Thrive: Survivorship Digital Magazine, Vol. 1, No. 1

Welcome to Thrive

January- March, 2023 Vol. 1, No. 1

We hope you enjoy the first edition of our new quarterly Survivorship digital magazine, Thrive! Designed for adult cancer survivors and their loved ones living with, through, and beyond cancer, the goals of Thrive are to provide important information, share inspiring stories, and offer helpful resources across our Network.

If you have any questions on our content, or ideas for articles in upcoming editions, please contact Amy Litterini at amy.litterini@mainehealth.org

If you haven’t already, please click here to sign-up for future editions.

Cancer Survivorship

Survivorship begins at the time of a cancer diagnosis. Any person with a history of cancer is considered a cancer survivor from the time of diagnosis through the balance of life, and includes those living with, through, and beyond a cancer diagnosis (see below). Some are survivors of more than one cancer. Some prefer the term thriver rather than survivor, while others prefer no labels at all. Each person gets the choice to decide when, how, and what they think about their own survivorship.

Phases of Survivorship

There are phases of survivorship, with each phase associated with different time periods and personal experiences following a cancer diagnosis. Individual needs for care and support often change over time.

Living With Cancer

Living Through Cancer

Living Beyond Cancer

Diagnosis

Active Treatment Management of treatmentrelated side effects

Living with cancer as a chronic disease, which requires ongoing follow-up care

Living with advanced cancer, which may include ongoing treatment with Palliative Care

The end of active treatment Support for Recovery

Usual timing of a survivorship visit and development of a Survivorship Care Plan Schedule for follow-up care established

Long-term Survivorship Routine monitoring and testing

Attention to cancer

prevention and healthy lifestyle Goal is to resume preferred activities

Survivorship Components

There are several components of cancer survivorship that can, and should, contribute to the health and quality of life of every survivor. Survivorship care may be different for each person, but there are several common components. Our magazine will be organized based on the concepts in the graphic below.

Health Promotion

Prevention Monitoring Routine Testing

Care Coordination

Assessment & Treatment

Keep an open line of communication with your cancer care team and primary care provider. Please discuss any questions or concerns you may have at any point with your providers. Our goal is to provide you with the specific care and support you need, when you need it.

Survivorship Care

Survivorship care is the process of anticipating and addressing immediate, long term (i.e. occur during treatment and persist), and late (i.e. begin after treatment has ended) effects from a cancer diagnosis and treatment over time. This includes routine monitoring and may include symptom management, addressing fears and concerns, rehabilitation, and ultimately focusing on health promotion and building a support network. Each

Survivor to Survivor

Survivor to Survivor With Lois Reckitt

Meet Lois

On New Year’s Eve, Lois Reckitt celebrated both her birthday, and the start of a new year. She was born in Massachusetts, and after spending summers in Maine as a child she has spent the last 52 years in South Portland. What Lois didn't expect from 2022 was a colon cancer diagnosis. Lois is an otherwise healthy, productive member of her community as a Representative in the state legislature for the Ocean end of South Portland. She had followed the guidelines for regular colonoscopies. She then started having some intestinal pain, which she attributed to constipation and/or diarrhea, depending on the day. She found at least a partial fix by a supplemental fiber treatment. Things were going along fine enough until midNovember when she experienced severe pain late on a Sunday night. She called her doctor, who told her to go to the emergency room first thing in the morning where she was admitted to Maine Medical Center. Unfortunately, a colonoscopy had revealed a large mass, which was biopsied. When they showed Lois a picture from the colonoscopy, she said it looked like “a ball of dark sticks”.

Initially, they treated her with antibiotics to see if the mass would shrink over the course of

her first few days in the hospital. When it didn’t shrink, she underwent a 3 1/2 hour operation by Dr. Hallagan where she woke up to her sigmoid colon having been removed. Lois was not entirely surprised, but understandably disappointed to have woken up from surgery with an ostomy. The biopsy results from the large mass on colonoscopy then came back, and they were negative for cancer. However, when the surgical pathology results came back, they did, in fact, confirm the diagnosis of colon cancer. Thankfully, the 21 lymph nodes they also removed came back benign (e.g. negative for cancer) leading to a better overall prognosis and a less aggressive treatment plan.

Lois has been a dedicated journal writer for several decades, but unfortunately she didn't have her journal with her in the hospital. What she did have was a dedicated wife by her side, an encouraging surgeon in Dr. Hallagan, and an optimistic medical oncologist in Dr. Voisine. Her gastrointestinal (GI) nurse navigator, Nicole, was also very helpful in taking care of the details and the scheduling of the multiple appointments Lois would need next. At one point during her hospital stay, she woke up and said to herself, “I don't think I can do this.” But, she followed that thought shortly thereafter with the decision to recover. She told herself “I had already bought holiday presents for my wife. I worried about what she do without me. I was determined not to make things worse for others, so I decided to recover”.

After a 16-day stay in the hospital, Lois was discharged to home with support of home care nursing, physical therapy (PT), and occupational therapy (OT), all of which proved to be very helpful in getting her back up on her feet. Her home PT realized that with the configuration of her home, she could walk for 10 consecutive minutes indoors to build her endurance. Her ostomy nurse was an invaluable resource for teaching her how to manage her new stoma and getting her the right equipment. The OT helped her regain her independence with daily activities.

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Lois Reckitt, at home in her back yard in South Portland

One of the biggest revelations Lois had was just how many friends came to support her, in particular from the Maine Irish Heritage Center. She had both male and female friends who came to stay with her during the day while her wife was at work. She attributes her ability to ask for help, which she says she's good at, in allowing her friends to be there for her at her time of need. One of them wrapped Christmas presents for her. One of them made sure her computer was running well. Her longtime manicurist even came and did a home visit for not only her acrylic fingernails, but also a pedicure. One of her friends realized her towel rack was not an appropriate grab bar for her to get around her bathroom, so he went out to get the right equipment and installed it properly so she would be safe. Her son-in-law put in floor ramps for the thresholds in her doorways so she could get through more easily. She ultimately concluded she had better support than she even thought she had, and she recommends that other survivors not only ask for help, but also accept it when offered.

Having a stoma has turned out to be both interesting and frightening. According to Lois, “having taught human biology in the past, I was fascinated by seeing the inside of the colon through my stoma”. She has already learned a significant amount on how to manage her stoma, and she now has what she needs where she needs it. The next step for Lois includes getting back to the state legislature on January 4th. She's been an activist in the women's movement since 1971 (see cover photo taken on the Statehouse grounds), and looks forward to continuing her many legislative pursuits and contributions, which include three new bills being proposed this session. She also looks forward to accessing the Dempsey Center for their supportive services to continue her cancer recovery.

Lois shares that: “All survivors go through that moment of terror, the shock, the fear of the unknown. But, they ultimately move on to a period of joy, and a realization that they just have to move. They just have to do it.” And, she's doing it!

Lois being sworn in to the State Legislature by Governor Janet Mills at her home office in South Portland.

Survivor to Survivor With Trevor Maxwell

By Trevor Maxwell

I’ve been living with stage IV colon cancer since March of 2018. Before that time, I was cruising along as a husband, father, and independent business owner. I was 41 years old and never imagined cancer would knock on the door.

Then, in what seemed like an instant, I found myself in a new world of scans, surgeries, and chemotherapy. I had colon surgery at Maine Medical Center in April 2018. Since that time I have had surgeries and treatment at Central Maine Medical Center in Lewiston, Mass General Hospital in Boston, Johns Hopkins Cancer Center in Baltimore, and New England Cancer Specialists in Scarborough.

The physical challenges hit me hard. But not nearly as hard as the mental health challenges.

Crippling anxiety and depression sank their teeth into me. For a few months after my diagnosis, I spent entire days weeping, without hope, and without the fighting spirit I felt I was supposed to have. I grappled with deep shame.

At the lowest point, my family did not abandon me. They carried me. I promised them: “No matter if I live one more year or 40 more, I’m going to do everything in my power to regain my mental health, and to live with joy and purpose.”

That process started by admitting I needed help. I found a local support group and a therapist. I also joined communities online and met amazing people who were facing cancer. Those connections have been essential in my emotional recovery. They have also been essential for providing

knowledge about my disease and my treatment options

But I noticed a glaring gender gap along the way. The vast majority of people seeking support are women. It’s largely a mix of women patients and survivors, as well as caregivers trying to find ways to help their husbands, sons, brothers, and fathers.

Trevor Maxwell, 46, has been living with stage IV colon cancer since March of 2018. He has undergone five major surgeries, chemotherapy, immunotherapy, and a clinical trial. He lives in Maine with his wife and two teenage daughters.

Where are the men? They don’t need help facing cancer?

Of course they do. They are just too proud, angry, ashamed, or depressed to seek it out. Too many men feel they have to take on every challenge on their own. We are taught to not burden others. The consequences of this are undeniable. When men isolate during cancer, they are at high risk for mental health problems, broken relationships, and poor medical outcomes.

I decided that I needed to do something about this problem. In January 2020 I launched an online community and purposedriven company called Man Up to Cancer.

Through our podcast, website, annual retreat, and local chapters across North America, we are changing what it means to “Man Up” in the face of cancer. It’s not just about being tough. It means having the courage to accept help, and knowing we are smarter and stronger as a pack than we are as lone wolves.

We have a private Facebook group called The Howling Place, which is a place for male cancer patients, survivors, and caregivers to unwind, make friends, and share stories.

In December 2022, I published a book, “Open Heart, Warrior Spirit: A Man’s Guide to Living with Cancer,” which explores the reasons why men go into our “man caves” when facing a cancer diagnosis, and how we can change that narrative.

There are thousands of men out there who feel just like I did a few years back. Anxious, depressed, overwhelmed, isolated by cancer. If this describes you, and you’re ready for change, there’s a whole wolf pack waiting for you.

Trevor has a background in journalism, communications, and public relations. He founded ManUptoCancer in January of 2020, as a purpose-driven company and support community for men impacted by cancer. As a patient leader, he has received the Annette Cook Cancer Warrior Award, presented by the WunderGlo Foundation; and the Amanda Dempsey Award, presented by the Dempsey Center.

Prevention

Monitoring

Routine Testing

Introduction to the Cancer Risk and Prevention Program

ByStephanieSharp,MS,CGC,GeneticsProgramManager

What Do Cancer Genetic Counselors Do?

Genetic counselors are healthcare professionals with advanced training in medical genetics and psychosocial counseling who partner with patients seeking information about inherited conditions affecting them or their families. A cancer genetic counselor works with patients and their providers to:

• Explore personal and family health history to better understand genetic risks for cancer

• Discuss the medical and emotional implications of genetic information and cancer

• Determine if cancer genetic testing is appropriate for patients and their families

Is Cancer Hereditary?

People with cancer often wonder what caused the disease. Relatives of those with cancer are often concerned that they may also be at increased risk for getting cancer. About 5-10% of cancers are hereditary. Hereditary cancers occur because of an inherited change (mutation) in certain genes that normally protect the body from developing cancer. This change increases a person’s risk for one or more cancers and can be passed down in families from one generation to the next.

Who Should Have Cancer Genetic Assessment and Counseling?

Experts recommend assessment if you or your family members meet any of these risk factors:

• Have three or more family members on your mother’s or father’s side of the family with the same type of cancer

• Have more than 1 type of cancer

• Have a diagnosis of cancer at an unusually young age

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• Have a clustering of cancers in the family fitting a known pattern, such as breast and ovarian cancer occurring on the same side of the family

• Have a family member with an abnormal cancer-related genetic test result

Why Should I Consider Genetic Counseling or Testing?

Information can be power! Your genetic test results could impact your options for detecting, preventing, and treating hereditary cancer. Sharing your test results with relatives can help them learn more about their own cancer risk and provide them with medical options for staying healthy.

Is Genetic Counseling and Testing Covered by Insurance?

Most insurance companies cover the cost for genetic counseling and testing for people who meet the risk factors. The Cancer Risk and Prevention team can help determine whether you qualify for genetic services under your health insurance plan.

How Do I Find Out More?

Stay tuned! We will share additional information and updates about our program and about hereditary cancer in future editions of this newsletter. You can talk to your oncologist or other healthcare provider to find out if cancer genetic counseling might be beneficial for you and your family.

You can contact our program at 207-396-7270 or CancerRiskandPrevent@mainehealth.org.

For more information on hereditary cancer, visit https://www.facingourrisk.org/ For more information on genetic counseling, visit https://www.aboutgeneticcounselors.org/

The Link Between Alcohol and Cancer Risk

Research has consistently shown a link between alcohol consumption and several types of cancer, but most Americans are unaware of the risks according to a new study. As an important modifiable cancer risk factor, the American Society of Clinical Oncology and the National Cancer Institute recommend both cancer survivors and the general public eliminate or reduce alcohol to lower the risk of cancer.

The recommendations to lower alcohol-related cancer risk include:

• Avoid drinking alcohol.

• Limit the number of alcoholic beverages you drink.

• For women, limit alcohol to 1 drink or less a day.

• For men, limit alcohol to 2 drinks a day or less.

A drink is defined as:

• 12 ounces (oz.) of beer

• 5 oz. of wine

• 1.5 oz. of 80-proof liquor

• 8-9 oz. of malt liquor

Discuss any questions or need for support with your care team, including your primary care provider. For resources in your area, call 211. For more information, click here.

Assessment & Treatment

Pediatric, Adolescent and Young Adult Survivorship Clinics

Our clinics are devoted to improving the health and well-being of people who have been treated for cancer. We offer two separate programs:

• Pediatric Cancer Survivorship Clinic: Under age 18 - 207-396-7565

• Adolescent and Young Adult (AYA) Cancer Survivorship Clinic: Age 18 and older - 207-396-7788

• Adult Survivorship Care: Please discuss any questions or concerns directly with your oncology and primary care providers.

We recognize that everyone's experience with cancer is unique. Some individuals will have few, if any late effects while others may have late effects for which they will need long term management. Our goal is to help you find your “new normal” and to live your life to its fullest.

We can help you understand and cope with:

• Managing body image issues

• Regaining your physical strength and how to live as actively as possible

• Reducing the risk of additional cancers and chronic diseases though improvements in diet and lifestyle

• Returning to work

Oncology Rehabilitation:

TheLymphedemaTreatmentActPassedbyCongress

December 23, 2022

After years of advocacy, Congress recently passed the Lymphedema Treatment Act (LTA). The LTA, which goes into effect 1/1/24, is a federal bill that aims to improve insurance coverage for the medically necessary, doctor prescribed compression supplies that are the cornerstone of lymphedema treatment. Although this bill will only change Medicare law, it will set a standard for Medicaid and private insurance to follow.

Over the next year, the Lymphedema Advocacy Group will be working with CMS (Centers for Medicare and Medicaid Services) as they write the rules to implement the coverage. This work will take time, so the changes will not be in effect immediately. The Lymphedema Advocacy Group has developed a ‘Frequently Asked Questions” section of their website to address questions from the public.

Rehabilitation for lymphedema is provided by lymphedema therapists (e.g. occupational or physical therapists). If you’ve experienced swelling associated with cancer treatment, please discuss it with your provider. To learn more about the LTA, click here: LymphedemaTreatment Act.org. To read the full press release, click here.

Care Coordination Planning

Navigation

SupportforBladderCancer Survivors

By Tracy Robbins, MS, RN, OCN, CCRP

In late 2019, the Nurse Navigation team at Maine Medical Center and MaineGeneral Medical Center helped initiate a Charter of the Bladder Cancer Advocacy Network (BCAN). The new Charter is called the Northern New England Bladder BCAN. It currently encompasses members from Maine, New Hampshire and Vermont.

Recognizing that the bladder cancer survivors we treat at MaineHealth have limited support through education and patient support groups, we felt it important to tap into this national organization to bring resources closer to patients. The mission of BCAN is for patient support both through an on-line community and in-person support groups and to advocate for increased research funding to deliver cutting edge methods of diagnosing, treating and working toward a cure for bladder cancer. Since developing the Northern New England Charter, efforts have been focused on organizing members, procedures and fundraising. The pandemic put limitations on what we could do so our focus in 2023 will be to increase awareness and to reach more patients and their families. We have some exciting fundraising events planned and are working to implement a patient support group in Southern and Central Maine.

Our largest fundraising opportunity will be the 2023 Walk to End Bladder Cancer. The theme of the walk is NoOneWalksAlone. It will be held at Fuller Farms in Scarborough on 5/6/2023. Registration details and how to donate can be found HERE.

We welcome anyone who would be interested in participating in, or donating to, this event. The Northern New England Bladder Cancer Advocacy Network charter is on social media! Please visit at Instagram: @nne_bcan; or Facebook: fb.me/NNEBCAN

Patient Navigator Amber O’Leary, RN (l), chats with patient Karen Burt (r)

Oncology Social Work

The oncology social workers in the MaineHealth Cancer Care Network help people with cancer and their families deal with the emotions, stress and changes that come with a cancer diagnosis. People with a cancer diagnosis face a lot of new information and decisions that can feel overwhelming. Social workers have the information that can make tasks easier for people and help them better cope.

The oncology social workers in the MaineHealth Cancer Care Network are Masters-level and licensed clinical social workers who specialize in working with people with cancer. They help patients and their families address issues such as adjusting to a cancer diagnosis, trouble sleeping; worries about the future; medical costs and job concerns; and how to talk with family, friends, and co-workers about their experience. If you would like more information on how to access social work services, please speak to your provider for a referral and/or click here.

MaineHealth Oncology Social Worker Joins National Certification Board

Trisha Warren-VanHorn, LCSW, OSW-C, has recently joined the Board of Oncology Social Work Certification (BOSWC). Trisha, who has been a Certified Oncology Social Worker for 12 years, will serve a two-year term.

The BOSWC promotes the mutual professional interest of oncology social workers and administers an oncology social worker certification program. In addition to validating the competency of individual social workers, the BOSWC promotes and ensures lifelong learning in oncology social work and other related disciplines. There are currently four OSW-Cs in the MaineHealth network, eight in the state, and over 800 nationwide. As a member of the Board, Trisha will be take part in reviewing all applications for new OSW certifications, as well as renewals.

According to Trisha, there are multiple benefits to becoming OSW certified. “It is so beneficial to be connected to a national group of

peers,” she says, “and this organization also helps in reinforcing the need for specialized training.” A specialized social worker with proper training is able to assist patients to develop coping skills for managing changing diagnoses and treatment options, and can help patients and their families with the practical issues of finding the allimportant community resources. Trisha says that these resources “...have become more sparse during the pandemic but Oncology Social Workers continue their efforts to try to find resources, while offering emotional support to [their] patients and offering unique perspectives to [their] medical colleagues.”

Trisha Warren-VanHorn, right, provides care at Maine Medical Center in Scarborough, ME.

Spiritual Care

What we do:

•Chaplains of many faiths are available to speak to, or pray with patients who so desire.

• Chaplains are also available to administer special sacraments of faith.

• The Alexander B. Cairns Memorial Chapel, located on the first floor of the Maine General Building, is available at all hours for prayer and reflection. Devotional materials are available.

• Denominational and ecumenical services are held weekly and seasonally for patients, families, and employees. In addition, special services are held to commemorate special events.

• We recognize the importance of the relationship between spirituality and physical health and the role that pastoral and spiritual caregivers provide in this process.

Virtual Prayer Book

The Chaplains at Maine Medical Center have a tradition of praying for our patient, staff, and community needs during our daily meetings. You can request prayers by entering them either in the prayer book kept in our Chapel, via email or using our webform.

Please use first names only and keep your request brief. Requests will be monitored daily and will be placed on the prayer list for our next meeting. Your request for prayer is a sacred trust and will be kept confidential.

Well-Wish Link

If prayer is not your need or custom, our Spiritual Care department is happy to receive your wish for well-being. This can be for a specific individual or more generally for our health care staff. You can send a message of encouragement and support via email or use our webform.

Please keep your message positive and brief. Our Chaplain staff rounds in the hospital daily and will share your message with the appropriate person or group. All messages shared will be edited to remove any personal information about the sender. Please know that we will receive your well-wish with gratitude, and share it in a spirit of honor and trust.

Health Promotion

Nutrition Guidelines for Cancer Survivors

Recommendations from the American Cancer Society

Some of the most important cancer risk factors that can be changed by an individual include consuming a healthy diet, maintaining a healthy body weight, being physically active, and avoiding tobacco use. In future editions, we’ll include some easy-to-make, healthy recipes. In the interim, feel free to learn more by checking out the American Cancer Society Guideline for Diet and Physical Activity for Cancer Prevention

Soup’s On! For Good Health

By Judy Donnelly, RDN, LD| Nutrition Program Manager, Dempsey Center

Soup season is here and there’s nothing like a bowl of soup to warm your insides during these wintery months in the Northeast! For people who are or have been in treatment for cancer, soup can be a supportive, easily digested, and nourishing option for a meal. The cozy warmth of the soup bowl and the mix of flavors and textures satisfy the body and soul. And the biggest benefit of all: it provides some joy to the taste buds, while supplying nutrients that are important for cancer risk reduction.

Kelly Falone, RDN at the Dempsey Center notes that “soups are a great way to add vegetables and legumes to your diet and that means fiber and other nutrients that support good health”. A high fiber diet is associated with a reduced risk of many different types of cancer. What’s more, soup is easy to prepare, you can make it when your schedule allows, and reheat it when you are ready to eat (see Hearty Lentil Soup recipe next).

What’s for dinner? Think soup!! Feel like you need a primer on how to make really good soup? Click HERE to check out the Dempsey Center Cooking and Nutrition Programs. Soup’s On is coming soon in both Lewiston and South Portland!

If you have specific dietary or fluid restrictions related to either your medical history or cancer treatment, or concerns related to swallowing difficulties, please speak to your provider about a referral to a registered dietitian or a speech-language pathologist.

Physical Activity in Cancer Survivorship

Activity Guidelines from the American College of Sports Medicine

Lifestyle Medicine

Learning To Cope With The Emotional Challenges Of The Cancer Experience

By Dr. Kevin Stein

The cancer journey, from the point of diagnosis to survivorship, and at every point along the way, can be stressful and may present challenges to maintaining positive mental health and emotional well-being. Learning stress management skills and, if necessary, talking to a mental health professional, are important strategies to being able to deal effectively with these challenges. The first step in managing stress associated with cancer is to pay attention to your own body and being willing to seek out help when you need it. This “self-awareness” includes recognizing signs of stress in yourself, including feelings of irritability, anger, sadness, fear, excessive crying, and lack of interest in things that once brought you pleasure. Your body may also exhibit physical signs of stress, including racing heart, poor appetite, decreased libido, headaches, difficulty sleeping, restlessness, and weight loss or gain. Finally, you may have cognitive symptoms such as problems with memory, attention, and concentration.

It is important to acknowledge that all of these signs of stress are normal reactions to a challenging situation. In other words, anyone going through the cancer experience may experience these symptoms. The idea is to learn some basic techniques that you can use on your own, often called stress management strategies, but to also recognize when things get bad enough that you might need help from a mental health professional. For example, mild-to-moderate feelings of worry or sadness can be self-managed using stress management strategies – see below for a list of a few techniques you can try. However, when these strategies are not enough and you experience more severe or persistent feelings of anxiety or depression, it is time to seek out the support of a mental health professional.

Some mental health professionals, like psychiatrists, can prescribe medications, such as anti-depressants, anti-anxiety medications, and sleep aids. Other mental health professionals, such as counselors and psychologists, focus more on talking to you about your issues and identifying non-pharmacological approaches. This approach is called psychotherapy. The best outcome for many mental health issues, such as a severe episode of depression, is achieved when the treatment plan includes a combination of psychotherapy provided by a mental health counselor along with psychotropic medications prescribed by a psychiatrists or primary care physician.

Before seeking out a mental health professional, it is worthwhile to try some basic self-help stress management strategies that are easy to learn and use. Here are a few examples:

Deep Breathing (aka Diaphragmatic Breathing) – to practice deep breathing, begin in a relaxed seated position or lie down on a bed. Allow the body to settle so that the breath can slow into its natural quiet state. Once the body has settled, slowly move the abdomen out, drawing down the diaphragm, which will draw air into the lungs. Counting to 3 or 4 while you breathe in can help you ensure you are taking a nice deep breath. To exhale, pull the abdomen in, which will expel air from the lungs. Again, count to 3 or 4 while you exhale. The pace of deep breathing should be slow and rhythmic so that the inhale length matches that of the exhale. You can do this for several minutes, and you should feel a sense of calmness come over your body. The great thing about deep breathing is that you can do this almost anywhere, anytime, and usually get relief from feelings of anxiety, nausea, or pain.

Guided Imagery (aka Visualization) -

Guided imagery is a relaxation technique that involves dwelling on a positive mental image or scene. This technique is sometimes called visualization, or guided meditation. The practice involves closing your eyes and intentionally visualizing a peaceful scenario or image. While one person might choose to visualize a pleasant scene, others use healing imagery, such as picturing white blood cells fighting illness and imagining the desired outcome. I often tell patients to pick their favorite place – it could be the beach, a garden, or the view from the top of a mountain - wherever you feel safe and calm. I then instruct them to go through each of the five senses and really attempt to experience what it would be like to be in that safe, calm place – imagine the sights you see, the sounds, the smells, the physical touch, even the tastes that you would experience if you were physically in that place. You can linger in the scene for as long as you like – the point is to really experience the calmness and sense of relaxation you achieve by being in that place.

Progressive Muscle Relaxation – this technique involves going through each major muscle group in your body, progressing from one to the next, first tensing that muscle group, holding it for a few seconds, recognizing what it feels like to have tension, and then releasing that tension, paying attention to what it feels like to have relaxation in that muscle group. I often tell patients to start with one leg, first tensing and relaxing the toes and feet, then move to the calf, then to the thigh, always tensing and relaxing each muscle group as you progress throughout your body. Moving from your legs, to your torso, to your shoulders, arms, and hands, and finally to your neck, face, and head. It should take 5-10 minutes to progress through all the muscle groups in your body. At the end, you should be able to experience an overall sense of

relaxation in your body.

Positive Thinking – This technique involves focusing your mind on happy, uplifting, and hopeful thoughts, and avoid letting negative, fearful, or sad thoughts dominate your active mind. This can be difficult to do, especially when you feel sad, anxious, or is in physical pain. So, I often instruct my patients to keep a running list of positive thoughts, either in a notebook or on an electronic tool, such as your phone, tablet, or computer. The important point is to PRACTICE positive thinking by reading and stating these positive statements to yourself over and over, several times a day or whenever you feel down and out. The repeating reading or saying of positive thoughts can lead to a more hopeful outlook on life.

Cognitive Re-Framing – like positive thinking, cognitive re-framing involves using positive thoughts, but in this case, it is used in response to a negative, sad, or fearful thought and to reframe a negative into a positive. This method involves being able to monitor one’s own thoughts and to recognize when one is engaging in a negative or fearful thought. I often tell my patients to use a 3-step process whereby they actively say STOP to themselves when they recognize a negative thought, LABEL that thought as negative, and then REPLACE the negative thought with a more positive thought.

For example, you might notice yourself thinking, “I am not strong enough to face this challenge.” When you hear that thought in your head, immediately stay STOP, then LABEL that thought as negative, and REPLACE that thought with something like “I am a strong person with a lot of support and love from others. I can and I will overcome this challenge!”

Mindfulness-Based Meditation – this technique involves the practice of bringing your attention to the present moment, focusing on what is happening right here and right now. By doing so, you avoid focusing on the past or the future, neither of which can you control. By actively focusing on the present, you can begin to appreciate what is happening right now, not what has happened in the past or what may happen in the future. Mindfulness-based meditation is not easy to master, and may be best learned by reading a book on the topic or by working with a trained therapist or joining a meditation group. Each of these approaches will provide support and encouragement. Like all of the stress management strategies discussed above, the most important part of a mindfulness-based meditation is to PRACTICE. Keep working on it and it will become easier over time, and you will reap the benefits.

Healthy Behaviors – this final recommendation is not so much a stress management strategy, but is more so a lifestyle approach, which involves eating healthy foods, exercising regularly, and maintaining a healthy weight. Doing all of these things can not only improve your physical health, but they can also manage stress and improve your mental health as well. I often encourage my patients to talk to a dietician and a cancer rehabilitation specialist to help you design a diet and exercise regimen that is right for you, and to run this plan past your doctor to ensure that it is both safe and achievable.

Summary: One of the most important things to highlight is that while these strategies may provide immediate relief, they work best when used early and often. Have you ever heard someone say “I practice a specific religion”? The operative word in that sentence is PRACTICE. These strategies work best when you PRACTICE, PRACTICE, PRACTICE them every day, at least once a day, for several weeks, until you become comfortable using them and they become part of your daily routine. I often tell my patients to set aside at least 30 minutes a day to practice stress management, at a time that you will not be disturbed and can focus on practicing the strategies. Setting aside time each day does several things: First, it allows you to become proficient at using these strategies, so that when you need them, you feel competent and confident in putting them to work. Second, it communicates to yourself and your loved ones that learning and using these strategies is a PRIORITY in your life. By taking this time each day to practice stress management, you are saying that my mental health is important! Third and finally, setting time aside to practice stress management can have a preventative effect –that is, over time you will begin to notice that your daily stress management practice may reduce the frequency and/or severity of the negative feelings and may ultimately make you feel like a happier, more fulfilled person. I therefore invite you to being your stress management practice TODAY and build it into your daily routine! And remember, if these strategies don’t seem to be working, it’s time to seek out a mental health professional.

Dr. Stein is a clinical psychologist and the Director of MaineHealth’s Center for Center for Interdisciplinary Population & Health Research

News Across the Network

The MaineHealth Medical Group and the MaineHealth Cancer Care Network Welcome Dr. Amit Sanyal

The MaineHealth Cancer Care

Network

is pleased to welcome Dr. Amit Sanyal to our leadership team as the Senior Medical Director of Medical Oncology. Dr. Sanyal came to Maine from Madison, Wisconsin, where he was the Regional Clinical Program Director of Oncology for Sisters of St. Mary’s (SSM) Health. Also while at SSM Health, Dr. Sanyal was the Division Chief of Oncology, the Medical Director of Oncology Research, and a member of the Board of Directors of Gilda’s Club Madison.

According to Dr. Sanyal, “For many years, the strategy statement of my prior organization was ‘we bring care to you’. I am therefore very familiar with the MaineHealth Cancer Care Network’s goal and hope that my prior experience will allow me to contribute to success of the model in Maine.”

Dr. Sanyal has been involved in several new initiatives since he arrived, including enhanced use of the electronic medical record, screening for distress, and the development of a new symptom management clinic.

“‘Time at home’ is a concept that tries to minimize the time our patients spend traveling to and waiting in physician offices.

Dr. Amit Sanyal

Senior Medical Director, MaineHealth Medical Group–Oncology and Director, Division of Medical Oncology at Maine Medical Center

It is imperative that we do everything necessary to enable this” said Dr. Sanyal.

In his free time, Dr. Sanyal enjoys cross training and rock climbing. Traveling is also a passion, as well as reading, world cinema, and photography. As a foodie, he and his family love to explore new and varied cuisines.

What’s New at Maine Medical Center

The staff members brought some holiday cheer to Scarborough’s Outpatient Care Center with their creative and colorful artwork!

Maine Medical Center Welcomes Dr. Burg

A Message from

Dr. Jennifer Burg:

I grew up outside of Philadelphia, PA (go Eagles!) and am the youngest of six children. We spent every summer on a lake just outside of Camden, Maine, and it has been a long-term goal of mine to live here someday. My undergraduate degree is from Cornell University and my masters (immunology) and medical degrees are from the University of Pennsylvania. Between undergrad and medical school I spent two years teaching biology in Doha, Qatar.

After medical school I did my General Surgery residency at Oregon Health & Science University in Portland, Oregon, followed by thoracic fellowship at the University of Michigan (Go Blue!).

My top priority is providing high quality and heartfelt thoracic surgical care to the patients of Maine. Outside of the OR I am passionate about improving early lung cancer detection through improved awareness of, and access to, lung cancer screening programs. Outside of work I enjoy martial arts, horse riding, hiking and skiing.

Above: Dr. Jennifer Burg, Thoracic Surgeon, Maine Medical Center. Below, Dr. Burg and her husband Joe on a recent hike at Bradbury Mountain State Park.

Maine Medical Partners Welcomes New Colorectal Surgeons

Maine Medical Partners Surgical Care Casco Bay would like to welcome three new colorectal surgeons to the region, Dr. Marie Audett, Dr. Kathreen Lee, and Dr. Joseph Mack. Each has advanced training in robotassisted colorectal surgery.

Located at 55 Spring Street in Scarborough, their office can be reached at 207-303-1000.

Joseph D Mack, MD | MaineHealth

Kathreen Portia Lee, MD | MaineHealth

Marie C Audett, MD | MaineHealth

What’s New at St. Mary’s Health System

St. Mary’s Health System is a proud partner of the MaineHealth Cancer Care Network, a coordinated system of care with the support of the Harold Alfond Foundation. Our cancer program is accredited by the American College of Surgeons, Commission on Cancer.

Feeling

By partnering with Androscoggin Home Healthcare + Hospice, St. Mary’s is able to offer Palliative Care services on-site in Lewiston. The Maine Center for Palliative Medicine helps to support and guide patients and their loved ones in navigating the complex dynamics of serious illness.

In December, St. Mary’s Schwartz Center Rounds focused on “Faith in the Stage IV Cancer Patient” and the different cultural learning opportunities our staff is presented with. Members of both our clinical and administrative teams, as well as group of medical students heard from a panel of St. Mary’s oncology staff members.

Cheryl Noe, FNP-C, Kris Dumond, RMA, Amy Marston, RN, and Grace Gallant, SW provided first-hand experiences and knowledge of what it is like to work with a diverse population, and how different cultures handle different diagnoses.

Alice Staires, an RN in our Breast Health program recently spent the afternoon at Schooner Estates Senior Living Community to educate their residents on the importance of breast cancer screenings!

Festive in our Infusion Dept.!

What’s New at Mid Coast Hospital

Oncology Rehabilitation Offered at Mid Coast Rehabilitation & Therapy

By Amy Litterini, PT, DPT

Cancer and cancer treatment can cause survivors to experience various challenges throughout their daily lives. These challenges are often physical, with the most common being cancer-related fatigue. For some, cancer-related fatigue can be associated with muscle weakness, and/or loss of cardiovascular endurance (loss of capacity in the heart and lungs). Some cancer medications have an impact on the muscles (such as steroids), while others may impact heart function directly (certain chemotherapies). Other physical complaints can be tightness of the joints and muscles, which can be associated with surgery and/or radiation therapy. Tightness can lead to lost range of motion, which may impact activities like getting dressed or even chewing. Some survivors may experience balance problems or difficulty with fine motor tasks (e.g. tying shoes or buttoning buttons), which can be seen with neuropathy, or loss of nerve function, in the hands and feet from certain types of chemotherapy. Some survivors will experience lymphedema, a chronic swelling condition, following the removal of lymph nodes and/or radiation therapy to lymph nodes. Other survivors may experience symptoms associated with the muscles of their pelvic floor, such as incontinence (loss of bowel or bladder function), or pelvic pain.

The rehab team at Mid Coast Hospital's Rehabilitation & Therapy center offers a full spectrum of services to meet the needs of cancer survivors. Their team of experienced physical, occupational and speech therapists can address a variety of cancer-related symptoms and conditions to help to improve the life of cancer survivors in the Mid Coast. They have comprehensive services including physical therapy to address balance issues, lymphedema management, pelvic health therapy, and speech therapy for head and neck cancer survivors.

Their center is located at 329 Bath Road in Brunswick, ME. Discuss any concerns you may have with your provider. For more information, feel free to call 207-373-6175.

What’s New at Southern Maine Health Care

Peer to Peer Breast Cancer Support Group

Beginning in 2023, Melissa Gerrish, LCSW, will facilitate a Peer to Peer Breast Cancer Support Group for Southern Maine Health in Biddeford.

DATES: 1st and 3rd Wednesday of the month (Please note that a 5 week month still meets on the 1st and 3rd)

TIME: 5:30 pm to 6:30 pm

LOCATION: Webber Building at SMHC (subject to change)

CONTACT: Melissa.Gerrish@mainehealth.org with your name and email to be added to the list serve for bi-weekly invites. Melissa’s office number is: (207) 283-7142

Please note: Masking and social distances may be required depending on both hospital guidelines and participant preference.

The Sanford practice hosted a Lung Cancer Prevention event at on 11/11/22 in partnership with the Partners for Healthier Communities (PHC) program. Pictured at left: Alexa Christie of PHC; at right: Lori Harrington, Medical Assistant.

What’s New at Southern Maine Health Care

MaineHealth Cancer Care Sanford Welcomes Laura Bickford, Doctor of Nursing Practitioner and Board

A Message from Laura:

I graduated University of Southern Maine with a bachelors degree in nursing in 2007. I spent most of my nursing career advancing my clinical skills in emergency medicine at local area emergency departments in Portland and southern Maine. I continued my education, clinical advancement, and leadership in clinical practice through Simmons University in Boston obtaining a masters degree in nursing and successfully completed American Nurses Credentialing Center (ANCC) board certification as a Family Nurse Practitioner in 2017, and doctor of nursing practice in 2021. Since 2017, I have specialized in pediatric care at a private pediatric primary care practice in southern Maine.

I reside in southern Maine with my husband and our black lab Jack. I enjoy running, yoga, weight training, camping and wilderness hiking, homeopathic and natural health, nutrition, and chasing my beautiful granddaughter.

LauraBickford,DNP,FNP-BC

MaineHealth Cancer Care Sanford

What’s New at Western MaineHealth

• Travel and food assistance

• Help with basic and emergency needs

• Support groups for both men and women

• Educational programs

• In-person and virtual wellness programs

• Health and wellness coaching

• Financial help with complementary therapies

• Women’s wigs (new)

• Comfort items such as quilts, hats and chemo shirts

The Cancer Resource Center of Western Maine is a non-profit organization dedicated to supporting the non-medical needs and overall well-being of cancer patients and their families in Western Maine. We welcome referrals of any adult cancer patient at any time during survivorship. The Center offers personalized support from a cancer resource navigator and an oncology social worker. This support includes: DianeMadden,executivedirector(left)&

The Center has benefited from generous donations and sponsorships throughout Oxford County and surrounding communities. The Center also receives grant funding from organizations such as the Maine Cancer Foundation and the Maine Community Foundation. Some funds go directly to help patients with travel needs while other monies are earmarked to support free services such as complementary therapies. We appreciate your support in helping us to ensure that cancer patients in Western Maine do not have to face cancer alone.

Care for Lymphedema at Stephens Memorial Rehab

Rebecca Mills, physical therapist, has rejuvenated lymphedema services at Stephens Memorial Hospital. Lymphedema is a swelling condition that can result from certain cancer treatments. In August 2022, with support of a Maine CDC grant towards survivorship care, Dr. Mills completed her certification in Manual Lymph Drainage and Complete Decongestive Therapy at the Norton School of Lymphatic Therapy in Raleigh, North Carolina. She offers comprehensive care including manual lymphatic drainage massage, bandaging and fitting for compression garments.

Rebecca has her doctorate in physical therapy from the University of New England. In her free time she enjoys cooking, camping, fly fishing and skiing among other outdoor pursuits. Lymphedema management is provided at the Bob & Sandy Bahre Health Center on the campus of Stevens Memorial Hospital. The office can be reached at 207-744-6160.

Resources & Quarterly Calendar

Learning Resource Center: Lending Library

OverDrive is our virtual library where you can check out eBooks and audiobooks and download them to your device. Email us your name and mailing address at learningcenter@mainehealth.org for a library card number. If you’d like to see more books about a certain health topic, please let us know!

Click the books below to access.

Surviving After Cancer: Living the New Normal

By Anne Katz (BOOK)

With so many people surviving cancer and living "the new normal," guiding survivors and their families through the phases of recovery has become an imperative. But learning to live as a survivor and dealing with both the triumphs and the challenges including fear of recurrence, depression, life and occupational stress, the need for surveillance for complications and secondary cancers, sex and relationship issues, diet and exercise for a healthy life can be confusing and difficult. Finding resources to help equip survivors and their families for this new phase can be a challenge. However, this book, based on studies and current practice in the area of cancer survivorship, will help guide readers through the most crucial areas of recovery post-cancer.

Everyone's guide to cancer survivorship : a road map for better health By Ernest H. Rosenbaum, et al. (BOOK)

The CDC's National Action Plan for Cancer Survivorship estimates that there are 9.6 million persons living following a cancer diagnosis. And this number is strictly related to patients; it does not include family members, friends, or caregivers, who are also affected by diagnosis, treatment, and the aftermath. This book was written both for survivors and health professionals, some of whom are cancer survivors, too, to provide you with a survivor's road map. More than thirty medical professionals reveal insights on surviving cancer to empower cancer survivors and their caregivers, as well as the doctors who manage their continued care.

Taking Charge of Cancer: What You Need to Know to Get the Best Treatment by David Palma & Chris Ciulla (AUDIOBOOK) Receiving a cancer diagnosis can be terrifying, and the first thing you probably want to know is: How am I going to survive this? Cancer care requires decisions from numerous professionals, delivering treatments that are potentially life-saving, but also potentially dangerous and life-threatening. The chances of cure and survival for any given patient depend on the expertise of the cancer team, and whether procedures are in place to ensure that cancer care is delivered properly. So, how can you make sure you choose the right treatment team and ensure the best chances of survival and long-term health after being diagnosed with cancer?

Email us your name and mailing address at learningcenter@mainehealth.org for a library card number.

Mindfulness-Based Cancer Recovery: A Step-byStep MBSR Approach to Help You Cope with Treatment and Reclaim Your Life by Linda Carlson & Michael Speca (EBOOK) A Mind-Body Approach to Healing. If you have received a cancer diagnosis, you know that the hundreds of questions and concerns you have about what's to come can be as stressful as the cancer treatment itself. But research shows that if you mentally prepare yourself to handle cancer treatment by getting stress and anxiety under control, you can improve your quality of life and become an active participant in your own recovery.

Expert information and supportive resources from a trusted source over the phone or at their interactive website: cancer.org

Also from the American Cancer Society, the Cancer Survivors Network is a peer support community for cancer patients. survivors, caregivers, families, and friends! CSN is a safe place to connect with others who share your interests and experiences. Cancer Survivors Network

The Beth C. Wright Cancer Resource Center

Serving Hancock and Washington Counties

The Beth C. Wright Cancer Resource Center provides compassion, support, wellness groups, advocacy and education for patients, families, and friends in the midst of a cancer diagnosis, treatment and/or remission. We strive to enhance cooperation, collaboration, and connection among medical providers, other nonprofit groups, social support, and educational resources in Hancock and Washington counties. Established in 2004 and located in Ellsworth, the nonprofit resource center was born from an organization created by Beth C. Wright, who died of breast cancer in 2000. Over the years, our educational, supportive, and wellness programs have expanded to several additional locations in Washington and Hancock counties.

Email: info@bethwrightcancercenter.org

Phone: (207) 664-0339

Address: 23 Commerce Park, Ellsworth, ME 04605

Cancer Resource Center of Western Maine

Serving Oxford County and virtually statewide

The Cancer Resource Center of Western Maine is a 501c3 non-profit organization funded by private foundations, individual and corporate donations, and fundraisers. We embrace anyone affected by cancer in a community that offers hope and caring through support, education and concepts in healthy living. We offer one to one support; resource navigation services; in-person, virtual and recorded wellness programs and activities; support groups for men and women; complementary therapy; travel and food assistance; and a variety of comfort items - all FREE - to anyone impacted by cancer....because no one should face cancer alone.

EMAIL ADDRESS: info@crcofwm.org PHONE: 207-890-0329

ADDRESS: 59 Winter Street Norway, ME 04268

Making Life Better for People Impacted by Cancer

We would like to thank our donors and grant funders for their generous support of the MaineHealth Cancer Care Network and the patients and families we serve.