Narrator: Coming up on Mayo Clinic Q&A:
Dr. Kathryn Ruddy: Some of the very common issues that cancer
survivors deal with include fatigue, distress, the anxiety
and emotional distress of dealing with the diagnosis and
with the ongoing therapies for some people can be really
significant, and even transitioning out of treatment
can be a distressing experience.
Narrator: Living with cancer is different for every person, and
at Mayo Clinic, Cancer Survivorship focuses on the well
being of the patient from diagnosis through treatment and
beyond. It's helped with the physical and mental aspects when
coping with cancer.
Dr. Kathryn Ruddy: Our social workers and psychologists
provide a really important type of care for our patients,
physical medicine and rehab to help with physical dysfunction.
Pain Management is very important. It's really a very
multidisciplinary practice that we bring to caring for our
cancer survivors.
Dr. Halena Gazelka: Welcome, everyone to Mayo Clinic Q&A. I'm
Dr. Halena Gazelka. June is National Cancer Survivor month,
dedicated to recognizing and celebrating the millions of
adults and children in the United States who have
experienced a cancer diagnosis. According to the National Cancer
Institute, there are nearly 17 million cancer survivors in the
US, and each one of them experiences cancer survivorship
differently. Some are living with cancer, some are cured of
their cancer, and some are suffering from long-term side
effects of the treatment of their cancer. Joining us today
to discuss cancer survivorship is medical oncologist, Dr.
Kathyrn Ruddy. Dr. Ruddy is the Associate Director of Patient
and Community Education, and co-chair of the Symptom Control
Survivorship Cross Disciplinary group at the Mayo Clinic Cancer
Center. Thanks for being here today. Dr. Ruddy.
Dr. Kathryn Ruddy: Thanks so much for having me.
Dr. Halena Gazelka: I wasn't sure I could get that title out,
that was a long one. I thought I was going to trip on that.
Dr. Kathryn Ruddy: Well, thank you.
Dr. Halena Gazelka: Thank you so much for being here. I find this
topic fascinating because I think we think so much about
treatment of cancer. But we don't necessarily think a lot
about what happens after people have treatment for their cancer.
And how wonderful that so many people are being cured or
surviving such that this is a hot topic.
Dr. Kathryn Ruddy: Absolutely.
Dr. Halena Gazelka: Can you tell us how you define cancer
survivorship?
Dr. Kathryn Ruddy: Well, it's interesting. I think some people
do think of survivorship as starting after cancer treatment,
as you kind of alluded to just now. But I tend to think of it
as actually starting kind of at the diagnosis of cancer and then
going on through the rest of life. So, for lots of people,
that means the time during treatment, and then after
treatment. For some people who need indefinite treatment for
their cancer, it means that they're always getting some type
of treatment, but the survivorship periods kind of
goes on throughout that.
Dr. Halena Gazelka: Well, that is interesting, because you're
right, I didn't think of it that way. I've already learned
something today. That's always my goal.
Dr. Kathryn Ruddy: Well, it's not that there's one right
answer. That's just for me. That's how I define it.
Dr. Halena Gazelka: So Katie, what is important about cancer
survivorship? What kind of physical and emotional needs do
patients and individuals have after a cancer diagnosis?
Dr. Kathryn Ruddy: Well, it differs a lot from person to
person, as you imagine, some related to the fact that people
are getting all different types of treatments that have
different side-effects. Some of the very common issues that
cancer survivors deal with include fatigue, because lots of
our different types of treatments can cause that,
distress, the anxiety and emotional distress of dealing
with the diagnosis and with the ongoing therapies for some
people can be really significant and even transitioning out of
treatment can be a distressing experience. There can be issues
related to finances. The financial stress related to loss
of work, or medical costs can be significant. And then there are
also physical side effects, things like numbness and
tingling of the hands and feet for people who get chemotherapy
that can cause that. So, it's really a wide variety of issues
that can happen.
Dr. Halena Gazelka: Well, I personally have experience with
having patients come into the Pain Clinic to see me who've had
chemotherapy induced neuropathies or other pain
syndromes, or even just long-term chronic pain after
their cancer treatment. So, I'm kind of familiar with that. What
other kind of medical care do individuals need after a
diagnosis of cancer, or even after their treatment is
completed?
Dr. Kathryn Ruddy: Our social workers and psychologists
provide a really important type of care for our patients. It is,
just as I mentioned, such a stressful experience that we try
to engage our social workers and psychologists often and really
offer that to all patients, and not everyone wants to take
advantage of that, but that's certainly a key piece of care
for a lot of people. Physical medicine and rehab to help with
physical dysfunction, fatigue, that's a very important. A you
mentioned, pain is a very common side-effect both related to the
chemotherapy, but also to all sorts of other parts of cancer
treatment, including surgeries and radiation. And so, pain
management is very important. It's really a very
multidisciplinary practice that we bring to caring for our
cancer survivors.
Dr. Halena Gazelka: What are some of the most common
long-term side-effects requiring treatment? You mentioned pain,
and a couple of other ones. But what are some of the long-term
physical side-effects that are left after cancer at times?
Dr. Kathryn Ruddy: Well, you know, it is so different from
person to person. I'm a breast oncologist, so one of the
symptoms that my patients often are dealing with is hot flashes.
And, of course, many women have hot flashes when we go through
natural menopause. But breast cancer treatments can make that
worse. Sometimes, women go through menopause at an earlier
age and more rapidly because of breast cancer treatments. And
our Women's Health Clinic is providing really important care
to help people manage or reduce the amount of hot flash burden.
Hot flashes can interfere with sleep and insomnia can be
really, really big problem, both related to hot flashes and
otherwise. And so, we have a Sleep Clinic here, but we also
have people in the Women's Health Clinic who help with kind
of reducing the night sweats and hot flashes that for some people
are really big problem overnight.
Dr. Halena Gazelka: I think one of the key things that I got out
of what you just said is that if people have side-effects, they
should ask about them, because there may be solutions for them.
I think sometimes we think, well, I've had, you know, an
individual might think I've had cancer, I've had treatments.
So, this is to be expected. I should just be grateful for what
I have. But I think knowing that there may be symptom management
available is really important.
Dr. Kathryn Ruddy: Absolutely. It's really important to talk to
your provider about these symptoms, but any symptoms that
you're having, but there are things that can be done. Dr.
Cheville, who is one of the PMR doctors, the rehab doctors here
at Mayo Clinic, Rochester has a huge project right now ongoing
to assess symptoms prior to every medical oncology visit in
Rochester and also through the Midwest Health System. And this
is really important. It is an incredible step forward because
it is encouraging us to communicate about these
symptoms, even prior to visits. And as part of her study, she
has nurse symptom care managers involved to help us better
address certain symptoms. Now that project doesn't address
every symptom, but really, I hope it will get people talking
more to their oncologists about all sorts of types of symptoms
so that we can offer the best treatments we can.
Dr. Halena Gazelka: That's great. Awareness is important.
In the intro, Katie, I mentioned that there are children
surviving cancer as well. And I imagine that they and their
families have very unique needs. What would some of those be?
Dr. Kathryn Ruddy: Well, you're absolutely right. For one
thing, the cancers that afflict children are quite distinct from
those that are common in adults. So, treatments and expected long
term symptoms are not the same. And so, I'm not a pediatric
oncologist. So, in my practice, I'm not seeing children or
childhood survivors. I do see adolescent and young adult
survivors. You know, breast cancer is one of the common
cancers in young women. We usually define adolescent and
young adult as actually going up to age 40. So, we do have many
young women in our clinic who actually can experience more
severe side-effects, sometimes due to our breast cancer
treatments, because of the sudden menopause. You know,
going into menopause at age 30, or at least your body feeling
like it's in menopause at age 30 comes with some pretty severe
side-effects at times: vaginal dryness, sexual dysfunction,
things that if you went into menopause at your normal age,
you know, at 50 or 55, at an average age, it would come on
more gradually and tend to be less of burdensome symptoms. So,
in terms of actual children and teenagers who are having cancer
and who are surviving, of course, there are all sorts of a
wide variety of symptoms that can happen. And really, the
experience of cancer is often both very difficult for the
children but also for their parents and lots of supports are
needed to help manage those.
Dr. Halena Gazelka: So, tell us a little bit more about some of
the unique things that Mayo Clinic is doing to help care for
cancer survivors.
Dr. Kathryn Ruddy: Well, I don't know if you've been to our
Cancer Education Center, but in Mayo Clinic, Rochester, we've
had this wonderful Cancer Education Center for years, and
there are also wonderful educational offerings at our
other sites in Florida and Arizona and the health system.
Right now, what we're working to do is to really bring all of
that together under a new education committee that will
allow patients across the whole Mayo enterprise, and even
outside of Mayo, to access these resources virtually, as well as
in person when on site. But I think one thing that the
pandemic has really helped to move forward is figuring out how
we can get these resources out to people, make them accessible,
even for patients who are living 10 hours away from here, or who
are being seen in other sites for people to be able to get the
information that they need about symptom management, about
surveillance, about psychosocial supports. And that's really, I
think, an exciting effort. We also have Mayo Clinic Connect,
which is a social media connectivity for patients to
find others who might be experiencing similar things and
to have conversations virtually, and to get support through a
moderated platform. So, these are things I'm really excited
about, and I think we'll see continue to grow over the years
to come.
Dr. Halena Gazelka: I'm really glad you mentioned the virtual
availability, because that's been one of the silver linings
of COVID that I think many of us have seen. And we're always
looking for silver linings. But we've talked so much about
virtual visits and how we are offering those even from our
oncology department, but also there's a lot of virtual
information that people can access. And so, I think that's
wonderful that we have that available and are even kind of
working on that program.
Dr. Kathryn Ruddy: I agree.
Dr. Halena Gazelka: Katie, supposing that an individual is
nearing the end of their cancer treatment, what questions should
they ask their doctor at some of their later appointments to
prepare them for what things will look like in the future and
what they should be watching for?
Dr. Kathryn Ruddy: I think some of the important questions are,
of course, what kind of care is going to be needed? You know,
when do I need to come back? Who do I need to see? What kind of
testing will I need if any? But then also, lifestyle wise, what
can I do in between those visits whether that's medications I can
take or not take or exercise or diet? Are there things I could
do to help me feel better or have a better outcome in various
ways? Those are the conversations, I think really we
should be having those throughout the cancer journey,
but from the time of diagnosis. But at the end of treatment is a
nice time to kind of have those conversations again, and to help
with the transition out of a more frequent visit schedule
into something that's probably going to be coming back, meaning
that patients are coming back less frequently. It's nice to
kind of talk about, okay what can I do at home, and when do I
need to come back?
Dr. Halena Gazelka: I think that would help a lot with
uncertainty. If people have a plan in place that's always
good. Knowledge is important.
Dr. Kathryn Ruddy: Yes, I don't know if you've heard about
survivorship care plans, which kind of refer to a document that
summarizes all of that, and survivorship care plans are
great. We love when we can provide those to patients. But
there's also just a real value to that conversation and talking
it through. And of course, for people who sometimes all the
visits can be very overwhelming. So, people should feel free to
reach out again to clinicians, if they're confused or can't
remember what was said or, you know, sometimes it's hard to
absorb and retain all that information at once.
Dr. Halena Gazelka: Katie, we talk a lot about clinical trials
for cancer and ongoing treatment for patients and various disease
states. What about cancer survivors? Are we doing research
at Mayo Clinic with cancer survivors?
Dr. Kathryn Ruddy: We are. Well, I mentioned Dr. Cheville's
really phenomenal symptom management study, which is
called E2C2 that's actually funded by the National Institute
of Health, and it's part of a much larger effort to better
assess and manage symptoms across the country. And the
symptoms I should mention on that study, the specific
symptoms that are being addressed are insomnia, pain,
anxiety, depression, fatigue, and physical dysfunction. So,
it's kind of six specific things. It doesn't cover
everything. It doesn't, for example, specifically address
numbness and tingling. But it's hard for any one study to cover
every symptom, it does cover what we think are the very
common symptoms that can occur across really all cancers and
across all types of treatment. And that's how this was
developed. But there are other studies too, that are a little
more focused, you know, focusing on clinical trials, sometimes
focus on a particular medication or a particular type of
exercise. And those are varied across the enterprise sector.
Dr. Cheville's study is the largest study I'm aware of
that's currently ongoing, that's both in Mayo Rochester and
across the entire health system.
Dr. Halena Gazelka: Katie, you know we're talking so much about
health care disparities, and we've talked about virtual
medicine as a way to be able to provide some equity and provide
care in areas and to individuals who might not be able to readily
receive it. Are their health care disparities related to
cancer survivorship that we should be aware of?
Dr. Kathryn Ruddy: Yeah, unfortunately, there are, and
this is an area of research and growing research. We really
want to do better with reducing these disparities. Some of the
issues are related to geographical and financial
barriers to care. Anything that makes it difficult to access
health care can contribute to impure outcomes for patients.
And so, it's important that we work hard to minimize these
barriers. You know, here at Mayo Clinic, Rochester, one of the
issues is we're hard to get to for a lot of people. So,
figuring out what we can provide virtually as we talked about
earlier, how can we get our resources out and available to
people who maybe live afar or have other barriers to getting
here is part of what I think we're making progress on, but we
need continued to work on.
Dr. Halena Gazelka: Well, as we are celebrating June, National
Cancer Survivor month, what else would you like caregivers and
patients to know about cancer survivorship?
Dr. Kathryn Ruddy: We're here for you. If you have questions,
please talk to your caregivers. If you're a Mayo Clinic,
patient, check out Mayo Clinic Connect, an incredible resource.
Mayo Clinic Connect is actually a sort of entry point for our
Cancer Education offerings of various sorts. National
Survivor's Day is coming up. Although this year, instead of
having a single day where we gather survivors in person,
we're actually having a month of celebration throughout June.
Every Monday in June, there'll be a new talk posted on Mayo
Clinic Connect, hosted by our Cancer Education Center,
focusing on different cancer survivorship topics. And on the
last Monday of June, there'll be a talk by a survivor, a really
inspirational talk. The talks will actually be available for
access then afterwards, for some period of months. And so please,
please check it out. And we hope that these will be useful.
Oh, that's wonderful. Thanks for sharing that. And thanks for
being here today, Katie.
Thanks so much for having me.
Dr. Halena Gazelka: It's wonderful. Our thanks to medical
oncologist, Dr. Kathryn Ruddy for joining us today to talk
about cancer survivorship. I hope that you learned something.
I know that I did. And we wish each of you a very wonderful
day.
Narrator: Mayo Clinic Q&A is a production of the Mayo Clinic
News Network and is available wherever you get and subscribe
to your favorite podcasts. To see a list of all Mayo Clinic
podcasts, visit newsnetwork.mayoclinic.org. Then
click on podcasts. Thanks for listening and be well. We hope
you'll offer a review of this and other episodes when the
option is available. Comments and questions can also be sent
to mayocllinicnewsnetwork@mayo.edu.