Cancer Resource Guide Find comprehensive care all under one roof.
From left to right: Heather Riggs, M.D., Derek Serna, M.D., Jeevan Sekhar, M.D., Tamika Turner, N.P.
Yes, it’s cancer. But it’s also...
Compassion Cancer Navigators guide you every step of the way. At Reid Cancer Center, patients never have to feel alone. Cancer Navigators provide patients and their families with support through every phase of treatment. “I can answer their questions, make sure they understand their treatment plan and suggest support services. Our goal is to help patients take control of their journey through cancer.” - Brenda Bowman, Cancer Navigator
Cancer Navigators: Kathy Macdonald, RN, BSN, OCH; Brenda Bowman, RN, BSN; Tammie Angeles, MSW, Dianne Bailey, RN, BSN; Jill Miller, RN
1100 Reid Parkway | Richmond, IN | ReidHospital.org/CancerCenter
October 2, 2013
WHAT IS CANCER?
Many diseases One name Cancer is the general name for a group of more than 100 diseases in which cells in part of the body begin to grow out of control. Although there are many kinds of cancer, they all start because abnormal cells grow out of control. The body is made up of trillions of living cells. Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person’s life, normal cells divide faster to allow the person to grow. After the person becomes an adult, most cells divide only to replace worn-out or dying cells or to repair
RESOURCES INDEX What is cancer? page 3 Support Groups page 4 Tips for Comminciating with your Health Care Team page 6 Prostate Cancer page 8 Long-Distance Caregiving page 9 Colon Cancer page 10 Infusion Therapy page 11 Talking to your Kids about your Diagnosis page 13 Care Giving during the Holidays and Special Occasions page 14 Screening Guidelines for Colon and Rectal Cancer page 15
injuries. Cancer cell growth is different from normal cell growth. Instead of dying, cancer cells continue to grow and form new, abnormal cells. They can invade (grow into) other tissues, something that normal cells cannot do.
Abnormal cell invasion defines cancer In most cases, cancer cells form a tumor, also called a mass or a lump. Some cancers, like leukemia, involve the blood and blood-forming organs, and the cancer cells circulate through other tissues where they grow. Cancer cells often travel to other parts of the body, where they begin to grow and form tumors that replace normal tissue. This process is called metástasis. It happens when the cancer cells get into the bloodstream or lymph vessels of our body. (Not all tumors are cancer. Tumors that aren’t cancer are called benign. Benign tumors can cause problems, but they do not invade other tissues and are almost never life threatening.) No matter where a cancer may spread, it’s always named for the place where it started. For example, breast cancer that has spread to the liver is still called breast cancer, not liver cancer. Likewise, prostate cancer that has spread to the bone is metastatic prostate cancer, not bone cancer. Different types of cancer can behave very differently. For example, lung cancer and breast cancer are very different diseases. They grow at different rates and respond to different treatments. That’s why people with cancer need treatment aimed at their particular kind of cancer.
October 2, 2013
Cancer is a Diagnosis No One Wants to Hear cancer. “The cancer navigators saw a need for emotional support for patients,” Angeles said. “We’ve had a patient support group for about 18 months.” The oncology support group usually is small, about five or so patients, Angeles said. “We try to help people reach out to whatever support community they have. Sometimes it’s family or a faith community or friends,” Angeles said. “Having a good Cancer navigators: Kathy Macdonald, RN, BSN, OCH; Brenda Bowman, RN, BSN; Tammie support system is very Angeles, MSW; Dianne Bailey, RN, BSN; Jill Miller, RN important.” Many patients By Pam Tharp diagnosed with cancer have found that joining a For the Palladium Item support group helps them manage the wide range of feelings and fears they experience during and after Cancer is a diagnosis no one wants to hear. their cancer treatment, Angeles said. Support groups also help family members When a patient at Reid Hospital gets that and friends handle the countless emotions they diagnosis, the Reid Cancer Center staff is ready experience when a loved one receives a cancer to help, both in fighting the disease and assisting diagnosis, according to the American Association For patients in managing their emotions and other Cancer Research. concerns. Studies have found cancer support groups can Oncology social worker Tammie Angeles enhance self-esteem, reduce depression, decrease said patient support groups were an important anxiety and improve relationships with family component in planning the cancer center, whic members and friends. opened two years ago. Angeles knows first-hand the feeling a cancer diagnosis brings because she had basal cell skin
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Support groups may also help patients better cope with a diagnosis and increase their knowledge of cancer and treatment options. Whether support groups actually extend the life of cancer patients
“The person-to-person connection is very valuable.” is still being debated, according to the American Association For Cancer Research. Many Reid patients come to the support group soon after they receive the first diagnosis, Angeles said. “They have a lot of concerns about what to expect. They learn about the resources available,” Angeles said. “Cancer can be very stressful and very anxietyprovoking. Not all patients have family nearby, so we may be their only support. It’s comforting to know you have someone you can call whenever you need to.” Patients whose cancer later returns often return to the support group for help and comfort, Angeles said.
Social worker Tammie Angeles speaks with patient Virginia Maddox
“The person-to-person connection is very valuable,” Angeles said.
October 2, 2013
“DOCTOR, CAN WE TALK?”
Tips for Communicating with your Health Care Team all of your health information in one place. You may want to write down the names and contact information of the members of your health care team, as well as any questions for your doctor. Keep a diary of your daily experiences with cancer and treatment. You can separate your journal or notebook into different sections to help keep it organized.
Prepare a list of questions. Write down
Talking to your doctor can be difficult. Regardless of your diagnosis, hearing about it may leave you feeling frightened or overwhelmed. Good communication with your doctor will help improve the quality of the care you receive.
Ways to Improve Communication With Your Health Care Team Remember that you are the consumer. As a patient, it is important to remember that you are a consumer of health care. The best way to begin making difficult decisions about health care is to educate yourself about your cancer and who is on your health care team, including nurses, social workers and patient navigators. Start a health care journal. Having a health care journal or notebook will allow you to keep
your questions and concerns about your illness and treatment before your next medical appointment. Write down the most important questions or concerns first. This way, you won’t forget to ask about something that was important to you. Remember to try and make your questions specific and brief as your doctor may have limited time. Once you’re at your appointment, ask your most important questions first.
Bring someone with you to your appointments. Even if you have a journal and a
prepared list of questions or concerns, it is always helpful to have support when you go to your appointments. The person who accompanies you can serve as a second set of ears. He or she may also be able to think of questions to ask your doctor or remember details about your symptoms or treatment that you may have forgotten. Continued on page 7
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Write down your doctor’s answers. Taking notes will help you remember your doctor’s responses, advice and instructions. If you cannot write down the answers, ask the person who accompanies you to do that for you. If you have a mobile device, you can also use it to take notes as well. Writing down notes will help you when you need to review the information at a later time. If your doctor allows it, record your visit.
Recording your conversation with your doctor gives you a chance to hear specific information again or share it with family members or friends.
Saying and Hearing: Tips For Understanding Your Doctor Use “I” statements. Doctors may use medical language that is normal for them but may be unfamiliar to you. If you’re having trouble understanding your doctor, say, “I don’t understand.” This will be much more effective than saying, “You’re being unclear.” Be assertive. If you don’t know or understand something, don’t be afraid to speak up and ask. Make your questions specific and brief. If you continue to be confused or overwhelmed or feel the question has not been answered in a way you understand, you may want to ask your doctor or nurse if there is another time that the two of you can discuss it in more detail. Ask your doctor how you can reach him or her, whether by phone or email, outside of office hours in case you have additional questions. If something is unclear, try repeating it back to your doctor. This is called “mirroring”
and sometimes is effective in clarifying what is being said. You might start with the words, “So you mean I should…”or “So I think you are suggesting that…” If you understand better with visual aids, ask your doctor to write down information about your diagnosis or your treatment. Asking to see the X-rays or slides may also help you.
Questions to Ask Your Doctor: Here are some questions to ask your doctor or nurse to help you understand your treatment and follow-up:
• What is my specific diagnosis? • Have you treated other patients with my type of cancer? • What are my treatment options? • What is the recommended treatment? • How often will I receive treatment? • What are the possible side effects? • What are the possible benefits and risks of this treatment? • How much will my treatment cost? • If I have questions during my treatment and my doctor is not available, who can I ask? Who can I call? For example, if you are not available, is a nurse, social worker, or other specialist available? • Is there any information that I can read about this treatment or procedure? • Is there anything else I should know?
October 2, 2013
One of the Most Common Cancers in Men By Pam Tharp For the Palladium Item
Prostate cancer is among the most common cancers in men, but new concerns about the accuracy of testing for the illness has resulted in new testing guidelines. The American Urological Society and the U.S. Preventive Services Task Force are responsible for the new testing recommendations, said Jill Miller, a Reid cancer navigator who works with prostate cancer patients. It’s now recommended men ages 55 to 69 undergo a PSA Penny Goff, Pharmacy Technician mixes custom doses of IV oncology medications for individual patients. (prostate specific antigrowing and pose a real threat. Current prostate gen) blood test and a digital rectal exam annually or as determined by their cancer tests aren’t always able to determine which physician after a shared-decision session, Miller said. cancers are aggressive and which are not, according to the American Cancer Society. African-American men and those with a close The guidelines for routine testing don’t include relative with prostate cancer are at a higher risk for men under age 55 because the PSA test is not as accuthe disease. Men in those categories should discuss rate predictor of cancer in that age group, Miller said. the risks and benefits of testing at age 40 with their family physician, Miller said. Prostate cancer, though, Routine screening is also not recommended for men 70 years old and above, or for those with less than 10 doesn’t have as strong a family connection as some to 15 years of life expectancy, Miller said. cancers, she said. Reid Hospital offers prostate cancer testing three Prostate cancer is tricky because some cancers times a year: September, December and in April. The are so slow-growing a man is unlikely to ever die April testing is done at the Wayne County Health from it. Other prostate cancers are much fasterContinued on page 9
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Clinic, which often reaches more African-American and Hispanic men, Miller said. The prostate exam and testing at Reid is popular, with more than 250 men using the service in the past 12 months, Miller said. Physicians volunteer their time to do the exams, Miller said. “It’s really worthwhile to come out for the testing,” Miller said. “We correlate the results and if there’s anything of concern, we notify the patient and their family physician.” Because prostate cancer is a disease whose treatment may affect sexual performance, that’s a frequent concern for patients, Miller said. New treatments options are available to reduce those problems, she said. Reid’s cancer navigators provide assistance to cancer patients for an array of problems, and emotional concerns, Miller said. “Performance a topic men still don’t like to dis-
cuss, but it is a concern,” Miller said. “We do counsel on performance concerns and we refer patients to the urologists to discuss their concerns.”
Screening Guidelines for
Prostate Cancer Starting at age 55, men should talk to a doctor about the pros and cons of testing so they can decide if testing is the right choice for them. If they are African American or have a father or brother who had prostate cancer before age 65, men should have this talk with a doctor starting at age 45. If men decide to be tested, they should have the PSA blood test with or without a rectal exam. How often they are tested will depend on their PSA level.
How to Help While You’re Far Away Calling – Talking on the phone is a great way to connect with loved ones. E-mailing or texting – E-mail messages and text messages provide fast and easy communication.
Recording special occasions – Consider recording friends, family, and special events as a way to bring the celebration to your loved ones. Many cell phones have a built-in camera that allows you to film any event and then email it to friends and family. “Skyping” – Skype is a technology that allows people to see and talk to each other online in real time, like a video telephone. Each person needs a web camera that is connected to the internet through his or her computer. Download Skype software from www.skype.com. The software is free, as is the cost of the call, as long as both of you are using Skype.
October 2, 2013
Early Detection is Important By Pam Tharp For the Palladium Item
Colon cancer is an illness that increases with age, making screening for the condition most important for those who are age 50 and above. A colonoscopy, a test in which a gastroenterologist examines the interior of the colon, is recommended for both men and women who are 50 or older or as recommended by their physician, said Kelly Witter, director of Reid Hospital’s oncology services. Nine of 10 colon cancer patients are age 50 years or above, according to the American Cancer Society. Inflammatory bowel diseases like ulcerative colitis or Crohn’s disease or a family history of colorectal cancer or polyps increase a patient’s risk of colon cancer. A yearly wellness visit, where a patient and doctor discuss concerns and consider possible screening tests, is vital to catching colon cancer and other conditions, Witter said. “Early detection is important,” Witter said. “It increases the possibilities for a positive outcome and may result in less invasive treatment if cancer is found.” In Wayne and surrounding counties, colon cancer is among the top five cancers, Witter said. Nationwide, excluding skin cancers, colon cancer is the third most common cancer diagnosed in both men and women, according to the American Cancer Society. The ACS estimates there will be 102,480 new cases of colon cancer in the U.S. this year and 40,340 new cases of rectal cancer in 2013. Diet is an important factor in promoting bowel health, Witter said. Eating a propert diet, which includes plenty of fiber and lots of fruits, promotes good bowel health, she said. Exercise is also beneficial for healthy bowel function, she said
Some people avoid colonoscopies because the preparation to clean out the bowel isn’t much fun. The occult stool test, wehere a stool sample is obtained from the rectum and tested for the presence of blood is still used by some physicians, but isn’t a test the hospital uses, Witter said. “It has a lot of false positives. It puts people through undue stress thinking they have cancer and then when a colonoscopy is done, they don’t,” Witter said. “The preparation for a colonoscopy is not pleasant, but the peace of mind it brings is worth it.”
October 2, 2013
Integrating Real Life with Therapy Promotes Well-Being
From left to right: Reid Chaplain Jonathan Hudnall, Corey Harger, Lynne Weber, Mike Weber and Marion Day.
By Pam Tharp For the Palladium Item
Getting married in the infusion therapy area at the Reid Cancer Center may not appear to be a romantic setting, but Reid infusion center nurses recently cheerfully fulfilled a cancer patient’s wish to tie the knot there, including recruiting the hospital’s chaplain for the event. Infusion therapy is where the rubber meets the road in cancer treatment, the place most patients visit regularly for up to a year to receive treatments, said Amber Blevins, infusion therapy director. The treatments can be as short as 30 minutes or as long seven or eight hours, Blevins said. “Each patient has their own semi-private space. There’s a recliner or a bed and a TV,” Blevins said. “Most have family members who come with them.” Each patient also has one nurse who sees them through their treatment, Blevins said.
“Whoever the patient starts with the first time, we try to have that same nurse take care of them every time they come,” Blevins said. “They get to know each other and it makes the treatment easier. Their nurse knows their comfort level and they develop a bond. Because they see the same nurse each time, she also hears about their troubles, which allows us to get the nurse navigator and the social worker invovled to work on their issues.” The ability to emphathize is important for any nurse, but it’s essential for an infusion nurse, Blevins said. “We’re treating the patient, not just their illness. We’re supporting their family members because the patient’s support system is really important,” Blevins said. “Most of our patients are really happy, despite what their going through.” When a patient finishes a round of infusion therapy, the milestone doesn’t go unnoticed. Continued on page 12
October 2, 2013
Front row left to right--Kristen Cole RN, Amber Blevins RN, Lisa Kinney RN. Back Row left to right - Erinn Frech RN, Tammy Anderson RN, Connie Haist RN, Peggy Robinson RN, Kathy Renner PCT/Clerk, Michelle Abernathy RN, Blayne Laswell PCT/Clerk, Logan Jones PCT/Clerk. Not present----Cindy Isaacs RN, Deb Fabert RN, Heather Wierzbinski-Cross RN, and Vicki Rogers PCT/Clerk.
“We make it a big deal when they finish and they often bring us stuff, treats or food,” Blevins said. “We have really good patient satisfaction scores on the survey that’s sent out randomly.” Kelly Witter, director of oncology services at the Reid Cancer Center, said the hospital’s comprehensive approach to cancer care means physicians, nurses, and cancer navigators are talking to each other daily to deliver the best care and cure for each patient. Experiencing cancer and going through chemotherapy is a life-changing experience for most, Blevins said. Being an infusion center nurse has also been lifechanging for Blevins. “I realize the importance of teamwork, of building relationships with the patient and their family. If you don’t have that relationship, you miss out on things you should know about them, and the opportunity to help or treat them,” Blevins said. “And it’s not just physical needs, it’s all the other things that affect their physical well-being. It’s not al-
ways easy being an infusion nurse, but all of my staff love what they do.”
Amber Blevins RN, Unit Manager Reid Cancer Center
October 2, 2013
HELPING CHILDREN UNDERSTAND CANCER
Talk to your Kids About your Diagnosis Your cancer diagnosis has a profound impact on your entire family. There is new information to learn. There are treatment decisions to make. And if you have children, you’re probably also concerned about how much to tell them about your diagnosis and what you are going through.
Here are some tips for communicating with your children:
Set the tone. As important as what you say is how you say it. Use a calm, reassuring voice, even if you become sad. This will help your children see how you are trying to cope, and will help them do the same. Give your children accurate, age-appropriate information about cancer. Don’t be afraid to use the word “cancer.” Tell or show them where the cancer is on your body. Practice your explanation beforehand so you feel more comfortable. Remember that if you don’t talk to your kids about cancer, they may invent their own explanations, which can be even more frightening than the facts. Explain the treatment plan and how it will affect their lives. Prepare your children for any physical changes you might go through during treatment (for instance, hair loss, extreme tiredness, or weight loss). Let your children know that their needs will continue to be taken care of (for example, “Daddy will take you to soccer practice instead of Mom for a while.”) Answer your children’s questions as accurately as possible. Take into account their age and prior experience with serious illness in the family. If you do not know the answer to a question, don’t panic. It’s okay to say, “I don’t know. I will try to find out the answer and let you know.” Reassure your children. Explain to them that no matter how they have been behaving or what they’ve been thinking, they did not do anything to cause the cancer. Let your children know that they cannot “catch” cancer like they can catch a cold. Let them know they can turn to other members of your support system, too. These people include your spouse or partner, relatives, friends, clergy, teachers, coaches and members of your health care team. Let your children know that they can ask questions of these adults and talk to them about their feelings.
Allow your children to participate in your care. Give them age-appropriate tasks such as bringing you a glass of water or an extra blanket. Encourage your children to express their feelings. Share with them that they can express any feelings, even those that are uncomfortable. Let them know, too, that it’s okay to say, “I don’t feel like talking right now,” if that is the case. Reassure your children that they will be cared for. Let them know that even if you can’t always provide the care directly, their needs are important and will be taken care of. To the extent possible, make communicating with your children a priority. Cancer treatments may leave you with less energy, but try to make every effort to really listen to your children. This will show them how much you love them, and help them to feel comfortable coming to you with their concerns in the future. As always, show your children a lot of love and affection. Let them know that although things are different now, your love for them has not changed. When helping your children cope with a cancer diagnosis, it’s almost impossible to be prepared for every situation. Sometimes, you may not know what to say. This is normal and okay. Remember that you are the expert on your children. Cancer can be overwhelming and disruptive, but it doesn’t change the fact that you know your children best. Trust your sense of how to best support them during this difficult time.
October 2, 2013
During the Holidays and Special Occasions Holidays and special occasions are meant to be joyful times that create lasting memories. Many people enjoy reuniting with family and friends to celebrate traditions during these times. However, for the person who is caring for a loved one with cancer, it can be challenging to balance caregiving responsibilities while preparing for an upcoming holiday or special occasion. By planning ahead and using the tips discussed in this fact sheet, caregivers and their loved ones can find ways to get the most out of special events.
Here are some tips for caregiving for a loved one with cancer during holidays and special occasions: Talk with your loved one about what the special occasion means to him or her. An
upcoming holiday could have a new meaning for someone who is going through cancer treatment. Ask your loved one how he or she would like to celebrate, and then try to honor those wishes.
Talk to your health care team about upcoming special events. They may be flexible
about appointments in order to accommodate travel or other needs.
Adjust your expectations. Consider if an upcoming event may place too much of a burden on you or your loved one. For example, caregivers who traditionally host a holiday celebration at their home may decide to invite fewer guests this year, or not host the event at all. They may also consider hosting a â€œpot luckâ€? dinner, in which others bring most of the food. Establish new traditions. Caregivers who usually cook holiday meals, for example, may decide to order the meal from a restaurant or caterer. Or, they could ask a friend or loved one to assist them with the cooking this year. Enjoy special moments. Try to focus on new Continued on page 15
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traditions that have been established, rather than dwelling on how cancer has changed a holiday or special occasion. It is also important for caregivers to care for themselves during these times, in order to provide the best care for their loved one. Here are some tips for doing this: Acknowledge your feelings. It is normal for caregivers to experience feelings of loss or sadness over how cancer has changed a special occasion. But some may feel they have to portray themselves as happy and cheerful so as not to alarm family, friends, or a loved one with cancer. Try not to hold in all your feelings; share them with someone you trust, such as a loved one or professional counselor.
Celebrate strengths you and your loved ones have developed. Many families who face the
day-to-day challenges of cancer discover strengths and courage they didn’t know they had. For example, you may recall how brave your loved one was while receiving chemotherapy. Reflect on the strengths you have developed, and build on them during the holidays. Do something good for yourself. Take some time out each day to relax and recharge, even if it is simply taking a walk around the block. This guide has been developed to give readers a basic understanding of various kinds of cancer in general terms, the process involved in treating cancer, and the innovative and sophisticated resources available locally. Throughout this section you will find guidelines on cancer screenings. We know that the most successful outcomes are generally the product of early diagnosis, which screenings offer. We, the Palladium-Item advertising staff, thank the American Cancer Society, CancerCare.org and Reid Hospital & Health Care Services for content contained in this section.
Recognize that you are doing your best.
Acknowledge your efforts to care for your loved one and all you are doing to make a special event memorable and enjoyable.
SCREENING GUIDELINES FOR
Colon and Rectal Cancer Beginning at age 50, everyone should have: • A flexible sigmoidoscopy every five years or a double contrast barium enema every five years or a CT colonoscopy every five years or a colonoscopy every 10 years. • A yearly fecal occult blood test or fecal immunochemical test. These tests are performed by the patient at home and can be purchased at a pharmacy. Those with a personal or strong family history of colorectal cancer or polyps should be followed more closely, as should those with a history of chronic inflammatory bowel syndrome.
Taking great care of cancer patients at Reid and beyond.
Heather Riggs, M.D.
Jeevan Sekhar, M.D.
Derek Serna, M.D.
Tamika Turner, NP
Dr. Heather Riggs, Dr. Derek Serna and Dr. Jeevan Sekhar, physicians with Reid Oncology Associates, and Tamika Turner, Nurse Practitioner, care for patients throughout the region.
Seeing patients in:
Reid Cancer Center â€˘ 1100 Reid Pkwy., Richmond (Enter through the Cancer Center entrance, north parking lot)
And at satellite offices in:
Connersville, Eaton & Winchester
Call (855) 935-8773 to schedule an appointment at one of these locations.
(765) 935-8773 â€˘ (855) 935-8773 ReidHospital.org/CancerCenter
This guide has been developed to give readers a basic understanding of various kinds of cancer in general terms, the process involved in tre...