One of the privileges of being a fourth year in medical school is the ability to select rotations in specialized fields beyond the basics of third year. For me, this resulted in three months of gynecologic oncology (GYN onc) and an additional month of breast oncology. Now that I’m up against the end of my gyn onc rotations, I feel I have a lot to reflect on. What has been most striking recently relates to issues of survivorship; in fact, I’m giving a survivorship presentation on Friday!
When a person is diagnosed with cancer, the shock and trials of treatment are undoubtedly heavy, overwhelming, and incredibly difficult to process. Each individual will react differently and employ different coping mechanisms. But from the time of diagnosis through treatment until remission, there is a set schedule and treatment plan that is adhered to. One of the biggest and often most underestimated challenges involves what happens after treatment, especially in GYN cancers. The extreme fatigue, persistent side effects of chemotherapy- numbness, tingling, chronic pain, body aches- and interpersonal issues sweep in and pose an entirely new set of challenges. Individuals often feel lonely, defeated, depressed, incapable, and guilty. This is a critical time in patients’ lives to seek out support, discuss their feelings, and work towards finding a manageable way to cope with the aftermath of their diagnosis.
Of course, there is no “one size fits all” plan for every person diagnosed with cancer. Certain types of cancer don’t require treatment with chemotherapy or radiation, and are cured immediately after surgery. Others require an extensive course which includes surgery, chemo, and radiation. It will come as no surprise that the consequences and emotions surrounding different ends of the spectrum may be drastically different. But the bottom line is the same: you are never alone and will always have providers who care deeply about your well being.
I want to spend some time talking about exercise and diet as important aspects of survivorship that are often overlooked and underestimated. Although these lifestyle factors are important for all individuals, they can become even more influential among people who previously underwent radiation or chemotherapy treatment. Why? Because of the extreme fatigue that sets in as a consequence of treatment. Patients will often feel frustrated by their lack of energy, which leads to being less active, giving up things that were once enjoyable, and can sometimes pave the way for a slippery slope to depression. It is extremely common. I’ve seen it more than half the time in my own patients.
This is where diet and exercise become so important to breaking the vicious cycle. People often feel it’s impossible to find the energy or time to exercise. It is even more complicated with respect to GYN cancers, where women feel their libido has declined in a way that negatively impacts their personal relationships. Moderate amounts of exercise are shown to increase endorphin levels, leading to improved physical functioning and mood. Even just 15-20 minutes of light to moderate activity per day can make a huge difference. It takes time, but starting light and building back up will slowly help improve quality of life.
Along those same lines, diets full of fruits, vegetables, and healthy lean proteins can also improve energy levels compared to heavier carbohydrate filled meals. The difference in the way people feel with healthier lifestyle choices is remarkable. It can truly alter the course of recovery and risk for subsequent health problems.
There is an organization called the Triumph Foudation which provides a community for cancer survivors to regain strength and fitness with specialized professionals.
More information about exercise during and after cancer treatment can be found here.
Cancer recovery is the best time to be selfish and invest time in self care. No matter what else is going on in life, it is impossible to care for others if you don’t first care for yourself. My patients are teaching me every day about what it means to be a compassionate and kind physician, and are constant reminders of resilience and perseverance. They are the reason I chose to study medicine in the first place and continue to teach me new life lessons and encourage me to be a better person. My physical capabilities at this point in my life are a gift, and I will do my best to continue providing the best possible resources for health and wellness in all physical phases of life.