The After Cancer Blog

A cancer diagnosis is never easy, but it may be even more challenging for older adults who may already be managing issues related to aging, such as decreased mobility, vision or hearing. Unfortunately, aging is also a risk factor for cancer, with the National Cancer Institute reporting rates of diagnosis increasing steadily with age. From 2013 to 2017, more than 1,000 per 100,000 people aged 60 and over were diagnosed with some form of cancer, while those under 20 faced rates below 25 per 100,000 people, and those aged 45 to 49 only faced rates of 350 per 100,000 people. In this guide developed by Caring , a leading senior care resource for family caregivers seeking information and support, older adults will learn how a cancer diagnosis may affect their senior living options. This guide also offers detailed information about how to find assisted living and nursing care facilities that provide cancer care to aging adults. Barriers to Receiving Cancer Care as an Older Adult Older adults may face barriers that younger persons aren’t subjected to when seeking care after a cancer diagnosis. This includes barriers to screening prior to receiving a diagnosis, as well as treatment and cancer therapy obstacles. Common Screening Barriers Unfortunately, there’s a lack of clinical trials and resulting data when it comes to cancer screening for seniors. According to Hopkins Medicine , the most likely reason for this is that it can be difficult to assess the efficacy of screenings in older adults. Researchers may also struggle to qualify or quantify risks vs. benefits of screenings in older adults.  Unfortunately, the problems mentioned above aren’t something that older adults can control when it comes to cancer screenings. However, there are factors that often influence seniors’ decisions about screenings that are within their control. Although recommendations suggest that adults over 65 should have regular screenings, including mammograms, PSA testing, gynecological checkups and colonoscopies, many make a conscious decision not to have these screenings. While reasons to delay screenings differ, there are some common personal barriers that older adults face. That includes:  A lack of education about the benefits of cancer screenings Concerns about the health impacts and side effects of cancer treatments, such as radiation and chemotherapy, should test results come back positive Personal preferences regarding their quality of life Religious beliefs and family values Common Barriers to Diagnosis and Treatment Although cancer prognosis tends to worsen with age, instances of delayed diagnosis continue to occur among seniors. Often, symptoms are excused as aging or being related to other health conditions instead of being checked by a doctor immediately, and unfortunately, by the time the patient seeks care and raises concerns to their health care provider, the prognosis has worsened. This barrier, along with several others, can create a significant delay in receiving timely and accurate diagnoses and opportunities to obtain effective treatment.  Aside from a delay in obtaining a proper diagnosis, older adults may also struggle to access appropriate diagnostic testing to determine the original source of cancers that have spread throughout their bodies. This is often the result of denial in the patient or their family members as well as pessimistic attitudes about treatment or test results. Once cancer has been diagnosed, seniors may face further barriers when it comes to obtaining adequate care for their condition. Unfortunately, the most common barrier in this scenario is ageism — whether subconscious or intentional — among health care providers. Examples of this include:  Assuming that, as a senior, the patient is unable to afford appropriate cancer care Assuming the patient may have personal beliefs about accessing advanced or experimental therapies Attributing discomfort and symptoms to aging and other medical conditions instead of investigating cancer symptoms appropriately Underestimating the patient’s ability to withstand treatment options, such as chemotherapy or radiation Underestimating the patient’s life expectancy and assuming they won’t want to undergo treatment Common Barriers to Cancer Therapies When it comes to making decisions about cancer therapy after a proper diagnosis and initial treatment has begun, many barriers can stand in the way of making the right choices. These may come as a result of patient or caregiver opinions and beliefs, caregiver or family stress, or the beliefs of the patient’s primary health care provider. The most common barrier to cancer therapy for older adults is the beliefs or stress of their family caregivers, who are typically spouses and/or adult children. Because a cancer diagnosis is a lot to take in, most older adults opt to bring a family member to their appointments to help them remember medical instructions and ask questions, but in some cases, this companion’s concerns and beliefs may overshadow those of the patient, resulting in: Patients acting less assertive when discussing treatment options or asking questions about their condition and prognosis Caregivers feeling overprotective and making harsh decisions on the patient’s behalf Physicians providing less information in an attempt to calm patients and their family members, which can lead to a lack of education for patients as well as a lack of treatment options Senior Living Options for Individuals With Cancer More than 15% of the U.S. population is aged 65 or older and according to 2019 data published by the National Center for Health Statistics, more than 2 million of those seniors reside in assisted living facilities or nursing homes. While some of these long-term care facilities don’t provide specialized care for residents with cancer, many do offer services that can make living with cancer easier, and in some cases, these facilities may offer on-site oncology care and cancer-focused nursing services. Each of the facilities varies in what services they offer residents. That said, those that provide cancer care typically provide services such as 24-hour medical supervision, medication administration or assistance, personal care, transportation to and from medical appointments, and nutritional support. There are several types of senior living options available for those seeking residential care. Assisted Living Assisted living facilities help seniors and those with disabilities to live as independently as possible while providing help with activities of daily living, such as grooming, mobility, hygiene, eating and toileting, whenever necessary. Assistance is available around the clock in these facilities, with many offering additional memory care services for those living with Alzheimer’s disease and other dementia-related disorders. Some assisted living facilities in the United States also have an on-site nursing staff that can provide cancer care services, such as medication administration, wound care and wellness checks, as well as health care service coordination. Other services that are typically provided in assisted living facilities include:  Housekeeping Social activities Transportation to and from appointments, errands and family visits Daily meals Case management Nursing Care Seniors with advanced cancer or other underlying disorders in addition to their cancer may want to consider nursing care. In a nursing home, residents are provided with 24/7 medical supervision by a registered nurse or physician, along with a team of caregivers and licensed practical nurses.  Often, nursing facilities have doctors or oncologists on staff who can conduct regular wellness checks on cancer patients and provide other health care services on-site. Home Care Home care enables older adults to age in place at home. It can provide a variety of services on a schedule that works best for the patient, whether that’s having a temporary live-in caregiver, weekly visits or something in between. Home care agencies typically employ nurses and professional caregivers who visit seniors to provide personal care and homemaker services. When cancer care is provided, additional services may include medication administration, wound care and wellness checks as well as transportation to and from medical appointments. Hospice Care Hospice care is reserved for those facing the end of their lives. When cancer has reached its final stages, hospice care ensures that the final days or months of a person’s life are comfortable by administering medication and treatments that address cancer symptoms or side effects from cancer therapies, as well as personal care and wellness services, as needed. Hospice care is typically provided in the patient’s home, but may also be administered in a facility. Choosing the Right Cancer Care Setting After a cancer diagnosis, it’s important to select a care setting that’s most appropriate for your needs. That means finding a facility or home care agency that understands the care you need to remain comfortable and preserve your health, as well as one that’s equipped to provide that care. Following are some steps to help you and your loved ones find the right care setting: Understand the diagnosis:  Meet with your oncologist or other health care practitioner and, if needed, bring along a spouse or family caregiver to help you take in the information they provide. Make sure to ask questions about your prognosis, treatment and medications as well as any additional symptoms or changes to watch for that require you to seek further care.  Make age considerations:  When determining the right course of action, your age is a factor that should be considered. If you’re approaching or into your senior years, you may find it more difficult to navigate aging while battling cancer, making senior living options, such as assisted living, a more appealing option thanks to the extra help that’s offered in these facilities. Evaluate your options at home:  If recovery at home feels like the best and most comfortable option for you, take time to review home care agencies that offer cancer care in your area. Medical equipment loans for beds, wheelchairs and other necessary supplies are available from charitable organizations in most areas across the United States to make healing at home a more affordable option. Re-evaluate regularly:  As your condition changes or progresses, regularly and frequently re-evaluate your needs and reconsider whether you need to upgrade or downgrade the care you’re receiving. To learn more about cancer care and assisted nursing facilities for elderly cancer patients, please visit this guide .

During cancer treatment you may experience difficulty in maintaining your weight. Some people lose weight and some people gain weight, this post will address the weight gain associated with treatment. What is it? Slight increases in weight during cancer treatment are usually not a problem and can sometimes be as simple as fluid retention, which will reverse after treatment. However, too much weight gain during treatment is linked to a poorer chance of recovery and also increases the risk of other health problems. Why does it happen? Cancer treatments such as chemotherapy, steroid treatment, and hormonal treatment can lead to weight gain in different ways. Chemotherapy: Can causes Fatigue, making it harder to exercise. Can cause Edema, where the body holds on to excess fluid. Can cause Nausea, which may be relieved by eating more food. Can lower Metabolism, causing your body to burn less calories. Can cause Menopause, also slowing down your metabolism. Steroid Therapy: Can cause an increase in your appetite. Can cause decrease in muscle mass. Can cause increase in fat tissue with long term use. Hormonal Therapy: Can cause decreased levels of your body's estrogen, progesterone, or testosterone resulting in increase in fat, decrease in muscle and making it harder to burn calories. How to manage it? The good news is that there are definitely steps you can take to decrease the amount of weight gained during treatment. First, try to nourish your body with plenty of fruits, vegetables and whole grains and avoid man made processed foods and sugar. The processed foods lack fiber and nutrients that your body needs and in fact cause you to overeat instead because you don’t feel full when you eat them. Essentially they are empty calories that you end up over consuming. Second, try to get regular exercise with an activity that you love to increase your metabolism and burn more calories. Try walking, biking, yoga or other strength building exercises. Just pick something you would look forward to even if you are tired and not feeling 100%. We are glad you read this blog post to the end. Let us know how we can best help on your cancer journey. We at The After Cancer are here for You! About Cheryl Hoover Cheryl Hoover is a breast cancer survivor and a nutrition coach at The After Cancer. Her mission is to encourage patients to embrace the opportunity they have to nourish their body for their best health and healing.

Taffie Lynn Butters  is a board-certified health coach at The After Cancer. She's a breast cancer survivor and is passionate about helping others recovering from cancer with lifestyle interventions. Toxic environments Here’s the truth, most of us live in a toxic environment. Not because we want to, but because most of the products for our homes are not made with our health in mind. As a culture we are being marketed to with the intention of brand recognition, fast and cheap, or disposable. Unfortunately, none of which are necessarily with prevention of disease as a focus.  In this blog, I will go over some simple steps to help you detoxify your environment to make it a safer healthier place to live. While we cannot completely eliminate all toxins, small changes add up, and can make a big impact! Information is power One of the first places to start when detoxifying your environment for cancer prevention is to have a trusted resource. The Environmental Working Group has a mission: “To empower you with breakthrough research to make informed choices and live a healthy life in a healthy environment.” ( www.ewg.org ) This amazing organization has been shining the light on harmful practices and products since 1993. EWG offers free databases and consumer guides to help you make informed choices about food, water, personal products that can easily be accessed on their website, or in a convenient app for your phone. You will also find advice on home products and current legislation efforts to change harmful practices. The biggest problem with chemicals and other synthetic substances in our environment is that they can mimic and often disrupt the natural influence that hormones have on our body, which can lead to the development of diseases. A recent Newsweek report revealed that a new study in the journal “Environmental Health Perspectives” searched through multiple government databases are discovered evidence that 921 chemicals point toward the promotion and development of breast cancer alone. This disturbing news is triggering a concern to layout a path forward for manufacturers to eliminate these chemicals, but this process will take time. What you can do to detoxify So, what can we do now to create a safe and healthy environment for ourselves and our families? The first step is not to panic and start small. It’s a good idea to trade out products slowly or as they run out. While replacing items can be expensive the cost to your health in the long run makes it worthwhile. Be creative. Many items can be purchased at Ikea, Amazon, and even Walmart. The idea is to reduce your toxic load, and remember it is impossible to completely eliminate every exposure. Let’s take a look room by room of what small steps you can start taking today! Kitchen The kitchen is one of the best places to start when detoxifying your environment because it’s where we feed and nourish our body. Here are some items to consider: Trade all plastic for glass or stainless steel – plastic has PFAS and can infiltrate your bloodstream with micro-plastics. This includes plastic forks, cups, and cutting boards Use wood or stainless steel utensils Use stainless steel or glass water bottles Replace any “non-stick” cookware  - with stainless steel or ceramic Use non-bleached waxed paper instead of foil Limit or avoid microwave use Use unscented trash bags Opt for unscented soaps and detergents (ewg resource for trusted brands) Laundry Swap dryer sheets for wool dryer balls Use clean detergent (ewg resource) Bedroom Place phone in EMF safe container or remove when charging Opt for sprays and candles scented with essential oils Opt for hard floor surfaces Choose natural fiber sheets, organic when possible Bathroom Use non-toxic cleaners (ewg resource) Use natural fiber towels Choose clean personal products (ewg resource) Living Room Choose candles scented with essential oils instead of fragrances. (fragrances are not regulated and are mostly synthetic and made with chemicals) Sweep or vacuum often Leave your shoes at the door – many viruses and bacteria come into homes on your shoes! Use a quality air filter Home Décor Look for low VOC paints and green products when possible. Opt for natural hard floor surfaces Avoid “stain resistant and water repellant” coatings Creating a non-toxic environment can be fun and rewarding. Ask yourself next time you make a purchase will this reduce my toxic load? If the answer is yes, you are one step closer to a healthy home! Enjoy the journey!

Donna McMillan  is a former Hospice Social Worker, a former Elder Law Attorney, and an ovarian cancer survivor. Check out her website . We've all had those days We have all had those days when things just don’t seem to be going right. As a cancer survivor, for me it’s often a day when the side effects of my maintenance medication are a little more pronounced, a little more in the forefront, a little too hard to ignore. Other times, it could be my anxiety creeping in, like if in and I haven’t been feeling well. We all know that that anxiety that surrounds scans and the worries of a recurrence are real. We can try as hard as we can to dismiss them or ignore them, but sometimes they just won’t go away. So, what do you do? How to boost your mood For me, a surefire way to boost my mood is to get outside and take a walk. I get an extra boost when it’s a sunny day, but the reality is, it doesn’t really matter. A cloudy day has its own form of beauty. I just need to get outside. Adding a walk to it is an easy way to boost your mood (i.e., reduce stress) and do another thing that’s good for the body (move). Part of living an anticancer lifestyle includes exercise. Now exercise can be hard as a cancer survivor. You may be at a point in your journey where you just barely have the energy to get through the day to day, or take care of your personal needs, and exercise seems truly monumental. Or your life is filled and busy with work, family, to-do lists, and you don’t think you can fit it in the time for exercise. But what about a simple walk? Walking is exercise right? It's being outside that counts Here's the thing, I’m not talking about a long meandering walk in the forest. Now don’t get me wrong, those long meandering walks and connecting to nature in that way can be wonderful gift and inspiring. But a mood lifting walk can be as simple as walking to the mailbox to get your mail. Walking out of your apartment to the corner and back. Taking it slow. Relishing in the sun or gazing at the cloud formations. Feeling the breeze, hot or cold on your face. Noticing if the air is moist and humid or dry. Listening for the birds. And if you’re truly not able to walk, then just stand outside and take it all in. Breathe. And right there you have a second element to an anticancer lifestyle, a little bit of mindfulness and stress reduction. What about a night walk? Want to try something different? Go outside at night, stare up at the stars and watch and listen. There are different sounds at night, or maybe no sounds at all. Everything looks different in the dark. Sometimes scarier, sometimes more magical. Can you hear the owls, the cars, the dogs barking? People laughing? What does your nighttime scape include? Is it different tonight from last night? A weekend versus a weekday? We can fill our minds with so many other things when we are outside and being present in the moment instead of in living in our head thinking about what scares us and what doesn’t feel right. Getting outside and maybe even adding a little walk helps boost our mood and gives us a moment of mindfulness and stress reduction without really trying . A win for us and our bodies. Sometimes we just need a reminder... Being outside helps me remember that I am part of this great big universe. Awe in the expansiveness and beauty. A reminder that there is value in just being. No matter what you can’t do, you can go outside, whatever that outside looks like for you, and let your body and mind remember the connectedness we all share. Even when we are alone, we are not alone. We are part of the greater whole of just being. Sometimes I need to be reminded of that. Being outside helps me remember.

"Chemo Brain" and "Brain Fog" As a Family Nurse Practitioner, I understand that the journey through cancer treatment can take a toll not only on the body but also on the mind. Many patients experience cognitive changes, commonly referred to as “chemo brain” or “brain fog” during and after treatment. These cognitive issues can include memory problems, difficulty concentrating, and mental fatigue. While these symptoms can be frustrating, there are practical strategies you can implement to help manage them and support your brain health post-treatment. What you can do to manage it Stay Mentally Active: Engage in activities that stimulate your brain, such as puzzles, crossword puzzles, reading, or learning a new skill or hobby. Keeping your mind active can help improve cognitive function and prevent mental decline. Get Physical Exercise: Regular physical activity not only benefits your body but also your brain. Aim for at least 30 minutes of moderate exercise most days of the week. Exercise increases blood flow to the brain, promotes the growth of new brain cells, and improves cognitive function. Prioritize Sleep: Quality sleep is essential for cognitive function and overall well-being. Establish a regular sleep schedule, create a relaxing bedtime routine, and ensure your sleep environment is conducive to restful sleep. Aim for 7-9 hours of sleep per night. Brain-Healthy Diet: Focus on a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. Certain foods, such as fatty fish, berries, nuts, and leafy greens, are particularly beneficial for brain health. Limit processed foods, sugary snacks, and excessive alcohol consumption. Manage Stress: Chronic stress can impair cognitive function and exacerbate brain fog. Practice stress-reduction techniques such as mindfulness, meditation, deep breathing exercises, and yoga. Prioritize self-care and make time for activities that bring you joy and relaxation. Stay Organized: Use tools such as calendars, planners, to-do lists, and reminders to help you stay organized and manage your daily tasks and appointments. Breaking tasks into smaller, manageable steps can also make them feel less overwhelming. Seek support: Don’t hesitate to reach out for support from friends, family, or healthcare professionals if you’re struggling with cognitive issues after cancer treatment. Support groups can also provide valuable guidance, encouragement, and understanding. It's normal, and there's help if you need it Remember, it’s normal to experience cognitive changes during and after cancer treatment, but with patience, self-care, and the implementation of practical strategies, you can support your brain health and navigate through the fog to a clearer, sharper mind. Take it one step at a time, and be gentle with yourself as you adjust to life after treatment. Your brain is resilient, and with the right care, you can optimize your cognitive function and overall well-being. About Gracienne Jean Pierre Gracienne Jean Pierre is a breast cancer survivor and nurse. She decided to specialize in techniques like biofeedback and heartmath to support patients in managing their stress.

Movement is key How do you thank your body? Move it! How does your body thank you? It moves! How do you thank your mind? Move your body! How do you free your mind? Move your body! What kind of movement is the best? Your favorite movement! How do you find your favorite movement? Try some different methods! They are all around you! You see, it is an amazing thing that simply by moving your body , you allow all of the systems of the body to do their jobs better. The blood flows, the synovial fluid flows, the lymph flows, digestion is aided, muscles get stronger, connective tissue gets stimulated and the list goes on and on and on. Can you consider movement as a way to partner with your body to feel good and lift your spirits? Can you think of moving as a way to open your world and mind? Or maybe it is a way to stay sharp at work. Or how about the fact that your stress levels go down? Take walking for example: you get out and about. You hear and see things that are soothing and uplifting. Your breath and heart delight in the rhythm and timing of moving. In nature you benefit from the peace and beauty that surrounds you. In a city you get to merge yourself into the flow and pace of people around you. You can listen to a podcast and learn something. You can walk with a friend. You can go to the gym and be a part of the action. How to get started moving your body after cancer How do you get started? Ummm…Well… You start. Don’t complicate it. It is part of your nature to move. How can you keep it simple? How can you keep it enjoyable? How can you keep it regular? What is the best part of moving for you? Is it seeing people? Being alone? The clothes? Is it the burn? The fresh air? Watching a show? Checking it off your list? Sleeping better? Taking a well-deserved shower? Don't buy into that old story Don’t buy into that old story that you need to exercise to improve yourself. The truth is you exercise to feel more like yourself: confident and at ease. Besides, it feels good to come home to the body and delight in all the ways it moves! The body is amazing. You are amazing. You and your body make a great team. Treat your body with love and kindness through movement . I really, really hope you don’t miss your chance to move today. Moving allows you to be the amazing person you really are. About Kathy Therber Kathy Therber is a breast cancer survivor and she's been teaching yoga for more than 20 years. Yoga is an essential part of my life as I work to stay active, healthy, and pain-free, and she loves teaching to people with cancer, survivors, and caregivers.

Rev. British Hyrams is an ordained pastor in the Presbyterian Church (USA) currently serving as a college chaplain. Blindsided As a health-conscious woman, I was naive when I went to check off my first “let’s get this over with” colonoscopy at age 50. So, when I awakened to find that I was not going to have a fun-filled, celebratory feast with my husband and instead the two of us were being counseled to visit a surgeon immediately to schedule the removal of a “suspicious” mass, I was blindsided! I was oblivious to the statistics indicating that Black people are diagnosed and die from colorectal cancer at rates significantly higher than any other racial group. I also had no idea about my own family’s history of polyps. I. DIDN’T. KNOW! My family was blindsided too. The family matriarch who encouraged eating plenty of vegetables, brushing of teeth, regular medical checkups and dental care among other things was now facing something serious. My husband had just been through several years of major surgeries and this seemed like a nightmare that just would not end. Little did any of us, including my high school and college-aged children, along with the rest of my family and friends, know that the initial surgery was only the beginning. Role reversal while tackling Stage 3 Sure enough, the surgery revealed that the cancer spread to nearby lymph nodes. This suggested chemotherapy as the best course of action to address my Stage 3 condition. Now, as a church leader (serving in an associate pastor type of role at the time) I was the one who needed the consistent prayers. I was the one who was sick, needed cooked meals, visits, and comfort from others. Words cannot describe how hard it was to lead a congregation while going through chemotherapy with all the physical, mental, and emotional difficulties it brings. As well-meaning as people are, and as much as you know they care, this “role reversal” situation was challenging even on the best of days. As a woman of faith, I could only trust that God would lead me to complete healing. I was blessed to have each of my three children rallying to take care of their mother. My out-of-town family and friends flew in for moral support. My beloved husband never left my side and committed to be physically present at every appointment throughout my journey. It's a necessary conversation - our lives depend on it! Now by the grace of God, I am feeling strong again and am 7 years cancer free ! I am also a relentless advocate in the Black community and willing to talk to anyone approaching the age of 40 about being screened for colorectal cancer. It’s a necessary conversation to have with our own families and throughout our community. Our lives depend on it!

We are excited to share our experience at the Run Jen Run event in Charlotte in March 2024. This event was another significant milestone for The After Cancer, marking our continued commitment to engaging with the community. Run Jen Run, an inspiring event dedicated to raising awareness and funds for cancer support services, provided an excellent platform for us to showcase our unique care model based on Integrative Oncology. Connecting with the Charlotte Community The day was filled with energy, enthusiasm, and an overwhelming sense of community. We had the incredible opportunity to meet many wonderful individuals from the Charlotte area, each with their own powerful stories of resilience and strength. These interactions were not only heartwarming but also underscored the immense need for comprehensive support for cancer survivors, reinforcing our mission . Engaging with the local community in Charlotte allowed us to better understand and address their unique needs. Introducing The After Cancer Resources to Cancer Survivors in the Charlotte area Our booth attracted numerous visitors eager to learn about our resources designed to help survivors manage treatment symptoms, adopt healthy behaviors, and reduce the risk of recurrence. The genuine interest and positive feedback we received were truly encouraging. Many of these amazing individuals decided to join our group sessions, where they can find a supportive community and access the personalized care they need. Our presence at Run Jen Run highlighted the importance of local engagement and support. Building a Supportive Community for Breast Cancer patients in Charlotte Attending the Run Jen Run event in Charlotte in March 2024 was a profound experience for The After Cancer team. It allowed us to connect with survivors, share our vision, and lay the foundation for lasting relationships within the cancer community. We are grateful for the warm reception and look forward to continuing our journey, providing the support and resources survivors need to thrive. Our involvement in the Charlotte area has strengthened our commitment to making a difference locally and beyond. By participating in events like Run Jen Run, The After Cancer aims to raise awareness and offer invaluable support to cancer survivors. We are excited to grow our presence in Charlotte and help more individuals on their journey to health and wellness. About Mariana Arnaut Mariana Arnaut  is the CEO and Co-Founder  of The After Cancer. She has a family history of different cancers (lung, melanoma, esophageal) and a background in digital & innovation. You can reach out to her at mariana@theaftercancer.com .

Dr. Kokenes is from Charlotte NC and practices at Charlotte Gastroenterology . He is a graduate of Duke University ’83 BS and UNC Chapel Hill ’87 MD. He did his internal medicine training at Boston University and gastroenterology fellowship at Emory University . He is a past board member of Hospice and Palliative Care Charlotte Region and past President of the NC Society of Gastroenterology . He is the UNC Chapel Hill School of Medicine Course Director for gastroenterology at the Novant Campus in Charlotte, NC Colorectal Cancer (CRC) I appreciate the opportunity from The After Care to explore the experiences of Colorectal Cancer (CRC) survivors. My work as a gastroenterologist typically focuses on diagnosing CRC and then referring patients to oncologists, surgeons, and back to their primary care providers. I do get to see them for the surveillance colonoscopies which is usually a joyous experience since it means they are through the shock of the diagnosis and the surgical and oncologic treatment. They can finally focus on a future without CRC. Let’s begin with the good news! The incidence of CRC is declining thanks to robust population colon cancer screening (CCS) especially since the Affordable Care Act of 2010 which made CCS a mandated benefit of health insurance. Also, with earlier detection and improved therapies, two-thirds of CRC survivors are living well beyond 5 years after diagnosis. I will outline some basic strategies to anticipate potential short- and long-term issues related to CRC aftercare. Before we review recognizing the symptoms of a recurrence it is important to be aware of the most current guidelines for CRC surveillance. Catching problems before symptoms develop is the real goal! American Cancer Society CRC Survivorship Care Guidelines 1-2 Years post treatment: History and Physical exam (H & P) every 3-6 months Carcinoembryonic Antigen (CEA) every 3-6 months if a candidate for further intervention CT scan of the chest/abdomen/pelvis every 12 months (Stages I-II if high risk and all Stage III) Colonoscopy in 1 year; if advanced adenoma found, repeat in 1 year, otherwise in 3 years 3-5 Years post treatment: H & P every 6 months CEA every 6 months if a candidate for further intervention CT scan of the chest/abdomen/pelvis every 12 months (Stages I-II if high risk and all Stage III) Colonoscopy in year 4; if no advanced adenoma found, repeat every 5 years > 5 Years post treatment: CEA not recommended. CT scan of the chest/abdomen/pelvis not recommended. Colonoscopy every 5 years starting 9 years after resection if no advanced adenomas found. Listening to Your Body and Knowing Your Poop Surviving cancer gives one the opportunity to reevaluate their overall health and make important adjustments in behavior and lifestyle. To be able to identify potentially alarming GI symptoms one must first establish excellent bowel health and then from as healthy as possible a baseline it will be easier to recognize important deviations. We only use unleaded gasoline in our cars, and we never give our pets food that we know can harm them. However, we are commonly ingesting foods with high concentrations of sugars and fats that are often overly processed and in greater than appropriate portions. Food is fuel. In essence, we take better care of our cars and pets than we do of our own bodies. As a result, many of us live with gas-bloat, abdominal cramps and discomfort, diarrhea and constipation which can lead to pathological hemorrhoids and bleeding. How can we identify pathologic symptoms of possible cancer recurrence when this is our norm? Nutritionists are largely in agreement that the Mediterranean Diet is the overall healthiest diet. In a nutshell this means daily fruits, vegetables, grains, and lean protein in proper quantities. A healthy colon is populated with a wide variety of bacteria known as the colonic biome. A diet rich in fiber is the best first step to having soft, easy to pass, regular bowel movements. When achieved, it is easier to identify changes that should be investigated between the scheduled exams, x rays, and labs listed above. It is important to note that there is no evidence-based research that indicates that a healthy diet will reduce one’s chances of recurrence. Furthermore, almost half of CRC survivors have some degree of chronic diarrhea independent of how well they eat because of post-surgical changes, chemotherapy side effects, and in cases of rectal cancer, chronic radiation injuries. Working with a gastroenterologist and nutritionist can help to optimize one’s quality of life and improve these symptoms so that the best possible baseline of digestive health can be achieved. Colorectal Cancer Symptoms to Look For Early-stage recurrence: A change in bowel habits, such as more frequent diarrhea or constipation Blood in stool Abdominal pain or discomfort such as cramps, gas or bloating The sensation of incomplete bowel movements Late-stage recurrence: Weakness, fatigue, shortness of breath, and dyspnea on exertion Unintentional weight loss Any of the above symptoms should warrant checking in with your physician for proper evaluation. This will allow for the earliest possible detection since even strict adherence to the CRC survivorship guidelines can miss things. Genetics and Colorectal Cancer Another way to enhance survival after CRC and any cancer is not just to listen to your body but to know your body all the way down to your DNA. Let me be clear, everyone with cancer does not need genetic testing. However, it can be critically important in many cases. Consider sharing your diagnosis with your family and creating a detailed family tree of other relatives with cancer. The more you know the more accurate genetic testing can be. Review this information with your physician and decide if you should see a genetic counselor. It is estimated that 20% of patients with CRC who are less than 50 years old have an inherited genetic defect that predisposes them to the disease. Knowledge of one’s genetics can modify the screening strategies for other malignancies and help guide the medical care of other relatives potentially at risk and otherwise unaware and asymptomatic. We have come a long way in the understanding, early detection, and treatment of CRC. We need to stay vigilant even years after successful treatment and follow the survivorship care guidelines, take excellent care of ourselves, know our bodies and our poop, and alert our physicians when there has been an unexpected change. Only when we work together will have the best long-term outcomes.

Howard Brown is a Silicon Valley entrepreneur, best-selling author of Shining Brightly, award-winning international speaker, inspirational podcaster, survivorship coach, health technology consultant and two-time stage IV cancer patient and survivor 30 years apart. He shares the keys to leading a resilient life with hope that drives successful community leaders, business innovators and healthcare advocates. Be prepared to be inspired! https://ShiningBrightly.com A Cancer Journey is a Team Sport I am a two-time stage IV cancer survivor, 30 years apart—so I know that the moment we hear the words, “You have cancer,” everything comes to a screeching halt. I was that deer in the headlights at age 23 in 1989 with stage IV non-Hodgkin Lymphoma. My story changed after the shock of my second diagnosis. This time, I became like a Marine on a mission when I was diagnosed with stage IV metastatic colon cancer after my 50-year-old colonoscopy. Even though my awareness of what I was facing and my commitment was different than when I fought cancer in my 20s—these diagnoses both filled me with fear. Cancer I In October 1989 at the age of 23½, I was diagnosed with stage IV T-cell non-Hodgkin Lymphoma (blood cancer of my lymphatic system). I moved back home with my parents, and they became my caregivers. As we started this journey, we knew nothing—and there was little we could find, compared with today’s Internet. We kept searching for answers, because I failed all the chemo regimens the doctors tried. I kept relapsing. In February of 1990, my twin sister turned out to be an exact 10-for-10 HLA match for a bone marrow (now called stem cell) transplant at Dana Farber Cancer Institute in Boston. Miracle No. 1: My twin sister had a 1-in-25,000 chance of being a donor match for me. On May 17, 1990, I checked into an isolation room for a blasting of chemotherapy and twice-daily full-body radiation to knock out my immune system. On the morning of May 24, 1990, my twin sister had bone marrow extracted from her hip bones. That marrow was treated and infused in me at 5:44 pm that day. We watched to see if the transplant would kill me right away, cause any type of severe graph-vs-host disease—or, we hoped, begin to rebuild my immune system. My twin sister saved me and I was able to put Humpty-Dumpty 1.0 back together again. As a result, I moved far from home to Marina Del Rey, California. One important side note: Before I did one drop of chemotherapy, my liver function tests were running too high for safe infusion. While we waited for those levels to subside, my oncologist spoke to me about fertility options and going to the cryogenic center to leave a sperm sample preserved. Miracle No. 2: Because I beat cancer, that decision to visit the cryogenic center allowed me to get married—then my wife and I could call for the frozen sperm eleven years later and be blessed with our miracle girl—our daughter Emily. Cancer II Those early successes gave me 26 years of life. I got married; put my career as a Silicon Valley technology entrepreneur back on track; became a dad; and involved myself in volunteer community service. Then, lightning struck again. At age 50 in June 2016, I went in for my routine colonoscopy and was diagnosed with stage III colon cancer. Back to more surgeries and chemotherapy. This time, my wife Lisa stepped in as my primary caregiver. One year later, I was metastatic stage IV with the cancer spreading to my liver, stomach lining, and bowel. Would I get to see my daughter, who was then in 9th grade, graduate from high school? Why was I hit twice? I learned that young-onset cancer patients can develop a secondary cancer. I wish I had gotten screened for colorectal cancer years earlier. In the US, the recommended screening age was just lowered from 50 to 45, unless you have family history or symptoms. Because I learned from my first bout with a deadly form of cancer that this fight is truly a team sport—I knew that I needed to reach out for allies. In 2016 there were many more digital support options and my wife and I found www.colontown.org for patient and caregiver information and support. It was there I learned about CRS HIPEC—a massive surgery to remove all cancer cells from my stomach lining, liver, abdomen, bowel and then my doctor used heated chemotherapy placed in the pelvis and abdomen to kill micro-cells of cancer. This life-extending mother of all surgeries helped me to reach NED (No Evidence of Disease)—and has kept me there for four years at this time. Once again, I am a work in progress, reassembling Humpty-Dumpty 2.0 day by day. Battling cancer, we share a lot—but we’re each on a unique journey There is no one-size-fits-all all survivorship plan . Whether you are still battling cancer or trying to reassemble the first pieces of your old life again—or you’re somewhere along the journey toward consistent reports of NED at your checkups—you have discovered that there are many different paths we can take. Our journeys likely start with chemotherapy, radiation, surgeries, side effects and often we are placed on “surveillance” mode. Typically, there are quarterly blood tests and CT scans. For me, I have the hidden side effects of chemo brain (also called brain fog / PTSD), peripheral neuropathy and digestive / bathroom issues still persist. They are hidden. People assume you look and feel great and many days I do — but I carry with me an enormous legacy of my treatments. If that’s your experience, you are not alone! We share so many challenges: Getting our emotional well-being back on track Building our physical stamina and fitness moving forward Figuring out our finances and career situation Nurturing relationships with our family, friends and co-workers That’s all part of what I call “putting Humpty-Dumpty back together again.” Many people are overwhelmed with trying to navigate “after cancer.” Our lives are not the same after what we have just lived through. These changes may be very difficult — including finding a job again. I chose to publish my memoir Shining Brightly to help others. I speak at conferences to share my stories and experiences so that others may find inspiration for getting back up again. I started an inspirational podcast to highlight others’ human resolve and ability to help lift up others. Survivorship, like fighting cancer, is a team sport. Build your team or let others like me help you take the positive steps forward to help you shine brightly every day. My heartfelt advice to others facing cancer: Do not go at it alone. It’s time to rally the troops and build your team. Surround yourself with a care partner, mentor and people who care for your well-being. Time to be selfish in your time of need. Be able to accept help from family, friends and even strangers. Get smart and educated about your diagnosis. Online resources and cancer advocacy networks have an abundance of resources. Collaborate with your caregivers—and thank them! Care partners, doctors and nurses are your lifeline. Thank them repeatedly. Make memories. Spend time with loved ones and experience things that lift your spirit. Find your happy place and go there often. Hiking, biking, nature, art, sports, cooking, yoga, meditation, travel—whatever lifts your spirit can be your “happy place.” Love yourself and share your light Each day, go to the mirror and say “I love myself because—" More and more people are living longer with cancer, I hope and pray you will too. Cancer is a team sport where we can all join hands and face it together.

Brenda Burk MSN, RN, NEA-BC, CSSM, CNOR, serves on the Board of Directors for Hospice and Palliative Care for Iredell County, is a national spokesperson to reduce incivility and bullying in nursing, and serves on the Executive Round Table of the Association of Operating Room Nurses. She is a recipient of the DAISY Lifetime Achievement Award by LNRMC, where she served as Director of Surgical Services before her recent retirement.  Brenda volunteers for cancer survivor events through various organizations and volunteers at RainbowKidz,  serving children experiencing grief and loss. In her free time, Brenda loves to cook, bake, sew, read, do jigsaw puzzles, travel the world, and spend time with her adult children. The day that changed my life… I had my first colonoscopy on a Friday, almost twelve years ago. I knew that I was three years late in getting the colonoscopy done per the American Cancer Society guidelines, but I was not worried about it as I was fit and healthy . Additionally, my three older siblings had been screened and were cancer-free. The reason that I delayed it was that I had a hectic job in a high-pressure environment and (stupidly) did not think I could take the time off. Boy was I wrong! I remember being woken up after the procedure by the Gastroenterologist (GI Doctor) who was holding a full-page photograph. Being a surgical nurse, I was able to recognize the image… a polyp, the size of my thumb, surrounded by a mass of about six inches in my colon. I said to him, “whose is that?” and he looked at me with concern and said, “it’s yours!” Believe me, I woke from the anesthesia right now and went into panic mode. I vividly remember saying to my husband, “ what are we going to do ?” We have three children, two were in college and the youngest in high school, so my immediate thought was of them not having a mother if it was cancer. Believe me, I had some crazy thoughts and emotions!  There was a flurry of activity in the ENDO unit, and the next thing I remember was a general surgeon walking in. He very calmly explained that I was going to need a colectomy ( a surgical procedure) to remove the part of my colon with  the tumor. He said he was available to do the surgery on the Monday morning. I was scheduled for a CT scan on the Saturday and was instructed to be on a clear liquid diet for the weekend.  That weekend was surreal, calling friends and family to tell them the news. We did not know if it was cancer yet, as the biopsy results would not be available for a few days. I had just resigned from my position and was scheduled to start a new job in two weeks. I called my new boss to tell her that I was not sure when, if ever, I could start; she was so kind and compassionate and told me that my health came first and they would wait for me!  Colectomy surgery Monday came quickly and I was wheeled into the OR to have a sigmoid colectomy, which went very well according to the surgeon. The colon, or large bowel, has three sides: the ascending colon (right side), the transverse colon, and the descending colon (left side). The left side of the colon has four sections: the descending colon, the sigmoid colon, the rectum, and the anus. The surgeon was able to remove the tumor laparoscopically and reattach my descending colon to the rectum, so no colostomy (bag), which was a fear.  On the Wednesday, the surgical team came in to break the news that it was Stage 1 colon cancer. It was really pretty weird being told that you have cancer when the surgery had already rendered me cancer free!!! I was very blessed that the surgeon was able to get clean margins and that all the lymph nodes were clean, so I did not need chemotherapy. I was in the hospital for five days and was able to start my new job six weeks later.  My cancer journey opened a new door for me Two years after my procedure, I walked the Get Your Rear in Gear 5k to show gratitude for my survivorship, and to walk in memory of a good friend who died 13 months after his Stage 4 colon cancer diagnosis. He was having symptoms and only went to be screened after he learned my diagnosis. The crazy thing was that I did not have any symptoms. I subsequently learned that colorectal cancer is referred to as a “silent killer” because by the time you are having symptoms you are typically in an advanced stage. I am now a big proponent for early colon cancer screening and prevention.   I started this blog saying my life was changed, so let me tell you why. I really believe that my cancer journey opened a new door for me and a reborn and better me emerged. For this, I will always be grateful. Through connections made at Get Your Rear in Gear, I was able to attend a cancer wellness retreat. At this beautiful nature retreat, I was treated to a session of Healing Touch therapy. This is an energy therapy in which the practitioners consciously use their hands in a heart-centered and intentional way to support and facilitate physical, emotional, mental, and spiritual health. I do not know how or why, but I felt amazingly lighter and brighter - it was life-changing! The transformation continues to be amazing. I used to be very rigid and science-based. I am now much softer, more creative, and have channeled my focus on helping others through their cancer journeys. I look at my diagnosis as a blessing which is allowing me to live my best life. I am now a student of Healing Touch. I do a daily walking meditation in my backyard labyrinth and love to host spiritual and creative gatherings. I assist at cancer wellness workshops and retreats where I have met many remarkably brave and wonderful people. I have made many new friends through our common diagnosis of cancer. In Charlotte NC, we are truly fortunate to have wonderful programs like TheAfterCancer.com with trained professionals to support us as we navigate our cancer journeys. I now have routine colonoscopies and have had numerous precancerous polyps removed during these procedures. I often think that if I had delayed any longer the outcome would possibly have been vastly different. So please, if you are reading this blog, go for your screening on time. The ACS recommends that people at average risk of colorectal cancer start regular screening at age 45 .

Lori Drummon d is a Registered Dietitian at The After Cancer Surviving cancer is a journey Surviving any cancer -- including colon cancer -- is a journey marked by perseverance, resilience, strength, and the unwavering determination to overcome one of life's greatest challenges.  While medical treatments play a vital role in battling this disease, the journey toward recovery extends far beyond the hospital or clinic walls. Nutrition plays a crucial role in supporting colon cancer survivors as they rebuild their health and vitality during conventional therapies and beyond.  Nutrition plays a crucial role It’s recommended that all cancer patients undergo nutritional screening to ensure that those likely to experience unwanted weight loss are identified and can be directed toward and guided by a nutrition professional such as a dietitian or nutritionist with advanced practice training in oncology.  The journey through colon cancer treatment can take a toll on the body, impacting everything from appetite to digestion. Chemotherapy, radiation therapy, and surgery can all affect the body's ability to absorb nutrients and maintain optimal health. Common side effects such as nausea, vomiting, diarrhea, and loss of appetite can further complicate nutritional intake, making it challenging for survivors to meet their body's needs. To bridge the gap during the transition phase which is immediately after treatment to the predisposition phase (surveillance stage), it remains important for a survivor to continue to eat well, get those essential nutrients, and optimize health with the right nutrition – to stay on track for the long run.  It’s so vital that it should be considered a life-long commitment or simply a permanent lifestyle change. This will rebuild strength and stamina but also support the body's immune system and promote overall well-being including good mental health while reducing the risk of recurrence.  How nutrition intervention supports colon cancer Here are some important ways in which nutrition intervention supports colon cancer: Supporting Digestive Health:   Survivors might experience changes in digestion or in bowel habits.  Consuming a diet rich in vegetables, fruit, and whole grains – all providing fiber -- can help improve digestion and restore bowel regularity, and potentially prevent complications such as constipation or diarrhea. Boosting Immune Function: Assuring a diet that provides sufficient vitamins, minerals, antioxidants, and phytonutrients can help strengthen the immune system, which is essential for fighting infections.  Eating the colors of the rainbow including foods such as dark green leafy vegetables, red or purple berries, orange citrus fruit, and nuts and seeds are loaded with immune-boosting nutrients that play a critical role in the body’s defense mechanisms.  Maintaining Healthy Weight: Obesity is a well-known risk factor associated with the development of many cancers. Therefore, recommendations are to work toward a healthy weight.  On the other hand, if weight loss during treatment results in becoming underweight, the goal is to obtain a healthy weight for your body height and type. That’s where a personalized plan created together with a nutrition professional is so important. Incorporating physical activity, if able, of 150 minutes per week of moderate exercise is recommended, or staying as physically active as your situation allows.  Reducing Inflammation: Chronic inflammation has been linked to an increased risk of cancer recurrence and other health issues. Consuming a diet rich in anti-inflammatory foods can calm inflammation. These foods include herbs, spices, and healthy fats such as found in cold-water fish and olives. Others include a variety of fruits and vegetables while avoiding processed or fast food and sugar-laden beverages.  Promoting Emotional Well-Being:   We all know that eating isn’t only about physical health, it’s an emotional and social experience. Preparing and sharing nutritious meals with loved ones can provide enjoyment, comfort, connection, and a sense of normalcy following a challenging and stressful time. Certain foods such as dark chocolate and leafy greens have been shown to support mood and mental health. This is equally so, as all these foods mentioned above support a healthy microbiome which has been shown to improve mood. All this to help survivors cope with the emotional toll of their cancer journey.  Nutrition-related recommendations for colon cancer survivors should provide personalized healthy nutrition-related guidance that includes specific measures that can help manage or prevent co-morbid conditions commonly present in cancer survivors. Seeking support from healthcare professionals, survivors can optimize their health and well-being in numerous ways as they embark on the journey toward a brighter, healthier future.