Many patients hold back from asking questions because they are worried about looking ignorant or stupid. If you don’t understand what your practitioner tells you it is because, whether deliberately or not, he or she hasn’t explained it well enough. Communicating effectively should be an important part of your practitioner’s responsibilities. He or she should be prepared to persevere until you do understand what is being said.

Nothing is so complex that it can’t be made perfectly understandable by someone who is willing to share it with you. It is possible that your practitioner is so familiar with certain words that he or she has forgotten that a non-medical person doesn’t know what they mean. You are not an expert and can’t be expected to understand medical terms so just say if you don’t understand. Sometimes a practitioner uses technical words to cover up his or her own emotions when giving bad news. You might have to help your practitioner by making it very clear that you want straight answers.

*7/40/1*

If you see or speak to doctors who are not oncologists, such as your gynecologist or cardiologist, be sure to tell them that you recently completed cancer therapy. Your history of cancer treatment is an important piece of information when a doctor is determining the cause of your problem and how serious the problem is or could become.

Can I Assume That Any Noncancer Medical Conditions Will Be Detected or Followed at Ну Cancer Checkups?

Not necessarily. Your cancer doctor tailors your evaluations to look for cancer- and treatment-related problems. Their offices and practices are not set up to perform routine comprehensive medical evaluations, such as the prevention, evaluation, and treatment of heart disease, diabetes, low thyroid, and other common medical conditions.

In fact, most oncology offices expect you to pursue your routine cancer screening for other cancers with your general medical doctor. For example, if you were treated for lung cancer, you should have your routine colon cancer screening done with your general medical doctor and your routine cervical cancer screening done with your gynecologist or general medical doctor.

Since I Have Had One Type of Cancer Already, Do I Need to Be Screened Any Differently for Other Diseases or Cancers Than Someone Who Has Never Had Cancer?

Some cancers are associated with an increased risk of another cancer. Some cancer treatments are associated with an increased risk of developing certain cancers or other medical problems. These factors will be taken into account when your routine screening regimen is planned.

If Ну Oncologist Dismissed He, How Can I Be Sure Ну

General Doctor Knows How to Take Care of Me Now That I Have Had Cancer?

Taking care of patients with a history of cancer is routine for internists and general practitioners. If you have any concerns about your follow-up,

• arrange for a visit with your oncologist to review the specifics regarding your follow-up

• request that your oncologist communicate with your general doctor by phone and/or letter, outlining the recommendations

• learn about the follow-up of your type of cancer from books, journals, and information hotlines, and discuss your findings with your general doctor.

Even if you are not actively followed by your oncologist, your oncologist is available for telephone or in-office consultation regarding questions, concerns, or new problems that arise at any time after completion of your cancer treatments.

*99/32/5*

As is discussed in the section on depression, dealing with the consequences of postcancer fatigue can increase your risk of developing depression. Depression may have been ruled out when you were first evaluated, and you may be coping as well as humanly possible. You believe that you cannot always choose your circumstances, but you can choose how you deal with them. Yet, despite your positive attitude, wonderful support, and deep faith, the physical changes caused by the chronic stress of dealing with postcancer fatigue can increase the risk of becoming depressed.

Depression is usually associated with such symptoms as lack of interest in activities that usually bring pleasure, significant weight loss or gain, changed sleep patterns, decreased ability to concentrate, and morbid thoughts. However, depression can also manifest itself solely as fatigue. Treating the depression will take care of this fatigue.

When being evaluated for postcancer fatigue, you will be assessed for any component of depression that might benefit from counseling and/or medication. When depression is misdiagnosed as postcancer fatigue, you are denied the benefit of effective treatment.

Take steps to minimize the development of depression in the setting of postcancer fatigue:

• Learn about postcancer fatigue.

• Learn about energy conservation measures that will allow you to match your energy requirements to supplies.

•Learn to accept the changes and losses necessary to deal with your fatigue.

•Allow yourself to grieve the loss of energy.

•Develop new sources of enjoyment and relaxation to replace those no longer available. A variation of the same activity, such as playing competitive table tennis instead of full-court tennis, or working part-time instead of full-time, may help. On the other hand, this approach may be counterproductive because of the constant reminders of what has been lost. In this case an activity unlike the favored one is more therapeutic.

Postcancer fatigue is a medical problem like other medical problems. Proper evaluation and treatment allow you to minimize its effect on your new life.

What If My Doctors and Nurses Say There Is No Such Thing as Postcancer Fatigue?

Since “postcancer fatigue” is a newly coined term, time will tell whether it becomes widely accepted. However, no matter what it is called, the fatigue following cancer treatment is real. All of the information provided about the causes, course, evaluation, and treatment of postcancer fatigue applies to the cancer survivor with persistent fatigue after all treatable causes of fatigue are resolved. Work with your health care team to prevent, minimize, and treat all of your symptoms, including fatigue. Learn how to adjust so as to minimize the pain, debility, and loss following successful treatment.

*71/32/5*

Recovery from cancer treatment often brings opportunities for making big changes. Your work situation may have changed while you were being treated. Your changed perspective may lead you to feel that you want to make a career change. Plans to move may have been postponed, and now you feel differently about the move. An unhappy marriage that was tolerated for many years may now seem intolerable.

This is a wonderful time to think about making changes that will move you toward a more satisfying life at home and at work. You do not have to change or fix everything right away. Your top priority is getting well. On the other hand, you want to take advantage of windows of opportunity. You want to hold on to your changed perspective and priorities to create a better life.

You may be swept up in the emotional intensity of recovery, tempted to make major decisions that seem absolutely right at the time but that can hurt you in the long run. A woman built a successful accounting firm prior to her cancer diagnosis. After surviving eighteen months of rigorous treatments, she felt that she wanted to do something more meaningful with her life. She was ready to close her office, sell the equipment, and look for part-time work as a consultant for cancer-related causes. The glamour of her plan wore off, as she realized how profoundly her decision would affect her family’s lifestyle and comfort and how she would lose the self-actualization that came from her flourishing accounting business. With time, she came to see her work as more meaningful. She provided an important service for others, and the contribution to the family income provided stability. Instead of abandoning her work, she made substantial changes in how she did it. Ultimately, she worked fewer hours per week, leaving more time for her children and volunteer work. Cancer encouraged her to look at what she was doing and make some positive changes in her life.

If you are going to undertake big changes or decisions, work with a close friend, family member, or professional counselor to arrive at wise, life-enhancing decisions. When possible, let some time pass before you make a final decision. Taking your time will help prevent rash decisions fueled by fear, anxiety, euphoria, fatigue, or stress. You want to look at alternatives in such a way that you do not hurt yourself professionally or financially. You must consider how any proposed changes will affect your family, insurance, health, and future job options.

How Do I Know Whether I Need Counseling?

Counseling is one way to help you deal with any stress or challenge. Through therapeutic listening and professional guidance, counseling provides support, understanding, and tools for making decisions about living your new life. Pursue counseling sooner rather than later if

•you are unable to communicate with your family and friends

• you are having trouble fulfilling your responsibilities

• you cannot sleep or eat

• you are unable to concentrate

• you feel overwhelmed

• you want professional guidance to maximize the benefits that can come from your cancer

experience

• you feel that unresolved issues have resurfaced and need attention

Other signs that counseling might be beneficial include

• persistent anxiety

• depression

• persistent anger

• confusion

The surviving of cancer is hard work in uncharted territory. Getting help demonstrates strong survival instincts.

*158/31/5*

Anxiety will come and go, especially around special times such as checkups and anniversaries. Recognize that anxiety is a common companion during the transition to your new normal life. The intensity and duration of your anxiety will depend on your normal tendency toward anxiety, your personal circumstances, and your reaction to your anxiety. In general, it helps when things are going well medically. The more confidence you have in your recovery and the more quickly you can return to normal activities, the less you will suffer from anxiety.

If I Am Anxious, How Can I Diminish Mу Anxiety?

Anxiety will not help you in any way. It wastes emotional and physical energy. Ask your doctor whether any of your medications could be causing or worsening your symptoms of anxiety. Sometimes you can alleviate anxiety by adjusting the dose or choice of your medications. You may benefit from short-term use of anxiety relievers, such as minor tranquilizers, while you pursue the other methods of anxiety reduction that take longer to be effective. It helps to avoid any stimulants, such as caffeine, or decongestants. Although your morning cup of coffee may not be causing your anxiety, it may be making the symptoms worse.

Try to determine what factors are causing anxiety. Many times it takes talking with friends, support groups, and counselors to identify what is making you anxious.

In the case of anxiety-provoking factors over which you have some control, such as worry about doing the right things to prevent recurrence or about your spouse’s being impatient with the slowness of your recuperation, you can help by getting information. Knowledge will enable you to get rid of the source of your anxiety. You will relax when you know that you are doing the right things to prevent recurrence and when you are reassured that a spouse’s impatience is a natural part of readjustment after cancer treatment.

In the case of anxiety-provoking factors over which you have no control, such as concern about whether you will be alive to see your grandchildren or worry about whether your car will last three more years, you can help by

•accepting that you can affect your future but that, ultimately, your future is out of your control

• training yourself not to worry about things that may not happen

• exposing concerns that are unrealistic, so that they are no longer concerns

• training yourself to not spend time worrying about things that may happen in the future but are not happening now (distract yourself from realistic worries, or repress realistic worries in a healthy way)

• being hopeful that future problems can be treated when they arise

• recognizing that anxiety is only hurting you

• praying to God, if you are a believer or want to become a believer, to attend to these things

• learning self-relaxation techniques so that you can have some control over your anxiety reactions

• getting adequate sleep (sleep deprivation can make you feel anxious, lose perspective, and think irrational thoughts)

• getting exercise, when possible

• joining a support group to share your anxieties and hear practical advice about relieving your anxieties from people who have experienced them

• talking with a survivor who is farther along the road to recovery and who is doing well

• seeking the advice and assistance of a professional counselor

Persistent anxiety drains your emotional and physical resources. Learning how to diminish and tame your anxiety will enhance your comfort and speed your recovery.

*131/32/5*

In the United States a cancer registry is a hospital-based person or group who collects information about patients diagnosed with, or treated for, cancer at that hospital. “Cancer registry” is also the name for the bank of information. Many hospitals have developed a separate department devoted to collecting, computerizing, and analyzing this information. Usually individual cancer patient’s oncologists or primary care physicians are responsible for keeping the registry informed about their patients’ cancer (present or absent, stable or progressive), any recurrences, the initial treatment received for the cancer, and any cancer-directed treatment received each year after the original diagnosis.