The following is a composite patient based on the experiences of cancer survivors. Though not an actual patient, the issues described are real and relevant to many survivors:
Today is an important day for Jane — it’s her “first birthday,” marking one year since completing cancer treatment. When she walked into the cancer center lobby, the receptionist welcomed her with a big smile and a hug. Jane could see genuine joy in the receptionist’s eyes. “I love your hair, Jane,” she told her.
“I am going to keep it short,” Jane said, gently touching strands of her hair as if they were delicate flower petals that might fall off if she wasn’t careful. She had heard compliments about her hair many times since the completion of her chemotherapy.
Jane could not believe it had been more than 18 months since she was diagnosed with breast cancer. Painful memories of the diagnosis, surgery, chemotherapy and radiation were still very fresh in her mind. She wasn’t sure how much her husband connected with her struggles, even though he tried his best to be supportive.
Even today, Jane is not completely back to where she was. She continued to work, through treatment, while caring for her children. But she forgets things and is challenged to find the words to express herself. She feels like she is no longer as sharp as her colleagues, causing significant anxiety and depression. Even though her energy level is improving, by the end of each day she feels like she is completely drained and exhausted.
While she isn’t yet 40 years old, Jane’s periods stopped after the treatment. Last week, when she saw her gynecologist, she talked about her severe vaginal dryness and hot flashes. She suspects the combination of fatigue, irritability, vaginal dryness and lack of sexual drive is straining her marriage.
When her oncologist walked into the room, Jane wanted to hear only one thing — that she has no signs of cancer. She did not want to tell the doctor about her daily struggle. Her mind was preoccupied with the patients who were sitting in the room, fighting to be alive and needing the doctor more than she did.
“I’m fine,” she told the doctor, “doing well.” She was in a hurry to get out of the cancer center clinic.
Jane is not alone in the challenges she faces; many cancer survivors struggle with the same side effects. The intensity, extent, duration and emotional toll of it all are real for many patients like Jane.
As cancer doctors, we could be more proactive in addressing these issues that patients are sometimes reluctant to bring up. They may think they’re alone in battling long-term effects, which could include:
— Memory problems
— Anxiety and depression
— Fatigue
— Lack of sexual drive and vaginal dryness
— Relationship issues
— Peripheral neuropathy
— Hot flashes
Many face these issues, and we are finding ways to improve our ability to detect the difficult effects that survivors experience, and counsel them on how to cope. Many hospitals are implementing survivorship clinics focused on addressing these long-term challenges, as per the Institute of Medicine and National Institutes of Health recommendations.
Patients are encouraged to voice their concerns, including those they might be reluctant to discuss with their doctor.
Support groups, regular exercise, rehab techniques and physical therapy, along with traditional clinical care, are becoming common “prescriptions” doctors are writing for an increasing number of cancer survivors. We owe it to all those who have conquered cancer to dedicate attention to their struggles, which continue even after the cancer is gone.
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The Questions Cancer Survivors Don’t Ask Doctors originally appeared on usnews.com
