

Additional information

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Communication with Others

You may encounter some difficult comments or situations - it is not about you, but more a reflection of what is going on inside the other person.  Family and friends may expect too much from you physically or emotionally.  They want to believe you are cured, trying to erase memories of treatment, and want to see your old self.  They may want to pretend that cancer never happened - more so out of love (not disrespect).  You are beginning to define your new normal once cancer treatment has ended.  Other people in your life may be on a different timeline or a different path than you are when it comes to defining this new normal.

Other people's anxiety and fear may override their thinking and judgement before they speak and seemingly insensitive comments may be made.  It is OK for you to say when something isn't helpful or that you don't want to talk about it right now.

Accept help!  Allowing others to help gives them purpose without expectation of anything in return.  Would you want to be kind to someone in your situation?  It is humbling to accept help.  Allow yourself to receive kindness.  It feels good to give.  You can tell yourself you are helping them to feel good.  What would be helpful?  Make a list as if you had a personal assistant.  For example, I need you to:

• bring a salad from a favorite restaurant
• pick up milk, bread and eggs from the store
• fill my car with gas or even take it through the car wash
• weed the garden
• run children to an activity or practice

Pretend you are rich and famous and have an army of people to take care of your tasks.  This will help you brainstorm.  The next time someone offers help, you have a list of ideas at the ready.  You may even give them a choice.  "I have a couple of things that would be helpful.  Which one fits best into your schedule?"

Assess your own energy and priorities when you are asked to do something.  There is a formula to help a person say "no."  It is called the positive, negative, positive "sandwich." An example, "Thank you for calling, I like helping with the girl scout cookie sale.  I can't help this year, but call me next year."  Have you ever heard saying no is like exercising a muscle?  It feels weak at first, but gets stronger with repetition, time and practice.

Watch this video: Boost Social Support

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Sexuality

Love, affection and intimacy each play a role in healthy relationships.  Surgery, radiation, chemotherapy and hormone therapy can all cause some sexual side effects.  Remember to give your body time to heal after surgery and treatment.  Sexual dysfunction is most common with cancers of the reproductive system, endocrine system and breast, as well as with cancer of organs located near the reproductive system such as prostate, bladder, and colorectal.

Sexual desires may also be altered due to fear, anxiety, financial pressure  and body image.  You may discover that intimacy takes on a new meaning and character.  Hugging, touching, holding, and cuddling may become more important, while sexual intercourse may become less important.  Be open and communicate with your partner.  Be honest with your feelings, concerns and needs.  If you are open with how you are felling, you can work together to address what is best for you as a couple.

Talk with your health care provider regarding what to expect and formulate a plan to address your concerns.

Sex and the Man with Cancer

Sex and the Woman with Cancer

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Late Effects of Cancer Treatment

Some side effects from treatment such as fatigue, memory changes and nerve damage may linger after cancer treatment. Other late effects of treatment may occur months to years after treatment is completed.  Early intervention is important.  Talk to your oncology health care team about what potential late effects you may experience based on the type of cancer and the treatment you have had and what you can do to prevent, reduce or prepare for them.  This list is provided not to frighten you, but rather to let you know there is help if any of these issues arise.  See your health care provider if you experience any of the below side effects so a treatment plan specific to you can be developed.

• Fatigue is the most common side effect from cancer and its treatment.  It also may be impacted by hormone levels, blood counts or medication side effects.  Fatigue may last weeks, months or even years.  Your health care provider may be able to prescribe treatment.  Self-care is very important such as physical activity, good nutrition and staying hydrated.
• Chemo Brain or memory problems may cause you to experience mental fogginess and difficulties concentrating.  This may be caused by chemotherapy or by radiation to the head. Treatment may include a review of current medications, a visit with a neuropsychologist or support from another health care provider.
• Neuropathy is caused by nerve damage possibly from chemotherapy.  Your hands or feet may feel numbness, burning or tingling.  Sometimes symptoms improve with the use of medications, acupuncture and/or physical therapy.
• Lymphedema is swelling in a body part related to blockage in your lymphatic system.  This may be caused by surgery or by radiation.  Usually it occurs in an arm or leg with a feeling of heaviness, tightness, aching and/or difficulty in movement.  Treatment may include the use of compression stockings or sleeves; physical therapy; and avoiding blood draws, vaccinations/injections and IVs in the affected limb.  You are at increased risk of infection due to lymphedema so monitor for redness, tenderness and fever.
• Pain may occur before, during and after cancer treatment.  It is important to have a plan to control pain so you can live the best quality of life and be as physically active as you are able. Treatments for pain include medications, nerve blocks, physical therapy, acupuncture, relaxation skills or radiation.
• Hormone changes commonly occur in patients with breast, prostate or ovarian cancer. Symptoms may include hot flashes, night sweats, fatigue, difficulty sleeping, changes in sex drive, infertility and possibly decrease in bone strength.  Treatment for hormone changes depend on the type of cancer treated and the exact symptoms it is causing.  Professional help may include your oncologist, your primary care provider or a sex therapist.
• Some treatments may also raise the risk of second cancers.  It is important to follow a healthy lifestyle including not smoking or vaping, eating healthy, daily physical activity and completing your recommended cancer screening tests.

Additional resources of interest:

Long-Term Side Effects of Cancer Treatment

Cancer Survivor Toolbox

Survivorship: During and After Treatment

After Treatment Tips

Fatigue video

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Follow-up Medical Care 

When you are nearing completion of your cancer treatment, ask your oncology health care team about a Survivorship Care Plan. This may include a summary of your treatment therapies, possible long-term effects, lifestyle recommendations and follow-up care related to your cancer diagnosis.

Discuss with your health care provider if follow-up will be done at the health care center your treatment was completed at or if can be done closer to home.  Your primary health care provider usually cares for your regular and preventive medical care.  Sometimes an oncologist is necessary for follow-up care related to cancer and other times it may be appropriate for your local doctor or nurse practitioner.

Be an active participant in your follow-up care.  Be informed about what to expect down the road and when you need follow-up care, tests and appointments.

• What do I need to watch out for based on my type of cancer and treatment plan?
• Where do I go for follow-up care?
• Check with your insurance carrier regarding coverage for follow-up care.

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Defining the "New Normal"

When you get to the end of treatment it is an opportunity to take stock of life.  You have likely been consumed by appointments, tests and treatments.  It may be the first time you can really process all you have been through.  While in active treatment you often only look a couple of steps ahead and try to have enough reserve to do the next thing that is required, yet now you may find yourself in a position to look further ahead in larger spans of time.  As one patient summed up so very well, "It feels like there is no clear way to proceed.  Do I live carelessly or carefully?  Do I go for the adventure or the usual?  Do I travel the world or stay close to home?"  Patients can have a rush of emotions at this juncture.  There is some comfort in knowing this is common.  Allow yourself some time to "feel all the feels."  You are healing physically and emotionally and that takes time.  When I talk to patients who feel as if they are in a quandary, I ask this question, "What brings you joy?"  The response is typically a pregnant pause accompanied by a thoughtful gaze.  It can be something very small such as sitting in their favorite chair with some coffee and sunshine; watching birds at the feeder; or a conversation with a dear friend.  Joy is a good place to start.  You are encouraged to carve a little time in your day where the focus is joy.  Be gentle with yourself as you navigate your new normal.  Bridging the gap between life before cancer and life after cancer takes time.  The video "Moving Forward" has many relatable points shared by other cancer patients.  As you watch it, find the pieces that resonate with you and build from there.

Moving Forward Video

 

 

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