Patients and their families know the journey through treatment can feel scary, but there are also many lingering questions about what comes afterward. For most, the period after treatment is an entirely new journey toward wellness – and it’s a road that has many supports along the way.
For cancer patients, there are three stages in the journey toward wellness: diagnosis, treatment, and rehabilitative care, both during and after formal treatment is completed. The ultimate goal is survival.
This journey can feel scary to a patient, but advancements in cancer treatment and rehabilitation are helping to make the process more effective and more comfortable for patients. As they strive toward becoming cancer-free, patients have a team of expert caregivers at their side, guiding them through every step.
When it comes to breast cancer, treatment involves surgery and then, depending on the stage of cancer and the biology of the tumor, other therapies may be required including the use of chemotherapy, biologic therapy, radiation therapy and possibly endocrine therapy, says Dr. Ryan Engel, a medical oncologist and hematologist with Mercyhealth Cancer Center in Rockford.
“Early stage, breast cancer is usually treated with surgery first, followed by additional therapies specific to the properties of the tumor,” Engel adds. “There is a goal for a smaller surgery to remove the cancer, called breast conservation (lumpectomy), and at times chemotherapy can be given first to shrink the tumor and then proceed to breast conservation, thus preventing the removal of the whole breast.”
Treatments are based on the patient’s overall health condition, the biology of the tumor and the stage of the cancer.
“Today’s cancer treatments are more tailored to each patient and to the biology of breast cancer, a more individualized approach,” says Engel.
The ultimate goal is for the patient to go through treatment while living as close to normal as possible.
“Some patients continue to work while being treated if they can,” Engel adds. “We encourage that because it helps them feel normal and distracts them from focusing only on the breast cancer treatment process. Quality of life is stressed throughout the treatment process.”
Engel stresses that the earlier the diagnosis occurs, the better the prognosis will be. With that in mind, he says careful attention is given to how early the cancer was diagnosed, and whether or not the breast cancer has spread to the lymph nodes and metastasized to other parts of the body.
There are many ways one can individualize therapy, including with biologic therapies based on the receptors found on the surface of the tumor, Engel says. One example is the use of targeted therapy against the estrogen receptor. More than 60 percent of breast cancer patients have estrogen receptor positive disease and need to take oral medicine to block cancer from reoccurring. Engel says patients take these medications for five to 10 years after treatment and are also monitored for side effects.
After patients have completed surgery and possible chemotherapy or radiation, Engel says he continues to care for patients in the form of “survivorship.” This may include following up on any side effects from therapy, continuing to monitor them while they are on endocrine therapy, and monitoring any long-term side-effects or recurrence of cancer.
“We also conduct age-appropriate tests including mammograms, colonoscopies and more,” Engel says. “We educate these patients about diet, bone health, weight control, exercise and other elements of overall wellness. After treatment, some patients need to catch their breath. Others suffer emotional reactions as an after-effect of treatment including depression and anxiety.”
Remorse is another cause for concern.
“Some patients feel they don’t deserve to survive because they know women who didn’t,” Engel adds.
“Survivorship for breast cancer includes assessment of each patient’s mental, emotional and physical needs. We try to address any of the survivor’s concerns, from financial to intimacy, and nothing is off the table.”
Engel explains that he takes his cues from the patient; while some need support on several levels, others are more private and prefer less support.
“Most patients are relieved that there is a plan to get them through this most difficult time,” Engel says. “And we are always there for them. After a patient is done with their primary therapy, I see patients every three months for the first two years, then every six months up to five years – and of course we are always available for any questions or concerns. Some opt to return to their primary doctors, while others prefer to remain with me after the five-year remission. I am happy to see them for as long as they need me.”
Cancers in the pelvic region can include prostate, colon, rectum, bladder, uterine, cervical and ovarian cancers. Treatment for these forms of the disease are patient-specific and determined by the location of the cancer, says Dr. Bobby Koneru, a radiation oncologist with FHN’s Leonard C. Ferguson Cancer Center in Freeport.
“Ovarian cancers are less common,” he says. “Uterine cancers are more common, but not as prevalent as breast cancer in women. The most common cancer found in the pelvic region for men is prostate cancer.”
Treatment of prostate cancer is determined by the advancement of the disease and three categories: low, intermediate and high risk. A diagnosis is made through a PSA blood test and an assessment of how “angry” (aggressive) the cancer cells appear, he adds. In low-risk patients, since the cells are not very aggressive, observation may be a reasonable option in some men.
“Prostate cancer can also be quite aggressive, and the staging tells us which treatment regimen to pursue,” Koneru says. “Prostate cancer patients have a choice between surgery or radiation therapy.”
It’s not an easy choice, he adds. Surgery is a valid choice with low-risk patients while higher-risk patients may survive best with radiation and hormonal therapies.
“The reason why high-risk patients have a better chance with radiation and hormone treatment is that testosterone feeds prostate cancer,” Koneru says. “We use hormone therapy to block testosterone that makes the cancer more aggressive.”
When surgery is chosen, removing the prostate involves cutting through the sphincter between the bladder and the urethra that controls urine flow. A side effect of this treatment is that the patient may become incontinent.
“The sphincter is damaged as the result of the surgery, leaving no way to close off the urine,” Koneru says. “Physical therapy using Kegel exercises after surgery rebuilds the muscles, helping the patient to regain continence. This can take several months to achieve, but the upside is that the surgery is done in one day.”
By contrast, the hormone blockade and radiation regimen require the patient to undergo treatment every day for several weeks, with a low dose of daily radiation. This treatment does not cause leakage, but Koneru says patients may feel the need to urinate more frequently and may experience diarrhea for a short term.
“The cure rates are about equal,” Koneru says. “After either regimen, I see the patient every three months for the first year, followed by every six months for two to three years, and once a year until five years have passed. The cancer most commonly comes back within the first two to three years. After five years, the patient is considered to be in full remission. The odds of it recurring after five years is very low.”
In women’s pelvic cancers, particularly uterine cancers, Koneru says the odds are high that surgery will be the first choice. This includes a full hysterectomy to remove the uterus, ovaries and Fallopian tubes.
“Oftentimes, radiation is given for female pelvic cancers in conjunction with either surgery or chemotherapy,” Koneru says. “This depends on the stage, how aggressive the cancer is and whether or not lymph nodes must also be removed. Side effects include irritated bowels and bladders. There is a risk of lymphedema, in which mild to severe swelling occurs in the legs, hands and abdomen.”
Physical therapy may also be needed for women who have undergone pelvic cancer treatment. “Women may require a longer recovery time for their cancers than men with prostate cancer. This is because they may need a combination of surgery, radiation and chemotherapy,” Koneru says. “It all depends on the extent of the treatment and how aggressive the cancer was.”
Depending on the stage and aggressive type, lung cancer is among the most difficult to treat and recover from. For Katie McGrail, a physician’s assistant with the Patricia D. Pepe Center for Cancer Care at OSF Saint Anthony Cancer Center in Rockford, successful recovery and survival require aggressive monitoring and mentoring.
“Lung cancer is treated with surgery, chemotherapy, radiation and, more recently, immunotherapy,” she says. “When cancer is diagnosed in its earlier stages, surgery is a valid option. However, if the cancer has progressed too far and/or is aggressive, surgery isn’t indicated in most cases.”
While all cases are patient-specific, McGrail adds that chemotherapy and targeted radiation are used to contain the lung cancer cells before they metastasize. Newer immunotherapy approaches “wake up” the immune system to fight cancer. McGrail says that lung cancer is one of the few cancers where immunotherapy has had great success.
While McGrail monitors patients during their treatments, she also keeps an eye on them for several years thereafter.
“After treatment, patients don’t just leave,” she adds. “We’re here for the long term. The more severe the lung cancer was, the longer we will be involved in the patient’s efforts to recover and survive long-term.”
Part of the recovery process is based on managing any long-term side effects from the disease and its treatment, McGrail says. This can include regular CT scans and monitoring for any signs or symptoms of the cancer’s return.
“We continue to watch patients for a minimum of up to five years after treatment is complete,” McGrail says. “How long depends on how advanced and aggressive the lung cancer was.”
In her role as physician’s assistant, McGrail alternates seeing each patient with advance-level providers and medical oncologists. This practice ensures that nothing is missed. In addition to monitoring, she says patients receive instruction on how best to support their recovery.
“Smoking is the most important issue,” she adds. “If they have not stopped smoking, they are encouraged to do so. We recommend eating a healthy, well-balanced diet. Staying active is another factor in the recovery and survival processes. We recommend about 20 minutes each day of physical exercise.”
Recovery is also influenced by the stage at which the lung cancer was diagnosed and the presence of other mitigating conditions such as chronic obstructive pulmonary disease (COPD), McGrail adds. Some patients may require oxygen therapy, depending on their oxygenation saturation, either short-term or as a lifelong condition.
Patients diagnosed with early stage lung cancer, such as Stage IA/IB, have better overall survival compared to later-stage diagnoses. Participating in low-dose CT scans on a yearly basis is helpful in diagnosing patients at earlier stages. Patients should speak with their health care provider to see if they qualify if they have a history of smoking. Early diagnosis can change their survival outcomes and course of treatment.
Emotional support is still another issue that directly impacts a patient’s recovery and sense of well-being.
“Cancer patients experience depression, anxiety and stress, as you can well imagine,” McGrail says. “Our support groups and programs are slowly coming back after the COVID-19 pandemic, and they can be cancer-specific or a general cancer recovery program. Patients are understandably nervous and worried about reoccurrence and their futures. They need a lot of reassurance.”
Accordingly, they’re also taught to beware symptoms that could indicate a return of the cancer – and those can include increased shortness of breath, headaches, unexplained weight loss, a new or worsening cough, and night sweats, McGrail says.
Lymphedema and Therapy
Occupational therapists are a vital element in cancer recovery. For Joanne Pickett and Cheryl Fritsch-Jarlsberg, registered occupational therapists at Beloit Health System’s NorthPointe Wellness Center in Rockton, Ill., helping cancer patients reach survivorship often means dealing with lymphedema. This condition involves swelling and built-up fluids that occur because of blockages in your lymphatic system, a part of the body that can be affected by cancer treatment. Managing these symptoms can improve a cancer survivor’s quality of life.
“Breast cancer patients are especially prone to this long-term condition, but it can also develop after a number of other cancer regimens,” says Pickett, who sees patients during and after treatment.
Pickett and Fritsch-Jarlsberg are certified in manual lymphatic drainage, a highly specialized form of massage that encourages the re-absorption of fluid, relieving swelling that can be severe and even life-altering.
“After radiation or surgery, it may be necessary to re-route built-up fluid around disrupted lymphatic and tissue areas,” she adds.
Fritsch-Jarlsberg, who recently joined Beloit Health System, has worked with patients both in and out of the hospital setting. “Certified lymphedema therapists have a unique skill in this technique, which we use to provide education and treatment to our patients,” she adds.
The two specialists also provide compression, exercises and manual techniques to improve range of motion, decrease edema, improve wound healing and reduce pain disrupted by radiation and surgical procedures.
“Each type of cancer has risk factors connected to scar tissue that forms from radiation or surgical procedures,” Pickett adds. “Depending on the severity, patients may need as few as three sessions and up to three months of treatment.”
Every aspect of aftercare for cancer patients focuses on survival. But along with that focus, the return of wellness, confidence, emotional stability and a renewed sense of hope are of equal importance – and those are possible to achieve with dedicated care and advancing treatments.