One of the mem­o­ries Gabriela Dow has from when she was di­ag­nosed with stage three breast can­cer at age 35 is stand­ing in the mid­dle of the gro­cery store, over­whelmed by the de­ci­sion of which foods to buy.

Los Angeles Times - - SATURDAY - BY LILY DAYTON health@la­times.com

“It felt like be­ing in a labyrinth,” says the San Diego com­mu­ni­ca­tions con­sul­tant, whose can­cer has been in re­mis­sion for five years. “I’ve nav­i­gated dif­fi­cult things be­fore — I worked as a jour­nal­ist with CNN, worked for the gov­ern­ment, launched a tech­nol­ogy startup. But here, I didn’t even know how to feed my­self. I wanted to be able to call 911 and have some­one help me.”

With two sons younger than 5 when she was di­ag­nosed, her pri­mary fo­cus was sur­vival. But she con­tin­ued to raise her boys along­side her hus­band as she un­der­went chemo­ther­apy, ra­di­a­tion and a dou­ble mas­tec­tomy, and she wanted to know how to main­tain her qual­ity of life dur­ing treat­ment — and how her treat­ment might af­fect her life af­ter can­cer.

There are 14 mil­lion can­cer sur­vivors in the U.S., and Dow’s con­cerns are shared by many oth­ers. As treat­ments im­prove and more peo­ple are di­ag­nosed at ear­lier stages, can­cer sur­vivors are living longer, prompt­ing a par­a­digm shift from merely living to living well.

And it turns out some fac­tors that im­prove qual­ity of life may also in­crease sur­vival. A 2013 study in the New Eng­land Jour­nal of Medicine com­pared late-stage lung can­cer pa­tients who re­ceived stan­dard on­col­ogy care with those who also re­ceived pal­lia­tive care (symp­tom man­age­ment, psy­choso­cial sup­port and help with de­ci­sion mak­ing) soon af­ter di­ag­no­sis. Pa­tients in the pal­lia­tive care group not only re­ported im­prove­ments in mood and qual­ity of life, but they also re­ceived less ag­gres­sive end-of-life care and lived 30% longer than those who re­ceived only stan­dard care.

“You’d ex­pect there would be a qual­ity-for-quan­tity trade-off,” says Dr. Daniel Stone, med­i­cal direc­tor of Cedars-Si­nai Med­i­cal Group, who was not in­volved in the study. “But the con­clu­sion was that pal­lia­tive care makes you feel bet­ter and helps you live longer.”

Stone adds that it’s un­known whether the sur­vival ad­van­tage came from the pos­i­tive benefits of psy­cho­log­i­cal sup­port or whether for­go­ing ad­di­tional chemo at the end of life made a dif­fer­ence. But, he says, “hav­ing some­one [on your team] whose ori­en­ta­tion is fo­cused on al­le­vi­at­ing symptoms is very help­ful.”

Man­ag­ing symptoms and de­creas­ing im­pair­ments that come from can­cer treat­ment is closely linked with psy­cho­log­i­cal well-be­ing, says Dr. Julie Sil­ver, as­so­ciate pro­fes­sor at Har­vard Med­i­cal School and cre­ator of Sur­vivor­ship Train­ing and Re­ha­bil­i­ta­tion, or STAR, a cer­ti­fi­ca­tion pro­gram that as­sists hos­pi­tals in de­vel­op­ing can­cer re­ha­bil­i­ta­tion pro­grams.

A re­ha­bil­i­ta­tion physi­cian, Sil­ver launched STAR in 2009 af­ter she had re­cov­ered from breast can­cer. She was in her 30s when her can­cer was de­tected.

“I was young and felt healthy,” says Sil­ver. “Then I had treat­ment, and I felt re­ally sick.” Af­ter treat­ment, she un­der­went ex­er­cise testing and found that, since her di­ag­no­sis, she had aged three decades in terms of her car­dio­vas­cu­lar fit­ness and strength.

Sil­ver wasn’t of­fered re­ha­bil­i­ta­tion. In­stead, she says, “the mes- sage was, ‘Try to go home and heal as well as you can, and then ac­cept the new nor­mal.’ ” But from her train­ing, she knew there were tar­geted re­ha­bil­i­ta­tion ex­er­cises that could help sur­vivors. And she also knew that, even be­fore treat­ment be­gins, life­style changes in diet, fit­ness and men­tal health could op­ti­mize pa­tient out­come and mit­i­gate the side ef­fects of treat­ment.

For many sur­vivors, a can­cer di­ag­no­sis of­fers a bit­ter­sweet op­por­tu­nity to make life­style changes that may ul­ti­mately save their lives.

“The same habits that make for health and well­ness be­fore di­ag­no­sis make for health and well­ness dur­ing treat­ment and af­ter­ward,” says Stone. “There are no guar­an­tees in life — all you can do is max­i­mize your chances. If you have healthy habits, you are less likely to get can­cer, and you max­i­mize your out­come if you do.”

Dow con­tin­ues to walk al­most daily and has joined a farm col­lec­tive that de­liv­ers fresh, sea­sonal pro­duce. She’s also made mind­ful­ness a part of her life — re­mem­ber­ing to pause, take a breath and fo­cus on the present mo­ment.

Af­ter sur­viv­ing can­cer, she says, “I don’t let things stress me out any­more.”

Getty Images / iStockphoto

ADOPT­ING BET­TER habits and pur­su­ing a lessstress­ful life­style can help in­crease the qual­ity of life for can­cer pa­tients dur­ing and af­ter their treat­ments.


THE RIGHT foods can make a big dif­fer­ence in re­cov­er­ing from — or avoid­ing — many types of can­cers, health ex­perts say.

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