Khamis, 7 November 2013

The Star Online: Lifestyle: Health

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The Star Online: Lifestyle: Health

Living after breast cancer


Breast cancer survivors get guidance for their post-treatment lives.

JUDITH Cornille survived breast cancer. The lumpectomy. The radiation. The utter shock.

But even as she recovered from treatment, her mind was on the future: Now what?

"Everyone was telling me to get on with my life, but I was still reeling emotionally," recalled Cornille. "This wasn't what I had planned."

Cornille, 65, was lucky. She enrolled in the new Breast Cancer Survivorship Clinic at the University of Miami's Sylvester Comprehensive Cancer Center, a three-month-old programme that supplements routine care provided by a breast oncologist with a multidisciplinary approach to managing the long-term effects of cancer and the side effects of treatment. The programme offers nutritional counseling, physical rehab and fitness training, psychiatric counseling and integrated medicine, including acupuncture, yoga and tai chi.

"It's like a GPS after treatment," Cornille said. "It helps me to know what I should expect and what I can do to feel better. It does a lot for the psyche."

The Breast Cancer Survivorship Clinic is part of a growing movement within the healthcare system to help survivors adjust to their new life, post cancer.

As more of them lead longer, healthier lives, hospitals are reorganising their services by offering a one-stop shop that gathers together various disciplines.

"We're moving toward a collaborative model," said Dr Beatriz Currier, who heads up the psychiatric part of the clinic. "We are all tackling the symptoms from our different expertise and a major asset is that everything is centralised."

Breast cancer survivor Judith Cornille, left, works closely with UM's exercise physiologist Stacy Cutrono in their U Survive & Thrive program, at the University of Miami's Wellness Center, October 4, 2013. (Marice Cohn Band/Miami Herald/MCT)

The Breast Cancer Survivorship Clinic at University of Miami's Sylvester Comprehensive Cancer Center is a programme that supplements routine care provided by a breast oncologist with a multidisciplinary approach to managing the long-term effects of cancer and the side effects of treatment. – MCT 

For years, breast cancer patients were released with little guidance on how to deal with post-treatment issues, everything from depression to weight gain, to sleep problems and sexual dysfunction. But that is changing as more patients of all cancers survive.

There are almost 14 million cancer survivors in the United States and that number is projected to increase by 31%, to almost 18 million, by 2022, according to the National Cancer Institute.

The medical community has realised such numbers demand follow-up guidelines to ease the lives – and the worries – of these former patients.

That's why the influential Institute of Medicine issued a report in 2005 recommending that all patients, after completing treatment, receive a survivorship care plan (SCP), a blueprint that helps a survivor steer her way through the maze that is post-treatment life.

A care plan includes both a record of care the patient has received and a follow-up plan about psychosocial effects of treatment, prevention of new cancers and surveillance of recurrent cancers, among other things.

The American College of Surgeons considers these survivorship plans such an important part of post-treatment cancer care that in 2011 its Commission on Cancer announced that it would require all of its accredited facilities – where about 70% of new cancer patients are treated – to provide these plans to all patients by 2015.

Because breast cancer survivors comprise the largest percentage of survivors, 22%, it was a natural step for local hospitals to begin implementing SCPs with them.

"They have a spectrum of issues but they are also more open, more motivated to deal with them," Currier said.

At the Sylvester clinic, the initial visit includes a two-hour screening to determine the issues a patient is facing. If, for example, she suffers from fatigue, she might see the psychiatrist, exercise physiologist or nutritionist, perhaps even an integrated medicine specialist for acupuncture or yoga.

All these disciplines can offer help.

The Breast Cancer Survivorship Clinic sees about five new patients a week. It is now open only to Sylvester patients, but Currier says it might one day open to other breast cancer patients who have been treated in other cities and institutions.

Cornille's first appointment was with the exercise physiologist. Eager to get her life back on track, she had tried the gym on her own, but her efforts were short-lived.

"I was on the elliptical for five minutes and my legs were like jelly," she recalled.

So she registered with the U Survive & Thrive programme at the survivorship clinic, where exercise physiologist Stacy Cutrono tailored an exercise routine and followed her through 16 supervised sessions.

Cornille said she was "very encouraged" to see her endurance and strength improve on every visit to the gym.

"It starts as hand-holding, then it takes off," Cutrono said. "They take what I teach them and they go from there."

Heidi Rowland, a 57-year-old breast cancer survivor, has seen both Cutrono and the nutritionist for follow-up care. In a couple of months, she will visit Currier for a cognitive assessment. These appointments are in addition to her follow-ups with the breast oncologist.

"To have to see several physicians who don't talk to each other and are in different places would be very stressful," she said. "It would be daunting, so it's great to have everyone gathered in one place and everyone talking to each other."

Other local hospitals have launched survivorship care plans for their breast cancer patients. Advanced Medical Specialties oncologist Dr Grace Wang, who chairs the Commission on Cancer (COC) committee for Baptist Health, has worked on the survivorship plan template the hospital gives to survivors for more than a year.

To those guidelines she plans to add a list of available community resources, as well as a financial component because cancer "can cause financial distress to so many of our patients".

Wang sees SCPs as a vital part of "a team effort" to reduce the recurrence of cancer and offer support to survivors so they can comply with post-treatment care. "You're educating and keeping them on task about what they should be doing," she said.

At the Memorial Center Institute in Broward, psychiatrist Patrick Reynolds, who heads a multidisciplinary oncology support system, has been supervising the rollout of the SCPs for breast cancer patients. Like other centres, Memorial plans to add other cancer survivors in the future.

"In the past, people fell through the cracks," he said. "The pieces were there, but the care tended to be fragmented. What we're doing now is formalising the process so survivors don't get lost in the follow-up." – The Miami Herald/McClatchy-Tribune Information Services


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