Healthy Living After Childhood Cancer
Survivors often wonder what steps they can take to live healthier after cancer. There is no one supplement or specific food you can eat to assure good health, but there are things you can do to live healthier, prevent other diseases, and find any subsequent cancers early.
In addition to medical problems and screening, cancer survivors may have issues with insurance, employment, relationships, sexual functioning, fertility, and emotional concerns because of their treatment. We encourage you to discuss these with your healthcare team who can help you find support resources.
Survivorship Care Plans
A survivorship care plan (SCP) can be a great tool to learn about life after cancer. An SCP should include information about health issues (called late effects) that can be caused by the cancer treatment you had. This information should give ways you can reduce the risk of these issues, any tests you should have to monitor for the issue, and things to report to your healthcare team. An SCP may also provide resources and information about practical concerns as well, including fear of recurrence, financial issues, sexual changes, and more.
Managing Your Healthcare
It is important to have a plan for who will provide your cancer follow up care (an oncologist, survivorship doctor, or primary care doctor). This care can include exams, reviewing any scans or blood work that is recommended after treatment, monitoring for the possibility of cancer returning, and any late side effects of treatment. You may benefit from seeing a provider who specializes in cancer survivorship to review your risks and any concerns. If you would like to find a survivorship provider you can contact cancer centers in your area to see if they have a survivor's clinic or search for a clinic on OncoLink's survivorship clinic list.
It is also important to have a primary care provider who can manage other health concerns (for example blood pressure, diabetes, etc.) and provide preventive care and screening (for example: checking cholesterol levels, getting a flu shot, ordering a mammogram). While it is ideal for these providers to know what the other is doing, it doesn’t always happen. Being involved in your care helps to be sure you don’t miss things that are important for keeping you healthy. You are the Captain of your ship!
Some survivors report significant fatigue years after completing therapy, which can be extremely frustrating for the survivor and those around them. It is important to remember that fatigue can have many causes and, particularly if fatigue is worsening or new, it should be discussed with your healthcare team to rule out treatable causes.
While it may seem overwhelming to start exercising, many studies have shown that light to moderate exercise can combat fatigue and improve your energy level. Exercise can take many forms, from walking, gardening or swimming, to more structured classes at a gym. Start slow and gradually increase the amount and intensity of your activities. Enlist a friend to be an exercise partner, who can encourage and support you on days when you can't get motivated.
- After making sure that fatigue is not being caused by another problem, find ways to best cope and manage the fatigue. Regular exercise, acceptance, and reprioritizing will help.
- Alert your healthcare provider if fatigue is worsening or a new symptom.
After being treated for cancer, you will be followed closely by your oncology team. In general, these exams, visits, and testing occur frequently (i.e. monthly) right after the end of therapy and are spaced out (i.e. every 3 months, 6 months, and then yearly) over time. In general, the further you are from treatment, the lower the risk of recurrence. You and your healthcare team should begin to discuss keeping you healthy in the long-term ("survivorship care"). Survivorship care may involve seeing other healthcare teams that specialize in survivor care. After a time, some survivors will not need to see the oncology team anymore.
Many survivors have questions about the genetics of their cancer and what that means for them or their family members. It is common for families to have more than one person who is affected by cancer. Most of the time, this is a random occurrence, but there are some cancers that are known to be associated with specific genes (part of a person's DNA) that can be passed from one family member to the next generation.
Healthcare providers will assess this risk by asking about your personal and family history of cancer. If you have concerns that cancer "runs in your family" you should speak to your provider and they can help determine if there is a known risk for you. Information you should find out for your provider includes types of cancer in your family, at what general age people had cancer, family members who have multiple cancers, and whether other risk factors were involved (like smoking).
Note, very few cancers are known to have this type of risk (less than 10%). If your providers have concerns, you will be referred to a genetic counselor for further testing.
Often, survivors of childhood cancer will have additional questions about the risk of cancer (or other problems like birth defects) for their children because of their history of cancer and cancer treatment. Luckily, looking at large groups of adult survivors there is no known increased risk of childhood cancer or birth defects in children of cancer survivors just because their parents had cancer.
Are cancer survivors at increased risk of cancer?
Some studies have found that cancer survivors are more likely to develop another cancer when compared to someone who has never had cancer. In some cases, a treatment (certain types of chemotherapy or radiation therapy) can increase the risk of another cancer. In this case, they are called "secondary cancers" because they develop as a result of therapy. The increased risk of developing another cancer may also be related to exposure to risk factors (smoking, for example), or a genetic predisposition in certain individuals, but in many cases the reason for the increased risk is unclear. While this may sound scary, it is a reminder of the importance of cancer screening and of maintaining a healthy lifestyle in your post-cancer life.
In anyone who has been treated for one cancer, one goal of medical care should be to prevent other cancers or detect them early.
General Cancer Screening and Prevention
Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. Various organizations have developed guidelines for screening for cancer where tests are available. For other cancers, certain health behaviors may decrease the risk of cancer.
Cancer prevention and screening for the general public (and all survivors unless they need additional screening) includes:
- HPV vaccine: Human Papilloma Virus (HPV) is a virus that causes cervical and other cancer types. Therefore, all who are eligible (boys and girls) should receive the HPV vaccine.
- Sun Protection: Skin cancer is one of the most common types of cancer. Practicing sun-safety including not tanning outside or in tanning beds, wearing sunscreen and protective clothing, can reduce your risk of skin cancer. Of note, those with darker skin pigment are still at risk of getting skin cancer. People who have received radiation are at higher risk.
- Colon Cancer: Most men and women over the age of 45 or 50 should undergo routine screening for colon and rectal cancer. This may be done with colonoscopy (most common) or other imaging or stool tests. Testing may be appropriate for younger people with a high-risk personal or family health history.
- Healthy Living. Diet (including only minimal consumption of alcohol) and physical activity is thought to be a good thing for a number of health conditions, including cancer.
- Not smoking! Tobacco is addictive and linked to several cancers (not just lung cancer). All types of cigarettes, including electronic cigarettes, should be avoided to prevent cancer.
Especially for Women
Cervical Cancer Screening is important and begins younger than most other cancer screening tests. Women should begin having pap smears at age 21 (per the American Cancer Society and the United States Preventative Task Force). HPV testing can begin at age 30. Screening frequency will depend on whether the result of the test is abnormal or normal and other factors, such as age.
Breast Cancer Screening is important for all women. Depending on which guidelines are followed, mammography begins at age 40 (American Cancer Society) or 50 (the United States Preventative Task Force). Clinical and/or self-breast exams may be part of a screening plan depending on guidelines and individual risk.
There are some women (because of family history, genetic tendency, or radiation exposure) who need to be screened with MRI in addition to mammograms. The number of women who fall in this category is low, but cancer survivors who received chest radiation do fall into this higher risk group.
Especially for Men
Prostate Cancer Screening: There are two ways to screen for prostate cancer. The first is a blood test called a PSA (prostate-specific antigen) and the other is a rectal exam to feel the prostate. Both have the benefit of detecting prostate cancer at an early stage, but the downside of many false positives (the test coming back concerning when there really is no cancer). For this reason, the American Cancer Society (ACS) and the National Comprehensive Cancer Network (NCCN) recommend that men discuss the risks and benefits of prostate cancer screening with their physician and make an informed decision about whether to be screened or not. Men at average risk for prostate cancer should have this discussion starting at age 50. Men with a father or brother who had prostate cancer before age 65, and all African American men, should have this talk starting at age 45.