BILH Hosts Virtual Cancer Survivorship Symposium
Experts From Across System Share Insights and Strategies for Thriving During Cancer Care
Beth Israel Lahey Health (BILH) hosted its third annual Cancer Survivorship Symposium recently. Seventy-five people attended the virtual symposium, which featured a diverse panel of experts who shared their expertise on the sometimes-overlooked aspects of cancer survivorship. Panelists included psychologists, a nutritionist and a cardio-oncologist who offer their services to patients through the BILH Survivorship Program.
The evening was co-hosted by the program’s founder and Director Krishna S. Gunturu, MD, who launched the program at LHMC in 2016. In mid-October, Symposium co-host Lata Thatai, MD, Director, Hereditary Cancer Program and Cancer Survivorship Program at LHMC will assume the role of director.
“We thank the presenters and the survivors in attendance, and we hope everyone takes away something that will enhance and enrich their recovery and survivorship journey,” Thatai said.
“People have been through quite a bit physically, mentally, emotionally, when they've gone through cancer treatments,” said Amy Fabiani, a Nurse Practitioner in the Survivorship program, said. “Patients go through a time when we're following them very closely and they have a lot of access to us, and then — all of a sudden — they're free of us [when treatments end]. A survivorship visit is a good opportunity to see what they might need to optimize their health.”
(Caregivers and survivors interested in learning more about the Cancer Survivorship Program, may reach out to its coordinator, Alanna Horowitz for more information.)
Katherine Thibedeau, PsyD, a clinical psychologist in the department of hematology/oncology at LHMC, provided an overview of the psychosocial support that her team offers individuals with cancer and their families. Treatment explores patients’ experiences of medical stressors, including physical symptoms such as pain, but also including the stress and economic strain of navigating the health care system, Thibedeau said. Other common themes are building coping and communication skills, adjusting to physical changes and how they impact self-image, and grieving for a future that may not come to pass. Her team offers individual or group therapy sessions. Group sessions are tailored for patients with cancer, family members and/or caregivers and are also stratified by age and treatment goals.
Her colleague, Kendea Oliver, PsyD, also a clinical psychologist at LHMC who focuses on sleep hygiene, shared some tips on ensuring a good night’s sleep. Oliver dispelled the common myth that people need less sleep as they age, noting that while people may sleep more lightly after age 30, 7 to 9 hours per night remains the gold standard for the entire life span. She also provided tips for survivors, or anyone, struggling to fall or stay asleep at night. In particular, Oliver reminded the audience to not keep doing the math as the minutes tick by on a sleepless night.
“The reality is like most of us actually do a fairly good job managing on not a lot of sleep,” she said. “We spent a lot of time in therapy working with patients on how to reframe thoughts to take that pressure off ourselves to get to sleep. Because, ironically, the less pressure we put on ourselves to sleep, the better our sleep turns out to be.”
Physical therapist Ronald Ponchak, PT, MBA, Executive director of clinical services (rehabilitation, emergency, anesthesia and pain) discussed fatigue in people with cancer, its many causes and how to manage it. Fatigue can be a side effect from cancer therapies, Ponchack suggested, but cancer-related anemia, deconditioning, poor nutrition, anxiety and/or depression may all contribute.
The key to overcoming fatigue, however, is not more rest, but activity. Ponchack showed research findings that suggested cancer survivors who exercised reported better fatigue scores compared to those who did not. What’s more, those who engaged in aerobic activities, such as walking, dancing or swimming, reported better fatigue scores than those who did only resistance training exercises—though Ponchak was quick to note resistance training is critical to rehabilitation efforts, too.
“Starting an exercise program is difficult for everyone, and more so if you've got a history of cancer,” he said. “Give yourself a while to get on track. Be sure all your medical issues are addressed or accounted for. Get the proper nutrition and hydration. But most of all, avoid prolonged inactivity.”
Bone is the third most common site of metastasis from cancers that originate in other organs, said orthopedic oncologist Dipak B. Ramkumar, MD, MS, and tumors that spread to the skeleton and, specifically, the spine, can cause significant pain, fragility and weakness in the extremities and potentially lead to fracture.
Ramkumar provided an overview of four patient success stories from his three-year old musculoskeletal oncology program at LHMC; two women in their 70s and two younger men, each with advanced cases of metastatic bone disease. Often, the person’s pain had been first attributed to arthritis before imaging revealed the dark malignancy—called a shark bite—leaching calcium and structural integrity away from the bone. In two cases, Ramkumar restored the patient’s bone with bone resorbing cement designed for just this purpose at LHMC. In the other two cases, Ramkumar used leading-edge 3D printing technology to re-build the patient’s bones—a femur for one, half a pelvis for the other—from scratch. All of the procedures restored the patients’ function and independence.
“We are really on the cutting edge of clinical practice,” he said. “We have multiple treatment options that are really only available in a very small number of centers across the country and we're specializing in minimally invasive salvage treatment for a lot of these tumors.”
“A lot of survivorship can be nutrition-related,” said Clinical Nutrition Manager, Katherine Carithers, MHA, RD, CSO, LDN, a Certified Specialist in Oncology Nutrition who manages a team of 15 inpatient and outpatient dietitians at LHMC. “But as we all know, cancer isn’t one disease, and cancers can impact us nutritionally in a lot of different ways.”
Carithers and her team frequently help patients with cancer who are undergoing treatments manage unintentional weight loss or weight gain, a poor appetite, nausea, dry mouth and chewing and swallowing challenges. But once a patient has completed their main course of treatment, Carithers helps patients shift toward achieving long-term nutrition goals that will help them maintain health throughout the rest of their lives.
Specifically, Carithers recommended making “vegetables the star of your plate,” using the well-validated Dietary Approaches to Stop Hypertension (DASH) diet—designed as an approach to target high blood pressure and emphasizing produce, lean protein and high fiber intake while limiting red meat, processed oils, added sugar and alcohol—as a guide to healthful eating patterns. She also emphasized the importance of avoiding processed foods.
“When you're choosing foods, choose foods in their most natural form,” Carithers advised. “If you're choosing an apple at lunch, choose the whole apple, not apple juice, not apple sauce. You're going to get more fiber and nutrients from that whole apple.”
BIDMC’s Alexis English, PT, DPT, NCS, discussed issues around the pelvic floor, the group of muscles that extend from the public bone to the tailbone to support the organs and tissues in the abdominal cavity. Regardless of a person’s gender, problems with the pelvic floor can impact respiration, the lymphatic system, waste excretion, sexual function and more. Cancer treatments, including surgeries, chemotherapy and radiation, can lead to pelvic floor dysfunction or exacerbate pre-existing issues, English said.
Physical therapists can help patients address these problems through lifestyle modifications including diet and through breathing patterns and other strengthening movements. However, English noted, strengthening is not recommended for everyone and can exacerbate incontinence, in some cases.
“A lot of people who have undergone radiation need to learn to relax their pelvic floors, so we teach them,” she said. “If you've been having incontinence and you’ve been doing Kegles and it's not getting better, it might be that you need the opposite.”
Cancer survivorship has grown significantly from 1970s, noted Sarju Ganatra, MD, Vice Chair of Research for the Department of Medicine and Director of Cardio Oncology Program at LHMC, with almost two-thirds of survivors 60 years of age or older. “That is also the age when we tend to develop risk factors for heart disease. It’s kind of a collusion between cancer and cardiovascular disease,” Ganatra said.
Cancer itself is associated with a higher risk of having heart disease, he said. Additionally, many types of cancer therapy—specifically radiation and the newer generation of immunotherapy treatments—are associated with significant cardiovascular side effects. But radiation-induced heart disease can take up to 15 years to appear, Ganatra said. That’s why he relies on his colleagues in nutrition and physical therapy to work with Survivors well before they come to him.
“It’s more important than ever before to control cardiovascular risk factors such as hypertension and cholesterol appropriately and aggressively in people with a history of cancer to give them the best chance at enjoying a healthy, long-term survivorship,” Ganatra said. “It's a multidisciplinary approach.”