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Education: Important in cancer treatment
Knowing what to expect helps patients cope
Cancer can be a life-altering disease, but Tammy Zeller, a mother with a career, wanted to keep her routine as normal as possible during treatment.
Diagnosed with stage-three breast cancer, she had a double mastectomy, 20 rounds of intravenous chemotherapy, six weeks of radiation, and four months of oral chemotherapy.
Education was one factor that helped Zeller continue in her job as an assistant principal at an elementary school in Dallas and maintain family life as a wife and mother of three children ages nine, six, and four. She was educated to know what to expect. For example, she was prepared for the time she would lose her hair, and she knew which days she would not be able to go to work following treatment.
Also, she was taught how to keep the side effects of chemotherapy under control. Zeller says she followed the instructions of her oncologist, taking the prescription drugs to control side effects exactly as she was told, drinking plenty of fluids, and exercising.
Preparation for treatment is extremely important, says Dana Zager, MA, ATR-BC, MS-LISW, OSWC, an oncology counselor in private practice in Columbus, OH. Patients need to know what to expect during their treatment, and also they need to be made aware of services and resources they might need. While patients don't always make use of the resources given right away, it is good that they have them should they suddenly realize they do need help.
Zeller said she was given a large binder filled with information about her cancer treatment that she would go to when she needed answers. Especially helpful was the section on side effects she might experience from the medications taken during treatment. She would look up her symptoms to determine if they were normal.
Cancer patients may or may not be able to follow their usual routine during cancer treatment, says Lakshmi Naik, MA, LCSW, assistant director of the department of social work at M.D. Anderson Cancer Center in Houston.
Many factors play into it, she explains. Some cancer is disfiguring or disabling, and other types require months and months of treatment. Timing is also an important element. For example, a 65-year-old and a 27-year-old are in different positions as far as their occupational life. One is in the beginning stages, and one is in the ending stages, so the importance of remaining in a job might be different.
There are other critical factors, such as personality traits, the type of cancer, personal priorities, level of education, as well as the economic and financial status of a patient. "As we grow older, life changes with the natural course of things; cancer expedites it," she says.
When first diagnosed, people are so focused on getting treatment as swiftly as possible, they don't often come to a full realization of the fact that cancer can be life-altering, says Zager. For many, a significant impact is missed work. People suffer from fatigue during treatment, or they cannot think as clearly during chemotherapy. If they undergo a stem cell transplant, there is a greater recovery time.
If these patients are single providers for a family, or on their own, it can be financially detrimental, says Zager. Therefore, patients must be made aware of financial assistance and other available resources.
Assess for needs
Because a cancer patient doesn't know right away what the outcome might be and what resources he or she may need, it is a good idea to do an assessment, says Zager.
"The psychosocial assessment includes identifying what some of their life stressors are, or what their current situation might be, including their family unit, support system, and resources outside the immediate family," she says.
Naik adds, "Cancer is a life-changing experience which brings with it many issues related to adjustment, coping, and surviving."
Zeller says she had a very strong support system that included her family, friends, and her church. Her sister did her laundry, and she was told of an organization called "Cleaning for a Reason" that cleaned her house once a month.
Most patients feel fairly well supported during treatment, says Zager. At that time, they make friends with other patients going through treatment and develop a rapport with their health care team. Also, friends and family rally around to help. However, when treatment is completed, that support often vanishes, and people can feel abandoned, she says.
Therefore, education must also address this period of time. Zager refers to it as the "new normal."
"Their life is resuming, but it is different and so are the resources they need. It is educating patients on how to reconnect with their lives and move forward," says Zager.
For some, their ability to complete tasks at work has been altered due to the chemotherapy treatment. Zager says she works with patients to come up with solutions to the problem, such as making lists or using oral reminders. "Whatever makes them more confident," she says.
A change in a person's stamina can linger for a while following treatment, as well. Zager says she once worked with a woman who had run 14 miles every weekend to train for marathons before cancer treatment. The woman became frustrated, because she could not seem to get back her routine. Together, they worked out a plan to break the miles into increments while resting in-between. "She met the goal but did it differently," explains Zager.
Some cancer patients change the way they make decisions following cancer treatment, having had a close brush with death, she says.
Many patients think they will go back to life as it was following cancer treatment, only to discover they are different, and the people around them are different. For example, their children may be different, because they have taken on different roles during the cancer treatment, says Zager.
Education not only must address issues caused by cancer treatment, but also lifestyle changes that may have resulted from the illness. "For some people, cancer is really quite a dramatic and traumatic life change," she says.
For more information about education before, during, and immediately following cancer treatment, contact:
Lakshmi Naik, MA, LCSW, Assistant Director, Department of Social Work, M.D. Anderson Cancer Center, Houston, TX. Telephone: (713) 794-5734. E-mail: Lnaik@mdanderson.org.
Dana Zager, MA, ATR-BC, MS-LISW, OSWC, oncology counselor, Columbus, OH. Telephone: (614) 832-6981. E-mail: DanaZagerTherapy@gmail.com.