What happens after you are given a cancer-free diagnosis

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Transcript

Host: Tessa Lackey:

What happens as you transition from receiving cancer treatment to that cancer-free diagnosis? Welcome to Prescribed Listening. I'm your host, Tessa Lackey. In today's episode, we explore what happens after you receive a cancer-free diagnosis with nurse practitioner Jodi Mcclain. Jodi works with UToledo Health Survivorship Clinic at the Eleanor N. Dana Cancer Center.

In this episode, we discuss the evidence-based decisions that go into what happens after cancer treatment. We also discuss survivorship appointments and tips to help you manage your mental health. So here's our discussion with Jodi. Jodi, thank you so much for joining us. Tell us about you and what you do for UToledo Health.

Guest: Jodi Mcclain:

Well, thank you, first of all, for the invitation to share more on this important topic. I'm an advanced oncology nurse practitioner. I've been a nurse for over 24 years. And early in my career, I learned that cancer patients, their families, I wanted to specialize in that. I just fell in love with it. I became very passionate. The Eleanor N. Dana Cancer Center is located at UTMC's Health Science Campus, and that is where I currently practice. My role includes patient education, follow-up appointments, side effect management, surveillance and survivorship.

Host: Tessa Lackey:

Awesome. Okay, so after going through cancer treatment and after hearing the words, something along the lines of cancer is gone, I imagine most people are obviously relieved to hear that, but that there's also mixed reactions to hearing it. So once you've gone through treatment, have had the appointment saying the cancer is no longer being detected, what happens next?

Guest: Jodi Mcclain:

So that is a great appointment for a lot of patients, but you're right, it is also scary for some patients. Many years ago, the Institute of Medicine came out with a report and it was called Lost in Transition. Basically, patients when they finish treatment, they're there with us often. They're there for appointments, treatments, lab work. And then all of a sudden, someone says, "Okay, well, we'll see you in three months," and that safety net gets pulled right out from underneath them.

The way I explain surveillance to my patients is watchful watching. We have evidence-based guidelines that we follow from the National Comprehensive Cancer Network or the NCCN. And for example, they give us an algorithm. So each diagnosis has evidence-based recommendations. When do we check blood work? Do we need to check blood work? When do we do imaging? For example, a woman who finishes breast cancer treatment perhaps after radiation, their mammogram, we would wait six months.

That's evidence-based, and we get that right from the NCCN algorithm. The appointments with the oncology team are about every few months. And survivorship, after completing treatment, we discuss things like healthy lifestyle choices, strategies to decrease the chance of a recurrence or another type of cancer. So those appointments, everything's looking great and how do we move forward and continue to have things look great.

Host: Tessa Lackey:

Essentially what I'm hearing from that is it's all evidence-based when you have that conversation and then everything moving forward is evidence-based. It's not just some routine or anything that's happening. There's science to all of it essentially.

Guest: Jodi Mcclain:

Correct. Correct. Some patients say, "Well, aren't you going to run me through a scanner?" That fear of recurrences is very real and very normal, but we can say to them with good evidence, "No, we don't need to do that, or yes, you will have a scan, but we don't need to do it for several months," and we can alleviate those fears and walk alongside the patient.

Many times survivorship, what they just went through being diagnosed, they just put their head down and get through it. And then when they're on the other side of it, they're looking back like, "Oh wow." They need to process what they just went through too. Some of these survivorship visits are a time and a place and a space for them to be able to do that as well.

Host: Tessa Lackey:

I would imagine that this is a time where they leave their appointment and go home and they start getting on the internet and looking at different things. So for anyone that's leaving their appointment or maybe just had it recently and is listening to this and they're going to Dr. Google for any questions or trying to find some kind of comforting article, what would you recommend to them?

Guest: Jodi Mcclain:

So what I recommend to my patients is the internet can hold good information, but it sometimes can also be a black hole. So we talk about trusted websites. For example, the NCCN I mentioned, they have a patient website full of resources that is not someone's blog or opinion that they're going to stumble onto.

Those are, again, evidence-based things. The American Cancer Society, they have a great... Cancer.org is their website. And again, that is a great place to look for. There's nothing wrong with Google. I mean, sometimes you can get to good things, but I just tell patients to be careful.

Host: Tessa Lackey:

Yeah, that makes sense. Make sure what you're searching for and looking at is accurate information and evidence-based. And then those links as well we'll include in the show notes. So anyone that's interested in looking at those sources, they can find those there. So what can patients expect from their body after cancer treatment? So what kind of symptoms could they be experiencing?

Guest: Jodi Mcclain:

Yep. Recovery is very individual. Many patients, they want to feel exactly how they felt before they were diagnosed. This includes physically and mentally. I talk with my patients and I encourage them to give themselves some grace. Symptoms such as fatigue or appetite take time to return to pretreatment. And for some people they may have this new normal, and I tell them, a little tincture of time can go a long way.

Six to 12 months is a time period that I discuss a lot with patients, and I have had many, many patients who say just about that six, seven, eight months, maybe they've had a couple of follow-up appointments, maybe they've had that good scan, that's when they really start to feel like they can almost let go of some of the physical and the mental side effects that they experienced.

Host: Tessa Lackey:

And so what does follow-up care look like?

Guest: Jodi Mcclain:

So for follow-up, something called a care plan includes a treatment summary and their follow-up moving forward. We want to ensure that there are other cancer screenings that are up-to-date. For example, a colonoscopy maybe for a breast cancer survivor or a mammogram for a lung cancer survivor. That follow-up is something that the nurse practitioners at the Dana Center, we try and look at holistically.

Yes, they're a survivor of this type of cancer, but what are some things in their life or what are some action steps that they can take to make sure that they're healthy overall? This care plan is meant to empower the patient to take an active role in their health. We use these appointments looking back at their diagnosis, their treatment, but really what we want to concentrate in is looking forward to their overall health.

Host: Tessa Lackey:

I love that, focusing on looking forward to your overall health and looking forward to the rest of your life.

Guest: Jodi Mcclain:

Sometimes my patients have said, "Okay, well, wow, that just happened," and they really are just taking a beat to just really acknowledge what they went through. And then at that moment, that's great because now we're going to look forward and what can we do to be healthy overall moving forward? So it's one of my favorite appointments are the survivorship visits.

Host: Tessa Lackey:

So how often do you normally have the survivorship appointments?

Guest: Jodi Mcclain:

I would say I probably have them more often than they're called a "survivorship appointment." Many of the follow-up visits include topics of survivorship, well-balanced meals, getting a little bit of exercise, how are they feeling intimately with a partner, getting their life not back on track, but doing the things that maybe in the middle of treatment, those things got pushed to the wayside so they could concentrate on their cancer treatment.

Host: Tessa Lackey:

And then how long are people able to have those appointments? Is it for the first six months, first two months, the first year?

Guest: Jodi Mcclain:

Honestly, I would say throughout their entire time of surveillance, that watchful watching period. Patients try and get to that five-year mark. That means a lot to a lot of people. But an appointment with one of the nurse practitioners, maybe that first appointment is the survivorship visit. But then when we see them again in maybe three, maybe six months, we're still talking about all those same things.

So it's the title of the appointment, but survivorship care is ongoing, is ongoing. If someone called our office and said, "I was treated with this type of cancer two years ago. I just moved to the area. I'd like a survivorship visit to continue my surveillance here in town," great, be happy to see you. So I don't want to say it never ends, but those appointments, there's no end date for us.

Host: Tessa Lackey:

Okay, it's kind of just like a check-in, overall check-in.

Guest: Jodi Mcclain:

For sure. For sure. What we try and do is a patient perhaps that was diagnosed, they've had their surveillance, and then if they're just entering into survivorship let's say five years out, well, there are so many things that during those first five years that hopefully have been happening, you would want to capture people sooner than later.

Host: Tessa Lackey:

Do you need a referral?

Guest: Jodi Mcclain:

You don't need a referral necessarily. Calling the office, and I'm sure you'll have the phone numbers listed for the Dana Center, they can explain. I mean, there is a process of getting the medical records or things of that nature, but I don't believe we need a referral for it. Some insurances may differ, and that is something that maybe the patient can check with their insurance provider. But our office, if they called and said, "I'd like to come in for an appointment," we would go into the steps to get their records and see them.

Host: Tessa Lackey:

From what I have heard and what I imagine for people, despite this good news, the fear of cancer doesn't just all of a sudden go away. So how can people cope with the fear of cancer and their mental health?

Guest: Jodi Mcclain:

Yes, it's very natural to fear recurrence. What we don't want is for this fear to overwhelm the patient. We have a wonderful, amazing resource in our area. It's called the Victory Center. They have places in Toledo, Perrysburg, and Defiance, and the American Cancer Society. There are many support groups that allow patients to express what they're feeling in a setting with others who are also coping.

I think that the mental aspect of it is important to share with other people that feel the same way and had the same feelings. I think there's a lot of power in supporting each other. Those resources have some local groups that patients can get in touch with.

Host: Tessa Lackey:

So tell us more about the Survivorship Clinic at UToledo Health.

Guest: Jodi Mcclain:

At the Dana Cancer Center, I work alongside two amazing nurse practitioners, Brittany Collins, Christine Warner-Valentine, and we offer appointments for patients. It's to review the diagnosis, the treatment, address any lingering symptoms, patient concerns, ensure that they have their follow-up plan in place, order their surveillance imaging, their labs. Really we help navigate them through this time after treatment moving forward.

It can be hard for a lot of people and we're here to help with that, answer questions and continue to walk alongside them. This is their journey. These appointments we usually schedule are about an hour. They can be less if the patient needs less time. But for those patients that really need that separate time, it's a great way to help support and give them that.

Host: Tessa Lackey:

Awesome. Well, is there anything else that you would like to add regarding the Survivorship Clinic or anything that we offer at UToledo Health or just about finishing cancer treatment and walking into a new stage of their cancer journey?

Guest: Jodi Mcclain:

Yeah, I think many patients aren't sure when they are survivors. It's a wonderful word, but it's scary for a lot of patients. We at the Dana Cancer Center, a survivor is any patient the day that they're diagnosed, they become a cancer survivor. Many of the topics that we cover today are a patient that has gone through curative intent treatment.

There are other patients that need supported in many other ways that maybe their diagnosis was not caught in the curative setting. They're still survivors too, so we're here to help them. We have an amazing team, and I'm really, really proud of what we do.

Host: Tessa Lackey:

I love that. Awesome. Well, how can people schedule an appointment at the Survivorship Clinic?

Guest: Jodi Mcclain:

So our number is 419-383-6644. Like I said, there are, myself included, there are three nurse practitioners. We are there Monday through Friday. We try and be as flexible as we can for these appointments, and we would love to meet with whoever needs us.

Host: Tessa Lackey:

Thank you so much again for joining us, Jodi, and thank you for listening. If you'd like to schedule a survivorship appointment, you can call the number that Jodi just listed for the Eleanor N. Dana Cancer Center in our show notes. In our next episode, we have Dr. Hadzi from Radiation Oncology at UToledo Health joining us again on the podcast to discuss radiation therapy.

We'll be diving into what radiation therapy is, discussing an overview of what you can expect during cancer treatment with radiation therapy, and the other uses radiation therapy can be used for outside of cancer. So don't forget to subscribe before you go so you don't miss any current or new episodes with UToledo Health providers.