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The Cancer Survivorship Guide - What next? After treatment. Freedom from fear

Cancer Care Treatment in Bangalore, India
  • Dr. Kumara Swamy,

    Sr. Consultant & Head - Radiation Oncology

Objectives

  • Primarily improving the quality of life.

  • Reducing the risk of recurrence.

  • To remove the fear of recurrence, which causes significant and enduring distress. Fear reduces the quality of life as well as motivation. While the body’s natural immunity acts continuously against cancer and towards healing, the long-term gnawing fear affects the body’s immunity and decreases the possibility of a cure.

  • Every person is different and therefore requires different approaches. Our Survivorship Clinic will help to identify the paths most suited to an individual.

  • To empower the inner strength of mind.

What is the Survivorship Clinic?

The Clinic is designed to serve cancer patients and help them live well after cancer treatment. However, the process of initiation begins right at the time of diagnosis. It primarily deals with the behavioural change of the person in order to significantly improve the quality of life. During the time of diagnosis and treatment, with emotions at their peak, it is possible to enable a strong motivation for behavioural change. It is an opportunity that should not be missed.

Cancer is a chronic disease where cure is an abstract concept, similar to conditions such as diabetes or hypertension. All these require not only regular medication but the concentrated effort in changing one’s lifestyle. Unfortunately, the knowledge and determination required to change a cancer patient’s lifestyle are drastically less prevalent, compared to other chronic diseases.

What is behavioural change?

As we know, behaviour is a term that encompasses a range of actions that one performs on any given day. This becomes nearly or completely involuntary over a period of time and considered as a habit. Since habit, by its very nature, is typically involuntary, most of our day-to-day actions happen without conscious effort.

The behaviour of an individual and its consequent habits can contribute to the development and progression of cancer in at least two-thirds of cancer cases. So, the modification of behaviour helps in controlling and reducing the chances of recurrence, thereby increasing the odds of being cured of cancer by the same proportion. In addition to focusing on medical treatment, it is equally important if not more, to invest significant emphasis and energy towards behavioural change simultaneously. This approach also acts as a diversion from unnecessary negativity.

There is another dimension to this. Changes in patient behaviour are likely to impact others in the family, helping them to adopt more positive behaviours, which in turn serves to protect their own health.

Let us understand ‘lifestyle’ in terms of the health impact on chronic diseases. Lifestyle is the way a person, or a group of people, repetitively performs activities on a daily basis through life. This, in turn, depends on the behavioural profile and ensuing habits of the person. Such repetitive acts, even if insignificant in terms of daily harm, do have a negative cumulative effect in chronic diseases like diabetes, hypertension and cancer. It takes years of misuse of the body for these diseases to appear. Therefore, to bring such diseases under control, even if not to eliminate them completely, we need to commit to changes in our repetitive acts. 

This can be done only if one consciously analyses the habits that could have contributed to the illness, and then take steps to change those factors. Of course, it isn’t easy to identify and change habits formed over the years. Herein lies the importance of the survivorship program. The survivorship program’s team members are specialised in handling the root causes of cancer. Also, since multiple factors are involved in the process, including adopting the right type of lifestyle, this needs a focussed effort for prolonged periods of time to alter the inappropriate habits. What is undeniable, is the fact that healthy lifestyles have been found to reduce recurrence and improve survival. At Aster CMI, we give a lot of importance to providing resources that encourage behavioural change, apart from providing quality & effective treatment.

What are the components of the Survivorship Clinic?

  • Psychological counselling team: The first aspect that gets seriously affected by the diagnosis of cancer, is motivation. Even before treatment begins, our team’s primary task is to restore the motivation required to undergo prolonged treatment, handle family issues and adopt necessary lifestyle changes.

  • Physical therapy team

  • Diet counselling team

  • De-addiction clinic

  • Comprehensive approach: We believe one-plus-one will always be more than two. That’s why all the above teams are interconnected to bring about a multiplier benefit. Also, correcting any one factor alone may not be enough. An integrated approach that simultaneously handles the mind, body, exercise and diet is essential

How to begin?

  • First step: Map out your prior habits and list out possible ways to improve, in consultation with the survivorship team.

  • Second step: Normalizing physical activity is the fundamental step which influences depression, motivation, nutrition, immunity, etc. Improvements in all these, in turn, helps in improving physical activity, thereby setting up a positive cycle.

Components of Lifestyle change:

Physical Activity

  • Physiotherapists under the guidance of Physiatrist will decide the type and duration of physical activity. Initially, start with the prescribed program (3–5 days/week for at least 30 min per session, preferably twice a day, 50%–70% of heart rate reserve). Interval exercise (periods of fast exercise, followed by periods of slow exercise) has its own benefits

  • Regular physical activity reduces anxiety and depression significantly

  • Proper (randomized) studies have shown that exercise training is safe for most survivors

  • Even a small reduction in excess weight or small increases in physical activity helps to reduce recurrence and improve overall health

  • Benefits of resistance training

  • Improves cardiovascular fitness

  • Positive effects on balance, body composition, fatigue and emotional well being

  • Improvement in bone density

  • Exercise and antidepressants are equally effective in mild to moderate depression

  • Discuss your barriers to exercise with the team & undergo exercise behaviour evaluation regularly

Nutrition Therapy

A. Principles

  • Maintenance of metabolic health

  • Weight gain is a priority for the under-weight

  • Weight loss is a priority for the overweight

  • Diet Supplement use is not found to be useful and is not recommended unless advised for specific situations such as Osteoporosis, cirrhosis etc. In fact, in some situations, a high dose of vitamins or supplements can be harmful

  • A BMI of 18.5 to 24.9 kg/m2 is considered optimal

  • Plant based diet of fruits, vegetables and whole grains having low glycaemic load should be a major part of the diet (2/3rd of the plate). A Mediterranean diet of olive oil, mixed nuts are also recommended

B. General Guidelines

  • Do not skip meals. Start your day with a well-nourishing breakfast

  • Avoid all processed, tinned, canned and frozen foods

  • Hydrate yourself with 2.5-3 litres of water per day

  • Keep yourself away from vices like alcohol and tobacco

  • Read nutrition labels carefully for salt, fat etc., while purchasing packed foods

  • Monitor your weight regularly

  • Regular exercise reduces body fat, increases muscle mass, lowers blood pressure, blood sugar and cholesterol and improves mental feelings of wellbeing

C. Food Hygiene Practices

  • Wash hands thoroughly before preparing food and after touching raw foods such as meat, poultry, fish, eggs and unwashed fruit and vegetables.

  • Ensure that all preparation surfaces are clean before you start preparing food

  • Cooked food should not come into contact with raw meat, unwashed vegetables or salads, or with utensils, cloths or surfaces contaminated by contact with raw food

  • Use separate chopping boards for raw food and ready-to-eat food

  • Wash salads, fruit and vegetables thoroughly before eating

Vegetables to be included Oils & Nuts to be included
Green leafy vegetables (Spinach, Fenugreek leaves, cabbage, broccoli, cauliflower, beans), tomato, garlic, onion, ginger, mushroom. Olive oil, Canola oil, nut butters (such as peanut butter or almond butter), avocado, nuts, and seeds.
High Calorie & Treatment Friendly Foods to be included High Protein Foods to be included
Vegetarian Non Vegetarian
Whole Grains:
Oats, quinoa, barley, brown rice, popcorn, corn, potatoes, peas,
whole grain bread, pasta, cereal and crackers
  • Beans
  • Lentils
  • Pulses (Channa, Rajma, Dhals)
  • Dairy Products (milk, cheese, greek yogurt, paneer,
    cottage cheese, and kefir)
  • Chicken
  • Turkey
  • Lamb
  • Fish & Seafood
  • Eggs
Apples, berries (blackberries, strawberries, blueberries), pomegranate, citrus fruits (orange, sweet lime, grapes, kiwi

Psychological

Must develop a strategy to feel strong internally. Develop a strong sense of purpose in life. Cognitive Behavioural Therapy (CBT) is recommended.

Techniques include:

  • Creative visualization – Continuous and persistent visualization (imagery) of what one desires most in life.

  • Replace the thought process in mind of “What will happen next?” (eg. Will the recurrence happen? What to do if recurrence happens? What will happen to the family? Etc.) With “What you want to happen” (getting normal is the only way).

Others

  • Limit alcohol intake and avoid tobacco

  • Using broad spectrum sunscreens & physical barriers, avoiding peak sun hours

  • Immunizations

Lifestyle Tips

Physical

  • Be passionate about physical activity

  • Do household chores to get physically fit and mentally relaxed

  • Practice deep breathing & meditation

  • Take staircase whenever possible; can limit to lower floors and then take the lift

  • Combine brisk walking, listening to music and stretching

  • Interval walking, which means brisk walking with short rests in-between, is a powerful technique of physical activity

  • Use an air-purifier at home

Diet

  • Fibre in the diet is key to maintain optimum weight, due to its anti-cancer properties

  • When you consume fruit juice, take it along with fibre

  • Remember citrus & related fruits can damage your teeth in the long term. Consuming juice along with well-ground fibre using straws will prevent harm to the teeth.

  • Look for seasonal fruits and certified organic foods that are not contaminated with chemicals.

  • Select a mix of different-coloured fruits.

  • Opt for low glycaemic index foods.

  • Try Greek probiotic yogurt.

  • Eat slowly to feel full.

  • Give up smoking: Have a carrot piece instead of cigarette.

Mind: Induction of anti-stress hormones

  • Acceptance is key. Stress may not be bad, as it is a part of life. But not coping with stress is bad for health.

  • Think “I am Ok, You are Ok and They are OK” (Book by Dr. Thomas A Harris, MD) in order to think right, reduce conflicts and improve socialization.

  • Practice altruism to increase feel-good hormones in the body.

  • Explore new horizons. If you are into science, learn some form of art. If you’re artistic by nature, try to explore scientific pursuits.

  • Power of Now: Focus on today than worry about future (Book titled “Power of Now” by Eckhart Tolle).

  • Convert disturbing thoughts to desirable thoughts in order to rejuvenate the subconscious mind, invoking immunity with cascading stimulation of cancer cell killer substances. (Book titled “Power of Your Subconscious Mind” by Dr. Joseph Murphy).

  • Creative visualization: A picture is worth a thousand words. Develop powerful imagery of spiritual, strong purpose or future to replace worrying thoughts. (Book titled “The Secret” by Rhonda Byrne).

  • Look out for and aim for big things in life (which will be sparse to come by), but also enjoy the small, day-to-day things of life (Book titled “The Power of Small'' by Thaler LK & Koval R).

Other

  • What you practice, will help the entire family and protect them against not only cancer, but also other chronic diseases like diabetes & hypertension.

  • Optimum sleep should be between 6 to 8 hours.

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