A chat with Dr. Dana Chase
In a recent “Ask the Experts” panel with Ilana Feuchter from the National Ovarian Cancer Coalition, Arizona Oncology’s Dr. Dana Chase went over the details of a cancer survivorship plan and how to build one.
A cancer survivorship care plan should contain four basic elements: what you went through, what you need to do for follow up, what to watch for, and how to keep yourself healthy moving forward. It may also include legal and insurance-related documents that can affect your future care. Let’s take a closer look at Dr. Chase’s tips for creating a cancer survivorship plan.
Who needs a survivorship plan?
First of all, you don’t have to be in full remission to be considered a survivor. The survivorship care plan can come into play at different times, but most of the time it is developed when one or more treatments are completed.
“When a patient finishes cancer treatment, whether or not it’s surgery, radiation and/or chemo, there are a lot of questions as to what’s going to happen next,” Dr. Chase said. “The patient has usually undergone a lot of different treatments, had different side effects, different experiences, and there’s a lot of build-up to this period of remission and an unknown as to what to do next.”
What is a survivorship plan?
So what does come next? Your survivorship care plan! Dr. Chase outlined four specific areas that should be covered in a survivorship plan:
What you went through. This is a summary of your cancer treatments. Obtaining this information might include printing out records you don’t already have. The summary should include pathology reports, medications you received (including notes on any medications you are allergic to), what kind of radiation you were given and for how long, etc.
“Staple these to your care plan,” Dr. Chase advised. “That helps doctors down the road know what you had and what to give you.”
Your follow up. This part of the plan details when you will need to come back to the doctor and what tests you’ll need to have done before you come. Dr. Chase recommended that you schedule these appointments right away. Often, the medical office’s automated systems will send out reminders for you, but it’s a good idea to have them written down in your care plan, too. Follow up might also include appointments with a genetic counselor and other health care professionals.
What to watch for. Your doctor will share information with you about the possibility of recurrence and signs of concern. You also need to know about red flags that signal you should come in to see the doctor sooner than your scheduled appointment.
How you can help yourself feel better. This last part of the plan can involve a number of topics from nutrition, exercise, and coping strategies to managing the side effects of your prior treatments or maintenance medications (if you are on any).
“Reaching out and letting us know if you are suffering is really important,” Dr. Chase said. There are ways to manage the side effects of maintenance medications, including lowering your dosage, treating the side effects with other meds, or switching medications. You may even be able to take a break from a PARP inhibitor if side effects are particularly difficult to manage, she stated.
Survivorship care plan templates
Templates to create your own survivorship care plan can be found online through the American Cancer Society and other support organizations. This cancer survivor care plan can be printed and filled out by you or a loved one. The American Society of Clinical Oncology offers free, downloadable diagnosis-specific survivorship care plans as well.
If your provider has not sat down with you to develop a survivorship plan yet, a good place to start is with a printout of the summary section or “note” in your medical chart. “Usually your note has your diagnosis, the treatment you’ve had, and your follow up,” Dr. Chase said.
Additional things to consider
Survivorship plans can be very personalized. Some additional things you might want to include are:
Legal documents. These could include a Living Will, Power of Attorney, and insurance documentation. While these aren’t necessarily comfortable topics, and the focus of “survivorship” is supposed to be positive, Dr. Chase stated that when you are healthy and feeling well is the best time to make these types of decisions.
Follow up for other health concerns. Often when you receive a cancer diagnosis, other less serious health problems fall off your radar. Dr. Chase said that once you’ve finished treatment, it’s a good time to check in with your general practitioner and other care providers regarding non-cancer-related health problems, such as high blood pressure or diabetes. This is also a good time to get up-to-date on cancer screenings you may have missed (i.e. PAP, mammogram, colonoscopy, skin check).
Talking with your family. Including your family in your survivorship plan can be stressful (for them and for you), but it’s important. Dr Chase offered some advice on talking to family members: “What is helpful is to say to the family member: ‘I realize this might be stressful to you, but the way you can help me to feel better is to know what happened to me and to know how to help me in the future’.”
Dr. Dana Chase is a board certified gynecologic oncologist at Arizona Oncology. Her expertise includes gynecologic cancers such as ovarian, endometrial, uterine, cervical and vulvar cancer. She is a member of NRG Oncology, the Society of Gynecologic Oncology, the American Society of Clinical Oncology, and is a Fellow of the American College of Obstetricians and Gynecologists. Dr. Chase has over 30 peer reviewed publications and 35 abstracts presented at organizational meetings. She has expertise in research and collaborative projects on scientific questions related to quality of life, symptom management, novel chemotherapy agents, and supportive care. You can learn more about Dr. Chase in her biography.
Cancer patients can greatly benefit from integrative (sometimes called “alternative”) therapies along with their medical treatments. Touch therapies like acupuncture, massage, manual lymphatic drainage, and reflexology can help with side effects of cancer treatment and also reduce pain and stress.
It is always important to talk to your doctor about any alternative therapy before starting it, as not all alternative therapies are recommended for all patients. Here is a list of Arizona Oncology Foundation’s approved touch therapies you can discuss with your doctor.
Acupuncture is a form of traditional Chinese medicine that has been used for thousands of years. Based on the concept of energy (chi or qi) passing through certain pathways in the body (meridians), acupuncture is believed to help re-balance energy flow in the body.
Acupuncture has been shown to help with a number of side effects of cancer treatment, including:
- Nausea and indigestion
- Diarrhea and constipation
- Anxiety and depression
- “Chemo brain”
- Peripheral neuropathy
- Sinus congestion
- Hot flashes and night sweats
- Joint and muscle stiffness
A trained acupuncture practitioner places very thin, delicate needles into specific areas of your skin. In many cases, you won’t feel them, but be prepared for a slight prick. The needles are left in place for a period of time while you relax. In some cases, mild electrical pulses are applied through the needles. You may have slight bleeding when the needles are removed.
Massage uses the power of touch for healing, applying pressure to soft tissues and pressure points throughout the body. While there are many types of massage, oncology massage therapists are trained to perform massage in a way that is safe and comfortable for cancer patients.
Many studies have found oncology massage to be helpful in combating:
- Stress and anxiety
- Poor circulation
- Reduced mobility
Massage can be a very comforting, relaxing, and therapeutic accompaniment to your treatment.
Manual Lymphatic Drainage
Manual lymphatic drainage is a special form of massage used to treat lymphedema. Lymph nodes damaged by cancer treatment can stop the normal flow of lymph in the body, causing fluid retention and symptoms like swelling, pain, heaviness, tightness and hardening of tissues.
Manual lymphatic drainage is a gentle, relaxing practice involving circular, upward movements that encourage healthy lymph flow. Because the targets of lymphatic drainage are just under the skin, this type of massage does not affect deep tissues. In this way, manual lymphatic drainage offers many of the same benefits as oncology massage.
Reflexology is a form of touch therapy applied to the feet. An ancient practice, its history is difficult to pinpoint, but the underlying theory is that specific areas of the feet are linked to certain organs or areas of the body. By applying pressure to “reflex areas”, the reflexologist works to remove energy blockages in the corresponding area of the body.
Reflexology has been shown to help with:
- Hair loss
- Appetite loss
- Sore mouth
- Skin reactions
- Stress relief
Reflexology is not appropriate for all patients, including those at risk for deep vein thrombosis, or those with bruising or severe edema in the feet.
Reiki is a Japanese form of energy work where the practitioner uses his or her hands to convey universal energy to the patient. Many patients experience a subtle warmth, tingling, or sensation of pressure during reiki sessions and find it very comforting. Reiki can help with pain, anxiety, and side effects from cancer treatment. It can also help patients gain resilience in the physical, mental and spiritual aspects of facing cancer.
CranioSacral therapy is a safe, noninvasive therapy that involves light touch applied to the bones of the head, sacrum (lower back), and spinal column. Through gentle compression (about the weight of a nickel), craniosacral therapy aims to release restrictions in the soft tissues around the nervous system. For cancer patients, it has been shown to:
- Improve immune function
- Decrease stress
- Decrease side effects of pain, nausea, headaches, and fatigue
- Increase tolerance of physical activity
- Improve sleep
Developed by osteopathic physician Dr. Fritz Smith, zero balancing involves special touch aimed at balancing body structures and energy. Finger pressure and gentle traction are applied to bones, joints, and soft tissue, helping to release tensions deep in the body so it can relax and reorganize. Zero balancing has been shown to reduce stress, improve vitality, and adjust bone alignment. After a zero balancing session, you may feel lighter, freer, and more energized.
To learn more about alternative therapies and other support services that can help you in your cancer journey, speak with your doctor or contact the Arizona Oncology Foundation at 520-324-2840.
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