After Treatment: Now What? Ali Schaffer, LCSW

“Walking out of the oncology clinic, after the last check up, I felt a mix of emotions…happy to be done, scared that it might come back, unsure about what to do next and confused about what it all means.” -35 year old female breast cancer survivor “After treatment, our doctor said to us, “You’re done.” And I wondered, where do we go from here?” -Caregiver of a breast cancer survivor

Feeling lost?

“It takes a while to turn the bus around.”

Truth #1 “The end of your cancer treatment is NOT the end of your cancer experience.”

The Institute of Medicine recognized the importance of providing long-term, comprehensive care to all cancer survivors and acknowledged gaps and shortcomings in current survivorship care. In November 2005, they released a report From Cancer Patient to Cancer Survivor: Lost in Transition to recommend best practices and “to ensure the best possible outcomes for all cancer survivors.” www.iom.edu/~/media/Files/Report%20Files/2005/From-Cancer-Patient-to-Cancer-Survivor-Lost-in-Transition/recommendations.pdf

Cancer Practical issues of cancer survivorship Education Healthcare Secondary health risks Financial Cancer Access to resources Coping with Late effects Insurance Employment Practical issues of cancer survivorship

of cancer survivorship Coping with late effects Emotional issues of cancer survivorship Mental Health Dating/ relationships Identity Sexual Health of offspring Fertility Cancer Self-esteem Coping with late effects Body image Family relationships Spiritual Social Healthy behaviors

Emotional Issues of Survivorship Impact of treatment and survivorship on mental health Integrating cancer and the impact of cancer into life Changes in family dynamics and personal relationships Re-establishing personal roles Coping with treatment related effects Psychological adjustment “Who am I?” Fear of recurrence Changes in sexual health and intimacy Monitoring health and well-being Financial, employment, and insurance related distress

The Emotional Tsunami

Survivor’s Guilt I’m Not Really A Survivor Because…

Truth #2 “Recovery from a cancer diagnosis and resulting treatment can often take longer than you expect, plan for, or are comfortable with.”

Manage Expectations It is important to think about your expectations of yourself and others as well as their potential expectations of you.

Physical abilities/stamina Emotional responses Changed by cancer? Life after cancer Speed and length of recovery Short-term and long-term side effects (physical, cognitive)

Survivorship is not a straight road.

“Sometimes a bad day is just a bad day.” Setbacks are normal. Healing plateaus and periods of progress and decline are common. Patience and perspective can help during these times. Take time to pause and reflect on where you’ve been and how far you have come.

“Everyone went back to their normal lives “Everyone went back to their normal lives. But I’m still dealing with this cancer.”

A Few Myths of Cancer: “Cancer changes everything.” “I am/my life is going to be so different after cancer.”

A Fact about Survivorship There is no right, or wrong way, to live as a cancer survivor… What matters is how you choose to live!

Why I’m Not Climbing A Mountain By Tom Sowa CURE Magazine, Summer 2007

Tips to be a successful survivor Do it YOUR way. Get organized. Get information. Create and maintain your support team. Address your physical, emotional, sexual, social, financial and spiritual needs. Periodically: Re-organize Re-prioritize Re-define Re-commit/Re-invest

Healthy Living Strategies Seek Support Utilize community resources Get a good nights’ sleep Gather the facts Pamper yourself Write it down Talk it out Meditate Eat well-balanced meals Obtain regular physical activity Learn a new hobby Maintain comprehensive health care check ups and screenings Laugh!

YOU are the common denominator. Survivorship requires your active participation as an important member of your healthcare team. YOU are the common denominator.

Remember… Your survivorship needs will change over time… Let them.

Who are the people in your neighborhood?

“The gifts of cancer.” There are many positive aspects of survivorship directly related to the practical and emotional issues of surviving cancer.

For additional information: Allison Schaffer, LCSW Program Coordinator, Patient Family Resource Center Vanderbilt-Ingram Cancer Center (615) 322-9799 allison.schaffer@vanderbilt.edu