Integrative Medicine Blog

Cancer Survivorship: Things To Consider

Heidi S. Puc M.D., FACP, ABIHM Sunday, June 12, 2016
Istock surviving cancer

Bringing attention to the after-math of surviving cancer is extremely important, as more people than ever are surviving cancer. Dr. Puc offers some things to consider based off more than 20-years of experience in the clinical practice of adult hematology and medical oncology.

Did you know that Sunday, June 5, 2016 was the 29th Annual National Cancer Survivors Day? Bringing attention to issues surrounding survivorship of cancer is extremely important, as more people than ever before are surviving cancer. There are now 14.5 million people alive after being diagnosed with cancer, and by 2025, this number will reach 24 million people according to the Centers for Disease Control (CDC).

Although the current overall decline in cancer death rates is welcome news, it is noteworthy that surviving cancer is often wrought with numerous challenges during and after treatment, including physical, financial, and psychological hardships. Physical problems can result due to side effects from surgery, radiation, and chemotherapy (for example, painful scarring from surgery or radiation, neuropathy from chemotherapy, memory and concentration issues related to chemotherapy—“chemo-brain”, amongst others). Fertility problems can also occur due to cancer therapy. Financial challenges include high out-of-pocket medical costs, sometimes leading to bankruptcy; missed work time/loss of productivity due to sick days or time needed for treatments; and possible job discrimination (studies have shown that cancer survivors are less likely to receive callbacks from potential employers). Various psychological consequences occur in cancer survivors, including anxiety/post-traumatic stress disorder, depression, social isolation, fatigue, and sexual dysfunction. Cancer survivors often develop significant fear of recurrence, and can experience stress due to shift of relationships with intimate partners, family members, and friends, often requiring counseling. They may also be at risk for secondary cancers either related to the primary cancer or to its treatments, and this can also trigger fear.

Cancer survivorship resources are available at both the national and community levels to help individuals deal with these hardships. These include The American Cancer Society, The National Cancer Institute, The Centers for Disease Control and Prevention, The American Society of Clinical Oncology ( website), National Coalition for Cancer Survivorship, LIVESTRONG, and many others.

Many oncologists and primary care physicians are now developing survivorship plans for patients who have experienced a cancer diagnosis and treatment. Depending on the type of cancer and type of treatments an individual patient has had, this plan can include periodic testing for recurrent disease (blood tests such as tumor markers; x-rays; and CT, MRI, and bone scans, for example), tests for secondary malignancies (complete blood counts after chemotherapies that can trigger secondary pre-leukemias or leukemias, for example), screening tests for other associated malignancies (mammograms for breast cancer, colonoscopies for colon cancer, for example), and periodic histories and physical exams to assess for possible recurrent disease or delayed side effects from therapies.

With over 20 years of experience in the clinical practice of adult hematology and medical oncology, I offer the following suggestions to individuals who are cancer survivors:

  • Make sure you are comfortable with your survivorship oncologist/primary care physician. You need this to be a healing partnership, and you should feel comfortable asking questions about all aspects of survivorship. You should request a written summary of your cancer diagnosis, staging, and treatment plan with potential delayed toxicities to look for (if you have not already received such). Information about screening for recurrent or secondary (new) cancers should be provided and reviewed, including information on genetic testing and possible risk to family members. Consider seeing an integrative medicine/oncology health care practitioner if your doctor cannot provide adequate nutritional and supplement counseling.
  • Don’t be afraid to consult family, friends, and professionals about financial hardship/planning. Treatment of cancer is costly, and asking for help in dealing with financial strains can help alleviate stress.
  • Be more than a survivor, be a “thriver”: look at what your lifestyle was like before the cancer developed, and make improvements. Were you eating an organic, plant-based, anti-inflammatory diet? Were you drinking at least half your body weight (pounds) in ounces of water each day (for example, if you weigh 150 lbs., water intake should be 75 ounces)? Are you at or close to your ideal body weight? Are you avoiding tobacco or excess alcohol? Are you getting 20-30 minutes of cardiovascular exercise as well as strength resistance exercise on most days of the week? Are you getting adequate, restorative sleep? Do you make use of resources to help alleviate stress (for example, meditation, relaxation breathing practices, yoga, journaling, massage, prayer or other spiritual practice, support from friends and family or professional counseling)? Are you an optimist (optimists have better health outcomes than pessimists)? Are you avoiding personal care products such as skin creams and lotions, toothpaste, shampoos, and deodorants with potential toxins (for example parabens, phthalates, BPA)? Have you checked your home for radon (risk factor for lung cancer)? Is your drinking water filtered and free of potential toxins? Are you balancing your life to make enough room for what brings you joy and laughter (strengthens the immune system)? Are your relationships nurturing? Are you living an authentic life in all its aspects, including your job/career?
  • Cultivate mindfulness. The experience of cancer can be a stark reminder that we do not have the past, or the future; all we have is in the moment of now. Many of my patients have told me that their cancer diagnosis and treatment at the time was devastating, but then turned out to be a true gift in their lives, forcing them to be mindful of the present moment, and to have gratitude for all the good in their lives. My advice to survivors is to view this time as an opportunity to relish “the little things” in your life, as well as your most important relationships, and to nurture a life of love, rather than of fear.