Cancer
An Eating and Exercise Plan for a Longer, Healthier Life The fear that cancer will return dances a ceaseless jig in your mind. Sure, you're scared. Yes, you're nervous.
But never forget that you are in remission.
"Every time you go to bed think, 'I'm in remission.' Every morning when you wake up think, 'I'm in remission.' Always, always think about remission instead of recurrence. Thank God every day that you are in remission. Embrace that feeling and hang on to it as tightly as you can," says Thommye Stewart, a Houston breast cancer survivor in her seventies who has been in remission for more than 25 years.
There is plenty that you can do to increase the odds that you'll stay in remission, doctors say.
"People shouldn't just sit around waiting to die. Sure, you have a chance of recurrence. But assuming that you didn't come in with a cancer that was in an advanced stage to begin with, the chances are you're going to be cured or survive for many years," says Hugh Shingleton, M.D., the American Cancer Society's national vice president for cancer detection and treatment. "So you should keep on practicing good health habits."
Although no direct evidence exists that lifestyle changes can reduce the risk of recurrence, some doctors suspect that the same measures recommended for preventing an initial cancer—a low-fat and high-fiber diet, regular exercise, weight control, optimism, spirituality, not smoking, and avoiding excessive alcohol use and nitrites—can help fend off a return of the disease.
"These preventive steps, which are beneficial to the general public, may be of heightened importance for someone who has already had a cancer," says Wendy Schlessel Harpham, M.D., attending physician at Presbyterian Hospital of Dallas, cancer survivor, and author of After Cancer: A Guide to Your New Life. "All people are at risk for developing the same cancer again. Many survivors are at an increased risk for developing another type of cancer just because of the original type of cancer they had. Some treatments themselves increase the risk of developing cancer. Taking these steps to prevent cancer can reduce survivors' overall risk of future cancers."
The Odds Are with You
For certain cancers that are detected and treated early, a cure is likely, and the odds of a recurrence are small, Dr. Shingleton says.
Take breast, colon, and prostate cancer, for instance. These three cancers are some of the most common cancers among men and women over age 60 and account for about 44 percent of all cancers. For women, the risk of renewed breast cancer rises by about 1 percent each year after treatment. So after 10 years, there is about a 10 percent chance of cancer developing in the other breast, says Charles Taylor, M.D., director of medical oncology at the Arizona Cancer Center in Tucson. In the colon there is a 10 to 15 percent risk of a second new cancer occurring in the remaining bowel.
Prostate cancer seldom recurs if the tumor is confined to the prostate and the organ can be surgically removed, says Paul Engstrom, M.D., a medical oncologist and senior vice president of population science at Fox Chase Cancer Center in Philadelphia. As with all cancers, there is a small chance that some prostate cancer cells will elude detection and spread to other organs even after the prostate has been removed. But if caught early, there is less than a 1-in-10 chance that prostate cancer will revive in some other part of the body in the next five years.
On the other hand, lung cancer is difficult to detect early and cure. Patients that are cured of lung cancer are more prone to develop new cancers of the lung, throat, or mouth. That's because smoking—the number one cause of lung cancer—damages many cells in the respiratory tract and makes them more susceptible to cancer, says Dr. Engstrom. At five years the risk is about 15 percent and doubles to 30 percent within a decade.
Living with Uncertainty
Yet, even with these favorable statistics, doctors can not guarantee that your cancer will never recur. Why? Sometimes, radiation or chemotherapy doesn't destroy all the cancer cells in a person's body. These microscopic cells, which often are undetectable, begin to grow, and eventually the tumor takes hold in another spot, says Peter Greenwald, M.D., head of cancer prevention and control at the National Cancer Institute in Bethesda, Maryland.
In other cases it is possible for cells at several sites in the same organ to be damaged by carcinogens like cigarette smoke. These damaged cells can develop into cancer at different rates. So even while you're being treated for one tumor, it is possible that a second or even third cancer may be slowly evolving within the same organ, according to Dr. Greenwald.
If a cancer does recur, it is often more difficult to fight than the initial cancer, Dr. Engstrom says. That's because the remaining cancer cells usually are more resistant to treatment than those destroyed the first time around.
"Unless all of the factors, such as smoking, that may have contributed to that cancer developing in first place are reversed, the risk of it happening again is still high," Dr. Harpham says.
That is why improving your diet and getting regular exercise like walking 30 minutes a day, three times a week, are so important after cancer. These and other preventive steps bolster the immune system and increase its ability to seek out and destroy any stray cancer cells, Dr. Harpham says.
"If your immune system is in good shape and you are well nourished, I do think that helps the body keep a cancer in check," Dr. Harpham says.
Making Your Remission Last
Your battle against recurrence begins in the doctor's office, since early detection is your first line of defense.
"In a sense, follow-up is further assurance for both you and your doctor that everything is okay," Dr. Shingleton says.
Your doctor will determine the best follow-up plan for you. In general, most oncologists like to see patients every three months during the first year of remission, every four months in the second year, and then every six months until year five. After that, your doctor will probably want to examine you annually, says David Bouda, M.D., assistant professor of oncology at the University of Nebraska College of Medicine in Omaha.
Here are a few tips to make your appointments more satisfying.
Chart your progress. Keep a record of your medications, side effects, and symptoms, Dr. Shingleton says. Take it with you every time you see your oncologist. It will help you plan the next step in your recovery.
Express yourself. Before each appointment, make a list of questions that you may have about your follow-up treatment. Then ask the oncologist to discuss these concerns with you, Dr. Bouda says.
"You need to be open about your feelings. Some people never discuss anything with their doctors, so they don't have a clue that there are any concerns," Dr. Bouda says. "Your doctor isn't a mind reader. You need to talk with your physician regularly and give him a fair chance to address your concerns."
If the doctor doesn't seem interested in your problems, find another oncologist. "The doctor-patient relationship is a partnership. If your doctor isn't your partner, fire him," Dr. Bouda says.
Don't panic. Blood tests such as prostate-specific antigen (PSA), which measures cancer activity in the prostate, can provide doctors with valuable clues about the status of your remission. But don't panic if a single test is elevated. Some tests have a wide range of normal readings, while others may be prone to imprecise results, Dr. Bouda says.
"People who focus on the outcome of every test tend to be fixated on recurrence," Dr. Bouda says. "They're often paralyzed to the point that they can't enjoy life."
If you're like that, you may be better off not getting tested, because any fluctuation is going to drive you nuts, Dr. Bouda says.
In fact, doctors may be able to detect some forms of recurrent cancer just as well without fancy tests. Researchers, for instance, have found that doctors who used sophisticated medical testing detected breast cancer recurrence only four weeks earlier than doctors who relied solely on physical exams, Dr. Bouda says. The earlier detection by testing made no difference in overall survival rates. Ask your doctor what a test really means, Dr. Bouda suggests. How reliable is it? What does it actually measure? How concerned should you be if the test isn't normal? Is it really necessary?
"If it's a simple, specific test, it should be done. But ordering too many tests just causes unnecessary anxiety," Dr. Bouda says.
Suspend alternative treatments before your appointment. Let your doctor know if you are using any alternative treatments like homeopathy, ayurveda, or vitamin and mineral therapy, Dr. Bouda says. These treatments may interfere with traditional medicines and testing.
Saw palmetto, for instance, an herbal treatment used by some men to prevent swelling of the prostate, may decrease PSA test readings. That can mislead you and your doctor into thinking that your prostate cancer is under control, says E. David Crawford, M.D., chairman of the Division of Urology at the University of Colorado Health Sciences Center in Denver.
"If you're doing something that is off the mainstream, you probably shouldn't take any alternative therapy for at least 24 hours before or after your conventional treatment," Dr. Bouda says.
Know the warning signs. Ask your doctor to explain the most important signs and symptoms of a possible recurrence, Dr. Harpham says. If you have any concerns about a symptom, don't hesitate to phone your doctor and make an appointment.
"After surviving cancer, particularly soon afterward, it is very normal to be a bit alarmist about changes or symptoms," says Dr. Harpham. "But you owe it to yourself and your doctor to go in with your concern and get it checked out. If it turns out to be nothing, what have you lost? If it does turn out to be something, you have maximized your health."
| How I Did It: A Survivor Helps Others Cope Thommye Stewart still cries a lot. "Crying is a blessing," says the Houston woman. "If I couldn't cry, I couldn't have gotten through all of this." "All of this" began in 1970 when she was diagnosed with breast cancer and underwent a radical mastectomy and radiation treatment at M. D. Anderson Cancer Center in Houston. More than a quarter- century later and now in her seventies, she's still in remission. "The prognosis was really grim. But from the beginning I told myself, 'Thommye, you're not going to think about dying,' " Stewart says. "I've known so many people who from the minute they knew they had cancer told themselves that they were going to die. And many did. I simply didn't want to think like that. I focused on living." Once she recovered, she became a volunteer at the cancer center, visiting new patients and running errands for families. She is still at it. "Volunteering is healing. If you can help patients get through their trauma and their anger, that certainly helps you, too," Stewart says. "The possibility of recurrence does pop into the back of my mind every once in awhile, particularly when someone comes in with a recurrence after 20 years. But I just focus on helping others, and any fear or anxiety that I may have about my cancer coming back just fades away." Instead, she reserves her tears for others. "I hurt when someone doesn't make it. And I cry whenever I hurt. That's when I feel angry about cancer," she says. "I didn't have those feelings for myself because I literally thought, 'Thank God, it's not my kids. I can handle anything but that.' "I'm happy because I've had 25 years that I wouldn't have had," Stewart says. "I thank God for every day that I've had. I love every day that I'm alive, whether it's good, bad, or indifferent." |
Diet: Get Back to the Pyramid
No diet or foods have been proven to suppress the return of cancer, says Carolyn Clifford, Ph.D., chief of the diet and cancer branch at the National Cancer Institute in Bethesda, Maryland. But several ongoing studies sponsored by the Institute are attempting to determine if eating a low-fat, high-fiber diet will lower recurrence rates of breast, lung, head, and neck cancer.
Although the results of these long-term studies are several years away, following the U.S. Department of Agriculture's food pyramid recommendations after you have had cancer is probably prudent.
"The feeling is, it is best to follow these guidelines to reduce the risk of recurrence as much as possible," says Christine Polisena, R.D., an oncology dietitian at the Cleveland Clinic Foundation. "For someone who has successfully gotten through cancer treatment, the recommendations I would give are to maintain your desirable body weight, watch your fat consumption, increase your fiber intake, try to eat more fruits and vegetables, and limit nitrate-cured foods and alcohol consumption."
Here are a few specifics that are especially important after cancer.
Eat more lean meat. "When some people are recovering from cancer, they'll think now is the time to become a vegetarian. But that's not necessarily true," says Cheryl Ritenbaugh, Ph.D., head of nutrition research at the Arizona Cancer Center in Tucson. "Many people lose muscle mass rapidly while fighting the disease, so getting enough lean meat and other forms of protein onto your plate is important at that point."
To help your body rebuild muscle, eat three servings—a total of 5 to 7 ounces a day—of fish, poultry, and lean meat for at least four months after your treatment ends, Dr. Ritenbaugh suggests. "You don't need to go overboard on meat. You don't need to eat a 16-ounce steak," she says.
Target 20 percent. In laboratory experiments excessive amounts of dietary fat fuels growth of certain types of tumors like prostate cancer, says William R. Fair, M.D., chief of urologic surgery and chairman of urologic oncology at Memorial Sloan-Kettering Cancer Center in New York City. Reduced dietary fat also may slow recurrence.
Try to limit yourself to 20 percent of calories from fat daily, Dr. Fair recommends. If you eat 2,000 calories a day, for instance, that means you can consume about 400 calories—44 grams—from fat. Look for total fat grams on food labels.
Stoke up on fruits and vegetables. Try eating at least five servings of fruits and vegetables like apples, oranges, carrots, and broccoli a day. These foods are loaded with antioxidants, fiber, and other cancer-preventing nutrients, says Polisena.
Fruits and vegetables are good sources of fiber, which speeds food through your body so that fewer carcinogens can be absorbed by your digestive tract, Dr. Bouda says.
Nix the nitrates. Limit or avoid nitrate-cured, salt-cured, or smoke-cured foods like ham, sausage, or bacon, Polisena says. These foods are linked to stomach cancer.
Go light on the hard stuff. Alcohol may promote recurrence of head, neck, mouth, and esophagus cancer. Limit your consumption each day to no more than one 12-ounce beer, a 4-ounce glass of wine, or one cocktail containing an ounce of liquor, Polisena says.
| Six Supplements That May Subdue Recurrence After cancer treatment, vitamin supplements, diet modifications, and lifestyle changes can reinforce your body's natural defenses and help prevent a recurrence, says Kedar N. Prasad, Ph.D., director of the Center for Vitamins and Cancer Research at the University of Colorado Health Sciences Center in Denver. "Taking these supplements may boost your immune system so it can seek out and destroy any undetected cancer cells that remain in your body," says Dr. Prasad, author of Vitamins in Cancer Prevention and Treatment. Here is the combination of oral supplements that Dr. Prasad recommends. Beta-carotene: 15 milligrams a day. Vitamin A: 5,000 international units a day, divided into two doses, taken once in the morning and once in the evening. Most vitamin A supplements come in a 10,000 international units dose, so quarter the tablet (equivalent to 2,500 international units) to get your 5,000 international units a day. Vitamin C: Up to 2 grams a day, divided into at least two doses, in the form of calcium ascorbate. Note: Amounts of vitamin C over 1,200 milligrams a day may cause diarrhea in some people. Vitamin E: 400 international units per day, divided into two doses, taken in the morning and evening. Each dose should contain 100 international units of alpha-tocopheryl-succinate and 100 international units of alpha-tocopherol. B vitamins: Take a multiple vitamin containing two to five times the Daily Value for thiamin, riboflavin, and vitamins B6 and B12. Selenium: 100 micrograms a day, divided into two doses, once in the morning and once in the evening. Levels above this should only be taken under medical supervision. Selenium must be taken in the form of organic selenium. Inorganic selenium, such as sodium selenite, is absorbed poorly by the small intestine. |
| How I Did It: A Super Bowl Coach Wins the Big One There is only one recurrence that Marv Levy would welcome in his life. "A chance to go back to the Super Bowl and win," says Levy, the 70-plus coach of the National Football League's Buffalo Bills. But even if he never gets that opportunity, Levy has already won the biggest challenge of his life. In 1995 he survived prostate cancer. "I think I was doing all the right things before I got prostate cancer. I was exercising. I was eating a very low-fat, high-fiber diet. So I don't know what else I could have done to prevent it. I was just fortunate that it was detected early during an annual physical," Levy says. He opted for surgical removal of the prostate. Like many other men, Levy feared impotence and incontinence, but neither of these two possible side effects of prostate cancer surgery affected him. After surgery, his faith in his lifestyle remained strong. "I got back into living a healthy life very quickly after my surgery," Levy says. "I work out, I run, I lift weights at least twice a week, I eat correctly, and I make sure that I get the proper amount of rest. I think all of that helped me come back very quickly." Still, anxiety about a recurrence does rumble through his mind every once in awhile like a blitzing linebacker. "Those concerns exist, but I can't live in fear," he says. "One thing that helped was that I did quite a bit of studying about prostate cancer once I discovered that I had it. That was very reassuring to me because I found out about treatments and ways to live with it even if it does spread. So education always helps. "I also talked with a lot of people who have been through similar experiences. And I found that to be very helpful." He also advises diving back into your regular routine. "As quickly as possible, I'd say return to as vigorous a life as you can," Levy says. "You don't have to become a workout nut. But don't make yourself an invalid mentally just because you've had cancer. Don't ever let this disease make you feel old." |
Look to the Future
When she was diagnosed with lymphoma in 1990, Dr. Harpham didn't know what to do about her magazine subscriptions.
"I always used to renew my magazines and medical journals for several years at a time," she says. "When I first got sick, I questioned whether it was worthwhile renewing any of them. Then when I felt a little more secure, I renewed them for a year. Now I renew them for three to five years at a time again. Instead of making me feel vulnerable, these subscriptions empower me, because I plan on being here to use them."
The lesson? Hang on to hope and cling to the future as you move into remission, she says.
Not only can that improve the quality of your life and lessen your fears of recurrence, it may boost your immune system's ability to wipe out any emerging cancers, Dr. Bouda says.
"Try to figure out some way to think positively every day, despite having had cancer," Dr. Bouda says.
Here are some suggestions.
Seek support. Cancer support groups can be breeding grounds for optimism, Dr. Bouda says. You'll probably meet many long-term survivors who can inspire you and offer lots of empowering self-help tips.
"A doctor may just tell you what the textbook says," Dr. Bouda says. "Someone at a support group meeting may tell you, 'Yeah, I tried what my doctor suggested, and it never worked. But I tried this instead, and I haven't had a problem since.' "
Most cancer treatment centers or hospitals can provide you with a list of support groups in your area.
Look to your past. You have lived for 60-plus years and probably have coped with many stressful and tragic situations before. Evaluate those experiences and try to identify what helped you survive those emotional upheavals, suggests Joan Hermann, director of social work services at Fox Chase Cancer Center in Philadelphia. Did it help to jot down your feelings? Talk to close friends? Pray? Whatever it was, it probably will help you deal with your fears now.
"Older people often handle cancer and its aftermath better than younger men and women because of their wisdom and experience," Hermann says. "An older person tends to think, 'This is how I dealt with another tragedy in my life, and I can get through this situation in the same way.' The younger person simply doesn't have that experience to fall back on."
Tame your imagination. Sometimes it is easy to imagine the worst. But if you learn to control your imagination, it can actually help calm your fears and strengthen your body's natural defenses, says Gloria Malone, Ph.D., a Phoenix psychologist in private practice who counsels many older people who have cancer.
"It's like a remote control on your television. With a little practice you can literally learn to turn off an unwanted thought," Dr. Malone says.
To do it, you might begin by imagining yourself in a very relaxed place in nature like a meadow filled with wildflowers or a lush tropical beach. See it, feel it, smell it, sense it. Practice that for a minute or two, 20 to 30 times a day, until visualizing your special place becomes almost automatic, Dr. Malone says. Then when fear or any other unwanted thought pops into your mind, imagine reaching for a remote control. Press the button and—zap—turn the unwanted thought or fear out of your sight. Take a deep breath, then press the button again and visualize yourself calm and relaxed in your special place in nature.
Treat yourself. Plan to do something special for yourself each day. It doesn't have to be time-consuming or costly. List two dozen nurturing activities like watching a sunrise, playing with your grandchildren, or reading an inspirational book. Then pick one a day and do it, Dr. Malone says.
"Doing something nurturing for yourself each day will help you feel less angry or deprived," Dr. Malone says. "It will help you focus on the positive aspects of your life instead of negative thoughts about recurrence."
Find hope. Inspirational posters and meaningful pictures from your life can help, too.
"I have a poster in my kitchen that reads, 'Keep on hoping, keep on wishing, keep on believing.' It would be easy to say that poster is childish and silly," Dr. Harpham says. "Well, you know what? This physician and mother derives benefit from looking at that poster. It is one more thing that helps me believe that I can get well again and stay well."
Prescription for Prevention
Fear of a recurrence is a common emotion after surviving cancer. Although doctors can't guarantee that you won't get cancer again, the odds of a complete cure for many forms of this disease are getting better every day, particularly if you adopt a healthy lifestyle.
Do:
* Focus on remission rather than recurrence. Rejoice every day that you are cancer-free.
* Know the warning signs of a recurrence. Like your initial cancer, early treatment of a recurrence increases your chances of recovery.
* Consume no more than 20 percent of daily calories from fat. If you eat 2,000 calories a day, that means you can have about 44 grams of fat daily.
* Eat plenty of fruits and vegetables rich in antioxidants and other cancer-suppressing nutrients. Try to eat at least five servings of foods like oranges and broccoli daily.
Don't:
* Get hung up on test results. Small fluctuations in a single test don't necessarily mean your cancer has returned.
* Take alternative treatments within 24 hours of a conventional cancer treatment or test. Some alternative medicines can interfere with more traditional treatments.
* Overindulge. Excessive alcohol consumption can promote head, neck, and other cancers. Limit yourself to one drink a day.
* Eat bacon and other nitrate-laden foods. Salt-cured, smoke-cured foods like ham or bacon might reignite cancer. If you can't completely give up these foods, limit your intake.
