Life After Cancer

Transcript

00:00 --> 00:02Funding for Yale Cancer Answers is
00:02 --> 00:04provided by Smilow Cancer Hospital.
00:06 --> 00:08Welcome to Yale Cancer answers with
00:08 --> 00:10your host Doctor Anish Chappar,
00:10 --> 00:12Yale Cancer Answers features the
00:12 --> 00:14latest information on cancer care by
00:14 --> 00:16welcoming oncologists and specialists
00:16 --> 00:18who are on the forefront of the
00:18 --> 00:20battle to fight cancer. This week.
00:20 --> 00:22It's a conversation about cancer
00:22 --> 00:24survivorship with Jeff and Britta Jevin
00:24 --> 00:25is a certified physician assistant
00:25 --> 00:28with the survivorship clinic at Smilow
00:28 --> 00:30Cancer Hospital and Doctor Chappar
00:30 --> 00:32is a professor of surgical oncology
00:32 --> 00:35at the Yale School of Medicine. So
00:35 --> 00:36Jeff, and maybe we can start off by
00:36 --> 00:38you telling us a little bit about
00:38 --> 00:39yourself and what it is you do.
00:40 --> 00:43I started back in July of 2018
00:43 --> 00:45after graduating from my CPA program
00:45 --> 00:48and I was lucky enough to get
00:48 --> 00:50the position I have and I really
00:50 --> 00:53have to say it's the dream job.
00:53 --> 00:54That's fantastic.
00:54 --> 00:56So you know the whole concept
00:56 --> 00:58of cancer survivorship is
00:58 --> 01:00something that a lot of people
01:00 --> 01:02might not know too much about.
01:02 --> 01:05I mean people kind of think about.
01:05 --> 01:06Cancer and they think OK,
01:06 --> 01:09you've been given this terrible diagnosis.
01:09 --> 01:12You go through this terrible treatment
01:12 --> 01:14and then there's like this dot dot dot.
01:14 --> 01:16So tell us a little bit more
01:16 --> 01:18about what cancer survivorship
01:18 --> 01:20really is and what it entails.
01:20 --> 01:22Cancer survivorship is really
01:22 --> 01:24centered around the definition of
01:24 --> 01:27the cancer survivor and that is a
01:27 --> 01:29person who's been diagnosed with
01:29 --> 01:31cancer for from that time through the
01:31 --> 01:33remaining balance of his or her life.
01:33 --> 01:35And that comes from.
01:35 --> 01:36The National Cancer Institute.
01:36 --> 01:39The NCI in that definition, and so.
01:39 --> 01:42Survivorship care focuses around
01:42 --> 01:46the care provided for a survivor
01:46 --> 01:47in that period of time from the
01:47 --> 01:49time of diagnosis throughout the
01:49 --> 01:51remaining balance of his or her life,
01:51 --> 01:53and so the benefit of cancer
01:53 --> 01:56survivorship clinics is that we create
01:56 --> 01:58this net for people to catch their
01:58 --> 02:01concerns that otherwise might not be
02:01 --> 02:03addressed during routine follow up.
02:03 --> 02:05Visits with their oncology team or
02:05 --> 02:07other providers as part of their care.
02:07 --> 02:09So we talk about things like
02:09 --> 02:10late effects from treatment.
02:10 --> 02:13We talk about their diagnosis and prognosis.
02:13 --> 02:17We address healthy lifestyle considerations
02:17 --> 02:19like exercise and nutrition.
02:19 --> 02:21We talk about health maintenance
02:21 --> 02:23and cancer screenings and keeping
02:23 --> 02:25up with all of that,
02:25 --> 02:27and so we really try to catch this
02:27 --> 02:28wide array of concerns and really
02:28 --> 02:30meet the person where they're
02:30 --> 02:32at first and foremost when they
02:32 --> 02:33come in to see us in our clinic.
02:35 --> 02:37Important because you know when you're
02:37 --> 02:39diagnosed with cancer and you are
02:39 --> 02:41going through your treatment so often,
02:41 --> 02:43you kind of are focused on.
02:43 --> 02:45OK, I I need to get through surgery,
02:45 --> 02:46I need to get through chemo.
02:46 --> 02:49I need to get through radiation and
02:49 --> 02:52then on the other side of it you have
02:52 --> 02:54persistent questions like how do I know
02:54 --> 02:56if my cancer is going to come back?
02:56 --> 02:59Who do I need to follow up with,
02:59 --> 03:02and what can I do to reduce my risk?
03:02 --> 03:05Should I be exercising or not exercising?
03:05 --> 03:06What should I eat?
03:06 --> 03:08How how should I go about life?
03:08 --> 03:11So maybe we can delve into some
03:11 --> 03:13of those issues so that whoever's
03:13 --> 03:15listening out there can get just a
03:15 --> 03:18taste of some of the things that you do.
03:18 --> 03:19So to start with,
03:19 --> 03:22tell us about what are the most common
03:22 --> 03:26concerns that you hear from patients.
03:26 --> 03:27We do see a lot of survivorship themes
03:27 --> 03:30as we like to call them coming through,
03:30 --> 03:31and maybe one of the most common
03:31 --> 03:34themes is fear of cancer recurrence.
03:34 --> 03:36And that happens in almost.
03:36 --> 03:39Every cancer survivor that we see
03:39 --> 03:43in our clinic and statistically,
03:43 --> 03:44you know around 60 to 90%
03:44 --> 03:45of cancer survivors.
03:45 --> 03:47But I would say it's almost everybody
03:47 --> 03:48that comes through and that can
03:48 --> 03:50really range from minimal fear of
03:50 --> 03:52cancer recurrence and more significant
03:52 --> 03:53fear of cancer recurrence where it's
03:53 --> 03:55greatly impacting their daily life.
03:55 --> 03:57Or maybe their sleep and it
03:57 --> 03:58needs to be addressed.
03:58 --> 03:59You know,
03:59 --> 04:02in in some capacity at that point we also
04:02 --> 04:05talk a lot about fatigue as it relates
04:05 --> 04:07back to a treatment that someone has had.
04:07 --> 04:10Whether that is from, you know,
04:10 --> 04:11recovering from surgery,
04:11 --> 04:14post radiation or post chemotherapy
04:14 --> 04:18and we also want to make sure we're
04:18 --> 04:19taking the whole clinical picture into
04:19 --> 04:21consideration there thinking about
04:21 --> 04:22other causes for fatigue as well.
04:22 --> 04:26But really our focus is on cancer
04:26 --> 04:28related fatigue as it relates back
04:28 --> 04:29to the treatment they've received
04:29 --> 04:32and then a very common concern we
04:32 --> 04:34also addressed is weight management
04:34 --> 04:36and that really encompasses a lot of
04:36 --> 04:39things with regards to physical activity.
04:39 --> 04:42Or exercise as well as nutrition as
04:42 --> 04:45you were mentioning before and those
04:45 --> 04:46healthy lifestyle recommendations
04:46 --> 04:49are key because of the fact that
04:49 --> 04:52one we know that there are several
04:52 --> 04:54cancers that benefit from exercise
04:54 --> 04:56and reducing risk of recurrence.
04:56 --> 04:59But in addition to that, we really,
04:59 --> 05:01really want to promote overall
05:01 --> 05:01healthy lifestyle.
05:01 --> 05:04And we know that there is benefit
05:04 --> 05:06to eating well,
05:06 --> 05:07nourishing your body and getting
05:07 --> 05:09the right amount of exercise.
05:09 --> 05:12And there is guidance on that from the
05:12 --> 05:13National Comprehensive Cancer Network,
05:13 --> 05:14the NCCN.
05:14 --> 05:14As well,
05:15 --> 05:17let's do a deeper dive into each of
05:17 --> 05:20those themes so you know First off
05:20 --> 05:22the the fear of cancer recurrence.
05:22 --> 05:24I mean, this is totally justifiable when
05:24 --> 05:27you've been given a diagnosis of cancer,
05:27 --> 05:29the fear that it might come back.
05:29 --> 05:32So how do you address that with patients?
05:32 --> 05:34I mean, for patients who it's
05:34 --> 05:37impacting their life is is that
05:37 --> 05:40it in the form of an anxiolytic?
05:40 --> 05:42Said that, you prescribe or is
05:42 --> 05:45it more in terms of information
05:45 --> 05:48and how to recognize a cancer if
05:48 --> 05:50and when it should come back?
05:50 --> 05:52Or is it reassurance that for the most
05:52 --> 05:56part we hope that we would be able to
05:56 --> 05:58catch recurrences early and treat them?
05:58 --> 06:00Can you talk a little bit more
06:00 --> 06:01about how you deal with a patient
06:01 --> 06:03who comes in and says Jevin?
06:03 --> 06:05You know I'm just I'm scared to death
06:05 --> 06:07that this cancer might come back.
06:08 --> 06:09Yeah, I mean and and it's.
06:09 --> 06:12There's definitely a lot to unpack there,
06:12 --> 06:15and it really is person dependent.
06:15 --> 06:17So first, as I mentioned,
06:17 --> 06:18it really comes down to what their
06:18 --> 06:20level of fear of recurrence is.
06:20 --> 06:22So when I'm talking with someone about that,
06:22 --> 06:24the first thing I want to reassure
06:24 --> 06:25them of is that this is normal.
06:25 --> 06:27To experience this and one of the things
06:27 --> 06:29that you mentioned very studly Dr.
06:29 --> 06:31Chappar before is that as people
06:31 --> 06:33are going through their treatment,
06:33 --> 06:34that's very all encompassing
06:34 --> 06:36and will the treatment work?
06:36 --> 06:38What's what are the side
06:38 --> 06:39effects from the treatment?
06:39 --> 06:40So I manage those side effects.
06:40 --> 06:43What are the other impacts from
06:43 --> 06:44having to go through that and
06:44 --> 06:46that can take a lot out of someone
06:46 --> 06:48as they're going through that.
06:48 --> 06:50So oftentimes this fear of recurrence
06:50 --> 06:52and a lot of these emotional
06:52 --> 06:54concerns start to come in later on
06:54 --> 06:56after they've completed treatment.
06:56 --> 06:59So I want to always reassure someone
06:59 --> 07:01up front that this is normal.
07:01 --> 07:03This is OK to have these emotions,
07:03 --> 07:06and we're here to talk about that,
07:06 --> 07:09so jumping off of that again.
07:09 --> 07:11Depends on where someone's at with
07:11 --> 07:13that level of fear of recurrence.
07:13 --> 07:16So if they're having more minimal,
07:16 --> 07:19you know effects from that,
07:19 --> 07:21then we talk about just that
07:21 --> 07:22level of reassurance.
07:22 --> 07:25Continuing with routine follow ups,
07:25 --> 07:27going for their routine health maintenance,
07:27 --> 07:30going for their cancer screenings,
07:30 --> 07:30for example,
07:30 --> 07:32with a history of breast cancer
07:32 --> 07:35going for annual mammograms is so
07:35 --> 07:37important to catch anything that
07:37 --> 07:40might recur or present newly.
07:40 --> 07:42And in that case,
07:42 --> 07:43again providing that reassurance
07:43 --> 07:45that someone is doing everything
07:45 --> 07:47that they can to prevent this
07:47 --> 07:49from coming back or find something
07:49 --> 07:51early if it were to come back is
07:51 --> 07:53one of the most important things,
07:53 --> 07:55and something that we also really hone
07:55 --> 07:57in on is providing that information
07:57 --> 08:00about someone's diagnosis and prognosis.
08:00 --> 08:03And we actually have data from the
08:03 --> 08:05literature that that improves fear
08:05 --> 08:07of cancer recurrence or reduces it.
08:07 --> 08:08I should
08:08 --> 08:10say, what do you do? When patients say,
08:10 --> 08:13OK, you've told me I should get an
08:13 --> 08:15annual mammogram, but I am still
08:15 --> 08:18really worried I had my mammogram.
08:18 --> 08:20You know, three months ago and it was fine,
08:20 --> 08:22but I I'm still concerned that this
08:22 --> 08:24cancer could be coming back and I I
08:24 --> 08:27think that it might be coming back.
08:27 --> 08:28How? How do you deal with that
08:28 --> 08:30reassurance that reporting
08:30 --> 08:32concerning symptoms is first and
08:32 --> 08:34foremost a thing that someone should
08:34 --> 08:36be doing with their care team?
08:36 --> 08:38Whether it's the oncology team,
08:38 --> 08:40whether it's their primary care provider?
08:40 --> 08:41And one of the things that we
08:41 --> 08:43have in our survivorship clinic
08:43 --> 08:45is a survivorship care plan that,
08:45 --> 08:47at the end, includes potential
08:47 --> 08:49symptoms of recurrence and potential.
08:49 --> 08:50Late effects from treatment that we
08:50 --> 08:53review and so that can be an opportunity
08:53 --> 08:55to share that information and answer
08:55 --> 08:56any questions that someone has,
08:56 --> 08:58especially with regards to
08:58 --> 09:00concerning symptoms and a lot of
09:00 --> 09:02people coming into the visit,
09:02 --> 09:04don't have a great understanding of what they
09:04 --> 09:06should be looking for or what they should be.
09:06 --> 09:10You know, not so concerned about.
09:10 --> 09:12Ranging from things like you know,
09:12 --> 09:13a common common cold type
09:13 --> 09:15symptoms all the way to,
09:15 --> 09:16for example, the breast cancer,
09:16 --> 09:19a new lump or something like that,
09:19 --> 09:20and so reviewing.
09:20 --> 09:25Reviewing that with people can be reassuring,
09:25 --> 09:27and again I try to provide
09:27 --> 09:29that that context of saying,
09:29 --> 09:30you know,
09:30 --> 09:31it's important to report
09:31 --> 09:32any concerning symptoms.
09:32 --> 09:34If you're uncertain to your care
09:34 --> 09:35team and getting the appropriate
09:35 --> 09:36work up from there,
09:37 --> 09:39and it's important also to
09:39 --> 09:40understand that treatment.
09:40 --> 09:41Self can have side effects,
09:41 --> 09:44some of which patients may get confused
09:44 --> 09:46between what's a treatment side
09:46 --> 09:49effect and what could be recurrent.
09:49 --> 09:51Can you talk a little bit more about that?
09:52 --> 09:55So part of those treatment
09:55 --> 09:57related side effects we have,
09:57 --> 09:59you know lots of information on and
09:59 --> 10:02a history to go off of of these
10:02 --> 10:03being treatment related side effects.
10:03 --> 10:06And it's important to distinguish
10:06 --> 10:10those from what could be.
10:10 --> 10:11Concern for recurrence.
10:11 --> 10:14One of the most common ones we see
10:14 --> 10:16in our survivorship clinic clinic
10:16 --> 10:19is post surgical pain and you know,
10:19 --> 10:20in cancer survivorship you see a
10:20 --> 10:21lot of breast cancer survivors,
10:21 --> 10:23so you might hear me refer to
10:23 --> 10:25that population a lot,
10:25 --> 10:27but I want to be clear that we
10:27 --> 10:29do see all cancer types and all
10:29 --> 10:31you know people coming from any
10:31 --> 10:34history of cancer diagnosis but
10:34 --> 10:37with regards to post surgical pain,
10:37 --> 10:38providing that reassurance
10:38 --> 10:40that that is a common late.
10:40 --> 10:42Connect after surgery
10:42 --> 10:44after radiation therapy.
10:44 --> 10:47Compared with the fact that
10:47 --> 10:49cancer pain associated with a
10:49 --> 10:51new breast cancer is less common,
10:51 --> 10:53that's some level of counseling
10:53 --> 10:55that I would give in that scenario,
10:55 --> 10:56for example.
10:58 --> 11:00The next big theme that you you
11:00 --> 11:02kind of mentioned that patients
11:02 --> 11:05may complain about is fatigue.
11:05 --> 11:08So how do patients kind of get over that?
11:08 --> 11:11Because I can imagine that you know,
11:11 --> 11:13particularly for patients, for example,
11:13 --> 11:15who have gone through radiation,
11:15 --> 11:16there may be fatigue,
11:16 --> 11:18but there may also be kind
11:19 --> 11:21of emotional fatigue as well.
11:21 --> 11:23After going through, you know,
11:23 --> 11:24rounds of chemotherapy,
11:24 --> 11:27a big long cancer diagnosis,
11:27 --> 11:29you might just get tired of cancer.
11:29 --> 11:31Just like many of us are
11:31 --> 11:32getting tired of COVID.
11:32 --> 11:34But then there's also the
11:34 --> 11:36physiologic fatigue as well.
11:36 --> 11:38So how do you kind of get
11:38 --> 11:40patients over that sense of?
11:40 --> 11:43I'm just so Dang tired all the time.
11:45 --> 11:46Great point, and it's something we
11:46 --> 11:48see a lot of. And you're right,
11:48 --> 11:50there is both a physical component to
11:50 --> 11:52fatigue and an emotional component,
11:52 --> 11:55and it's important to assess that when you're
11:55 --> 11:57talking with people from the start of the
11:57 --> 12:00visit when they have concern of fatigue,
12:00 --> 12:04there are lots of reasons for fatigue.
12:04 --> 12:04And you know,
12:04 --> 12:07when we're talking about fatigue, it's a.
12:07 --> 12:10It's a multidisciplinary concern for
12:10 --> 12:12sure that each member of our team,
12:12 --> 12:12our physical therapist,
12:12 --> 12:14or social worker, and myself,
12:14 --> 12:17we all talk about so really discussing
12:17 --> 12:19where that level of fatigue is coming
12:19 --> 12:21from the timeline after treatment,
12:21 --> 12:25and how that can factor into fatigue.
12:25 --> 12:27Those are all things that we address
12:27 --> 12:30as a team overall and and how long
12:30 --> 12:32to expect that fatigue and the
12:32 --> 12:34recommendations that we would.
12:34 --> 12:35Provide for fatigue as well.
12:35 --> 12:37Well, we have to take a short
12:37 --> 12:38break for a medical minute,
12:38 --> 12:40but after the break I hope that
12:40 --> 12:43we can take a deeper dive into
12:43 --> 12:45what recommendations you have for
12:45 --> 12:47fatigue as well as a variety of
12:47 --> 12:49other issues that might come up
12:49 --> 12:51during the survivorship period.
12:51 --> 12:54So please stay tuned to learn more about
12:54 --> 12:55cancer survivorship with my guest,
12:55 --> 12:56Jeff and Britta.
12:57 --> 13:00Funding for Yale Cancer answers comes
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13:02 --> 13:05the Susan Barrass MD brain tumor webinar
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13:08 --> 13:13Org or email cancer answers at yale.edu.
13:13 --> 13:15There are many obstacles to
13:15 --> 13:16face when quitting smoking.
13:16 --> 13:18As smoking involves the potent drug.
13:18 --> 13:20Nicotine quitting smoking is a
13:20 --> 13:22very important lifestyle change,
13:22 --> 13:24especially for patients undergoing
13:24 --> 13:25cancer treatment,
13:25 --> 13:27as it's been shown to positively
13:27 --> 13:29impact response to treatments
13:29 --> 13:31decrease the likelihood that patients
13:31 --> 13:33will develop second malignancies
13:33 --> 13:35and increase rates of survival.
13:35 --> 13:37Tobacco treatment programs are currently
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14:01 --> 14:02to Connecticut Public Radio.
14:04 --> 14:06Welcome back to Yale Cancer answers.
14:06 --> 14:08This is doctor anise Chappar and I'm joined
14:08 --> 14:11tonight by my guest, Jeff and Britta.
14:11 --> 14:12We're learning more about the
14:12 --> 14:15field of cancer survivorship now,
14:15 --> 14:16right before the break, Kevin,
14:16 --> 14:19you were saying that one of the more
14:19 --> 14:22common things that you hear from cancer
14:22 --> 14:25survivors as a theme as you will,
14:25 --> 14:28is this whole aspect of cancer fatigue,
14:28 --> 14:30whether that's physical
14:30 --> 14:32fatigue or emotional fatigue.
14:32 --> 14:33People just get tired.
14:33 --> 14:36And whether that is a late side effect
14:36 --> 14:39of things like radiation or whether
14:39 --> 14:42they just get tired of appointments,
14:42 --> 14:44or whether you know they are
14:44 --> 14:47just run down and run out.
14:47 --> 14:49But are there any specific recommendations
14:49 --> 14:52that you can give people that might
14:52 --> 14:54help them to get some energy back?
14:55 --> 14:55Yes, exactly.
14:55 --> 14:58And and we were talking about how
14:58 --> 15:00this can really be multifactorial,
15:00 --> 15:01and there are lots of reasons for it,
15:01 --> 15:04so we typically will talk with people.
15:04 --> 15:06About fatigue as it relates
15:06 --> 15:08back to their treatment,
15:08 --> 15:09whether it's chemotherapy or radiation,
15:09 --> 15:12for example, and lasting anywhere
15:12 --> 15:16between up or up to 6 to 12 months.
15:16 --> 15:17Even and really,
15:17 --> 15:19that can be individual though,
15:19 --> 15:20and it's not a hard,
15:20 --> 15:22fast rule that says you will have this
15:22 --> 15:24fatigue as it relates to the treatment
15:24 --> 15:26you've had for that exact amount of time.
15:26 --> 15:28But there are things, thankfully,
15:28 --> 15:30that you can do to help with fatigue,
15:30 --> 15:32so the first and foremost
15:32 --> 15:34recommendation I have is staying.
15:34 --> 15:36Active getting exercise,
15:36 --> 15:39so the NCCN or National Comprehensive
15:39 --> 15:42Cancer Network guidelines recommend
15:42 --> 15:4530 minutes of moderate level exercise.
15:45 --> 15:47Moderate intensity exercise.
15:47 --> 15:49Five days a week.
15:49 --> 15:51So that's a total of 150 minutes
15:51 --> 15:53or more of exercise a week.
15:53 --> 15:54And that's something that as part again
15:54 --> 15:57as part of a multidisciplinary clinic.
15:57 --> 16:00Our physical therapist tends to go into
16:00 --> 16:03a bit more in detail and can really
16:03 --> 16:06hone in on someone's physical limitations.
16:06 --> 16:09Additional physical concerns,
16:09 --> 16:10maybe range of motion related
16:10 --> 16:12concerns and really do it deeper.
16:12 --> 16:14Dive into what the best exercises
16:14 --> 16:17are for someone and how they can stay
16:17 --> 16:19active and that will be one of the best
16:19 --> 16:22things that someone can do for fatigue.
16:22 --> 16:24Now you do realize jevin before
16:24 --> 16:25you get into the next thing.
16:25 --> 16:28I I just have to push back a little bit
16:28 --> 16:31on the exercise because I can imagine
16:31 --> 16:33that patients likely will say to you.
16:33 --> 16:35Jevin, I'm exhausted.
16:35 --> 16:39How can I possibly exercise?
16:39 --> 16:42Wouldn't it be better for me to just sleep?
16:43 --> 16:44Yeah, and it's a very
16:44 --> 16:45common thing that we hear.
16:45 --> 16:48It's like I could hear our our cancer
16:48 --> 16:49survivors coming right through you,
16:49 --> 16:52doctor Shadfar, and so yes,
16:52 --> 16:54it sounds counterintuitive indeed.
16:54 --> 16:57But believe it or not, it can be helpful,
16:57 --> 16:59and it's if you get the body moving,
16:59 --> 17:03your body will respond and want to move more.
17:03 --> 17:04So that's one thing that I'll
17:04 --> 17:06talk about with them, but.
17:06 --> 17:07Part of it too is,
17:07 --> 17:10as we choose not to use our bodies,
17:10 --> 17:12our bodies get used to that state
17:12 --> 17:13and our muscles will say, well,
17:13 --> 17:15I guess we don't need to be used
17:15 --> 17:17and it further feeds into that level
17:17 --> 17:19of fatigue that one may be having.
17:19 --> 17:21So really trying to get that body
17:21 --> 17:23conditioned again from that deconditioning
17:23 --> 17:25that's happened through the treatment
17:25 --> 17:27and the recovery that they've had
17:27 --> 17:29is the important thing to focus on.
17:29 --> 17:30And really starting where someone
17:30 --> 17:32is at with their level of physical
17:32 --> 17:34activity is so important,
17:34 --> 17:37because if someone sedentary all day.
17:37 --> 17:38Say like me,
17:38 --> 17:40sitting around doing documentation all day,
17:40 --> 17:42suddenly standing up from a chair
17:42 --> 17:44is more physical activity than I've
17:44 --> 17:46had throughout most of the day.
17:46 --> 17:48So it's really about starting where
17:48 --> 17:50someone is at taking their physical
17:50 --> 17:51limitations into consideration
17:51 --> 17:52and going from there,
17:52 --> 17:54and building upon that as someone
17:54 --> 17:56becomes less and less deconditioned.
17:57 --> 17:59Great, so you were going to tell
17:59 --> 18:00us some more recommendations
18:00 --> 18:02with regards to fatigue.
18:02 --> 18:03Before I interrupted you.
18:04 --> 18:06I appreciate the interruption.
18:06 --> 18:08So the other thing that we'll
18:09 --> 18:11talk about is setting priorities
18:11 --> 18:13because some people have, you know,
18:13 --> 18:16fairly profound fatigue and you know
18:16 --> 18:18setting priorities is important,
18:18 --> 18:19so really differentiating between
18:19 --> 18:22what you need to do during the day,
18:22 --> 18:24what you want to do versus what you don't
18:24 --> 18:26really need to do and and determining
18:26 --> 18:28the things that are important to
18:28 --> 18:31get done on a day to day basis and
18:31 --> 18:33those activities of daily living as
18:33 --> 18:34they're called is so important.
18:34 --> 18:37In finding the time to rest when it's needed.
18:37 --> 18:41So capitalizing the time when you're you have
18:41 --> 18:44more energy to be more physically active.
18:44 --> 18:46But when you feel very fatigued
18:46 --> 18:48and feel like you can't do that,
18:48 --> 18:50it's it's important to listen
18:50 --> 18:51to your body and rest.
18:51 --> 18:53But part of that, too,
18:53 --> 18:54is getting the appropriate
18:54 --> 18:55amount of rest as well at night.
18:55 --> 18:57And that's when we get into some of these
18:57 --> 18:59other secondary reasons for fatigue,
18:59 --> 19:00like sleep or medications.
19:00 --> 19:02And those are things that will
19:02 --> 19:03counsel on as well,
19:03 --> 19:05depending on a person's situation.
19:06 --> 19:10Perfect now, before the break you were saying
19:10 --> 19:13that another big area that many patients
19:13 --> 19:17come to talk about is weight management.
19:17 --> 19:20Because you know, weight really does
19:20 --> 19:23fluctuate with cancer, some cancers and
19:23 --> 19:25some treatments make you gain weight.
19:25 --> 19:28Some make you lose weight and for
19:28 --> 19:30a number of different cancers,
19:30 --> 19:33being overweight actually puts you at
19:33 --> 19:35increased risk of either getting cancer
19:35 --> 19:38or getting a recurrence of your cancer.
19:38 --> 19:42And for the majority of the US population.
19:42 --> 19:44Wait something that all of us
19:44 --> 19:46struggle with at the get go even
19:46 --> 19:48without a diagnosis of cancer.
19:48 --> 19:51So what recommendations do you have to
19:51 --> 19:56get to and maintain ideal body weight?
19:57 --> 19:59So and and that is a big concern
19:59 --> 20:01that we hear about as you mentioned,
20:01 --> 20:04and a lot of people going through
20:04 --> 20:06treatment sometimes will will in fact
20:06 --> 20:08gain weight and they come in thinking.
20:08 --> 20:10I thought I was supposed to lose
20:10 --> 20:12weight going through cancer treatment,
20:12 --> 20:15but it can sometimes be the
20:15 --> 20:17opposite effect as well.
20:17 --> 20:19So what we talk about is really
20:19 --> 20:21focusing on healthy lifestyle
20:21 --> 20:23and I always encourage people to
20:23 --> 20:26try to focus less on a number.
20:26 --> 20:27Although there are healthy and
20:27 --> 20:30appropriate ways to look at weight
20:30 --> 20:32and a number and and take that
20:32 --> 20:34into consideration when trying to
20:34 --> 20:36achieve a goal for weight loss.
20:36 --> 20:36However,
20:36 --> 20:39it's important to really focus on lifestyle,
20:39 --> 20:42nourishing your body with the foods it needs,
20:42 --> 20:44the nutrients it needs in order to
20:44 --> 20:47keep moving and be active and then.
20:47 --> 20:47Again,
20:47 --> 20:50putting that into action and actually
20:50 --> 20:52being active doing exercise,
20:52 --> 20:54some level of physical activity
20:54 --> 20:55to help manage weight as well.
20:57 --> 20:59So talk a little bit more about that.
20:59 --> 21:01I mean that all sounds very good,
21:01 --> 21:04but it's kind of a 20,000 foot view.
21:04 --> 21:07If people come to you and say jevin,
21:07 --> 21:10what practical advice do you have?
21:10 --> 21:12I mean, how do I actually do this?
21:12 --> 21:14Are there things I should eat?
21:14 --> 21:16Are there things I should avoid?
21:16 --> 21:20You know? Should I do a keto diet?
21:20 --> 21:22Should I do a paleo diet?
21:22 --> 21:24Mediterranean so many patients
21:24 --> 21:25have questions about?
21:25 --> 21:26You know what?
21:26 --> 21:28What should I do?
21:28 --> 21:31Uhm, how do you respond to that?
21:32 --> 21:34It's a great question and and we have
21:34 --> 21:35so many people are right coming in
21:35 --> 21:37asking about specific diets or plans
21:37 --> 21:39that they should be adhering to.
21:39 --> 21:42And you know the the truth of it is is
21:42 --> 21:44that oftentimes people trying to stick
21:44 --> 21:48to a diet and I use that word very
21:48 --> 21:50pointedly here often end up falling off
21:50 --> 21:52a Cliff with that because what happens
21:52 --> 21:54is a lot of these diets that are out
21:54 --> 21:56there become too restrictive and it
21:56 --> 21:58becomes difficult to adhere to it.
21:58 --> 22:00And then that can be very discouraging
22:00 --> 22:01for people and actually have.
22:01 --> 22:04A reverse effect where someone.
22:04 --> 22:08Falls off of this diet and falls
22:08 --> 22:11back into poor eating habits.
22:11 --> 22:13Maybe things that they were challenged
22:13 --> 22:15with before trying to adhere to the diet.
22:15 --> 22:17So really the focus is around plant
22:17 --> 22:20based nutrition and trying to get
22:20 --> 22:21plenty of vegetables and whole
22:21 --> 22:24grains and healthy types of protein
22:24 --> 22:26into your nutrition each day.
22:26 --> 22:28And it's about portion size.
22:28 --> 22:31It's about the types of meats
22:31 --> 22:33you're choosing like fish and
22:33 --> 22:35poultry limiting red meats.
22:35 --> 22:37Limiting highly processed foods
22:37 --> 22:39limiting added sugars for overall
22:39 --> 22:42health and well being and as a way to
22:42 --> 22:45help with weight management overall.
22:46 --> 22:48And so you know, one of the
22:48 --> 22:50questions that we often get asked
22:50 --> 22:52with regards to plant based diets
22:52 --> 22:56is but but but don't I need protein?
22:56 --> 22:58How can I get protein if I'm
22:58 --> 23:00eating a plant based diet?
23:00 --> 23:02And what do you say to that?
23:03 --> 23:05It's a great question and something I
23:05 --> 23:07always tell people whenever talking about a
23:07 --> 23:09plant based diet is by that I do not mean
23:09 --> 23:11going or becoming vegetarian or vegan.
23:11 --> 23:13It means getting plenty of vegetables
23:13 --> 23:15and whole grains as part of your diet.
23:15 --> 23:17So when you look at the a plate.
23:17 --> 23:20There's a great resource that we have we
23:20 --> 23:22provide with patients and that to patients,
23:22 --> 23:25and it's a circular disk and it shows
23:25 --> 23:28portions on this disc that you can go
23:28 --> 23:30and slide around the top part to to
23:30 --> 23:32see 2/3 of the plate should be made
23:32 --> 23:34up of vegetables and whole grains.
23:34 --> 23:36Your other third should be your
23:36 --> 23:39source of protein like chicken or
23:39 --> 23:41fish or something like that.
23:41 --> 23:44And beyond that you know
23:44 --> 23:46you can have carbohydrates,
23:46 --> 23:48but don't make it the mainstay of the meal.
23:48 --> 23:51Really focus on those larger servings
23:51 --> 23:53of vegetables and whole grains as
23:53 --> 23:55part of your meals throughout the
23:55 --> 23:58day. Perfect, you know the other question
23:58 --> 24:01that I think a lot of patients might have
24:01 --> 24:04as they're thinking about this fear of
24:04 --> 24:06recurrence and and trying to get healthier,
24:06 --> 24:10healthier into air quotes.
24:10 --> 24:13Are vitamins and supplements
24:13 --> 24:16and alternative therapies?
24:16 --> 24:18Can you talk a little bit about about that?
24:18 --> 24:20Are there supplements that people
24:20 --> 24:22should be using or not using?
24:22 --> 24:23How do you?
24:23 --> 24:26How do you advise patients when they
24:26 --> 24:29come in and they say I just read
24:29 --> 24:31this article in this magazine about
24:31 --> 24:34this herb or this natural supplement
24:34 --> 24:36that is supposed to cure cancer
24:36 --> 24:39or prevent it from coming back?
24:39 --> 24:39It's
24:39 --> 24:40a great question.
24:40 --> 24:42It's one of the most common things that
24:42 --> 24:44we talk about in our clinic as well,
24:44 --> 24:45and I will say, you know,
24:45 --> 24:48with as it relates to nutrition supplements,
24:48 --> 24:51exercise, all of it is individual and if
24:51 --> 24:54they're if you have any questions about that,
24:54 --> 24:56you should always consult
24:56 --> 24:57with your care team,
24:57 --> 25:01your providers and before making
25:01 --> 25:03a significant lifestyle change.
25:03 --> 25:06But specifically with regards to supplements,
25:06 --> 25:07I don't have any specific
25:07 --> 25:09recommendations that I make.
25:09 --> 25:11In our clinic, but again,
25:11 --> 25:14I will say if someone has a
25:14 --> 25:15nutritional deficiency again,
25:15 --> 25:17it's important to talk with your care
25:17 --> 25:19team about that and take the appropriate
25:19 --> 25:21supplements that you might need,
25:21 --> 25:23assuming that that's not the case,
25:23 --> 25:25I don't give any specific
25:25 --> 25:27recommendations for taking supplements
25:27 --> 25:28because believe it or not,
25:28 --> 25:30we actually can get almost all of
25:30 --> 25:32what we need from our nutrition,
25:32 --> 25:34and we're blessed in the country that we
25:34 --> 25:37live in here in the United States that
25:37 --> 25:39we actually have great access to food.
25:39 --> 25:41And a lot of the foods that we eat
25:41 --> 25:45are rich in the supplements or the
25:45 --> 25:47vitamins rather and nutrients that
25:47 --> 25:49we need and so really trying to
25:49 --> 25:51focus on this plant based nutrition
25:51 --> 25:53incorporating a wide variety of
25:53 --> 25:55different fruits and vegetables is
25:55 --> 25:57so important to get those different
25:57 --> 25:59vitamins in our bodies each day.
25:59 --> 26:02And the great thing about that too
26:02 --> 26:04is there's a good guide to follow.
26:04 --> 26:06It's eat the colors of the rainbow
26:06 --> 26:08and our I have to give credit
26:08 --> 26:09to our registered dietitian.
26:09 --> 26:11He was in her clinic for this one
26:11 --> 26:13and she would counsel on this a lot.
26:13 --> 26:15But trying to look at the rainbow
26:15 --> 26:17as a good guide for picking out
26:17 --> 26:18different fruits and vegetables
26:18 --> 26:19to eat throughout the day.
26:19 --> 26:21Try to get as many of those colors
26:21 --> 26:23in to get those what are called
26:23 --> 26:25phytonutrients or plant based
26:25 --> 26:26nutrients in each and every day.
26:26 --> 26:28So that's a great tip and
26:28 --> 26:30you make a great point about,
26:30 --> 26:33you know living in the US and having
26:33 --> 26:35access to fruits and vegetables.
26:35 --> 26:37But one of the other issues is
26:37 --> 26:40that not all patients and not all.
26:40 --> 26:43Cancer survivors have the same resources,
26:43 --> 26:45so unfortunately some of our patients may
26:45 --> 26:48live in food deserts where getting fresh
26:48 --> 26:50fruits and vegetables is really hard,
26:50 --> 26:53on top of which it can be a bit
26:53 --> 26:55expensive for some patients and
26:55 --> 26:57patients are dealing with the
26:57 --> 26:59financial toxicity of their treatments,
26:59 --> 27:00their doctors visits.
27:00 --> 27:03So what recommendations do you have
27:03 --> 27:06for patients who are struggling
27:06 --> 27:08with another form of survivorship
27:08 --> 27:10toxicity and that that's the.
27:10 --> 27:12Kind that hits the pocketbook.
27:13 --> 27:16Yes, and that is a strong concern that
27:16 --> 27:20a lot of people have as well and a lot
27:20 --> 27:22of people when they think about healthy
27:22 --> 27:24eating they think to what the media
27:24 --> 27:27sort of puts out there and and a lot of
27:27 --> 27:29ways or what we see on TV shows or in
27:29 --> 27:32the movies or on commercials where it's
27:32 --> 27:35like you're eating all these organic,
27:35 --> 27:40fresh, non GMO foods and and all of
27:40 --> 27:43these you know more expensive options.
27:43 --> 27:44But the reality is,
27:44 --> 27:47there are a lot of inexpensive options and
27:47 --> 27:49one example for you know this is frozen.
27:49 --> 27:51Fruits and vegetables believe it or not,
27:51 --> 27:53and oftentimes these are flash frozen.
27:53 --> 27:55This is another tip I had learned
27:55 --> 27:57from our our dietitians and that
27:57 --> 27:59they are flash frozen,
27:59 --> 28:01and so you can certainly go to the store,
28:01 --> 28:04pick up some frozen vegetables for example,
28:04 --> 28:06and get the nutrients you
28:06 --> 28:07need from that as well.
28:07 --> 28:09So that's one of many
28:09 --> 28:11tips that you might get,
28:11 --> 28:13but I would recommend talking
28:13 --> 28:14with a registered dietitian.
28:14 --> 28:16About those options as well,
28:17 --> 28:19and for patients who are struggling
28:19 --> 28:20with their medical bills,
28:21 --> 28:23yes. And that is so important to
28:23 --> 28:25address during the visit as well.
28:25 --> 28:27I would advise that anyone going
28:27 --> 28:29through that reach out to their care
28:29 --> 28:31team and talk about the resources that
28:31 --> 28:33exist to help with financial concerns.
28:33 --> 28:36Jevin bretta is a certified physician
28:36 --> 28:37assistant with the survivorship
28:37 --> 28:39clinic at Smilow Cancer Hospital.
28:39 --> 28:41If you have questions,
28:41 --> 28:43the address is canceranswers@yale.edu
28:43 --> 28:46and past editions of the program
28:46 --> 28:48are available in audio and written
28:48 --> 28:49form at yalecancercenter.org.
28:49 --> 28:51We hope you'll join us next week
28:51 --> 28:52to learn more about the fight.
28:52 --> 28:53Against cancer here on
28:53 --> 28:55Connecticut public radio.
28:55 --> 28:57Funding for Yale Cancer Answers is
28:57 --> 29:00provided by Smilow Cancer Hospital.

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May 8, 2022

Yale Cancer Center

visit: http://www.yalecancercenter.org

email: canceranswers@yale.edu

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