Recently by Fran Zandstra

Yesterday was National Cancer Survivors Day, though for many of our survivors and their loved ones, every day is a celebration of life.

The National Cancer Survivors Day Foundation defines a "survivor" as anyone living with a history of cancer, from the moment of diagnosis through the remainder of life.

As a dedicated day, we celebrate our cancer survivors' journeys and raise public awareness that for many, there is life after a cancer diagnosis that is meaningful and productive. At MD Anderson, we have planned a Cancer Survivors Week of events open to everyone. 

This week is a great time for everyone to stop and think about the survivors they know and love. I reflect on the cancer survivors and caregivers that I have had the honor to care for over the last 30 years. I see a collage of your faces and remember your stories. 

One such survivor story happened early in my nursing career. When I was 26 years old, I met Anna, who was 22 and single. She had been diagnosed with an ovarian germ cell tumor and came to my unit for treatment. Over the next 12 months, Anna's tumor was successfully treated with chemotherapy and surgery. She fought hard and her cancer was gone, but the treatment left her unable to have children. 

Over the next 15 years, Anna would occasionally call or, at the least, return yearly to our clinic and we would "catch up." Anna earned a college degree in education and teaching third graders became her passion. She began dating and called me once to ask my thoughts of when she should divulge that she was a cancer survivor. Eventually, she met and married a wonderful man and we continued to celebrate her health and prosperity. The world seemed only to have open doors with a promising future.  

On one visit to our clinic she emotionally shared that she felt guilty (because she also felt so lucky to be alive), yet still grieved that she would never be a mother. We talked at length, I listened, reassuring her that her feelings were normal, encouraging her to discuss options with her doctor. She did and also visited with social work services to get information and resources for adoption agencies. Eventually, Anna was able to adopt a beautiful baby girl. Today, advances in medicine include minimally-invasive surgery that preserves fertility, egg harvesting and more. 

Anna is one of the many survivors who have taught me about courage, determination, faith, hope, love and living with gusto. 

I recently read that it takes a minute to find a special person, an hour to appreciate them, a day to love them, but an entire life to forget them. This is how I see the women and men who I have had the honor to provide nursing care for. They will forever survive in my heart. 

zandstra.jpgCancer invaded my life as a new graduate nurse. I vividly remember the doctor coming out of the operating room and speaking those three haunting words, "we found cancer."

My 57-year-young mother endured surgery, chemotherapy and radiation treatments that left her weak, nauseated and in constant pain. In eight short months, she was gone. I felt helpless.
The next year, 1979, I traveled from California to Houston and found MD Anderson Hospital and Tumor Institute. I came with a thirst for knowledge and a need to serve.

I joined a nursing unit specializing in the gynecologic cancers that had claimed my mother's life. I was excited to be joining a top cancer center, yet fearful of what I might find.

Would I be up for this challenge? Would I be surrounded by sorrow and suffering? Would all my patients die? With all this in mind, I committed to stay two years.

Making Cancer History® has been a journey I have now traveled for more than 30 years.  Why? I found that each day, I could make a difference. I found a place of hope, inspiration, innovation and discovery.

I have had the opportunity to be on the cutting edge of discovery -- new surgical techniques that would preserve a woman's fertility, novel cancer treatments, new medications to manage pain and nausea, and to improve the quality of life.

cancerstrikethru.jpgEach day and each year, those we have the honor to care for contribute to our mission of eliminating cancer.

Making Cancer History begins with hope -- hope to end suffering from the effects of cancer and its treatment. It's measured not only by the quantity of lives saved, but also by the quality of life experienced by the cancer survivor.

It's also measured by the tireless work of outstanding scientists and clinicians who are learning more about cancer every day and are developing improved methods to treat the disease.


NYT_VirginiaMThe New York Times article by Gina Kolata -- Forty Years' War, A Place Where Cancer Is the Norm -- made my heart swell with pride to be part of the M. D. Anderson team and my eyes well with tears for those whose struggles she wrote about.

I think about the thousands of patients I have had the honor to care for over the last 30 years. I wish Kolata could have met my patient Dorothy.

Flashback to 1979, I was a new oncology nurse at M. D. Anderson when I met this 38-year-old, petite and strikingly beautiful brunette who had advanced cervical cancer. Her doctors at home told her that she had only one year to live.

Dorothy came to M. D. Anderson searching for treatment that would allow her to live to see her 10-year-old daughter graduate from high school. She entered a clinical trial receiving intra-arterial chemotherapy using a then-new drug named Cisplatin. Dorothy received this drug for four months. It wasn't for the weak of heart. She lost her hair, vomited and was exhausted for two weeks after the chemotherapy was completed. Just as she began to feel "normal," it was time for the next round of therapy. Then the treatment regimen was complete. 

For the next five years or so, I saw Dorothy when she returned for her doctor's visits. We'd share stories about our families while she anxiously awaited her test results. After her doctor would give her the results of yet another "clean" CT scan, she would give us a hug and huge sigh of relief.

Dorothy beat her cancer with what I think Kolata would call "unconventional treatment." For Dorothy, this was a clinical trial.  

You would have to be living on a deserted island these days not to hear about health care reform. Reforming the American health care system was a key aspect of President Obama's domestic agenda and Congress is moving this initiative forward.

 But advocacy and industry groups, the public and elected officials, and even policy wonks have been talking about the need to make reforms to our nation's health care system for years. While one group's interest may be slightly different than the next, all are voicing their opinions on what's working and what's not working. One voice that needs to be heard is that of cancer survivors.

So as health care discussions continue this fall, be sure to let your family and friends know your perspective about what's important. Attend any health reform town hall sessions scheduled in your area and voice your opinion. Talk with or write to your elected officials and let them know to consider cancer survivors' needs as they set about reforming the system.

This is the story of one cancer survivor's effort to ensure her voice was heard.

At a loss of what to say? Most of the time, our elected officials just need to hear our stories. But if you want to say more than that, an advocacy group for cancer survivors, the National Coalition for Cancer Survivors, has posted Lance Armstrong foundation posted its cancer policy platform. Also read the National Conference of State Legislatures Cancer Survivorship: State Policy Issues

Cancer survivors know that the effects of the disease and its treatments aren't merely physical. While each person is unique, many cancer survivors share some common concerns.

One of the most basic is the fear that the cancer will recur. It's important to remember that while you can't control whether cancer recurs, you can control how much you let the fear of recurrence impact your life.

A first step in coping with fear is to try not to feel guilty or ignore feelings in hopes that they'll go away. Instead, there are certain things you can do to help cope with this fear:

• Talking often reduces fears and anxieties. Talk with your health care team or friends, or join a support group.

• Try writing down your thoughts and feelings in a journal.

• Try other complementary modalities like yoga, music therapy, tai chi, guided imagery, reflexology and massage. There are reputable centers all across the country that offer classes in these disciplines.

M. D. Anderson Resources

M. D. Anderson's Place ... of wellness provides a service where persons touched by cancer may enhance their quality of life through programs that focus on the mind, body and spirit. It offers more than 75 complementary therapy programs, most are free of charge.

Place ... of wellness is open to anyone touched by cancer, their family members and caregivers, whether or not they were treated at M. D. Anderson. No physician referral is required. For more information, call 713-794-4700

Other Resources
Yoga Bear Blog 
Integrative Therapies at Dana Farber
Integrative Therapy Classes at Sloan Kettering
Integrative Services at Cleveland Clinic

Thanks to early detection and improved treatments, millions of American's are surviving cancer. Why is this important? As many survivors have learned, recovery isn't always end of cancer experience. the transition from active treatment surveillance survivorship care is critical their ability to live longer,stronger and healthier lives.

If care isn't planned and coordinated, cancer survivors and their community physicians may not know enough about heightened risks for second cancers, potential late effects of cancer treatment or the long-term plan of follow-up care.

For genitourinary cancers, we've developed unique survivorship services to address their needs. A component of this care includes development of a comprehensive care summary. The "Passport Plan for Health" is an electronic tool, provided through myMDAnderson to the patients and health care providers, that summarizes an individual's:

•    Cancer diagnosis and treatments received
•    Cancer screening recommendations
•    Ways to reduce risks for other cancers
•    Potential late effects of treatment and how to monitor for them
•    Preventive care recommendations
•    Patient concerns
•    Recommended referrals to community providers

The passport communicates the necessary follow-up regimen and timing -- including potential late effects of treatment, how to identify them and what to do about them -- and explains which provider is responsible for what care. It also can be helpful in explaining the survivor's personal situation when visiting new physicians or other health care professionals.

The "Passport Plan for Health" is good preventive medicine.

Thanks to public awareness, earlier detection and improved cancer treatments, the National Cancer Institute (NCI) reports that nearly 12 million cancer survivors are living in the United States today. This number is estimated to increase to 19 million by the year 2020 as baby boomers enter their cancer-prone years.

According to the U.S. Centers for Disease Control and Prevention and the NCI, 64% of adults diagnosed with cancer today can expect to be alive in five years. For children, survival rates range between 70% and 92%, depending on the type of cancer.

Who are cancer survivors? A cancer survivor is commonly defined as anyone who has been diagnosed with cancer, from the time of diagnosis and treatment through the remaining years of life. The definition has been expanded to include people who have been affected by the diagnosis, such as family members and caregivers.

Within this definition are stages or phases of survivorship:

  • Living with cancer refers to the experience of receiving a cancer diagnosis and any treatment that may follow
  • Living through cancer is the period following treatment in which the risk of cancer recurring is relatively high
  • Living beyond cancer refers to post-treatment and long-term survivorship

Why is this important? As many survivors have learned, recovery is not always the end of the cancer experience. Even years after successful treatment, cancer recurrence is a possibility. Cancer therapies can leave health issues that require lifelong surveillance. Finally, recovering from the emotional, social, and economical trauma of cancer can take longer than recuperating from treatment.

To address the needs of our survivors, M. D. Anderson is developing survivorship as a distinct phase of cancer care. Providing the framework for the survivorship effort is our multidisciplinary, patient-centered care model, in which every patient benefits from a diverse team of cancer specialists participating in cancer treatment planning. We're using this platform for cancer care to lead, develop and implement an integrated, multidisciplinary survivorship program, easing the transition from illness to wellness.

As a cancer survivor, what are your biggest concerns or questions? Please take a few minutes to post your comments and I'll do my best to address them.


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