Surviving the Emotional Roller Coaster of Cancer

by John Leifer, with Lori Lindstrom Leifer, MD

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For many people with cancer, the emotional roller coaster that began at the time of diagnosis may con­tinue well into treatment. It’s hard to imagine not feeling distressed when facing a life-altering disease.

However, emotional distress often goes unaddressed during the early stages of diagnosis and treatment – a time when, ironically, intervention may be most beneficial. Distress manifests in many ways. You may feel sad, afraid, hope­less, anxious, discouraged, or even exhausted. It is the intensity, frequency, and duration of these feelings that de­termine whether they are a normal emotional reaction to cancer or some­thing more significant.

When Distress Crosses the Line and Becomes More Serious
It’s important to bear in mind that there is no sharp line in the sand separating “normal” distress from more debilitating levels of anxiety, depression, and posttraumatic stress. However, according to the Amer­ican Cancer Society, there are warning signs that may indicate the need for some level of intervention, including
Feeling overwhelmed to the point of panic
Being overcome by a sense of dread
Feeling so sad that you think you cannot go through treatment
Being unusually irritable and angry
Feeling unable to cope with pain, tiredness, and nausea
Poor concentration, “fuzzy thinking,” and sudden memory problems
Having a very hard time making decisions – even about little things
Feeling hopeless – wondering if there is any point in going on
Thoughts about cancer and/or death all the time
Trouble getting to sleep or early waking (getting less than four hours of sleep a night)
Trouble eating (a decrease in appetite, or no appetite) for a few weeks
Family conflicts and issues that seem impossible to resolve
Questioning your faith and religious beliefs that once gave you comfort
Feeling worthless and useless

You Are Not Alone
If your anxiety or depression has reached clinically significant levels, you are not alone. We know from extensive research that a meaningful percentage of cancer sur­vivors will be affected – though many survivors with distress go undiagnosed. Two major studies suggest that approx­imately 20 to 45 percent of cancer survivors experience clinically signifi­cant anxiety, depression, or both.

Approximately 20 to 45 percent of cancer survivors experience clinically significant anxiety, depression, or both.

Author of Article photo

John Leifer, with Dr. Lori Leifer

Certain People Are More Likely to Experience Distress
Though distress may be a universal human reaction to a cancer diagnosis, we know that some people are more affected than others are:
Women experience greater rates of anxiety and depression than men do. Based on their type of cancer, these rates may be two to three times as great as those that are found in men.
Age can play a significant role, with younger survivors experiencing higher levels of distress.
A prior history of psychological distress is a major risk factor for re-kindling anxiety or depression in people with cancer.
Education, social status, levels of physical activity, and other factors also determine one’s vulnerability to emotional distress.

Who Is Monitoring My Distress Levels?
Despite the prevalence of distress, don’t count on your physician to address your mental health or well-being. The reality is that physicians do an inadequate job of identifying and addressing the psychological needs of their cancer patients. As one physician told me, “I wait for the patient to bring it up. I don’t initiate conversations about their feelings.”

Because doctors are often focused on physical symptoms and treatment, studies have found that emotional and psychological issues may be overlooked or discounted. Survivors, for their part, may be too embarrassed or reluctant to report their concerns. And while large cancer centers have the resources and staff to screen for distress and provide help, community hospitals and oncol­ogy practices often don’t have the time or funding.

If you are feeling unduly anxious or depressed, it is important that you talk to your physician about it. Ask him or her if there is a social worker in the office or other mental health professional with whom you may speak. If not, you may want to ask for a referral. In many communities, there are cancer support organizations that address this gap in care. If you are suffering, it is important that you seek out empathic providers who can help you manage the emotional roller coaster of cancer. There is no reason to suffer undue anguish if it can be remedied, and there are very real physical consequences to impaired mental health or well-being.

Coping with Cancer-Related Distress
Although cancer may be the most daunting challenge you have faced to date, there undoubtedly have been other difficult periods during your life­time. You probably discovered a variety of methods for coping with these stress­ful times that could prove quite effective in improving your well-being during cancer treatment and survivorship.

Some of these strategies involve other people, including family, close friends, and clergy. Other strategies are solitary endeavors. Whatever brings you peace, comfort, meaning, or joy should be considered. Here are some of the myriad ways that people with cancer can reduce their stress levels and im­prove well-being:
Physical activity Exercise has been shown to have a profound effect on stress and well-being. Consider new forms of exercise, such as yoga, that may be easier to manage while undergoing treatment.
Quiet and contemplation This could take the form of meditation, prayer, guided imagery, or similar practices.
Journaling The simple act of writing about your experiences and feelings can be profoundly cathartic.
Practicing gratitude Gratitude exer­cises that focus on the many “gifts” that you still enjoy and that enrich your life have been demonstrated to have a powerful effect on well-being.
Maintaining normalcy Seek to main­tain those aspects of your life that make it feel “normal,” and hold onto as much of your daily routine as possible.
Support groups Experiment with support groups to determine if they are helpful for you.

Many communities are fortunate enough to have dedicated cancer resource centers that provide well-being services. Ask your physician or nurse about the types of services available in your com­munity. You can also search online. It is best if you can find services offered by a nonprofit community organization whose mission is to improve patients’ well-being.

When Some Additional Help Is Needed
When your existing methods of coping fail to bring adequate relief from distress, take comfort in knowing that numerous additional interventions are available, including supportive therapies (i.e., talk therapies), medical therapies, physical activity, and posi­tive psychology interventions.
Supportive therapies People who seek supportive or talk therapy will likely receive care from a psychologist, psychiatric social worker, counselor, or similarly trained professional. These mental health professionals employ a variety of techniques, including cogni­tive behavioral therapy, to help people reconceptualize their distress.
Medical therapies If medical thera­pies are indicated, your physician will either prescribe drugs designed to mediate your anxiety and depression or refer you to a psychiatrist or psy- chiatric nurse practitioner. It is important for you to understand the benefits, limi­tations, risks, and side effects of any medication prescribed to you. You should also ensure that new medica­tions do not interact with any current medications and that there are no dietary restrictions associated with taking the new medications.
Physical activity As previously indicated, physical activity is among the most powerful interventions known for improving well-being. A doctor-approved exercise plan can make a tremendous difference in your overall mental health and ability to endure the rigors of treatment.
Positive psychology interventions The final group of interventions is de­rived from the emerging field of positive psychology. Whereas psychology tradi­tionally has focused on what is wrong with patients, positive psychology seeks to build on what is right. Its focus is on enhancing well-being and mitigating the damaging effects of distress. Though it has been occasionally derided for being focused on happiness, positive psychol­ogy is a scientifically rigorous discipline that has yielded important findings about how to enhance meaning, fulfillment, joy, and vigor in our lives.

Among the most researched positive psychology interventions is mindfulness, a form of meditation that is quickly learned and easily practiced. Though it may have little to no impact on the physical course of a person’s disease, it can improve quality of life, accep­tance of one’s condition, and the ability to smooth out the bumps in the long journey through cancer. Other forms of positive psychology interventions commonly used with cancer patients include resilience training, gratitude exercises, and music therapy.

Your Take-Away Message
People’s emotional reactions to cancer are as varied as their personalities. Even so, the preponderance of anxiety, depression, and other conditions that negatively affect cancer survivors’ well-being are well documented. If you are feeling a moderate to high level of distress, it is important to discuss this issue with your doctor. Depending on the significance of your symptoms, you may benefit from a variety of treat­ments, ranging from physical activity to meditation to medication. You can learn to manage your distress and may benefit significantly in the process.

♦ ♦ ♦ ♦ ♦

John Leifer has spent more than 30 years seeking to catalyze positive change within the healthcare industry as a senior healthcare executive, consultant, academician, writer, and, most recently, as a senior vice president for a hospital health system. An outspoken advocate for patients’ rights, John has pub­lished widely on the need for patients to receive appropriate, safe, and effective care. Dr. Lori Leifer is both a cancer doctor and a cancer survivor. As a radiation oncologist, she has provided care to patients for the past 25 years. In addition to her clinical practice, Lori holds a teaching position as assistant clinical professor at the University of Kansas School of Medicine, in Kansas City, KS.

For more information on John, Lori, and the book from which this article is adapted, After You Hear It’s Cancer: A Guide to Navigating the Difficult Journey Ahead, visit

Reprinted with permission from After You Hear It’s Cancer: A Guide to Navigating the Difficult Journey Ahead, Copyright © John Leifer. Used by arrangement with Rowman & Littlefield. All rights reserved. No part of this excerpt may be reproduced or printed without permission in writing from the publisher.

This article was published in Coping® with Cancer magazine, November/December 2015.

12 Tips for Coping with Cancer during the Holidays

by Kaylene Chadwell

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When you have limited time and energy, it’s best to spend it with the people who matter most to you, doing the things you most enjoy.

For most, the holiday season is a wonderful time of year, filled with cherished traditions and time spent with loved ones. However, when you’re dealing with cancer, the holiday hubbub can become exhausting and stressful. While there’s no right or wrong way to celebrate, here are 12 tips to help you have a joyful, stress-free holiday season.

1 Remember the reason for the season.
Think about what the holi­day season means to you. Focus on what’s most important to you and your family. Don’t get too wrapped up in getting the best gift for loved ones or making the perfect family dinner. Ap­preciate being around the people you love and enjoy the memories you make.

2 Adjust expectations.
Set realistic expectations. Don’t feel like all your holiday festivities need to be “perfect.” Overextending yourself and your body can cause stress, which can make you miss valued quality time with friends and family.

3 Make priorities.
You may not have the time or energy to do some activities. Figure out what is most important to you and your loved ones. Making a list of the holiday activities you want and need to do can help you see which ones you can skip this year.

4 Be open to change.
There may be some holiday traditions you just don’t have the time or energy to participate in. Don’t get stuck in the old ways of doing things. Modify your usu­al holiday traditions to meet your needs this year, or create new ones that make the most of your energy.

Don’t feel guilty when you have to turn down an invitation
or skip out on an activity.

5 Don’t be afraid to say no.
And don’t feel guilty when you have to turn down an invitation or skip out on an activity. Saying yes to everything can lead to stress and exhaustion during this busy time of year. Your loved ones will understand if you can’t participate in every holiday activity.

6 Ask for and accept help.
You don’t have to do it all. If someone offers help, accept it. This will help you preserve your energy during the long holiday season. Be realistic about what you can do. If there are certain traditions you want to continue this year, it’s OK to ask for help to make them happen.

7 Relax.
Sometimes the holidays get so busy we forget to relax. Set aside days where you don’t have much planned. Take a bath. Read a book by the fireplace. Spend time alone to get away from all the holiday craziness.

8 Maintain a regular routine.
Try to keep your normal mealtimes and sleep schedule. Don’t miss meals. Keep late nights and long days to a min­imum, especially when you’re feeling tired. Don’t compromise your health for holiday festivities.

9 Be mindful of your eating habits.
It’s easy to overindulge when there are holiday parties and seasonal goodies everywhere you turn. Control your por­tions. Eat balanced meals, and avoid drinking excessive amounts of alcohol. Give your body plenty of the healthy food it needs.

10 Keep moving.
It’s easy to bypass exercise during the holidays, but it’s important to make time for it. Get your loved ones involved. Go on walks with family members, or build a snowman with the kids. Physical activ­ity can help you feel better and give you more energy. Just make sure to talk with your doctor before starting any exercise program.

11 Be with people who lift your spirits.
Spend time with people who make you happier, and not those who drag you down. Don’t feel like you have to spend time around negative relatives just because it’s the holiday season. When you have limited time and energy, it’s best to spend it with the people who matter most to you.

12 Listen to your body.
You won’t always feel up for participating in holiday events. Take a break from all the festivities when you need to. It’s important to balance activity and rest throughout the holiday season.

♦ ♦ ♦ ♦ ♦

This article was published in Coping® with Cancer magazine, November/December 2015.

Living Well with Lung Cancer


Photo by Cancer Type

Lung cancer can be treated in several different ways. Each person’s experience is unique, but the more information you have, the better equipped you will be to ask questions and make decisions.

The treatment for lung cancer de­pends on your lung cancer type, stage, and treatment goals. You will work with your lung cancer care team to decide what the goal of treatment should be: cure, control, or comfort.

Every doctor, patient, and caregiver hopes that treatment will get rid of the cancer completely. This is a more realistic goal for some people with lung cancer than for others. It de­pends on your lung cancer profile – the type and stage of your cancer and what treatment options you are eligible for. When a lung cancer cure is your goal, you may be willing to endure more intense side effects in return for the chance at a cure.

Sometimes, when your cancer is at a later stage or previous lung cancer treatments have been unsuccessful, your treatment goal might change to controlling your lung cancer. This might mean choos­ing treatments that try to shrink or stop your cancer from growing. If this is your goal, you might not want to choose harsher lung cancer treatments and the side effects they may cause.

If you have an advanced-stage lung cancer or one that hasn’t responded to treatments, you might consider lung cancer treatment that allows you to be comfortable and enjoy your life instead of treatment that will continue to address the cancer but might cause harsh side effects. You and your doctor will work together to make sure you are free of lung cancer symptoms and able to live your life.

Choosing Your Treatment
Once your doctors have determined your lung cancer profile and you have set your treatment goals, your doctors will present you with one or a combination of the following treatment options: surgery, radiation therapy, chemotherapy, targeted therapy, immunotherapy, clinical trials, and supportive (palliative) care.

Each lung cancer treatment option has risks and possible side effects. Most side effects can be managed fairly well, but you should consider all of the pos­sibilities when you examine your lung cancer treatment options.

Knowing What to Expect
No one can predict what your individual jour­ney will be like, but knowing what to anticipate during and after treatment can help you feel more prepared. Re­search as much as you can from trusted resources, and maintain an open dia­logue with your healthcare team about your needs. You should also ask if your hospital or cancer center has a nurse navigator or care coordinator on site to help you make decisions and manage your lung cancer care.

♦ ♦ ♦ ♦ ♦

Source: American Lung Association,

This article was published in Coping® with Cancer magazine, November/December 2015.

What Can Cancer Rehabilitation Do for Me?

by Leslie J. Waltke, PT, DPT

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As if hearing the words “you have cancer” isn’t difficult enough, it can be even more distressing to discover that the very treatments used to save your life may cause you pain, fatigue and weak­ness, sapping you of the energy needed to enjoy the very life you are fighting to save. But there is promising news – cancer rehabilitation can help.

Years ago, people were told to take it easy following surgery or injury. How­ever, with time and research, healthcare providers have learned that a strict reg­imen of rest is a poor treatment tool. Today, those in recovery are sent to physical therapy and encouraged to ex­ercise. And research is telling us the same thing about rehabilitation during and after cancer treatment.

Cancer rehabilitation and exercise programs have been shown to increase cancer survivors’ quality of life, lengthen life, and possibly even decrease the risk of cancer recurrence. The evidence is so strong that the National Comprehensive Cancer Network recommends that rehabilitation begin right away at cancer diagnosis.

What is cancer rehabilitation?
Cancer rehabilitation is the area of physical medicine that specializes in treating the physical and functional problems that often arise during cancer treatment, including fatigue, pain, dif­ficulty walking, weakness, stiffness, poor balance, neuropathy, swelling, bladder control issues, and sexual prob­lems. Cancer survivors should not have to face these challenges alone. With the help of a physical therapist specializing in cancer rehabilitation, many of these problems can be reduced, eliminated, and sometimes even prevented.

Author of Article photo

Leslie J. Waltke

Where does exercise fit in?
Perhaps the most common and distressing side effect cancer survivors encounter is fatigue. For decades, survivors were told that rest was the best way to com­bat this tiredness. Now, researchers have learned that this was bad advice. Re­search has shown that too much time on the couch actually makes fatigue worse and survivors weaker. Exercise, it turns out, is one of the best treatment tools for reducing cancer-related fatigue. Study after study resoundingly backs this up.

Exercise is not only safe during chemotherapy and radiation, but it is critically important. By keeping the heart, lungs, and muscles strong and active, people who exercise during treat­ment have less fatigue, less nausea, less pain and weakness, and a much quicker recovery. Exercise may also protect the heart from the toxicities associated with some types of chemotherapy.

What else can cancer rehabilitation do for me?
Another set of common physical complaints of cancer survivors is pain, weakness, and decreased func­tion. Regardless of the type of cancer treatment, most people should expect to return to full pain-free function after a recovery period. Unfortunately, however, this is often not the case. But there is hope. A cancer rehabilitation therapist can work with you to help you regain full mobility, strength, and function after cancer treatment, much like rehab after knee replacement surgery.

It is never too late to start feeling better. Whether you are just diagnosed, currently in treatment, or finished with active treatment, talk with your doctor about starting a rehabilitation program. You’ve been through a lot, and you deserve to return to the highest level of pain-free function possible. Cancer rehabilitation can help.

♦ ♦ ♦ ♦ ♦

Leslie J. Waltke is a physical therapist who has dedicated her practice to cancer care. She is the cancer rehabilitation coordinator for Aurora Health Care in Milwaukee, WI.

This article was published in Coping® with Cancer magazine, 2015.

Tick Tock

As my mother’s cherished clock collection dutifully marks time’s passage, time itself has taken on a much deeper meaning since cancer entered the picture.


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Every hour, on the hour, a cacoph­ony of chimes swells throughout our three-level home. A grand- father clock in the living room chimes Beethoven’s “Ode to Joy.” The golden face of a Rhythm clock gracefully opens up as it fills the dining room with the melody of Simon and Garfunkel’s “Bridge Over Troubled Water.”

After their solos, these two prima donnas are joined by the clocks in the upstairs and downstairs family rooms as they ring in the hour. Then, as an encore, the adorable little cuckoo in the basement pops out of its clock to announce the time.

These are just the clocks that make their presence known every hour. We also have clocks that are not so boister­ous: the steady, dependable wall clock in my office; the adorable cat clock whose tail serves as its pendulum; the tall swinging clock held in the hands of an ornate antique female statue; the kitchen clock ap­propriately created entirely of forks and spoons; and the small clock face set in the stunning red rock of Zion National Park. Then, of course, there are the less stately digital timekeepers found on the microwave, the oven, and the bedside alarm clocks.

Our home hasn’t always been filled to the brim with clocks. For most of the ten years we’ve lived here, there was even a shortage of time devices. Our only clock hung shamefaced in the hallway perpetually displaying the wrong time, having been inoperative for years.

While we painted her bedroom Social Butterfly yellow, she was busy figuring out which of our walls would be graced by one of her precious clocks.

About Coping

Paige Kraus

It wasn’t until two months ago, when my clock-obsessed mother moved in, that our home became flooded with clocks. While we laid new carpet in her base­ment living area and painted her bedroom Social Butterfly yellow, she was busy figuring out which of our walls would be graced by one of her precious clocks. My loving husband dutifully hung each one per Mom’s specifications. And after each clock was hung, she would stand back and smile gratefully. All was right with her world as long as her clocks were there to herald the passage of time.

Time itself has taken on a much deeper relevance for my mom and all who love her. She was diagnosed with Stage IV colon cancer in March 2013. Time seemed to stand still as the doctors delivered the prognosis that devastated us all: there was no cure for this in­sidious cancer that had already spread throughout her liver and abdominal wall by the time it was discovered. No radia­tion, no surgery, no hope of wrenching this horrific disease from my mother’s body. Our only hope was that chemo­therapy could contain the tumors and keep them from spreading their destruc­tiveness any further.

The two weeks I spent with my mother in the hospital after that initial diagnosis were a blur. The passage of time was marked by the flow of nurses in and out of her hospital room, day and night. The arrival of a plastic meal tray announced meal times. When a white-coated doctor appeared, we knew it was morning rounds. The only clock in the room was a silent, black-rimmed circle whose hands moved with aching slowness toward each number in their progression around and around and around the stark-white clock face.

Two years have now passed since that awful day. Is Mom healed? No. However, she has learned to live well with cancer.

Now, time passes in weeks that are labeled “a good week” or “a chemo week.” In the good weeks, she shops for new clothes, bakes for the family, and tends to her flower gar­den. During her chemo weeks, she goes to blood draws and sits for hours in the infusion center receiving the chemo­therapy treatments that are containing the tumors and keeping her alive.

Months now are measured by CT scans. Every two to three months, the tumors lurking within her organs are made visible to the radiologists who compare and measure, and then pro­nounce the words we love to hear, “No new growth.”

How long will the cancerous tumors be controlled? Only time will tell.

The one thing we do know is that with each tick tock of Mom’s clocks, we have been given the gift of time. And we will cherish that gift for as long as time allows.

♦ ♦ ♦ ♦ ♦

Paige Kraus is a cancer caregiver living in Colorado Springs, CO.

This article was published in Coping® with Cancer magazine, September/October 2015.

From One Survivor to Another

These Are the Lessons I Learned While Battling Cancer

by Sara Nelson O’Brien

Inspiration image

To help unleash her inner superhero, Sara wore these super socks to every chemo treatment.

My battle with cancer began in the summer of 2012 when I was diagnosed with stage III endometrial cancer. This June, I celebrated two years of being cancer-free. It has been a hard fight, with plenty of good times, and more than enough difficult moments too. Along the way, I’ve learned a few lessons that I want to share with you – from one survivor to another.

Hold on to your faith.
It is easy to neglect religious practices, like prayer and scripture reading, when you feel tired and ill. However, if you are a spir­itual person, now is the time to cling to your faith. It can become your greatest source of strength and comfort.

Seek friendship with a fellow survivor.
It helps to know you are not alone in your struggle, and it can be therapeutic to talk with someone who understands what you’re going through.

Exercise (with your physician’s OK).
Even a small amount of exercise each day can help combat stress, pain, and fatigue. Exercise is a valuable tool for recovery after cancer treatment.

Try not to stress about food.
I found that obsessing about eating increased my anxiety and decreased my appetite. Eat when you feel relaxed, and always have a variety of options on hand. Your sense of taste does change during chemotherapy. Try not to expect a favorite dish to taste the same as you remember. Approach every food as if you are trying something new. That way, you’re less likely to be disappointed if it doesn’t taste the way you expect.

It helps to know you are not alone in your struggle.

Talk to a social worker.
Your hospital or clinic should be able to connect you with an oncology social worker. I was fortunate to meet one after my first oncologist visit. It was part of my clinic’s protocol, and the introduction was invaluable. Social workers have experience dealing with all the issues that come along with a cancer diagnosis, and they can help you establish a plan for managing bills, returning to work, talking with your family, taking care of your emotional health, and many other challenges cancer survivors face.

Have a sense of humor.
It’s OK to laugh during treatment. Some of my best moments were spent joking with my fellow radiology “inmates.”

Let people know what you need.
Friends and family want to help you. Give them practical ideas, like grocery shopping, rides to and from treatment, house cleaning, preparing meals, walking the dog, or even cleaning the litterbox.

Give yourself a break.
Not only are you battling a life-threatening disease, but you are also experiencing the often-harsh side effects of potent treatments. You will feel tired. You will need to scale back at work and at home. Don’t feel guilty about it. You need your energy to attack the cancer.

Keep in touch with your friends.
Through phone calls, group texts, email, Facebook, Twitter, whatever method of communication appeals to you. Also, feel free to let people know when you are tired and not up for a visit or a chat. Your friends will understand.

Elect a “sanitation officer” in your home.
Their job is to help protect your weakened immune system by ensuring visitors wash their hands upon entering your house. My mom accepted this role for me, and she laid down the cleanli­ness law. She even had a powwow with my husband and son when she felt the amount of soap in the dispenser wasn’t decreasing to her satisfaction.

Get out of the house.
If you are able, a change of scenery can do wonders for your mood. My husband and I would often go out for ice cream. I would eat it in the car while enjoying the countryside.

Don’t compare yourself with other cancer fighters.
Treatment plans, energy levels, and medication responses are very individual. One person may be able to train for a half marathon during treatment. Another may be lucky to get up and out of bed each morning. Both are doing what they can to battle this beast. Try not to judge yourself, or others.

Wear your superhero t-shirt …
and socks and undies on treatment days. It really does help!

♦ ♦ ♦ ♦ ♦

Sara O’Brien is a mother, nurse, caregiver, cancer survivor, and author of The Bald Headed, Tattooed, Motorcycle Mama’s Devotional Guide for Women Battling Cancer and Those Who Love Them. To learn more about Sara, visit her website

This article was published in Coping® with Cancer magazine, September/October 2015.

Don’t Underestimate the Importance of Good Nutrition during Cancer Treatment

by Jennifer Fitzgibbon, MS, RDN, CSO, CDN

A cancer diagnosis is life alter­ing, to say the least. As soon as you hear the words “you have cancer,” you are thrust into a world of complex medical language, difficult treatment decisions, and overwhelming emotions. Your diet is probably the last thing on your mind.

However, you may want to think twice about putting nutrition on the backburner after a cancer diagnosis. Nutrition is an important part of cancer care. Eating the right kinds of foods, in the right amounts, and at the right times can make a noticeable difference in your cancer treatment and recovery. Research has shown that eating well during cancer treatment can help you
keep your scheduled appointments;
increase your strength and energy;
stay hydrated;
boost your immune system;
decrease your risk of infection;
maintain your prescribed treatments;
heal and recover more quickly;
maintain a healthy weight;
preserve your body’s store of nutrients; and
better tolerate treatment-related side effects.

Treating Nutrition Problems Early
Both cancer and its treatments can affect the way your body tolerates cer­tain foods and uses nutrients. Likewise, your nutritional status can affect how well you tolerate cancer treatments. For example, someone who is underweight or malnourished may not be able to endure cancer treatment as well as some­one who is well nourished. Therefore, it’s important to find and treat nutrition problems early.

Plant foods should form the basis of your diet. At each meal, try to fill two-thirds of your plate with colorful plant foods.

Author of Article photo

Jennifer Fitzgibbon

A thorough nutrition screening and assessment should be done soon after cancer diagnosis in order to find prob­lems that may affect how well your body can deal with the effects of cancer treatment. Finding and treating these problems early can help you maintain an optimal weight, prevent nutrition-related treatment issues, and improve recovery. Your nutrition assessment can also assist your doctor or dietitian in developing a personalized plan to help you eat well during cancer treatment.

Getting the Right Nutrients
Eating well means eating a variety of foods that provide the nutrients you need to maintain your health while fighting cancer. These nutrients include protein, carbohydrates, fat, water, vitamins, and minerals. A healthy diet during cancer treatment should consist of an assortment of foods from all of the food groups.

Plant foods should form the basis of your diet. You should eat five to eight servings of fruits and vegetables every day. At each meal, try to fill two-thirds of your plate with colorful plant foods. Keep in mind, however, that some peo­ple may need to avoid eating raw fruits and vegetables at certain times during cancer treatment; for example, when your blood counts are low. Talk with your doctor about whether there are any foods you need to avoid and when you can introduce them back into your diet. In the meantime, cooked fruits and vegetables are always an option.

Protein assists with growth and the repair of body tissue. It is also essential to maintaining a healthy immune system. People with cancer often need extra protein. Good sources of protein include lean meat, fish, poultry, dairy products, nuts, dried beans, peas, lentils, and soy foods. Supplemental shakes can also provide additional protein if needed.

Carbohydrates supply the body with the bulk of the calories it needs to func­tion properly. The amount of calories you need depends on your height, weight, gender, age, and activity level. Good sources of carbohydrates include fruits, vegetables, whole grain breads, pasta, whole grain cereals, dried beans, peas, and lentils. Refined carbohydrates, like white breads, white rice, and pasta, can provide needed calories, but they should be consumed sparingly.

Fats play an important role in nutri­tion. Contrary to what some people believe, you do need healthy fats in your diet, as they are a valuable source of energy. Fats are found in butter, mar­garine, oils, nuts, seeds, dairy products, meats, fish, and poultry. However, you should keep in mind that some types of fats are considered healthier than are others.

Healthy fats, like those contained in nuts and seeds, help protect against heart disease, decrease triglycerides, and lower blood pressure. Healthy fats are divided into two groups: monounsaturated fats and polyunsaturated fats, which include omega-3 and omega-6 fatty acids.

Unhealthy fats include trans fats and saturated fats. The most common sources of trans fats in our diets are partially hydrogenated vegetable oils. These are found in many convenience items, baked goods, and deep fried foods. Saturated fats are found mainly in animal sources. It’s a good idea to limit the amount of trans fats and saturated fats you consume.

Vitamins and minerals help us to heal and grow. They also allow the body to use the energy (calories) sup­plied in foods. A person who eats a balanced diet usually gets plenty of vitamins and minerals from the food they eat. However, eating a balanced diet can be challenging when you are undergoing cancer treatment, particu­larly if bothersome treatment side effects like nausea, vomiting, mouth sores, and taste changes persist. If you think you’re not getting the vitamins and minerals you need in your diet, ask your doctor or dietitian about whether you should take a daily multivitamin or mineral sup­plement.

Water and other fluids are also essential to your health. If you don’t take in enough fluids, you may become dehydrated, which can lead to high blood pressure, dizziness, nausea, and mouth sores. In general, you should drink about eight 8-ounce glasses of water a day to stay hydrated. If you are having trouble taking in enough liquids, or if you are experi­encing vomiting or diarrhea, talk to your doctor about what you can do to prevent dehydration.

Good nutrition is important for everyone, especially people undergoing cancer treatment. Not only will eating a healthy diet help you cope better with the side effects of treatment, but it may also help those treatments work better. If you’ve been diagnosed with cancer, talk with your doctor about how you can incorporate nutrition into your cancer care plan.

♦ ♦ ♦ ♦ ♦

Jennifer Fitzgibbon is a board-certified registered oncology dietitian at Stony Brook University Cancer Center in Stony Brook, NY, where she helps cancer survivors main­tain their weight, strength, and quality of life during cancer treatment.

To learn more about diet and nutrition during cancer treatment, visit

This article was published in Coping® with Cancer magazine, September/October 2015.

Chrisley Knows Best

Reality Show Matriarch Julie Chrisley Shares What She Learned from Surviving Breast Cancer

by Laura Shipp

Celebrity Cancer Survivor

Meet the Chrisleys, the picture-perfect Southern family at the center of all the laughs on USA Network’s reality series Chrisley Knows Best: Savannah Chrisley, Chase Chrisley, Todd Chrisley, Julie Chrisley, Lindsie Chrisley Campbell, and Grayson Chrisley.
(Photo by Andrew Eccles/USA Network )

It’s no secret that the Chrisleys – stars of the USA Network reality series Chrisley Knows Best – live an opulent lifestyle. The show, which bills itself as a real-life family comedy, follows the ostensibly fairy-tale lives of multi-millionaire real estate developer Todd Chrisley, his wife, Julie, and their five children. Always dressed to the nines in designer labels, and living in a 30,000 square foot Atlanta mansion, the Chrisley family may seem on the surface like typical vainglorious reality stars.

However, once you look past the Gucci suits and Louis Vuitton hand­bags, you’ll see that what the Chrisleys value most is family. This was never more evident than during Julie’s battle with breast cancer in 2012 – well before TV cameras began documenting the family’s side-splitting antics.

Julie recently opened up to Coping® about how facing breast cancer quickly taught her who’s really in control (Hint: It’s not Todd.) and reaffirmed a lesson she’s known all along – that the most important things in life are those that money can’t buy.

Julie was diagnosed with breast cancer in March of 2012 after a not-exactly-routine mammogram. She was only 39 years old (45 is the current, though controversial, recommended screening age), and she had no family history and no symptoms. What she did have, however, was a husband with strong opinions who doesn’t easily back down. After all, the Chrisley referenced in the show’s title is Todd.

“I had a husband, five children, and a business to take care of.
I had no time to be sick.”

Julie Chrisley
(Photo by Andrew Eccles/USA Network )

Whether you want to call it intuition, divine intervention, or just a hunch, what matters is Todd was convinced Julie needed a mammogram, and one morning he insisted that she get screened. So she called her doctor that day.

“They told me my insurance prob­ably wouldn’t pay for the screening,” she says, “but I went ahead and got it because I knew Todd would not give up.”

It turns out that Chrisley did know best. The mammogram revealed a malignant lump. And life as they knew it came to a halt for Julie and the rest of the family.

“My life was crazy and busy during that time. I had a husband, five children, and a business to take care of. I had no time to be sick,” Julie says. “Boy, did I learn quickly that God was in control and not me!”

Though cancer upended her life, Julie says she still felt blessed. Her cancer was early stage, it was removed completely with a double mastectomy, and Julie required no further treatment. However, like many breast cancer survivors, Julie had a difficult time accepting the loss of her breasts.

“After breast cancer, your body is forever changed,” she says. “Our society puts so much emphasis on breasts, and to lose them is a trau­matic experience. I had to keep telling myself how blessed I was because my cancer had not spread and I was able to have reconstruction right away.”

Todd also played a large part in helping Julie regain her self-esteem. “He was consistent from the very beginning,” she says. “I will never forget him saying to me that as long as I survived, nothing else mattered. He never once made me feel insecure. We became closer than ever, and I realized how fortunate I am to have him in my life.”

In fact, according to Julie, Todd was “the best nurse a girl could ask for.”

“When I came home from the hos­pital, he had the room covered with flowers,” she says. “He was there for me every minute of the day. He took care of all of my medicines and changed every bandage, which was amazing considering he passes out at the sight of blood! He never one time flinched.”

Julie is now three years cancer-free. (“Praise God!” she says.) Through every­thing, Julie says one lesson has stuck with her: “Cancer has reminded me that the things that matter most in life can’t be bought.”

And with that, it might be safe to say that maybe it’s Julie who knows best.

♦ ♦ ♦ ♦ ♦

You can catch Julie, Todd, and the rest of the Chrisley family on the USA Network as season three of Chrisley Knows Best returns November 10 and airs Tuesdays at 10/9c.

This article was published in Coping® with Cancer magazine, November/December 2015.

My Parent Has Cancer

10 Tips for Teens Coping with a Parent’s Cancer

by Marc Silver and Maya Silver

Wellness image

You’re a teen, and your mom or dad was just diagnosed with cancer. You may be scared, sad, mad, nervous. And if one of your first thoughts is Who’s going to drive me to my friend’s house after school, don’t feel guilty. That’s a perfectly normal teenage concern. But things won’t exactly be normal as the months of treatment go on. You’ll need to find ways to cope.

After interviewing more than 100 teens and many cancer experts, we’ve put together these 10 tips for coping with a parent’s cancer.

1. Get The Information You Need.
Jackie, whose dad had cancer, told her parents, “If you receive information and you think, This is some­thing we shouldn’t tell Jackie, that’s what I want you to tell me.” Kaitlin, on the other hand, would retreat to her room with earbuds in place to block out thoughts of her mom’s cancer.

Whether you’re an information hound or a minimalist, you need to keep up with key developments. Tell your parents the best way to communi­cate with you: family meeting, sticky notes on the bathroom mirror, a knock on your door and an update. Just make sure you stay in the loop in some way.

2. Google With Caution.
Online information about cancer isn’t always correct – or may not apply to your parent’s situation. If you have a question, ask mom or dad. If they don’t know the answer, they can ask their cancer doc.

Even after cancer rudely barges into your family’s life, you’re still allowed to have a good time.

3. Find A Confidante.
It could be a relative, a teacher you’re close to, or a friend who’s gone through a similar experience.

4. Share Any Angry Feelings.
“If you don’t talk about your anger, it can boil and boil … and then boil over,” says school social worker Melissa Ford. “You’ll snap at a teacher, wreck a friendship, or do something dumb.”

5. Social Media Can Help … Or Hurt.
Talking about your parent’s cancer online can bring support from friends. But a mean class­mate might tease you, or a self-centered one may say something like, “You think you’ve got problems, listen to what’s going on with me.”

Also, check with your parents be­fore going social – maybe your mom or dad hasn’t told the boss or certain friends, so your post could create an awkward situation.

6. Tell Your Teachers.
Zoning out in class? Struggling to stay afloat in the sea of homework? Do yourself a favor and let someone at school know what’s up. (Or ask mom or dad to do this for you.) Perhaps your teachers can adjust your workload. If you’re really struggling, see if the school would grant you a get-out-of-class pass for rough moments so you can take a breather in the guidance office.

7. Don’t Feel Guilty If You Get Mad At Your Mom Or Dad.
That’s part of being a teen­ager. One girl we interviewed told her mom, “I can’t even get mad at you now because you have cancer.” Her mom replied, “Even though I’m going through a hard time, I’m still able to manage that you get mad at me.” (Of course, your parents will be grateful if you’re nice to them whenever possible.)

8. No Need To Be Optimistic 24.7.
A positive attitude can make you feel better. But there may be days when everything sucks. It’s okay to express those feelings. “Give yourself permission to feel what you feel,” says child psychiatrist Paula Rauch.

9. Say Sayonara To Stress.
If you’re having the Worst Day of All Time, what will make things better? A run? A video game? Writing in your diary? All of these activities are coping mechanisms. Figure out what works for you, and bust out your stress-busters when you’re bummed.

1O. It’s Ok To Smile, Laugh, And Have Fun.
Even after cancer rudely barges into your family’s life, you’re still allowed to have a good time: watching a comedy with friends, just hanging out, or maybe a family game night. Your parents will be glad to spend time with you – and you may find it’s not too bad spending time with them either.

♦ ♦ ♦ ♦ ♦

Marc Silver is the author of Breast Cancer Husband. His daughter Maya was 15 years old when her mom was diagnosed with breast cancer (her mom is now in good health). Together, Maya and Marc have coauthored My Parent Has Cancer and It Really Sucks: Real-Life Advice from Real-Life Teens (

This article was published in Coping® with Cancer magazine, July/August 2015.

Managing the Fear of Prostate Cancer Recurrence


Prostate Cancer Image

Don’t worry alone. Joining a support group offers the chance to share your feelings and fears with others who understand.

The completion of prostate cancer treatment can bring both relief and worry. When caught early, initial treatment can lead to cure, and most men will live cancer-free for years, possibly forever. However, despite successful treatment, you may still feel worried, anxious, or fearful that your cancer may come back.

The good news is that the five-year survival rate for men with localized prostate cancer is nearly 100 percent. However, up to 40 percent of all men treated for prostate cancer will experi­ence a recurrence. Therefore, it is important to understand your risk for recurrence, but it is equally important to live your life after cancer.

The fear of recurrence is normal and reasonable for all cancer survivors. Though you cannot control whether your cancer recurs, you can control how much you let the fear of recurrence affect your life.

What is cancer recurrence?
Cancer recurrence is the return of cancer after a period when no cancer cells could be detected in the body. When a man has treatment for prostate cancer, his PSA level will drop significantly. Regular testing with PSA is one of the tools the physician will use to measure if the cancer has returned. There are two types of prostate cancer recurrence: biochemical recurrence and metastatic prostate cancer.

What is biochemical recurrence?
When PSA levels rise to a certain threshold after prostate cancer treatment, this is known as biochemical recurrence. This means that some cancer cells have survived and are producing PSA. If this happens, your doctor will order addi­tional tests and make recommendations for how to manage your disease. Just as you did at the time of diagnosis, consider a second opinion and seeking care from a multidisciplinary team.

Telling yourself not to worry or criticizing yourself for being afraid won’t make these feelings go away.

There are differing opinions in the medical community about how best to manage a biochemical recurrence, ranging from immediate treatment to delayed treatment. Many factors will need to be considered, including the characteristics of your initial cancer, the rate of your PSA doubling time, your initial treatment option, and your personal health. Talk with your health­care team to make a plan.

What is metastatic prostate cancer?
When PSA levels rise and tests and scans show prostate cancer in other parts of the body, such as the bones, this means the cancer has returned and is now metastatic prostate cancer. Fortunately, there are many treatments available today to help men with meta­static prostate cancer.

What can I do to ease my fears about my prostate cancer coming back?
♦ Accept your fears. It is common to experience some fear about your cancer recurring. Telling yourself not to worry or criticizing yourself for being afraid won’t make these feelings go away. Accept that you are going to experience some fear, and focus on finding ways to help yourself manage the anxiety.

It may also help to remember that the fear usually lessens over time, and that you won’t always feel so anxious. Be aware that your anxiety may temporarily increase at certain times, such as before follow-up care appointments, around the anniversary date of your diagnosis, or if a friend is diagnosed with cancer.

♦ Don’t worry alone. Talking about your fears and feelings, or writing down your thoughts in a journal, can help re­duce your anxiety. Talking and thinking about your concerns can help you ex­plore the issues underlying your fear. Fear of recurrence might include fear of having to repeat cancer treatment, losing control of your life, or facing death.

Many cancer survivors find joining a support group to be helpful. Support groups offer the chance to share feelings and fears with others who understand, as well as to exchange practical infor­mation and helpful suggestions.

♦ Adopt a healthy lifestyle. Eating a well-balanced diet, exercising regularly, and getting enough sleep helps you feel better physically and emotionally. Doc­tors do not know why cancer recurs in some people and not in others, but avoid­ing unhealthy habits, like smoking and excessive drinking, may help reduce the risk of recurrence. Adopting a healthy lifestyle will also lower your chances of developing other health problems.

♦ Reduce stress. Finding ways to lower your stress will help lower your overall level of anxiety. Experiment with differ­ent ways of reducing stress to find out what works best for you. Despite your best efforts to stay well, you may find yourself overwhelmed by fear or recur­rent thoughts of illness. If in doubt, talk with your doctor or nurse and consider a referral for counseling.

♦ ♦ ♦ ♦ ♦

Reprinted with permission from ZERO – The End of Prostate Cancer,

This article was published in Coping® with Cancer magazine, September/October 2015.

Where Is That Silver Lining?

by Rosemary Bobay

Inspiration image

Six years ago, on the day before Thanksgiving, I got the call. You know which one I’m talking about. The one where the doctor says, “It’s cancer.” Invasive ductal carcinoma in my case.

Before my diagnosis, I often read about people who faced catastrophic life events like cancer and had their world changed forever – in a good way. “Cancer was a gift,” they’d say. Or, “If it weren’t for cancer, I wouldn’t have smelled that rose, or climbed that mountain, or become the fabulous new person I am today.”

I had always wondered whether you needed to go through something horrific to have that kind of epiphany. Now that I was facing my life-changing moment, I began to wonder, Where is that silver lining I’ve been reading about?

As I took my first baby steps into the frightening new world of surgeons, tests, scans, needles, and drugs with names I couldn’t pronounce, I was pumped up and ready to fight. I was in high gear, but I still hadn’t fully processed my new reality. I even told people that I wasn’t sick; I just had cancer.

I tried to focus on the silver lining as the tears rolled down my face. But I couldn’t find it.

Everyone has that pivotal moment that smacks you in the face and shakes you out of your denial when you’re in that stage of grieving, which I was in without knowing it. My moment came while I was standing in the middle of a wig shop.

Since my doctors said I would likely need the kind of chemotherapy that caused your hair to fall out, I wanted to get fitted for a wig while I still had my hair. When the wig fitter placed that little cap on my head to hold my hair down so the wig could be sized, I looked at myself in the mirror and started crying. Cancer was staring back at me. I saw what I would look like once chemo took my hair, and for the first time, my diagnosis sud­denly became real.

I tried to focus on the silver lining as the tears rolled down my face. But I couldn’t find it.

Five years have now passed. I’ve en­dured a double mastectomy, aggressive chemotherapy, radiation treatments, and numerous reconstructive surgeries. Some of the drugs (and, yes, the comfort foods I ate) caused me to gain over 40 pounds, and my fiancé, who did stay with me through my treatment, eventually left. Then, my older brother – my ardent sup­porter, protector, and caregiver – suddenly passed away. I had begun to think that perhaps that silver lining was not to be, at least not for me.

But one morning I woke up, in more ways than one, and my epiphany came to me in the form of an often over-used quotation about it not being the destina­tion, but rather the journey. And I realized the silver lining had been there all along.

I am alive, I am healthy, and I have a beautiful new head of hair. I have a loving extended family, loyal lifelong friends, and a wonderful younger brother, who is also an ardent supporter and care­giver. I have been given another chance; I’ve won the lottery of life. Now it’s up to me to choose how to live it – to see the silver lining.

♦ ♦ ♦ ♦ ♦

Rosemary Bobay is a breast cancer survivor living in Belmar, NJ.

This article was published in Coping® with Cancer magazine, September/October 2015.

Navigating the Journey after Cancer Treatment

by Tish Knobf, PhD, RN, FAAN, AOCN

Wellness image

The end of cancer therapy is often a long awaited milestone that many cancer survivors joyously celebrate. However, your last day of treatment doesn’t signal the end of your cancer journey. No, the end of active therapy simply marks the start of a new voyage, one where you will traverse the uncharted path to survivor­ship. Here are some navigation tips to help you SURVIVE your first year after treatment.

Side effects
Most cancer survivors will continue to experience side effects after treatment ends. Fatigue is almost universal. It may take months before you feel like you have your energy back. You may also experience side effects that are unique to your cancer site and the type of treatment you received. Some persist; others resolve soon after treat­ment ends. Some may wax and wane. And new ones may even crop up unexpectedly. Talk with your doctor about how you can best manage the side effects and late effects of your treatment. And if these don’t improve satisfactorily, ask your doctor for additional coping strategies or palliative treatment options.

After treatment ends, visits to healthcare providers de­crease and support from family and friends may begin to wane. You may feel pressure to get back to “normal,” or to how you were before cancer. This can lead to a lot of uncertainty surrounding this leg of the journey: How long will my side effects last? What can I do to get healthier? Why am I so emotional? How do I respond to my family who wants me to put this behind me when it’s still so new? Will I ever feel normal again? Just relax. It takes time to recover both physically and emotionally from cancer. And it is normal to have these questions. Talk with your friends and family mem­bers about how you are feeling, and let them know how they can help. If your feelings of uncertainty are interfering with your daily life, talk with your doc­tor or a counselor about what you can do to manage your anxiety.

The end of active therapy simply marks
the start of a new voyage.

Author of Article photo

Dr. Tish Knobf

Fear of recurrence is one of the most common concerns of cancer survivors. To help mitigate your fears, talk to your doctor about your risk for recurrence and work with him or her to develop a survivorship care plan that includes instructions for follow-up visits, as well as suggestions for positive lifestyle changes to reduce your risk of recurrence and improve your post-cancer health. However, keep in mind that even with a plan in place, there are certain situations that can trig­ger a surge in fears – follow-up visits, scans or tests, the appearance of un- explained symptoms. Let your doctor know if you are having trouble manag­ing your fear. He or she can point you to resources that can help.

You are a cancer survivor. Take a moment to consider your strengths, and acknowledge your ability to overcome the challenges you may face during this phase of your cancer journey. If you feel your vitality waning, you can help restore it by eating well, getting adequate sleep, exercising, and seeking support.

Interpersonal relationships
The ad­age “No man is an island” is never more true than during the cancer jour­ney. This path you are navigating will be made easier by having companions walking alongside you, whether they be family, friends, or other survivors.

Good communication with your healthcare providers is crucial to a successful survivorship journey. Follow-up visits are often brief. Com­ing to your appointment prepared with specific questions and concerns you’d like to address will help you get the information you need. Don’t be afraid to speak up if something isn’t clear.

Daily physical activity is recommended for nearly all adult cancer survivors. Exercise can improve your mood, help you sleep better, reduce fatigue, and combat depression. Mod­erate exercise can also reduce your risk of high blood pressure, cardiac disease, and diabetes. Even just walking as little as 20 minutes a day can help.

♦ ♦ ♦ ♦ ♦

Dr. Tish Knobf is a professor at the Yale University School of Nursing in West Haven, CT, where she is also chair of the Acute Care/Health Systems Division. Her clinical practice and program of research focuses on quality of life for women with breast cancer and interventions for those who transition into survivorship.

This article was published in Coping® with Cancer magazine, September/October 2015.

Balancing Cancer and Your Career as a Young Adult

by Rebecca V. Nellis, MPP

Photo by Cancer Type

No matter your age at diag­nosis, you’ll likely feel the impact of cancer in every corner of your life. However, for young adults, cancer poses unique challenges, especially when it comes to employment. Perhaps you had just begun the job hunt, or maybe you recently landed the posi­tion you were vying for or were starting to establish yourself professionally, finally feeling secure in your career path, when cancer hit. And now you’re left wondering what your next move should be. Will you need to take some time off or work fewer hours, or will you be able to maintain your current work schedule?

Determining Your Best Path Forward
The first step to figuring out what comes next is to think about where you are in your career, where you are in your can­cer journey, and what role your job plays in your life.

Next, you’ll need to do some fact finding. Talk with your healthcare team to ensure that you not only understand your diagnosis and treatment plan but also know how all of it could affect your work. Find out how much time off you should anticipate for surgery or treatment, discuss how treatment-related side effects might affect your job performance, and come up with solutions to help mitigate any issues they may cause.

Author of Article photo

Rebecca Nellis

Finally, find out what policies and benefits your employer already has in place for you. This information is often located in your employee handbook or your hiring paperwork. You’ll need to research what legal protections you’re entitled to as well. (Both federal and state laws may apply.)

Clinching Control with “the Swivel”
Regardless of whether you choose to continue working full time, decrease your workload, or take a medical leave, if your company is aware of your can­cer diagnosis, you may be concerned that the disease will dominate your interactions with coworkers. One way to regain control of your work identity is to learn how to constructively refocus conversations to a more productive topic. This technique is called “the swivel.”

Here’s how it works. If a coworker says, “My uncle had cancer too,” re­spond by validating the comment, and then swivel the conversation away from cancer and toward something work related. For instance, you could say, “Thank you for sharing that. It must have been hard for your family. Do you have time this week to go over our upcoming meeting?” By continuously steering conversations away from cancer and back toward work, you’ll reinforce how you want your colleagues to see you – as a coworker, not a cancer patient.

The swivel technique also comes in handy during job interviews. Although it’s illegal for employers to ask specifics about your health, an interviewer may inquire about a gap in your education or employment history. Go ahead and think about how you will answer these types of questions in advance. Be brief, speak in general terms, and talk more about the future than the past. The key to the swivel is to not leave an opening for the interviewer to dig further into the gap. Instead, you want to nudge them to pick up the conversation from where you have swiveled it.

Moving Past Your Worries
Along with concerns about your current or future employment, you may also be struggling with the idea of being left behind while your peers move for­ward, being a burden to your parents, or never having an identity that isn’t cancer-related. The best way to start moving past these worries is to begin a conversation – with your­self, your employer, your healthcare team, your family – so that whether you work during cancer treatment, take time off, or look for new opportunities, you’ll be empowered to take charge of your career, as well as your life.

♦ ♦ ♦ ♦ ♦

Rebecca Nellis is the chief mission officer for Cancer and Careers, a national nonprofit organization addressing the intersection of work and cancer. For more information, tools, and programs, visit

This article was published in Coping® with Cancer magazine, May/June 2015.

Journaling through Cancer in the 21st Century

by Deborah Ludwig

Wellness image

Marni visited me in the hospital during one of my admissions for chemo in the spring of 2004. I was bemoaning the difficulty of responding to all the emails I’d received from people who’d reached out to inquire about my health. She suggested I start a blog. I could write whenever I felt like it, posting health updates and giving my family and friends one central place to go for information.

“What a great idea!” I thought. I had never blogged before, but I had been journaling since 1992. For me, journal­ing was a way to record my life, work through challenges, set goals, and heal emotionally. Blogging was just a new way to journal.

How Writing Can Help
Did you know that expressive writing has health benefits? Research has shown that ex­pressive writing can strengthen the immune system, increase lung and liver function, improve cognitive function, reduce stress, lower blood pressure, boost your mood, decrease symptoms of arthritis and asthma, and increase well-being in cancer survivors.

It doesn’t matter if the topic of your writing is positive or negative; healing benefits are achieved as long as your emotions are involved. Though not a substitute for professional help, jour­naling can help you work through the difficult emotions that accompany a cancer diagnosis. It is a wonderful therapy tool for cancer survivors.

In our digitally connected world, a blog may be the preferred medium for today’s journal writers.

Author of Article photo

Deborah Ludwig

Getting Started
All you need to start writing is a journal, a notebook, or a computer. In our digitally connected world, a blog may be the preferred medium for today’s journal writers. A quick Google search for blogging platforms will provide some options – most of them free. There are even healthcare-specific blogging commu­nities, like and, where users can create their own personal websites to share health updates.

Most blogging platforms allow you to control the privacy of the posts you publish. For example, you can make your blog viewable only to people who have a password. And if you don’t want to share your writing, you can even change the privacy settings so that only you have access to your blog.

Going Social
If writing long blog posts isn’t really your thing, you can still “journal” your cancer experience using social media. Social media sites like Facebook, Twitter, and Instagram are a terrific way to provide quick updates to family and friends while simultaneously creating your story through photos and posts about your treatment, your feelings, and the chal­lenges you are facing.

As you post and share content, each social media site provides a record of your journey, dating all the way back to when you first started posting on the site. When you review past posts, you will make discoveries about your values, the patterns in your life, what drives you, where you have grown and healed, and where you remain stuck. What is revealed in those social media posts can be enlightening and, ulti­mately, healing.

Cancer can make your life feel out of control. But there are at least two things you can control during cancer: when you write and what you write. Writing can help transform your cancer experience into a journey of healing and self-awareness. And in the digital age we now live in, we have access to entirely new avenues for journaling. So pick up that pen – or log on – and start writing.

♦ ♦ ♦ ♦ ♦

Deborah Ludwig, a leukemia survivor, has completed 31 journals and is the author of Rebirth: A Leukemia Survivor’s Journal of Healing during Chemotherapy, Bone Marrow Transplant, and Recovery. To learn more about Deborah and her writing, visit

This article was published in Coping® with Cancer magazine, September/October 2015.

Live the Life You Love

by Wade Brill

Wellness image

Holy shit, I am a cancer survivor. Five years after my diagnosis, I am finally able to embrace those words.

Back in 2010 while studying abroad in Buenos Aires, Argentina, my life was rudely interrupted by a swollen lymph node on the right side of my neck. A biopsy, a bone marrow test, and various PET-CT scans later, I was diagnosed with Hodgkin lymphoma, and I anxiously embarked on a six-month chemotherapy course. Then barely two months in, I lost my mother – my everything – to leukemia, just two floors down from my infusion room.

It shook the ground beneath my feet. My heart sank. Nausea slithered through my bones, swirling with the precarious­ness of my own health. The uncertainty of where I was going to live, how I was going to pay for my healthcare, and who was going to take care of me was overwhelming. Everything around me was crumbling.

Then I realized that I could let this make me a victim, or I could take charge of my life. For me, life was no longer about just surviving. No, it was some­thing bigger. It was about living.

For me, life was no longer about just surviving.
No, it was something bigger.

Each day became a precious vehicle to express my true self. During treatment, I spent my energy and time exploring who I was and what I valued. I steered myself through darkness and uncer­tainty so that I could find light and beauty again.

I may not have been in control of everything that was happening inside my body, but I could control what I fed myself, what activities I consumed, how I interacted with others, and whom I spent time with. Every day, I made a conscious effort to engage my external world – asking the bus driver how his day was, spending time with friends who made me laugh, eating clean foods that made me feel strong, grounding myself in meditation and movement.

As cancer survivors, we possess a drive and a sense of urgency to accom­plish what we want. We know the value of our health, the importance of our time, and the preciousness of each breath. We no longer take for granted the days we feel healthy and strong because we have experienced what it feels like to have our bodies disobey and our minds pushed beyond discomfort.

We know that life is whatever we want it to be because we get to create our own narrative. We don’t have to be slaves to our desks or prisoners of unhealthy relationships. The power and strength to create the life we want lies within us. Our souls see nature’s true colors, the richness of fresh air, and life’s endless array of opportunities.

Living the life you love after the in­vasion of cancer requires looking inward and building a strong internal foundation. Let go of the assumptions you might hold about what it means to be a cancer survivor, and define survivorship for yourself. Spend time journaling, meditat­ing, moving, creating, and exploring who you are, what you value, where your pas­sions lie, and how your strengths shine.

Cancer, like many of life’s rude interruptions, can give you whiplash. But when you have built a resilient foundation, you can withstand sudden and harsh jolts. Don’t be afraid to ask the tough questions and to give consid­erate thought to why you are here, to the gifts you can share with the world.

Doing this for myself allowed me to follow my heart back to Buenos Aires, where I opened my own Pilates, meditation, and coaching practice, met the love of my life, and launched my career as a holistic life coach.

Life is beautiful. Let go of the sorrows of the past, ground yourself in your body and your spirit, hold gratitude for this moment, act with intention, and live.

Live the life you love.

♦ ♦ ♦ ♦ ♦

Wade Brill is a holistic life coach who helps clients mindfully make themselves a priority in their lives. She cofounded Centered in the City, an events collective grounded in self-development, community, and connection. She is also a Pilates and Barre instructor, a foodie, a mindfulness-based stress reduc­tion practitioner, and a Hodgkin lymphoma survivor.

For monthly tips from Wade to keep you breath­ing, staying balanced, and living brilliantly, you can sign up for her “Wade a Minute” newsletter at

This article was published in Coping® with Cancer magazine, September/October 2015.

Spiritual Care for Cancer Survivors

by Jamie Alexis Cohen, PsyD, and Rev. Susan P. Conrad, ACPE

Inspiration image


A cancer diagnosis changes your life. Suddenly, you may find yourself on shifting sands, unsure if your feet will ever land on solid ground. When faced with the un­certainty and fear that this diagnosis can bring, you may wonder, “In whom, and in what, can I trust?” You may suddenly feel vulnerable, searching for sources of meaning, faith, connection, and belonging. A cancer diagnosis may shift your relationship with spirituality.

Broadly defined, spirituality is a con­nection with something or someone beyond ourselves. The spiritual dimen­sion includes how we relate to others, to our surroundings, and, potentially, to a higher power. A recent University of California – San Francisco study by Shields, Kestenbaum, and Dunn (2014) defines spirituality as “the dimension of life that reflects the needs to seek mean­ing and direction, to find self-worth and to belong to a community, and to love and be loved.”

Your journey with cancer may deepen your spiritual connection. Or you may experience difficulty connecting with something beyond yourself. Both reac­tions are normal.

Tapping into your spirituality can boost your sense of well-being during this challenging time.

Author of Article photo

Dr. Jamie Cohen

However, research demonstrates that having a spiritual connection can enhance your coping skills and improve your quality of life during cancer treatment and recovery. While it is no substitute for traditional oncology care, tapping into your spirituality can boost your sense of well-being during this challenging time. It can ground you and help you find strength, hope, connection, and meaning in the midst of chaotic or painful experiences.

For some, spirituality includes reli­gious observances, community, and practices. For others, spiritual connec­tion comes from nature, or spending time with a beloved person or animal. Others connect by serving and giving back to the community.

You can connect with the spiritual dimension of life in many ways:

Seek support and cultivate relation­ships that provide a sense of energy, peace, and joy. This may include con­necting with friends, family, local clergy, a hospital chaplain, your com­munity, or your healthcare providers.

Figure out what makes you feel peace­ful, and do more of these activities. Try meditation or yoga. Spend some quiet time in a place of personal meaning or importance, such as a serene spot out­doors or in a house of worship, listening to your breath and to the sounds that surround you.

Author of Article photo

Rev. Susan Conrad

Explore the kind of reading you feel drawn to. This could include religious or spiritual texts, or even poetry.

Embrace or create a ritual, such as chanting, praying, reciting a personal mantra, journaling, or reflecting on what you are thankful for.

Consider the values you wish to embrace in caring for yourself and your meaningful relationships. Come up with a goal or plan for expressing these values in your daily life.

Treat yourself with compassion and patience, as you would treat someone dear to you.

Seek support as you explore new spiritual practices.

Advise your medical team of any spiritual or religious beliefs and prac­tices that you value so your team may respect them when creating your treat­ment and recovery plan and incorporate them in your care.

Be encouraged by knowing that there is no “right” way to connect with the spiritual dimension of life. It is a deeply personal journey. In this tender time, we encourage you to pay gentle attention to what matters most.

In closing, we offer this intention adapted from Buddhist spirituality:

May you be safe, may you be well, may you find moments of joy in the present moment. May you be free from undue suffering and find your­self held in love and care.

♦ ♦ ♦ ♦ ♦

Dr. Jamie Cohen serves as a clinical psychologist with the psycho-oncology service at the University of California – San Francisco Medical Center. The Rev. Susan P. Conrad serves as manager of spiritual care services at the UCSF Medical Center. She is a board-certified chaplain with the Association of Professional Chaplains, a certified supervisor with the Association for Clinical Pastoral Education, and an ordained and fellowshipped minister with the Unitarian Universalist Association.

This article was published in Coping® with Cancer magazine, July/August 2015.

Develop a Cancer Conqueror’s Mindset

by Lauren E. Miller

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When the doctors told me, at age 38 with three young children while going through a divorce, that I had a 50/50 chance of survival, I had no idea how strong my survival instinct was. In less than two years, I went through divorce, a double mas­tectomy, 16 chemotherapy treatments, an additional year of chemo, 6 weeks of daily radiation, and 12 surgeries.

I remember standing in the shower one day, bald and breastless, surveying the scars on my chest where my breasts used to be. “Wow, I am earning my PhD in suffering,” I pondered aloud. It was at that moment that I decided I would take the lessons I had learned (and am still learning) as a cancer con­queror to help others develop a cancer conqueror’s mindset. I realized that, rather than languishing in my situation feeling vulnerable and victimized, I could use my vulnerability to connect with others facing similar situations.

That’s the most important aspect of a cancer conqueror’s mindset – realizing that you have the ability to shift your perception of any situation. Once you do this, you open yourself up to oppor­tunities for growth and healing. After all, negative emotions are simply your body’s response to negative thoughts. And fear is just a label we place on a situation that we do not feel capable of handling.

Whenever a destructive thought enters your mind, hit the mental delete key as quickly as possible.

Guard Your Thoughts
One of your greatest tools for developing a cancer conqueror’s mindset is to remain vigilant at the gate of your thoughts. Whenever a destructive thought enters your mind, and you begin to feel spun emotionally, hit the mental delete key as quickly as possible. And replace that negative thought with a more positive one. For example, “I’ve overcome difficulties in the past, and I am confident that I can do it again.” The goal is to prevent external events from negatively affecting your mindset, caus­ing undue stress and worry.

Breathe Deeply
Practice deep breathing techniques every day. When we feel under attack, our breathing be­comes restricted, which limits oxygen flow to our body and brain. By devel­oping a daily habit of deep breathing exercise, these techniques will come naturally to you the next time you feel steamrolled by life. When this occurs, try this approach: Standing with your feet shoulder width apart, roll your shoulders up, back, around, and down, inhaling deeply as your shoulders lift and exhaling as they return to their original position. Repeat five times, or until you feel calm.

Surround Yourself with Positivity
My bathroom, kitchen, and office are filled with uplifting quotes. One of my favorites is this one from the author Bruce Barton: “Nothing splendid has ever been achieved except by those who dared to believe that something inside them was superior to circumstance.”

Choose Your View
Be a seeker of rainbows no matter what surrounds you, and you will see them appear in the most unlikely situations. Be present to the lessons and learning opportuni­ties around you, even in the midst of hardships like cancer. Use this unique challenge to reconnect to what you value most in this life. And no matter what life throws at you, choose to view it with a cancer conqueror’s mindset. For by your thoughts, you form your choices, and by your choices, you form your life. Choose wisely.

♦ ♦ ♦ ♦ ♦

Lauren Miller is an award winning author, international speaker, and managing partner of Grab & Go Stress Solutions. In addition to being a conqueror of two of life’s top stressors at the same time: advanced cancer and divorce. Lauren is a Certified Master Business Success Coach and holds her Master Certification in Neuro Linguistic Programming and Advanced Training in Emotionally Focused Therapy. She meets with clients and facilitates stress relief/ personal excellence workshops and semi­nars. She has worked in youth and adult ministries for 20 years. Her website is

This article was published in Coping® with Cancer magazine, July/August 2015.

How to Build a Deeper Intimacy

Reconnect with Your Partner and Enhance Your Sexual Connection

by David Bullard, PhD

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Whether we voice them or not, most of us at times have questions about how we can deepen the intimacy and sexuality of our closest relationships. Cancer survivors also can find it challenging to voice their need for deeper intimacy and share their concerns and feelings about resuming a sexual relationship after cancer.

Regardless of whether you are in an existing relationship or hoping to start a new one, it can be difficult to talk about what helps you feel closer to your partner, what you enjoy sexually, and what you miss about your intimate relationship before cancer. However, despite the intimacy challenges that a cancer diagnosis presents, many cancer survivors find that intimacy and sexual fulfillment are still possible after can­cer, though this may look different than it did before cancer entered the picture.

For example, some survivors find greater satisfaction in emotional inti­macy after cancer than in sexual activity. Others learn to expand their ideas of what sex is and discover a greater appreciation for all the intimate activities they can participate in and enjoy. Still others find that discuss­ing their fears and sexual limitations with their partners can lead to deeper conversations that inspire greater inti­macy and increased sexual pleasure.

Re-establishing intimate touch may feel a little awkward at first.
This awkwardness is perfectly normal.

Author of Article photo

Dr. David Bullard

There are several things couples can do to deepen their intimacy and enhance their sexual connection after cancer.

♦ Respect each other’s feelings. When you focus the conversation on how your partner’s actions or words make you feel (rather than on criticizing them or trying to change their behavior), it becomes easier to understand and empathize with one other. Your relation­ship should be a safe place where each of you is able to express your feelings without judgement.

♦ Remember that you are a sexual being. Regardless of whether you are sexually active, sexuality is part of who you are as a human being. Your sexuality is not defined by what you do, how often you do it, or with whom.

♦ Prioritize intimacy. Studies reveal that most married couples in the U.S. do not make as much time for sexual intimacy as they would like. And when your already-busy life has been dis­rupted by cancer, it can be even more difficult to find the time for intimacy. That’s why you need to make intimacy with your partner a priority. Set aside some time each day to share your feel­ings with your partner, instead of the usual rundown of your to-do list. Even just 15 minutes of intimate conversation can make a difference.

♦ Embrace the awkwardness. Reestablishing intimate touch may feel a little awkward at first after the inter­ruption of cancer and its treatments. This awkwardness is perfectly normal. Instead of looking at it as a problem, embrace it. Remember to laugh, be patient with each other, and keep practicing intimacy. Eventually the awkwardness will subside.

♦ Get to the root of your relationship distress. If you feel irritation, annoy­ance, or frustration toward your partner, these feelings may actually be symptoms of deeper, more painful emotions. It’s important to get to the root of what is causing your annoyance or irritation. When you identify and acknowledge the pain, sadness, or fear beneath the surface, you will be better able to resolve the relationship distress that results from it.

♦ Take your partner’s feelings seriously, but not personally. When your partner is upset or frustrated, try not to react defensively. Instead, hear them out, acknowledge their feelings, and ask how you can help resolve the situation.

♦ Choose being kind over being right. When conflict occurs, accept your part of the responsibility rather than engag­ing in faultfinding.

♦ Hold on to love. Remember, sex can be part of love, but love is not sex. We are loved for who we are.

♦ Find simple ways to reconnect. In a relationship, it is important to feel safe, cared for, and deeply understood. During difficult or uncertain times, find simple ways to reconnect with your partner – a gentle touch on the shoulder, a caring smile, a hug, or comforting words.

♦ Ask for help if you need it. If you are struggling with intimacy or sexual difficulties after cancer, don’t be afraid to ask for help. Talk to your doctor about your concerns. He or she can answer your questions, refer you to a specialist, and help you find solutions.

♦ ♦ ♦ ♦ ♦

Dr. David Bullard is a clinical professor of medicine and medical psychology (psychiatry) at the University of California, San Fran­cisco, where he consults with Spiritual Care Services, as well as the Symptom Management Service at the Helen Diller Family Comprehensive Cancer Center.

This article was published in Coping® with Cancer magazine, July/August 2015.

Real Housewife and Endometrial Cancer Survivor Camille Grammer

Wants All Women to “Love Your Lady Parts”


Photo by Cancer Type

Camille Grammer, best known for her role as a “housewife” on the Bravo reality series Real Housewives of Beverly Hills, is a third-generation gynecologic cancer survivor. Her grandmother had endometrial cancer; her mother was diagnosed with ovarian cancer at 47 and is now fight­ing colon cancer; and she is a one-year survivor of endometrial cancer. Now, she is on a crusade to raise awareness about gynecologic cancers by encour­aging all women to “Love Your Lady Parts.” Here, she shares her story with Coping magazine.

How were you diagnosed with endometrial cancer?
My grandmother and mother both had gynecologic cancers, so I had genetic testing done and tested positive for Lynch Syndrome when I was 35. Be­cause of that, and unlike many women, I was familiar with the symptoms and had regular checkups every year – sometimes twice a year. Yet I was still caught off guard by my diagnosis of stage II clear cell carcinoma, an agres­sive form of endometrial cancer. My doctors had recommended I have a full hysterectomy at 35, but I wasn’t psychologically ready for that at the time. I waited several more years, and in retrospect, I waited too long.

What did your treatment involve?
My treatment included a radical hyster­ectomy, as well as chemo and radiation, which was done concurrently over a seven-week period – a grueling regimen. While I was undergoing treatment, I said over and over to my doctor, my nurses, and other caregivers, “We have to get the word out about these cancers. No one is talking about them, and that needs to change!”

“We have to get the word out about these cancers. No one is talking about them, and that needs to change!”

What were some of the biggest struggles you faced as a mother going through cancer?
As a mother, the first thing you think of when you’re diagnosed with cancer is, “Am I going to be around to raise my children?” I knew that I had to conquer cancer for my children so I could see them graduate high school and get mar­ried. Not being there for them was my biggest worry.

How do you continue the battle even after your cancer treatment?
It’s a continuing healing process. The radiation side effects seem to stick with you, so even now, more than a year after I’ve finished radiation, I’m still trying to get my strength back. My body has changed. I’ve been paying attention to my diet, hiking, playing tennis, and trying to get my body back to where it was. It’s definitely a life changer, but I will continue to strive for my kids and my mother, who is still battling cancer.

Do you have any advice for other women going through cancer?
My advice to other women is to stay strong and hang in there. Be strong for your children and keep a positive attitude, even though it’s difficult. Pray or meditate, or do whatever you believe in. Keep your support team around you. I had a lot of support, and that’s very important.

What’s next for you?
I have been in the public eye as a Real Housewife for several years, but most of my fans don’t know that I’ve also been a longtime advocate for gynecologic cancer awareness, due to my family’s health history. Currently, I am honored and excited to serve as a national spokes­person for the Foundation for Women’s Cancer, as well as chair of the 2015 National Race to End Women’s Cancer. I consider this one of the most impor­tant roles of my life.

The Foundation wants people to think outside the bra – because we have other lady parts and we need to talk about them! I want my own daughter, and all our daughters, to grow up in a world where we have defeated these below-the-belt cancers that claim far too many lives.

It’s time to “Love Your Lady Parts!” We want all women to learn the symp­toms, listen to their bodies, and seek care from a gynecologic oncologist for the best outcomes. That is the Foundation’s key message, and I am proud to share it and help raise aware­ness and research funding to save more women’s lives.

♦ ♦ ♦ ♦ ♦

Learn more about the Foundation for Women’s Cancer and its mission to raise awareness and research funding to defeat gynecologic cancers at For more on the 2015 National Race to End Women’s Cancer, visit

This article was published in Coping® with Cancer magazine, September/October 2015.

Know Your Multiple Myeloma Treatment Options


Photo by Cancer Type

While there is no cure for mul­tiple myeloma, the cancer can be managed successfully for years in many people. Your multiple my­eloma treatment will depend on whether you are experiencing symptoms and your overall health. In many cases, a team of doctors will work with you to determine the best treatment plan. The goals of treatment are to eliminate myeloma cells, control tumor growth, control pain, and allow you to have an active life.

Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options, including clinical trials, and be sure to ask questions about anything that is unclear. Also, talk to you doctor about the goals of each treatment and about what you can expect while re­ceiving the treatment.

Active Surveillance for People without Symptoms
People with early-stage myeloma and no symptoms, called smoldering myeloma, may simply be closely monitored by their doctor through check-ups. This approach is called ac­tive surveillance or watchful waiting. If symptoms appear, then active treat­ment starts.

Treatment Options for People with Symptoms
Treatment for people with symptomatic myeloma includes both treatment for the disease and support­ive therapy to improve quality of life, such as by relieving symptoms and maintaining good nutrition. Disease-directed treatment typically includes drug therapy, such as targeted therapy or chemotherapy, with or without steroids. Stem cell transplantation may also be an option. Other types of treatments, such as radiation therapy and surgery, are used in specific circumstances. Each type of treatment is described below:

♦ Targeted Therapies
Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treat­ment blocks the growth and spread of cancer cells while limiting damage to healthy cells. Targeted therapy has proven in recent years to be quite suc­cessful at controlling myeloma, and researchers continue to investigate new and evolving drugs for this disease in clinical trials.

Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests on cancer cells to identify genes, proteins, and other factors. This helps doctors better match each person with the most effective treatment when­ever possible.

Targeted therapy has proven in recent years to be quite successful at controlling myeloma, and researchers continue to investigate new and evolving drugs for this disease in clinical trials.

Lenalidomide (Revlimid), pomalid­omide (Pomalyst), and thalidomide (Synovir, Thalomid) are drugs that stop the growth of myeloma cells in the bone marrow. These drugs strengthen the im­mune cells to attack cancer cells. They starve the cancer cells by blocking new blood vessel formation, a process called angiogenesis.

Bortezomib (Velcade) and carfilzomib (Kyprolis) are classified as proteasome inhibitors. They target specific enzymes called proteasomes that digest proteins in the cells. Because myeloma cells produce a lot of proteins, they are particularly vulner­able to this type of drug.

Panobinostat (Farydak) is an inhibi­tor of the enzyme Histone Deacetylase (HDAC). These enzymes help keep the DNA tightly coiled, while panobinostat helps uncoil the DNA and activate genes that arrest the growth of cancer cells.

Thalidomide, lenalidomide, and bort­ezomib may be used to treat those who are newly diagnosed, while lenalidomide, pomalidomide, bortezomib, carfilzomib, and panobinostat are effective for treat­ing recurrent myeloma. Targeted therapies may also be used in combination with chemotherapy or steroid medications, as certain combinations of drugs can some­times have a better effect than a single drug. For example, the drugs lenalido­mide, bortezomib, and dexamethasone, as well as bortezomib, cyclophospha­mide, and dexamethasone, are offered in combination.

Clinical trials are underway to explore whether the combination of lenalidomide, bortezomib, and dexa­methasone alone may be as effective as lenalidomide, bortezomib, and dexamethasone followed by stem cell transplant. Also, targeted therapy can be effectively used before or after a stem cell transplant. However, the decision to undergo a stem cell transplant is com­plex and should be discussed carefully with your doctor.

Research has shown that maintenance therapy (the ongoing use of a drug) with lenalidomide extends patients’ survival time and extends the time they live without active myeloma. However, maintenance therapy has to be used with caution. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them.

♦ Chemotherapy
Chemotherapy drugs that have been used successfully for the treatment of myeloma include cyclophosphamide (Cytoxan, Neosar), doxorubicin (Adriamycin, Doxil), mel­phalan (Alkeran), etoposide (Toposar, VePesid), cisplatin (Platinol), and carmustine (BiCNU).

Often, more than one drug is used at a time. It may also be recommended to combine chemotherapy with other types of treatment, including targeted therapies or steroids. For instance, the combination of melphalan, the steroid prednisone, and the targeted therapy bort­ezomib is approved by the U.S. Food and Drug Administration for the initial treatment of multiple myeloma because it increases survival when compared with melphalan and prednisone. A person may also be given a combination of melphalan, prednisone, and thalido­mide. Additional combinations of drugs are being evaluated in clinical trials.

The length of chemotherapy treat­ment varies from person to person and is usually given until the myeloma is well controlled.

♦ Other Drug Therapy
Steroids, such as prednisone and dexamethasone, may be given alone or at the same time as other drug therapy, such as targeted therapy or chemotherapy. For example, lenalid­omide (Revlimid) and dexamethasone as induction and maintenance therapy is recommended for those who are not able to have a stem cell transplantation. In addition, most people with myeloma receive monthly infusions of bisphospho­nate therapy, which are drugs that help to prevent bone disease from myeloma.

♦ Stem Cell Transplantation
A stem cell transplant is a medical procedure in which bone marrow that contains cancer is replaced by highly specialized cells, called hematopoietic stem cells, that develop into healthy red blood cells, white blood cells, and platelets in the bone marrow. Hematopoietic stem cells are blood-forming cells found both in the bloodstream and in the bone marrow. Today, this procedure is more commonly called a stem cell transplant, rather than bone marrow transplant, because it is the stem cells in the blood that are typi­cally being transplanted, not the actual bone marrow tissue.

There are two types of stem cell transplantation: allogeneic (ALLO) and autologous (AUTO). ALLO uses donated stem cells, while AUTO uses the patient’s own stem cells. For multiple myeloma, AUTO is more commonly used. ALLO is being stud­ied in clinical trials.

In both types, the goal is to destroy all of the cancer cells in the marrow, blood, and other parts of the body using high doses of chemotherapy and/or radiation therapy and then allow replace­ment blood stem cells to create healthy bone marrow.

♦ Radiation Therapy
Doctors may recommend radiation therapy for people with bone pain when chemotherapy is not effective or as a way to control pain. However, the use of radiation therapy should be a careful decision. In many instances, pain (especially back pain) is due to structural damage to the bone. Radiation therapy will not help this type of pain and may compromise the bone marrow’s response to future treatment.

♦ Surgery
While not a disease-directed treatment option for multiple myeloma, surgery may be used to relieve symptoms.

Getting Care for Symptoms and Side Effects
Cancer and its treatment often cause symptoms and side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a per­son’s symptoms and side effects. This approach is called palliative or support­ive care, and it includes supporting a person’s physical, emotional, and social needs. Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies.

You may also receive palliative treat­ments similar to those meant to eliminate the cancer, such as chemotherapy, sur­gery, or radiation therapy. For example, surgery may be used to relieve pressure from a plasmacytoma on the spine or other organs. More recently, procedures such as kyphoplasty and vertebroplasty have been considered to relieve pain, restore lost height due to collapsing vertebra, and strengthen the spine.

Before treatment begins, talk with your healthcare team about the possible side effects of your specific treatment plan and palliative care options. And during and after treatment, be sure to tell your doctor or another healthcare team member if you are experiencing a problem so it can be addressed as quickly as possible.

Refractory Myeloma
If your myeloma no longer responds to treatment, this is called refractory myeloma. People with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer because there can be different opinions about the best treatment plan. You may also want to get a second opinion before starting treatment so you are comfort­able with the treatment plan chosen. For people with refractory myeloma, palliative care to reduce symptoms and side effects is also very important.

Remission and the Chance of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. A remis­sion may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer re­turning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return.

If the cancer does return after the original treatment, it is called recurrent myeloma or relapsed myeloma. When this happens, a cycle of testing will be­gin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often, the treatment plan will include the treatments described above (such as targeted therapy and chemo­therapy), but they may be used in a different combination or given at a different pace.

Your doctor may also suggest clinical trials that are studying new ways to treat recurrent/relapsed myeloma. There are several drugs currently being researched in the late stages of clinical trials that have shown promise as treatments for recurrent myeloma. Whichever treat­ment plan you choose, palliative care will be important for relieving symptoms and side effects.

♦ ♦ ♦ ♦ ♦

This article is based on content from Cancer.Net®. Copyright 2015. All rights reserved.

This article was published in Coping® with Cancer magazine, September/October 2015.

Coping® does not endorse or recommend any particular treatment protocol for readers, and this article does not necessarily include information on all available treatments. Articles are written to enlighten and motivate readers to discuss the issues with their physicians. Coping believes readers should determine the best treatment protocol based on physicians’ recommendations and their own needs, assessments and desires.

I Survived Cancer

Why Do I Feel So Guilty?

by Kimarie Knowles, LCSW-R

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Survivor guilt is common among survivors of traumatic events – such as war, natural disasters, epidemics, and illnesses like cancer. Survivor guilt is a deep sense of guilt felt by people who have survived an experience that others did not.

Questioning Your Existence
If you have survivor guilt, you may begin to question the meaning of your experience. Those nagging “Why me?” questions that surface when you are first diagnosed often begin to morph into questions such as “Why did I survive when others did not?” or “Why have others had a more difficult experience than I have?” as you move through active treatment and into survivorship.

You may begin to feel as if there needs to be greater meaning and purpose in your life to justify your existence since you survived when others did not. You may also start having judgments about what you think you “should” be doing, thinking, feeling, saying, or believing.

While it is true that some survivors make changes in their lives that lead to greater purpose and meaning, most survivors just want to return to the life they had prior to cancer. Not everyone has a grand epiphany or is driven to make major life changes after surviving cancer. How­ever, the notion that because you were diagnosed with cancer you “should” be doing something different or “better” may still linger, and can lead to feelings of survivor guilt.

Confronting Your Notions of Fairness and Equity
Most people would like to believe that life is fair and equitable. But we know that cancer does not work this way. It is unfair that some people die from their disease while others sur­vive. And no one experiences cancer equally; some people do have a more traumatic experience than others do. For those survivors who believe they had “better luck” for no apparent reason, feelings of survivor guilt can emerge.

You may begin to feel as if there needs to be greater meaning and purpose in your life to justify your existence since you survived when others did not.

Author of Article photo

Kimarie Knowles

Another commonly held notion of fairness and equity is the erroneous belief that for you to experience fortune, someone else must experience misfortune. Without recognizing it, you may unconsciously believe that there are only a certain number of people allowed to survive, and if you survive, then that means someone else doesn’t. However, the reality is that your survival has no bearing on anyone else’s, and vice versa.

Experiencing Conflicting Feelings
After surviving cancer, you may feel relieved and grateful to be alive. How­ever, these feelings often conflict with the great sense of sadness and grief you likely experience when someone around you succumbs to the disease. Moreover, you may still feel anger and grief over the personal losses brought on by your own cancer experience, resulting in an internal conflict of emotions.

You are entitled to all the emotions you may be experiencing – happiness, sadness, relief, anger, gratitude, and grief. Conflicting emotions do not cancel each other out. You can be grateful and happy to be alive while also feeling anger and grief over cancer’s devastating effects. However, it can be difficult to balance all these conflicting emotions, and this can lead to feelings of survivor guilt.

Avoiding Difficult Emotions
Survi­vor guilt can be a way of avoiding other difficult emotions. Being diagnosed with cancer can expose you to a world where you witness and experience pain and suffering. Confronting your own mortality, experiencing loss and trauma, and losing fellow survivors to cancer can bring up intense feelings of grief, sadness, and helplessness. When faced with this, guilt is one emotion that can help you feel in control. Survivor guilt can actually mask emotions such as grief, sadness, and helplessness, preventing you from fully experiencing – and learning how to manage – these diffi­cult emotions.

Overcoming Survivor Guilt
The first step to overcoming survivor guilt is to acknowledge it and try to uncover the underlying causes that may be responsible for your feelings of guilt. If you are experiencing survivor guilt, remember that you are not alone. Connecting with other survivors and sharing your experiences can help you manage your feelings of guilt, as can talking with a nonjudgmental listener, such as an oncology social worker or a therapist who specializes in working with cancer survivors.

Give yourself space to grieve your losses – whether the loss of fellow sur­vivors or your own personal losses. Find ways to honor your own experience, as well as the experiences of others. And always, always remember that you are not responsible for another person’s survival. When loss occurs, cancer is the only guilty party. Don’t let survivor guilt keep you from living your life. You survived cancer; you deserve to enjoy it.

♦ ♦ ♦ ♦ ♦

Kimarie Knowles is a clinical social worker at Memorial Sloan Kettering Cancer Center in New York, NY, with special training in cancer survivorship, bereavement issues, and group psychotherapy.

This article was published in Coping® with Cancer magazine, September/October 2015.

The Waiting Room

by Lisa Pawlak

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While I am sitting in the oncol­ogy waiting room, I often wonder what I am doing here. I pass the time by flipping through magazines, browsing the web on my smartphone, and sending text messages to my husband. Often, I complain that I am still waiting.

I glance around the room at the others. Today, an elderly couple stands by the registration desk. The frail- looking woman leans on her bony husband who, in turn, is leaning on a wooden cane. I wonder which one is the patient. Another older lady in a wheelchair, afghan tucked around her lap, is nodding off as her daughter fusses over her, stroking her hand and smoothing her hair. A middle-aged woman, with a scarf wrapped around her hairless head and her missing eye­brows meticulously penciled in, sits across from me reading a novel. She deftly avoids eye contact, though probably senses me staring.

The minutes slowly tick by.

I wonder who is newly diagnosed. And who is in remission. I wonder if any of them are about to discover a recurrence. Or if anyone is dying. I wonder what type of cancer they all have.

I wonder if any of them are wondering why I am here, since – I assure myself – I am much too young, I look way too healthy, and I am far too stub­born for it to ever come back.

The minutes slowly tick by. I wonder who is newly diagnosed.
And who is in remission.

Although I don’t doubt that my husband, or a friend, would come with me if I asked, I have always preferred to go to the oncologist alone. I don’t want anyone to see me here, because that would make everything more real. Although I go in regularly for my rec­ommended check-ups, lab work, and various scans, I generally like to pre­tend that I am not a cancer patient. I just don’t think of myself that way.

I certainly don’t want anyone else to think of me that way, either.

What am I waiting for, anyway? To talk to my doctor, to have him listen to my lungs, to go over my latest test results? Am I waiting for the day when he tells me there is another “something” to monitor? To biopsy? To surgically remove? To attack with chemotherapy? To radiate? And, if that day comes, will I freeze up in shock? Will I burst out in tears? Will I run screaming out the door? Or will I simply sit there, calmly, and discuss my options with him?

What a crazy thing to sit around and wait for. So I wonder, again, what I am doing here, here in this waiting room. I don’t belong here; I am sure of that. Yet despite the conviction that I have been misplaced, that I am not actually a cancer patient, and that none of this could have actually happened to me, there is no denying it when the cheerful nurse pops her head out and loudly calls my name.

“Yes, I’m right here,” I say. And this is true.

Suddenly, intensely, I am filled with hope. I hope that I am still waiting here when I am a frail old lady, leaning on my husband – and maybe even on his cane – for support. I hope that one or both of my kids will fuss over me, strok­ing my hand and smoothing my hair. I even hope, if I should ever have a hair­less head and missing eyebrows, that I will quietly allow someone to openly stare at these battle scars, recognizing that they are a source of pride and survivorship.

We are survivors here, in the wait­ing room. We have scars, some visible and some hidden, but we are all still here – sitting, standing, reading, tex­ting, staring, complaining, wondering, waiting, living.

I put my magazine down, and my phone away. I breathe in deeply and slowly – because, stubborn as I am, I don’t actually know what is coming my way.

I follow the nurse through the door. I hope that I will feel just as out of place during future visits to the oncologist. I hope that my primary complaint to my doctor continues to be about the waiting.

♦ ♦ ♦ ♦ ♦

Lisa Pawlak is a carcinoid lung cancer survivor living in Encinitas, CA.

This article was published in Coping® with Cancer magazine, September/October 2015.

Get Help for Speech and Swallowing Difficulties after Head and Neck Cancer

by Mary J. Bacon, MA, CCC-SLP, BCS-S

A diagnosis of head and neck can­cer often raises concerns about speech clarity, voice quality, and swallowing ability. The degree to which a person’s speech and swallowing func­tions are affected varies depending on the type, size, and location of the tumor and the method used to treat it. Some people glide through treatment with little difficulty, while others experience impairment that is more extensive.

What Are the Potential Complica­tions?
Base-of-tongue and throat (pharynx) tumors can hinder swallow­ing. Cancer of the voice box (larynx) has the potential to instigate voice changes as well as swallowing issues. Surgical removal of the larynx (laryngectomy) is sometimes necessary and requires voice restoration therapy afterward. Surgery involving the lips or tongue can cause changes in articulation and can affect the oral stage of swallowing. Nasal re­gurgitation when eating or drinking is a concern after treatment for tumors on the roof of the mouth, as are changes in nasal resonance during speech.

Non-surgical treatments can also cause problems. Radiation therapy directed at the head and neck area can produce both short-term and long-term changes in speech and swallowing function. The effects of chemotherapy on speech and swallowing tend to be short term; nonetheless, these changes deserve attention during cancer treat­ment as well.

What Can You Do about Them?
Regardless of your level of impairment, a speech pathologist can be tremen­dously helpful in managing the side effects of head and neck cancer and its treatment.

Difficulty Swallowing If you’re having difficulty moving food and liq­uid through your mouth to your throat, a speech pathologist will need to ob­serve the swallowing process. This is done by viewing a moving-picture X-ray (videofluoroscopy) or by introducing a small flexible telescope through your nose, allowing a view of the swallow­ing process from above.

Author of Article photo

Mary Bacon

After the swallowing evaluation, the speech pathologist can recommend strategies to help you swallow food and liquids so that they go down the right way or exercises to maximize the strength and range of motion of your swallowing structures.

Other professionals can help too. For instance, dietitians can give you advice on how to get the nutrition you need when swallowing is difficult. Dentists can help you maintain good oral hygiene, which is important when a threat of aspiration (food or liquid going into the airway) exists. If dry mouth is making swallowing difficult, you can turn to your speech pathologist, dentist, or nurse, each of whom can provide sug­gestions for relief.

Speech and Voice Quality Treatment directed toward your tongue or lips can affect speech clarity. A speech patholo­gist can suggest strategies to help you speak more clearly or provide therapy to help you improve specific sounds that you may be struggling with. In rare situ­ations, you may have to consider using an alternative communication mecha­nism, such as a computer-generated speech device.

If your soft or hard palate (roof of the mouth) has been affected, your speech pathologist may need to enlist the assistance of a specialized dentist who can fashion a prosthesis to separate the oral and nasal cavities.

If you have a laryngeal tumor, your voice, as well as your swallowing func­tion, may be compromised. If you do experience voice changes, your speech pathologist can offer therapy to help you maintain functional voice quality. If total laryngectomy is required, your speech pathologist will offer training with an artificial larynx device (often called an electrolarynx), esophageal speech, or tracheo-esophageal speech.

Knowing that speech, voice, and swallowing problems can result from head and neck can­cer, you should schedule a visit with a speech pathologist before beginning treat­ment if possible. Your speech path- ologist, along with the other members of your healthcare team, will work with you to help to ensure your best possible treatment outcome.

♦ ♦ ♦ ♦ ♦

Mary J. Bacon is associate professor emerita of communication disorders and sciences at Rush University in Chicago, IL. With more than 30 years of experience working with head and neck cancer survivors, she holds the Certificate of Clinical Competence from the American Speech-Language Hearing Association and is board certified in swal­lowing and swallowing disorders.

For more information on coping with head and neck cancer, Mary recommends visiting,,, and

This article was published in Coping® with Cancer magazine, March/April 2015.

Healing Your Spirit

by Kava Schafer, MDIV, MA

Inspiration image

Every day in my work as a hospital chaplain I meet with people who are living with cancer in ways that inspire me. Many of these folks tell me they cultivate spiritual well-being, even while dealing with a serious diagnosis or while facing treatment challenges. And yet, it is not at all unusual for these situations to bring survivors and their families to the existential brink. Every­thing of value and importance may feel under threat as uncertainty grows. Even with a positive attitude and good progress, something will feel lost. There are many responses to this sense of rupture between life before cancer and life with cancer.

From my vantage point, I see that crisis brings opportunity for self- reflection. As human beings we seem to have this innate capacity to craft new meaning when faced with adversity. One way we do that is through a pro­cess of questioning and evaluating what is happening to us. Through that process, we may find that what once sustained and supported life may actu­ally deepen through the experience of illness. There is also the potential that our system of meaning or values may not prove sufficiently elastic to create safety or lead to ways to cope and move in life-enhancing ways through the experience of cancer.

Everything of value and importance may feel under threat.

Author of Article photo

Kava Schafer

It is human to question and wonder why illness comes, but if the questions oppress and strangle the spirit, spiritual distress may appear. When recognized and attended to, spiritual struggle may lead to new transformational spiritual insights and healing. In fact, it often does, but if it is ignored, it has the power to poison the spirit and create obstacles to healing. It is such a potent force that spiritual pain may actually make it difficult to manage physical pain effectively.

This is not difficult to understand since, for many, spirituality is the uni­fying core of our being; it is that which animates us, gives our lives meaning, and fuels our aspirations. It is not mea­surable, but it is the elusive factor that fosters resiliency in the experiences of change. Many people express their spirituality through religious beliefs and practices, but there are countless others who express their spirituality in non-religious ways through family, communion with nature, art, or service to others, to name a few. Living with cancer requires the capacity to draw on every available resource, and if one’s spiritual wholeness is fractured, it makes sense that depression or in­creased anxiety might be among the resulting symptoms.

In my experience, it is not unusual for people to admit that events from the past resurface and cause them to reflect on a possible connection be­tween the past and their cancer. These responses might be related to religious beliefs that carry additional weighted responsibility.

As a chaplain, I frequently hear people wonder if they are being pun­ished for past mistakes. Why has a loving God let this happen to me? Was there something I did that needs forgiveness? Perhaps a past regretted action or omission has come back to haunt me, even if it has been con­fessed to and forgiven. Religious representatives may have offered absolution, but it is often harder to forgive ourselves.

As the person struggles privately with these thoughts, increased sleep­lessness, reduced hope for the future, anxiety, and emotional flatness aren’t unusual. If that is not complicated enough, anger at God might be under the surface. Take any one of these possibilities, partner it with shame and guilt, and it becomes easier to see why much of this remains hidden.

Cancer is difficult enough without these complications. If you or someone you love is carrying guilt, laboring under a sense of punishment, or strug­gling angrily and despairingly with their religious faith, I encourage you or your loved one to seek the help of a religious or spiritual specialist who is skilled and compassionate. Delicacy may require that the person of choice be someone outside of your current frame of reference. The core advice is to seek companionship from someone trustworthy and knowledgeable. This language implies a Chris­tian religious perspective, but spiritual distress occurs in other religious frameworks, and just as frequently occurs in people who are non-religious. No one is immune from spiritual distress and no one should struggle alone without hope of spiritual healing.

♦ ♦ ♦ ♦ ♦

Kava Schafer is a certified spiritual director and palliative care chaplain at University of Pennsylvania Health System in Philadelphia, PA.

This article was published in Coping® with Cancer magazine, May/June 2015.

Coping with the Cognitive Side Effects
of Cancer

by Jeffrey S. Wefel, PhD, ABPP, and Mariana E. Bradshaw, PhD, ABPP

Knowledge image

Among the possible side effects of cancer, many survivors report changes in their thinking skills during and after treatment. The severity of these changes varies by person and can include memory problems; difficulty with concentrating, multitasking, and word finding; and slowed thinking. This cancer-related cognitive impairment is often referred to as chemo brain.

Chemo brain can result from cancer treatment (such as chemotherapy, surgery, radiation, or hormonal therapy), or it may be a side effect of the cancer itself. Additional factors like low blood counts, certain medications, and mood disturbances (such as anxiety or depres­sion) can also contribute to chemo brain.

For most people, cognitive issues generally fade soon after cancer treat­ment ends. However, for some, it may take a year or more to feel normal again, and even then, some survivors may never regain full cognitive function. Fortunately, with the right tools, you can reduce the impact chemo brain has on your daily functioning in order to improve your quality of life.

Behavioral Strategies
You can maximize your cognitive function by making some simple lifestyle changes and by using organizational tools and memory aids:

  • Rather than trying to multitask, you should prioritize your to-do list, mini­mize distractions, and focus on one task at a time.
  • Designate a station where you can store your keys, your cell phone, and other important items to avoid the frustration of having to search for mis­placed possessions.
  • Keep track of important information and upcoming appointments using your smartphone, a day planner, or a calendar.
  • Use your phone, alarm clock, or kitchen timer to set audible reminders for important tasks and appointments.
Author of Article photo

Dr. Jeffrey Wefel

In addition to these compensatory strategies, it’s equally important for you to manage the factors that might be worsening your chemo brain:

  • Follow a healthy diet.
  • Get plenty of rest, and practice good sleep hygiene.
  • Regularly exercise your brain and your body. Physical activity can help combat fatigue and improve mood, while memory and thinking exercises can help improve cognitive functioning.
  • Practice relaxation strategies to help reduce stress.
  • If you’re experiencing symptoms of depression or anxiety, let your doctor know so you can discuss your options for treatment.

Author of Article photo Dr. Mariana Bradshaw

Cognitive Training
Numerous prom­ising cognitive training approaches are available to help enhance cancer survivors’ brain function. For example, hospital-based education and cognitive remediation programs have been success­ful in ensuring academic development and improving attention span for children undergoing cancer treatment. Likewise, home-based, computerized cognitive training programs can help improve memory and executive functioning in both children and adults. Talk with your doctor about your cognitive training options.

Advances in cancer management have resulted in an increasing number of cancer survivors, some of whom must cope with cancer-related cognitive side effects. Fortunately, the impact of these side effects on daily functioning and quality of life can be minimized with appropriate interventions, more of which may be on the way, as efforts are underway to discover medications that may be helpful in enhancing brain function in cancer survivors.

If you’re currently experiencing chemo brain, you may want to ask for a referral for a neuropsychological assess­ment. This assessment can identify your cognitive strengths and weaknesses and help guide a more personalized plan to manage your chemo brain symptoms.

♦ ♦ ♦ ♦ ♦

Dr. Wefel and Dr. Bradshaw are board-certified neuropsychologists at the University of Texas MD Anderson Cancer Center in Houston, TX. Their practice focuses on the neuropsychological effects of cancer and cancer therapy in adult cancer survivors.

To find a board-certified neuropsychologist in your area, visit

This article was published in Coping® with Cancer magazine, July/August 2015.

On the Job Hunt after Cancer

Expert Tips for Job Search Success

by Julie Jansen

About Coping

A recent Harris Poll survey conducted on behalf of Cancer and Careers ( found that 78% of the cancer survivors surveyed were concerned that their cancer diag­nosis would hinder their ability to find a new job. For many survivors, job hunting after cancer proves to be a chal­lenging experience. However, you can rest assured that if you are qualified for a job, an employer cannot refuse to hire you simply because you have had cancer.

If you are one of those survivors who is back on the job market after battling cancer, here are some tips to help make your job search a success.

Spiff Up Your Resume
The primary goal of your resume is to describe your experience and achievements in a way that makes a prospective employer want to set up an interview with you to talk about how you can do the same great things for them. A resume is not a job description. So keep lists of tasks and responsibilities short and to the point. Instead, your resume should focus more on your accomplishments and how you were able to make a positive difference to your department or company. A bul­leted format works best for this part of your resume.

Another important element of a contemporary resume is a profile or summary, which is a brief paragraph at the top of your resume that summarizes your work experience. Your summary can be used to add a bit of personality to your resume. This is a good place to list the unique qualities that make you the right fit for the job.

The most important thing an employer is looking for during the interview process is how you, the job candidate, can solve their problems and meet their needs.

Author of Article photo

Julie Jansen

Most companies use applicant-tracking software to scan your resume’s keywords before a human reads it. So it’s important to add the right keywords to your resume. Use technical or functional descriptors such as project management, event planning, and website design, rather than clichéd phrases like effective communicator and team player.

Absolutely add volunteer experience to your resume, especially if you have an employment gap because you took time off for treatment or had to leave your job. Include a list of achievements for your volunteer experience, just as you would for your paid jobs. Finally, despite the persistent myth that a resume should only be one page, if you have worked for two or more years, then a two-page resume is the new rule of thumb.

Prepare for the Interview
Interview­ing for a new job is nerve wracking for most people, with or without a cancer history. Preparation is the key to feeling more comfortable and confi­dent during the interview process – and to getting invited back for that second interview.

The most important thing an employer is looking for during the interview pro­cess is how you, the job candidate, can solve their problems and meet their needs. Research the company as much as you can so that you can incorporate your knowledge of the company into the interview. This will also help you to ask smart, thoughtful questions about the job you’re applying for.

Prepare answers to the standard questions that are often asked during an interview, for example:

  • Tell me about yourself.
  • What are your strengths and weaknesses?
  • Describe a time when you failed.

When answering, tell stories about your achievements and use concrete ex­amples – but keep your answers brief and meaningful. Stay composed, and don’t let an interviewer’s quirky questions rattle you. Unless a question or request is discriminatory, just go with the flow.

Speaking of discrimination, you are not obligated to share the fact that you had cancer. And a prospective employer legally cannot ask you this question. However, in case a question about your health history does come up, you should decide in advance what your response will be. It is also a good idea to come up with a brief answer to ques­tions about gaps in your work history. If you are asked an uncomfortable question, try not to ramble. Instead, turn the conversation back to how you can make a positive difference for your po­tential employer.

The thought of looking for employ­ment after cancer can be a frightening one. However, the good news is that many companies are hiring, and now that you are armed with these job-hunting tips, you’re more prepared than ever to land that job you’re after.

♦ ♦ ♦ ♦ ♦

Julie Jansen is a career coach, resume and LinkedIn profile writer, and the author of I Don’t Know What I Want, But I Know It’s Not This: A Step-By-Step Guide to Finding Gratifying Work. Her website is

This article was published in Coping® with Cancer magazine, July/August 2015.

Good Morning America’s Amy Robach

On Surviving Breast Cancer, Overcoming Fear, and the On-Air Mammogram that May Have Just Saved Her Life

by Kaylene Chadwell and Laura Shipp

Celebrity Cancer Survivor

Amy on the set of Good Morning America in New York
(Photo by ABC/Heidi Gutman)

Three years ago, Amy Robach made the move from the host position at NBC’s Weekend Today to take a job at rival network ABC’s Good Morning America. Little did she know at the time that her new job may have helped save her life.

In September 2013, GMA producers approached Amy with the idea of her getting a mammogram live on the show to kick off Breast Cancer Awareness month in October. Amy was 40 years old, had never had a mammogram, and didn’t have a family history of breast cancer. That was the exact demographic GMA wanted to reach.

At first, Amy was hesitant. (After all, who wants their mammogram broadcast live to millions of television viewers?) So she turned to GMA cohost and breast cancer survivor Robin Roberts for advice. Robin encouraged her by saying that if just one life was saved because of early detection, it would be worth it. With that, Amy knew what she had to do.

The Mammogram Broadcast Live to Millions
When the day of her mammogram arrived, like many women, Amy was nervous about the potential pain and physical discomfort it might cause, not to mention the millions of people who would be watching. “I was nervous about how it was going to look having a live camera right there on me as I was getting a mammogram,” she confesses in an interview with Coping magazine. “But more than that, I was worried about whether it would be effective. I didn’t want it to be a distraction to what we were trying to do, which was encourage women to get mammograms and to show that it isn’t that painful or scary.”

“I honestly thought it was nearly impossible for me to have breast cancer given my age and my lack of family history.”

The one thing she wasn’t worried about, however, were the results. “I honestly thought it was nearly impossible for me to have breast cancer given my age and my lack of family history,” Amy admits. “Even when I got the call from the mammogram technician saying, Hey, we see something a little suspicious; you should have a follow-up mammogram, alarm bells didn’t go off.”

The Diagnosis that Shook Her World
Still convinced she couldn’t possibly have cancer, Amy kept her breezy compo­sure through a series of follow-up tests, including a second mammogram and a needle biopsy. In fact, cancer was such a remote possibility to her that she even came to her ap­pointments alone. It seemed she had nerves of steel.

Then the results came in. The mass in her right breast – the one that was first spotted during her reluctant on-air mammo­gram – was malignant. Amy was floored.

“I had a visceral, guttural reaction,” Amy shares. “To say I was sobbing is an understatement. There was nothing any­one could have told me that would have been more shocking than that. I didn’t know how to react. My entire world col­lapsed, and I was there alone. It was absolutely the worst day of my life.”

As soon as they got the news, Amy’s family rallied to her side. But they were just as new to cancer as she was. So the next day, Amy picked up the phone and called the one person she knew would understand. Once again, her friend and col­league Robin Roberts was there to give her the emotional support and the “I’ve been where you are” advice she needed.

Right away, Amy knew she wanted to continue sharing her experience with the public. “I felt a deep responsibility to share my news,” she confides, “because I knew that when women who had watched me go into that mammogram heard I had breast cancer, they would stop making excuses, pick up the phone, and call their doctor to schedule their appoint­ment. I knew for a fact that women’s lives would be saved.”

So just six weeks after broadcasting her first mammogram live from Times Square, Amy revealed her breast cancer diagnosis to the viewers of Good Morning America. Though she did it to help other women, Amy says she feels like she got more in return than what she gave.

“Sharing my journey helped me get through those hor­rible months of treatment,” Amy says. “I felt the collective love and support of all the other women out there who were struggling with the same thing I was. I felt like I had a whole new set of friends and sisters. And it had a huge impact on my recovery.”

The Grueling Treatments
To rid her body of cancer, Amy opted for a double mastectomy followed by reconstruction. During surgery, her doctors discovered a malignant tumor in her left breast that hadn’t shown up on her prior mammo­grams. They also found that her cancer had spread to her sentinel lymph node. It was stage II. Now she would need to undergo eight rounds of intense targeted chemotherapy – complete with side effects like fatigue, nausea, and chemo brain – plus a decade-long course of Tamoxifen, of which she’s currently in her second year.

“There’s nothing like turning 40 and then taking a pill and feeling 55,” Amy jokes. “I’m in a constant state of menopause. I have hot flashes and night sweats. [Tamoxifen] basically robs my body of estrogen, because that’s what fuels my can­cer. The hope is that by taking this for the next nine years, I give myself the best chance of staving off recurrence.”

On Getting Back to Normal
“The cancer journey doesn’t end the day of your last treatment,” Amy shares. “It stays with you forever, and you figure out how to fight through it each day and live a better life.” However, two years later, it appears Amy has settled in to her new normal, cohosting Good Morning America and publishing a memoir, though she never really stopped working. She has also made it her mission to speak out about early detection.

She admits, though, that the one thing she hasn’t completely overcome yet is the fear cancer imposes. “I’m working on it,” she says. “But sometimes fear washes over you when you least expect it. I was on a ferry recently, and I saw some grandparents with their grandchildren. All of a sudden, this dark thought entered my head: Will I ever get to be old? Will I ever get to hold my grandchildren?

“Even now I get emotional thinking about it. But I’ve decided that when those moments happen, I’ve just got to cry it out a little bit. Then I can smile and say to myself, But I’m here right now. I’m more aware of how precious time is and how lucky I am to be here. So I’ve been fighting through my fear by using it to remind myself that right now I have everything I need.”

♦ ♦ ♦ ♦ ♦

Amy Robach’s memoir, Better: How I Let Go of Control, Held On to Hope, and Found Joy in My Darkest Hour, hits bookshelves on September 29. The book details her breast cancer journey and how her illness affected her family and her marriage.

This article was published in Coping® with Cancer magazine, September/October 2015.

The Other Seat

by Melissa Gallagher

Inspiration image

Melissa Gallagher (right) with her mother-in-law Carol Gallagher

On March 10, 2005, I was diag­nosed with a rare form of ovarian cancer when I was just 26 years old. I experienced a slew of emotions after the cancer bomb was dropped on my life, but self-pity was never one of them. In a way, I was relieved that I was the one with cancer and I didn’t have to watch one of my loved ones go through it. In my mind, now that our cancer card had been dealt, that meant my family members would somehow be protected from having to face this awful disease themselves. I’ve since learned that it doesn’t work like that.

For nearly a decade, I had been the one sitting in the “hot seat.” I’ve sat in the seat directly across from the oncologists as they explain options and rattle off medical terms. I’ve sat in the seat where you wait to be called into the exam room, the seat where you await your chemo hookup, the seat that gets wheeled into the operating room and then to recovery.

Fortunately, I’ve always had someone sitting in the seat beside me. Someone has always been there to hold my hand while I wait. Someone has always sat next to me, hearing the doc­tors say the same things I was hearing them say. Someone has always been waiting for me every time I’ve been examined or had an operation. For this I’m thankful, as I now know that the “other seat” is also a tough one to sit in.

For nearly a decade, I had been the one sitting in the “hot seat.” I now know that the “other seat” is also a tough one to sit in.

In November 2013, I received a phone call from my mother-in-law that shattered my belief that my cancer diagnosis would spare my family from the same fate. I felt my legs give out and the air escape my lungs as I heard the all too familiar words: oncologist, surgeon, cancer. For a fleeting second, I thought my own denial could prevent the things she was saying to me from being reality. If I just said no enough times, I could stop all this from happen­ing to her the way it happened to me.

Within a week, I was sitting beside my mother-in-law during a surgical con­sultation. This time, I wasn’t sitting in my regular seat; I was in the other seat.

I toyed with the stack of business cards on the desk in front of me and glanced around the room. I wondered if the nurse realized that I was sitting in the wrong chair. I listened as the nurse asked my mother-in-law questions about her ovarian cancer symptoms. Reality was caving in on me. I gave her a quick smile, as if to say, “Don’t worry; it’s going to be OK,” but really I felt like I had been transported back to the day I learned of my own diagno­sis. All the familiar feelings resurfaced – fear, desperation, hope, uncertainty.

I had always been thankful that my family members never had to sit in my seat. Today, I know how it feels to sit in theirs. Neither one is desirable. But with someone in each, you’ll never have to navigate the rough seas of cancer alone.

♦ ♦ ♦ ♦ ♦

Melissa Gallagher is a two-time small cell ovarian cancer survivor living in West Islip, NY.

This article was published in Coping® with Cancer magazine, July/August 2015.

Embracing Survivorship After Breast Cancer

by Carolyn Vachani, RN, MSN, AOCN

Breast Cancer image

“Congratulations! We’ll see you in six months.” You’ve been eagerly anticipating this announcement since you first heard the words “You have breast cancer.” But after settling in to a routine of treatments, scans, and doctor’s appointments, the news that you’ve beaten breast cancer might provoke an unexpected response.

Although you may have planned to celebrate the end of treatment, when the time comes, you may be surprised to find yourself bogged down by feelings of fear, uncertainty, and vulnerability, not to mention lingering side effects. You may have expected to get back to life as you knew it before cancer, but things have changed. You have changed.

While each breast cancer survivor has to find her own way of settling into her post-cancer life, there are some universal actions you can take to help make the transition a little easier.

Kick fear to the curb.
One of the most common fears people have after cancer treatment is fear that the cancer will return. Unfortunately, this fear may never completely go away. That’s not to say, however, that it doesn’t get easier to manage. Think of fear as a passenger in your car. Fear rides up front with you for a while, but as time goes by, you pick up new strategies for coping with difficult emotions, sending fear to the backseat. As you continue to pick up coping strategies, you have less and less room in your car for fear. Eventually, it is forced out of the car completely, and it becomes merely a reflection in your rearview mirror.

Talk with your medical team about putting together a survivorship care plan to help guide you through survivorship.

Author of Article photo

Carolyn Vachani

Fear may muscle its way back into the car now and then, riding shotgun as you face that annual mammogram or notice a worrisome symptom. That’s OK – just don’t let it take control of the steering wheel. Make use of the coping mecha­nisms you’ve picked up to help you manage your worries (such as meditation, exercise, or an enjoy­able activity like knitting or gardening) until fear is once again just a speck in the rearview mirror. And remember that your doctor is only a phone call away if you need reassurance.

Stick to a plan.
Talk with your medical team about putting together a survivorship care plan to help guide you through survivorship and address your post-treatment concerns. Whether it involves long-term hormonal therapy or annual mammograms, your survivorship care plan can help keep you on the path to wellness, so it’s important to stick with it. If side effects or other issues are interfering with your ability to follow the plan as prescribed, talk with your medical team to come up with ways to manage these issues so you can stay on track.

Make your health a priority.
Re­search has shown that certain healthy behaviors – like maintaining a healthy weight – may lower the risk of breast cancer recurrence. Use the transition from treatment to survivorship as a time to implement a healthier lifestyle. Since everyone can benefit from making healthy choices, you can recruit your whole family to join you in your quest for wellness. Make a commitment to eat healthier meals and incorporate ex­ercise into your daily routine. You may have to start slow, but a simple daily walk through the neighborhood is a great way to get started. Push yourself to go a little far­ther each week.

Pay it forward.
Many breast can­cer survivors find it helpful to use their cancer expe­rience to help others. Give your­self time to heal both physically and emotionally, and when you’re ready, consider giving back to the cancer community in some way. You could join a mentorship program to guide women who are newly diag­nosed with breast cancer, help raise funds for a cancer charity, or volunteer at your local cancer treatment center. Many survivors find that giving back to the cancer community gives mean­ing to their cancer experience and helps them move forward as a breast cancer survivor.

The transition from active treatment to breast cancer survivorship isn’t always an easy one. However, with the right tools and a survivorship care plan in place, you can embrace your survivorship with a renewed sense of purpose and a new outlook on life.

♦ ♦ ♦ ♦ ♦

Carolyn Vachani is an oncology advanced practice nurse at the University of Pennsylvania’s Abramson Cancer Center in Philadelphia, PA. She is the managing editor of OncoLink ( and creator of the OncoLife Survivorship Care Plan.

If you’re nearing the end of active treatment for breast cancer, ask your doctor for a survivorship care plan, or create one at

This article was published in Coping® with Cancer magazine, July/August 2015.

Tips for Young Adults Navigating the Challenges of Cancer

by Phoebe Souza, LCSW, and Karen Fasciano, PsyD

Photo by Cancer Type

While cancer disrupts life at any age, for young adults, the disruption often occurs while you are still establishing a sense of personal identity and making crucial de­cisions regarding your education, career, and relationships. Before your diagnosis, you were probably making plans for the future, feeling in control, and exploring your newfound independence. However, the emotional burden of cancer may have left you feeling isolated from your peers, vulnerable, dependent, and uncertain about what comes next. Changes in rela­tionships, issues surrounding sexual health and body image, and difficult emotions are common areas of concern for young adults going through cancer treatment, and figuring out how to bal­ance normal life and the demands of cancer can be a challenge.

Most young adults diagnosed with cancer have never had a serious illness. Feeling sick, navigating health insurance options, undergoing scans and blood work, and scheduling countless doctor’s appointments are new experiences, so you’ll probably need a little help. Although moving back home, receiving financial assistance, and asking for help with daily tasks can be difficult – especially if you were enjoying your first taste of independence prior to your diagnosis – you may need to rely more on your parents, your partner, or your friends during this time.

Your needs will change throughout treatment, so open and frequent com­munication with your family and friends is necessary. In many cases, connections between you and your support system will become stronger and more honest. However, you may learn that certain friends or family members are not able to provide the support you need, and instead may actually contribute to your stress.

Author of Article photo

Phoebe Souza

Sexual Health and Body Image
Like their peers, young adults coping with cancer grapple with issues surrounding fertility, sexual function, intimacy, and body image. Consequently, sexual problems and changes in your physical appearance resulting from treatment are particularly distressing. Talk to your doctor about any concerns you may have. Seeking support and information on these issues from your healthcare team, and possibly even from a mental health professional, can help you better cope with the physical and sexual changes brought on by cancer.

Difficult Emotions
As you make your way through diagnosis and treatment, you may experience strong, unpredict­able emotions. Anxiety and sadness are common for young adults dealing with cancer, and the intensity of these feel­ings can be overwhelming. Everyone copes differently, so you’ll need to de­termine which coping strategies work best for you. Coping strategies for dif­ficult emotions might include practicing self-reflection, distracting yourself from anxiety-provoking situations, focusing on the positives in your life, and engaging in relaxation exercises, mindfulness-based practices, or other activities you find pleasurable. You may also benefit from working with a mental health professional.

Author of Article photo

Dr. Karen Fasciano

Peer Support
Peer support is critical for young adults who desire normalcy in the face of illness, as many young adults experience isolation in cancer treatment settings, where there aren’t many fellow survivors in their age group. Since social media and Internet-based communities are staples of young-adult culture, on­line support groups can be a great way to connect with other cancer survivors in your age group. However, you’ll want to err on the side of caution when you log in. You may come across stories from survivors who had negative experiences, which can cause unnecessary anxiety.

While happiness and re­lief are common feelings after treatment, so are a range of conflicting emotions, including gratitude, guilt, grief, anger, sadness, and hope. Survivorship is a transitional time for young adults during which they integrate their new perspec­tives into their future goals. However, young adults often find that they need increased emotional support during this time, sometimes even more so than dur­ing active treatment.

As a young adult with cancer, you’ll face unique challenges and require differ­ent types of support compared to children and older adults with cancer. But with the right tools and support, you can success­fully navigate the challenges of cancer. Cancer may have changed the way you imagined your life would turn out, but you can use this experience as an oppor­tunity to grow and to gain important life skills that will help guide your future.

♦ ♦ ♦ ♦ ♦

Phoebe Souza is a social worker in the Department of Psychosocial Oncology and Palliative Care at Dana-Farber Cancer Institute in Boston, MA, who works with adolescents and young adults with cancer and their families. Dr. Karen Fasciano is an instructor in the Department of Psychiatry at Harvard Medical School in Boston, MA, as well as a senior psychologist in the Department of Psychosocial Oncology and Palliative Care and director of the Young Adult Program at Dana-Farber Cancer Institute.

This article was published in Coping® with Cancer magazine, March/April 2015.

Adopting a New Normal after Cancer

by Kathleen McBeth, MA

Author of Article photo

Kathleen McBeth

After my doctor told me I had cancer, the rest of the visit was a blur. I was told that I would eventually discover a “new normal,” but this concept was lost on me. I just wanted to have my old normal back.

Despite the addition of frequent doctor’s appointments and trips to and from treatment, I tried to maintain my pre-cancer routine. After finishing treatment, I went to graduate school to become a clinical psychologist. Through my focus on working with cancer sur­vivors, I found that many people shared my aversion to adopting a new normal. However, as I learned from my own cancer experience, some lifestyle modifications are necessary.

Having cancer is a full-time job. In addition to enduring the actual cancer treatments, your tasks include regaining a sense of normalcy and finding new ways to carry out essential daily activi­ties. For many of the people I work with, this adjustment takes a few tries. We may cry, grieve, or get angry, and then finally we focus on what needs to happen with our oncology treatment and our emotional well-being.

The first 100 days post-diagnosis is often a time of heightened activity. For many survivors, this is also a time of shock and emotional numbness. This initial sense of emotional disconnect actually protects you as you face sur­gery or the beginning of chemotherapy or radiation treatment.

Once the shock wears away, you become more aware of the difficulty of your situation, and you eventually have to deal with the emotions you were previously numb to. These feel­ings shouldn’t be ignored. There are many avenues of coping with these difficult emotions, and it’s important to find the ones that are most helpful for you.

Having cancer is a full-time job.

Uncovering coping mechanisms that have worked for you in the past is a good place to start. Was finding a distraction, such as visiting with friends, going to a movie, or lis­tening to music, helpful? Have you tried mindfulness techniques like meditation or visualization? Does it help to talk about your distress with family members, friends, or medical professionals?

Being able to recognize that you’ve found ways to cope with challenges in the past, and you can use these same methods to help you get through your current situation is often helpful. Learn­ing new strategies, such as taking a yoga class, joining a support group, or journal­ing can be effective tools.

Adjusting to a new normal after cancer treatment requires you to think about how you lived your life in the past, as well as how you want to live it going forward. Are you willing to take a step toward living fully by focusing on what you have now instead of what you would like to have in the fu­ture? For many the focus is to make the best of your relationships and build new ones.

Many of the survivors I work with say that cancer has taught them to live in the present. This statement is very helpful when you are concerned about whether your treatment is work­ing or anxiously awaiting the results of your latest scan – focus on the present moment. Relish the time you spend with friends. Delight in the laughter of your children or grandchildren. Savor the sensation of cool rain falling onto your skin.

In 2013, when I was diagnosed with cancer for a second time, I didn’t spend time asking “why me?” and clinging to my now-old new normal. Instead, I gathered my support system – my medical team, my family, my friends, my books, and my sense of purpose – and I enlisted the help of coping strategies that got me through my first round with cancer. Prepared to accept and adapt to another new normal, all I needed to do was remind myself that I could pick up the tools I found so helpful in the past and utilize new strategies when necessary.

♦ ♦ ♦ ♦ ♦

Kathleen McBeth is a two-time cancer survivor and a clinical psychologist at the Vermont Cancer Center in Burlington, VT.

This article was published in Coping® with Cancer magazine, July/August 2015.

Get the Facts on Myelofibrosis


Photo by Cancer Type

Myelofibrosis is a rare bone mar­row cancer in which the marrow is replaced by fibrous (scar) tissue. Myelofibrosis can occur on its own, called primary myelofibrosis, or as a progression of other bone marrow diseases. Myelofibrosis belongs to a group of closely related blood cancers, known as myeloproliferative neoplasms, in which the bone marrow cells that produce the body’s blood cells develop and function abnormally. The result is excessive fibrous tissue formation in the bone marrow, which can lead to severe anemia, weakness, fatigue, and an enlarged spleen and liver.

The cancer develops when a muta­tion occurs in the DNA of a single blood-forming stem cell. Blood stem cells have the ability to reproduce and divide into multiple specialized cells that make up the blood. As the mutated blood cell replicates and divides, it passes along the mutation to new cells. Eventually, this abnormal cell produc­tion overtakes the bone marrow’s ability to produce enough normal blood cells, including

  • red blood cells, which carry oxygen to the tissues,
  • white blood cells, which fight infection, and
  • platelets, which help blood to clot.

When the bone marrow is unable to make enough healthy blood cells, the result can be severe anemia, weakness, bone pain, fatigue, and increased risk of infection. The abnormal growth of blood-forming cells can also take place outside of the bone marrow, called extramedullary hematopoiesis, in such organs as the liver, spleen, lungs, lymph nodes, and spinal cord, causing swelling.

An important constant feature of myelofibrosis is the production of too many megakaryocytes, the term for the giant cells in the marrow that break up into fragments and produce hundreds to thousands of platelets. Platelets are small blood cells that stick to the site of a blood vessel injury and form a plug to seal off the injured blood vessel to stop bleeding. Normally, new platelets are made to replace used platelets in the body. With myelofibrosis, extra mega­karyocytes are made, causing too many platelets to be released into the blood and chemicals called cytokines to be released into the marrow. The cytokines stimulate the development of fibrous tissue in the marrow. Paradoxically, the number of megakaryocytes can become so abnormal that platelet production de­creases in some people with this disease.

About 50 percent of people with myelofibrosis have a mutation called V617F JAK2 found in the JAK2 gene. The gene mutation causes abnormal signaling in the JAK pathway, which regulates blood cell production. This dysregulation of the JAK pathway can lead to an enlarged spleen and other serious complications, such as a low platelet count and severe anemia. Be­tween 5 and 10 percent of people with myelofibrosis will have a myeloprolifera­tive leukemia (MPL) gene mutation, which also affects the JAK signaling pathway. In addition, mutations in the TET2 gene have been found in 5 to 15 percent of people with myeloproliferative neoplasms. Scientists are investigating the role TET2 mutations, and other gene mutations in other signaling pathways, may have on myelofibrosis onset.

The reason these genetic mutations occur in myelofibrosis is unknown. Exposure to petrochemicals, such as benzene and toluene, and ionizing radia­tion may raise the risk of developing the cancer. However, only a small propor­tion of people exposed to these chemicals develop myelofibrosis. A theory about why myelofibrosis develops in some people is that they have inherited genes that limit their ability to detoxify the causative agents. However, myelofibro­sis itself is not an inherited disease. There is no known prevention.

♦ ♦ ♦ ♦ ♦

Reprinted with permission of The Leukemia & Lymphoma Society from, Myelofibrosis Facts. All rights reserved.

This article was published in Coping® with Cancer magazine, July/August 2015.

10 Years Later …

What Can I Do Now?

by Dennis “Doc” Knowles

Inspiration image

It’s been 10 years. Ten, sometimes very long, years since I was diagnosed with multiple myeloma. I’ve outlived my oncologist’s most optimistic predic­tion. The cancer that was once the sole focus of my life is no longer the center of my universe. The disease is no lon­ger detectable in my body. For this, I thank God often.

I don’t really know what I expected to happen after I was given the all clear. Perhaps a parade or some wild celebra­tion publicized by a full-page ad in The New York Times: “Dennis has survived cancer! Join him and everyone he’s ever known for a mega party in Shea Stadium!”

I can’t say that I’m disappointed this wasn’t my reality (OK, maybe a little), because I know that life just doesn’t work that way. Cancer has left me more than a little broken, physically and financially. I should probably be bitter, but I’m not. My life is what it has always been – a journey.

My life is what it has always been – a journey.

I, however, have found myself on a quest to be relevant. I want to be useful again. I want my life to have meaning and purpose. I feel as though I’ve been lost at sea for 10 years, and now that I’ve made it safely back to shore, I want to pick up where I left off. The prob­lem is that I can’t. Before cancer, I was able to work 10 to 15 hours a day. Now if I work 10 hours, I need 24 hours to rest. I used to get up at 3 a.m. I would shower, get dressed, and go. Now I sleep until seven and then sit for an hour or two until I know that all of my parts re­quired for moving will actually move. This definitely is not how I imagined my recovery.

Don’t get me wrong. I’m not com­plaining. I’m just trying to be honest about what I can and can’t do. Horse ranching, for example, is out. So is skydiving and panning for gold in Alaska. No big loss. Those things were never on my bucket list anyway.

So what can I do? I can stay active, mentally and as physically as my 63-year-old cancer survivor’s body will allow. I can also share what I’ve learned over the past 10 years. I can offer hope and encouragement to other cancer survivors and their families.

I can tell them that there is life after cancer. I can reassure them that there will come a time when whole weeks will pass without a single utter­ance of the C word. I can tell them that one day they’ll wake up from this nightmare, and it will be time to get busy reclaiming their lives. I can attest that surviving cancer is significant and life changing but it’s not the end – it’s only the beginning. Finally, I can say that I’ve found that the sweetest fruit always grows at the end of the branch, and to get it, you have to go out on a limb.

♦ ♦ ♦ ♦ ♦

Dennis Knowles is a multiple myeloma survivor living in Orting, WA.

This article was published in Coping® with Cancer magazine, May/June 2015.

A Transformative Moment for Cancer Research

Annual Progress Report from the National Cancer Institute

by Douglas R. Lowy, MD, acting director of the National Cancer Institute

Knowledge image

"An investment in knowledge,” Benjamin Franklin once wrote,
“pays the best interest. "

Although he was writing specifically about financial advice, Franklin’s words could no doubt apply to decades of scientific investment that is opening up numerous, exciting opportunities for progress against cancer. From the rapid emergence of immune-based therapies to the continued advances in cancer genomics that are forever altering how we think about and approach preven­tion, diagnosis, and treatment – this is truly a transformative moment for cancer research.

As the leader of the U.S. National Cancer Program, the National Cancer Institute is focused on seizing this moment. Over the last year, since the readers of Coping last received an annual report from NCI, I can confidently say that we have made important progress. And during that time, much has changed.

In March 2015, after five years as NCI Director, Dr. Harold Varmus stepped down from the position. Among his many achievements while at NCI, Dr. Varmus launched important initia­tives that will have a lasting impact on our ability to reduce the burden of cancer not only in the United States but also in other countries.

I was honored to be asked by President Obama to serve as acting NCI director, and it was an offer that I enthusiastically accepted. Because after more than three decades of conducting research at NCI, I believe we have reached a crucial moment in cancer research. Perhaps at no other moment in history, in fact, have we had such a singular opportunity to make monumental leaps in our understanding of the collection of diseases that we call cancer, and in our ability to prevent and treat it.

Perhaps at no other moment in history have we had such a singular opportunity to make monumental leaps in our understanding of cancer.

Part of this belief is rooted in President Obama’s January 2015 an­nouncement that he was launching a Precision Medicine Initiative. The President called precision medicine “one of the biggest opportunities for breakthroughs in medicine that we have ever seen,” and I wholeheartedly agree. NCI will play a critical and lead­ing role in the President’s Precision Medicine Initiative as we seek to make precision medicine a regular part of cancer care in the very near future.

In general, precision medicine in­volves routinely using detailed genetic and other molecular information about a person’s cancer to select effective, patient-specific remedies to treat it. For nearly ten years, NCI has been at the forefront of precision medicine – launching important programs like The Cancer Genome Atlas and, more recently, the Exceptional Responders Initiative. A large component of the Precision Medicine Initiative is devoted to cancer, and NCI will continue to ini­tiate new research to explore the benefits of precision medicine in cancer preven­tion and treatment.

Our focus will be on conducting precision medicine clinical trials, better understanding tumor resistance to treat­ment, and developing robust information platforms that facilitate the study of the molecular drivers of cancer and the incorporation of precision medicine into everyday patient care.

In June, we announced a rigorous, large-scale precision medicine trial called NCI-MATCH (Molecular Analysis for Therapy Choice). In this clinical trial, which will enroll as many as 1,000 people with different cancer types, participants will be assigned to smaller component trials in which their treatment will be based not on their type of cancer but on certain genetic abnormalities thought to be driving their cancer (based on genomic testing of their tumor samples). Treatments will be selected from more than twenty FDA-approved and investigational agents to “match” a specific genetic abnormality in each person’s tumor.

Although NCI already supports a large portfolio of cancer health disparities research, it’s one of several areas where I believe the Institute can more sharply focus its efforts.

Importantly, a pediatric counterpart to NCI-MATCH is being planned that will enroll children with advanced cancer that has progressed despite standard-of-care treatments. This trial will offer a unique opportunity to study whether many of the targeted therapies used in or being studied for use in adults can benefit children with cancer.

The adult and pediatric NCI-MATCH trials are just two of a series of new precision medicine trials being conducted under the auspices of NCI’s National Clinical Trials Network (NCTN). Last year at this time, the NCTN – the product of a complete revamping of NCI’s prior clinical trials program, known to many as the Cooperative Groups – was just launching. I’m happy to report that the new program is now in full swing and is offering people across the country easy access to all NCI-supported trials, including precision medicine trials such as NCI-MATCH.

Last year, NCI also launched the NCI Community Oncology Research Program (NCORP). This program, which replaced NCI’s previous community-based clinical trials program, will bring cutting-edge trials to more communities across the country – to people where they live.

NCORP will also conduct studies to assess and improve how everyday cancer care is delivered, and to help address what in my view is an extremely serious public health issue: disparities in cancer incidence and death among racial, ethnic, and socioeconomic groups. Examples of these disparities are dis­couragingly abundant, such as the higher rate of prostate cancer death among African American men and the high incidence of cervical cancer among Hispanic and Latino women.

Although NCI already supports a large portfolio of cancer health dispari­ties research, it’s one of several areas where I believe the Institute can more sharply focus its efforts. Two other areas in which I think NCI can bring more clarity to our efforts are prevention and early diagnosis and basic research.

We must remain committed to funding excellent science. Because excellent science, by its very nature, will always promote progress.

With health disparities, I believe it’s critical that we focus on what we consider to be the most serious and important concerns and take the neces­sary steps to better address this issue. The same holds true for prevention and early diagnosis. We’ve had some important and high-impact successes in prevention – including dramatic reductions in smoking rates and the development of HPV vaccines – but with 1.6 million new U.S. cancer cases and 600,000 cancer deaths forecast for 2015, clearly there are opportunities for greater progress.

Basic research accounts for ap­proximately half of NCI’s budget. And although that research is often viewed through the prism of its likelihood of leading to a clinical application, such as a new treatment or screening test, many of our most important advances have come from basic research that had no such ambitions. In short, we must remain committed to funding excellent science. Because excellent science, by its very nature, will always promote progress.

Beyond changes at NCI, the past year has seen a number of noteworthy, practice-changing advances – progress that is due in no small part to NCI-conducted and supported research.

For example, immunotherapies continue to generate much-deserved enthusiasm. The U.S. Food and Drug Administration has already approved immunotherapy drugs known as check­point inhibitors for the treatment of melanoma and, in March 2015, for treat­ing people with advanced non-small cell lung cancer. Based on a growing body of data from ongoing clinical trials, many in the research community ex­pect that immunotherapies will become part of our standard treatment arsenal for many cancers.

The FDA also recently approved a third HPV vaccine that protects against nine different types of the human papil­lomavirus, seven of which can cause cancer. While we already know that the vaccines protect against cervical cancer, there is emerging evidence that they also protect against other cancers, including head and neck cancer, the rates of which have increased dramatically over the past decade, particularly in men.

And we now have the first approved treatment for children with a high-risk form of neuroblastoma, the most com­mon solid tumor in children – the immunotherapy drug Unituxin. For the better part of two decades, NCI supported the development of this agent, which is now the standard of care for children diagnosed with high-risk neuroblastoma.

In short, I’m happy to report that progress is happening on many fronts. And I look forward to penning this report a year from now, confident that I will have other important successes to share and that our investment in cancer research will continue to lessen the burden of cancer and improve the health and well-being of our nation.

♦ ♦ ♦ ♦ ♦

Since 1994, the National Cancer Institute has written an exclusive annual report for Coping’s July/August Celebration issue.

If you would like to learn more about precision medicine, the NCI-MATCH trial, or any of the other information presented in this article, call NCI’s Cancer Information Service at 1-800-4-CANCER or visit the NCI website, And for news on the latest cancer research findings and new NCI programs and initiatives, visit NCI’s Cancer Currents blog at

This article was published in Coping® with Cancer magazine, July/August 2015.

How I Learned Acceptance on the Berkeley Fire Trails

by Marcia Renée Goodman

Inspiration image

Standing in the specialty running store with my 25-year-old daugh­ter Dani and my childhood friend Felice, I am in good fitness company as we survey the options of running shoes laid out before us. Dani was an All-American athlete in college. Felice was the fastest runner in our elementary school. Both have kept in shape.

I, on the other hand, have slacked off in the fitness department over the last several years of cancer treatments. My knees ache, I have neuropathy in my feet, and cancer-related fatigue is a constant presence.

But on this morning, I’ve decided to gear up and hit the fire trails. It is springtime in Northern California, after a long winter, and I am learning to live with ongoing maintenance chemotherapy for recurrent ovarian cancer. I’m not feeling great on this particular day because of a recent chemo treatment, but I’m happy to be out in Berkeley with two dear ones.

After an indulgent hour of trying on this and that brand, we walk back to my house, each of us carrying a bag with bright new running shoes in neon trim colors. By the time we walk the half-mile home, all I can do is sit on the sofa. So Dani and Felice run the hilly fire trails of Berkeley without me.

My friends often remind me that none of us is young anymore; all of our bodies have lost something.

I feel sorry for myself at first, and then I rally and set to work grading essays. I find a sense of peace and pur­pose sitting there evaluating my students’ efforts as the afternoon drops around me.

The next day, my daughter and friend go out again to run the trails together. I am still not up for it. A feeling of loss and longing washes over me as I think about my younger, pre-cancer body and the reality sinks in that I likely will never be off treatment. I push those thoughts aside and get back to grading. Again, I am soothed by the feel of papers and words in my hands, by the struggles of my students, and by the light streaming in through the window.

By the following week, I am feeling better. Felice has returned home to the East Coast, so I hit the fire trails with Dani. We walk together and then jog a bit before she takes off to run at her own pace without me slowing her down.

The next day, I’m out there alone, interval jogging: jog, walk, jog, walk. And the day after that, I am back again. Then the next day, and the next, until I realize I am continually jogging. Very slowly, but I am actually keeping pace.

I am flooded with memories of being 23 years old and running through Golden Gate Park, of playing softball, tennis, and volleyball. Sometimes I find it hard to believe that I was ever that fit.

My friends often remind me that none of us is young anymore; all of our bodies have lost something – whether to cancer or just aging. None of us can do what we used to. I find comfort knowing that I’m not alone in this. I am getting older, after all – it’s not just cancer treatment slowing me down. And getting older is the thing I’ve wanted most since my diagnosis 17 years ago.

But it’s not always easy to accept the reality of growing older. Or the reality of cancer treatments that will never end. Like many who are strug­gling with loss, sadness, or fear, when these things keep me awake at night, I try to think about what I have to look forward to the next day, what I can be grateful for. I try to relax and just be.

Lately, amazingly, I’ve been on a chemotherapy break, the first extended chemo break I’ve had in several years. Slowly, my body has been coming back to me. The neuropathy has lessened some, the fatigue is much milder, and my appetite is almost completely re­stored. My hair is back to some extent, though it is thinner, grayer, and more limp. I don’t know how long this break will last. The cancer will be back; it’s just a question of time.

I often wonder how others think about time, my great preoccupation since my diagnosis at age 43. Certainly, I’ve had more years than I once feared I would have. I’ve had a long, loving marriage and a deeply satisfying career; I’ve seen my children grow up. But I am not satisfied.

I often tell my doctor that he must keep me alive until I’m 70. That seems a fair age to me, the beginning of “being old.”

“Oh, but then you will say 80,” he tells me.

“Of course,” I answer. “Of course.”

♦ ♦ ♦ ♦ ♦

Marcia Renée Goodman is an ovarian cancer survivor living in Berkeley, CA.

This article was published in Coping® with Cancer magazine, July/August 2015.

Treating Cancer in Older Adults

by Hyman B. Muss, MD

Knowledge image

“I didn’t know older people got cancer.” I hear this frequently from newly diagnosed older adults, who are often surprised to find out that the risk of getting cancer rises dramatically with age. But the fact of the matter is that, thanks to improvements in healthcare, people are living longer, resulting in an increasingly larger population of older Americans and, subsequently, an ever-growing number of older adult cancer survivors.

Currently, in the United States, the average age of someone newly diagnosed with cancer is 67. The problem is that most of what we know about caring for older adults with cancer comes from re­search done on much younger patients. What may be the best treatment for a 40-year-old may not be the best treat­ment for a 75-year-old. Moreover, the goals of treatment may differ according to a person’s age.

Someone who is younger may accept harsher side effects in exchange for small improvements in survival, while someone who is older may focus on maintaining function and living independently for as long as possible. The challenge in taking care of an older adult with cancer is accurately weighing the treatment’s effect on function and independence against its potential benefit in treating their cancer. A cancer diagnosis is scary, but for an older adult with other major illnesses, like heart or lung disease, cancer may not be the primary health concern.

Ask your doctor if he or she is experienced in caring for older adults with cancer and if you would benefit from a geriatric assessment.

Author of Article photo

Dr. Hyman Muss

When it comes to making treatment decisions, it’s not your age that matters; it’s how much longer you’ll likely live. Healthcare professionals have a variety of tools that can help them predict an individual’s life expectancy by taking into account other, non-cancer illnesses, as well as functional status. On aver­age, a healthy 65-year-old will live to be 85, a healthy 75-year-old will live to be 87, and a healthy 85-year-old will live to be 91. So for an otherwise healthy 77-year-old who has developed a life-threatening but potentially treat­able cancer, state-of-the-art cancer treatment should be considered. Older adults with cancer who are in good health generally tolerate modern cancer therapies, including surgery, radiation, and even chemotherapy, just as well as younger survivors.

Making decisions is harder when an older individual is diagnosed with a cancer that isn’t curable but is causing side effects, or when that person has a potentially curable cancer in addition to a non-cancer illness that is causing major problems in function and quality of life. In these instances, medical care should be tailored to the individuals’ treatment goals, and the potential for cancer treatment to make a bad situa­tion worse should be considered.

So what should you do if you’re an older adult newly diagnosed with cancer? First, put together a team of healthcare professionals you trust. Make sure you know each team member’s role in your care.

Ask your doctor if he or she is experi­enced in caring for older adults with cancer and if you would benefit from a geriatric assessment, which would eval­uate your level of functioning, nutritional status, and available social support. This assessment can detect problems related to aging that cancer specialists may overlook but that can be addressed to make your cancer treatment more easily tolerable.

Bring a friend or family member along to your appointments to keep you company, take notes, and support you. It’s hard to remember everything said to you during a clinic visit, and although many doctors provide treatment summa­ries, it is very helpful to have someone there to take notes and serve as a second pair of ears.

You may want to ask your doctor if you’re eligible to participate in a clinical trial. Clinical trials usually represent the cutting edge of cancer care; however, doctors are less likely to offer them to older adults, even if they’re eligible to participate. That’s why you should always ask. In the majority of clinical trials with senior adult participants, the older population has benefitted from the exciting new treatments just as much as the younger individuals have.

Make sure you and your family are on the same page concerning your wishes. Sometimes family members want you to take a more aggressive treatment route than you do; sometimes it’s the other way around. You should discuss your goals and wishes with your friends and family, but ultimately, you’re the one who should make the final decisions regarding your care.

♦ ♦ ♦ ♦ ♦

Dr. Hyman B. Muss is professor of medicine at the University of North Carolina at Chapel Hill School of Medicine and director of geriatric oncology at UNC’s Lineberger Comprehensive Cancer Center in Chapel Hill, NC.

This article was published in Coping® with Cancer magazine, May/June 2015.

My Raven Moccasins

by Barbara Center

Inspiration image

I’d forgotten about my raven-black moccasins, still safe in their box on the top shelf of my bedroom closet. I’d for­gotten about their rubber nonslip soles, the white and gold beads that gently adorn their black leather tops, and the trim – four inches of soft black fur – that hugged my ankles and lower calves.

A year had passed since I’d bought my beloved moccasins at the Native Canadian Centre in Toronto. A mild winter had given way to an early spring, and the cozy black moccasins were on sale in the gift shop. Like Cinderella, I slipped them on my feet – a perfect fit. Immediately I fell in love, thinking they would make a fantastic Leap Year birthday present to myself. Even at half-price, they were a little rich for my pocketbook. But something more sinister was causing me to hesitate on my splurge.

“You have stage IV incurable lym­phoma,” my oncologist had told me. “Your only chance for survival is seven months of aggressive chemotherapy, followed by six rounds of total body radiation, culminating in a month-long hospital stay and a stem cell transplant.”

Like Cinderella, I slipped them on my feet – a perfect fit.

At age 64, I was a high-risk prospect for a transplant. Why was I even consid­ering buying the moccasins? If I didn’t survive treatment, they would just be one more thing that my sons would have to deal with as they sorted through my estate. But what if I did survive? Like their raven-black color, the moccasins were symbolic – they signified my future beyond cancer. Choked up and teary-eyed, I bought my precious gift.

Inspiration image

Barbara’s moccasins symbolize her future beyond cancer.

That April, I started my treatment, and in September, I was admitted into the hospital for the stem cell transplant. By mid-October, bald and severely underweight, I was discharged to a convalescent home for seven weeks of recuperation. I finally returned to my apartment in December after three months away. The clocks hadn’t been changed, and the calendars still showed the autumn leaves of September.

When January rolled around, my oncologist gave me a new report: “Your CT scan shows no signs of lymphoma.”

Another Leap Year birthday ap­proached, and I refused to take it for granted. Gingerly, I opened the box that had kept my moccasins safe. I lifted them softly from their cradle and slipped the extravagant beauties on my impoverished feet. As I savored their soft caress, tears began to flow.

Never again will my raven mocca­sins sit untouched on my closet shelf. I wear them every day as a witness to my future.

♦ ♦ ♦ ♦ ♦

Barbara Center is a stage IV lymphoma survivor living in Toronto, ON, Canada.

This article was published in Coping® with Cancer magazine, May/June 2015.

WOW, Am I Ever Angry!

7 Steps for Coping with Angry Feelings

by Gary McClain, PhD

Author of Article photo

Dr. Gary McClain

I don’t know anyone who doesn’t get angry. And there’s nothing wrong with that. After all, anger is a basic human emotion, like sadness or happiness. Certain situations evoke angry feelings by reminding us that life isn’t always fair, that it doesn’t always go the way we think it should. No one knows this better than someone who is living with cancer.

In my job as a therapist, I work with people who are facing illness. Cancer survivors often talk to me about their angry feelings and the causes behind them. Some common complaints include day-to-day uncertainty, complications from treatment, unwanted lifestyle changes, financial issues, and stressors at home.

Our culture teaches us that we shouldn’t get angry; it won’t do us any good. Anger will cause us to lose con­trol, which will ultimately lead to disaster. Allow me to quash this mis­conception. Anger does have a pur­pose. It triggers the fight response from our fight- or-flight instinct, which motivates us to take action. Sometimes fighting – by defending or advocating for ourselves – is what we need to do.

While getting mad is a human reaction, holding on to anger can have a negative effect on your wellness and can contrib­ute to conditions like depression. Still, knowing how to release these feelings isn’t always clear, so here are seven steps to help you let go of anger.

1 Count to 10. Yes, this is one of the oldest tricks in the book. You’ve probably seen it used in a television sitcom or two. But I can tell you from personal experience that it works. Counting to 10 gives you a chance to calm yourself down before you react in a way you might regret later. As you count down, don’t forget to breathe.

2 Step out of the story. Ask yourself if there is a story behind your anger. If you’re thinking, “this always happens to me,” or “I never get what I want,” you may be setting yourself up to relive angry feelings from your past. Try to react to your current situation, not to a similar situation from the past. By staying in the moment, you’ll be less likely to blow your current situation out of proportion.

3 Reconsider your expectations. If you’re feeling angry about the outcome of a situation, ask yourself what you were expecting to happen. Were your expectations realistic? Remind yourself that you’re not in control of everything. (Isn’t that a relief?) Keeping realistic expectations helps you avoid disappointment that can lead to angry feelings.

4 Look for the humor. Finding the humor in a situation can go a long way toward diffusing the rage rush that anger can evoke and helping you keep your perspective. Give it a try. How about having a good laugh about the way life seems to get in the way of our plans?

5 Have a heart. Accept your feelings – all of them – and recog­nize that you’re only human. Don’t be too hard on yourself. Give yourself a break, and you’ll find it easier to give others a break too.

6 Reach out for support. Find a friend or family member who will listen to you without judging your feelings or trying to tell you what to do. Vent if you need to. Let those angry feelings out.

7 Take care of yourself. Are you placing the needs of others before your own needs? Has your self-care routine been neglected? Not taking care of yourself can leave you feeling emotionally and physically depleted and especially vulnerable to angry feelings, so it’s important to make some time for yourself every day. Take a walk, listen to music, do something you enjoy.

Remember, you don’t have to avoid feeling angry, but you don’t have to allow anger to control you either. Accept difficult feelings for what they are, and find positive ways to release them.

♦ ♦ ♦ ♦ ♦

Dr. Gary McClain is a therapist, patient advocate, and author living in New York, NY, who specializes in working with individuals who have been diag­nosed with chronic and catastrophic medical conditions, their caregivers, and professionals. Visit his website at

This article was published in Coping® with Cancer magazine, May/June 2015.

Life After “The News”

Managing Distress after a Cancer Diagnosis

by Alexandra Gee, PsyD, and Teresa Deshields, PhD

Inspiration image

So you’ve been diagnosed with cancer. Your mind is flooded with questions, and waves of difficult emotions wash over you. Or maybe you’re feeling nothing at all, stricken with numbness or disbelief. The days following your diagnosis are a blur as you try to pro­cess the news and prepare for what’s to come. It’s difficult to think of any­thing other than cancer and what it means for your life.

This sudden health threat, and all that accompanies it, can lead to physi­cal and emotional distress. How do you deal with it when you already have enough on your plate?

It’s important to know that distress is a normal reaction to life-altering news. In fact, allowing yourself to feel the emotions that arise, without the pressure to “be strong” or “think positive,” can be helpful in this early phase following diagnosis. Transition periods, such as the beginning and the end of treatment, are a bit more diffi­cult to handle. Try to cut yourself some slack. The good news is there are a number of coping strategies that can help you manage distress as you navigate this journey.

Outside of the doctor’s office or treatment center, try your best to keep up your normal daily routine.

Author of Article photo

Dr. Alexandra Gee

Trust in Yourself
First, think about what has gotten you through difficult times in the past. Trust in your own ability to cope with a situation. Chances are you have successfully traversed rough terrain before, perhaps without giving much thought to how you did it at the time. Reflect on those tough times and try to remember what you did in order to come out on the other side. What helped you get through it? Did you lean on a family member or friend when you needed to talk things through or just needed someone to be present? Maybe you gathered informa­tion and you felt empowered by the knowledge you acquired. Or you may have participated in activities that helped you feel relaxed or centered. The coping mechanisms that have worked for you in other situations will likely work again, even if a cancer diagnosis feels monumental compared to the obstacles you’ve handled in the past.

Author of Article photo

Dr. Teresa Deshields

Lean on Others
Next, turn to your support system. An important tip – you are allowed to be picky with whom you choose. Surround yourself with people who make you feel relaxed and supported.

Seek Out Normalcy
It can also be beneficial to maintain a routine when­ever possible. Granted, you’ll have more appointments to accommodate in your schedule, but try to think of them as minor parts of your day. Outside of the doctor’s office or treatment center, try your best to keep up your normal daily routine. A sense of nor­malcy can go a long way in helping to ease distress.

Ask for Help
Finally, know that it’s OK to ask for a little bit of extra help when you’re dealing with distress caused by a cancer diagnosis. Whether you seek assistance from a loved one, a spiritual or religious leader, a support group, or a mental health professional, it’s good to have someone in your corner. Ask your treatment team about supportive services in your area, and don’t be shy about taking advantage of them.

♦ ♦ ♦ ♦ ♦

Dr. Alexandra Gee is a postdoctoral fellow, and Dr. Teresa Deshields is a licensed clinical psychologist, both at the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, MO.

This article was published in Coping® with Cancer magazine, May/June 2015.

Major League Survival

Finding My Identity in the First Inning after Cancer

by Dave Dravecky

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Battling cancer is hard enough, but for many survivors, of which I am one, cancer leaves us with an even tougher battle to fight. That battle has to do with our identity.

When I look back on my life, discovering who I am has been an ever-evolving journey. I believe I am not alone in that. In fact, I know that while we may be on different paths and experience different life-changing events, many of us find ourselves on the same quest.

I have evolved from a son and a brother to a hus­band and father. And I have been a student and an athlete – first an amateur and then a professional. I have loved, accepted, and transi­tioned with every new identity. But my first major identity crisis – asking God, “Who am I now?” – came when I lost my arm to cancer.

Battling cancer is hard enough, but for many survivors, of which I am one, cancer leaves us with an even tougher battle to fight. That battle has to do with our identity. When the storm of cancer sweeps into our lives, the landscape can change dramatically. Everything familiar may be wiped away or changed beyond recognition. We may have lost the rela­tionships, skills, and resources that had been an essential part of who we are and had given us a sense of joy and purpose in living. So some of us journey out of cancer as very different people.

Inspiration image

Dave Dravecky

When I lost my arm, I lost my career, my position, and my sense of identity. All I had ever done was play baseball. Who was I if I was not a pro baseball player? It was a long, painful, and difficult journey to identify the real Dave Dravecky.

For me, the journey did not begin right away. Partly because I didn’t take the time to mourn the loss of my arm. That would have been the emotionally healthy thing to do, but oh no, not me! Instead, I had a cavalier attitude about it. Before the amputation, I jokingly waved my left arm in the air, pretend­ing it was saying goodbye. After the amputation, I thrust myself into travel and speaking engagements to prove that I could overcome this loss.

The truth was I didn’t want to face the pain and the reality of the loss or the fact that I was a changed person. However, the questions of who I was and where I was supposed to go from here could not be held at bay any longer. My wife, Jan, continued to say to me, “The only way to heal from the pain of losses suffered is to go through the pain. There is no way around it. You can stuff it, and you can dodge it. But eventually you’ll have to face it.”

When I started to take that first step by asking those questions instead of ignor­ing them, I was surprised to dis­cover that so much of my identity was wrapped up in that arm and what it had been capable of doing. My arm had brought me joy, worth, and status, and had provided an unbelievable career and wonderful lifestyle. I lost all of these when I lost my arm. Until I came face to face with the deeper losses that came with the physical loss of my arm, I was awash in a storm of denial and depression.

If I have learned anything through the loss of my arm, it’s that ignoring the loss and not taking the time to mourn that loss was a huge boulder on my path to discovering who I truly was. So step one for me was to remove that boulder by honestly facing my pain and loss and then moving on with God.

♦ ♦ ♦ ♦ ♦

In 1988, duing his seventh year in Major League Baseball, San Francisco Giants pitcher Dave Dravecky was diagnosed with a cancerous desmoid tumor in his pitching arm, which eventually had to be amputated. Though the loss of his arm ended his base­ball career, Dave found a new calling as a motivational speaker. He penned the books Comeback and When You Can’t Come Back, and he, alongside his wife, Jan, founded Endurance, a nonprofit organization that offers resources for people facing serious illness, loss, or de­pression. Learn more at

This article was published in Coping® with Cancer magazine, May/June 2015.

HELP! My Skin’s Not the Same after Treatment

by Carol R. Drucker, MD

Knowledge image

“My skin just hasn’t been the same since chemo­therapy.” I hear this comment frequently from cancer survi­vors, who often follow the statement with a list of the changes they’ve ob­served: drier, more sensitive skin; brittle nails; hair alterations; skin discoloration; and more. Survivor skin can be different from pretreatment skin in many ways. Some skin changes will resolve with time; others may not.

Rest assured, however, that post-treatment skin changes are common. Many cancer survivors come out of treatment with alterations to their birthday suits.

Cancer Treatment vs. Your Skin
A common complaint among survivors is that their skin is drier after treatment. Chemotherapy, radiation, and hormone therapy all can alter your body’s oil and sweat gland functioning, sapping your skin of moisture. Dry skin is more sen­sitive and less elastic than hydrated skin, so it feels thinner and is more prone to tearing, bruising, and splitting.

Sometimes, one area of skin receives more damage than the rest. A prime example being skin that’s exposed to radiation. The affected area is more sen­sitive and prone to itch. Irritating factors like dry weather, certain cleansers, and new clothes can cause this portion of skin to break out in a rash while the surrounding skin remains unaffected.

The appearance of a rash can be alarming. However, keep in mind that some areas of skin may be less resilient than others after treatment, and it is unlikely that your skin irritation is a sign of something more serious, like cancer recurrence in the skin. Though that’s not to say you shouldn’t discuss skin discomfort or other concerns with your doctor.

Your skin is more sensitive now
than it was before treatment.

Author of Article photo

Dr. Carol Drucker

With radiation therapy, your skin will probably go through several stages of change. During treatment, you may experience sensitivity, redness, and burning in the treatment area. As your skin heals, discoloration can persist. Over time, you may notice dilated blood vessels, and the affected skin may become shiny and firm. In the long term, skin that has been exposed to radiation is more susceptible to developing growths and skin cancers, so it should be checked regularly. Simi­larly, radiation can leave skin vulnerable to discoloration, which warrants regular skin checks as well.

Not all skin changes are bad; some can be a bonus. Certain chemotherapies react with spots of precancerous sun damage in the skin. What appears to be a rash could actually be the rejuvenation of sun-damaged skin.

Give Your Skin a Fighting Chance
You may not be able to completely avoid treatment-related skin changes, but you can manage them by caring for your post-treatment skin.

To start, be aware that your skin is more sensitive now than it was before treatment. For dry skin, unscented creams and ointments are often more effective than lotions. Avoid scratching dry, itchy skin. Instead, stop the itch with an over-the-counter itch cream. Keep damp washcloths in the freezer that you can apply to the affected area; the cold can help stop a sudden itch attack.

Be gentle with your skin when bathing. A hot shower feels so good, especially after a long day, but the hot water actually increases the dry- ness and itchiness of your skin. Take warm showers instead, using gentle cleansers.

Use caution when trying any new skin product, fragrance, or procedure. If your skincare routine previously included products with harsh or abra­sive ingredients, reintroduce them into your routine one at a time. Start by adding one step back into your skin regimen for a week or two before adding another step.

Be careful if hair removal is part of your grooming routine, especially if you wax. Areas of your skin may be more sensitive than they were in the past. Additionally, newly resurfacing hairs can irritate the skin as they regrow. This irritation looks similar to acne, but it’s not, so don’t use harsh treatments meant for oily, acne-prone skin. Instead, man­age ingrown hairs with gentle cleansing and mild exfoliation.

During and after treatment, your skin may be more sensitive to the sun than ever. Before going outside, shield yourself from the sun’s rays with protec­tive clothing and sunscreen. The tincture of time is the real solution to treatment-related skin changes. Your skin has endured a barrage of insults through treatment, so it may take a while to heal. Until your skin returns to nor­mal, or to its new normal, pamper yourself by taking care of your skin.

♦ ♦ ♦ ♦ ♦

Dr. Carol Drucker is a professor of dermatology at the University of Texas MD Anderson Cancer Center in Houston, TX. She specializes in skin cancers and cancer-related skin conditions.

This article was published in Coping® with Cancer magazine, May/June 2015.

Quiet, Please ...

It’s Time to Connect with Your Soul

by Elizabeth Lenegan, PhD

Wellness image

Bombarded – that’s the word survi­vors often use to describe what happens to you right after finding out you have cancer. You barely have time to absorb the shock of the diagno­sis before you’re hit with complicated medical information and instructions, a calendar full of medical appointments, and a cascade of phone calls.

In all the turmoil, and with most of the emphasis on physical treatment and recovery, it can be easy to overlook your spiritual needs. Yet research shows that people with cancer are more likely to wrestle with spiritual issues than are people with other chronic illnesses. Christina Puchalski, MD, MS, founder and director of the George Washington Institute for Spirituality and Health in Washington, D.C., points out that a cancer diagnosis “changes the lives of patients forever … triggering deep questions of meaning and purpose,” which can result in spiritual distress.

Why is this a problem? Be­cause spirituality enables us to reach beyond the temporary and sometimes-shallow aspects of our lives to our deep and enduring core – our soul. It defines what makes us human, what our life is all about, what connects us to other people and the world as a whole. For some, it can mean a connection with God or a higher power.

Spirituality enables us to reach beyond
the temporary and sometimes-shallow aspects of our lives
to our deep and enduring core – our soul.

Author of Article photo

Dr. Elizabeth Lenegan

When life moves along without inter­ruption, the demands of our day-to-day activities can distract us from our need to set aside time for nurturing our spirit, nourishing our soul, and thinking about life’s most important questions. Illness forces us to stop and do just that.

When cancer puts the brakes on your normal routine, spending time in spiritual practices can heal your soul and reduce stress. It can also provide physical benefits; studies show that spiritual practices can actually lower your blood pressure, decrease your risk of heart disease, and lead to better control of nausea and pain.

Whether you’re experiencing spiri­tual distress or you’re looking for new ways to tap into your spirituality, one of the most powerful ways to connect with your spirit is through quiet reflec­tion. (Think of it as a visit to an oasis of peace far removed from our noisy, fast-paced world.) If you don’t have time for quiet reflection every day, aim for at least a day or two each week. Even 10 minutes of quiet time can re-energize your soul. Here are a few suggestions that might help as you be­gin to practice quiet reflection:

bullet Find a place where you will not be disturbed; for example, a chapel, a peaceful area of a park, or a room in your home where you can be alone.
bullet Eliminate distractions. Turn off the TV, radio, and cell phone. Silence the ringer on your landline phone. Ask family and friends to give you the time you need to be alone.
bullet During your quiet time, avoid think­ing about chores, obligations, or specific worries. Instead, focus on answering the following questions:

Beyond my job, my family ties, and my hobbies, who am I?
What is the meaning of life? What is the meaning of my life?
What things are most important to me?
What do I hope for?
What makes me happy?

Whether you were diagnosed with cancer only yesterday or many years ago, finding quiet time to reflect on your life and connect with your spirit can help relieve stress, give you strength to cope with life’s challenges, and help you look toward your future with optimism and hope.

♦ ♦ ♦ ♦ ♦

For the past 15 years, Dr. Elizabeth Lenegan has served as director of pastoral care at Roswell Park Cancer Institute in Buffalo, NY. She manages a staff of chaplains and vol­unteers who work with survivors and their families, and coordinates retreats for survi­vors and caregivers.

This article was published in Coping® with Cancer magazine, March/April 2015.

Lost Appetite?

Satisfying Solutions for Getting the Nutrition You Need

by Elise B. Cushman, MS, RD, CSO, LD

Wellness image

Elise teaches survivors how to whip up healthy, flavorful meals during a cooking demonstration.

As important as it is to eat well during cancer treatment, for many survivors, finding the motivation to do so can be challenging. Cancer can put you in a hypermetabolic (fuel-burning) state that can rob your muscles of pro­tein and cause weight loss, depleting your stamina and leaving you easily fatigued.

Furthermore, chemotherapy drugs target rapidly developing cancer cells. However, rapidly growing healthy cells can get caught in the crossfire, resulting in unpleasant side effects, including changes in taste and smell. These taste and smell alterations can diminish your appetite, making it hard for your body to get the nutrients it needs. So what can you do to overcome these barriers to good nutrition?

When Food Doesn’t Taste the Same
Due to treatment-related taste changes, your favorite foods may now be unappealing. If food no longer tastes the same, try following these recom­mendations:
⇒ Clean the Slate Brush your teeth before you eat. Then rinse your mouth with a baking soda and salt-water solu­tion made by mixing one teaspoon of salt and one teaspoon of baking soda into a quart of water.
⇒ Mind the Salt Iodized salt can impart a metallic taste. Try using kosher or sea salt instead.
⇒ Spice It Up! Adding seasonings and sauces can help awaken foods that taste bland during treatment. Try hot sauce, chili powder, vinegar, or a splash of citrus to cut through the flavor doldrums. Garlic, chives, basil, rosemary, or other fresh herbs can help liven up meals as well. (A word of caution: stick to a bland diet if you have mouth sores.)
⇒ Metal Mouth? Eat with plastic uten­sils to reduce metallic taste. Cast iron naturally imparts metallic flavors onto foods, so cook in glass or ceramic casserole dishes in­stead of metal pots and pans. Sucking on sugar-free hard candy in between meals can also help counteract metallic taste.
⇒ Prep Your Protein Red meats tend to taste metallic or just off in some way during treatment. Stick to more neutral protein choices, such as cheese, eggs, beans, tofu, chicken, and pork. Another option is to marinate your meat. Try a simple solution of juice or vinegar, olive oil, fresh herbs, garlic, salt, and pepper. Or you can save time by using your favorite vinaigrette or Italian dressing as a marinade.
⇒ Sweeten Up If food tastes bitter or salty, sprinkle in a pinch of sugar to make it more pleasing to the palate.

When Scents Stifle Your Appetite
If food odors induce nausea or cause you to lose your appetite, give these suggestions a try:
⇒ Put a Lid on It If shakes and liquids are easiest for you to swallow but you’re put off by the smell, put them in a cup with a lid and sip through a straw.
⇒ Send Off Scents If the slightest sniff of food sends you running from the kitchen, use a fan and keep the hood vent on when cooking on the stove. Cook with the windows open, and keep food covered. If possible, enlist someone else to do the cooking while you’re in treatment.
⇒ Cool It Down Hot foods smell stronger and can be off putting. Allow food to cool before sitting down to eat, or stick to room temperature or cold foods, such as sandwiches, gela­tin, fruits and vegetables, cheese and crackers, or yogurt.

What to Eat
The American Insti­tute for Cancer Research suggests a plant-based diet that is rich in fruits, vegetables, and whole grains. For protein, choose beans, legumes, poul­try, fish, and low-fat dairy. Limit your consumption of red meat to 18 ounces a week.

When eating full meals becomes challenging due to early satiety, you may be able to tolerate small, frequent meals instead. Eat every two to three hours, and make every bite count by eating calorie-rich and protein-packed foods, such as peanut butter and toast, cheese and crackers, Greek yogurt, or scrambled eggs with cheese. If liquids are easier to tolerate, sip on high-calorie, high-protein shakes throughout the day. With a little ingenuity, and perhaps the help of a dietitian, you can get the nutrition you need to stay strong through treatment.

♦ ♦ ♦ ♦ ♦

Former chef Elise Cushman is a registered dietitian at Dartmouth Hitchcock Medical Center’s Norris Cotton Cancer Center in St. Johnsbury, VT.

For more information on eating well during cancer, and to find a certified specialist in oncology nutrition, Elise recommends visiting

This article was published in Coping® with Cancer magazine, March/April 2015.

Be the Author of Your Story

by Rosemary E. Newnham

Wellness image

Ten years ago, I experienced some sudden, scary changes in my health. I went through nine months of doctor’s appointments and countless blood tests before I learned the cause of these changes. At first, I felt as if my life was orbiting out of control. Then I started writing about it.

On the page, I emerged as a brave, truth-seeking warrior. No longer a scared, wounded victim, I was the au­thor of my own life again.

When you find out you have cancer, it’s normal to feel angry, anxious, de­pressed, disoriented, or all of the above. By writing about how you feel and what you’re going through, you can impose a sense of order on your experiences and take stock of the people around you. Your family members, friends, healthcare team – these are the characters in your stories. They may do funny and heroic and awful things. Writing allows you to process what’s going on in your life and figure out what happens next.

Find the “Write” Setting
Some hospitals offer creative writing groups. Ask a social worker if your hospital has one, and if not, whether he or she knows of any writing groups in your community. You could also regularly meet with a few friends and host your own informal writing group. Or you may feel more comfortable writing privately in a journal. Journaling is a highly portable activity. You can do it in the waiting room or during chemo to help focus your thoughts.

Remember a time when you acted bravely. Write about how it felt.

Author of Article photo

Rosemary Newnham

Ready, Set, Write
If you want to give creative writing a try, here are some tips for getting started:
Sit in a quiet spot with a computer or a pen and paper – whichever feels best.
Set a timer for 20 to 30 minutes, and try to keep writing until the timer goes off.
Recall simple sensory details: the scent of the doctor’s office, the sound of the scanning machine, the feel of a waiting room chair, or even the taste of hospital food.
Be sure to include your feelings. Sometimes writing is easier if you write about yourself in the third person.
Your words might come out as a poem or a rant. Don’t limit yourself.
When you’re done, share your writ­ing with a friend. It can seem scary at first, but sharing your thoughts is a powerful way to help others better understand what you’re going through.

Writer’s Block Be Gone
Still not sure what to write about? It’s easy to feel overwhelmed by the big changes going on in your life. Writing is easier when you take the big picture and break it into smaller, more manageable pieces. Here are some ideas:
Write about the moment of your diagnosis. Where were you? How did you feel? Do you remember the words your doctor said?
Remember a time when you acted bravely. Maybe it’s the moment you walked into your first chemo treatment, or the first time you called your doctor when you noticed a troublesome side effect. How did it feel?
Think of a time you felt down, de­pressed, lonely. What cheered you up? Write a letter to your sad self. Keep it to read when the blues come back.
Imagine having permission to say absolutely anything you want to your doctor, your cancer cells, your family. What would you say? Don’t hold back. Express your gratitude, anger, wishes, and hopes.
Tell the story of a moment when you needed help. How did you get it? Was it difficult to ask for or accept help?
Remember an important decision you’ve had to make since your diagno­sis. For example, deciding which course of treatment you should follow or when you should tell your kids about your diagnosis. How did you make up your mind? If you had it to do over, would you make the same decision?
Picture yourself at some point in the future, be it after completing treatment or just after your next appointment. How do you want to feel? What are you do­ing? Who is with you? It doesn’t matter if your imaginings are “realistic” – indulge yourself with the best pos­sible scenarios.

Writing can help you feel better in many ways: you can write out your bad feelings, re­member the good things that happen, and give life to your hopes for the future. You’ll also have a log of your entire experience as a reminder of how far you’ve come.

♦ ♦ ♦ ♦ ♦

Rosemary Newnham is a medical writer living in New York, NY. She coauthored After Prostate Cancer: A What-Comes-Next Guide for a Safe and Informed Recovery with Dr. Arnold Melman.

For more creative writing resources, Rosemary suggests and

This article was published in Coping® with Cancer magazine, March/April 2015.

If You Build It …

by Gail Presnell-Jones

Inspiration image

I started my regeneration at Goodwill. No, I didn’t volunteer or utilize their many services; I simply shopped. After a year of battling cancer and an 18-month depression, I realized that I had two choices: I could continue to sit around in my fuzzy bathrobe, waiting for a miracle to lead me back into life, or I could get up, get dressed, and … Well, I wasn’t so sure what should come next, but I decided to go with that sec­ond option anyway. I would get up, get dressed, and take it from there.

The first problem with my plan was that I didn’t have anything to wear that was much of an improvement over my well-worn bathrobe – just a few pairs of jeans and some t-shirts. The second problem was that my budget didn’t allow much room for new clothes. Neverthe­less, like Kevin Costner in The Field of Dreams, I told myself, “If you build it, he will come.” Only I was building a new image for myself, not a baseball field in the middle of Iowa, and “he” referred to my new lease on life.

Years ago, I had worked as a cloth­ing designer, so I felt confident in my ability to separate the wheat from the chaff, so to speak, in the local discount and thrift stores. I took my mission seriously, rarely spending more than 10 dollars on any item and scoring an amazing array of name-brand garments and accessories.

One of my last purchases was a three-strand, shell-disk necklace in a color that can only be described as neon tangerine-pink. It had the potential to be either horrifically gaudy or fantastically over the top. I took my chances, bought the necklace, and went home to find my husband making reservations for a business trip to Charleston, SC. Because our 25th wedding anniversary had re­cently come and gone with little to no fanfare, I decided to tag along.

I packed the necklace.

For three long days, my husband was immersed in meetings, so I took the opportunity to wander aimlessly around the city, enjoying museums, restaurants, and everything else Charleston had to offer. On my second day of sightseeing, I paired my bargain neon necklace with white jeans, a black Kenneth Cole halter-top, a brilliant sunflower-yellow Escada blazer, and dainty bronze sandals. (The total cost of the outfit came in at just under 40 dollars – score!)

Famished from a day of exploring, I waltzed into a local deli, feeling sassy in my second-hand finds and looking for a snack. As I rounded a corner, I came face-to-face with a beautiful, mahogany-skinned older woman who gasped and smiled broadly on seeing me.

“Well, I do love your necklace,” she declared guilelessly.

I sidled up to her. “It’s from Good­will,” I whispered.

“Don’t you go telling that,” she said with a giggle. “You look like a million bucks.”

And for the first time in years, I felt like a million bucks. I thanked the woman for her com­pliment and moved around to the next aisle, clutching the necklace’s clasp at the base of my neck. I so wanted to share something lovely with someone equally lovely – something that, no matter how inexpensive, was a symbol of my survival and my reemergence from the pits of depression. Maybe she, too, would pass it on one day.

It took a moment for me to release the clasp, but I eventually removed the necklace, shoved it into the outside pocket of my purse, and returned to the previous aisle.

“Excuse me,” I alerted my approach to the woman. “Would you do me a favor?” She never hesitated. “Well of course, darling,” she answered.

I took her beautiful, timeworn hand in mine and put the necklace in it, wish­ing that it were made of diamonds. “Please take this,” I said.

She balked, “I can’t take your jewelry.”

“I would be so happy knowing you were wearing it. Please,” was all I could say as I dashed away.

“Well, you are my blessing today,” she called to my back.

“And you are mine,” I whispered. I hope she heard me.

♦ ♦ ♦ ♦ ♦

Gail Presnell-Jones is a breast cancer survivor living in Valrico, FL.

This article was published in Coping® with Cancer magazine, March/April 2015.

Communities to Recognize Cancer Survivors, Raise Awareness on National Cancer Survivors Day® – Sunday, June 7


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On National Cancer Survivors Day® – Sunday, June 7, 2015 – cancer survivors and supporters in communities around the world will gather to celebrate life and raise awareness of the issues of cancer survivorship.

On Sunday, June 7, 2015, tens of thousands of people around the world will gather in their local communities to observe the 28th annual National Cancer Survivors Day®. Hundreds of cities across the U.S. and abroad will hold celebrations on this day to honor cancer survivors, to bring attention to the ongoing challenges of cancer survivorship, and to show the world that life after a cancer diagnosis can be fruitful, rewarding, and inspiring.

National Cancer Survivors Day® is an annual worldwide Celebration of Life that is held on the first Sunday in June. It is the one day each year when everyone joins forces to recognize the cancer survivors living in our communities and raise awareness of the ongoing challenges they face. NCSD also provides an opportunity for cancer survivors to connect with other survivors, celebrate the milestones they’ve achieved, and acknowledge the family members, friends, and healthcare professionals who have supported them along the way.

“A ‘survivor’ is anyone living with a history of cancer – from the moment of diagnosis through the remainder of life,” according to the National Cancer Survivors Day® Foundation, administrator for the celebration.

“For the vast majority of survivors, cancer is no longer the automatic death sentence that it was a few decades ago,” says Foundation spokesperson, Laura Shipp. “The reality is that, among U.S. adults, the 5-year relative survival rate for all cancers combined is now approximately 68 percent. In 1987, the year that NCSD began, that number was just 56 percent.

“National Cancer Survivors Day® is an opportunity for cancer survivors to join with each other and celebrate this new reality in cancer survivorship that more people are living longer and better quality lives after cancer than ever before. It is also an opportunity to bring attention to the challenges these survivors face after diagnosis, and sometimes even years after treatment ends.”

NCSD celebrations will be as diverse as the communities where the events are being held. There will be motivational speeches, health fairs, parades, carnivals, block parties, art exhibits, awareness walks, inspirational programs, and more. Cancer survivors will share their unique stories of how surviving cancer has affected their lives. And communities will come together to stand with these survivors and make a commitment to help find ways to lessen the burdens a cancer diagnosis brings.

The National Cancer Survivors Day® Foundation encourages everyone to participate in their community’s event. To locate the one nearest you, check with your local cancer treatment center, hospital, or American Cancer Society office. Or you can host an event of your own. The NCSD website,, has everything you need to plan an NCSD celebration.

NCSD started in the United States in 1987, and it is now celebrated worldwide in countries including Canada, Australia, India, South Africa, Greece, Saudi Arabia, Italy, and Malaysia, according to Shipp.

The nonprofit National Cancer Survivors Day® Foundation provides free guidance, education, and networking resources and assistance to hundreds of hospitals, support groups, and other cancer-related organizations that host official National Cancer Survivors Day® events in their communities. The Foundation’s primary mission is to bring awareness to the issues of cancer survivorship in order to better the quality of life for cancer survivors.

More Americans than ever are surviving cancer. According to the American Cancer Society’s Cancer Treatment & Survivorship Facts & Figures 2014 – 2015, there are 14.5 million cancer survivors alive in the US today, and that number is expected to grow to almost 19 million by 2024. Even though cancer incidence rates are dropping, the number of cancer survivors is rising due, in part, to earlier detection and better treatments. As the number of cancer survivors continues to grow, it will be more important than ever to address the unique needs of these survivors.

Many survivors face limited access to specialists, a lack of information about promising new treatments, inadequate or no insurance, difficulty finding employment, and psychosocial struggles. Once active treatment ends, cancer survivors still must cope with the long-term effects of cancer, which can include physical side effects; psychological, social, and emotional concerns; and financial hardships.

“To say that surviving cancer is challenging would be an understatement,” says Shipp. “But it is a challenge that millions of people – 14.5 million in the U.S. alone – are overcoming. National Cancer Survivors Day® is a celebration of how far we’ve come in extending life after cancer. However, the NCSD Foundation hopes that National Cancer Survivors Day® also serves as a call to action for more resources, research, and increased public awareness to improve quality of life after cancer.”

The National Cancer Survivors Day® Foundation, along with the NCSD 2015 national supporters Amgen, Astellas, Bristol-Myers Squibb, Coping with Cancer magazine, Genentech, Seattle Genetics, Takeda Oncology, and Teva Oncology, is encouraging a greater commitment to resolving quality of life issues for cancer survivors.

“It’s true that cancer survivors are now living much longer after diagnosis thanks to advances in modern medicine,” says Shipp. “However, long-term survivorship poses its own unique challenges. And we need to do a better job of addressing the hardships cancer survivors face beyond treatment.”

For more information, visit the official website of National Cancer Survivors Day, a service of the National Cancer Survivors Day Foundation.

♦ ♦ ♦ ♦ ♦

Actress Valerie Harper is Living Life Fully

… even with a diagnosis of metastatic lung cancer

by Jessica Webb Errickson

Celebrity Cancer Survivor

According to the American Lung Association, every five minutes, a woman in the U.S. is diagnosed with lung cancer. In 2009, beloved tele­vision and stage actress Valerie Harper became one of them. Following surgery to remove a tumor from her right lung, Valerie enjoyed four cancer-free years before learning that not only had her cancer returned, manifesting itself in the tissue surrounding her brain and spinal cord, but this time, it was terminal.

Valerie, well known for her charac­ter Rhoda Morgenstern on the classic Mary Tyler Moore Show and its spinoff, Rhoda, first learned she had cancer after a routine X-ray detected a suspicious spot on her right lung. Having caught it early, her surgeon was able to remove the tumor, along with the top lobe of the affected lung, without the need for additional treat­ment. Once she recovered, Valerie was back to business as usual, even earning a 2010 Tony Award-nomination for her role in the Broadway production Looped.

“The year unfolded, and my doctor was just so thrilled with how well I was doing,” Valerie tells Coping. “I didn’t require any radiation or chemo. So that was great news!”

Valerie remained in good health until early 2013 when the sudden onset of stroke-like symptoms prompted her to seek medical attention. However, a battery of tests revealed that Valerie’s slurred speech and difficulty with re­membering lines from the play she was rehearsing weren’t caused by a stroke. Instead, she was experiencing side effects from a recurrence of lung can­cer to her brain.

"I can't say I've suffered as some have. I've been extremely lucky."

Officially, Valerie was diagnosed with leptomeningeal carcinomatosis, a con­dition caused by the spread of cancer cells to the tissue surrounding the brain and spinal cord (the meninges). The rare diagnosis has caused confusion in the media regarding her type of cancer, but Valerie is quick to clarify that she does not have brain cancer. “It’s lung cancer, but there’s nothing in my lungs,” she says. “However, the doctors found lung cancer cells in my meninges.”

With lepto, cancer cells don’t accu­mulate into solid tumors. It’s terminal, as Valerie explains, “because they can’t get to all the little culprits, the cancer cells, spread throughout my head and up and down my back.” Given the rarity of the condition, her doctors estimated that she would only have three to six months to live.

Despite a grim prognosis, the sea­soned performer, who’s just as vivacious as the TV character that made her famous, hasn’t shown signs of slowing down anytime soon. With unwavering positivity, she’s survived two years beyond her doctors’ best predictions and has avoided any pain associated with the condition. “I can’t say I’ve suffered as some have,” she says. “I’ve been extremely lucky.”

Though she’s living with terminal cancer, it isn’t stopping her from living a full life. Armed with the support of her medical team and her husband, Valerie receives targeted therapy and makes use of complemen­tary therapies, such as acupuncture and meditation. With her humor intact, she has continued to work steadily, performing on Broadway, making guest appearances on TV Land’s Hot in Cleveland and Hall­mark’s Signed, Sealed, Delivered, and starring in the UP original movie The Town That Came A-Courtin’. And at 74 years old, Valerie shined on ABC’s Dancing with the Stars, proving that nothing can stop her from living her best life.

“I believe in visualization of winning. I imagine myself kicking the cancer cells on their little butts right out of my body,” she says with a laugh. On a more serious note, she adds, “It’s not so much about resist­ing death. It’s accepting that it’s there and then making sure that I’m living to my utmost potential.”

She’s defied the odds, but sur­vival isn’t enough for the showbiz veteran. Valerie has teamed up with the American Lung Association as a spokesperson for their LUNG FORCE initiative to promote education and raise awareness about the often-overlooked disease. “I didn’t know that I, as a nonsmoker, could even get this disease. But I’ve learned that if you have lungs, you’re at risk,” Valerie says. “I’m devoting myself to speak­ing out as much as I can to educate women so they know that this is a real threat to their health. Anyone can get lung cancer, and no one deserves it.”

♦ ♦ ♦ ♦ ♦

Learn more about the LUNG FORCE initiative and how you can get involved at

This article was published in Coping® with Cancer magazine, May/June 2015.

10 Things I've Learned in 10 Years

by Emily Miller Land

Inspiration image

Emily, pictured with her two children, celebrates more than a decade of survivorship.
(Photo by Peter Barta, © St. Jude Children’s Research Hospital)

More than 10 years have passed since I beat cancer as a teenager. Reflecting on my life from diagnosis to today, I came up with 10 things I’ve learned and embraced through my journey. These thoughts are applicable to anyone who has gone through cancer treatment or is facing a serious health challenge.

1. As unimaginably hard as this may be to believe, cancer can do more good than harm. Your experience can make you a stronger person, bond you to your fellow survivors, heal your spirit, and remind you to focus on the things and people in your life that are important to you.

2. Even though I never want to have to fight cancer again, I know that I could if I ever had to. Cancer gave me more strength than it took away.

3. Most people probably interpret Christina Aguilera’s “Fighter” as a song about the end of a tumultu­ous relationship. For me, it holds a broader meaning. Christina sings, “Makes me that much stronger, makes me work a little bit harder, makes me that much wiser – thanks for making me a fighter.” Every survivor should listen to the song and consider its message of going through a difficult situation only to come out stronger on the other side.

4. In some situations, it’s OK to say, “This is not a big deal,” and let it go. There is peace in perspective.

5. Cancer exposes you at your weak­est, even if you’re the only one who sees it. You can use this as a chance to rebuild yourself from the in­side out, beginning with an even stronger foundation.

6. Faith is part of the fight. Whether it lies in the doctors, the medicine, the research, a higher power, or your­self, faith is a necessary component of beating cancer. Find it.

7. Coffee smells beyond horrible when you don’t have nose hair, and cayenne pepper isn’t the least bit spicy to someone who lacks freshly regenerated taste buds. Oh, and yes, your eyebrows are actually functional – an often overlooked oddity of the human body, until you don’t have any.

8. Something still feels right and refreshing about shampooing and conditioning a bald head, especially when everything else in your world feels wrong and out of place.

9. People are often in awe of survi­vors, and although survivorship is a badge that we carry with immense pride, being undetectable as a survivor for the first time in a sea of normality is often our proudest moment. We are not our cancer, but we are what cancer has made us. We only want to be seen as who we are, not who we were.

10. When it comes to the human life cycle, you only get to go around once. But if you do it right, once is enough. Don’t just exist – live the life you’ve fought so hard to save.

♦ ♦ ♦ ♦ ♦

Emily Miller Land is a mother of two and an osteosarcoma survivor.

This article was published in Coping® with Cancer magazine, March/April 2015.

Finding Comfort in the Midst of Fear

by Deborah Seagull, PhD

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Many survivors worry about can­cer recurrence every day, which isn’t sur­prising. A cancer diagnosis can rupture your sense of security. It seems to make no difference if your can­cer is early or late stage, once you’ve been diag­nosed with the disease, it can be difficult to control your fear.

Before cancer, you may have lived in denial about your mortality. Even though we all know that we will die someday, we don’t usually think about it. We do other things. We live our lives. But a cancer diagnosis snaps you back to reality. Once your sense of security has been com­promised, it can be hard to get back to business as usual. You may find it difficult to enjoy day-to-day ac­tivities and live a fulfilled life because you’re so preoccupied with negative thoughts and fears about the future. All you want is to go back to being the “old you.” The truth is you can never go back to being the person you were before cancer. Your life and identity have forever changed. This can be dif­ficult to accept, and you may be overwhelmed with worry that your negative thoughts and fears will never go away. But there are some things you can do to manage your fear.

The truth is you can never go back to being the person you were before cancer. Your life and identity have forever changed.

Author of Article photo

Dr. Deborah Seagull

The first thing you need to realize is that most people with cancer – no matter what stage or type – share this sense of fear. You are not alone. Fear is a natural response to something that is frightening or potentially threaten­ing. Instead of trying to force this feeling away, tell yourself that it’s OK to feel this way. Be understanding of what you have been through and what you are facing. Fear tends to grow when you dwell on it. Taking an honest look at your situation will help you move forward.

Once you have started to accept the reality of your new normal, and the fact that a degree of fear is going to be part of it, you can begin to seek the antidote to fear: comfort. When we are fearful, our natural reaction is to fight or flee, but sometimes we need to suppress our impulse to either put up our dukes or run for the hills. Instead, gently remind your­self that anyone in your situation would feel this way. Then focus on finding what brings you comfort. Perhaps you can share your feelings with a friend, take a walk outside, get a massage, or enjoy a relax­ing bath. It’s easy to resist seeking comfort when you’re anxious or afraid, but it’s crucial that you follow through in caring for yourself.

Since finding comfort is vital to alleviating fear, you may also want to consider reaching out to other survi­vors, perhaps in a cancer support group. Sharing your fears and connecting with others can make you feel less alone.

You can manage your fears on a practical, hands-on level as well. Remind yourself of all the things you’re doing to safeguard your future. Write them down. Your list may include eating well, exercising, keeping your follow-up appointments, and setting goals for the future. It’s quite common to worry that any twinge or ache that you get is cancer related, even if it’s not. Being assertive with your doctor and asking any ques­tions to mitigate unfounded fears may also be helpful.

Taking measures to reduce your fears is an important step in improving your well-being and conquering wor­ries about recurrence. Although you may feel fearful from time to time, rest assured that you can find peace and joy in your life no matter what the future may bring.

♦ ♦ ♦ ♦ ♦

Dr. Deborah Seagull is a licensed clinical psychologist who consults for the Abramson Cancer Center in Philadelphia, PA. She has a private practice in Center City Philadelphia where she works intensively with cancer survivors and their families to improve coping and overall well-being.

This article was published in Coping® with Cancer magazine, March/April 2015.

A Race to Remember

by Khevin Barnes

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Running is one of cancer survivor Khevin Barnes’ greatest joys.

When I was 12 years old, my family lived in a quiet neighborhood in Riverside, CA. I wasn’t very good at your typical school sports like baseball and football, but I was good at running. And I loved it. I loved it so much that it became one of my life’s greatest joys.

Back then, I’d organize regular weekend races with my friend Dennis Potter, who lived down the street from me. We didn’t hang out together often, but we met almost every weekend for our race around the neighborhood. The two-mile course took us along the streets around my house, and the finish line was in a vacant lot right next to old Mr. Stringfellow’s expansive yard.

Something of note about this little competition is that I always won. Always. Dennis would huff and holler, trying his hardest to beat me, but in the end I always, without exception, won the race. In the last 50 yards, without fail, I would surge ahead with great confidence to victory. Dennis, ever frustrated by his string of losses, would shake his head and mutter under his breath that he’d “get me next time.”

Our friendly competition went on for many months, until one day when my father announced that our family was moving to Newport Beach. I would be saying goodbye to my school, my friends, and my weekend race against Dennis Potter.

Dennis and I met one last time be­fore I moved. Our final race went as expected, with me leading the way. But as we rounded the last corner, with about 100 yards to go, a spontaneous and startling thought entered my mind and shook me from head to toe. With the finish line in my sights, the victory dance that had already begun in my mind was shoved aside and replaced with an image of Dennis Potter win­ning the race, a thought that until that very instant seemed impossible. I always won. In order for him to finish first, I would have to throw the race. That would be crazy, right? Then I wondered, what would hap­pen if I let him win – just this once? I knew of course that he would gloat and puff up with pride, just as I had for so many months. I also knew I was the faster runner – no doubt about it – and winning this race would further prove that point. But what if there was something even more important to be gained from not winning?

These thoughts raced through my brain as fast as my footsteps were land­ing on the hot pavement. I had only seconds to process this crazy idea, but in those few seconds, I experienced a feeling that was even more exhilarating and satisfying than any I ever got from winning. I was, perhaps for the first time in my young life, feeling a touch of compassion for another human being.

With the finish line in view, I sud­denly pulled up with one leg, pretending to lose my balance for a moment. I cursed out loud and kicked up a little puff of dust as Dennis, savoring the sweet taste of victory, shot by me like a conquering gladiator and crossed the finish line with outstretched arms.

“I did it! Oh my God, I did it!” he shouted. I pretended to be disappointed in myself but congratulated him on his well-deserved win. To my surprise, Dennis didn’t celebrate his victory alone. Instead, he ran over to me, grabbed my shoulders, and pulled me close in a sweaty embrace. I can still see the pride on his face and the excitement in his eyes as we hopped up and down, sharing in his dance of glory.

Now, 64 years old and battling breast cancer, I reflect on the many gifts I’ve received in my life. Though the memory of running with Dennis has faded, the feeling I got from watching and join­ing him as he celebrated his great achievement is just as strong today as it was then.

I don’t think we have one-sided lessons in life. Just as a broken bone heals stronger at the point of fracture, every defeat allows us to grow. I be­lieve that each time my cancer knocks me back a few steps, the reverence that I have for life and its endless lessons grows. And I know now that on that race day so many years ago, I needed to lose just as much as Dennis Potter needed to win.

♦ ♦ ♦ ♦ ♦

Khevin Barnes is a male breast cancer survivor living in Vail, AZ.

This article was published in Coping® with Cancer magazine, March/April 2015.

Questions and Answers about Lymphedema

What It Is, Who’s at Risk, and What You Can Do about It

by Stanley G. Rockson, MD, FACP, FACC

Photo by Cancer Type

Lymphedema is the accumulation of a protein-rich body fluid called lymph, typically in one part of the body, when the lymphatic system for fluid transport is damaged. For example, if lymph nodes are removed from the armpit region during breast cancer treatment, lymphedema can occur in that arm.

Why is the lymphatic system important?
The lymphatic system is part of the im­mune system. It fulfills the function of immune trafficking, the process whereby infection-fighting cells can be mobilized to the tissues that require assistance. When the lymphatic system is compro­mised by surgery, trauma, or improper development, the affected part of the body is prone to recurrent infection.

How does surgery affect my risk of lymphedema?
Your risk of developing lymphedema is chiefly aligned with lymph node removal. For instance, individuals who have undergone lumpec­tomy without lymph node removal are at such low risk that it is impossible to estimate. However, sentinel node removal, a technique that involves the removal of no more than four lymph nodes, increases the risk of develop- ing lymphedema to about 6 percent. If you have more than four lymph nodes removed, your risk rises to 15 to 25 percent.

Does radiation increase the risk of lymphedema?
Yes, radiation alone can traumatize the lymphatic system just as much as surgery can. In general, the risk of lymphedema following radia­tion therapy is roughly equal to that of axillary lymph node dissection. More­over, radiation therapy increases the lymphedema risk associated with sur­gery if both treatments are performed.

Author of Article photo

Dr. Stanley Rockson

If I’ve had lymph nodes removed under one arm, do I have to worry about the lymph nodes in other areas of my body?
No. The lymphatic system is present throughout the body, but lymphedema affects only the part of the body that’s been treated.

Do I have to worry about lymphedema for the rest of my life?
A better way to phrase it is you’ll have to stay vigilant. The primary risk for lymphedema de­velopment is in the first year following surgery or radiation therapy, when 90 percent of lymphedema cases occur. By the end of three years, 95 percent of lymphedema cases will have appeared. If you don’t have lymphedema after three years of vigilance, the risk remains but is quite small. If you take the proper precautions and watch out for signs of lymphedema, your risk will remain relatively small.

Is it safe to exercise after cancer surgery?
While exercise is beneficial in the long run, it’s important to give your body adequate time for healing after surgery. In general, for the first three to four weeks following surgery, you should remain relatively inactive. After that time, you can slowly and progressively increase your activity. Your doctor can give you specific guidelines based on your condition.

What about exercise during radiation therapy?
You can expect a certain amount of inflammation related to the radiation, and you need to avoid over-taxing your lymphatic system. Accordingly, it is reasonable to take it easy during radiation.

Prior to my cancer diagnosis, I led an active lifestyle. Now I’m worried that my former activities could cause lymphedema to emerge. What should I do?
As a cancer survivor, you must enjoy the gift of life. This means not placing boundaries on your definition of living well. With certain activities, there is a small, finite risk of lymph­edema appearing for the first time if cancer treatment has affected your lymph nodes, or of lymphedema becoming worse if you already have it. However, with the appropriate precautions, those risks remain quite small.

You should weigh the risk-to-benefit ratio of each activity you’re interested in. Yes, there is some risk of lymphedema with activities like surfing or rock climb­ing, for example, but you have to weigh the importance of those activities in your life against the risk involved in continuing them.

With or without risky activities, appropriate treatment is essential if lymphedema appears. It’s important to use the compression garment that is provided to you (particularly during activities that pose theoretical risk) and to watch for changes in the at-risk limb. Take precautions against infection when you have breaks in your skin, and seek medical attention early if you notice any skin changes. When you go outside, put on a sun block, because sunburn can aggravate lymphedema. Be careful when you’re working in the kitchen. When you’re in the garden, wear gloves to avoid cuts and scratches. Talk with your doctor about any specific guidelines you should follow, but in general, you should be able to do what you want to do and go where you want to go as long as you’re careful.

♦ ♦ ♦ ♦ ♦

Dr. Stanley G. Rockson is the Allan and Tina Neill Professor of Lymphatic Research and Medicine at Stanford University School of Medicine in Stanford, CA. He is a mem­ber of Lymphatic Education & Research Network’s Scientific/Medical Advisory Council.

The Lymphatic Education & Research Network is a nonprofit organization whose mission is to fight lymphedema and lymphatic disease through education, research, and advocacy. Learn more at

Reprinted with permission from © 2015 Lymphatic Education & Research Network.

This article was published in Coping® with Cancer magazine, March/April 2015.

RX for a Good Night’s Sleep

by Jeanne Erickson, PhD

Wellness image

Imagine waking from a restful night of sleep feeling refreshed, rejuvenated, and ready to start the day. If you’ve spent countless restless nights tossing and turning, this may seem like an unattainable luxury. But it doesn’t have to be.

Many of us simply don’t get enough sleep. We’ve adopted lifestyle habits that diminish our quality of sleep, and we often sacrifice the amount of sleep we get by extending our daytime ac­tivities well into the nighttime hours. Add a cancer diagnosis to the equation, and you’re faced with a bevy of chal­lenges to getting an adequate amount of quality sleep.

Why Sleeping Well Matters
In gen­eral, most adults need seven to nine hours of continuous, uninterrupted sleep each night. Insufficient sleep can lead to reduced daytime alertness, memory problems, irritability, and poor decision-making. Over time, poor sleep may contribute to weight gain, an in­creased incidence of diabetes, and a higher risk of death associated with heart disease and other illnesses. On the other hand, getting an adequate amount of restorative sleep promotes energy, as well as optimal mental and physical health and safety.

In general, most adults need seven to nine hours of continuous, uninterrupted sleep each night.

Author of Article photo

Dr. Jeanne Erickson

How Cancer Can Affect Your Sleep
Side effects of cancer and its treatment can affect both the quantity and quality of your sleep. Physical side effects, such as unrelieved pain and shortness of breath, can make it difficult for you to find a comfortable sleeping position. Likewise, emotional side effects like worry and anxiety can make it difficult for you to fall asleep and stay asleep. Other factors like early-morning ap­pointments, overnight hospitalizations, or any change in your normal routine can cause problems by knocking your usual sleeping schedule out of balance.

What You Can Do about It
If you’re having trouble sleeping or you don’t feel rested when you wake, a number of strategies can help improve your sleep quality and daytime functioning.

♦ Make getting a good night’s sleep a health priority.
Treat sleep with as much importance as you do taking medication on time and getting proper nutrition. This may mean you’ll have to cut some daytime activities short or eliminate them altogether to get the seven to nine hours of sleep your body needs each night.

♦ Establish good sleep hygiene.
To do this, you’ll need to develop habits that promote good sleep, such as going to bed and waking up around the same time each day. Avoid eating large meals, drinking alcohol or caffeinated beverages, and using nicotine close to bedtime. You should also avoid stimu­lating activities, such as playing games in front of a bright computer screen, before bed. Use your bed for sleeping – not for watching television or using the computer – and keep your bedroom quiet, cool, and dark to create a good sleep environment.

♦ Stay active during the day.
Stay as mentally engaged and physically active during the day as possible so you’ll be more inclined to relax at bedtime. Aim for 15 to 30 minutes of physical activ­ity each day (with clearance from your doctor), as well as brain-stimulating activities, such as crossword puzzles or computer games, to keep both your body and your mind energized. Try to avoid daytime naps. However, if a nap is needed, limit napping to 45 minutes or less; otherwise, you may have a harder time getting to sleep at night.

♦ Talk to your healthcare team.
Alert your doctor if you’re experiencing sleep disturbances. Certain medications may improve your quality of sleep, but you and your doctor should measure the benefits of taking a sleep aid against its possible side effects. If you have a more serious sleep issue that is unrelated to cancer, such as sleep apnea, your doctor might refer you to a sleep specialist who can conduct a thorough assess­ment of your condition and pro­vide you with a sleep-management plan.

As a cancer sur­vivor, you need the best quality sleep possible. By making sleep a priority and adopting some simple lifestyle habits that pro­mote good quality sleep, you can look forward to enjoying the benefits of rest­ful nights and refreshing mornings.

♦ ♦ ♦ ♦ ♦

Dr. Jeanne Erickson is an assistant professor at the University of Wisconsin–Milwaukee College of Nursing. An oncology nurse for more than 30 years, Dr. Erickson works to improve the way survivors manage the troubling side effects of cancer and its treatment.

For resources to help you sleep better, visit the website of the National Sleep Foundation,

This article was published in Coping® with Cancer magazine, March/April 2015.

Go to Your Happy Place

by Ginger Johnson

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Some people say that the cancer experience is like drinking from a fire hose – overwhelming. I tend to disagree.

Being diagnosed with breast cancer at 31 years young and five months preg­nant felt more like being run over by a gigantic steamroller that, when finished with the first pass, shifted into reverse to roll over me again for good measure – and quite literally flatten me.

I had my first mastectomy when I was six months pregnant. During recovery, I delivered a healthy baby boy. I then endured three additional surgeries, and when my son was only eight weeks old, I started chemotherapy.

My world turned completely upside down as I was torn from my comfort zone and transported to an unknown realm where the natives spoke a for­eign medical language and wore white lab coats and plastic gloves.

It was around this same time that the Great Recession was gaining speed and wrecking the economy, resulting in the loss of my husband’s business and our main source of income. Any sense of pride I had left was squeezed right out of me. Or rather, steamrolled.

What can you do when everything you’ve lived for and worked to achieve is snatched from your grasp? Where can you go for comfort when everything in your life has changed?

I suggest going to your Happy Place. No, I’m not talking about some delusional, euphoric, drug-induced state. I’m talking about a place where humility drives you to be teachable and willing to rely on the divine natural abilities that are inside each of us.

Adversity has the ability to make us better
if we choose not to let it make us bitter.

A wise man once said, “Adversity does not build character; it reveals character.” I completely agree. Adver­sity has the ability to make us better if we choose not to let it make us bitter.

Holocaust survivor and psychiatrist Viktor Frankl put it this way, “Every­thing can be taken from a man but one thing: the last of the human freedoms – to choose one’s attitude in any given set of circumstances, to choose one’s own way.”

But how do you find your way to happiness when the darkness sets in and the path seems blocked? You get lost.

Lose Yourself in Service
A study published in the journal BMC Public Health found that those who serve others have lower depression rates, increased well-being, and reduced mortality risk. Additional studies show that when you serve others, positive endorphins rush through your body, increasing your overall happiness.

Lose Yourself in Gratitude
A Uni­versity of California, Davis, study on gratitude and well-being revealed that those who practiced gratitude had “higher reported levels of the positive states of alertness, enthusiasm, deter­mination, attentiveness, and energy” compared to those who focused on what they thought was wrong with their lives. In addition, a 21-day grati­tude intervention resulted in “greater amounts of high energy, positive moods, a greater sense of feeling connected to others, and better sleep duration and sleep quality.” Who doesn’t want that?

Lose Yourself in Love
In the end, love really is all that matters. Accord­ing to George Vaillant, a Harvard psychologist and the director of a 75-year study on love, “Love is key to a happy and fulfilling life.” The study proved that successful careers, money, and even good physical health do not determine happiness. Support­ive, loving relationships define true happiness and meaning in life.

Losing yourself in service, gratitude, and love, even in the middle of cancer, directs your attention away from the negativity and toward a place where feelings of satisfaction flourish. You have the power to create your Happy Place. So what are you waiting for? Get lost today.

♦ ♦ ♦ ♦ ♦

Breast cancer survivor Ginger Johnson is an entrepreneur, speaker, national cancer ambassador, published author, and founder of, which provides re­sources for people facing cancer.

This article was published in Coping® with Cancer magazine, March/April 2015.

Ready to Get Back to Work?

by Leah Slagenwhite

Author of Article photo

First of all, you need to know that you are a conqueror. Seriously! The fact that you are even tinkering with the idea of going back to work during or after cancer is a success. Consequently, you may be excited to get back to work. Or you may find the prospect of re-entering the workforce unnerving. No matter what end of the spectrum you’re on, going back to work during or after cancer brings up many questions:

Am I ready?
Is this job the right fit for me now?
How will my coworkers perceive me
How will I be treated?

All of these questions are valid. Cancer is life altering. And returning to work after cancer can be a challeng­ing transition. As a stage IV cancer conqueror, mother of two little ones, and the breadwinner of my family, I know this firsthand. I went back to work full time within a month of my last chemo infusion.

After having taken time off for treatment, I struggled tremendously with anxiety over the thought of going back to work. Some days, I still do. But, overall, on a moment-by-moment basis, I feel calm and at peace with my decision.

Knowing who you are holds more power than the skills you possess.

If you’re wrestling with the idea of going back to work, these steps can help ease the transition from the cancer world to the workplace.

Take stock of the situation you’re in and how you feel about it.
Then take a deep breath. Know that what­ever emotions you are feeling are OK. It is all a part of being alive.

Own and honor your experience.
The more comfortable you are with yourself and the experiences that you’ve gone through, the more com­fortable others will be with you. Others will feel at ease because you are at ease. Your presence is your power.

Know your assets.
I’m not just talking about your education or your job experience; I’m also referring to your inherent qualities. Knowing who you are holds more power than the skills you possess or the hours you’ve worked in the past. Who you are as a person matters most.

Make a list of your personal and career goals. Then take measurable actions toward achieving them.
Maybe going full force back to a 50-hour workweek isn’t the answer. But easing back into pursuing your career goals by working part time might be doable. Or perhaps you might ease the transition by first getting back into a hobby – for example, doing woodwork on the side – because you enjoy it and are good at it. Taking small steps toward your desired goals will help you achieve them without overwhelming yourself.

Any situation that arises in your life can be used as a catalyst for personal growth. If you’re in a less-than-ideal work situation, use this experience to learn more about your­self and find meaning in it. As the poet Rumi once said, “Live life as though everything is rigged in your favor.”

♦ ♦ ♦ ♦ ♦

Leah Slagenwhite, founder of, is the creator of Healing Sutras: the e-Course and a stage IV Hodgkin lymphoma survivor.

This article was published in Coping® with Cancer magazine, January/February 2015.

Forgiveness Is within Your Reach

by Everett L. Worthington Jr., PhD

Wellness image

Coping with cancer is stressful – not only for the person diagnosed but also for everyone in his or her life. When people are under stress, little annoyances often compound into bigger issues. People do and say things they regret. Emotions flare. Past wounds resurface. When one person lashes out, the other is left with hurt feelings, resentment, and anger. Con­versely, the one who delivered the barb might feel guilt, remorse, shame, and self-condemnation.

After these kinds of interactions, we want to forgive and forget. Yet sometimes we don’t know how to get past the hurt and grasp the freedom of forgiveness. Whether you need to forgive yourself or someone else, here are some things you can do to set yourself on the path to forgiveness.

REACH Forgiveness of Others
For­giveness isn’t always easy, but here are a few steps you can take to help you forgive someone who has hurt you.

Recall the hurt
To heal, you have to face the fact that you’ve been hurt. Make the choice not to view the person who hurt you as a jerk. Decide to forgive. Choose not to pursue payback. Decide to treat the offender as a valued person.

Empathy is all about put­ting yourself in the other person’s chair. Build empathy by pretending that the person who hurt you is in an empty chair across from you. Tell them what is bothering you. When you’ve had your say, sit in the other chair and respond. Even if you find you can’t empathize with the person, you might feel sym­pathy, compassion, or love for them, which can also help you heal from hurt.

Altruistic gift
We all can remember a time when we wronged someone and that person forgave us. We felt light and free and didn’t want to wrong them again. You can give that same gift to someone who has hurt you.

Once you’ve forgiven some­one, write a note to remind yourself of your forgiveness – something as simple as “Today, I forgave John for hurting me” is adequate.

Hold on to forgiveness
The reason for writing a commitment note is because there may be times when you doubt that you really forgave the person who wronged you. Reread the note. You did forgive them.

Accept yourself as someone who is flawed but precious.

Author of Article photo

Dr. Everett Worthington Jr.

Six Steps to Forgiving Yourself
If you’re feeling guilt, shame, or remorse, you can apply these ideas to forgive yourself. But you must remember to forgive yourself responsibly; don’t use forgiveness as an excuse to just let your­self off the hook for wrongdoing. To deal with your self-blame because you feel you did something wrong or failed to live up to your own standards, follow these three steps:

♦ STEP 1: Seek a higher forgiveness.
First, make things right with that which you consider sacred. For many, that would be God or a higher power. Others might feel they need to reconnect with humanity or with nature.

♦ STEP 2: Repair relationships.
If you feel that you’ve hurt someone else, try to pick up the pieces. Even if you’ve done what feels like unrepairable dam­age, you can do things to pay forgiveness forward so perhaps others won’t expe­rience fallout from your acts.

♦ STEP 3: Rethink ruminations.
Some­times regret and remorse dominate us because we are feeling a bit perfec­tionistic. Rethink those unrealistic assumptions, and remember that you’re not perfect. No one is.

Once you’ve completed steps 1-3, these next three steps can help you cultivate inner peace:

♦ STEP 4: REACH emotional self-forgiveness.
Apply the “REACH Forgiveness” steps to yourself.

♦ STEP 5: Rebuild self-acceptance.
Accept yourself as someone who is flawed but precious. Talking with a loved one is often paramount in re­building a positive sense of self.

♦ STEP 6: Resolve to live virtuously.
If you’ve made mistakes, make up your mind not to make the same ones again.

Winning the battle against cancer and emerging a victor is a huge triumph, but the stress of having had the disease can linger well into survivorship. You can improve your quality of life (and the quality of life for those you love) by committing to “REACH Forgive­ness” – for yourself and for others.

♦ ♦ ♦ ♦ ♦

Dr. Everett Worthington Jr. is a clinical psychologist who has studied forgiveness for more than 30 years. For additional in­formation and resources to help you “REACH Forgiveness,” visit and and

This article was published in Coping® with Cancer magazine, January/February 2015.

“Go Live Your Life”

Country Music’s Wade Hayes Talks Surviving Colon Cancer and Looking toward Tomorrow

by Jessica Webb Errickson

Celebrity Cancer Survivor

Wade Hayes got his start in country music at age 14, play­ing lead guitar in his father’s band. Entertaining rowdy regulars at local honky-tonks four nights a week fueled his desire for country music stardom, and at 22, Wade packed up his guitar and set out to make a name for himself in Nashville.

Wade’s talent didn’t go unnoticed in Music City. He soon snagged a record deal and, in 1994, released his debut album, Old Enough to Know Better. Since then, Wade has, in his own words, “had several #1 hits, won some awards, and been on tour with the biggest artists in country music.”

In 2011, Wade was touring as the lead guitarist for fellow country artist Randy Owen, as well as performing his own music and writing songs for an up­coming project. Things were going well. But that all changed when Wade was diagnosed with stage IV colon cancer.

Despite the cancer having spread to his large intestine, liver, lymph nodes, and diaphragm, Wade successfully completed treatment, which included a more than seven-hour surgery, fol­lowed by chemotherapy. When the cancer returned to his lymph nodes a year later, Wade again beat the dis­ease, this time emerging with a new attitude and a mission to inspire other cancer survivors.

The country crooner recently talked with Coping magazine about surviving cancer and how he became a changed man, inside and out.

Coping: How did you find out that you had colorectal cancer?
Wade Hayes: I was touring at the time, about to fly to Houston, and out of nowhere I doubled over in pain in my kitchen, and I started bleeding profusely. It felt like somebody had stuck a knife into my abdomen. I was really worried, but my symptoms subsided a little bit, and I was able to make it to the show. As soon as I got back home to Nashville, I went straight to the doctor and told him what was going on. He recommended a colonoscopy, and that’s when we discovered I had a tumor a little larger than an orange in my large intestine.

What was the biggest challenge you faced with cancer?
Neuropathy is the one that stands out in my mind. It’s a condition where the nerve endings in your hands and feet are damaged. If you touch anything that isn’t room temperature, it’s very uncomfortable. You can’t feel things, but you’ve got this strange tingling yet numb sensation. I play guitar for a living, but I couldn’t feel where my fingers were on the neck of my guitar. You have to be pretty dex­terous to play guitar with any accuracy, so it was difficult. It took about a year to get my dexterity back, but my hands are fine now. I still feel the effects in my feet, but fortunately, I don’t play with my feet.

"I’m into positivity. I want to inspire and lift people up."

Celebrity Cancer Survivor

What helped you get through the more difficult moments?
A lot of prayer. Also, I heard some wise words: “Don’t think about where you are. Think about where you want to be. Then put your head down and move forward.” I took long walks every day to help clear my mind. I figuratively and liter­ally put my head down, moved forward, and thought about tomorrow. To any­body who is going through cancer, I’ll say that you will have tough days, but you’re going to find out that you’re a lot tougher than you think you are.

Has your experience with cancer influenced your songwriting?
Absolutely. At one point after my diagnosis, I wrote a song called “Is It Already Time?” which was kind of an admission of how serious my situation was. Fortunately, I don’t have to sing that song anymore, because I’m hope­ful for the future. I’ve come a long way. The inspiration for my new song “Go Live Your Life” came during one of the last visits to see my oncologist after finishing treatment for the second time. He looked at my bloodwork and said, “Wade, this is a big deal. You’re cancer-free.” Then he said, “I want you to listen to me. I want you to go live your life.” His words hit me like a ton of bricks. They affected me so much that I went home and wrote a song around them. In the past, I gravitated toward darker songs. (I didn’t know what drinking and cheating were when I was a little kid, but I loved listening to songs about them.) These days, I’m not into that so much. I’m into positivity. I want to in­spire and lift people up. My new album really reflects that.

How has having cancer changed your life?
I had been praying earnestly to be a better man before this happened. I’m a very hardheaded, stubborn person. I’m hesitant to say that this needed to happen – I would like to think I could change on my own – but maybe this is what it took. I feel like I’m looking at everything through different eyes. It’s changed me for the better. I like the guy I am right now much more than the person I was before this hap­pened. I actually feel like I’m doing something that matters.

What’s next for you?
I’m not just a singer-songwriter any­more. I’m also a colon cancer advocate, and I want to help others in any way I can. I feel like this is part of my job description now. If I can raise awareness and encourage somebody to be screened so they don’t have to go through what I’ve gone through, then I’ve done my job.

♦ ♦ ♦ ♦ ♦

Wade has teamed up with Genentech and the Colon Cancer Alliance to release his song “Go Live Your Life” during Colorectal Cancer Awareness Month. For every per­son who downloads the song from iTunes, Genentech will donate a dollar (up to $50k) to the Colon Cancer Alliance’s Blue Note Fund. Learn more about the campaign at

This article was published in Coping® with Cancer magazine, March/April 2015.

Signs along My Road Trip through Cancer

by Jody Winsick-Soluri

Inspiration image

My journey through leukemia over the past six years has seemed somewhat like a road trip to an undetermined destination. Along the way, I’ve encountered several road signs, just as you would on any period of extended travel.

The first sign I saw had me slamming on my brakes – it came out of nowhere. My life came to a screeching STOP on January 19, 2009. This is the day I was diagnosed with Philadelphia chromosome–positive acute lymphoblastic leukemia.

Inspiration image

The news of my cancer diagnosis set me on a sudden and unexpected DETOUR. I worried that life as I knew it – being a full-time mother, profes­sional, homemaker, and philanthropist – was over. Just days before my diagnosis, I was kickboxing at the gym. Now I was lying in a hospital bed, wondering what the future would hold.

Inspiration image

The road ahead was rougher than I had anticipated. Murphy’s Law took effect; whatever could go wrong went wrong. Loops and twists, climbs and dips – medical setbacks had me riding a physical, mental, and emotional rollercoaster. Traveling under HAZARDOUS CONDITIONS became a way of life.

A year after my diagnosis, my condition began to improve. I was gradually adjusting to my new normal. I put on my rose-colored glasses, and as far as I was concerned, I was cured. In May 2010, I celebrated my first anniversary post-transplant. As sum­mer turned to fall and fall to winter, I felt like my life was finally getting back on track. I was on the HOME STRETCH, racing toward a cancer-free life.

Inspiration image

Two years post-transplant, I had a follow-up appointment with my oncologist. Though my blood count had dropped, I finally got the news I had dreamed of hearing – I had a 95-percent chance of a cure. Despite the great news, my gut instinct told me to proceed with CAUTION.

Inspiration image

Three days later, I found myself veering straight into a FALLEN ROCK ZONE. My blood counts had fallen again, and I was back in the ER. I didn’t believe that lightning could strike twice, but the Philadelphia chromosome was back and so was the leukemia.

About Coping

Along the treacherous road through cancer, I tried my best to remain positive, even when I learned I had relapsed. I presented my arm to my doctor and told him to start chemotherapy immediately. I figured the sooner I began treatment, the sooner I would be done with it. I had my eyes focused on the light at the end of the TUNNEL.

Inspiration image

I knew I was facing a BUMPY ROAD. My second transplant was successful, but I have emerged visibly weathered from my journey. My hair is much thinner than before treatment, and my eyelashes are considerably shorter and sparser. My muscle tone has decreased, my complexion dulled. Chronic fatigue, pain, neurological issues, balancing problems, forgetfulness, and mood swings have become part of my new normal. It’s amazing how simple tasks such as getting out of the bed in the morning can seem as difficult as participating in a triathlon. Despite these bumps along the road, I am thankful to be alive.

Inspiration image

In August 2014, I had my three-year follow up. To say that I was nervous would be an understatement. Three times would definitely not be a charm. However, I am proud to say that I have defied the odds; I am still in remission. Though I’m cautiously optimistic, I try to keep my glass half-full and not take life for granted. I am finally starting to see the FINISH LINE.

♦ ♦ ♦ ♦ ♦

Jody Winsick-Soluri is an acute lymphoblastic leukemia survivor living in Hillsdale, NJ.

This article was published in Coping® with Cancer magazine, January/February 2015.

When Cancer Pain and Chronic Pain Coexist

by Pamela J. Haylock, PhD, RN, FAN, and Carol P. Curtiss, MSN, RN-BC

Knowledge image

During a session on survivorship issues at the Oncology Nursing Society’s 39th Annual Congress, a nurse described a situation that shocked the audience. A cancer survivor in her care, we’ll call him Hank, had painful mouth sores as a side effect of chemo­therapy. Hank’s oncologist prescribed a medication to relieve the pain, but he did not mention that the drug contained an opioid, nor did he notify Hank’s primary care physician of the new pre­scription. When Hank went to have the prescription filled, he was distraught when his pharmacist refused. Moreover, the pharmacist also refused to refill his usual prescription for the opioid medi­cation he used to manage his chronic, severe back pain. Hank called his oncology nurse looking for answers, but she had none.

So what happened here? Hank’s prob­lem is a result of several issues. First, due to recent crackdowns on opioid abuse, many pharmacies have protocols in place to catch people who doctor-shop to obtain multiple prescriptions. Since Hank was trying to fill two different opioid prescriptions from two different doctors, it signaled a red flag. Second, his oncology providers failed to fully assess and understand Hank’s medical history and health status. Third, there was poor communication all around. If you find yourself in a situation where you are dealing with cancer pain in addition to chronic pain, here are some things you should know if you want to avoid a situation like Hank’s.

Approximately one in four people in the U.S. has intense pain that interferes with daily life.

Author of Article photo

Dr. Pamela Haylock

Pain: The Basics
Approximately one in four people in the U.S. has intense pain that interferes with daily life. Pain that is expected to be a short-term prob­lem, usually caused by injury, trauma, or surgery, is called acute pain. Conversely, chronic pain, also called persistent pain, (the type that is associated with late stages of cancer and long-term conditions like arthritis and neuropathy) can last for months, years, or a lifetime. Both types of pain, if moderate to severe, require a personalized management approach.

Many types of non-pharmacological therapy are used to relieve pain; for example, heat therapy, cold therapy, relaxation exercises, guided imagery, massage, physical therapy, and music therapy. These can be used alone or in conjunction with pain-relieving medica­tions. When medication is added to the equation, the World Health Organization recommends that pain first be treated with non-opioid medications (such as aspirin and acetaminophen). If pain is moderate to severe, then opioid medica­tions (like morphine) may be used as needed for pain management.

Carol Curtiss

Efforts for Safe and Effective Treatment
Though opioids tend to get a bad rap, they are safe for most people. However, they can cause adverse effects, such as constipation and clouded thinking, and some people who take opioids may be at risk for addiction and overdose. While most people who are prescribed opioids take them as intended, unfortunately, opioid diversion (use of prescription medication by someone other than the person for whom it is prescribed) and misuse are not uncommon. Consequently, local, national, and global drug control efforts to stem opioid abuse are being ramped up.

Healthcare providers, who are obli­gated to relieve their patients’ pain, also are being held accountable by agencies that oversee drug use (such as the DEA), and they are expected to identify people who might be at risk for opioid prescrip­tion abuse. Though this should not deter doctors from prescribing opioids to peo­ple who need them, it does mean that healthcare providers must take steps to safeguard against the misuse of opioid pain relievers.

One way this is being done is by issuing an opioid treatment agreement. Opioid treatment agreements are written contracts that are signed by an indi­vidual who is prescribed opioid pain medication and the healthcare provider managing his or her chronic pain, who subsequently assumes responsibility for their patient’s opioid prescriptions. These documents clearly state the con­sequences of prescription drug abuse and identify the responsibilities of the pain treatment team as well as the per­son receiving opioid therapy.

A Personalized Approach to Pain Management
If you’re dealing with pain, especially coexisting cancer pain and chronic pain, it’s important to get it under control. Work closely with your healthcare team – your oncologist, nurses, primary care physician, phar­macist – to create a personalized pain management plan. Your plan ideally should address your physical, psycho­logical, spiritual, and social needs. When talking to clinicians, respond honestly and completely to questions about your health history, current medications, and pain status. Be sure that everyone in­volved in your care knows whether you have an opioid agreement in place. They will use that information to de­vise a pain control plan that doesn’t conflict with the agreement.

Effective communication among the members of your healthcare team is paramount, especially when dealing with coexisting pain conditions. Con­firm that everyone in your healthcare team communicates with each other. If you experience new or worsening pain, let your team know. Successful pain control is possible, but it does require a team effort.

♦ ♦ ♦ ♦ ♦

Dr. Pamela (PJ) Haylock is an oncology nurse, oncology care consultant, adjunct professor in the RN to BSN program at Schreiner University in Kerrville, TX, and past president of the Oncology Nursing Society. Oncology nurse Carol Curtiss is an oncology clinical specialist consultant, ad­junct faculty at Tufts University School of Medicine in Boston, MA, and past president of the Oncology Nursing Society.

This article was published in Coping® with Cancer magazine, January/February 2015.

Serving Up Tips for Regaining a Lost Appetite

by Kalli Castille, MS, RD, LD

Wellness image

A nutritionally balanced diet is an important part of a healthy lifestyle. This is especially vital when you’re fighting cancer. Good nutrition helps keep your body and immune system strong to help prevent malnutrition and other complications that could interrupt your treatment.

Unfortunately, when you’re in cancer treatment, side effects such as nausea, vomiting, and taste changes can decrease your appetite. It’s hard to get the nutri­tion you need when you just don’t feel like eating, so it’s imperative to be pre­pared for low-appetite days. Talk with your doctor or a registered dietitian about the specific dietary guidelines you should be following. Then, consider these tips for regaining a lost appetite, and set daily nutrition goals based on your needs:

Focus on eating small, frequent meals every three to four hours. Each meal should contain a high-quality protein source, such as a handful of almonds.

Make sure each bite you take is rich in nutrients. This means bypassing that prepackaged snack cake and instead reaching for foods that are as close to their natural state as possible, such as hummus and celery.

Easy-to-prepare foods are best. Recipes that require little effort will take the stress out of food preparation.

Colder foods seem to be better toler­ated when early satiety is an issue. Cold or room temperature foods also tend to release less of an aroma, which may be helpful if strong smells make you feel queasy. Try cold sandwiches, main-dish salads (such as pasta salad or chicken salad), or nut butter with fruit preserves.

Visually appealing meals with a variety of colors and textures may help increase your appetite and desire to eat more.

Take your medications with a protein drink to sneak in some extra calories.

If sitting down to a full meal seems daunting, you can replace a large, heavy meal with a quick and easy snack. Try these options:

  • Yogurt with granola, nuts, or seeds
  • Cottage cheese with fruits or vegetables
  • Half a sandwich with nitrate-free lunch­meat topped with vegetables and cheese
  • Cooled soup with crackers
  • Baked potato with cottage cheese, vegetables or salsa, and low-fat sour cream
  • Burrito with black or pinto beans and cheese
  • Scrambled eggs with salsa or chopped vegetables
  • Whole-wheat waffles or pancakes with peanut butter
  • Hard-boiled eggs
  • Oatmeal with berries, nuts, or seeds
  • Salad with nuts and avocados

Meals with a variety of colors and textures may help
increase your appetite.

Author of Article photo

Kalli Castille

When Food Just Doesn’t Taste Like It Should
Sometimes poor appetite is due to taste changes. Certain foods may no longer taste the same as they used to, or they may have no taste at all. If this is the case, here are some additional tips to consider:

Add a slice of lemon to a glass of water and drink a bit just before eating to help your food taste better. You can try other citrus fruits, such as limes and oranges, as well.

Foods often taste metallic during treatment. Try meals with sweet and sour flavor combinations. Top fish with a fruit relish, squirt lemon or lime juice over chicken, or use a sweet and sour dipping sauce.

Maintain good oral hygiene, and use mouth-care products designed to help with dry mouth, which can be a cause of taste changes.

Don’t be afraid to try different foods. Something that tastes bad one day may taste fine the next. Some foods that you disliked before may actually taste quite pleasant now.

If foods taste metallic, eat with plasticware instead of metal forks or spoons.

Taking a zinc supplement can be helpful; however, you should talk with your doctor before you begin taking any supplements.

If you have taste aversions to red meat, switch to chicken, turkey, and blander protein foods.

In addition to these strategies, your doctor may recommend medications to help stimulate your appetite. If your decreased appetite lasts for several days, or if you’re losing a lot of weight without trying, contact your doctor. He or she can help you get back on track with the balanced diet you need in or­der to defeat cancer.

♦ ♦ ♦ ♦ ♦

Kalli Castille is director of Nutritional Support and Culinary at Cancer Treatment Centers of America at Southwestern Regional Medical Center in Tulsa, OK, ( Kalli is currently serving a two-year term as Oklahoma State Representative for the Oncology Nutrition Dietetic Practice Group of the Academy of Nutrition and Dietetics. She has also served as president of the Oklahoma Dietetic Association, which she has been a member of since 2001.

This article was published in Coping® with Cancer magazine, January/February 2015.

The Grief and Mourning of Cancer

When grief counselor Dr. Alan Wolfelt was diagnosed with prostate cancer, he learned firsthand the significance of grief and mourning in the wake of a serious illness.

by Alan D. Wolfelt, PhD

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Dr. Alan Wolfelt

I was riding my bike through the gorgeous mountains outside Aspen, CO. The day was bright and beautiful. The furthest thing from my mind was my recent biopsy, or anything else related to cancer, for that matter – but that was about to change. Just as I was rounding a slight bend on the bike trail, my phone rang. The woman on the other line didn’t mince her words: “I’m sorry to have to tell you this on the telephone, but your biopsy results came back. You have prostate cancer.”

As a grief counselor and educator, I have spent more than 30 years teach­ing people to embrace and express their grief after experiencing a significant loss so they can reclaim their lives. As a cancer survivor, I’ve had to learn to take my own advice. My diagnosis brought with it a series of significant losses I’d need to grieve.

The Cancer-Loss Link
No matter your type or stage of cancer, from the moment of diagnosis, you’ve suffered losses of many kinds. You lost your health. Even if your health improved after treatment, you still lost the inno­cence of not knowing what it’s like to feel healthy one moment and frighten­ingly unhealthy the next.

You also lost your sense of normalcy and safety. Your life was going along in its usual way when – wham! – cancer broadsided you. The uncertainty of your prognosis likely made you feel unsafe, anxious, and worried – for yourself as well as for those who love and depend on you.

If your treatment was extensive or ongoing, you may have lost your abil­ity to work in the same capacity you were accustomed to before cancer. You may have lost the comfort of financial stability. Perhaps you lost a body part or two, your hair, your appetite, and even some of your friends.

Grief – A Normal Reaction to Loss
When we lose people we care about or things we hold significant, we naturally grieve. Grief is what we think and feel on the inside when we lose someone or something important. When someone we love dies, for example, we experi­ence a range of emotions – shock, anger, guilt, sadness. We think dark and dif­ficult thoughts. These thoughts and emotions are the ingredients for grief.

Have you grieved since your cancer diagnosis? I know I have, and I con­tinue to do so. It is essential for us to embrace our grief as normal and neces­sary and to find ways to express it.

Then Comes Mourning
When you express your grief, that’s called mourning. Mourning is the act of opening up, letting out, and sharing the thoughts and emotions you’ve kept bottled up inside. Without mourn­ing, grief festers. Contrary to the cliché “time heals all wounds,” grief does not magically dissipate through the passage of time alone. If you don’t express your grief fully and honestly, you leave yourself vulnerable to ongoing prob­lems, such as depression, difficulty with intimacy, chronic anxiety, and substance abuse, among others.

Mourning can take many forms. It can involve talking to others about your thoughts and feelings of loss, par­ticipating in support groups, journaling, crying, praying, creating artwork, and anything else that helps you express your grief in a safe and healthy way. What’s important is that you find a way to mourn that works for you. Among the mourning activities that helped me during my cancer journey were express­ing myself to close friends and keeping a journal.

Mourning helps us not only cope with our cancer but also live fully and with a purpose. It helps us survive and thrive – no matter how long we live, breathe, and love on this Earth.

♦ ♦ ♦ ♦ ♦

Dr. Alan Wolfelt is an author and educator on healing in grief. He serves as director of the Center for Loss and Life Transition in Fort Collins, CO, and is on faculty at the University of Colorado Medical School’s Department of Family Medicine. Dr. Wolfelt has written many books designed to help people mourn well, including Understanding Your Grief, The Mourner’s Book of Hope, and Healing Your Grieving Heart After a Cancer Diagnosis, from which this article was adapted. Visit to learn more about the process of grief and mourning.

This article was published in Coping® with Cancer magazine, January/February 2015.

Beauty is in the Eye of the Beholder

What I Learned from Being Bald

by Stephanie Madsen

Inspiration image

My long, blonde hair used to be a prized possession of mine. Having been a hairstylist for many years, I’d spend hours upon hours styling my luxuriant locks. I wore my hair up, down, and every way in between. I took pride in my frequently complimented tresses.

That all changed shortly after my 25th birthday, when cancer barged into my life. It was then, as I faced the loss of my cherished hair, that I realized it had become my security blanket. For as long as I could remember, my hair had been a major part of my identity.

I will never forget the moment my locks began to fall out. It started exactly two weeks after my first chemotherapy treatment. Like a shaggy dog, I was shedding everywhere. I found hair on my pillow, in my clothes, all around my house and my car. I even found hair hiding in my socks.

Each glance at myself in the mirror was a reminder of my diagnosis – stage III large-cell neuroendocrine cervical cancer. As if the diagnosis of a rare and aggressive type of cancer wasn’t enough, losing my hair was the icing on the cake. Not only did I have to endure the exhaustion and nausea from treatment, but I also had to do it bald.

Long hair is beautiful, and a bald head is equally so.
Our hair does not define us.

I remember the embarrassment I felt after the last of my locks was shaved off and I ventured into public with no wig or hat to cover my head. Stares came from every direction. I felt pity, sadness, and confusion surrounding me. I wanted to snap my fingers and be home in my bed, away from the unwanted attention. I stuck out like a sore thumb, and for once in my life, I missed blend­ing in with the crowd.

Cancer changes everything. Dreams, goals, and plans are put on hold, ad­justed, transformed. My life changed forever when I was told I had cancer. However, nearly three years out after battling this disease four separate times, I have learned to embrace the changes. I am not who I was before my diagnosis. And, dare I say, I’m thankful for that.

Prior to my cancer battle, the way I viewed myself was skewed by our so­ciety’s standards of beauty. I thought I had to have a specific body type, a cer­tain style of hair, and a trendy set of clothes to be beautiful. I thought I needed to conform to the beauty standards pro­moted in movies, television, and fashion magazines. Cancer was my rude awaken­ing. This disease stripped my previously conceived notions of beauty and molded for me a new definition of what it means to be beautiful.

Now I understand that beauty is in the eye of the beholder, not in the hair on her head.

Beauty is strength, determination, and passion. Beauty is hope and faith in something bigger than we are. Beauty comes in every form, shape, and color. Long hair is beautiful, and a bald head is equally so. Our hair does not define us.

Knowing it wouldn’t last forever, I learned to embrace my baldness as a reminder of just how strong I really am. No longer would I look into the mirror and see my diagnosis. Instead, I would see a strong, courageous young woman who is surviving beautifully. Like me, you have a choice to make on how to view yourself without hair. You can be a victim or a survivor. You can wither into the crowd and hide, or you can stand with your shoulders back and a smile on your face.

♦ ♦ ♦ ♦ ♦

A four-time rare cancer survivor by age 27, Stephanie Madsen is a writer and motiva­tional speaker based in Denver, CO. Her blog, Derailing My Diagnosis, is a candid account of her experiences: highs, lows, fears, accomplishments, raw emotions, faith, hope, and ultimately, triumph. Follow her journey at

This article was published in Coping® with Cancer magazine, January/February 2015.

Fight Fatigue. Feel Better.

Six Strategies for Dealing with Cancer-Related Exhaustion

by Arash Asher, MD

Wellness image

Fatigue is the most common and often the most distressing side effect of cancer treatment. For some survivors, the issue can persist for months after treatment ends.

Before diving into the practical steps you can take to deal with this trouble­some side effect, let’s take a closer look at what cancer-related fatigue is. Almost everyone has experienced some level of fatigue at one time or another. However, the fatigue you may have experienced before your cancer diagno­sis is often very different from fatigue caused by cancer treatment. For ex­ample, if you stay up late dancing the night away at a wedding, you may feel exhausted the next day. But if you take a nap and get some extra sleep the next night, chances are you’ll feel refreshed and back to normal.

With cancer-related fatigue, however, the exhaustion you feel seems to be out of proportion to your level of activity. Washing a couple loads of laundry or running a few errands could be all it takes to trigger cancer-related fatigue. Moreover, a nap or extra sleep at night often won’t solve the problem. It’s kind of like when you have the flu; you feel tired, foggy, and perhaps a bit blue.

So now that you have a better un­derstanding of cancer-related fatigue, what can you do about it? Here are a few suggestions.

Make time for exercise.
It may seem counterintuitive to exercise when you’re feeling wiped out, but research has consistently shown that moderate exercise (walking, pedaling on a sta­tionary bicycle, etc.) can reduce fatigue. Plus, emerging evidence indicates that exercise can reduce the risk of some cancers returning and can prolong life. Just be sure to talk with your doctor before beginning an exercise routine.

The fatigue you may have experienced before your cancer diagnosis is often very different from fatigue caused by cancer treatment.

Author of Article photo

Dr. Arash Asher

Invest in your sleep.
Our anxiety, worries, medication side effects, hor­monal changes, and busy lives can keep us from getting enough sleep. Aim to get at least eight hours of sleep per night. Getting some natural light during the day and keeping your bedroom pitch dark at night (perhaps with the help of blackout shades) is an easy way to improve the quality of your sleep.

Try yoga.
Gentle yoga (such as Hatha yoga) also has been shown to reduce fatigue and improve vitality. Not only may practicing yoga help you relax and strengthen your body, but it also may improve your quality of sleep.

Minimize your stress.
This may be easier said than done, but managing your stress is im­portant. Learning to cope with the challenges of a medical illness is one of the most empowering skills you can master. Avoiding social isolation, practic­ing mindfulness meditation, working fewer hours, seeking support from a therapist or support group, exercising, and spending time in prayer or other spiritual activities can all help man age stress and, in turn, reduce your fatigue.

Delegate and conserve.
Ask others to help with chores and tasks that aren’t essential for you to do yourself. Close family and friends are often looking for ways to be helpful, and accepting their help will allow you to conserve your energy for the tasks you have to do on your own. Set realistic goals for what you want to accomplish each day, but realize that it may still be impossible to accomplish everything you want to get done while you’re in treatment and recovery. Identify the time of day when you have the most energy, and use this window of time to do your most important tasks.

Talk to your doctor.
Some people may benefit from stimulant medications if their fatigue is severe and nothing else has helped. Ask your doctor about poten­tial drug interactions and appropriate dosing. Remember, unless you bring it up, your doctor may not evaluate you for fatigue. If you’re going through depression, have significant anemia, or have other medical problems, let your doctor know. Treating these issues may help reduce your fatigue.

♦ ♦ ♦ ♦ ♦

Dr. Arash Asher is the director of cancer survivorship and rehabilitation at the Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center in Los Angeles, CA. Dr. Asher’s expertise is in the nonpharmacologic management of pain, cancer-related fatigue, cognitive dys­function, neuropathy, exercise prescription for people with cancer, and the management of other musculoskeletal problems. Dr. Asher is board certified in Hospice and Palliative Medicine by the American Board of Physical Medicine and Rehabilitation.

This article was published in Coping® with Cancer magazine, January/February 2015.

Managing Cancer’s Impact on Your Relationships

by Ruth Oratz, MD, FACP

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Amid the initial shock of hearing the words “You have cancer,” in­numerable questions enter your mind: What does this mean for me? How will this affect my partner, my children, my parents, my friends? What about my job? You begin to realize that cancer will have a profound effect not only on your life but also on the lives of those around you.

Though the unique shape and texture of each of your relationships varies, com­munication is the foundation on which all human relationships stand. Talking to others about what cancer means to you and reflecting on their reactions is the first step in figuring out how to manage the impact your cancer diagnosis has on each of your personal relationships.

Intimate Relationships
The steadi­ness of your relationship with your significant other may be challenged during cancer. Your partner won’t know how you’re doing physically and emo­tionally unless you tell them. Sharing your needs and feelings will help your partner better understand what you’re going through and allow them to partici­pate in your experience more closely. Aim to work together to find new mean­ing in your relationship and cultivate a strong physical and emotional bond.

Your Children
The intrusion of can­cer on your household will alter your family’s normal pattern of everyday life, and children of all ages will notice that something has changed. As difficult as it is to talk to children about cancer, pre­tending that nothing has changed isn’t generally a successful coping strategy.

The language you use and the amount of detail you provide should be based on the age and level of understanding of your children. Young children will likely be more worried and frightened if you leave things to their own imagi­nation. Often the reality is less scary than the fantasy they create in their heads. Along with honest, age-appropriate information, your children will need reassurance that you still love them and want to spend as much time as possible with them, even though you may not always feel well and someone else may have to step in to take care of them now and then.

Though the unique shape and texture of each of your relationships varies, communication is the foundation on which all human relationships stand.

Author of Article photo

Dr. Ruth Oratz

Older children may find solace in supporting you by helping out around the house or caring for younger siblings. However, some kids will act out, rebel, withdraw, and struggle in school. It’s a good idea to talk to your children’s teachers, coaches, counselors, and other school administrators about what’s going on at home. They can provide additional emotional support and observe how well your children are coping dur­ing school hours.

Extended Family
Added support from your extended family can be both a benefit and a burden. Trying to keep everyone updated on how you’re doing while also maintaining some semblance of privacy and personal space can leave you feeling overwhelmed. Consider des­ignating a trusted friend or relative to be your “spokesperson.” He or she can send periodic group messages via email, social media, or other means to keep your loved ones up to date and to clear up any concerns they may have about your condition. Accept help from your family members when you need it, but know that it is OK to maintain boundaries and ask them to respect your privacy.

Elderly Parents
No matter what stage of life you’re in, it’s difficult to burden your parents with concerns about your own health and well-being. This is es­pecially true if you’re the caregiver for an elderly parent. Depending on your parent’s physical, cognitive, and emo­tional condition, choose to share as much information about your diag­nosis as seems reasonable. Do let your parent know if there will be a change in his or her normal rou­tine, and allow other family mem­bers or caregivers to fill in while you focus on your health.

Social Circles
Friends, neighbors, and other members of your community will likely learn of your diagnosis even­tually, but it’s best if you’re the one who controls the flow of information. Start by talking to your closest friends – the ones who are supportive, positive, and helpful. As you become more com­fortable and begin to gradually open up to others about what’s going on in your life, don’t feel pressured to share any more information than what you feel is appropriate.

At times you may feel overwhelmed by the flood of support surging your way, and even the most well inten­tioned efforts can feel like an invasion of your personal space. Learn to politely but firmly thank others for their concern and tell them if you don’t need their help or would rather not talk about cancer right now. Your designated spokesperson can help manage the flow of well-wishers and messages from others to help you feel less inundated.

Perhaps one of the most delicate areas in which to nego­tiate relationships is in the workplace. You will likely need to take some time off work, or at least adjust your work­load, to make time for treatment and recovery. Ask your healthcare team to explain the details of your treatment, including the number of clinic visits you’ll need to schedule, the length of time each treatment will last, and which side effects to expect and how to man­age them. Then, let them know what your job entails so you can come up with a treatment schedule that will interrupt your normal routine as little as possible.

Be sure to study up on the legal and financial implications your diag­nosis has on your job. Find out what your medical insurance will cover and if you’re entitled to any other benefits. Then consider discussing your condi­tion with your supervisor so you can work together to come up with a strat­egy for accommodating your medical needs while ensuring your work is taken care of.

Dealing with cancer brings a new dimension to all of your personal rela­tionships. Give yourself time to process your thoughts and feelings as you journey through treatment and recov­ery. Consider each of your personal relationships individually, and draw comfort and strength from the love and support of those who care about you.

♦ ♦ ♦ ♦ ♦

Dr. Ruth Oratz is a board-certified medi­cal oncologist who specializes in treating women with breast cancer. She is a clini­cal professor of medicine at the New York University School of Medicine, and she sees patients at the NYU Perlmutter Cancer Center in New York, NY.

This article was published in Coping® with Cancer magazine, January/February 2015.

Getting the Psychosocial Support You Need to Get through Cancer

by Nancy W. Fawzy, RN, DNSc

Wellness image

You can find an endless supply of information on just about any psychosocial issue online. However, you should only access regularly updated and reputable sources.

Cancer is not just life-threatening; it is also life-altering. Cancer and its lifesaving treatments often cause psychosocial issues that last long after cancer treatment has ended. Dealing with these psychosocial issues can be tricky. They affect people differ­ently, depending on age and health status. They also may change or evolve as you journey through diagnosis, treat­ment, and follow-up care.

Some possible psychosocial issues cancer survivors may experience include:

♦ Practical issues Concerns about making treatment decisions, managing finances, navigating health insurance, finding or keeping a job, and getting adequate nutrition and exercise
♦ Relationship issues Sexuality and intimacy problems, parents’ concerns for their child
♦ Emotional issues Anxiety, depres­sion, anger, sadness, hopelessness, helplessness
♦ Physical issues Pain, fatigue, pre­mature menopause, diminished fertility, osteoporosis

Focus on One Thing at a Time
Just contemplating, let alone actually deal­ing with, the reality of these potential psychosocial struggles can be com­pletely overwhelming. Before you panic, know that there is no guarantee that you will have to deal with any of these issues. However, you should be prepared to handle those that do arise. As with any major task, prioritize what you need to deal with first; then focus on resolving that issue before moving on to the next.

Rather than trying to manage your difficult emotions and concerns on your own, ask for help.

Author of Article photo

Dr. Nancy Fawzy

Ask for Help
Rather than trying to manage your difficult emotions and concerns on your own, ask for help. Some people are hesitant to ask for help because they don’t want to be a burden. What many don’t realize is that their friends and family are struggling with their own feelings of helplessness; they want to help you, but they may not know how. Asking for and accepting help benefits everyone.

Be Informed
Seek out information on your disease, its treatment, and potential side effects, including psycho-social concerns. Talking with your healthcare team is a great place to start. Make a list of questions you want to ask, and write down the answers. When possible, take someone with you to act as a second set of ears and an extra brain to process all the information you’re given. It’s equally important to provide your healthcare team with detailed in­formation about your condition and any side effects you’ve been experiencing to ensure that all your issues are ad­dressed and you get the personalized treatment you need.

In addition, you can find an endless supply of information on just about any psychosocial issue online. However, you should only access regularly updated and repu­table sources, such as and, to ensure that the in­formation you’ve found is accurate and up to date.

Move Forward with a Plan
The end of active cancer treatment brings with it an entirely new set of psychosocial issues. Having a survivorship care plan can help you navigate the post-treatment journey. Your survivorship care plan should include a summary of your diag­noses, treatments, and follow-up plans beyond surveillance for recurring or new cancers. It should also include doctor visits and testing schedules, strategies for preventing or mitigating chronic and late-occurring side effects, tips for maintaining (and encourage­ment to adhere to) a healthy lifestyle, and information on available resources for psychosocial and other practical support. The care plan specifies which healthcare provider (primary care doc­tor, surgeon, medical oncologist, etc.) is responsible for each aspect of your ongoing care so there’s no confusion.

Research in designing and imple­menting survivorship care plans is ongoing. Ask your healthcare team if this is something they can provide. After all, the best way to confront psychosocial struggles throughout your cancer journey is to become your own personal advocate in getting the help you need.

♦ ♦ ♦ ♦ ♦

Dr. Nancy Fawzy has specialized in psycho­social oncology for 40 years. She is currently president of the board of directors at Triage Cancer (, a nonprofit organization that provides education and resources on the continuum of cancer survivorship issues to survivors, caregivers, and healthcare professionals.

This article was published in Coping® with Cancer magazine, January/February 2015.

TLC’s The Little Couple Star
Dr. Jennifer Arnold’s On-Camera Cancer Battle

by Jessica Webb Errickson

Celebrity Cancer Survivor

“I’m ready to be a little boring and just enjoy the kids,” says Jen (pictured with her husband, Bill) of her post-cancer life.
(Photos on this page courtesy of TLC)

Since 2009, TLC’s The Little Couple has followed Dr. Jennifer Arnold and her husband, Bill Klein, as they navigate life’s unique challenges. What makes this couple stand out from a sea of all-too-similar reality stars is that they were both born with dwarfism.

After watching the couple grapple with fertility issues and endure the heart­break of a failed surrogacy, viewers of the hit reality series shared the pair’s excitement as they fulfilled their long-deferred dreams of parenthood with the adoption of their son, Will, from China. Then, shortly after being matched with Will, the couple’s joy was dou­bled as they were also given the opportunity to adopt a little girl, Zoey, from India.

A few months before Jen and Bill were scheduled to pick up Zoey, Jen was shocked to discover that she had become pregnant. However, she learned early on that the pregnancy had not been viable.

“It turned out to be a molar preg­nancy, which means that there was no chance it would ever become a fetus. It was just an abnormal growth of cells,” Jen tells Coping. “Molar pregnancies have a very small chance of turning into cancer, but we didn’t think that would actually happen in my case.”

I went into survival mode.

When filming began for the sixth season of The Little Couple, Jen and Bill had set off as planned to New Delhi, eager to adopt their second child. How­ever, what should have been a joyful journey took an unfortunate turn when Jen experienced a medical emergency that cut her trip short. She had devel­oped abnormal vaginal bleeding. The hemorrhaging was so severe that she needed to seek medical attention. Shortly after holding her daughter for the first time, Jen was on a flight home to Texas, where she was diagnosed with a rare form of uterine cancer resulting from her molar pregnancy.

Celebrity Cancer Survivor

Jen and Bill renew their vows with Zoey and Will by their sides.

“Not long after I was evaluated by my ob-gyn, we discovered that I actu­ally had a tumor in my uterus that was growing uncontrollably and causing the bleeding,” says Jen. “It ended up being gestational trophoblastic neoplasia, which is a type of choriocarcinoma, and it was stage III at that point.”

While Bill and the kids were still in India wrapping up the adoption process, Jen wasted no time starting treatment. “There was just so much going on at the time,” she explains. “I went into survival mode.”

Though hesitant at first, Jen ulti­mately decided to allow TLC to film her journey in order to capture the reality of facing cancer as a new par­ent. “It’s so hard to be a mom with young kids and be dealing with cancer at the same time,” she says, “but it seems as if you don’t hear a lot about that particular struggle.” So Jen set out to change that, and the cameras kept rolling.

Treating Jen’s cancer was tricky due to her skeletal dysplasia and resulting airway issues. After surgery to remove her primary tumor, respiratory compli­cations landed her back in the hospital. And coming up with an appropriate chemotherapy dosage was an exhaust­ing trial-and-error process, given Jen’s size in contrast with her age. She also experienced many of the common chemo side effects: hair loss, neutropenia, fatigue.

For someone like Jen, a busy neonatologist at Texas Children’s Hospital and the mom of two young children, fatigue can be especially frustrating. But she found an upside to her downtime.

“I got to spend more time with my kids – albeit very tired, laying-on-the-couch time – after bringing them home than I would have otherwise,” she ex­plains. “And I think that really helped with our family’s bonding.”

Talking about cancer also played a big role in family bonding. “We defi­nitely discussed it very openly with our kids,” says Jen. “With Will, we played doctor, we pretended to give each other shots – he may not have understood what cancer was, but he understood that Mommy was sick.” Jen showed the kids her bald head and her ports. She even let Zoey try on her wig. “We wanted them to understand as much as they could so that it wouldn’t be as scary to them.”

By the time TLC aired the sixth season of The Little Couple in March 2014, Jen had successfully completed treatment. As her life gradually returns to normal, she says, “My number one focus is my family and raising the kids to be happy, healthy, and successful adults.” She has also returned to her work at Texas Children’s, a job she’s very passionate about.

“[Cancer] is slowly becoming a distant memory,” Jen muses. “For me, life after cancer is about remembering that life is truly short – no pun intended – and we have to prioritize the things that make us happy, the things that we want to do, and the things that are important to us and to those we care about. I’m trying not to stress so much about little stuff, and I think keeping that mantra will serve me well in everything I do.”

♦ ♦ ♦ ♦ ♦

Keep up with Jen, Bill, and the kids on TLC’s The Little Couple. Visit for air dates and times.

This article was published in Coping® with Cancer magazine, January/February 2015.

Against All Odds

How a Brief Encounter in a Baby Store Changed My Perspective

by Stacey Polak

Inspiration image

In 1998, I received chemotherapy while I was preg­nant. Diagnosed with non-Hodgkin lymphoma at the end of my first trimester, the prognosis wasn’t great, and the unknowns were terrifying. I was sick from both the pregnancy and the chemo. Weak and exhausted, I rarely left the house. The odds weren’t in my favor, yet by my third cycle of chemo, my tumor was shrinking.

I wanted so much to experience just one moment of a “normal” pregnancy – one moment to be excited and happy and to feel like my situation wasn’t all so scary – so I decided to take a trip to the baby store. I planned my outing just be­fore my next cycle of chemo when my side effects were less severe. I gathered every bit of energy and determination I could muster and drove myself to the baby store to shop and to pretend I was no different from any of the other happy moms-to-be in the store. I held tightly to my shopping cart for support and lost myself looking at all the cute baby items I hoped I would soon need. It felt good. I felt hopeful, just me and my baby belly enjoying an hour away from reality.

Then a woman on my aisle noticed my bandana-covered bald head, my lack of eyelashes and eyebrows, and my pale, colorless skin.

In my search for positive survivor stories, I found that one against-all-odds story of hope and survival can sometimes negate the worry brought on by ten sad ones.

“I hope you don’t mind me asking, but are you having chemo?” the woman probed. When I told her that I was, that I had lymphoma, she became visibly upset and replied, “My brother died from lymphoma.”

Shocked by her thoughtless remark, I just smiled and continued shopping, trying to hold it together.

When I got home, I immediately began searching for sur­vivor stories – stories of hope, of surviving against all odds. I chose to focus only on the stories with good outcomes, disregarding the sad stories I came across. I told myself that those people were different from me and I would have a more positive outcome.

After that shopping trip, I didn’t go out again except for doctor’s appointments or medical treatments. I got weaker and sicker, but the chemo was working. After my sixth chemo cycle, my water broke, and my daughter was born five and a half weeks early. Weighing in at just over five pounds, she was healthy, gorgeous, and perfectly normal. I went on to have two more cycles of chemo, followed by radiation.

Sixteen years later, I still think back to that moment in the baby store, to how much the woman’s comment wounded me. The insensitivity of her remark was likely unintentional, but it really hit home in that moment. It reminded me of all I could lose. However, in my search for positive survivor stories, I found that one against-all-odds story of hope and survival can sometimes negate the worry brought on by ten sad ones. This is why I’m sharing my story. When you’re fighting can­cer, you need all the hope and encouragement you can get.

Today, my daughter is a smart, beautiful, kind, talented, amazing teenager, and I’m a happy, healthy 44-year-old mom who lived through cancer despite the odds stacked against me. I’ve learned that you shouldn’t always put stock in what the “odds” say, and you should never let insensitive comments bring you down. As the saying goes, “You can’t always choose your circumstances, but you can choose your attitude.”

♦ ♦ ♦ ♦ ♦

Stacey Polak is a non-Hodgkin lymphoma survivor living in Indian Trail, NC.

This article was published in Coping® with Cancer magazine, November/December 2014.

Facing Prostate Cancer Treatment?

Here are some things to keep in mind as you consider your options.


Prostate Cancer Image

For most men who are diagnosed with prostate cancer, the cancer is found while it is still at an early stage. These men often have several treatment options to consider.

If you have early stage prostate can­cer, there are many important factors to take into account before deciding on a treatment, such as your age and general health, and the likelihood that the cancer will cause problems for you. You should also think about the possible side effects of treatment and how bothersome they would probably be for you. Some men, for example, may want to avoid possible side effects such as incontinence or im­potence for as long as possible. Other men are less concerned about these and more concerned about removing or de­stroying the cancer.

If you are older or have other serious health problems and your cancer is slow growing (low-grade), you might find it helpful to think of prostate cancer as a chronic disease that will probably not lead to your death but may cause symp­toms you want to avoid. You may be more inclined to consider active sur­veillance, and less inclined to consider treatments that are likely to cause major side effects, such as radiation and surgery. Of course, age itself is not necessarily the best basis on which to make your choice. Many men are in good mental and physical shape at age 70, while some younger men may not be as healthy.

If you are younger and otherwise healthy, you might be more willing to put up with the side effects of treatment if they offer you the best chance for cure. Most doctors now believe that external radiation, radical prostatectomy, and brachytherapy all have about the same cure rates for the earliest stage prostate cancers. However, there are pros and cons to each type of treatment that should be considered, including possible risks and side effects.

This is complicated even further by the explosion of newer types of surgery (laparoscopic prostatectomy and robotic-assisted prostatectomy) and radiation therapy (conformal radiation therapy, intensity-modulated radiation therapy, proton beam radiation, etc.) in recent years. Many of these appear very prom­ising, but there is very little long-term data on them, which means comparing their effectiveness and possible side effects is very difficult, if not impossible.

Such a complex decision is often hard to make by yourself. You may find it helps to talk with your family and friends before making a decision. You might also find that speaking with other men who have faced or are currently facing the same issues is useful. The American Cancer Society and other organizations offer support programs that provide a forum for you to meet and discuss these and other cancer-related issues. For more information about the programs that ACS offers, call (800) 227-2345 or visit the “Find Support Programs and Services” section of It’s important to note that each man’s expe­rience with prostate cancer is different. Just because someone you know had a good (or bad) experience with a certain type of treatment doesn’t mean the same will be true for you.

You may also want to consider get­ting more than one medical opinion, perhaps even from different types of doctors. For early stage cancers, it is natural for surgical specialists, such as urologists, to favor surgery and for radiation oncologists to lean more toward radiation. Doctors specializing in newer types of treatment may be more likely to recommend their therapies. Talking to each of them may give you a better perspective on your options. Your primary care doctor may also be helpful in sorting out which treatment might be right for you.

Before deciding on treatment, here are some further questions you may want to ask yourself:
Are you the type of person who needs to do something about your cancer, even if it might result in serious side effects? Or would you be comfortable with watchful waiting/active surveillance, even if it means you might have more anxiety (and need more frequent follow-up) in the future?
Do you feel the need to know right away whether your doctor thinks he or she was able to get all of the cancer out (a reason some men choose surgery)? Or are you comfortable with not know­ing the results of treatment for a while (as is the case in radiation therapy) if it means not having to have surgery?
Do you prefer to go with the newest technology, which may have some theoretical advantages? Or do you pre­fer to go with treatment methods that are better proven and with which doctors may have more experience?
Which potential treatment side effects (incontinence, impotence, bowel prob­lems) might be most distressing to you? (Some treatments are more likely to cause certain side effects than others.)
How important for you are issues like the amount of time spent in treat­ment or recovery?
If your initial treatment is not suc­cessful, what would your options be at that point?

Many men find it very stressful to have to choose between treatment op­tions, and are very fearful they will choose the “wrong” one. In many cases, there is no single best option, so it’s important to take your time and decide which option is right for you.

♦ ♦ ♦ ♦ ♦

Reprinted by the permission of the American Cancer Society from, copyright © 2014 American Cancer Society, Inc. All rights reserved.

This article was published in Coping® with Cancer magazine, November/December 2014.

Your Guide to Lung Cancer Treatment


Photo by Cancer Type

(Photo © / tetmc)

There are four basic ways to treat lung cancer: surgery, radiation therapy, chemotherapy, and targeted therapy. Your treatment will depend on several factors, including the type and stage of your cancer, pos­sible side effects, and your preferences and overall health. In addition to these standard therapy options, you may also consider taking part in a clinical trial.

A thoracic surgeon is spe­cially trained to perform lung cancer surgery. The goal of surgery is the com­plete removal of the lung tumor and the nearby lymph nodes in the chest. The tumor must be removed with a surround­ing border or margin of normal lung tissue. A “negative margin” means that when the pathologist examines the lung, or piece of lung that the surgeon has removed, no cancer is found in the healthy tissue surrounding the tumor.

The following types of surgery may be used for lung cancer:
♦ Lobectomy The lungs have five lobes – three in the right lung and two in the left lung. For non-small cell lung cancer, the removal of an entire lobe of the lung in a procedure called a lobectomy is often the most effective type of surgery, even when the lung tumor is very small.
♦ A wedge If the surgeon cannot remove an entire lobe of the lung, the surgeon can remove the tumor, surrounded by a margin of normal lung tissue.
♦ Segmentectomy This is another way to remove the cancer when an entire lobe of the lung cannot be removed. In a segmentectomy, the surgeon re­moves the portion of the lung where the cancer developed.
♦ Pneumonectomy If the tumor is close to the center of the chest, the surgeon may have to remove the entire lung.
♦ Radiofrequency ablation This tech­nique uses a needle inserted into the tumor to destroy the cancer with an elec­trical current. It is sometimes used for a lung tumor that cannot be removed with the other types of surgery listed.

The time it takes to recover from lung surgery depends on how much of the lung is removed, as well as your health before surgery. Talk with your healthcare team about what to expect before your surgery, including recovery time and possible side effects.

Adjuvant Therapy is given after surgery to lower the risk of the lung cancer returning.

Adjuvant Therapy
Adjuvant therapy is given after surgery to lower the risk of the lung cancer returning. Adjuvant therapy may include radiation therapy, chemotherapy, and possibly targeted therapy. It is intended to get rid of any lung cancer cells that may still be in the body after surgery. It also can decrease the risk of recurrence, though there is always some risk that the cancer could come back.

Radiation Therapy
Radiation therapy uses high energy X-rays or other par­ticles to destroy cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen usually consists of a specific number of treatments given over a set period. This can vary from just a few days of treatment to several weeks. When radiation treatment is given using implants, it is called internal radiation therapy, or brachytherapy. However, brachytherapy is rarely used for lung cancer.

Like surgery, radiation therapy can­not be used to treat widespread cancer. Radiation only destroys cancer cells directly in the path of the radiation beam. It also damages the normal cells in its path; for this reason, it cannot be used to treat large areas of the body.

Sometimes CT scans are used to plan exactly where to direct the radia­tion to lower the risk of damaging healthy parts of the body. This is called intensity-modulated radiation therapy or stereotactic body radiation therapy. It’s not an option for everyone, but it may be used for those with early dis­ease and small tumors when surgery is not an option.

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. It has been shown to improve both the length and quality of life for people with lung can­cer of all stages.

Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy can be given through an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swal­lowed. Most chemotherapy used for lung cancer is injected into a vein.

A chemotherapy regimen usually consists of a specific number of cycles given over a set period. You may receive one drug at a time or combinations of different drugs at the same time. The type of lung cancer you have (adeno­carcinoma or squamous cell carcinoma) will affect which chemotherapy drugs you receive. Newer chemotherapy regi­mens cause fewer side effects and are as effective as older treatments.

Targeted Therapy
Targeted therapy targets the cancer’s specific genes, pro­teins, or the tissue environment that contributes to cancer growth and sur­vival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

Research has found that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. For some lung cancers, abnormal proteins are found in unusually large amounts in the cancer cells. Running tests to find these proteins can help doctors better match each individual with the most effective treatment whenever possible.

♦ Anti-angiogenesis therapy This targeted therapy is focused on stopping angiogenesis, the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor. Bevacizumab (Avastin) is an anti-angiogenic drug given along with chemotherapy for lung cancer.

♦ Drugs that work on specific mutations in cancer cells Researchers have found that drugs that block EGFR (epidermal growth factor receptor) may be effective for stopping or slowing the growth of lung cancer. Erlotinib (Tarceva) is a drug that blocks the EGFR. This drug has been shown to work better than chemotherapy if the lung cancer has a mutation in the EGFR gene. It is approved by the U.S. Food and Drug Administration for peo­ple with locally advanced and metastatic non-small cell lung cancer and as a maintenance therapy for people with non-small cell lung cancer that has not grown or spread after at least four cycles of chemotherapy.

Gefitinib (Iressa) is another drug that blocks the EGFR; however, this treatment is only available in Europe and Asia.

Gilotrif (Afatinib), a tyrosine kinase inhibitor, was approved by the FDA in 2013 as an initial treatment for non-small cell lung cancer. It works by stopping uncontrolled cell growth caused by a mutation in the EGFR gene.

Crizotinib (Xalkori) is another type of targeted therapy approved by the FDA for advanced non-small cell lung cancer that has a mutation in the ALK gene.

In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving your side effects.

Combining Treatments
Most people with lung cancer receive more than one type of treatment from more than one specialist. This is called a multidisci­plinary team approach. For example, chemotherapy can be given before or after surgery or before, during, or after radiation therapy. Your doctors should have a coordinated plan of care and work effectively with one another. If you do not feel that your surgeon, radiation oncologist, or medical oncologist is communicating effectively with you or each other about the goals of treat­ment and your plan of care, you should discuss this with your doctors or seek additional opinions before starting treatment.

Palliative Care
In addition to treat­ment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving your cancer-related side effects. This approach, called palliative or supportive care, includes supporting you with your physical, emotional, and social needs.

Palliative care can help a person at any stage of illness. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, those who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutri­tional changes, relaxation techniques, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, and radiation therapy. The following treat­ments may be given to help relieve the symptoms of lung cancer:
A tumor in the chest that is bleeding or blocking the lung passages can be shrunk with radiation therapy.
During a bronchoscopy, lung passages blocked by cancer can be opened to improve breathing.
A surgeon can use a laser to burn away a tumor or place a stent to prop open an airway.
Medications are used to treat cancer pain. Most hospitals and cancer centers have pain control specialists who pro­vide pain relief, even for very severe cancer pain. Many drugs used to treat cancer pain, especially morphine, can also relieve shortness of breath caused by cancer.
Medications can be used to suppress cough, open closed airways, or reduce bronchial secretions.
Prednisone or methylprednisolone can reduce inflammation caused by lung cancer or radiation therapy and improve breathing.
Extra oxygen from small, portable tanks can help make up for the lung’s reduced ability to extract oxygen from the air.
Medications are available to strengthen bones, lessen bone pain, and help pre­vent future bone metastases.
Appetite stimulants and nutritional supplements can improve appetite and reduce weight loss.

Before treatment begins, talk with your healthcare team about the possible side effects of your specific treatment plan and supportive care options for managing them. During and after treat­ment, be sure to tell your doctor or another healthcare team member if you are experiencing a problem so it is addressed as quickly as possible.

♦ ♦ ♦ ♦ ♦

Reprinted with permission from Cancer.Net © 2014 American Society of Clinical Oncology. All rights reserved.

This article was published in Coping® with Cancer magazine, November/December 2014.

Coping® does not endorse or recommend any particular treatment protocol for readers, and this article does not necessarily include information on all available treatments. Articles are written to enlighten and motivate readers to discuss the issues with their physicians. Coping believes readers should determine the best treatment protocol based on physicians’ recommendations and their own needs, assessments and desires.

Steps toward Rebuilding a Positive Sense of Self after Cancer

by William Penzer, PhD

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In an ideal world, after your last cancer treatment your doctor would offer an infusion of self-esteem, a magic potion to plug the holes in your self-image left behind from your journey through Cancerville and replenish your reserves of self-confidence. Unfortunately, it isn’t that easy. If cancer has left your self-esteem in shambles, the task of reclaiming a healthy sense of self will be a unique chal­lenge – but it’s definitely a doable one.

Your self-image boils down to the way you see yourself as a person, taking into account your appearance, intelligence, accomplishments, finances, relationships, and emotional and physical health. The way you feel about yourself in relation to these character­istics contributes to your sense of worth, or your self-esteem. To­gether, self-image and self-esteem form the basis of your self-confidence, the trust you have in yourself regarding your qualities and abilities.

Many filters can distort the way you view yourself and cause you to feel in­adequate and down on yourself. Cancer is just one of them. The following steps can help you re-establish a positive self-image and make way for renewed self-esteem and confidence in the face of cancer.

Prioritize the things you want in life and go after them.

Author of Article photo

Dr. William Penzer

Recognize that everything is relative.
Each crisis is relative to every other crisis. As bad as things can seem, they could always be worse. By accepting this concept, you’ll be less likely to fall into a cycle of self-pity that works against your efforts to renew a positive sense of self. Yes, you have cancer. But you’re still alive, and you most likely have op­tions available for treating your cancer.

Accept that bad things happen.
Cancer doesn’t discriminate. You can’t change the fact that it happened to you, so rather than dwelling on the inequity of it all, try to focus on the future and search for ways to reinvent yourself.

Adapt to change.
Human beings are amazingly adaptive. We have been adapting to change and finding new solutions to challenges since the dawn of time. Instead of assuming that you will never adjust to the changes brought on by cancer, believe that you will grow from your experience. With this attitude, you can begin to rebuild your life in a meaningful way.

Re-evaluate your goals.
Think about your goals, dreams, and aspirations. Have they changed since your cancer diagno­sis? Have you dropped the proverbial Ferrari fantasy and now simply seek health, peace of mind, and financial stability? Prioritize the things you want in life and go after them.

Learn from your journey.
There are many lessons you can learn from your experience with illness that will bolster your sense of self. For example, many cancer survivors say they’ve learned to stop sweating the small stuff. You may also learn the importance of taking better care of yourself, focusing on the present, and cultivating meaningful relationships.

Redefine yourself.
Allow yourself to adopt a broader definition of self, one that acknowledges that you are more than your illness. It should include the qualities that make you unique, special, and loveable, as well as your accom­plishments and your goals.

Turn your energies toward inner healing.
Just as our bodies often need help to heal, our minds also require some healing assistance. You might consider seeing a counselor or therapist, meeting with a life coach, joining a support group, reading inspiring books and articles, journaling, meditating, repeating daily affirmations, or all of the above. Healing takes time, so be patient with yourself as you find the approaches that work best for you.

Keep moving forward.
Try to see the challenge of reclaiming your self-image and self-esteem as a necessary, doable, and transformative part of your overall recovery from cancer. This is your chance to become the most self-confident and self-loving person you have ever been. After all, being a survi­vor of anything suggests a pride-worthy strength of will and determination.

♦ ♦ ♦ ♦ ♦

Dr. William Penzer has been a practicing psychologist in Ft. Lauderdale, FL, for more than 40 years and has written three books for cancer survivors and caregivers. For details, visit

This article was published in Coping® with Cancer magazine, November/December 2014.

Sex & Men with Cancer

by Nelson Bennett, MD

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Sexual dysfunction is common in male cancer survivors. The range of sexual issues cancer and its treatment can cause includes erectile dysfunction, decreased libido (sexual desire), and changes in the way a man experiences ejaculation and orgasms. Unfortunately, many of these threats to male sexuality are under-recognized, under-evaluated, and under-treated. It’s important to discuss with your doc­tor the potential side effects associated with your treatment so you’ll be better prepared to manage any sexual issues that arise.

Any type of pelvic surgery can affect the way you experience or­gasms or ejaculation. Surgery near the nerves responsible for the pleasurable feeling produced with orgasm can in­jure those nerves, altering the usual sensation you feel during an orgasm. If your prostate is removed, thus elimi­nating your major source of semen production, you should still be able to feel the pleasure of an orgasm, but little or no semen will be produced upon ejaculation. Some men report that these “dry orgasms” feel normal, while others say they experience an altered sensation.

Because the interior of the penis is composed of muscle, it is important to exercise this muscle by achieving erections. However, most men will experience erectile dysfunction follow­ing the removal of one or more pelvic organs, such as the bladder, prostate, or rectum. If you cannot achieve or maintain an erection on your own, your doctor may prescribe oral medications or recommend penile injections or vacuum pumps to assist your efforts.

The psychological implications of cancer can have as great an impact on a man’s sexual functioning as the physical side effects of treatment.

Author of Article photo

Dr. Nelson Bennett

Fortunately, erectile dysfunction fol­lowing surgery is not always permanent. Men who had nerve-sparing surgery have a 60 percent chance of regaining the ability to have erections without the aid of medication within two years af­ter surgery. It is important to note that men who had good erections before cancer surgery are more likely to regain good erections than men who had erec­tile problems before surgery.

Radiation Treatment
Many pelvic cancers, including prostate, bladder, and colon cancer, are treated with radiation, which can cause scarring and damage to the blood vessels that travel to the penis. This damage can result in erectile dys­function. Radiation can also injure the nerves that facilitate erections. Injury to these nerves can cause your erections to decrease in hardness.

Hormone Treatment
Some men require hormone therapy, or androgen deprivation therapy (ADT) , to slow the progression of their cancer. Hormone therapy works by either blocking your body’s production of the androgens (male hormones) needed to stimulate the cancer cells’ growth or by prevent­ing the cancer cells from using them. However, a common side effect of hor­mone therapy is decreased libido. In addition, decreased testosterone levels due to hormone treatment can negatively affect the hardness of your erections.

Psychological Considerations
Can­cer is a catalyst for many life changes, beginning with diagnosis and continu­ing throughout life. The psychological implications of cancer can have as great an impact on sexual functioning as the physical side effects of treatment. Men may experience depression, decreased self-esteem, fear, guilt, anxiety, and feelings of sexual inadequacy, all of which can greatly affect libido. In addi­tion, chemo-induced hair loss and other treatment-related bodily changes can deliver a blow to your self-esteem and interfere with your level of desire.

The good news is studies suggest that most people actually remain psycho­logically resilient in the wake of cancer. While that resilience is tested through­out the course of treatment and recovery, most people do adjust well.

From diagnosis to treatment, cancer can threaten a man’s sexual health. For­tunately, doctors are better equipped to evaluate and treat sexual issues than ever before. Having open and honest conversa­tions with your healthcare team prior to and throughout the course of treatment will help you get the support you need to manage sexual side effects and possibly minimize the impact of any treatment-related sexual difficulties in the future.

♦ ♦ ♦ ♦ ♦

Dr. Nelson Bennett is a urologist at the Lahey Hospital and Medical Center in Burlington, MA.

This article was published in Coping® with Cancer magazine, November/December 2014.

Divine Secrets of the Ta-Ta Sisterhood

13 Insights from a Breast Cancer Survivor

by Joanna Chapman

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1. It can be really hard to make treatment decisions.
Nobody warns you about how tough it can be to make treatment decisions. Sometimes your gut instincts contradict what your brain is telling you. Don’t be afraid to seek out second or even third opinions. Brilliant doctors don’t always offer the same advice or opinion.

2. Seek out your pink tribe, the group that feels right to you.
All breast cancer survivors are Ta-Ta Sisters, but just like all families, some­times you’ll feel closer to one sister than you will to another. Find the support group that feels right for you. I cannot overemphasize how helpful it is to make this connection.

3. Remember that it’s emotionally exhausting for your loved ones too.
You’re not the only one who is stressed and scared. Try to take into account the feelings of your spouse, friends, caretakers, etc. Everyone is focused on you and your feelings, but they’re having a hard time, too, and may not feel comfortable sharing their anxieties.

4. You can do this!
Repeat after me: I can do this, I can do this, I can do this, I can do this, I can do this, I can do this, I can do this, I can do this, I can do this, I can do this, I can do this, I can do this, I can do this, I can do this, I can do this, I can do this, I can do this …

5. Deep inside, we are more alike than different.
Rather than night-vision goggles, cancer has given me soul-vision spectacles. We may appear separated from others by nationality, race, age, religion, education, or income bracket, but cancer, or any other serious illness, is a profound equalizer. All of us – Wall Street wizards, African goat-herders, European countesses, school lunch ladies – share the same raw, human experiences: fear, grief, love, and hope.

6. Don’t wring your hands in regret, second-guessing your medical decisions.
You make your treatment choices, but you can’t control the out­come. You take your best shot based on the information you have at the time. Sometimes your decision is a slam-dunk or buzzer-beater that clinches victory. But sometimes it’s an air ball, a complete miss.

7. Healing takes time.
Everyone wants the fastest route out of Cancerland, but sometimes you have a detour. You may encounter unanticipated bumps in the road that require a delay of surgery or treatment. Try to be patient.

8. Let the good times roll!
Break out of your comfort zone and have some much-needed fun. Spend time hanging out with friends and family. Love and laughter are a salve for your soul.

9. Healing takes place on many levels.
Your body will recuperate, but your spirit needs time to recover too. Give yourself permission to deal with sad, angry, and scared feelings, but try to find a way to move forward. Look for opportunities to reflect on your cancer journey and how it has changed you. Rest, renew, recharge.

10. Survivorship is not a competition.
We each have our own path to follow through Cancerland. Nobody’s perfect; don’t compare your accomplishments to those of others. Realize you might be coping with some post-traumatic stress, and give yourself time. Many breast cancer survivors eventually volunteer to help those who have been newly diagnosed, but at first, revisiting thoughts of the disease can be too painful. Give yourself a break.

11. Don’t imagine a zebra stampede.
An old medical school adage instructs interns, “When you hear hoofbeats, think horses, not zebras.” Some cancer survivors, like me, obsess over every random symp­tom; the fear of recurrence haunts us. Try to take a deep breath and remind yourself that sometimes a fever, ache, or bruise is just a simple fever, ache, or bruise.

12. Laughter is the best medicine.
Drugs may stop working, cause an allergic reaction, or result in trouble­some side effects. But laughter always brings a measure of relief.

13. Cancer can do a lot of bad things, but it can never, ever extinguish love.

♦ ♦ ♦ ♦ ♦

This article is adapted from breast cancer survivor Joanna Chapman’s memoir, Divine Secrets of the Ta-Ta Sisterhood: Pledging the Pink Sorority. Learn more about Joanna’s book, available through most booksellers and ebook platforms, at

This article was published in Coping® with Cancer magazine, November/December 2014.

Let’s Be Honest …

The New Etiquette for Cancer Survivors
and Their Friends

by Letty Cottin Pogrebin

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(Photo by Mike Lovett)

In essence, you should be able to make these three simple, forthright statements to a loved one who has cancer:
Tell me what’s helpful and what’s not.
Tell me whether you want to be alone or want company.
Tell me what to bring and when to leave.

However, I know that the above sentences are easier for me to write than for the average person to speak, and it’s going to take a paradigm shift to make people feel comfortable saying them. Traditional illness etiquette leaves little room for such exchanges. Lacking the sense of permission to speak openly or the talent for mind reading, cancer sur­vivors and their friends often continue to spout bromides, fly on instruments, and sometimes miss the runway.

Nevertheless, giving your friend with cancer permission to tell you the truth about what they want and what they’re feeling doesn’t mean they have to tell you absolutely everything. When friends of mine asked how I was doing during breast cancer, I used to answer in detail – until I started noticing how often their eyes glazed over. (This usually happened at first mention of a sentinel node or estrogen receptor.) If we were talking on the phone, I’d hear the audio equivalent of a glazed eye – the soft click of computer keys or the whoosh of running water, a sure sign that they were multitasking. I took no offense. They didn’t mean to be rude. Medical terms are daunting, and minds wander.

Giving your friend with cancer permission to tell you the truth about what they want and what they’re feeling doesn’t mean they have to tell you absolutely everything.

Eventually, I realized that I didn’t have to report every detail. I wasn’t under oath. Besides, most people aren’t interested in our blood count or oncotype. Yes, they care about us, and yes, they hope we’re on the mend, but what they really want to know is pretty straightforward: Are we feeling better or worse? Are we hurt­ing? What can they do to help? Above all, they want clues to indicate how we wish to be treated.

We cancer survivors should provide that information not in coded messages but in just so many words. We should tell you whether we want visitors and, if so, when to come and how long to stay. We should admit if we’re exhausted or we don’t feel like talking. We should be clear about whether we want you to make us dinner and hang around while we eat or just deliver a covered dish. And if you’re going to bring us a pres­ent anyway, we may as well mention the book we’ve been eager to read, the edibles we most crave (and are permitted to consume), or the kind of flowers that make us happy.

I’m absolutely convinced that in illness, as in every other aspect of our lives, honesty is the best policy. It’s high time for the tyranny of politesse to give way to the frankness of truth telling. Were candor to become the prevailing modus operandi, people with cancer could be direct and honest without coming off as arrogant or demanding, and their friends would no longer flounder around trying to strike the right chord. Frankness may feel weird at first, but once both sides sign onto it, you and your friends will have one less thing to worry about.

♦ ♦ ♦ ♦ ♦

Letty Cottin Pogrebin is an author, activist, journalist, national lecturer, and breast can­cer survivor. This article is adapted from her book How to Be a Friend to a Friend Who’s Sick (published by PublicAffairs, a division of the Perseus Books Group). Learn more about Letty at

This article was published in Coping® with Cancer magazine, November/December 2014.

Chemo Brain

What It Is and What You Can Do about It

by Fremonta Meyer, MD

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Over the past several years, the medical community has become increasingly aware of a phenom­enon that cancer survivors have long experienced – chemo brain. Yes, recent research shows that cancer-related “brain fog” is real, and it can have a significant impact on quality of life.

What Is Chemo Brain?
Chemo brain refers to the cognitive impairment that can occur after cancer treatment. Up to 67 percent of people who receive can­cer treatment that’s not directed toward the brain experience cognitive changes in some form. Symptoms vary from person to person but generally include short-term memory problems, word-finding difficulties, short attention span, difficulty concentrating, and inability to multitask.

For most people, these symptoms are mild to moderate and will resolve grad­ually on their own over time. Many survivors notice a definite improvement in symptoms within six to nine months of finishing chemotherapy. However, some people experience cognitive changes that can last years after treat­ment ends. Keep in mind, though, that chemo brain is not a progressive dement­ing condition. In fact, some research has even found that chemotherapy may be associated with a lower risk of developing Alzheimer’s and other types of dementia.

What Can I Do to Improve My Symptoms?
If cognitive problems are affecting your performance at school or at work, requesting some simple accommodations (like extra time for taking exams or a private workspace) may help. Your doctor can suggest pos­sible accommodations, and can even write a letter to your employer or school administrator if needed.

Chemo brain symptoms generally include short-term memory problems, word-finding difficulties, short attention span, difficulty concentrating, and inability to multitask.

Author of Article photo

Dr. Fremonta Meyer

To help with memory problems, create a system to help you get organized and stay on top of things. Keep your to-do lists and calendars in one central notebook. Set alarms on your phone to remind you of upcoming doctor’s appointments, when to take medica­tions, a family member’s wedding, or anything else you want to remember. Read to-do lists, names, directions, and appointments aloud to help you remem­ber them. The combined visual and auditory input makes the information more likely to stick.

Avoid multitasking while you recover your cognitive skills. If you’re over­whelmed with daily responsibilities, write down a task list in order of im­portance. Once you prioritize, focus only on the first task that needs to be done – don’t think about anything else.

Regular aerobic exercise is also im­portant, as it has been shown to increase blood flow in the frontal lobes of the brain. In addition, mindfulness practices like yoga and meditation can help you culti­vate the ability to pay attention, which in turn leads to better memory retention.

Several research studies have shown that neurofeedback ( and computer-based brain fitness exercises, like Lumosity ( and Posit Science (, can reduce chemo brain symptoms. If you try brain fitness exercises, be sure to practice them regularly, four or five times a week for half an hour or more, for opti­mal results.

How Can a Medical Provider Help?
A neuro-psychologist can perform for­mal cognitive testing to give you a better understanding of your individual cognitive strengths and weaknesses. This testing also can provide evidence to support your need for accommoda­tions in school or at work. In addition, cognitive rehabilitation therapy may help you develop coping strategies tai­lored to your specific needs. This type of therapy is often covered under your health insurance’s occupational therapy benefit. Some people benefit from taking psychostimulants, such as methylphenidate (Ritalin), dextroamphetamine (Adderall), and modafinil/armodafinil (Provigil/Nuvigil). These medications tend to be most helpful for managing fatigue and improving attention and concentration.

Could Other Factors Be Involved?
If you’re six to nine months out of active treatment and you continue to experi­ence cognitive changes that affect your quality of life or ability to function, you should see your doctor for a medical evaluation. Many factors other than chemotherapy can affect cognitive func­tion in cancer survivors. Fatigue, low blood counts, aging, pain, difficulty sleeping, stress, anxiety, depression, pre­scription medications, hormonal changes, and medical conditions like diabetes, thyroid disease, and sleep apnea can all affect cognitive function. Your doctor can help you identify and treat these issues.

If your medical evaluation doesn’t point to any contributing factors, that’s OK. Doctors are still trying to pinpoint the exact cause of chemo brain. Be pa­tient with yourself and try the techniques mentioned here to help manage your cognitive symptoms. They should im­prove over time. When you’re feeling frustrated, remember that chemo brain is a sign of strength – in order to have chemo brain, you have to be a cancer survivor!

♦ ♦ ♦ ♦ ♦

Dr. Fremonta Meyer is a psychiatrist at Dana-Farber Cancer Institute in Boston, MA, and assis­tant professor of psychiatry at Harvard Medical School. She has an interest in women’s cancers and cognitive function in cancer survivors.

This article was published in Coping® with Cancer magazine, November/December 2014.

Coping with Cancer and the Holidays

A Delicate Balance

by Christina Bach, MBE, MSW, LCSW, OSW-C

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Festive parties, neatly wrapped gifts, cheerful cards, elaborate meals, family traditions, New Year’s resolutions – there’s a lot to be excited about leading up to the holidays.

For many, the holiday season is a joyous time of reconnecting with family and friends, overindulging in seasonal treats, and observing long-standing tra­ditions (or creating new ones). However, along with good tidings and cheer, the holidays also bring steep expectations, obligations, and stress. When cancer is thrown into the mix, the season becomes all the more difficult.

Perhaps you’re struggling to sched­ule your treatments so you can attend the annual family gathering held 1,000 miles from home. Maybe you can’t afford to host your usual holiday party, let alone buy gifts for the kids, due to mounting medical bills. Or simply, after all you’ve been through, maybe you’re just not in the mood for a big celebration.

Regardless of your situation, you don’t have to choose between decking the halls and coping with cancer. Here are some tips to help you enjoy the season while balancing the obligations and expectations of the holidays and the demands of cancer.

You might decide to modify existing traditions or even create new ones.

Author of Article photo

Christina Bach

Remember the reason for the season.
The holiday season isn’t a competition to see who can spend the most money, travel the farthest, send out cards the earliest, wrap pres­ents the best, or bake the most cookies. Think about what the holidays mean to you. What tradi­tions does your family observe? Which ones are feasible given your health status, treatment schedule, and supportive care needs? Take time to reflect on your goals, wishes, hopes, and expectations for the holiday season, and focus on what’s most important to you and your loved ones. You might decide to modify existing traditions or even create new ones.

Prioritize your to-do list.
Write down the things you would like to do during the holidays this year. Whom would you like to see? Perhaps you have been away from work for some time and would really like to reconnect with your coworkers and thank them for their support. In this case, attending your company’s holiday party may take pre­cedence over another event.

Once you’ve made a list of things you would like to do, move on to the things you need to do and think of ways to make them easier on you. For example, if you are in charge of hosting your family’s Hanukkah dinner this year, you might ask that everyone pitch in to help cook, clean, and prepare for the party.

The events and traditions left over after you’ve made your want and need lists are the ones you might consider skipping this year; although, this doesn’t mean that they aren’t important to you. You can find other ways to engage in holiday traditions even if you won’t be physically present. For example, if you’re unable to attend your friend’s annual tree trimming party, send an ornament for her to hang on the tree in your absence. Instead of embarking on a marathon trip to the mall on Black Friday, wait until cyber Monday and shop online from the comfort of your home. If you don’t have the time or energy to prepare a grand feast, hire a caterer or go to a restaurant for a holiday meal. By shifting how you participate in traditional activities, you can conserve your energy for the things you need and want to do most.

Keep the lines of communication open.
It’s important to let your family and friends know your needs and wishes for the holiday season. Otherwise, they may assume that because you have can­cer you won’t be up for celebrating the holidays. If this is not the case, tell them so. It’s also OK to set limits and to say no if you aren’t feeling up to doing some­thing. Figure out what works best for you and your family, and take on the holidays accordingly.

Coping with cancer during the holi­days is a challenge, but finding ways to navigate the season on your own terms can help you make the most of this spe­cial time of year. Your “holidays by design” may turn out to be the most memorable yet.

♦ ♦ ♦ ♦ ♦

Christina Bach is an educational content specialist and psychosocial content editor at OncoLink (, as well as the education director for the Association of Oncology Social Work. Previously, Christina worked as a clinical oncology social worker in both inpatient and outpatient settings at Penn Medicine/Abramson Cancer Center in Philadelphia, PA.

This article was published in Coping® with Cancer magazine, November/December 2014.

Confronting Cancer as a Senior Adult

Factors to Consider While Making Treatment Decisions

by Amy MacKenzie, MD, and Andrew E. Chapman, DO, FACP

Knowledge image

Making treatment decisions can be challenging. Meeting with multiple specialists to discuss everything from chemotherapy to sur­vivorship plans is an overwhelming part of the cancer experience for anyone diagnosed with cancer. However, if you’re a senior adult, you also have a unique set of challenges to consider as you work with your healthcare team to plan your treatment.

One Size Doesn’t Fit All
Your course of treatment should not be chosen based on your age alone. Some cancer survi­vors aged 65 years and older are quite fit and healthy. Others may have illnesses that can complicate cancer treatment. Thus, the best course of treatment for one person might not be right for another. In addition, seniors are often worried about how their partner will cope, how much treatment will cost, which side effects they could ex perience, and how to get to and from the treatment center. These concerns may factor into your treatment plan.

An emerging approach to individual­izing cancer treatment for senior adults is the development of specialized senior adult oncology centers. Upon visiting one of these centers, such as the Senior Adult Oncology Center at Thomas Jefferson University in Philadelphia, PA, you will first connect with a senior adult oncology navigator who will guide you through every step of the process. You will then meet with a geriatrician, an oncologist, a registered dietician, a geri­atric pharmacist, and a social worker. Each healthcare professional will spend time with you to assess your cancer diagnosis, as well as any other health problems you may have. You will also have the chance to discuss any concerns you have about treatment.

Your treatment plan should reflect your individual goals, as well as offer symptom relief and, ultimately, remission or cure.

Author of Article photo

Dr. Amy MacKenzie

A Unique Set of Challenges
When making cancer treatment decisions, the following considerations are unique to senior adults:

♦ Life Expectancy This can vary widely, depending on the health of the individual senior. An understanding of a person’s life expectancy, despite his or her can­cer diagnosis, can be incredibly helpful in deciding how aggressive to be with treatment. If a person’s life expectancy is especially limited by another medical problem, such as heart failure, this should be considered in the decision-making process. Above all, your treatment plan should aim to provide some perceived benefit without shortening life.

♦ Comorbidities Some seniors have other medical conditions like diabetes or high blood pressure. These illnesses, called comorbidities, can complicate the treatment decision–making process. Seniors with comorbid conditions can be more sensitive to cancer treatment side effects, and their oncologists will need to adjust their treatment plans accordingly. If the comorbidities are severe, cancer treatment may have to wait until the other medical conditions are treated or under control.

Author of Article photo

Dr. Andrew Chapman

♦ Medications Many seniors are already on multiple medications. It’s important that all the medications a person is taking be considered while making treatment plans because some medications might not be necessary anymore or may interact with cancer drugs. Having a pharmacist as part of the healthcare team is helpful when dealing with multiple medications.

♦ Individual Preferences For senior adults, quality of life may be as impor­tant as, if not more important than, “quantity” of life. A frank discussion with your healthcare team about the risks and benefits of treatment is essen­tial. Your treatment plan should reflect your individual goals, as well as offer symptom relief and, ultimately, remis­sion or cure.

Putting It All Together
In a senior adult oncology center, after you have met with each healthcare provider indi­vidually, the healthcare team will meet to review their findings and put all the pieces together. A thorough review of your health status, medications, social issues, and dietary concerns will be in­corporated into a comprehensive cancer treatment plan. The goal of this plan is to maximize treatment benefit and minimize risk while taking into account your indi­vidual needs and goals. If you are unable to seek a comprehensive evaluation in your area, you can meet with your pri­mary care physician and your oncologist to create a comprehensive treatment plan that addresses the unique considerations covered here. The best cancer treatment plan is one that is patient centered, goal oriented, and team based.

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Dr. Amy MacKenzie is an assistant professor in the Regional Cancer Care Division of the Department of Medical Oncology at Thomas Jefferson University in Philadelphia, PA. Dr. Andrew Chapman is an associate pro­fessor and director of the Regional Cancer Care Division of the Department of Medical Oncology and the cofounder of the Senior Adult Oncology Center at Thomas Jefferson University.

This article was published in Coping® with Cancer magazine, November/December 2014.

Former Good Morning America Host
Joan Lunden

Takes on Breast Cancer as the Opportunity of a Lifetime

by Jessica Webb Errickson

Celebrity Cancer Survivor

In 1980, aspiring news anchor Joan Lunden broke into the media spotlight by landing a job co-hosting ABC’s Good Morning America. Over the course of her nearly two-decade run on the show, Joan se­cured her position as one of most popular and respected media personalities in the business.

In addition to longest-running host on early morning television, Joan has many titles: wife, mother of seven (including two sets of young twins), journalist, bestselling author, and motivational speaker. However, as Joan relates during a conversation with Coping magazine, “At the heart of Joan Lunden is a health advocate.”

Much of Joan’s post-GMA work has revolved around her interest in health and wellness. So when she dropped by the show this past June to make an announcement, she stunned the audi­ence when, instead of promoting an upcoming book or television show, Joan announced on air that she was battling breast cancer.

Though her diagnosis was unex­pected, Joan’s response to the situation was anything but. In true journalistic fashion, driven by her passion for health and wellness, Joan set out on a mission to shed light on the disease and the importance of early detection by sharing her story as she lives it.

Diagnosis: Cancer
Joan’s journey began June 5, 2014, when she went in for her annual mammogram and follow-up ultrasound. For women with dense, fibrous breast tissue, like Joan’s, she cites breast ultrasound as an integral step in annual screening to check for anything the mammogram may have missed.

“People say that nobody goes through breast cancer and comes out the same person. And they’re absolutely right.”

As it turns out, Joan’s mammogram had missed something. Though the mam­mogram indicated that she was in the clear, the subsequent ultrasound revealed two tumors in her right breast. “If I had not gone in for that ultrasound, I might not have been around for my next mam­mogram,” says Joan, emphasizing the importance of knowing the best method of screening for your particular type of breast tissue.

Celebrity Cancer Survivor

Joan works from her phone on infusion days.

A biopsy confirmed that Joan had triple-negative breast cancer.

“The first thing that went through my mind was how I might let people down,” the health-advocacy figurehead reveals. “What would people think? ‘Oh, she was supposed to be so healthy and taking such good care of herself, and now look.’”

However, after a few days of rumi­nation, Joan realized that her diagnosis didn’t have to be seen as something negative that had to be kept secret.

“I’ve always felt very self-satisfied that I went into the business of dissemi­nating information that helps people make better choices about their health,” Joan says. Rather than viewing her imminent journey as something to fear, she adds, “I knew that I was being handed an opportunity.”

Outpouring of Support and Solidarity
Joan joins a sisterhood of GMA hosts who have publicly battled cancer. Robin Roberts and Amy Robach, both breast cancer survivors, have also allowed viewers to watch their journeys unfold. And when Joan visited the GMA set to make her cancer announcement, it was Robin who interviewed her on her diag­nosis, spearheading Joan’s mission to spread awareness about the disease.

Celebrity Cancer Survivor

Recognizing the importance of staying active, Joan, far right, enjoys a workout session with friends.

“Robin was a major source of strength for me right in the beginning,” Joan says. “I told her, ‘I have to get in front of this situation.’ And she said, ‘Abso­lutely. Let’s decide when you’re coming on the show.’”

Whether they’re offering to cover Joan’s speaking engagements or to accompany her to chemo, overwhelm­ing support from her colleagues has bolstered Joan’s positive attitude. Her friends and family are key in her arsenal of support as well. “Don’t try to do it alone,” she advises her fellow cancer fighters. Especially in the begin­ning. “I don’t think you should go to any of those initial appointments alone, be­cause you are in shock. I took one of my daughters or my husband to every single appointment. They took great notes about everything the doctors were saying. I never would have remembered it all.”

A Bold (Bald) Choice
After scouting multiple opinions regarding her treat­ment plan – each one different from the last – Joan settled on a regimen comprising a round of chemotherapy to shrink the tumors in her breast, fol­lowed by lumpectomy, another round of chemo to eradicate any remaining cancer cells, and then radiation. “You can’t play Russian roulette with cancer,” she says. “If I follow this plan, I should be cancer-free.”

When Joan’s first round of chemo began, Robin remained situated as a pillar of strength, offering some advice gleaned from her own experience: Don’t wait around for your hair to fall out. It’s just torture. Shave it off. So she did. “I felt like G.I. Joan,” she avows. “I was so empowered by it.”

However, in the days that followed, reality set in, and the knockout blow to Joan’s self-esteem came with the loss of her eyebrows and eyelashes. “At that moment, I saw a cancer patient looking back at me,” she concedes. “I don’t want to sound superficial, that hair is so important, but it is a big part of what you look like.”

Despite her insecurities, Joan ditched her wig to pose for the cover of People magazine’s October 6 issue. “I want to share my journey in a way that takes the mystery away from all the things you have to go through with breast cancer,” she says of her decision.

Moving Forward with a Mission
Reflecting on her journey so far, Joan’s task is all the more clear. “I want to get as many women as I can to make sure that they’re doing self breast exams,” she says, especially in regard to women who have not yet had a mammogram. “Every young woman has to under­stand that performing self breast exams is one of her prime responsibilities to her health. We know that the earlier you catch it, the better your chances for sur­vival. Up until your first mammogram, that’s all on you.”

Currently undergoing her second round of chemotherapy, Joan is proud to be an ongoing voice for breast cancer survivors. “My going public, allowing People magazine to take that picture, all of this – to say it’s been worthwhile is the understatement of my life,” says Joan. “If my life was defined by what I have been able to do in terms of breast cancer, I would be happy.”

♦ ♦ ♦ ♦ ♦

Keep up with Joan as she blogs about her cancer journey on her website,

This article was published in Coping® with Cancer magazine, November/December 2014.

The Story of the Stomachless Chef

Gastric Cancer Survivor Hans Rueffert

by Kaylene Chadwell

Celebrity Cancer Survivor

Hans Rueffert

Renowned chef Hans Rueffert’s culinary roots run deep. When he was only four years old, his parents bought the Woodbridge Inn, a hotel and restaurant nestled in historic downtown Jasper, GA. Hans grew up working in the restaurant’s kitchen alongside his German chef father, washing dishes, shucking oysters, preparing salads, and generally loathing the family business. It wasn’t until Hans, at 18 years old, learned how to cook that he fell in love with the culi­nary arts.

“I had spent my childhood thinking that I hated the restaurant business,” Hans recalls in an inter­view with Coping magazine. “Then one day I realized that I actually loved it. I just hadn’t been involved in the right area of it yet.”

Hans’ penchant for cooking grew as he honed his skills, and he even­tually took over his father’s post as head chef of the Woodbridge Inn. In 2005, the fine-dining aficionado got the chance to travel to New York and show off his skills on the first season of Food Network’s culinary competition The Next Food Network Star. Hans’ cooking chops carried him all the way to the finale, where he came in third place – not too shabby for a self-proclaimed small-town Georgia boy in the Big Apple.

However, the elation he felt from progressing so far in the nationally broadcast competition was short lived. Two weeks after the show’s finale, Hans got the worst news a foodie could pos­sibly hear: He had stomach cancer.

There I was, during the scariest time of my life, and the one thing that always gave me comfort had turned into my enemy.”

“I thought I was having a heart attack,” Hans says, explaining the event that led up to his diagnosis. “I dialed 911, and – long story short – they found a tumor at the intersection of my esoph­agus and stomach.”

Hans initially underwent surgery to remove half of his stomach and half of his esophagus, followed by six weeks of chemo and radiation. However, over the next six years, infections and other complications necessitated more than 11 surgeries that eventually left him with no stomach and a completely reworked digestive system. “Anytime I go for an X-ray, it’s fun to watch the technician’s eyes light up,” Hans says with a laugh. “They’re like, ‘Whoa, nothing in here is where it should be.’”

Joking aside, adjusting to life without a stomach was challeng­ing for Hans, particularly during chemotherapy. He experienced extreme nausea, and because he was physically unable to vomit, he had to deal with all the discomfort of retching without any of the relief. Moreover, taste alterations and appetite loss were a night­mare for the professional chef, even causing him to shed a sub­stantial amount of weight.

“Food had always been my security blanket,” Hans admits. “But there I was, during the scar­iest time of my life, and the one thing that always gave me com­fort had turned into my enemy.”

As he slowly regained his appetite and his taste buds regen­erated, Hans adopted a diet that accommodated his new, stomach­less life. “My diet is how a lot of people really should be eating,” he says. “It’s similar to a diabetic diet – low-carb, low-sugar, and high in plant-based protein.” As his diet evolved, so too did his recipes. The experience served as the inspira­tion for a cookbook, Eat Like There’s No Tomorrow.

“The ‘live like there’s no tomorrow’ motto is the banner under which cancer survivors thrive,” explains the acclaimed chef. “For me, it’s almost celebratory in that I want to end every day know­ing that I’ve had a good day. The same goes for every meal. I want to ‘eat like there’s no tomorrow.’ I want every meal to be something I’m proud of.”

♦ ♦ ♦ ♦ ♦

Hans is still running things down at the Woodbridge Inn, and he serves on the Board of Directors of the Gastric Cancer Foundation ( Whether it’s through his cookbook or in-person cooking classes, Hans spreads his love of the culinary arts by teaching others how to prepare meals that are not only healthy but also delicious. You can keep up with Hans at

This article was published in Coping® with Cancer magazine, September/October 2014.

Diagnosis: Kidney Cancer


Photo by Cancer Type

(Photo by / monkeybusinessimages)

Kidney cancer begins when nor­mal cells in one or both kidneys change and grow uncontrollably, forming a mass called a tumor. Several types of kidney cancer can develop, in­cluding renal cell carcinoma, transitional cell carcinoma (also called urothelial carcinoma), sarcoma of the kidney, and Wilms tumor.

Treating Kidney Cancer
Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and your preferences and overall health. Kidney cancer is most often treated with surgery, targeted therapy, or immuno­therapy. Talk with your doctor about your treatment options, and ask what you can expect while receiving treatment.

Active surveillance may be an option, especially if your cancer is small and slow growing. If so, your doctor will recommend that you be monitored closely and wait to start active treatment until there is evidence that the disease is worsening. This approach is also called watchful waiting or watch-and-wait.

Surgery is the removal of the tumor and surrounding tissue. If the cancer has not spread beyond the kidneys, surgery to remove the tumor, part or all of the kidney, and possibly nearby tissue and lymph nodes may be the only treatment necessary. Several types of surgery are used for kidney cancer, including radi­cal nephrectomy, partial nephrectomy, laparoscopic and robotic surgery, radio­frequency ablation, and cryoablation (also called cryotherapy or cryosurgery).

Kidney cancer is most often treated with surgery, targeted therapy, or immunotherapy.

Targeted therapy involves the use of drugs that target the cancer’s specific genes, proteins, or the tissue environ­ment contributing to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells. Anti-angiogenesis therapy is a type of targeted therapy used in kidney can­cer treatment. It is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor.

Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defenses to fight cancer, using materials made either by the body or in a laboratory to improve, target, or re­store immune system function. Kidney cancer may be one of the few cancers that the body’s immune system can fight, so immunotherapy is often effective in treating kidney cancer. Interleukin-2 (IL-2) is an immunotherapy drug that has been used to treat later-stage kidney cancer. Alpha-interferon is another type of immunotherapy used to treat kidney cancer that has spread. Researchers have tested many combinations of IL-2 and alpha-interferon for people with advanced kidney cancer, and these treatments have also been combined with chemotherapy. However, research hasn’t shown that these combinations are better than IL-2 or interferon alone. Newer forms of immunotherapy called checkpoint inhibitors are being tested in clinical trials.

Radiation therapy is the use of high-energy X-rays or other particles to destroy cancer cells. Radiation therapy is not considered to be effective as a primary treatment for kidney cancer. It is used alone only rarely to treat kidney cancer because of the high rate of dam­age that it causes to the healthy kidney. Most often, radiation therapy is used after the cancer has spread to help ease side effects, such as bone pain or swell­ing in the brain.

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and di­vide. While chemotherapy is useful for treating most types of cancer, kidney cancer is often resistant to chemotherapy. However, transitional cell carcinoma and Wilms tumor are much more likely to be successfully treated with chemo­therapy than other types of kidney cancer.

Metastatic Kidney Cancer
In the most advanced stage (stage IV), kidney cancer cells have broken away from the original tumor and have traveled through the lymphatic system or blood to other parts of the body, where they begin grow­ing new tumors. The most common place kidney cancer spreads is to the lungs, but it can also spread to the lymph nodes, bones, liver, brain, skin, and other areas in the body. If you have metastatic kidney cancer, you should talk with doctors who are experienced in treating this stage of cancer because there can be different opinions about the best course of treat­ment. Your treatment plan may include a combination of treatments. Currently, the most effective treatment for meta­static kidney cancer is targeted therapy that slows or prevents tumor growth and blood vessel formation. Supportive care is also important to help relieve symptoms and side effects.

Remission and the Chance of Recurrence
A remission is when can­cer cannot be detected in the body and there are no symptoms. While many remissions are permanent, it’s important to talk with your doctor about the pos­sibility of the cancer returning. If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (local recurrence), nearby (regional recurrence), or in another place (distant recurrence). When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence, including whether the cancer’s stage has changed. Then, you and your doctor will talk about your treatment options. Often the treatment plan will include the same previously mentioned therapies, but they may be used in a different combination or given at a different pace. Your doctor may also suggest that you look into clinical trials that are studying new ways to treat recurrent kidney cancer.

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Reprinted with permission from Cancer.Net © 2014 American Society of Clinical Oncology. All rights reserved.

This article was published in Coping® with Cancer magazine, September/October 2014.

Coping® does not endorse or recommend any particular treatment protocol for readers, and this article does not necessarily include information on all available treatments. Articles are written to enlighten and motivate readers to discuss the issues with their physicians. Coping believes readers should determine the best treatment protocol based on physicians’ recommendations and their own needs, assessments and desires.

Still Struggling with Post-Cancer Loneliness?

Here’s the Secret to Putting It Behind You

by Debbie Woodbury

Inspiration image

I’m OK with solitude. In fact, I crave it. What I’m not OK with is loneliness. Before my breast cancer diagnosis and mastectomy, I thought I knew what lone­liness felt like.

The night I gave birth to my first child, I eagerly anticipated the joy of holding her in my arms. Instead, because my doctor feared that I had a virus, I was quarantined away from my baby girl until the next day. It was the loneliest night of my life … until I got cancer.

For the first six and a half months of diagnostic tests, doctor visits, and sur­gery, I was rarely alone in the trenches. Together, my family and I trudged through diagnosis, treatment, and re- cuperation. I fully expected survival to be a celebration.

It wasn’t. Instead, I was hit with the emotional fallout of living with cancer and was left standing in the rubble as my loved ones, convinced “the worst was over,” returned to normal without me. This wasn’t like the night apart from my newborn. Nor was it like the five long years of miscarriages and fertility struggles my husband and I endured to get to that night. We soldiered through those difficult experi­ences together, in solidarity. This time, it was just me, all alone and facing an in- escapable, unrecognizable “new normal.”

My salvation began two days after my mastectomy, when a breast cancer navigator walked into my hospital room and introduced me to the world of cancer support services. Desperate to crawl out of the black hole of loneliness, I committed to meeting weekly with a therapist. As I talked through all the grief, fear, anxiety, and trauma of my cancer experience, I learned that I wasn’t alone. I had a tribe. I was, and am, part of a massive community of cancer survivors.

Eventually, I gathered the courage to join support groups and attend a reha­bilitation exercise class. It was in these group settings that I discovered the secret to putting my post-cancer loneliness be­hind me: connecting with other survivors.

With this discovery, I began having conversa­tions with other survivors about what it’s like to feel alone in a crowd, how others often judge without understanding, and the difficulty of recovering emotionally while everyone around you wants to move on. Through commiser­ating with my fellow cancer survivors, I found the ladder I needed to climb out of the deep pit of loneliness.

As I look back, I realize that the solu­tion to my post-cancer loneliness was simple. All I had to do was show up and allow myself to be supported. (Of course, that’s not to say that simple is synony­mous with easy, especially when cancer has sapped you of the energy to put your­self out there.) Yet, the reward was worth the effort. Connecting with others who understood what I was going through vanquished my loneliness, and I was able to begin healing emotionally.

You are not doomed to live in the depths of post-treatment loneliness. Show up to support groups, make an appointment with a therapist, call cancer helplines, seek out mental health pro­fessionals, and connect with your fellow survivors. If you can muster the energy to put yourself out there, you will find the support you need to light your way out of the dark shadows of loneliness.

♦ ♦ ♦ ♦ ♦

Debbie Woodbury is a breast cancer survivor, motivational speaker, blogger, and author of the books You Can Thrive After Treatment and How to Build an Amazing Life After Treatment, which are available at You can keep up with Debbie on her blog at, as well as on Twitter (@DebbieWWGN) and Facebook (WhereWeGoNow as Cancer Survivors).

This article was published in Coping® with Cancer magazine, September/October 2014.

Leaving Fear and Uncertainty Behind

A Plan for Embracing New Choices and Opportunities

by Merle H. Mishel, PhD, RN, FAAN, and Barbara B. Germino, PhD, RN, FAAN

Wellness image

Everyone experiences feelings of uncertainty now and then. But as a cancer survivor, you may find yourself wrestling with a unique type of uncertainty – the possibility of cancer recurrence. This fear of your cancer returning can linger long after treat­ment ends.

Though your concerns may subside over time, certain things can cause your fears to resurface, such as pain or unusual physical symptoms, particu­lar sights and smells, looming doctor’s appointments, and stories of others’ experiences with cancer or recurrence. What’s more, feelings that often ac­company fear, such as worry, sadness, and anger, only add fuel to the fire. The good news is there are a number of techniques you can use to manage your fear and uncertainty so you can take full advantage of your life after cancer.

Practicing basic relax­ation exercises can help you manage your body’s reaction to stress by reduc­ing muscle tension, pain, and soreness. Relaxation exercises also come in handy when you’re feeling anxious or fearful. For instance, if you feel anxious before a follow-up appointment with your oncologist, you can use a relaxation exercise such as this one to regain a sense of calm:

Take a long, deep breath. Say the word relax, and slowly exhale. Pay attention to your breathing, and slowly begin to let go of any tension or tightness in your body, starting from your head and gradually mov­ing all the way down to your feet. Repeat as necessary.

While uncertainty may leave room for a less-than-desirable outcome, a positive outcome is also possible.

Author of Article photo

Dr. Merle Mishel

Staying active and keeping busy can help take your attention away from your fears and reduce your anxiety. When you notice yourself feeling anxious, try shifting your focus elsewhere to distract your­self from the anxiety-provoking thought or situation. Here’s how:

Imagine a big, red stop sign. Then, simply stop what you’re doing and do something else. You can distract yourself by doing something you en­joy, like reading a book or going for a walk around the block, or by doing something that requires your concen­tration, like tackling a project at work or completing chores around the house. The important thing is to choose activities you can fully im­merse yourself in to help take your mind off your fears and calm your nerves. When you’re feeling more in control, you can go back and face the cause of your fear, if necessary.

Calming Self-Talk
The process of calming self-talk involves thinking to yourself or speaking aloud comforting words and phrases to counter your anxious or fearful feelings. When practicing calming self-talk, you should be positive but realistic; think of what you would say to comfort a close friend during a difficult time.

Author of Article photo

Dr. Barbara Germino

It’s helpful to have some substitute phrases prepared to replace any troublesome thoughts you may encounter. Take this for example:

Replace the troublesome thought “I’m afraid my cancer will come back” with the substitute phrase “This feeling of uncertainty is only temporary. I am in control.” Likewise, you might replace “I worry that I might not see my children grow up” with “I need to be positive and strong for my children. I will do everything I can to be there for them and make every day count.”

Embracing Positive Change
Another way to manage fear of recurrence is to look at uncertainty from a different perspective. When you’re certain about a situation, you expect a specific outcome. However, when you’re uncertain, many possibilities exist. This means that while uncertainty may leave room for a less-than-desirable outcome, a positive outcome is also possible.

Cancer offers an opportunity for you to experience growth and positive life changes, appreciate the fragility of life, and rediscover what’s important to you. By practicing the coping strategies mentioned here, and by learning to anticipate the fear-provoking situations that might necessitate using them, you’ll be better equipped to manage your fear and uncertainty so you can focus on enjoying your best life after cancer.

♦ ♦ ♦ ♦ ♦

Dr. Merle Mishel is a Kenan Distinguished Professor of Nursing, and Dr. Barbara Germino is a research professor, both in the School of Nursing at the University of North Carolina at Chapel Hill.

For audio files with step-by-step guidance through the coping strategies mentioned in this article, visit

This article was published in Coping® with Cancer magazine, September/October 2014.

Managing Speech and Swallowing Complications Resulting from Head and Neck Cancer

by Jan S. Lewin, PhD

Photo by Cancer Type

Head and neck cancer often results in significant functional changes in speech, voice, and swallowing. These problems can occur as a result of the disease or of the treatment. It is important to have a thorough and real­istic understanding of the functional effects of treatment because the restora­tion of communication and the ability to swallow may be critical to your treatment decision.

Speech and swallowing are highly complex processes that depend on pre­cisely coordinated interactions of the structures of the oral cavity (mouth), pharynx (throat), and larynx (voice box). Any alteration to these structures or movements will result in speech and swallowing changes. Therefore, rehabilitation should begin at the time of cancer diagnosis.

The most common problems experi­enced by people with head and neck cancer include difficulty with tongue movements (especially those that involve the back of the tongue), problems with pharyngeal contraction, and limited motion of the larynx. These three actions are critical to the ability to speak, eat, and drink by mouth.

Your speech and swallowing function should be thoroughly evaluated before and throughout your treatment. Some people report no problems swallowing, while in fact they are silently, without coughing or any other indication, aspirat­ing what they swallow. In other words, food is entering the windpipe, placing the individual at risk for pneumonia. Several tests allow clinicians to deter­mine your ability to safely swallow, including the modified barium swallow study and the flexible endoscopic evalu­ation of swallowing.

As much as possible, you should continue to swallow throughout the course of radiation therapy.

Speech and voice evaluation should include examination of sound production and observation of vocal fold movement. Videostroboscopy is the best clinical assessment for visualization of the larynx and assessment of true vocal fold vibration. It is not a radiologic pro­cedure. It is performed as an office procedure and provides important information regarding the ability of the larynx to function properly to pro­duce sound.

After surgery, speech and swallow­ing are generally most impaired when surgery damages the tongue, specifi­cally the anterior tongue for speech and the tongue base or root of the tongue for swallowing. The degree of impair­ment often depends on the quality, rather than the extent, of reconstruction. Some people who have undergone total glos­sectomy, or removal of the entire tongue, swallow better than those who have undergone partial resections that pre­vent tongue movement. Speech and swallowing therapy is essential for functional recovery.

Effects of radiation therapy can produce both immediate and long-term changes in speech, voice, and swallow­ing that may increase in severity years after the completion of treatment. Effects vary among individuals, but most people will experience some degree of speech and swallowing impairment. People who cannot swallow adequately before treatment are at higher risk for long-term swallowing disability after treatment and may require a permanent feeding tube. The addition of chemo­therapy can make the problems worse because chemotherapy intensifies the effects of the radiation. Currently, inten­sity modulated radiation therapy (IMRT) is being used as a routine treatment to cure head and neck cancer. One of the goals of IMRT is to reduce normal tissue damage, thereby preserving function. New studies are being developed to de­termine the potential benefit of intensity modulated proton beam therapy (IMPT) to cure head and neck cancers while still preserving function.

Most swallowing problems occur because of the scarring or fibrosis that happens after radiation therapy. This can result in problems related to chewing, muscle contraction, and airway protec­tion. As much as possible, you should continue to swallow throughout the course of radiation therapy. Even brief periods of not eating by mouth should be avoided. Changes in posture and various types of exercises are often used to strengthen the muscles involved in swallowing. Exercises that are started early provide the best prevention of long-term swallowing problems after radiation therapy. Research shows that people who adhere to swallowing exercises have the best chance to avoid permanent feeding tubes and continue to eat by mouth.

For some people, particularly those with cancer in the oropharynx and larynx, the use of new laser and robotic surgeries are often able to spare the muscles that are critical to speech and swallowing function. However, even when treatment spares organs, preserva­tion of speech and swallowing cannot be ensured. In other words, just because the organ can be saved does not mean it will work. It is important to discuss realistic expectations for functional recovery after organ-sparing procedures with your doctor because neither speech nor swal­lowing may ever fully return to normal, but good functional results are possible.

The focus of speech and swallowing intervention should be early and preven­tive to maximize restoration following treatment. People who are going to receive treatment for head and neck cancer and are at risk for speech or swallowing prob­lems should see a knowledgeable speech pathologist before treatment begins, to start appro­priate therapy to prevent long-term speech and swallowing deterioration.

♦ ♦ ♦ ♦ ♦

Dr. Jan Lewin is a professor in the Depart­ment of Head and Neck Surgery and chief of the Section of Speech Pathology and Audiology at the University of Texas MD Anderson Cancer Center in Houston, TX.

This article was published in Coping® with Cancer magazine, July/August 2014.

The Hidden Scars of Breast Cancer

by Beverly McKee, MSW, LCSW

Inspiration image

As I emerge from a year of treatment for stage III breast cancer, I have 12 new scars. They vary in size, but each one bares a story of survival and a reminder of how much my body has endured in the name of surviving a life-threatening disease.

Though my physical scars have begun to heal and will eventually fade, I con­tinue to contend with the hidden scars left behind by breast cancer. The scars that you cannot see are often the hardest to heal.

♦ Loss of Innocence
The deepest hid­den scar of breast cancer was caused by the innocence I lost when I learned that cancer doesn’t discriminate. An unexpected breast cancer diagnosis put my life on a course that I never planned to take. One day I was finishing a 5K, healthy and happy, and the next I was fighting an insidious disease with all my might. My innocence was stolen on the day of my diagnosis, and my life will never be the same.

♦ The Big Bad Wolf of Recurrence
The fear of recurrence is an ever-present be­ing in my life. I refer to this fear as the big bad wolf. If I have a new ache or pain, I can feel him breathing down my neck, evoking sheer terror and over­whelming anxiety. I know that he will never leave for good, but I look forward to the day when he moves deep into a distant forest, leaving behind only an occasional footprint as evidence of his presence.

The deepest hidden scar of breast cancer was caused by the innocence I lost when I learned that cancer doesn’t discriminate.

♦ Research-Based Paralysis
Knowledge is power, but too much knowledge can be paralyzing. I miss being able to enjoy an occasional glass of wine without worrying about the statistics and purported causes of breast cancer recurrence. Wading through conflicting research to get to the facts is challeng­ing, no doubt.

♦ Chemo Brain
There’s a saying that goes “Of all of the things I’ve lost, I miss my mind the most.” It’s meant to be a joke, but anyone who has been through chemo knows that mental clarity should never be taken for granted. I liken my brain to swiss cheese – full of holes that the words on the tip of my tongue often slip through, derailing my train of thought.

♦ Early Menopause
Hot flashes, moodiness, and insomnia – oh my! The hormonal impact of chemo, a hys­terectomy, and estrogen-suppressing medication has certainly left its mark. Just ask my husband. He’s hiding in his office, fearfully anticipating my next outburst about how to load the dishwasher properly.

♦ Financial Repercussions
Cancer treatment is expensive. Even with great insurance, often there are deductibles to meet, co-pays to shell out, and certain medications, procedures, and treatment-related expenses that aren’t covered. What’s more, missed workdays, time off taken for medical appointments, and decreased productivity due to sleepless nights can affect your paychecks, depend­ing on your line of work.

Despite these scars, I have seen rain­bows through the storm of breast cancer. I may have lost my innocence, but I have a new appreciation for the little things in life. Every hug from my boys is precious, and the vivid beauty of the changing leaves is more awe-inspiring than ever. The big bad wolf of recurrence and my research paralysis have paved for me a path to a healthier lifestyle. My chemo brain is annoying, but I am learning to work around it with notes and reminders. Plus, I have a valid excuse for forget­ting a birthday or appointment here and there. As far as menopause, it happens to every woman at some point in life. And while the financial impact of can­cer is burdensome, I came out of this year alive. Who wouldn’t write a blank check to save their life?

After breast cancer, we can choose to hide our scars, viewing them as a tragic reminder of our journey, or we can wear them proudly, like a badge of survival. As for me, I choose to embrace my scars as battle wounds from a fight that I’m winning with every breath I take.

♦ ♦ ♦ ♦ ♦

Beverly McKee is a breast cancer survivor living in Wildwood, MO. Learn more about Beverly and her upcoming book, Celebrating Life Decades after Breast Cancer, at

This article was published in Coping® with Cancer magazine, 2014.

One Foot in Front of the Other

Why You Should Keep Moving through Cancer

by Linda T. Gottlieb, MA, CPT, CET

Wellness image

You probably already know that exercise is an important part of staying healthy and can even help prevent disease. But what if you have cancer? What can exercise do for you?

Many people living with cancer are eager to learn new ways to support their health. But some buy in to the misconception that because they have cancer, they can’t exercise. While it’s true that in the past doctors instructed people with cancer to avoid physical activity in order to get more rest – and this may still be the case for someone who has recently had surgery or for whom exercise causes an unhealthy increase in heart rate, feelings of dizziness, or severe pain – research has shown that exercise is actually beneficial for many cancer survivors. In fact, the American Cancer Society now recommends that survivors adhere to the same exercise guidelines as the general population: a minimum of 150 minutes of cardiovascular activ­ity per week.

The Benefits
Studies consistently show three benefits of exercise: improved physical fitness, greater self-esteem and well-being, and decreased levels of anxiety, depression, and fatigue. Because a cancer diagnosis and ensu­ing treatments can leave you feeling depressed, tired, and lethargic, this research is extremely encouraging.

Author of Article photo

Linda Gottlieb

Furthermore, exercise can provide you with a sense of control over your life, helping you feel like an active participant within your healthcare team. For many cancers, exercise has even been proven to help decrease the chance of recurrence.

Getting Started
Exercise doesn’t have to be a complicated activity. Simply walking to the mailbox, taking a stroll around the perimeter of your home, or walking up and down the stairs can be a terrific start. Take one step at a time (literally), and progress at your own pace. Don’t measure yourself against anyone else, especially the super-fit models and actors you see on TV or in magazines.

As you ease into an exercise routine, it might be helpful to record your prog­ress, thoughts, and feelings in a journal. This will provide a log of the posi­tive results your exercise efforts have returned, like improved sleep, decreased body fat, and a brighter view of your future. When you see how far you’ve come, your confidence will soar.

Before starting any exercise pro­gram, it’s important to talk with your doctor about the possible risks. But in most cases, the benefits of exercise far exceed any possible risks for cancer survivors. Exercise might be just what you need to help you get back to an improved level of physical and psycho­logical functioning.

♦ ♦ ♦ ♦ ♦

American Cancer Society/American College of Sports Medicine cancer exercise trainer Linda Gottlieb is a fitness and wellness professional at Yale University working on a national clinical trial involving gynecological cancer survivors. She is the author of No Ifs, Ands, or Butts: How to Turn the Top 10 Exercise Excuses into Fitness Triumphs.

This article was published in Coping® with Cancer magazine, July/August 2014.

Living Well with Advanced Prostate Cancer


Prostate Cancer Image

When your side effects are under control, you can get back to doing the things you love with the people you love.

Advanced prostate cancer refers to cancer that has spread beyond the prostate. If you’re facing a diagnosis of advanced prostate cancer, the key to maintaining good quality of life and a positive attitude while fight­ing the disease is making sure you understand the potential side effects of each treatment option you’re consider­ing, as well as how to deal with them.

Managing Side Effects
The side effects you will experience depend on several factors, including cancer stage, treatment choice, and your overall health. Here are a few suggestions for managing the most common side ef­fects of advanced prostate cancer.

Pain Taking steps to minimize pain is the best way to support your- self as you fight cancer. Reducing your pain makes it easier to think clearly and decreases stress, espe­cially when you’re in active treatment. Talk to your doctor about your op­tions for managing pain, which can include medications, physical therapy, and complementary techniques, like acupuncture.

Incontinence Urinary incontinence associated with advanced prostate can­cer is commonly caused by radiation treatment. Kegel exercises, which involve contracting and relaxing the muscles of the pelvic floor, can help to manage incontinence by strengthening your pelvic floor muscles. Ask your doctor to explain how and how often to per­form Kegel exercises.

Additionally, absorbent products, penile clamps, and catheter devices can be useful in managing incontinence. Another solution is a surgically im­planted device called a male sling that can be used to support the urethra. For moderate to severe incontinence, a surgically implanted urinary sphincter that permits voiding to empty the blad­der may be an option.

Intimacy Issues For many men, a healthy sex life is important; however, loss of libido is a common side effect of hormone therapy. Depending on the treatments used to attack your prostate cancer, regaining the level of sexual functioning you enjoyed before treat­ment may be difficult, but you do have options.

Medications such as erectile dys­function drugs help relax the penis, enabling blood to rush in and produce an erection. For difficult cases of erectile dysfunction, your doctor may recommend a penile implant that keeps the penis in a permanent semi-rigid state. Another option is an inflatable pros- thesis with a squeeze-activated pump.

Maintaining a Healthy Lifestyle
Studies continue to show a link between prostate cancer and diet. These studies indicate that men who wish to reduce their risk of prostate cancer, as well as men who have already been diagnosed with prostate cancer, may benefit from changing their diet. Specifically, fol­lowing these dietary principles may be helpful:

  • Reduce your intake of animal fat. Studies show that excess fat, primarily red meat and high-fat dairy, stimulates prostate cancer growth.
  • Avoid fried and baked foods, as well as the trans fatty acids in foods like margarine.
  • Eat more fresh fish with omega-3 fatty acids, especially cold-water fish like salmon, sardines, and trout. Avoid fried fish.
  • Significantly increase the amount of fresh fruits and vegetables in your diet. Studies show that colorful fruits and vegetables, as well as some nuts and seeds, contain powerful anticancer nutrients. Cruciferous vegetables (cabbage, broccoli, cauliflower) are protective against cancer. Red grapes and products from red grapes contain flavonoids that inhibit cancer cells. Similarly, tomatoes, especially tomato products, are rich in lycopene, a power­ful anticancer substance.
  • Avoid high-calcium diets. Studies show they promote prostate cancer growth.
  • Add pomegranate juice to your diet, as it may directly reduce PSA.
  • Choose supplements wisely.
  • Drink green tea several times per week.

An overall wellness plan of healthy living is important for promoting pros­tate health and fighting prostate cancer. Remember, if it’s heart healthy, chances are it’s also prostate healthy.

♦ ♦ ♦ ♦ ♦

Reprinted by the permission of ZERO – The End of Prostate Cancer from the “Managing Advanced Pros­tate Cancer” brochure, available at

This article was published in Coping® with Cancer magazine, July/August 2014.

For Better or For Worse

Denise & Alan Jackson Open Up about
Surviving Cancer as a Couple

by Jessica Webb Errickson

Celebrity Cancer Survivor

(Photos in this article courtesy of the Jackson family)

It all started in the small town of Newnan, GA – at the local Dairy Queen to be precise – long before country music veteran Alan Jackson would become the honky-tonk legend he is today. No, this wasn’t where the “Chattahoochee” singer got his big break. It was where, as a teen­ager, Alan met the love of his life, Denise. And today, after three and a half decades of marriage, three chil­dren, and a 25-year (and counting!) music career, the high-school sweet­hearts are more in love than ever.

That’s not to say that their relation­ship has been without struggle. Amid award-winning albums and chart- topping hits, Alan and Denise have survived some rough patches in their marriage, a topic Denise covers in her book It’s All About Him, but they’ve always managed to come out stronger on the other side. However, in 2010, when Denise was diagnosed with colorectal cancer, that strength was tested as they faced their biggest challenge yet.

Anniversary, Interrupted
“We were in Florida celebrating our anniversary when I got the call from my doctor,” Denise explains during an interview with Coping magazine. Prior to the trip, she had met with her doctor to address some unusual bleeding. A colonoscopy revealed a small growth, but Denise and her doctor both believed it was nothing to worry about. Lab results proved otherwise.

“It was the first time I felt like I was living out the phrase in our wedding vows ‘for better or for worse.'" - Alan

“When I found out it was squa­mous cell carcinoma, to say that it was the shock of my life is an under­statement,” Denise says with residual astonishment. “I eat a healthy diet. I exercise. I never dreamed that a doctor would tell me that I had cancer.”

Alan shared her sentiments. “I was just in disbelief. Denise had never even been sick in her life,” he says.

Without hesitation, the couple cut their romantic getaway short and hopped on the next flight home to Nashville.

In Sickness and In Health
Upon arriving in Music City, Denise met with an oncologist to learn more about the cancer she was facing and to come up with a plan of action. “Going into the treatment facility was overwhelming,” Denise admits. “To even walk into the cancer wing of a hospital – nothing can prepare you for the anxiety and fear that can bring.” Fortunately, she had Alan by her side.

“Sometimes the challenges we face lead us to discover what it is we’re commissioned to do in life." - Denise

“As her husband, I felt that my main responsibility, the thing I tried the most to do, was to just reassure and encourage her,” says Alan. “It made me realize how important it is to have someone there to walk with you through something like this.”

“When we would come home from doctor’s appointments and I was confused or worried,” Denise adds, “Alan was the one who would give me the clarity and encouragement I needed.”

“It was the first time I felt like I was living out the phrase in our wedding vows ‘for better or for worse,’” Alan says.

A Ray of Light
As frightened as she was to begin treatment, Denise had a good prognosis. She also had resolute faith that she would survive this challenge. “I’m a Christian, and I’m really strong in my faith. I cannot imagine going through this without that faith,” she says. “You think you’re so self-sufficient and you’re so in con­trol of everything, but when cancer comes, you realize ‘this is way bigger than me.’”

“[Cancer] gives you a new clarity about things and reminds you of how precious your family and your loved ones are." - Denise

Denise quietly underwent 30 days of radiation and two four-day rounds of chemotherapy. After two months of treatment, she was cancer-free.

“I never would have thought I would be calling myself a cancer survivor,” Denise says. “I do believe that I was allowed to go through this so that I could minister to others who are facing a similar situation and be there to encourage them. Sometimes the challenges we face lead us to discover what it is we’re commissioned to do in life. I feel like that’s the good that has come out of this experience.”

A Caregiver’s Ballad
Singer-songwriters seem to possess an innate ability to draw inspiration from the most unlikely sources, including per­sonal experiences that may be difficult to revisit. Denise’s Grammy-winning husband is no exception. “A few weeks after Denise’s diagnosis, this song just sort of came to me,” Alan says. “The lyrics reflect the thoughts and feelings I had during that time.”

Baring his soul, Alan penned “When I Saw You Leaving,” a power­ful ballad expressing the emotions he felt as a caregiver. The opening line perfectly captures the life-altering moment when a spouse is diagnosed with cancer: “Ain’t it funny how, one minute, your whole life’s looking fine, and a short few words later it all just comes untied?”

The song made its way onto Alan’s 2012 album, Thirty Miles West, which debuted in the #1 spot on Billboard’s country music chart. Fans had the chance to hear it performed live in March 2013 during Alan’s set at Stars Go Blue, a concert benefitting the Colon Cancer Alliance’s Blue Note Fund.

Having firsthand experience, Alan says his main piece of advice for people whose partners have been diagnosed with cancer is to just be there for them. “Be there to reassure them, encourage them, and support them,” he says. “You have to be strong for them.”

Moving Forward
Thinking back to that day at the beach when a phone call changed her life forever, Denise says, “Cancer opens your eyes to how pre­cious life is, how each day is a gift. It gives you a new clarity about things and reminds you of how precious your family and your loved ones are.”

Even after three years of clear scans, Denise admits that she still copes with fears of recurrence, but she doesn’t let them get the best of her. “This experi­ence has made me more proactive about staying healthy for the rest of my life – with exercise, less stress, and a healthy diet,” she says. “Cancer has had a tre­mendous impact on me, but it’s not going to define me.”

♦ ♦ ♦ ♦ ♦

In honor of a career spanning a quarter of a century, Alan has planned a year-long celebration, including a special Country Music Hall of Fame exhibit, which opened August 29, 2014, some new music, and an anni­versary tour scheduled for 2015. Keep up with Alan, Denise, and the rest of the family at

This article was published in Coping® with Cancer magazine, September/October 2014.

Words of Wisdom from “The Running Rabbi”

on Facing Illness and Adversity

by Rabbi Hirshel Jaffe

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Rabbi Hirshel Jaffe running in the 1978 New York City Marathon

In 1978, I bounded across the finish line of the New York City Marathon wearing a shirt identifying me as “The Running Rabbi.” I was equally as tireless in my calling as a rabbi in Newburgh, NY. I had marched for civil rights in the 1960s, rallied to free Soviet Jews, and in 1980 visited the hostages held in Iran. I’d never been sick in my life. I felt indestructible. That was then.

My illusion was shattered when, six years later, I was diagnosed with leuke­mia. For more than 20 years as a rabbi, I had helped others through crises. I was supposed to have all the answers. Yet when I got sick, I discovered I didn’t have them.

I won’t claim to have it all figured out now, but my experience has given me insights on how to cope with a serious illness, or any adversity for that matter. I want to share some of them with you.

♦ Cheer yourself on.
Ultimately, you must learn to comfort yourself. No mat­ter how many people are around during the day, reality can be very hard to face in the loneliness of the night.

♦ Be kind to yourself.
Hug yourself if you can’t find anyone else to hug. Don’t think of yourself as worthless, or worth less than you were before your diagnosis.

♦ Don’t be passive about your medical treatment.
Let your doctors know what you need.

♦ Learn to cherish your very existence.
Don’t feel guilty if you’re too sick to do something. You have value simply because you exist, even if you can’t be productive in the ways you were before your diagnosis.

♦ Hang on to your fighting spirit.
I really believe my fighting spirit meant the difference between life and death for me. My nurses told me that once, when I was delirious, I pounded on my bed rails yelling, “Come on, Hirshel!” I was cheering myself on like my wife and daughters cheered for me when I ran the marathon.

Author of Article photo

Rabbi Hirshel Jaffe

♦ Conversely, remember that attitude isn’t everything.
Having a good attitude can help you make the best of every situation, but it may not help you change your situation. You can’t control every­thing, only some things.

♦ Set goals for yourself.
No matter how small, reaching any goal helps you feel a sense of achievement.

♦ Write about your experience.
Writing a book about my illness gave me some­thing to live for. Some days it took a lot out of me to write even a few words, but com­pleting my book helped me keep my fighting spirit alive.

♦ Keep some normalcy in your life.
If you’re able to use your energy in some capacity, do it, even if you have just five good minutes a day. If physical limita­tions prevent you from doing usual tasks, try to devise new ways to do them.

♦ Do what makes you feel good about yourself.
When my physicians noticed how depressed I was in the hospital, they said, “Be a rabbi. Go counsel other patients.” Doing that made me feel important again. My friends who are fighting cancer tell me the same thing: helping others is one good thing they can do and find real fulfillment in doing.

♦ Don’t lose your sense of humor.
Learn to laugh at yourself and enjoy life. One morning in the hospital as the doctors made their rounds, I said to them, “I think these antibiotics are doing something to me! Something strange is happening to my body!” They burst into laughter. I was wearing a Frankenstein mask!

♦ Be thankful for each day and greet it joyously.
Live your life to the fullest. Since my diagnosis, every moment has been special to me.

♦ Decide what’s important in your life.
I’m learning to say no to people. I don’t want to fritter away my life letting others tell me how to live. For me, being with my loved ones is most important. And I make a point of telling these people how I feel about them often.

♦ Accept the support of your friends and family.
The strong support of every­one who loved me and prayed for me kept me going through my darkest hours. Don’t be afraid to let others know how vulnerable you are; it’s not a sign of weakness to accept help.

♦ Search for meaning from your adversity.
We can find meaning and hope even in our darkest days. I didn’t ask for this painful experience, but I can choose to grow from it and shape it into a positive force in my life.

By facing death, I learned how to live. My illness taught me the real mean­ing of being a rabbi. It’s not who can be the best scholar; it’s who can touch people, who can comfort them. I hope that as you walk your own path through illness, you let the power within you carry you over the rough spots, and I hope it stays with you too.

♦ ♦ ♦ ♦ ♦

Rabbi Hirshel Jaffe is a four-time leukemia and lymphoma survivor living in Peekskill, NY. On behalf of cancer survivors every­where, he received the Award of Courage from former president Ronald Reagan. Visit his website at

This article was published in Coping® with Cancer magazine, July/August 2014.

When a Grandparent has Cancer

by Kathleen McCue, MA, LSW, CCLS

Wellness image

There are many excellent resources for talking to children when a mom or dad is facing cancer. Countless websites, books, and magazine articles have addressed these issues, and the same points are identified and empha­sized time and again:

Be honest with children.
Offer information at the child’s developmental level.
Use the word cancer, instead of just saying that the person with cancer is sick, to help children distinguish be­tween this illness and others he or she may encounter.
Discuss feelings and emotions as much as you discuss the facts about cancer.
Emphasize ways for children to manage their reactions to the cancer.
Prepare children for what they will see, hear, and experience.
Assure children that they didn’t cause the cancer and they can’t catch it.
Help children understand how their own lives will be affected by a parent’s cancer.
Maintain as much of a normal routine as possible.

But what if the person with cancer is a grandparent, instead of a parent? Do the same strategies apply? The short answer is yes. However, there are some special considerations when helping a child cope with a grandparent’s cancer.

First, it’s important to remember that the most significant relationships in a child’s life are usually with his or her parents. The reason so much focus is put on helping children when a parent has cancer is we know that any challenge af­fecting a parent will also affect the child.

It is critical that parents and grandparents work together to decide what, when, and how to tell children about a grandparent’s cancer.

Author of Article photo

Kathleen McCue

But a child’s relationship with his or her grandparents is important too. It can be very confusing and disturbing for a child to hear one thing from a parent and then something conflicting from a grand­parent. Therefore, it is critical that parents and grandparents work together to decide what, when, and how to tell children about a grandparent’s cancer. You don’t want children to be caught in the middle of a conflict or disagreement between two very important people in their lives.

Parents generally have the ultimate responsibility for and authority over their children. So, even though it may be difficult, grandparents must respect the final decisions made by the parents regarding information provided to their children.

There are many types of relationships between children and grandparents. Some children are incredibly close to their grandmothers and grandfathers. Per­haps the grandparents care for the children while their parents are at work. Or they live nearby and see their grandchildren frequently. Perhaps the grandparents are actually legal guardians for their grand­children. For children in these types of situations, their responses will be very similar to those of a child whose parent has cancer. The stronger the relationship between grandparent and grandchild, the stronger the reactions the child will probably have, and the more support that child will need.

Sometimes the relationship between grandparents and grandchildren is not that close. Such might be the case when the grandparents live in another city or state and only see their grandchildren occasionally. However, it can be shock­ing to see a changed or ill grandparent, so children need to be prepared for what they will see before going for a visit. If a parent is spending a lot of extra time caring for the grandparent with cancer, children may react negatively to the parent’s absence. Children may also react to the worry and stress they perceive in their parents. Therefore, sometimes parents may need to provide a child with extra information about the situation and make sure that the child has additional support.

Even though grandparents are en­couraged to follow the wishes and guidance of the parents in talking to their grandchildren about cancer, grand­parents should not be put in the position of having to be dishonest with their grandchildren. What if a child asks a grandparent “Do you have cancer?” or “What’s the matter with you?” and his or her parents haven’t given the grand­parent consent to discuss the topic with that child? The grandparent can affirm that the child has asked a very good question, and suggest that they talk to his or her parents together about it. Then, the grandparent should let the child’s parents know what’s coming and en­courage an honest but hopeful response.

By working together, parents and grandparents can help children under­stand and cope well with cancer in the family while also teaching them skills for managing any challenges they may face.

♦ ♦ ♦ ♦ ♦

Kathleen McCue is the children’s program direc­tor at The Gathering Place (, a cancer support center in Northeast Ohio. Kathleen is the author of several books, including Someone I Love is Sick, a resource for helping very young children cope with a parent or grandparent’s cancer.

This article was published in Coping® with Cancer magazine, July/August 2014.

Write Your Way through Cancer

by David Tabatsky

Wellness image

(Illustration by Flash Rosenberg)

Expressive writing can be a wonder­ful tool for clarifying your thoughts, relieving stress, and improving communication skills. Each of these benefits alone is a great reason to write. Who can argue against clearing up the haze of our daily overload of informa­tion, stimulation, and trepidation? Who can object to writing their way to relax­ation? Who can rail against the benefits of better communication?

Twenty years of research, including a study conducted at the Lombardi Cancer Center at Georgetown Univer­sity in Washington, DC, and published in The Oncologist, reveals that dealing with our deepest thoughts and feelings through expressive writing can contrib­ute to improved physical and emotional health. For example, study participants who completed just one 20-minute writing session reported improvement in their general outlook on cancer and on their physical quality of life.

TIP: Play your favorite music as you write.

Author of Article photo

David Tabatsky

What if writing could do the same for you? What if you began expressing yourself in writing and that led you to communicate more effectively with your family, friends, and doctors? What if writing relieved some of your stress and helped you feel more in control of your situation? What if other people in your life were inspired by how well you’re coping with your challenges through writing and that helped them cope with their own?

Staying connected to your true self through expressive writing allows you to be present in three tenses at once: past, present, and future. Together, they represent one state of being, of living in the moment. Through expressive writing, you have the chance to get in touch with everything you’re dealing with – the good, the bad, and the ugly.

TIP: Read your writing aloud.

Two words can get you started: I am. I begin all of my writing workshops by prompting participants to describe them­selves, beginning with these two words, because in times of great change and stress, our sense of self is turned upside down and we question the way we pre­viously identified ourselves. Your “I am” description can start at your emotional center, or it may take off from a more philosophical place. It may incorporate a wide-angle view or focus on the minutiae of the moment. There are no rules. But there are compelling rea­sons for getting in touch with yourself through writing, especially when your very existence is being challenged.

If you’ve been diagnosed with cancer, this is the time to focus on you. If you’re a caretaker, focusing on your­self now and again is a good idea, too. Writing down your fears, your ques­tions, and your dreams will enable real communication with loved ones, friends, and doctors. Eventually, you may wish to share your writing with others, inspiring them with your per­sonal perspective.

TIP: Leave notebooks around the house
and fill them with your thoughts.

Right now, you may be feeling too raw to imagine sharing your innermost thoughts in this way. You may simply feel intimidated. The idea of writing may rekindle a nightmare called high school English class, during which your teacher made you write down that yucky stuff called “feelings” in a journal, and you forced yourself to produce just enough to secure a passing grade.

Relax. There are no grades to be earned here, only benefits to be ex­perienced. You just have to give your­self permission to express how you feel. This is your chance to get started. Each of us needs to communi­cate and share our feelings, no matter how tough that may be.

♦ ♦ ♦ ♦ ♦

David Tabatsky is the author of Write for Life: Communicating Your Way Through Cancer and has coauthored Chicken Soup for the Soul’s The Cancer Book, The Intelligent Divorce, and Beautiful Old Dogs, among many others. He teaches writing workshops at cancer centers around the country. Learn more about David at

For more inspiration and writing resources, visit

This article was published in Coping® with Cancer magazine, July/August 2014.

Drug Combination May Be Highly Effective in Treating Recurrent Ovarian Cancer


Photo by Cancer Type

Research presented at the American Society of Clinical Oncology’s 50th Annual Meeting suggests that the use of a combination drug therapy can provide significant improve­ment in women who have recurrent ovarian cancer.

A study sponsored by the National Cancer Institute compared the effec­tiveness of a combination of the drug olaparib (which blocks DNA repair) and the blood vessel inhibitor drug cediranib to the effectiveness of olaparib alone. Results showed a near doubling of progression-free survival benefit (the length of time during and after treatment that the cancer did not get worse) for the combination therapy over the use of the single drug alone.

“The findings of this study are excit­ing because they support the idea that combining these two targeted oral ther­apies results in significant activity in ovarian cancer, more so than olaparib alone,” says Joyce Liu, MD, MPH, the study’s lead investigator and medical oncologist at the Susan F. Smith Center for Women’s Cancers at Dana-Farber Cancer Institute in Boston, MA. “We are looking forward to further explor­ing this combination in ovarian cancer and potentially increasing effective treatment options for our patients with this cancer.”

In the study, 90 women with recurrent ovarian cancer were randomly assigned to one of two study arms, the first taking capsules of olaparib (400 mg twice daily) and the other taking a combination of the two drugs (200 mg olaparib in cap­sule form twice daily and 30 mg of cediranib by tablets once daily). Study participants, whose median age was 58, were enrolled from October 2011 to June 2013. As of March 2014, median progression-free survival was 9.2 months for the olaparib group and 17.7 months for the combination therapy group, which is a significant advantage. Although participants on the combination therapy experienced more side effects – most commonly fatigue, diarrhea, and hyper­tension – these side effects were all manageable.

“Of particular note is the fact that both drugs used in this trial are in pill form and could offer an alternative to intra­venous chemotherapy,” says Percy Ivy, MD, associate chief of NCI’s Investiga­tional Drug Branch. “Therefore, this combination therapy could be used anywhere in the world where patients can be safely monitored for the side effects of olaparib and cediranib, such as diarrhea and hypertension.”

Based on the results of this study, two phase III trials are being planned to study women with platinum-sensitive and platinum-resistant ovarian cancer by the NRG Oncology Group, one of NCI’s new National Cancer Trial Network Groups.

♦ ♦ ♦ ♦ ♦

This article was published in Coping® with Cancer magazine, July/August 2014.

I'm Not Waiting to Live

by Melissa J. Gallagher

Inspiration image

Melissa Gallagher with her daughters, Leah Faith and Paige Hope, and her husband, Matthew

Patience is a necessary virtue. We all have heard countless times throughout our lives that in order to succeed, we must be patient. To achieve what we want in life, we sim­ply must wait. I find myself repeatedly telling my own children, “Please, be patient. Wait.” But there are certain situ­ations in which we can’t wait; we have to act. Fighting cancer is one of them.

In 2005, at age 26, I was diagnosed with a rare type of cancer: small cell carcinoma of the ovary, hypercalcemic type. After repeatedly being told that my cancer had an average survival rate of three months, I was determined to create some new statistics.

Various factors contributed to my survival, including my age, overall health status, stage of disease, location, and plain good luck. But I believe there is one reason why I am alive today: I didn’t wait.

I didn’t wait to address my symp­toms. I didn’t wait to find oncologists who were willing to mix statistics and data with just the right amount of hope and optimism. I didn’t wait to live.

When I began experiencing symp­toms of what I would learn was ovarian cancer, my gynecologist determined that a large cyst was to blame, and I was scheduled for surgery two weeks later. Instinctively, I knew that two weeks would be too long to wait. I ended up having surgery only a week and a half later, and by a stroke of luck, it was performed by an oncologist who dis­covered my tumor.

I was determined to create some new statistics.

Once I was officially diagnosed with this rare cancer, I was thrust back into the waiting game. I called physicians around the world and waited when I was placed on hold. I scheduled appoint­ments and waited for them to arrive. I waited for my name to be called in waiting rooms, and then I waited again to see doctors in exam rooms.

I had come to accept that a certain amount of waiting would be necessary, but when I contacted a major cancer center and was told I’d need to wait a few weeks just for an appointment, I knew that this was one of those times when waiting just wasn’t an option. So I called back, sometimes several times a day. I explained my situation and its urgency over again until I hit the jackpot and appealed to that one person who was willing to listen. I got in.

Once I began treatment, which included three different types of chemotherapy drugs and an additional surgery, I knew I couldn’t wait until it was over to resume my life. So I kept on living. It was hard to live life to the fullest some days, but other days felt more full. I’ll never forget stepping outside the hospital doors on the day of my last treatment, the sun shining and the fresh March air on my face. Certain aspects of life were magnified and brilliant. The sun was almost blinding. Air had a life of its own. My feet were overly sensi­tive to the ground they touched. All of my senses were heightened. I knew sincerely that I was still alive.

When my cancer came back four years later, I found myself in the emer­gency room, waiting. I waited for a scan, and then I waited for the results. I called doctors and waited on hold. But I knew I couldn’t afford to wait to have the large tumor that was growing inside me removed. My life depended on it. I contacted the same major can­cer center, and rather than accept that I would have to wait for an appointment two weeks later, I managed to find a new physician and have a successful surgery a few days later.

People who don’t know me can’t believe that I was diagnosed on a Thursday and operated on by a new doctor the following Monday. The people who do know me can’t believe I waited that long! I won’t wait to live. You shouldn’t either.

♦ ♦ ♦ ♦ ♦

Melissa Gallagher is a two-time small cell ovarian cancer survivor living in West Islip, NY.

This article was published in Coping® with Cancer magazine, July/August 2014.

Just Got Diagnosed?

Here’s How You Can Prepare for the Road Ahead

by Gary R. McClain, PhD

Wellness image

“I just got diagnosed with cancer. Now what do I do?” As a therapist who works with people facing illness, I hear this question often. People come into my office struggling with their reaction to their cancer diagnosis, as well as all those strange and uncomfortable feel­ings that come with it. We talk about their fears and hopes regarding treat­ment, and we talk about what a cancer diagnosis means for their future.

Why Me?
If you’re like most people who have recently been diagnosed with cancer, you might be asking that unanswerable question, along with a few others: What will happen to me? What will my life be like? Will I be changed? It’s normal to feel this way. But it’s also possible to face your cancer diag­nosis, and all it will mean for you, from a position of power. This requires that you first form an optimistic outlook and arm yourself with information. It means you’ll need to connect with the people in your life who can help you as you develop a sense of a greater meaning beyond your day-to-day experience. It also means you’ll need to devise a realistic but hopeful plan for your future.

Allowing yourself to experience your negative emotions may give way to hope, optimism, and a renewed passion for life.

Author of Article photo

Dr. Gary McClain

Don’t Be Afraid to Feel
In many ways, the emotional reaction to a cancer diagnosis resembles the grieving pro­cess. A cancer diagnosis can feel like a loss; one meeting with your doctor suddenly changes the course of your life, at least for the near future. You may feel like your life has been turned up­side down. And you may grieve your pre-cancer lifestyle.

You can start preparing for the future by acknowledging the emotions you’re experiencing right now. It’s only human to have feelings of fear, anger, disappointment, and confusion when you’re told you have cancer. These feelings are normal, so don’t judge yourself harshly for having them. And don’t try to just ignore them, either. Your feel­ings won’t disappear just because you don’t want to deal with them. But when you acknowledge your true feelings, even those you wish you didn’t have, the effect is almost magical. Those difficult feelings lose their power over you. Sure, they might reappear at times, but allowing yourself to experience your negative emotions may also give way to hope, optimism, and a renewed passion for life.

Start Talking
Get to know other people with cancer, and learn how they’re coping. Get tips from the peo­ple you meet who are coping well with their own diagnosis. Talk to positive role models. Talk to your friends and family, and have conversations about how you can support each other in all aspects of your relationship, not just those related to your diagnosis. You might even want to consider joining a support group, linking up with online patient communities, meeting with a mental health professional, or all of the above. You don’t have to go through this alone.

Don’t Neglect Your Spirit
When you feel connected to your higher power, your sense of meaning expands beyond what you see and experience. There are many ways to define and experience spirituality. You can pray, practice medi­tation, read the works of spiritual teachers and apply their philosophies to your life, or become a member of a religious com­munity, church, or synagogue. Simply listening to music that is meaningful to you, doing something relaxing, enjoy­ing a hobby that makes you forget about everything else going on in your life, and spending time with loved ones can also be spiritual experiences.

A cancer diagnosis can feel like a punch in the gut, followed by the sense that life as you have known it has come to an end. Here is what you need to keep in mind: You are not a diagnosis. Your diagnosis is only a part of who you are. Remind yourself every day that you are a fascinating, multidimensional person with a past, a present, and a future that belongs to you and you alone. Try to see your diagnosis for what it is, and then look beyond it. Embrace your life with all of its triumphs, setbacks, surprises, and detours.

♦ ♦ ♦ ♦ ♦

Dr. Gary McClain is a therapist, patient advocate, and author living in New York, NY, who specializes in working with individuals who have been diagnosed with chronic and catastrophic medical conditions, their care­givers, and professionals. You can visit his website at

This article was published in Coping® with Cancer magazine, July/August 2014.

New Guidelines Address Long-Term Needs of Prostate Cancer Survivors


Photo by Cancer Type

New American Cancer Society Prostate Cancer Survivorship Care guidelines outline post-treatment clinical follow-up care for the myriad long-term and late effects that an estimated 2.8 million prostate cancer survivors in the United States may face.

The guidelines, published in the American Cancer Society’s CA: A Cancer Journal for Clinicians, are designed to promote optimal health and quality of life for prostate cancer survivors by facilitating the delivery of comprehensive post-treatment care by primary care clinicians. Based on recommendations set forth by an expert panel convened as part of the work of the National Cancer Survivorship Resource Center, the guidelines address health promotion, surveillance for recurrence and screening for second primary cancers, and the assessment and management of physical and psychosocial long-term and late effects of prostate cancer and its treatment.

The following recommendations for primary care clinicians are included in the guidelines:

Since information needs evolve as men transition from treatment through various stages of survivorship, regularly assess survivor and caregiver information needs and provide or refer to informa­tion and support services as necessary.

Evaluate survivors regularly to deter­mine appropriate levels of participation in health promotion and lifestyle modi­fication programs.

Routinely assess body mass index among survivors, and recommend that survivors who are overweight or obese limit their consumption of high-calorie foods and beverages.

Educate survivors on the association between physical activity and lower overall and prostate cancer-specific mortality and improved quality of life.

Because smoking after prostate cancer treatment increases the risk of cancer recurrence and second cancers, ask survivors about tobacco use, and offer or refer them to cessation coun­seling and resources as needed.

Measure PSA levels every six to twelve months for the first five years after definitive treatment, and then recheck annually.

Be aware that men who have had radiation treatment have a slightly increased risk of developing second primary cancers compared to men who underwent surgery. Adhere to routine ACS screening guidelines for the early detection of any new cancers.

Assess physical (urinary, sexual, bowel) and psychosocial effects of prostate cancer and its treatment; the focus of assessment should be tailored to the type of cancer treatment received and current disease state to trigger ap­propriate self-management and clinical management strategies for support and therapy.

Identify, treat, and routinely assess survivors for psychological distress.

♦ ♦ ♦ ♦ ♦

This article was published in Coping® with Cancer magazine, July/August 2014.

Diagnosis: CLL

Your Guide to Understanding How Chronic Lymphocytic Leukemia is Treated


Photo by Cancer Type

Chronic lymphocytic leukemia is a type of cancer in which the bone marrow makes too many lympho­cytes (a type of white blood cell). CLL, a slow-growing blood and bone marrow disease, is one of the most common types of leukemia in adults.

If you’ve been diagnosed with CLL, you’re probably wondering about your options for treating the disease. Differ­ent types of treatment are available for people with CLL. Some treatments are standard (the currently used treatments), and some are being tested in clinical trials. Certain factors affect treatment, including the stage of the disease; red blood cell, white blood cell, and plate­let blood counts; presence of symptoms such as fever, chills, or weight loss; whether the liver, spleen, or lymph nodes are larger than normal; response to initial treatment; and whether the CLL has recurred.

Currently, five types of standard treatment are used for CLL: watchful waiting, radiation therapy, chemotherapy, surgery, and targeted therapy. Here is a breakdown of these treatments, as well as some information on a couple of treatments that are being tested in clinical trials.

Five types of standard treatment are used for CLL.

Watchful waiting involves your doc­tor closely monitoring your condition without treating it until CLL symptoms appear or change. During this time, problems caused by the disease, such as infection, are treated.

Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a ma­chine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the blood­stream and can reach cancer cells throughout the body (systemic chemo­therapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy).

Surgery to remove the spleen (splenectomy) can relieve the discom­fort of an enlarged spleen and, for some people, increase blood cell counts. However, surgery is not in­tended to cure the disease.

Targeted therapy uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibody therapy and tyrosine kinase inhibitor therapy are types of targeted therapy used in CLL treatment.

♦ Monoclonal antibody therapy uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances in the body that may help cancer cells grow. The antibodies attach to those substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

♦ Tyrosine kinase inhibitor therapy is a treatment that blocks signals needed for tumors to grow.

Clinical trials are research studies meant to help improve current treatments or obtain information on new treatments for people with cancer. When clinical trials show that a new treatment is bet­ter than the standard treatment, the new treatment may become the standard treatment. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. The following are two CLL treatments that are being studied in clinical trials.

♦ Chemotherapy with stem cell transplant is a method of giving chemo­therapy and then replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from your blood or bone marrow, or from that of a donor, and are frozen and stored. After chemo­therapy is completed, the stored stem cells are thawed and infused into your body, where they can grow into (and restore) your blood cells.

♦ Biologic therapy (also called biotherapy or immunotherapy) uses your immune system to fight cancer. Substances made by your body or made in a laboratory are used to boost, direct, or restore your body’s natural defenses against cancer.

Follow-up tests may be needed throughout the course of your treatment. Some of the tests that were done to diagnose or stage your cancer will be repeated in order to see how well treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some tests will be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred.

♦ ♦ ♦ ♦ ♦

If you’re interested in joining a clinical trial, visit to find one in your area.

Source: National Cancer Institute,

This article was published in Coping® with Cancer magazine, July/August 2014.

Still Standing with Late-Stage Lung Cancer

8 Years and Counting

by Joseph Liguori

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If I’ve learned anything from my battle with cancer, it’s that can­cer can find anyone; it doesn’t discriminate. But more importantly, I’ve learned that a frightening and bleak cancer diagnosis is not necessarily a death sentence.

My entire life was turned upside down when I was diagnosed with lung cancer eight years ago. I had enjoyed an active, healthy lifestyle. I didn’t smoke. I watched what I ate. It wasn’t until a physician friend of mine ex­pressed concern about my cough during a game of basketball that I had any reason to see a doctor. Everyone in my office had a cough, so I didn’t think much of it. Still, I took my friend’s advice and visited a nearby hospital to have it checked out.

I was shocked to learn that my cough wasn’t merely a symptom of a cold go­ing around my workplace. I had stage IV lung cancer that had metastasized to my chest and spine. What’s more, I was told that the cancer had spread so far that neither surgery nor chemo­therapy would help and that I should get my finances in order and go on a vacation with my family.

I decided that I would do everything I could to beat this cancer.

Instead, I decided then and there that I would do everything I could to beat this cancer. I was sure there were more options, and I was determined to find them. My local hospital had a great reputation nationwide, but it specialized in cardiovascular care, so I decided to seek out the top cancer treatment centers this country had to offer.

I believe it is because of my perse­verance in pursuing the best possible cancer care that I am still here today. I did some research, chose a cancer center, and began an aggressive treatment regimen to fight my lung cancer. In addition to the tumors in my lung, chest, and spine, the cancer had metastasized to my brain, resulting in recurrent brain tumors for which I’ve received various forms of targeted chemotherapy and brain radiation, including stereotactic radio­surgery, a treatment that delivers a high dose of targeted radiation over a short time.

While my journey with cancer will never truly be over, I am thankful that advanced options for cancer treatment are available for people like me with late-stage cancer. I still make a con­scious effort to live a healthy lifestyle, which includes eating nutritiously and exercising. I also stay up to date on the latest developments in the field of oncology and continue to work with an all-star team of doctors to manage my ongoing care. Taking these steps helps me feel more in control of my own destiny and proud knowing that I’m playing an active role in yielding my best possible chance of survival. My advice to fellow cancer survivors is this: Advocate for yourself, seek out the most advanced cancer treatments available, and most importantly, never give up hope.

♦ ♦ ♦ ♦ ♦

Joseph Liguori is a stage IV lung cancer survivor living in AZ.

This article was published in Coping® with Cancer magazine, July/August 2014.

A Clinical Trial System for the Era of Precision Cancer Medicine

A Report from the National Cancer Institute

by Jeffrey Abrams, MD

Photo by Cancer Type

The National Cancer Institute has the largest oncology clinical trials program in the world, supporting, fully or in part, 3,775 active clinical trials and enrolling more than 35,000 clinical trial participants annually. Yet, as a di­rector of NCI-supported clinical trials, I know that behind every statistic is a person, each of whom brings his or her own motivations and hopes to the table when deciding whether to participate in a clinical trial.

For instance, Pamela, who was diag­nosed with multiple myeloma, explains her decision to participate in a clinical trial this way: “This will be my chance to help give back and to help other people, maybe even my family, in the future.”

Clinical trials, which typically involve hundreds of volunteers like Pamela, are the final step in the often long, arduous process of determining whether new medications, tests, imaging techniques, and other treatment strategies are safe and effective. The U.S. Food and Drug Administration approves most cancer drugs only after a large clinical trial finds the drug to be capable of improving treatment outcomes, either by delaying tumor recurrence or prolonging survival compared to the standard treatment, assuming that the new treatment doesn’t produce serious side effects that outweigh the potential benefit of extended life.

NCI-supported clinical trials, which take place in research institutions and in communities across the country, have produced many important advances in cancer care over the past 50 years. For example, clinical trials have dem­onstrated the importance of using chemotherapy after surgery to improve survival in common cancers like colorectal and breast cancer, established new ways to manage treatment-related side effects like nausea and fatigue, and vastly improved survival for many children with cancer while reducing the short- and long-term side effects of treatment.

Many of the changes to NCI’s clinical trials pro­grams are the result of nearly a decade of work, including exhaustive reviews by several groups of outside experts and recommendations from the Institute of Medicine.

Author of Article photo

Dr. Jeffrey Abrams

However, even with a solid record of accomplishments, we know it is crit­ical that the structures we support to conduct clinical trials keep pace with the latest advances in cancer research. The pre-clinical component of new drug development – that is, the research per­formed in the laboratory on cells and in animal models, for example – has shortened, and new drugs now move from the laboratory to the clinic with much greater speed than in the past. To take advantage of this, the clinical trial infrastructure must be nimble, efficient, and capable of screening large numbers of people to find those whose tumors are best suited to the new drug being tested. That’s why we are transforming NCI’s clinical trials system in a way that ben­efits researchers, the institutions that support and conduct the trials, and most importantly, people like Pamela, who rely on clinical trials for state-of-the-art treatments that may lead to better strat­egies for treating and managing cancer.

Responding to Complexity
Advances in medical technology and our under­standing of cancer have changed the science of cancer research. To keep pace with those advances, and to accommo­date the fiscal climate in which we live, NCI is adapting its clinical trials pro­gram to ensure that we serve the needs of the people who are relying on it.

Researchers can now dive deep into the machinery of cancer cells, as well as the normal cells and tissues that sur­round tumors, allowing them to dissect the communication pathways in tumor cells and catalog the molecular changes that allow tumor cells to evade chemo­therapy, radiation, and attack by the immune system.

This evolution in our understanding of cancer means that we no longer think of cancer as a monolithic disease that behaves in a uniform fashion in every person who is diagnosed. We are increas­ingly describing and treating individuals’ diseases according to the genetic and biochemical changes that are driving it to grow and spread. We call this treat­ment approach precision medicine. It recognizes that each person’s cancer is unique, and that, as much as possible, treatment must be selected based upon the alterations seen in each tumor.

It’s our greater appreciation of the complexity of cancer, and the always present need to manage taxpayer dollars in the wisest, most judicious fashion, that necessitate the way we plan and conduct clinical trials.

Better Science, Better Results
This past March, NCI officially launched the National Clinical Trials Network (NCTN), a new clinical trials network that pro­vides an infrastructure for NCI treatment, screening, and diagnostic trials. Later this year, NCI will launch the National Community Oncology Research Program (NCORP), a community-based program that complements the treatment trials of the NCTN but also emphasizes can­cer control (trials aimed at reducing side effects from cancer or its treatment) and cancer prevention trials. NCORP will also study cancer-care delivery issues, studying how cancer care is ac­tually delivered to people in their own communities by examining the impact of economic and behavioral issues af­fecting healthcare delivery. Both NCTN and NCORP are the products of the consolidation of existing clinical trials programs. Indeed, the predecessor to the NCTN, the Clinical Trials Cooperative Group Program, had remained essentially unchanged for more than five decades.

NCTN is devoted to conducting late-stage (phase II and III) clinical trials that test new treatments and new ways of incorporating advanced imaging tech­nologies into treatment. Working in tandem with NCTN, NCORP will focus (although not exclusively) on trials that will test new ways of preventing cancer and improving the delivery of care, as well as studies that provide important information about the effectiveness of commonly used treatments.

The former nine adult Cooperative Groups (research teams, often from large academic medical centers, that work together on clinical trials) have consolidated to form four adult groups in NCTN, and, as was the case under the previous clinical trials system, an ad­ditional large group is focused solely on childhood cancers.

The NCTN launch features a num­ber of other critical changes, including

  • a new infrastructure to capture and manage the wealth of data from NCI-funded trials;
  • a standardized process for reviewing and prioritizing proposals for new clinical trials, with an emphasis on supporting trials that are likely to most benefit patient care;
  • a focus on speeding up the launch of trials and establishing a more rigorous process for ensuring that they stay on schedule and are completed as quickly as possible; and
  • a unified, centralized system that en­sures a more streamlined ethics review is possible while still insuring all the necessary safety precautions are in place for trial volunteers.

NCORP consolidated two community-based clinical research programs into a single entity. The new program ensures that people across the country, in com­munities large and small, have access to cutting-edge research and can be part of the movement toward precision med­icine. The program’s operating approach will share the principles underlying the approach used in the NCTN.

We’re already seeing what the future of clinical trials looks like with the re­cent launch of Lung-MAP, the first of several NCTN precision medicine clin­ical trials. These trials will use the latest genomic technologies to identify the molecular drivers of individuals’ cancers and test whether new agents that target tumors with these molecular abnormali­ties are superior to standard treatments.

Upholding Our Commitment
Many of the changes to NCI’s clinical trials pro­grams are the result of nearly a decade of work, including exhaustive reviews by several groups of outside experts and recommendations from the Institute of Medicine. Leading cancer researchers, experts in clinical trials, and patient advocates all played critical roles in formulating these changes.

Even with the extensive feedback and preparation that has gone into this transition, changes as substantial and important as these are never easy. We are working closely with the research community to manage the challenges, to answer the critical questions, and to ensure as smooth a transition as possible.

Throughout this process, we at NCI will make certain that the fundamental principles and values of clinical research are upheld. We remain committed to each person enrolled in a clinical trial and will ensure that they continue to have the opportunity to receive the full benefit of those trials.

The leadership at NCI is confident that this effort will succeed. The pace of scientific advances and the hundreds of thousands of people each year who depend on those advances demand nothing less.

♦ ♦ ♦ ♦ ♦

Since 1994, NCI has pro­vided an exclusive report for Coping’s July/August Celebration Issue. Dr. Jeffrey Abrams is associate director of the Cancer Therapy Evalu­ation Program and acting director of Clinical Research in NCI’s Divi­sion of Cancer Treatment and Diagnosis.

If you’re interested in participating in a clinical trial, visit to find a study near you.

This article was published in Coping® with Cancer magazine, July/August 2014.

Should You Consider Genetic Counseling and Testing?

by Ellen T. Matloff, MS, CGC, and Karina L. Brierley, MS, CGC

Knowledge image

Genetic counseling and testing have become integral tools in the fight against cancer. The results can provide important informa­tion to help guide appropriate surgical decisions, treatment, surveillance, and prevention strategies for an individual and his or her entire family. Awareness and availability of cancer genetic coun­seling and testing, criteria for insurance coverage of testing, and available test­ing options have expanded rapidly in the past decade. Therefore, even cancer survivors who did not previously have the chance to undergo genetic counsel­ing and testing, or who tested negative in the past, may now be candidates for these services.

What is genetic counseling?
Genetic counseling is a communication process with a board-certified genetic counselor that involves a thorough investigation of your personal and family medical history to assess the likelihood that the cancers in your family are due to a genetic muta­tion (change in the genetic code) and help determine if you are a good candidate for genetic testing. A genetic counselor can also help deter­mine which testing options would be the most appropriate – there are numerous genes associated with cancer risk and many testing options – and if your insur­ance will likely cover the cost of testing. He or she can discuss the risks, benefits, and limitations of testing and the medi­cal options available to individuals who carry a genetic mutation. The genetic counselor will also interpret your test results, discuss your medical options based on the results, assist you in relay­ing this information to your medical team, and provide resources and support for you and your relatives.

Author of Article photo

Ellen Matloff

Who should consider genetic counseling?
Most cancers are not due to a single hereditary mutation. How­ever, there are a number of risk factors that increase the chance that cancer is hereditary:

♦ Early age of cancer onset When certain cancers are diagnosed at an early age (for example, breast, colon, or uterine cancer before age 50, or kidney cancer before age 46), it in­creases the chance that the cancer is hereditary.
♦ Multiple family members with the same cancer If several relatives on the same side of the family have all had the same type of cancer, it increases the chance that these cancers are hereditary.
♦ Clusters of cancers caused by the same genetic mutation If relatives on the same side of the family have differ­ent cancers that are known to be caused by the same genetic mutation (for example, diagnoses of breast, ovarian, and pancre­atic cancers or colon, uterine, and ovarian cancers), the chance that the cancers are hereditary is increased.
♦ Multiple primary cancers diagnosed in one person If a single person devel­ops more than one primary cancer (as opposed to one cancer that has spread to other parts of the body), particularly if those cancers fall into the clusters described above, it increases the likeli­hood that the cancers are hereditary.

Author of Article photo

Karina Brierley

♦ Ethnicity Some genetic diseases are more common in certain ethnic back­grounds. For example, hereditary breast and ovarian cancer is more common in people of Jewish ancestry.
♦ Unusual presentation There are several uncommon cancers (like male breast cancer) and findings (such as dozens of colon polyps) that are more often hereditary and warrant a referral to a genetic counselor.
♦ Pathological findings In some cases, pathology is a critical tool in genetic risk assessment. Certain subtypes of cancer are more likely to be hereditary (for example, triple-negative breast can­cers). Pathology can also determine which hereditary cancer syndrome is more likely to be the cause of a par­ticular cancer.

Why would I want this information?
Some cancer survivors wonder why they would want genetic counseling and test­ing if they have already had cancer, and some worry that it will feel like opening Pandora’s Box. However, genetic coun­seling and testing can help you to prevent a future cancer and arm your relatives with important knowledge that can help them avoid developing cancer.

Do I really need to see a genetic counselor? Can’t I just have testing through a direct-to-consumer testing company or have my doctor order it?
In order for genetic testing to be benefi­cial, the correct, validated test must be ordered through a clinical laboratory, results must be interpreted accurately, and the appropriate medical recommen­dations must be made. The genetic tests offered through direct-to-consumer companies are often classified as “enter­tainment” rather than for clinical use and may not meet these standards. Many cases of errors resulting in unnecessary surgery and advanced cancer diagnoses have been reported when testing was not accompanied by counseling through a certified genetics professional. Be­cause this testing may be critical for you and your entire family, it is essential that you work with a provider who has grad­uate training and certification in genetics.

♦ ♦ ♦ ♦ ♦

Ellen Matloff is a research scientist in Genetics and director of Cancer Genetic Counseling, and Karina Brierley is a genetic counselor, both at Yale Smilow Cancer Center at the Yale School of Medicine in New Haven, CT.

To find a genetic counselor in your area, visit the National Society of Genetic Counselors website, For telephone-based genetic counsel­ing services, you can contact InformedDNA at (800) 975-4819, or visit for more information.

This article was published in Coping® with Cancer magazine, May/June 2014.

Let’s Talk about It

by Julie Larson, LCSW

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A cancer diagnosis can impose a great deal of uncertainty into your life. As you struggle to make sense of your experience, you may find it difficult to decipher your needs and feelings, let alone communicate them to the people in your life who want to help. Facing your first day back to work, a large family gather­ing, or even a casual night out with friends can be daunting when you’re not sure how to approach conversa­tions about your cancer. Learning a few simple strategies for better communication can help keep you from feeling misunderstood, isolated, and overwhelmed.

♦ Identify your needs and feelings.
Before you can begin to com­municate your needs and feelings to others, you must first identify them for yourself. What do you need people to understand about your situation? What has helped you during difficult situa­tions in the past? Do you need someone to help you with a task, offer advice, or simply listen to what you have to say? The answers to these questions might help tailor your response when people ask what they can do to help you. If you’re still not sure, it’s OK to say, “I don’t even know what I need right now” or “I’m still working to understand everything, and it’s best if I don’t get ahead of myself.”

Let your loved ones know if you want to talk about your feelings or if you prefer to be more private.

Author of Article photo

Julie Larson

♠ Know your audience.
Once you’ve identified your needs, you can begin to pinpoint the people in your life who can help meet those needs. While some people consistently know the right things to say, others are more likely to pitch in and help in prac­tical ways. So for example, you might approach the former when you’re feel­ing overwhelmed and need someone to offer advice to help calm you down, and the latter when you’re feeling fa­tigued and need someone to help you with household chores.

♣ Help others help you.
Don’t feel shy about teaching people how to talk to you or letting them know where you want a conversation to go. In fact, your loved ones are often seek­ing this type of guidance. Let them know if you want to talk about your feelings or if you prefer to be more private. If you don’t feel like talking about cancer, tell them, “I just need to distract myself and focus on other things today.” On the other hand, if you need a little extra support, you might say, “My thoughts keep coming back to the possibility of recurrence. Normally I feel more in control, but today I am more sensitive.”

♥ Rehearse a “back pocket” response.
When you’re caught off guard with unexpected questions, inappropriate statements, or the unsolicited opinions of others, you might find yourself feeling flustered and babbling as you work to procure a response. Having a few simple, straight­forward responses prepared, rehearsed, and “in your back pocket” can help you feel more in control and confident when an unexpected comment pops up. You might say, “Thanks for checking in. I’m taking things one day at a time and finding what works best for me,” “I’ve had ups and downs, but I have a great medical team, and my family has been a wonderful support,” or even “I appre­ciate your concern, but let’s talk about something else today. I can’t focus on cancer all the time. How are you?” These responses can shift the focus of the con­versation, correct a person’s assumptions about what you’re going through, and perhaps even calm their worries about your situation.

♦ Remember that communication encompasses more than words.
Body language is a powerful tool that allows us to communicate without using any words at all. A simple touch or a glance across a dinner table can speak for you when words are hard to find. You can also use body language to appear more confident; for example, by sitting up straight and maintaining eye contact with the person you’re talk­ing to. This can be helpful when you need to assert yourself despite under­lying feelings of uncertainty. Moreover, when you appear more confident, you may even end up feeling more confi­dent too. Communication is an integral part of the cancer experience. From the vital conversations you have with your med­ical team regarding treatment planning to the intimate expressions of emotion and hope you share with loved ones, these moments help shape your cancer experience. Learning how to communi­cate your needs and feelings takes time. But each conversation you have pro­vides vital feedback to help you improve your communication skills for future conversations.

♦ ♦ ♦ ♦ ♦

Julie Larson is a psychotherapist in New York, NY. In her practice, she works primar­ily with people under the age of 40 on issues surrounding wellness, loss, and life transi­tions. She speaks often to both survivor and professional audiences on the impact of a serious illness at a young age.

This article was published in Coping® with Cancer magazine, May/June 2014.

Managing Nutrition-Related Side Effects of Cancer Treatment

Tips You Can Chew On

by Carly Roop, RD, LDN, CSO

Wellness image

Many studies have found that good nutrition plays a role in improved cancer survival. How­ever, treatment-related side effects, if left unmanaged, can complicate things. Side effects can compromise a person’s ability to get the nutrition they need and stay on course with their treatment. As a nutrition counselor, my job is to help you prevent and manage side ef­fects that interfere with good nutrition during treatment.

Nausea and Vomiting
Managing nausea caused by radiation or chemo­therapy requires a proactive approach. Some chemotherapy drugs are more likely to cause nausea and vomiting than others are. Moreover, your propensity for nausea may play a role in the extent of nausea and vomiting you experience. If you are prone to nausea, the use of prescription anti-emetics may be neces­sary to manage this side effect.

Smaller food portions are often easier to handle when you’re feeling queasy, and snacking throughout the day on dry cereal, pretzels, or other bland foods, like a baked potato, may help to dissipate nausea. Consuming ginger and ginger-infused products has been shown to provide relief as well. It’s important to stay well hydrated during treatment, so drinking water is always encouraged, but you may be able to better tolerate broth, lemonade, or ginger ale when you’re nauseated.

Smaller portions are often easier to handle when you’re feeling queasy.

Author of Article photo

Carly Roop

Sometimes even the smell of food can trigger nausea. Keep a window open while cooking or baking, and wait for foods to cool down before eating them. You might want to consider sticking to cold foods, as they have less of an aroma. Nevertheless, even chilled liquid meal replacement drinks or shakes may be better tolerated when their scent is concealed in a travel mug.

Chemotherapy and radiation can sometimes cause you to experience heartburn, especially after overindulging or eating spicy foods. Heartburn may also result from consti­pation, another common side effect of cancer treatment. If you’re experiencing treatment-related heartburn, ask your doctor if you would benefit from taking a proton-pump inhibitor, a medicine that reduces the amount of stomach acid made by glands in the stomach lining. You also should limit your intake of caffeinated beverages and greasy, spicy, or acidic foods, such as tomatoes and citrus fruits, and you’ll want to avoid peppermint as it may increase heart­burn as well.

Managing constipation can be as simple as eating high-fiber foods, drinking more fluids, and engag­ing in some physical activity. Many people find that adding flax meal to smoothies or oatmeal is a successful way to manage constipation. Some old-fashioned remedies, such as drinking hot water with lemon or eating stewed prunes, also can do the trick. However, if you’re taking opioids to control pain, you may need to talk with your doctor about taking stool softeners or laxatives to help with constipation as a side effect of those medications.

On the other hand, if you’re experiencing loose stools during treat­ment, try incorporating foods that contain stool-bulking soluble fiber, such as bananas, applesauce, white rice, and white toast, into your diet. Smooth nut butters, white pasta, tapioca, and, surprisingly, marshmallows can help by slowing down digestion. Drinking sports drinks containing electrolytes is also recommended. If you’re undergoing radiation to the lower abdomen or pelvis, or if you’re on certain chemotherapy drugs, it may be necessary to take anti-diarrheal medication and follow a low-fiber diet.

Oral Complications
Sore mouth and taste changes can make eating difficult during treatment. It may be wise to avoid crunchy, salty, and acidic foods if you have mouth sores. It may also be help­ful to drink through a straw.

If you’re struggling with taste aver­sions, this is a good time to experiment with dips, condiments, and different herbs and spices to enhance your food’s flavor. If you enjoy only the first few bites of a food, try fixing yourself a meal with small portions of a few different foods so you aren’t overwhelmed but won’t get bored while eating either. Rins­ing your mouth with saltwater or baking soda solutions can help rid your mouth of bad tastes and heal mouth sores.

As you go through treatment, con­sider keeping a journal to track any side effects you experience. Then, work closely with your doctor and a regis­tered dietitian (if one is available at your cancer center) to ensure that your side effects are well managed and you’re getting the nutrition you need.

♦ ♦ ♦ ♦ ♦

Carly Roop is a certified specialist in oncol­ogy nutrition at Abramson Cancer Center at Pennsylvania Hospital in Philadelphia, PA.

To find a certified oncology nutrition specialist in your area, visit

This article was published in Coping® with Cancer magazine, May/June 2014.

The Bald Blessing

by Nicole Malato

Inspiration image

The other morning I looked into the mirror, just as I do every day. The woman with no wig on her head and no makeup on her face had a very different appearance from the dolled-up version who prefers to shield those around her from what cancer really looks like. This is the real me, a private reality that often brings sadness to my heart as I examine my reflection.

However, this particular morning was different. I saw that same bald woman sans makeup, but rather than thinking how pathetic, the world blessed came to mind. I realized that I have received so many blessings through my cancer journey.

Simply being in treatment is a bless­ing. I know that may sound odd. Trust me, nothing would be more pleasing than to hear my doctor say that all is well and I don’t need treatment any­more. But in the meantime, I am more than OK with having to go for treatment because it means there are things my doctors can do to manage my disease. No matter how unpleasant those things may be, knowing that my cancer can be treated is a blessing.

Knowing that my cancer can be treated is a blessing.

With this realization, I stopped feel­ing sorry for myself. Instead, I now feel proud and blessed to have options available to me. I am bald because my cancer is being treated, and that’s a good thing. To be honest, wearing a wig takes the extra stress of styling my hair out of my morning routine anyway. Plus I don’t have to worry about taming the humidity-induced frizz I battled for the previous 34 years.

My advice for you is this: Don’t fret over treatment. Treatment begets hope, and hope is what carries us forward each day, giving us dreams to live for and reasons to fight. I am here because my cancer can be treated. I may be bald, but I am blessed.

♦ ♦ ♦ ♦ ♦

Nicole Malato is a breast cancer survivor and mother living in Toms River, NJ.

This article was published in Coping® with Cancer magazine, May/June 2014.

Women, Cancer, & Sexual Health

by Yung A. Park, MD, and Elena Ratner, MD

Wellness image

Sexual dysfunction is a common side effect of cancer and its treat­ment, but this doesn’t mean you have to accept it as part of your “new normal.” You can reclaim your sexuality. Many women are even able to get back to the level of sexual functioning and intimacy they enjoyed before cancer.

First, it’s important to understand how cancer affects sexual health. Cancer treatments can temporarily or perma­nently alter the nerves, blood vessels, and sex hormone levels that control nor­mal sexual function. In female cancer survivors, this sex hormone is estrogen. Low estrogen levels can significantly affect a woman’s quality of life in a number of ways.

Hot flashes are a common issue caused by low estrogen levels. They can be severe enough to impair your quality of sleep, which can affect your sexual health. Steps you can take to control hot flashes include eating a healthy diet, losing excess weight, limiting your caffeine intake, and avoiding alcohol, spicy foods, and MSG (monosodium glutamate). Wearing clothing made of natural rather than synthetic fibers, and wearing loose, thin layers rather than thick, tight-fitting clothing, can help as well. If hot flashes are affecting your quality of sleep, try lowering your bed­room temperature at night by keeping a window open or using a fan. Both hormonal and non-hormonal medica­tions are available for relieving hot flashes, but you will need to talk with your doctor to determine which options might work best for you.

By keeping an ongoing open and honest dialogue about your feelings, fears, and concerns with your partner, you can begin to overcome the barriers to sexual intimacy.

About Coping

Dr. Yung Park

Vaginal dryness is another sexual health issue caused by low estrogen levels. Vaginal dryness can result in painful intercourse as well as frequent urinary tract infections. While over-the-counter lubricants can be effective for many women, they may not work as well for some. For the latter group, your doctor may recommend medications to help counteract vaginal dryness.

Low sex drive, or libido, can also be caused by low estrogen levels; however, it can be psychologically based as well, brought on by depression, anxiety, body image issues, or feelings of shame, guilt, or anger. After cancer treatment, fear of recurrence also may be a contributing factor to your low sex drive. A mental health provider who specializes in psycho-oncology can help you get to the bottom of what’s causing your decreased libido and can teach you techniques you can use to improve sexual functioning.

Author of Article photo

Dr. Elena Ratner

Intimacy problems may also arise during cancer. You may avoid being intimate with your partner if physical changes have negatively affected your body image. Likewise, your partner may feel wary of initiating sexual activity due to fear of causing you discomfort or pain. If you’re single, you may refrain from dating because of low self-esteem or the fear that you would be rejected because you have cancer. By keeping an ongoing open and honest dialogue about your feelings, fears, and concerns with your partner, or by seeking professional help from a sex therapist or a psychol­ogist who specializes in individual or couples therapy, you can begin to overcome these emotional barriers to sexual intimacy.

A growing number of cancer centers across the nation have opened sexual health centers, as healthcare providers are recognizing that sexual health is a significant area of concern for many cancer survivors. However, if a sex­ual health center is not available in your area, ask your doctor to refer you to a specialist who can help. In the mean­time, you can make some simple lifestyle changes to lessen the emotional impact of sexual issues on your life. Regular exercise can help reduce anxiety and depression and boost self-esteem, and relaxation skills, meditation, and yoga have been shown to help relieve pain and reduce stress.

♦ ♦ ♦ ♦ ♦

Dr. Yung Park is a doctor of internal medi­cine and psychiatry who is currently a fellow of Psychosomatic Medicine at the Yale School of Medicine in New Haven, CT. Her main interest is in hormones, cancer, and women’s health. Dr. Elena Ratner is an assistant professor of Obstetrics, Gynecology, and Reproductive Sciences at the Yale School of Medicine. She works with Dr. Park at the Sexuality, Intimacy, and Menopause Clinic at the Yale Cancer Center.

This article was published in Coping® with Cancer magazine, May/June 2014.