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Survivorship 101

Dr. Carol Rosenberg October 28, 2010 3:00 PM This chat has ended. Thank you for participating.
Patrick Gut (Moderator) - 2:46 PM:
Welcome! Today’s chat: ‘Cancer Survivorship 101’ will begin shortly. Please start submitting your questions and Dr. Carol Rosenberg will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit the Living in the Future (LIFE) Survivorship Program section of the website to obtain more information about cancer survivorship.

Dr. Carol Rosenberg (NorthShore) - 2:59 PM:
Hello, my name is Dr. Carol Rosenberg. I am the program director of the Living in the Future Cancer Survivorship Program (LIFE). As you may know, Survivorship is the new frontier in the cancer care continuum. At NorthShore University HealthSystem we know the end of treatment is not the end of the cancer experience. That is why we have the LIFE Cancer Survivorship Program, a cancer survivor's personal prescription for living healthy in the future.

Kate (Mundelein, IL) - 3:01 PM:
I just completed chemotherapy for what I am told is triple negative breast cancer. Are there things that I can do to reduce my risk for breast cancer recurrence? My other friends who have had breast cancer get to take tamoxifen or arimidex. I feel pretty uncomfortable with the idea of being off treatment.

Dr. Carol Rosenberg (NorthShore):
This is an excellent question. It brings us to discuss an important study called the Women's Intervention Nutrition Study (WINS). Women with prior breast cancer who reduced fat in their diet reduced their risk of cancer occurrence compared with women who did not. The important point here is that these women who had the greatest decrease in the risk of of recurrence were triple negative breast cancer (i.e. estrogen negative, prog. negative, her 2 negative) Thus the most important thing that you can do to reduce the likelihood of a recurrence is to follow three lifestyle imperatives: 1 - A low fat diet full of fresh fruits and vegetables. 2 - Physical activity at a minimum of 30 minutes moderate intensity walking a day, seven days a week 3 - No more than three alcoholic beverages a week. Also remember that some of the most important revelations about decreasing recurrence rates in women with breast cancer are related to lifestyle changes that are in your control. (Cont.)

Dr. Carol Rosenberg (NorthShore) - 3:09 PM:
We cover this topic and more in the LIFE's MRW Cancer Survivor 101 series. You can learn more here - http://www.northshore.org/cancer/survivorship/events/.

Julie (Des Plaines, IL) - 3:09 PM:
I am a 25 year old woman and am BRCA positive. I want to know if there is anything that I can do besides surgery and medication to lower my risk for cancer development. Can you address this with me?

Dr. Carol Rosenberg (NorthShore):
The answer to this question is similar to the previous answer. That is, absolutely you can lower your risk with the modifiable lifestyle steps of weight management through plant-based diet, physical activity and limited alcohol consumption. And, of course, no smoking.

Angie (Arlington Heights, IL) - 3:11 PM:
Your website talks about a survivorship care plan. What is that? Should I have one? I was treated at Glenbrook Hospital for breast cancer last year.

Dr. Carol Rosenberg (NorthShore):
Every survivor needs to make the transition from the intensity of the oncology treatment environment back to their community, their family and their primary care environment. While being treated for cancer you are coddled and cared for by medical, surgical and radiation health professionals. But the new normal until this time has been a "do it yourself" situation. A Survivorship care plan is an important piece towards having an organized approach towards the rest of your life when out of the oncology treatment environment. A Survivorship care plan consists of the following: 1 - A summary of the survivor's cancer history and treatment in order to help survivors better understand their medical history. 2 - A personalized risk assessment with medical surveillance guidelines to instruct the survivor regarding the monitoring for a potential recurrence, a second malignancy and the long term and late affect consequences of cancer and their specific treatments. (cont.)

Dr. Carol Rosenberg (NorthShore) - 3:20 PM:
3 - Preventive practice recommendations specifically for cancer survivors which promote personal health such as lifestyle modifications, diet, physical activity and smoking cessation. 4 - Navigation to appropriate health providers, community-based resources and services as well as regional and national programs addressing all aspects of Survivorship including fertility, lifestyle, psychosocial issues, insurance, employability and legal protection. 5 - A survivor notebook to consolidate all records and resources. This personalized manual becomes a portable detail of records, resources and information which survivors may choose to share with other healthcare providers. The LIFE program offers each patient exiting the treatment environment an opportunity for their own personalized visit with the clinical nurse coordinator wherein they receive a complete Survivorship care plan in a face-to-face visit. Discuss it with your doctor at your next visit.

Ingrid (Evanston, IL) - 3:22 PM:
I just finished treatment for breast cancer and was just referred to your program. I'm not sure if I consider myself a survivor because I still have 5 years of hormone therapy to complete...am I a survivor?

Dr. Carol Rosenberg (NorthShore):
The definition of Survivorship is really from the first day of diagnosis onward. The LIFE program is ideal for survivors who are out of an active treatment protocol but still on long term adjuvant hormonal therapy as you are. We invite you to make an appointment with us for your Survivorship care plan. 847-926-5818.

Brittney (Skokie, IL) - 3:24 PM:
I keep hearing about a cancer survivor diet and that there are exercises that breast cancer survivors do. How do I find out more about this?

Dr. Carol Rosenberg (NorthShore):
The LIFE program offers monthly Survivorship 101 seminars which address the science of Survivorship diet and physical activity recommendations. Entitled "Eat to Beat Malignancy, Walk Away from Cancer" this particular seminar is a 2.5 hour workshop with interactive discussion and the expertise of myself, Carole Martz RN and an oncology dietitian. We're holding a program tonight, but you can register for our next one to be held January 27th. All are welcome and there is no charge for this seminar. Learn more about it at northshore.org/life .

Brittney (Skokie, IL) - 3:29 PM:
Can you explain the association between alcohol and breast cancer that I have been hearing about?

Dr. Carol Rosenberg (NorthShore):
Most recently at the San Antonio Breast Cancer Conference (12/09) several papers linked alcohol with poor Survivorship. We know for certain is a carcinogen and increases the risk of breast occurrence. We now also know on the basis of several new studies from the SABCC that the risk of recurrence among breast cancer survivors is 34% higher among those who drink three drinks a week as opposed to those who drink none. By a drink we mean 12 oz. of beer, 5 oz of wine or 1.5 oz. of spirits. Additionally one Danish study that obesity, smoking and alcohol together influence the development of a second primary breast cancer in the opposite in estrogen positive cancer survivors.

Ron (Arlington Heights, IL) - 3:33 PM:
My wife just got out of the hospital from repair of a femur fracture. She is 49 and a breast cancer survivor of 6 years. Could her cancer treatments (chemo and radiation) have impacted this? She also stopped having periods during chemo.

Dr. Carol Rosenberg (NorthShore):
If your wife is no longer having periods then she is considered post-menopausal. Cancer treatment can also affect the hormonal mileau altering estrogen levels and thereby increasing risk for osteoporosis and ultimately fracture. Your wife's treatments could have impacted this hormonal state and ultimately led to her fracture. Therefore, the most important advice that we give all cancer survivors in order to decrease the likelihood of osteoporosis and ultimate fracture is as follows: 1 - Weight bearing exercise such as walking 30 mins/day 7 days/week. 2 - Calcium supplementation - 1200mg/day 3 - Vitamin D3 - At least 400-600iu 4 - No smoking 5 - No alcohol 6 - Consume foods rich higher in calcium and vitamin D 7 - 10 minutes of sun exposure daily to activate vitamin D stores from the skin We also recommend that the family physician be consulted for a BMD (bone mineral density) testing and the recommendation for possible bisphosphonate therapy.

Debbie (Lincolnwood, IL) - 3:40 PM:
What are the most common symptoms experienced by cancer survivors?

Dr. Carol Rosenberg (NorthShore):
The most common symptoms for all cancer survivors are: 1 - Fear of recurrence 2 - Fatigue 3 - Anxiety 4 - Weight gain (especially in breast cancer survivors) Of note, depending on the type of cancer and the areas physically affected the physical symptoms as a consequence of the cancer and its treatment may vary. In the case of breast cancer lymphedema (the swelling of the affected arm) is a major concern.

Debbie (Lincolnwood, IL) - 3:43 PM:
How often will I be examined for my cancer recurring?

Dr. Carol Rosenberg (NorthShore):
Depending on the type of cancer you have, the national guidelines (NCCN) and your oncologist's familiarity with your particular cancer will dictate the frequency of your monitoring. Most people who are finished with an active treatment protocol are monitored by their oncologist in 3-6 month intervals for the first five years. Some cancers are monitored more frequently, it just depends.

Debbie (Lincolnwood, IL) - 3:46 PM:
What body changes will I experience because of cancer?

Dr. Carol Rosenberg (NorthShore):
Depending on the type of cancer and the type of treatment will depend on what body changes you will experience. For example, in the case of breast cancer there are surgical aspects of removing a portion of the breast and the consequences associated with that procedure. Chemotherapeutic regimens may cause hair loss or thinning. In addition, some people experience weight gain or weight loss. Radiation can cause skin tanning and some breast changes that will evolve over time.

Patrick Gut (Moderator) - 3:49 PM:
Thank you everyone for your great participation, the chat will be ending in approximately 10 minutes. Please submit any final questions you have.

Debbie (Lincolnwood, IL) - 3:49 PM:
Am I at risk of other diseases because I have had cancer?

Dr. Carol Rosenberg (NorthShore):
An important aspect of Survivorship care planning is the knowledge that a survivor has to gain regarding the possibility of a second primary cancer occurring. All cancer patients are at risk for another type of cancer to occur at a greater rate when compared to the general population of people without cancer. For example, breast cancer survivors face a slight increase in risk for the development of another breast cancer, ovarian cancer, uterine cancer, colon cancer and skin cancer. These elevated risks can be enhanced by genetic predisposition syndromes such as BRCA 1&2, hereditary non-polyposis colon cancer (HPNCC) syndrome and hormonal therapy such as tamoxifen.

Debbie (Lincolnwood, IL) - 3:54 PM:
Will getting insurance be difficult and more costly for me?

Dr. Carol Rosenberg (NorthShore):
The question of insurance and employability predominated the cancer Survivorship landscape. Importantly, each cancer survivor needs to understand their rights and their insurance policies. The LIFE program offers an important seminar on insurance and employability facilitated by an attorney with an expertise in this subject matter. I encourage you to attend our next seminar on Nov. 18th at Highland Park Hospital. You can sign up for it online. This seminar will surely answer all your questions specific to your needs and cancer situation. In the meantime you may want to take a look at http://www.cancerandcareers.org.

Dr. Carol Rosenberg (NorthShore) - 4:01 PM:
Thank you all for the great questions. I invite you to participate in our MRW Cancer Survivor 101 workshops held monthly. Our next workshops include: Thurs 11/18 - How life events impact insurance and employment Thurs 12/9 - Genetics and the cancer survivor Thurs 1/27/11 - Eat to beat malignancy, walk away from cancer If you are a NorthShore patient, ask your physician for a referral for a Survivorship visit and care plan. You can call our office 847-926-5818. You can learn more at our web site at www.northshore.org/life where you can watch our videos and hear patients describe their experience with LIFE!

Patrick Gut (Moderator) - 4:02 PM:
Thank you again for participating in our chat today. For more information please visit our LIFE Cancer Survivorship Program pages.

Also, a transcript of this chat will be available shortly.
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