Beating A Killer
Cancer was once the end of the line. Today, it can be managed and defeated
Quality time. Even if treating depression does nothing to improve long-term survival, it goes to the heart of improving the quality of a cancer survivor's life. Miller and others would like to have depression, fatigue, and cognitive problems considered as a sixth vital sign in patient care--along with respiration, blood pressure, pulse, temperature, and pain level. Says Miller: "When we think of vital signs, we should include all behavioral signs, so that patients who are having symptoms can be referred to an appropriate physician."
Pain in itself may not stop when treatment ends. "You can have symptoms that go on for years, whether from the tumor itself, chemo, radiation, or surgery," says Ada Jacox, professor of nursing at the University of Virginia and director of clinical practice guidelines for the American Pain Society. Shingles can flare up in older cancer survivors and become a chronic problem. Nerve pain, called neuropathy, can occur if you're placed a certain way on an operating table during surgery. Women can have long-lasting pain from constricting tissue after a mastectomy.
The feedback loop between pain and depression is sometimes difficult to untangle. Indeed, the nerve tracks that receive pain and those that channel emotion are very closely connected in the brain. Studies have shown that previous episodes of depression predispose a patient to the development of chronic pain, and preliminary evidence suggests that pain may indeed become chronic because of the close connection between these two tracks. University of Miami psychiatrist David Fishbain says, "There is good evidence that if you treat patients who are depressed, you will make them less sensitive to the pain stimuli. They may focus on it less, and they will just tolerate their pain better."
Fatigue is another complication. Pam Massey, who runs the rehabilitation center at M. D. Anderson in Houston, says her team has found that the severe fatigue experienced by bone-marrow-transplant patients can be lessened with exercise. Massey's team added carefully supervised conditioning to its regular outpatient therapy sessions. "You'd see patients on treadmills," she says, "or sitting on exercise bikes with IV poles and five or six bags hanging from them."
Massey also helps patients handle their lymphedema, the painful and disfiguring limb swelling reported by nearly half of breast cancer survivors treated with radiation who are at least 15 years beyond treatment, as well as survivors of melanoma, cervical, and prostate cancer. "We can't tell whether it will start or when," she says. The disruption of the lymphatic system, which can come either from pressure from the tumor or from treatment like surgery or radiation, can be treated, she says, with special exercises, physical therapy, and compression bandages.
Survivorship. The main message from doctors to patients is: Speak up. And sometimes it's imperative to raise questions before treatment begins, as in the case of patients concerned about their future fertility. Many women can bank eggs, and even young boys can have sperm banked. The bad news: Surveys show about half of men and women don't remember being warned about infertility at the time of diagnosis or treatment. Lindsay Nohr, diagnosed with tongue cancer in her 20s, found it frustratingly difficult to explore all her options under time pressure. After doing her own research, she had her eggs frozen, then founded Fertile Hope as a source of information for other young patients. About 100 babies worldwide have been born following egg freezing. Even more cutting-edge techniques are on the horizon.