Cancersurvivorshipandresilience:aframeworkforcoping

TimothyPearman,PhD,ABPPDirector,Suppor:veOncologyRobertH.LurieComprehensiveCancerCenterProfessorDepartmentofMedicalSocialSciencesDepartmentofPsychiatry&BehavioralSciencesNorthwesternUniversityFeinbergSchoolofMedicine

Overview

I.  CancerSurvivorship:facts,figuresandtrendsII.  Briefdescrip:onofmostcommonlyreportedsymptomsIII.  WaystoenhancecopingwithchronicillnessIV.  Normaladjustmentandtheconceptof“posttrauma:c

growth”

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Survivorship: Definition •  “An individual is considered a cancer survivor from the time of diagnosis through

the balance of his or her life”1,2

•  Some definitions also acknowledge the impact of cancer on families, friends and caregivers2,3

•  To many, “cancer survivor” may indicate someone who “beat cancer” – this is not always the case1

1.Na:onalCoali:onforCancerSurvivorship.TimelineofAchievements.Availableat:hgp://www.canceradvocacy.org/about-us/what-weve-done/.2.HewigM,etal.Washington,DC:Na:onalAcademiesPress;2006.3.Na:onalCancerIns:tute.AboutCancerSurvivorshipResearch:SurvivorshipDefini:ons.Availableat:hgp://cancercontrol.cancer.gov/ocs/sta:s:cs/defini:ons.html.

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Whileapa:entbecomesacancersurvivoratthe:meofdiagnosis,thispresenta:onwillfocusontheen:recancer

experience,includingpost-primarytreatment

Cancerfactsandfigures

• Cancersurvivorsnownumber15.5million(NCI,2016)• Cancersurvivorscompriseapproximately5%oftheUSpopula:on

• 67%ofpeoplediagnosedwithcancertodaycanexpecttolive>5years

• 17%ofcancersurvivorsare>20yearsurvivors• S:llnotabledispari:esincancersurvivaldependingonspecificcancertypeandstage

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Bluethmann,ShirleyM.etal.An:cipa:ngthe“SilverTsunami”:PrevalenceTrajectoriesandComorbidityBurdenamongoldercancersurvivorsintheUnitedStates.CancerEpidemiolBiomarkersPrev;July201625(7),pg1029.

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Estimated cancer prevalence by age in the US population from 1975 to 2040

Why the Increase in U.S. Cancer Survivors? •  Cancer is primarily a disease of aging. The number of older

people in the U.S. is rapidly increasing1

• Widespread screening efforts have led to early diagnosis and improved prognosis2

•  Clinical trials

•  Advances in multi-modal cancer treatment have improved survival2

1.  Cancer.net.AgingandCancer.Availableat:hgp://www.cancer.net/coping/age-specific-informa:on/cancer-older-adults/aging-and-cancer.

2.  HewigM,etal.Washington,DC:Na:onalAcademiesPress;2006.

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Long-termandLatePhysicalEffectsofCancer

•  Oneinfourcancersurvivorsreportpoorphysicalhealth1•  Theterms“lateeffects”and“long-termeffects”canbeusedto

dis:nguishhealtheffectsaccordingtotheironset2

1.  AmericanCancerSociety.StudiesShowCancerSurvivors’PhysicalandEmo:onalProblemsOrenGoUntreated.Availableat:hgp://www.cancer.org/cancer/news/studies-show-cancer-survivors-physical-and-emo:onal-problems-oren-go-untreated.

2.  HewigM,etal.Washington,DC:Na:onalAcademiesPress;2006.

•  Prevalentearlyonandmaylastforweeksormonths

•  Persistfollowingacutecareandbecomechronicproblems

Long-termeffects:

•  Arisemonths,yearsarertreatmentLateeffects:

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Examples:Long-termandLateEffects

•  Symptomsdifferfrompersontopersonandwitheachdifferenttherapy1•  Examples:

Long-termEffects

• Treatment-relatedfa:gue,andneuropathies2

• Persistentpain1• Skinsensi:vity,andlymphedema2• Cogni:vechanges3• Infec:ons1• Fer:lityissues1• Prematuremenopause,andropause1• Skinintegrityrelatedtoostomies1

LateEffects• HeartProblems2

• NerveProblems2

• Increasedriskofothercancers2• Osteoporosis1

1.LeighS.AJN.2006;106(S3):12-14.2.Na:onalCancerIns:tute.ChemotherapyandYou.Availableathgp://www.cancer.gov/publica:ons/pa:ent-educa:on/chemotherapy-and-you.pdf.3.DickermanJ.Pediatrics.2007;119;554-568.

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Symptomprevalence

• Cella,SeminarsinOncology,1998

0 20 40 60 80

Fatigue

Pain

Anxiety

Sadness

Nausea

Consequencesofemo:onaldistressandfa:gue

• QOLimpairment

• Decreasedemploymentfunc:oning

• Decreasedmedicaladherence

• Increasedmedicalcosts

• Increasedhealthriskbehaviors

• Decreasedhealthprotec:onbehaviors

Whymusttheseeffectsbeaddressed?

• Needs,opportuni:es&op:onsareorenhidden:orenpa:entsdon’tdiscussthesesymptomswithprovidersandprovidersdon’talwaysask

• 94%ofoncologyspecialistsseesupportservicesasapriorityfortheirpa:ents.

• Pa:entsandfamilieswantsupport

• Forpa:entsexperiencingdepression,anxiety,andfa:guethereAREGOODTREATMENTSAVAILABLE

Components of Healthy Behavior: Self-Care

PhysicalacMvity1,2 NutriMonalrecommendaMons1,2

StressreducMon1 Medicalcare1

1.  Livestrong.org.PlanningforHealthyLiving.Availableathgps://www.livestrong.org/we-can-help/healthy-living-arer-treatment/planning-for-healthy-living.

2.  RockCL,etal.CACancerJClin.2012;62:242-274. 275

EXERCISE! • Exercise is the most strongly

supported behavioral intervention for fatigue

• Consult with physician and/or physical therapist

• Surgeon General recommends 30 min moderate activity most days

• Generally, easy to find community resources: look for senior centers, churches, cancer support communities

Exercise parameters • Ac:vitypacing:startwith10minutes,increase:meby20%perweek

• Lowtomoderateintensitytostart(e.g.walking,swimming,taichi)

• Weightbearingexercisetostrengthenbones(esp.inmenopausalwomen)

• Gentlestretchingandbreathingexercises

• Yoga:mostrigorouslyvalidatedfa:gueinterven:oninoncologypa:ents

Nutrition •  Choose food and drinks in amounts to

get to and maintain ideal body weight

•  Limit amounts of processed meat and red meat

•  Eat at least 2½ cups of vegetables and fruits each day

•  Choose whole grains instead of refined grains

•  Limit alcohol to no more than 1 drink per day for women or 2 per day for men

RockCL,etal.CACancerJClin.2012;62(4):243-274.

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Stress Reduction

•  Engaging in activities that are enjoyable and create laughter1,2

•  Scheduling daily leisure time and social activities2

•  Writing in a journal1,2

•  Practicing relaxation techniques (e.g., meditation, guided imagery, breathing exercises, yoga)2

•  Prioritizing tasks2

•  Asking for help with daily activities2

•  Attending a support group or counseling1,2

1.  Livestrong.org.PlanningforHealthyLiving.Availableat:hgps://www.livestrong.org/we-can-help/healthy-living-arer-treatment/planning-for-healthy-living.

2.  Cancer.net.ManagingStress.Availableat:hgp://www.cancer.net/all-about-cancer/cancernet-feature-ar:cles/quality-life/managing-stress.

ThereareseveralbasicacMviMesthatsurvivorscanusetomanagestress:

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Adjustmentarerdiagnosis

• Manycancersurvivorsshowposi:veadjustmentwithin1-2yearspost-diagnosis(Stantonetal.,2005)

• Posi:velifechangesarereportedbythemajorityofsurvivors(Stantonetal.,2006)

• Reportedbenefitsinclude:- Greatercompassion- Enhancedin:macy,rela:onshipquality- Apprecia:onforlife- Enhancementofskillsandstrengths- Deepenedspirituality

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Aboutgrowthandresilience

• Manysurvivorsshowevidenceofresilienceandgrowth• Resilienceand/orgrowthmayhappeninoneareaoflifeexperience,yetnotanother

• Growthanddistresscan,anddo,co-exist!

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Whatispost-trauma:cgrowth?

• Posi:vechangeorgrowth(Tedeschietal.,1998)• Basedontwocondi:ons:- Presenceormajorthreatortrauma(e.g.cancer)- Evidenceofposi:vegrowthoradjustmentrelatedtothetrauma(“despite”or“becauseof”)

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Whyfocusonpost-trauma:cgrowth?

• “Thelawoffloata:onwasnotdiscoveredbycontempla:ngthesinkingofthings,butbycontempla:ngthefloa:ngofthingswhichfloatednaturally,andthenintelligentlyaskingwhytheydidso.”

•  -ThomasTroward

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Respondingtocancerinthecontextofalife

• Ovariancanceristhe“trauma”thatbroughtustogethertoday

• Foreachsurvivor,however,thattraumaisjustonepieceofhis/herlifeandlifespan

• Survivorquotes:- “Idon’tsweatthesmallstuffanymore.”- “Itakemore:meformyfamily…Idon’ttakethemforgranted.”- “Havingthisdiseasemademerealizethatthereweres:llthingsIwantedtodo,andplacesIwantedtogo.”

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Thankyou!