Sunday, December 27, 2015

Happy Holidays

This holiday season has been crazy. I had something scheduled nearly every day since celebrating Thanksgiving. I am way behind in my reading for the most up to date science in the world of breast cancer. I'll make it my New Year's resolution to keep on top of it better. However, I will also resolve to continue to be present when I am with people and not choose looking at my phone, sending emails or blogging over spending time with other human beings. I will continue to be present and an active participant in life. I will continue to express my gratitude and continue to journal my gratitude periodically to keep me a happy human being.

I resolve that 2016 will be a happy, healthy year full of adventure and updating the world on the latest breast cancer research.

Until then, I have a whole bunch of Christmas cookies to eat.

Below is the Hail and Farewell from CBS Sunday morning. I was reminded while watching it this morning that we lost too great cancer advocates this past year, Stuart Scott and Lauren Hill. It does give you pause and motivation to keep making New Year's resolutions and living your life.

Thursday, December 10, 2015

Survivor Guidelines for a Survivorversary

Today is the 3 year anniversary of finishing chemotherapy. It is also the first day I have gone to work and not done something fun in the past 2 year. Unfortunately, it didn't work out with my work schedule to take today off, but I still made the most of it. And by most of it, I mean I read the new American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. Do I know how to party or what? If you too want to be party animal you can read the full text here.

These guidelines are great step towards offering more standardized care and ideally helping to increase breast cancer survivors quality of life. In literature quality of life is often abbreviated QOL and it is such an important marker. The guidelines I also found to be quite comprehensive, so let's review some of the ACS/ASCO recommendations.

Follow up in the post treatment phase, the authors recommend a detailed history and physical every 3-6 months for the first 3 years, then every 6-12 months the next 2 years and then annually every year after with your oncology team. I think this will actually help people with the sudden drop off in appointments, also, after treatment. It can be a little jarring to go from weekly/monthly appointments down to nothing. It's also nice to know that at some point the frequency of trips to the doctor does drop off. That does help with the whole QOL

For screening for recurrence, lab tests and imaging and signs of recurrence the overall recommendation is that the oncology team SHOULD NOT offer routine lab tests or imaging, besides mammography, in patients who have no symptoms. The article goes on to state that patient's should be counseled on the signs of recurrence. These guidelines do not recommend that patients have MRIs as follow ups unless they are at high risk for recurrence (such as BRCA positive), because of the tendency for the amount of false positives. I found this fascinating that an annual mammogram may be enough screening as long as your not having any symptoms. I wonder if there is hope for me and not having to drink mochaccino flavored barium once the PRESENT study is done. It didn't mention anything about CT scans.

One of the major difficulties for breast cancer survivors is to continue on their endocrine treatment, or in my case tamoxifen. These guidelines offer concrete guidelines on how to lessen the side effects and hopefully increase the compliance. Many of the ways that musculoskeletal pain and neuropathy can be combated is through exercise. The guidelines recommend:
150 minutes of moderate or
75 minutes of vigorous aerobic exercise per week
and
strength training exercise twice a week. 

So as I was reading this as I skipped my run this morning as my plantar fasciitis has flared up, but it is important to find a way to keep moving.  Moderate exercise would be walking, vigorous would be running. (For more information on the difference, see the american heart association's definitions here)

Another major side effect that puts breast cancer survivors at higher risk for recurrence is being overweight/obese. I found the statistic astounding that 61% of breast cancer survivors were overweight with 30% being obese. I hear all the time the importance of maintaining a healthy body weight and how the breast cancer treatment can make people gain weight, I just didn't realize how many were struggling with this recommendation.

The guidelines outline a basic diet that all human beings should follow without specific recommendations re:soy or flax. They recommend a diet:
High in Fruits, Vegetables, Whole Grains and legumes and low in Saturated Fat. The dietitian in me was not surprised to read this. This is the general diet that most of the world should follow. And then I got off the bus and ate a cinnamon roll. Because I'm human. (And then followed it with plain nonfat yogurt and berries, for balance) And they recommend limiting alcohol to at most 1 serving/day. Some studies have shown reducing alcohol to less than 4 servings per week to be beneficial, but there was not enough information for the authors to fully comment on that.

Many of the recommendations were for post menopausal women as they make up the largest group of breast cancer survivors, but one particular recommendation was made. A baseline DEXA scan should be done to check your bone health. Apparently, chemotherapy and long term SERM (drugs like tamoxifen) can decrease your bone density and put you at higher risk for osteoporosis. Good to know.

The other major QOL recommendation that these guidelines made was to address FOR. Fear of Recurrence. FOR is real and palpable sometimes. Some of my cancer friends are often paralyzed by it, so it is good to see it being addressed in the guidelines.

The bottom line for me
1) Keep my bottom line in check (i.e maintain a healthy weight)
2) Continue to eat a heart health diet (cinnamon rolls not withstanding)
3) Just keep running or moving or dancing
4) I need to add an additional weight lifting day in as I currently only get one
5) I'll keep taking my 1000 units of vitamin D3 daily for my bone health
6) I'll have to ask my oncologist if I should be getting a DEXA scan? (to check my baseline bone health, ugg do I really want to ask for more tests)

and most importantly

7) Don't let the FOR ruin your QOL

(I think I need a bumper sticker that says this. Except for that I don't drive. Maybe the MBTA would let me put it on my bus.)