Far away there in the sunshine are my highest aspirations.
I may not reach them, but I can look up and see their beauty,
believe in them, and try to follow where they lead.
~ Louisa May Alcott
Welcome to the Spring/Summer issue of Life to the Fullest – the Swedish Cancer Institute’s newsletter for cancer survivors.
For those of us in the Pacific Northwest, the arrival of spring and summer is a much-anticipated annual event. Rain and gray skies give way to sunshine and bountiful color. These months renew our spirits and inspire hope. We want to shed layers of winter clothing and expose white arms and legs to the sun’s rays. We look forward to outdoor activities and trips to far off places. The articles in this issue of Life to the Fullest are intended to help cancer survivors safely address those desires.
Table of Contents
- The Sunshine Vitamin
- Sun, Fun and UV Safety
- Importance of Exercise During and After Cancer Treatment
- Travel Tips for Cancer Survivors
- A Clinic for Cancer Survivors
- Learn More about ABC and ACT
- Cancer Services Close to Home
- Patient and Family Education Classes
- Cancer Support Groups
- Creative Expression Programs
Kathleen Pratt, N.D., Northwest Natural Health
Vitamin D plays an important role in your health. It has many functions, such as:
- Absorbing and utilizing calcium and phosphorus
- Helping bones and teeth to grow, especially in children
- Preventing rickets (soft bones), osteoporosis (weak bones) and osteomalacia (an adult form of rickets)
- Strengthening the immune system, which may help prevent certain types of cancer
Nearly every tissue in the body responds to vitamin D in some way. Even after a lot of research, though, we still don’t fully know all of its functions.
Vitamin D is a steroid hormone precursor. That means that it is inactive until something activates it. Your body stores vitamin D primarily in your skin. Sunshine, mainly ultraviolet-B rays, activates it. That is why many people call vitamin D the sunshine vitamin.
If you don’t get a lot of sun, your vitamin-D level may be much lower than what you need to maintain good health. A low vitamin-D level is called vitamin-D deficiency.
There are many factors that may limit exposure to the sun. People may not get enough sun if they:
- Have darker skin
- Always use sun block
- Live or work primarily indoors
People who live in a northern area, like the Pacific Northwest, also are “sun challenged” because the sun is weaker than it is closer to the equator and it is often hidden behind clouds.
Vitamin-D deficiency can cause a number of problems. Severe deficiency will block bone mineralization and keep bones from becoming strong and hard. Weak bones can cause osteoporosis. Soft bones can lead to osteomalacia. Vitamin-D deficiency can also affect a child’s growth plates, which could result in rickets.
Vitamin-D deficiency can cause other problems, too. For example, there is some evidence it may increase the risk of Type I diabetes in children and multiple sclerosis in adults. It may also contribute to Seasonal Affective Disorder (SAD), a form of depression that typically occurs during winter months when there is limited sunlight. Researchers are also looking at the relationship between vitamin-D deficiency and an increased risk of some types of cancer. But more studies are needed to understand the potential link.
On the other hand, too much vitamin D can be toxic and affect how well the body uses calcium. Over dosing on vitamin-D supplements — rather than too much exposure to the sun — is the main way we get too much vitamin D. And, because vitamin D is fat soluble, not water soluble like vitamin C and the B vitamins, we can’t get rid of the excess in our urine.
Vitamin D in Your Diet
Diet and nutritional supplements can help you maintain a healthy level of vitamin D when you are not able to get enough sunshine. Foods rich in vitamin D include:
- Fatty fish, such as salmon and mackerel
- Fortified foods, such as milk and cheese
- Cod liver oil
Boosting Your Vitamin D
Although a healthy diet can usually provide a good supply of vitamin D, it probably doesn’t contain enough to correct a deficiency. If you suspect you might not be getting enough vitamin D, it might be worthwhile to have your doctor check your vitamin-D level. Talking with your doctor about the test results can help you decide whether you need to take a supplement.
Usually, a supplement of 1000-2000 IU (international units) each day is sufficient. If you are very deficient, however, your doctor may give you a prescription for high-dose vitamin D.
Increasing your exposure to the sun is another way to increase your vitamin D. But to be effective, you cannot wear sunscreen. Because exposure to the sun can increase your risk of skin cancer, be careful about how much time you spend in the sun without sunscreen. Exposing your unprotected arms and legs to the sun for 15 minutes once or twice a week will increase your vitamin-D level. But a few reminders will help reduce your risk of skin cancer:
- Avoid exposing your unprotected skin to the sun between 10 a.m. and 4 p.m.
- Except for your short exposure to increase your vitamin D, be sure to wear sunscreen or protective clothing the rest of the time
Prevention and a healthy lifestyle are important to cancer survivors — and to their families, too. Make vitamin D — the sunshine vitamin — part of your health routine.
Ed. Note: Dr. Pratt sees patients at Swedish First Hill and Swedish Issaquah, and will soon see patients at Swedish Edmonds, too.
After a wet and rather dreary spring, the sun has finally come out to play in the Northwest – just in time to help us celebrate UV Safety Month. During the month of July, health-care professionals nationwide are encouraging us to protect our skin – and our kids’ skin – from the damaging effects of the sun.
Although this is important information for everyone, it is particularly important to cancer survivors who may have areas of skin that are overly sensitive to the sun as a result of chemotherapy or radiation therapy. These sensitivities may be temporary or long term, so it is important to consult with your medical and/or radiation oncologists for specific recommendations about sun exposure.
The yin and yang of sun exposure
Just because you aren’t a fair skinned, blue- or green-eyed blonde or red head, doesn’t mean you can’t get skin cancer. Anyone can get skin cancer.
Sunburn, especially in children, is associated with a greater risk of skin cancer. Isn’t it ironic, therefore, that we produce 80 percent of our required vitamin D (an important anticancer agent and builder of strong bones) from exposure to the sun?
Tips for sun seekers
You don’t need to be a hermit – shades drawn and never going outside – to protect yourself from the sun. You just need to be smart.
- Stay out of the sun between 10 a.m. and 4 p.m.
- Use sunscreen with SPF 15 or higher.
- Cover up with long sleeves and pants, and a wide-brimmed hat.
- Wear sunglasses to protect your eyes and the skin around your eyes from UV rays.
- Check your skin. (www.cancer.gov/cancertopics/wyntk/skin/page15)
- Remember – you are exposed to UV rays even on a cloudy day.
Learn more about skin cancer from the National Cancer Institute.
Melissa Kwaterski, P.T., DPT, CLT, ATC
Avoid inactivity. That is good advice for all Americans — including cancer survivors, whether they are undergoing treatment or have completed their treatment regimen. Whenever possible, individuals living with cancer should try to follow the age-related guidelines established by the American College of Sports Medicine. Those guidelines recommend at least 150 minutes of moderate aerobic activity each week.
That may sound like a lot of time, especially if treatment makes you feel lousy. A few simple steps, however, can make the guideline more manageable.
- Spread your 150 minutes over the entire week. That could mean as little as 20 minutes a day.
- Exercise in small increments several times a day. Remember, as little as 10 minutes of moderate or vigorous activity can be beneficial.
- Develop an activity plan that works best for you. The following tips can help you build exercise into your daily life.
- Be moderately active on most days of the week. Begin your new activity plan by walking on a flat surface for 10 minutes. If it feels easy, you are ready to do more. If it is challenging, or you get overly tired or out of breath, stick with a 10-minute walk until it does feel easy. Then, progress in one- or two-minute increments until you reach 30 minutes of walking. As your energy level increases, add other elements to your walk, such as carrying weights or changing your route and adding an incline.
- Measure your rate of perceived exertion. Using a 10-point scale, with one being very little exertion and 10 being a lot, estimate how hard you think your body is working during an activity. Aim for an exertion level between three and four. In this zone, your cells use oxygen efficiently, but you are not working to the point of fatigue. You should be able to talk during your activity without getting breathless.
- Be smart. Avoid getting overheated or exercising to the point of exhaustion.
- Dress wisely. Check the weather before leaving home.
- Warm up and cool down. Allow time to properly warm up and cool down. Warming up allows your body to slowly go from a rested state into activity. Cooling down helps your body recover after being stressed.
- Schedule a rest day. Listen to your body — especially when are feeling run down or unwell. At those times, rest may be best.
- Keep an exercise log. Track your fatigue/energy levels and perceived exertion. Your log will help your physical therapist adjust your routine based on your body’s needs.
Benefits of Exercise During and After Cancer Treatment
Many cancer patients report that exercise is helpful during and after treatment. Benefits may include:
- Fewer or reduced side effects from treatment, including less nausea and fatigue
- Improved aerobic fitness and strength
- Help maintaining weight
- Improved circulation
- Reduced risk of falling
- Increased quality of life
- Quicker recovery from treatment
Seeking Healthcare When you Need It
Cancer and your treatment can leave you feeling physically drained or less steady on your feet. And, sometimes, despite your best intentions, you may reach a plateau with an existing activity plan. Talk with a health-care provider with a background in cancer rehabilitation or a certified cancer exercise trainer who can help you establish or alter an exercise routine that will meet your body where it is. At the Swedish Cancer Institute, the ACTIVE program can provide that type of assistance. Our physical therapists are certified lymphedema therapists and certified cancer exercise trainers. They also have extensive education in orthopedic, neurologic and balance impairments.
The ACTIVE program teaches you how to maximize your well-being and quality of life during and after treatment. Cancer places an incredibly high demand on your energy systems. Physical therapists and onco-physiatrists (doctors who specialize in all aspects of cancer rehabilitation) can provide exercise instruction, guidelines for progression, manual techniques and education about changes you may experience through exercise as you learn about your body’s “new normal”. Please call 206-215-6333 for more information about the ACTIVE program.
The American College of Sports Medicine offers several resources that can help guide you in your pursuit of the appropriate level of exercise.
- American College of Sports Medicine Exercise Guidelines 2008
- Resource Manual for Guidelines for Exercise Testing and Prescription, sixth edition
- Guidelines for Exercise Testing and Prescription, seventh edition
Ed. Note: Melissa Kwaterski is certified by the American College of Sports Medicine as both a cancer exercise trainer and personal trainer. She sees patients at Swedish Outpatient Rehabilitation Services at Swedish Issaquah.
If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.
As the warmer months approach, thoughts turn to vacations with family and friends. As a cancer survivor, you may be ready to get away and have some fun – but may also have concerns about whether traveling is a good idea. Every patient and every reaction to cancer treatment is different; therefore, there is no simple response to the question, “Is it ok to travel?” These travel tips are offered as a starting point for your decision process and preparation for travel.
- Talk with your doctor. Ask your doctor if you are well enough to travel. Ensure he/she knows your exact plans, including mode of transportation, the countries you will visit and where you will stay. Ask if there are travel restrictions. For example, your immune system may be compromised for a while after your last treatment; therefore, airplane travel or being in large crowds may leave you vulnerable to infection.
- Do some preliminary research. Before you leave, identify medical resources you may need while away from home. Take extra medication in case your return is delayed. And, prepare a short description of your medical history so you have it available for a provider who is unfamiliar with you. It is also wise to ask your insurance administrator how the company will process claims for care you receive while you are out of town.
- Plan a trip that is in sync with your energy level. Set realistic expectations. Plan activities that you will be able to enjoy and complete without getting too tired. Build in time for relaxation – short stops in your sightseeing schedule, a mid-afternoon nap before an evening out, a morning of people-watching in a park.
- Enjoy! You are a survivor – and there’s a lot to see, do and appreciate.
Your needs change as you make the transition from diagnosis to treatment to survivor. As you complete your last treatment, it is normal to feel both joy and anxiety. Joy that your treatment is over. Anxiety that your support structure may be changing as you transition from active treatment to routine and follow-up care, and have fewer appointments with your oncologist.
Personalized medicine at the Swedish Cancer Institute doesn’t stop when you complete active treatment. The SCI’s patient-focused approach offers survivors many support services. There are numerous classes, counseling and rehabilitation specifically for survivors.
SCI recently added a new support service — the SCI Survivorship Clinic. This clinic helps cancer patients as they begin their very personal journey into survivorship.
“We help patients move forward after they have completed their last treatment,” says Helen Geraci, R.N., M.N., ARNP, program coordinator for the new Survivorship Clinic. “Patients are still a bit overwhelmed when they see us. We ensure they understand their follow-up care when they will have less contact with their oncologists. We also send the patient’s treatment summary to his or her primary-care provider, so the entire health-care team knows what’s going on.”
Appointments at the Survivorship Clinic focus on:
- Evaluating the patient’s needs, such as counseling, education, nutrition and rehabilitation
- Addressing patients’ concerns
- Discussing the patient’s treatment summary
- Understanding the traits of the patient’s cancer
- Learning about treatment side effects that may occur years down the road
- Reviewing their plan of care for the next three months, six months, one year and five years
- Encouraging preventive exams, immunizations and lifestyle changes
“One of our goals is to help our patients prevent a recurrence or a new primary cancer,” says Geraci. “We stress preventive exams and screenings, and routine immunizations. We also help patients understand the importance of fighting infection and making wise lifestyle decisions.”
The Survivorship Clinic can also help identify resources you may need to address other concerns, such as:
- Bone loss
- Cardiovascular risks
- Fear of recurrence
- Living with uncertainty
- Memory issues
- Sexual dysfunction
- Situational depression
- Spiritual health
Scheduling an Appointment
The first step in scheduling an appointment at the Survivorship Clinic is to ask your oncologist for a referral. Also, please call your insurance administrator to confirm that your health plan covers survivorship services. It is also wise to ask them if you will have any out-of-pocket expenses. Then, call 206-215-6558 to schedule an appointment at SCI’s Survivorship Clinic.
Supporting cancer patients after they complete treatment is a long-standing tradition at the Swedish Cancer Institute. For several years, the SCI has offered two unique classes that were designed specifically for cancer survivors. ABC — After Breast Cancer: What’s Next? is a free group class for women who want to learn practical life skills after completing breast cancer treatment. ACT — After Cancer Treatment: What’s Next? is a similar class for men and women who are completing treatment for other types of cancer.
Both of these groups offer cancer survivors a safe and supportive environment in which they can gently explore life after treatment and share plans for survivorship. ABC and ACT give cancer survivors the opportunity to:
- Make peace with the impacts of cancer treatment
- Reduce the stress cancer places on relationships
- Overcome the fear of recurrence
- Renew hope and increase resilience
Both groups run every eight weeks, January through November, at Swedish First Hill and Swedish Edmonds. Advance registration is required. Please call 206-386-3200 or visit www.swedish.org/classes for more information and to register for the next session.
You gain strength, courage and confidence by every experience in which you really stop to look fear in the face.
~ Eleanor Roosevelt
The Swedish Cancer Institute (SCI) is committed to continually look for ways to make cancer care more convenient for patients and their families. Most recently, SCI opened a new cancer center at Swedish Edmonds and expanded its services at Swedish Ballard.
Serving north Puget Sound communities
The new outpatient cancer center at the Edmonds campus opened in April 2013. The new center provides medical oncology and chemotherapy services for patients living in south Snohomish and north King counties. And, at the end of the year, SCI completed a multi-million-dollar improvement to its radiation therapy services at Edmonds. This second project included installation of a new state-of-the-art linear accelerator for radiation therapy.
“The number of people turning to Swedish Edmonds for their cancer treatment has grown over the last decade,” said Jeffery Ward., M.D., one of six SCI cancer specialists who see patients at the center. “The new center and upgraded radiation therapy services enhances the care we can provide this growing population. With the addition of a seventh cancer specialist this summer, we will be able to care for even more patients from the neighboring communities.”
The cancer center is located at 21632 Highway 99 in Edmonds. There is clinic space for patients seeing their medical oncologists, and onsite chemotherapy, laboratory and pharmacy services. The center also offers patients the support services they require, such as social work, support groups, American Cancer Society navigation and resources, financial counseling, cancer-specific education classes, and an education/resource outlet.
The center’s patients are also linked with the entire SCI network of cancer experts through the electronic medical record system. This makes it particularly convenient for patients to access any additional cancer-related services they may need anywhere in the SCI network.
Expanding cancer care at Swedish Ballard
Cancer care has been available at Swedish’s Ballard campus for more than 35 years. In late 2013, SCI expanded those services by opening its new Medical Oncology and Treatment Center. Housed in more than 8,000 square feet, the center includes:
- Clinic space for five cancer specialists
- 13 infusion-therapy bays (biological and hormone therapies, chemotherapy and stem-cell transplant)
- 2 private rooms with hospital beds
- Street-level access and patient drop off
The center, which is located at 5300 Tallman Ave. NW, is across the street from SCI’s Radiation Treatment Center (5225 Tallman Ave.), which offers TomoTherapy® HiArt® system — one of the most advanced radiation technologies that uses 3D imaging to provide very precise treatment. Now cancer patients in the surrounding communities have access to doctors’ appointments, chemotherapy and highly sophisticated radiation therapy services on one campus.
“People really like cancer care delivered close to home in a restful setting, instead of having to drive downtown every day,” said Jennifer Graves, M.S., R.N., Swedish Ballard chief executive/nurse executive. “We are pleased we are able to offer our cancer patients convenient access to the exceptional care and exceptional caring of our highly skilled and truly compassionate team of cancer doctors, nurses, technicians and support staff.”
Since opening the center, SCI has also increased the availability of medical oncologists, with five cancer specialists now available to see patients at Ballard.
The Swedish Cancer Institute offers programs for you, your family, friends and caregivers. Classes help you make treatment decisions, manage your symptoms and access complementary programs to help your mind, body and spirit to heal. Registration is required for all classes unless otherwise indicated. For dates, times and locations of the following classes, or to register for a class, call 206-386-3200 or go to www.swedish.org/classes.
ABC - After Breast Cancer: What’s Next?
An eight-week class for women who have completed breast-cancer treatment. This class gives women an opportunity to discuss coping, relationships, fear of recurrence, resilience and hope.
ACT - After Cancer Treatment: What’s Next?
An eight-week class for men and women who have completed treatment for any type of cancer. This class gives them an opportunity to discuss coping, relationships, fear of recurrence, resilience and hope.
Active Women, Healthy Women
From cancer patient to survivor, there is an exercise activity appropriate for you. The class is co-sponsored by Team Survivor Northwest and focuses on stretching, strength training and cardio workouts.
Learn how to create an anticancer lifestyle by eating beneficial foods, protecting yourself from environmental threats and enhancing your physical and emotional wellbeing.
Don’t Keep Putting It Off: A class to discuss living wills, medical and financial POA, and hospice
A class for cancer patients and their loved ones to answer questions about end-of-life issues and available resources.
Getting Back to the Real You after Cancer Treatment
A class that is co-sponsored by the Swedish Cancer Insti¬tute and Northwest Natural Health that focuses on natural ways to help your body heal and repair after treatment.
Create balance in your body, breath and mind in this therapeutic yoga class.
Healing the Whole Person: Body, Mind and Spirit
This class explores ways to enhance the lives of those with cancer and those who have completed treat-ment, and their family members.
Look Good, Feel Better
This American Cancer Society class is designed for women undergoing cancer treatment. The class focuses on skin care, cosmetics, hair care and hair loss.
Meditation for People with Cancer
A two-part class that focuses on mindfulness meditation.
Probiotics: The Good-For-You Bacteria
This class focuses on safety, health benefits and the potential risks of using probiotics during chemotherapy or radiation.
Women’s Natural Guide to Avoiding Cancer
This class explores ways to maintain good health and minimize the risk of getting cancer with optimal diet recommendations.
The Swedish Cancer Institute (SCI) offers a variety of support groups that are open to all people in the community. These groups provide an opportunity to meet with others having experiences similar to your own. An experienced support-group facilitator from the Swedish Cancer Institute leads these groups.
We offer the following support groups for all patients and caregivers, whether the patient is receiving care at Swedish Medical Center or at another cancer center in the community. Please call 206-386-3228 for more information about cancer support groups at the SCI.
Living with Cancer Support Group
- A group for those living with any type of cancer
- Swedish First Hill: Meets weekly on Thursdays, from 1:30 to 3 p.m.
Swedish Issaquah: Meets the second and fourth Monday of the month, from 10-11:30 a.m.
- (Note: For the most current information about the Swedish Issaquah support group, please call Tricia Matteson, oncology social worker, at 425-313-4224.)
Caregivers Support Group
- A drop-in support group for caregivers
- Swedish First Hill: Meets weekly on Thursdays, from 1:30 to 3 p.m.
Gynecological Cancers Support Group
- A support group for women with any type of gynecological cancer
- Swedish First Hill: Meets weekly on Tuesdays, from 10:30 a.m. to noon.
Prostate Cancer Educational Support Group
- A support group for men with prostate cancer
- Swedish First Hill: Meets the third Thursday of the month, from 8:30 to 9:30 a.m.
- Call Leo Ward, prostate cancer survivor, at 425-957-7440, for more information about this support group.
Expressing yourself through creative outlets has been shown to be an effective coping and healing technique. The Swedish Cancer Institute offers a variety of opportunities for cancer patients, their family members and caregivers to explore their creativity.
Art Therapy: An Approach for Healing
Art therapy is a confidential, supportive and individualized experience for visually and verbally examining health issues through self-ex¬ploration. Experience or confidence in art-making is not necessary. All materials are provided. Ongoing weekly sessions are available by appointment only. Please call 206-215-6178 to make an appointment.
Location: Swedish First Hill — A-Floor West, Cancer Education Center
Healing Arts Group
Experience the healing benefits of art-making in a supportive setting. These drop-in art-therapy group sessions are open to cancer patients, their family members and caregivers. Experience or confidence in art-making is not necessary. All materials are provided. Questions? Please call 206-215-6178.
Location: Swedish First Hill — True Family Women’s Cancer Center Healing Forum (Arnold Pavilion, 5th Floor)
Day/Time: Thursdays, from 10 a.m. to noon
Knit for Life
This network of volunteers uses knitting as a healing experience to enhance the lives of cancer patients, their family members and caregivers during treatment and recovery. It provides a supportive environment for beginners and experienced knitters. All materials are provided. Sessions are available at two locations at Swedish First Hill and at Swedish Issaquah. For more information, call 206-386-3200.
Location: Swedish First Hill — True Family Women’s Cancer Center Healing Forum (Arnold Pavilion, 5th floor)
Day/Time: Wednesdays, from 10 a.m. to noon
Location: Swedish First Hill — Swedish Cancer Institute (Arnold Pavilion, First-floor Lobby)
Day/Time: Thursdays, from 1 to 3 p.m.
Location: Swedish Issaquah — Medical Office Building, main lobby, in front of fireplace
Day/Time: Mondays, from 1 to 3 p.m.
Location: Swedish Edmonds — Medical Oncology Building, first-floor lobby
Day/Time: Tuesdays, noon to 2 p.m.
Once you choose hope, anything’s possible.
~ Christopher Reeve
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