Do this one .... it will bring a smile......
New Survivorship Clinic at Stanford Specializes in After- Cancer Care
February 1, 2012
Holly Gautier, RN, Program Manager of the Stanford Cancer Institute Supportive Care (left), talks about the Institute's new Survivorship Clinic with its manager, Kelly Bugos, RN, NP, MS.
Janelle O’Malley has been cancer-free for eight years, a long time since the removal of a malignant tumor required a complete hysterectomy, sending her into menopause at age 49.
She jokes wryly about not feeling like a cancer survivor because she didn’t go through radiation or chemotherapy, but the aftermath of that surgery defines her as one of more than 12 million Americans who have had cancer. More than half the 1.5 million diagnosed with cancer this year will also prevail beyond that pronouncement, adding O’Malley to that growing population whose cancer often leaves lingering effects and is fueling a new dimension of cancer care – care for its survivors.
This month, the Stanford Cancer Institute opens its first Survivorship Clinic, at its Clinical Cancer Center, with O’Malley as one of its first patients. The clinic, which will focus initially on gynecologic cancer survivors, joins a small but growing number of such clinics, where all care is focused on wellness post-cancer treatment. “There’s a whole body of knowledge, and more importantly, a whole collection of needs that cancer survivors have,” said Douglas Blayney, MD, the Cancer Center’s medical director. “Some are common across tumor types and some are unique to various tumor types. We are trying to meet those needs and serve those patients.”
“Our health care system is much more geared to acute rather than chronic care and we haven’t had a good transition back to routine care,” said David Spiegel, MD, director of Stanford’s Center for Integrative Medicine and a long-time researcher on the interaction between the psychosocial and physiological impact of cancer. “People develop significant issues after cancer – the question becomes how to live with this for the rest of your life,” he said. “We want to develop a program to provide emotional and medical support for people who are beyond very acute care. Survivorship care should be there from day one.”
The focus of care will be on those areas already known to be present for most cancer survivors: fatigue, anxiety, body image, sexual function and relationships. At Stanford, a clinic patient will most likely be seen by a nurse practitioner she has already gotten to know during the course of initial treatment, said Kelly Bugos, a nurse practitioner who is establishing Stanford’s survivorship clinic. Should a concern arise beyond those issues, that patient will be seen quickly by an appropriate physician.
Initial patients will be limited to those who have had gynecologic cancers, like O’Malley. “We’ve set this up so we will be seeing patients we’ve been following for quite a while, with the expectation that they are cured or have a chance for a long-term remission,” said Jonathan Berek, MD, director of the Stanford Women’s Cancer Center and an internationally-known clinician and researcher in gynecologic cancers. “The focus will be on issues important to them: health maintenance, screening for other cancers and the psychological and physical adaptations for someone who has gone through the trauma of being diagnosed and treated with a life-threatening disease.”
Such patients don’t need to be seen by their oncologists, Berek said, “but we’re not relinquishing them. This is an adjunct to their care that maximizes the quality of their care because they’ll have someone who can spend more time with them, go over tests, get them involved in support groups they haven’t been involved with and pay more attention to those needs not related to a cancer recurrence.”
Kelly Bugos, RN, NP, MS, will be managing the new Survivorship Clinic at the Stanford Cancer Institute.
“We’re ahead of the game because we have practice teams integrated around each patient’s cancer type,” Blayney said. “This means we will add to that team people with the special skills to meet our patients’ needs as they transition into survivorship, and weave them into the fabric of our care.”
Bugos has worked in cancer care at Stanford since 1989. “We’ve done a beautiful job of helping rid people of their cancer; the piece that’s been missing is helping them to return to wellness after treatment. It’s time for us to give people tools to make that transition and extend the treatment safety net a little bit longer. We know that when treatment ends, the cancer experience continues.”
Stanford’s Survivorship Clinic was developed after a year of study, site visits and discussions with experts from the LIVESTRONG Survivorship Center for Excellence Network. Established in 2005, it now collaborates with institutions like Stanford to create nationally-recognized standards and metrics of care. Stanford’s experience will become part of LIVESTRONG’s ongoing advocacy work in the field, Bugos said.
“The goal is to return to wellness, as defined by each individual,” she said. “To help focus our attention, and shape each visit, we developed a pre-clinic survey so we know what’s important to each patient. We want our treatment to be a partnership.”
“My path toward healing continues,” said O’Malley. “Once you have cancer, it embodies your spirit, your family, your friends, and your future. I am extremely thankful that I am a part of the new Survivorship Clinic.”
From the initial visit will come a plan, Bugos said. It will include when certain tests will be done and other relevant health issues to be addressed. Having a plan makes a difference. “Being diagnosed with cancer can make you feel out of control, but once you have a treatment plan, you can follow that plan,” she said. “Once that initial treatment plan is done, you can feel out of control again, so having a survivorship plan is important.”
Many of the resources Survivorship Clinic patients will learn about are part of supportive care programs and services at the Stanford Cancer Center and the Stanford Center for Integrative Medicine. The Survivorship Clinic also creates an additional layer of care opportunities through clinical research trials lead by Spiegel and Oxana Palesh, MPH, PhD.
Spiegel’s research into the psychosocial aspects of the cancer experience dates back 30 years. It was among the first to show that being part of a cancer patient support group made a significant impact on quality of life during treatment. Now, Spiegel, Palesh and their Stanford colleagues are leading research into the treatment of sleep disturbance, which 80 percent of cancer patients develop. It often endures beyond the finish of initial treatments and can contribute to subsequent health issues. Shelli Kesler, PhD, another collaborator in Spiegel’s group, is looking at the cognitive dysfunction related to chemotherapy, sometimes called cognitive fog or chemo brain. “We have a couple of trials open and are starting others,” Bugos said.
“The good news about disrupted sleep is that it’s treatable,” Palesh said. Another area of interest is how to treat the anxiety that can remain even after a patient is found to be cancer-free, she said. “It makes sense that people are apprehensive; not all cancers have very clear symptoms. And it can be bittersweet: You’re finished with treatments and congratulated but still expected to come back for check-ups.” The higher survival rate after a cancer diagnosis can mean it’s less “scary than it was 20 years ago,” she said. “The science of survival is very new – we haven’t done a lot of research – but we now have the luxury of doing it. We plan to become a program that offers the latest and best evidence-based interventions for our patients.”
The survivorship clinic for gynecological cancer survivors is now open. For more information, please call the new patient coordinator for the survivorship clinic at the Women’s Cancer Center at 650-498-6004.
By Sara Wykes
About Stanford Hospital & Clinics
Stanford Hospital & Clinics is known worldwide for advanced treatment of complex disorders in areas such as cardiovascular care, cancer treatment, neurosciences, surgery, and organ transplants. It is currently ranked No. 17 on the U.S. News & World Report’s "America's Best Hospitals" list and No. 1 in the San Jose Metropolitan area. Stanford Hospital & Clinics is internationally recognized for translating medical breakthroughs into the care of patients. The Stanford University Medical Center is comprised of three world renowned institutions: Stanford Hospital & Clinics, the Stanford University School of Medicine, the oldest medical school in the Western United States, and Lucile Packard Children's Hospital, an adjacent pediatric and obstetric teaching hospital providing general acute and tertiary care. For more information, visithttp://stanfordhospital.org/.
Support community for young women who have gynecological cancers.
Accent on Health Boutique
625 Steele Lane
Santa Rosa, California 95403
A store for mastectomy forms and bras, post-operative garments, custom-fitted compression garments for lymphedema, wigs and head coverings.
A Lady’s Touch
612 D Street
San Rafael, California 94901
California Pacific Women’s Health Resource Center
3698 California Street
San Francisco, California 94118
A store offering breast prostheses, bras, post-operative camisoles and slips fitted by certified personnel. Provides synthetic and human hair wigs, turbans, hats, scarves, and jewelry.
American Cancer Society
A nationwide, community-based volunteer health organization dedicated to eliminating cancer as a major health program. ACS materials include pamphlets, brochures, booklets, and cards providing general information on pap tests and other cancer-related materials. Supports research and conducts educational programs.
American Cancer Society Marin County Unit
750 Lindaro Street, Suite 100
San Rafael, California 94901
A unit of the national volunteer health organization that provides comprehensive education and service programs. Co-sponsors support groups as well as one-on-one peer support. Offers referrals to an array of community resources and access to funding for home care services. Free services and support programs for breast cancer patients including “Look Good … Feel Better” program, free wigs, hats, scarves, and prostheses, free transportation to and from treatments, Cancer Survivors Network, one-on-one peer support program with a breast cancer survivor.
American Cancer Society Programs include
Cancer Survivors Network
Web-based service for survivors, their families, caregivers, and friends that provides live online chat sessions, virtual support groups, pre-recorded talk shows, and personal stories.
Hope Lodges are free temporary housing facilities for cancer patients who are undergoing treatment and their families. Provide guests with private rooms, kitchen facilities and, in some locations, transportation to treatments. Accommodations and eligibility requirements vary by location. Call ACS to learn more about a specific facility.
Look Good … Feel Better
Cancer radiation and chemotherapy treatments can have a negative impact on patients’ appearance and self-esteem. The American Cancer Society program helps cancer patients regain self-esteem and confidence in their appearance in a non medical and supportive environment. Licensed cosmetologists demonstrate make-up techniques and wig care while offering other tips to deal with the appearance related issues of cancer treatment. If you are a licensed cosmetologist or esthetician and would like to volunteer for this program please call 1-800-227-2345, or to reach the local office in Marin County, call 415-454-8466.
Reach to Recovery
Provides support for breast cancer patients. If you are a breast cancer survivor, one year out of treatment, and wish to provide support to someone going through treatment, please talk with ACS about becoming trained as a Reach to Recovery volunteer. Call 1-800-227-2345, or to reach the local office in Marin County, call 415-454-8466.
"tlc" Tender Loving Care
A "magalog" (magazine/ catalog) of helpful articles and products for women coping with cancer treatment. Products include wigs, hairpieces, breast forms, prostheses, bras, hats, tubans, swimwear, and accessories.
Anita’s Salon and Scalp Clinic
Mark Wise for Wigs
A retail establishment that offers wigs and head coverings for patients undergoing chemotherapy. Home and hospital visits can be arranged. Certified as part of American Cancer Society’s Look Good …. Feel Better program. Maintains a wig bank for patients that cannot afford to purchase wigs.
Mountain View, California
A retail establishment that carries a full line of breast care products, bras, and lymphedema garments.
Bischoff’s Medical Supplies
1635 Divisadero #105
San Francisco, California 94115
Distributor of custom vascular support garments, compression lymphedema pumps, and post-mastectomy products.
1180 Avenue of the Americas, 7th Floor
New York 10036
This national nonprofit, founded in 1944, is dedicated to providing emotional support, information, referral, and practical assistance to people with cancer and their loved ones, at no charge. Cancer Care has helped over a million people nationwide through its toll-free Counseling Line, its teleconference programs, and its website. It was founded on the principle that "living doesn't end when cancer begins."
Founded by Fran Drescher in 2007, this group engages in education and lobbying to ensure that all women's cancers are diagnosed at stage 1.
Centers for Disease Control and Prevention
CDC works with national, state, and local partners to create and implement successful strategies to help the millions of people who live with, through, and beyond cancer. Materials are available for patients, physicians, and health professionals. Provides low-income, uninsured, and underserved women access to timely high-quality screening and diagnostic services to detect breast and cervical cancer at the earliest stages through the National Breast and Cervical Cancer Early Detection Program. CDC enhances the growing knowledge about ovarian cancer by initiating research projects with partners, colleagues, and national organizations to help identify factors related to early detection of the disease, treatment, and survivorship.
Charle … A Hair Studio
35 Mitchell Boulevard #4A
San Rafael, California 94903
A retail establishment that provides sensitive solutions for hair loss due to chemotherapy/ radiation treatment. Offers human and synthetic hair pieces and accessories including a line of sleep caps.
Charlotte Maxwell Complementary Clinic
5691 Telegraph Avenue
Oakland, California 94609
201 Mission Street
San Francisco, California 94110
A state-licensed health clinic providing free complementary and alternative medical treatments (acupuncture, massage, herbs, imagery) to low-income women with cancer. Services include supervised exercise and gorup support. The In-Home Comfort Care Program provides complementary and alternative medicine for those clients with end-stage cancer who are too weak to come ot the Clinic. The Carol Zambel Treatment Access Fund provides financial assistance for additional treatments, herbs, and medications that are not offered by the Clinic.
Chinatown Public Health Center
1490 Mason Street
San Francisco, California 94133
Offers book Chinese Guide to Breast Cancer Resources. “Dr. Play,” a support group for children whose parents have cancer, meets concurrently with the Chinese Women’s Cancer Support Group, on the first and third Saturdays of the month from 1:30 to 3:30.
Chinese Community Cancer Information Center
835 Jackson Street
San Francisco, California 94133
Serves the Chinese community in the Bay Area. Education, information, breast self-exam training, referral service, patient navigation, transportation services, support groups, nutrition services, prosthesis, wardrobe, grooming, appearance, make-up, wigs.
Chinese Community Health Resource Center
835 Jackson Street
San Francisco, California 94133
Promotes a healthier lifestyle among Chinese people through culturally competent, linguistically-appropriate heath education programs and services. Offers health education seminars and classes, cancer-related information and support, and a bilingual health library. Breast prosthesis, hats, turbans, wigs, make-up.
Coping with Chemotherapy
Eyes on the Prize.org
Mission is to provide information and emotional support from the survivors’ perspective to women with gynecologic cancers, their families and friends, and healthcare providers.
Reproductive information, support, and hope for those whose medical treatments present the risk of infertility. Addresses risks, preservation options, and financial assistance.
Named for comedienne Gilda Radner, who died of ovarian cancer, the club's 30 U.S. affiliates provide support and education for all cancer survivors and their families.
Newsletter published by the Women’s Cancer Resource Center, which focuses on both supportive care during the cancer journey and active advocacy for cancer prevention for future generations.
Gynecologic Cancer Foundation
800 444-4441 hotline
Established by the Society of Gynecologic Oncologists to promote public awareness about the prevention, early detection, and treatment of gynecologic cancers. Seeks funding for programs which reduce the impact of gynecological cancers on the physical and emotional health of women and their families.
Program initiative called Health Women, Healthy Lives serves as the umbrella for the entire Women’s Health Program. Provides substantive educational information on exercise, nutrition, prevention, and early detection of diseases that affect women. Offers program on patient/doctor communications which empowers and educates women by providing them with the knowledge necessary to make appropriate and informed medical decisions. It teaches them how to partner with their physicians, thus resulting in improved health care.
Caren Miranda offers wigs or laser treatments for hair growth after chemotherapy.
Mission is to support healing, activate hope, and promote thriving. Offers free conferences titled “Cancer as a Turning Point, From Surviving to Thriving” which are designed to heal, celebrate, empower, awaken, and network all women whose lives have been touched by cancer. The conferences include speakers, performers, music, humor, healing stories, from many women who are thriving after a cancer diagnosis, all aimed at inspiring and encouraging people to strengthen their own healing potential and their ability to thrive.
Life Beyond Cancer
A four-day retreat for women living with cancer. Includes workshops, lectures, and group activities that will enable them to return to their communities to begin support services and advocacy programs.
Financial assistance for hormonal and oral chemotherapy, pain and anti-nausea medication, lymphedema supplies and durable medical equipment. In partnership with the Susan G. Komen Breast Cancer Foundation.
The first magazine devoted to meeting the needs of women diagnosed with breast and reproductive cancers. Helps readers understand more about their diagnoses, improve their quality of life, and assess current treatments and new therapies on the horizon.
Marin General Hospital Foundation
1350 South Eliseo #140
Greenbrae, California 94904
Provides a one-time grant of financial assistance up to $300 to women for complementary treatments, medications, wigs, nutritional supplements, and miscellaneous expenses while they are in treatment.
Marin Center for Independent Living
710 4th Street
San Rafael, California 94901
Program for under-insured, low-income residents. Provides financial assistance with medical premiums and rent/mortgage payments. Maximum allotment is $2000 per person. Offers benefits counseling, advocacy, referrals to resources, lists of jobs and affordable housing, and case management. Public and private benefits counseling services for individuals diagnosed with breast cancer in Marin County.
Marin Community Clinic
250 Bon Air Road, Greenbrae
400 Professional Center Drive, Suite 424
Novato, California 94947
Provides comprehensive primary healthcare services to uninsured and low-income residents in Marin. Mobilizes physicians, other healthcare providers, public agencies, and a network of community organizations to create an extensive healthcare delivery system serving more than 14,000 patients every year. Monthly Breast Health Days are held on the first Saturday of every month for Marin Community Clinic patients (low-income, underinsured or uninsured women from all ethnic groups). Participants receive clinical breast exams, breast health education, and a screening mammogram.
479 Entrada Drive
Novato, California 94947
A retail durable medical equipment store with certified fitters. Provides a full line of mastectomy and ostomy products and lymphedema sleeves.
Mission is to bring joy and comfort to children and teens by helping them keep alive traditions or simple pleasures they shared with their mothers.
Mothers’ Living Stories Project
2011 Cedar Street
Berkeley, California 94709
Helps Bay Area mothers living with cancer audio-record a life story and personal legacy for their children. Another Morning: Voices of Truth and Hope from Mothers with Cancer
by Linda Blachman, Project Founder, is based on the mothers’ stories and the work of the Project.
National Asian Women’s Health Organization
One Embarcadero Center, Suite 50
San Francisco, California 94111
NAWHO works to improve the health status of Asian women and families through research, education, leadership, and public policy programs. Designed and implemented national health promotion campaigns and programs on breast and cervical cancer.
National Lymphedema Network
1611 Telegraph Avenue
800 431-3259 Hotline
Provides education and guidance to lymphedema patients, healthcare professionals, and the public by disseminating information about the prevention and management of primary and secondary lymphedema
Planned Parenthood Federation of America
801 Montgomery Street
San Francisco, California 94133
Offers gynecological care, Pap tests, and breast exams. Some Planned Parenthood clinics offer the HPV vaccine to protect against contracting the Human Papilloma Virus that has been associated with cervical cancer, vulvar cancer, and penile cancer. Call toll-free number to determine if your local clinic provides these services.
Reeling and Healing Midwest
Offers fly-fishing retreat programs for women diagnosed with or surviving cancer. The mission is to renew spirit and hope through fly-fishing, nature, peer coaching, positive camaraderie, and support.
Ross Valley Pharmacy
2 Bon Air Road #130
Larkspur, California 94939
Provides compression garments, sleeves, gauntlets, gloves, and bras for the treatment of lymphedema. Custom fitting and standard sizes available.
Society of Gynecological Oncology
Purpose is to improve the care of women with gynecologic cancers by encouraging research and disseminating knowledge to raise the standards of practice and treatment.
2850 22nd Street
San Francisco, Califoirnia 94110
A salon specializing in hair loss. Licensed staff provides complete service, including custom hair color matching. Complete online catalog service.
UCSF Ida and Joseph Friend Cancer Resource Center
1600 Divisadero Street
San Francisco, California
Supports wellness and the healing process by providing information and treatment options, emotional support, and community resources. Free programs to bring patients together, foster community, educate patients about their diagnoses, and give them effective tools to navigate the disease process. Services include classes in exercise and movement, meditation, guided imagery, a lending library, preparing for surgery, nutrition, support groups for partners, families and friends, gays and lesbians, peer support, spiritual support, appointment planning, smoking cessation, special seminars and events, referrals for individual and family counseling and psychotherapy, and breast prostheses, hats, turbans, wigs, make-up.
WomanKind Health Resource Center
Saint Mary’s Medical Center
450 Stanyan Street
San Francisco, California 94117
A resource center within Saint Mary’s Hospital. Offers a breast cancer support community and a comprehensive lymphedema program.
Women's Bodies, Women's Wisdom
Women’s Cancer Network
Developed by the Gynecological Cancer Foundation. Website dedicated to informing women about gynecologic cancer risk factors, diagnosis, treatment, and clinical trials. Site features an interactive risk assessment survey and helps connect patients with gynecologic oncologists.
The Gynecologic Cancer Foundation released the "State of the State of Gynecologic Cancers --- First Annual Report to the Women of America," detailing the most recent advances in the detection and treatment of gynecologic cancers. www.wcn.org/gcf/whatsnew/stateofthestate.htm
The report will be distributed each year in September, the Gynecologic Cancer Awareness Month.
Women’s Cancer Resource Center
5741 Telegraph Avenue
Oakland, California 94609
510 420-7900 helpline
Empowers women to be active and informed consumers and survivors. Provides community for women with cancer and their supporters. Educates the general community about cancer. Actively involved in the struggle for a life-affirming, cancer-free society. Especially strives to meet the needs of low-income women, women of color, immigrant, lesbian, older, and disabled women. Multi-lingual lending library. Services include peer-facilitated support groups, including a group for teens who have a parent or guardian with cancer, an information and referral helpline that includes services for Spanish-speaking survivors and for the deaf community, the Sister to Sister program for African American women, a Latina Services Program, and the Lesbians with Cancer support community. Other programs help low-income women obtain financial assistance and in-home support services. Offers a list of free and low-fee therapists throughout the Bay Area experienced in working with people with cancer and their families.
Dedicated to the radical notion that women are entitled to information, services, and support.
- Information and Referral Helpine
Several hundred calls from women with cancer, their friends, family and loved ones come into the helpline each month. Volunteers who staff the helpline provide information on support groups, peer referrals, community resources, and treatment options, and refer to physicians as well as other health care providers.
Our comprehensive lending library includes 2,000 volumes, materials in Spanish, and Internet access. The library is one of the few that offers Spanish materials and information on a full spectrum of both mainstream and complementary therapies.
- Multicultural Outreach Program
We provide culturally approrpiate and linguistically accessible information, educational workshops and gatherings, support services and referrals, as well as outreach and continued follow-up to African Americans, Latinas, and other women of color living with a diagosis of cancer.
- Educational Forums, Advocacy, and Public Policy
Forums and workshops are offered on a range of topics. We offer free workshops on relevant issues for the cancer patient and those living with cancer. The Center partners with other organizations to make the link between cancer and environmental toxins and works to change policy to stop cancer where it starts.
- In-Home Support Services (Betts Program)
Our 1-to-1 Betts Program is the only program of its kind in the San Francisco Bay Area. We link volunteers with low-income women who need practical and emotional support. Volunteers assist with activities such as shopping and cleaning, as well as provide emotional support to those with limited resources and those who feel isolated and lonely in the face of their illness.
This program focuses on families whose first language is Spanish. Staff and volunteers facilitate access to responsive and effective services and treatment. The program also includes community education programs in Spanish to ensure a greater understanding of a cancer diagnosis and care.
- Cultural and Healing Arts Programs
We provide a wide array or workshops and classes to help you get through treatments and assist you with wellness after your recovery, including Gentle Yoga, Writing for Wellness, Yarn Divas, Cooking Club, Nutrition, Creativity and special offerings.
One of the key health issues facing the African American community is the overwehelming silence about cancer. Our clients agree that the silence in this community can be deadly. SIster to Sister encourages African women to "break the silence" about cancer by providing a forum for discussion, a place for support, and a means to disseminate resources and support information to build community. The program brings the powerful message to women of African descent that, "Sisters, no one needs to face this journey alone. Let's talk about cancer."
Our groups are run by trained facilitators with experience pertinent to the focus of the group. The groups are: Women with Cancer, Spanish-Speaking Women with Cancer, African American Women with Cancer, Complementary and Alternative Treatments, Adults with Blood-Related Cancers and Their Families and Friends; Spanish-Speaking Friends and Family of Women with Cancer, Women with Metastatic Cancer, Teen Support (for teens with a parent or caregiver with cancer), and a Lesbian Support Group.
Callers are linked to women with similar medical diagnoses, ethnic backgrounds, languages, sexual orientations, and/ or treatment choices. By connecting women with peers who have 'been there,' this service provides invaluable information and emotional support.
- East Bay Breast Cancer Emergency Fund
The EBBCEF provides financial assistance to low income women with breast cancer living in Alameda and Contra Costa Counties who are currently in treatment. The fund will provide women with access up to $500 per year to help with basic living needs. This fund is sponsored by Friends of Faith and To Celebrate Life Breast Cancer Foundation and several other donors.er and their families.
Women’s Health Resource Center
3698 California Street
San Francisco, California 94118
Provides health information and education services. Gynecological Cancer Recovery Program. Operates a boutique with products to cope with hair loss, breast surgery.
Women’s Health Services County of Marin Department of Health and Human Services
361 Third Street, Suite E
San Rafael, California 94901
Full service OB-GYN and reproductive health clinic with day and evening clinics serving all ages. Access to Family Pact and Cancer Detection services as well as the Breast and Cervical Cancer Treatment Program.
A MESSAGE FROM PRESIDENT OBAMA
"My mother died of ovarian cancer at the age of 53, and, in those last painful months, she was more worried about paying medical bills than getting well. For millions of Americans, my mother's story is all too familiar. That is why we need health-care reform that guarantees affordable coverage for every American who wants it and prevents insurance companies from discriminating against those who are sick and need care the most.
"Earlier this year, I announced an additional $6 billion investment for cancer research as part of a long-term strategy to combat the disease, and the recovery package includes a two-year infusion of $10 billion for the National Institutes of Health, which funds cancer research. We know this fight will not be easy, but we have gone far too long without necessary reforms of our health-care system.
"Now is the time to commit ourselves to waging a war against cancer as aggressive as the war cancer wages against us."
SIGNS OF CANCER?
These symptoms do not usually mean cancer, but talk to your doctor if you experience any, especially if the problem is persistent and doesn't respond to the usual treatments.
- Bleeding between periods or spotting after menopause ... Check for cervical or uterine cancer
- Unusual discharge ... Check for cervical or uterine cancer
- Longer or heavier periods ... Check for cervical cancer
- Bleeding after intercourse ... Check for cervical cancer
- Pelvic or abdominal pain ... Check for ovarian cancer
- Bloating ... Check for ovarian cancer
- Increased abdominal size ... Check for ovarian cancer
- Constipation or diarrhea ... Check for ovarian cancer
- Indigestion, gas, nausea ... Check for ovarian cancer
- Frequent and/or urgent urination ... Check for ovarian cancer
- Loss of appetite ... Check for ovarian cancer
- Feeling full after even small amounts of food ... Check for ovarian cancer
- Lower back pain ... Check for ovarian cancer
- Fatigue ... Check for ovarian cancer
- Pain during intercourse ... Check for cervical, uterine, or ovarian cancer
WOMEN'S "SILENT" CANCERS
By Leslie LaurenceLadies' Home Journal
Awareness of and screenings for ovarian, uterine, and other gynecological cancers need to be vastly improved. Women's lives are at stake.
In December 2006, actress Fran Drescher went to Washington. But unlike Frank Capra's wide-eyed junior senator, Mr. Smith, Drescher was no babe in the woods. As the author of Cancer Schmancer, her 2002 book about the fact that it took eight doctors and two years for her to get a diagnosis of what proved to be stage 1 uterine cancer, she came to town on "a very dedicated lobbying effort," she says. Her agenda was to use her celebrity to push for passage of the Gynecologic Cancer Education and Awareness Act, also know as Johanna's Law, after Johanna Silver Gordon, who died from ovarian cancer in 2000. Drescher's efforts proved fruitful. In January 2007, President Bush signed the bipartisan bill, which authorized the launch of a national campaign to educate American women and healthcare providers about the symptoms of gynecologic cancers.
In fact, ovarian cancer patients had been pushing to get their illness on the national radar for some time. In 1997, seven grassroots organizations had come together to form the Ovarian Cancer National Alliance (OCNA). Among their goals were lobbying for more federal funding and bringing much-needed public attention to the disease's risks and symptoms.
The nascent advocacy hopefully will help change what has been a tragic reality for decades. Research into gynecologic cancers --- ovarian, uterine, and cervical --- has been underfunded. Counted together, these are the third most common cancers in American women. More than 72,000 were diagnosed in 2007. While more women get breast cancer (there were 178,000 new cases last year), a higher proportion of women with cancers of the reproductive tract die. In 2007, the National Cancer Institute (NCI) reported spending of nearly $600 million for breast-cancer research and $296 million for prostate cancer. By contrast, only $97 million was earmarked for research into ovarian cancer --- the most dangerous of these cancers though one of the rarest. More than 20,000 new cases are diagnosed and 15,000 women die of the disease each year. And funding for uterine and cervical cancers combined was a mere $98 million.
While the overall five-year survival rate for women with breast cancer is 89%, it is just 46% for those with ovarian cancer (cervical is about 72% and uterine is 83%). What is more, 80% of ovarian cancers and 25% of uterine cancers are found at stage 3 or 4, when they have already spread and are less curable. Today, thanks to mammograms, 61% of breast cancers are found at stage 1.
The delay in diagnosis has many causes. For starters, even for women who see a gynecologist annually, the standard physical exam usually does not pick up early-stage uterine or ovarian cancer. And while there is a universally accepted screening test for cervical cancer --- the Pap smear --- there is no reliable screener for ovarian or uterine cancer.
In fact, when women report symptoms that should send up a red flag for gynecologic cancer, many physicians routinely attribute these complaints to other conditions, such as peri-menopause, stress or indigestion. Result? Women don't receive the tests that could distinguish between something benign, such as indigestion, and cancer.
Much needs to change, but perhaps the most critical step of all is for women to become more proactive about their reproductive health.
ARE GYNO CHECKUPS IN THE DARK AGES?
Your first protection against cancer of the reproductive tract is an annual visit to the gynecologist --- more often if your doctor recommends it. She should start by taking or updating your medical history and paying attention to factors that increase your cancer risk, such as having a family history of these cancers, being overweight, and not having had children.
She should perform a pelvic and rectal exam. While these exams --- standard medical practice for many years --- don't typically detect ovarian or other reproductive tract cancers in early stages, they do allow a doctor to feel the uterus and ovaries and, potentially, find tumors that could be cancerous. Studies have found that manual exams alone don't save lives. Especially when it comes to ovarian cancer, you also need testing. During a pelvic exam, the doctor will get a sample for the Pap and HPV tests, if needed, to screen for cervical cancer,
There is still no routine screening test for ovarian or uterine cancer that is given without the presence of symptoms. At least one outspoken advocate, Fran Drescher, believes that a transvaginal ultrasound (TVU), which lets doctors see abnormalities of the uterus and ovaries, including tumors and cysts, should be a routine part of every woman's gynecologic checkup. Most mainstream health organizations, though, support the use of TVU only when a woman reports symptoms associated with ovarian or uterine cancer. They also support CA-125 testing in women who have symptoms associated with ovarian cancer, as it measures a blood protein that tends to spike in women with the disease. Women with a family history of ovarian cancer or who carry a genetic mutation for breast cancer should get both tests every six months.
If you have to fight your doctor to get these tests, consider switching to one who will order them. Without possible ovarian cancer symptoms, your insurance company may not cover the cost of either --- an average of $60 for the CA-125 test and $250 for TVU.
Neither test is ideal. Both risk false positives that require more testing. But Drescher feels strongly that women should be able to decide whether or not they want these tests. "Being diagnosed with a gynecologic cancer beyond stage 1 is unacceptable," she says.
MENOPAUSE AND CANCER RISKS ... GET ANSWERS
Focused on Health - October 2012
by Laura Nathan-Garner
Menopause often brings more than physical changes. It also may bring uncertainty about cancer risks and cancer prevention.
Below, Therese Bevers, M.D., medical director of MD Anderson’s Cancer Prevention Center, clears up the confusion about menopause and cancer.
Use her answers to start an informed conversation with your doctor about menopause-related concerns.
How does menopause affect a woman’s cancer risk?
Menopause does not cause cancer. But your risk of developing cancer increases as you age. So women going through menopause have a greater chance of developing cancer because they’re older.
How does the age at which a woman starts menopause affect her cancer risk?
Starting menopause after age 55 increases a woman’s risk of breast cancer andendometrial cancer. That’s probably because she’s been exposed to more estrogen. During a woman’s menstrual cycle, estrogen stimulates the uterus and breast tissue. So the more menstrual periods a woman has, the longer these tissues are exposed to estrogen.
Women who start menopause later also may have an increased risk of ovariancancer possibly because they have had more ovulations.
Some women receive hormone therapy (HT) to cope with menopause symptoms. How safe is HT?
We encourage women to try safer alternatives before using HT. Postmenopausal use of HT increases a woman’s risk of breast cancer.
The Women’s Health Initiative showed that women who took combined hormone therapy (estrogen and progestin) had a bigger risk of breast cancer. There also may be a higher risk for women taking estrogen alone, but study results on this risk are still inconclusive.
Some studies also suggest that using HT after menopause may slightly increase ovarian cancer risk. Generally, the longer you use hormone therapy, the more your cancer risk appears to increase.
That said, one study actually showed that women who used HT had a smaller risk ofcolorectal cancer. But the increase in breast cancer risk is still bigger than the decreased risk for colon cancer. So HT risks tend to outweigh any benefits.
Speak with your doctor before using hormone therapy. Make sure you understand all the benefits and harms before you start taking them.
What are some safer HRT alternatives that you recommend?
Even small lifestyle changes can make a big difference. For instance, you may have terrible hot flashes if you drink coffee before showering. But your hot flashes may not be nearly as bad if you try drinking coffee after showering.
Some safe and healthy ways to manage menopause symptoms include:
If lifestyle changes don’t help, women may wish to talk to their doctor about anti-depressants. Certain anti-depressants tend to reduce frequency and intensity of hot flashes. And they curb moodiness and irritability associated with menopause, so they make help women who use them feel better.
Anti-depressants don’t help with a common menopause symptom — vaginal dryness, though. Many over-the-counter moisturizers and lubricants can help with this. But they only work if you use them on an ongoing basis.
What can women do to reduce their cancer risk during and after menopause?
The same ways you reduce your cancer risk before menopause: exercise, eat ahealthy diet, don’t smoke and avoid secondhand smoke, and maintain a healthy body weight.
Research shows that gaining weight after menopause increases a woman’s risk of breast cancer, but losing weight after menopause can actually reduce your risk.
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