Guiding patients on the journey of cancer survivorship

The Yale Survivorship Clinic, one of the oldest in the state, is helping more patients navigate the sometimes long and lonely transition once treatment is completed.

A new patient describes her cancer history and treatment to Tara Sanft, MD, medical director of the Yale Survivorship Clinic.

(July 2012) Once the radiation and surgery to treat her breast cancer were complete, Virginia Vanini, 59, of Derby, Conn., got back to her work as a realtor. But when she visited the Yale Cancer Center’s Survivorship Clinic she realized she still had healing to do.

“I learned that physical activity also helps me psychologically,” she says, after trying advice from the clinic’s physical therapist to use the treadmill more and try a yoga exercise called the plank. “It helped me push back the free floating anxiety that you tend to feel afterward.”

This year the clinic, one of the oldest in its field, expanded its hours to serve more patients in brand new quarters on the first floor of Smilow Cancer Hospital at Yale-New Haven. The clinic serves patients regardless of their type of cancer, and turns away no patient because of inability to pay.

Serving a growing need

While survivorship care is still relatively new, the clinic serves a growing need. Sixty-six percent of cancer survivors are now living beyond five years, and many will die from something other than cancer.

“I see survivorship type of care empowering patients. They feel they have more of a road map to follow going forward,” says Tara Sanft, MD, medical director. “The idea is that if you can give survivors information and direction regarding treatment and surveillance going forward, important aspects of their care won’t fall through the cracks, and indirectly that will impact their health overall.”

Many patients find their visits to the clinic to be reassuring. “In their minds, every ache and pain might represent cancer coming back. That’s a very scary thing,” Dr. Sanft says. The clinic team can let patients know such worries are normal, discuss warning signs or symptoms that may not be normal, and reassure them that, in most cases, everything is OK.

Personalized care plan

Each member of the clinic’s team contributes to the patient’s personalized survivorship care plan. Pictured (l-r): registered dietitian Maura Harrigan; Dr. Sanft; social worker Lina Chase, and physical therapist Scott Capozza.

Most participants make their first two-hour visit within a year of completing their treatment, but they can come at any point after treatment, even years after a diagnosis. They make a second two-hour visit eight weeks later.

The team reviews each new patient’s cancer history, including details of surgical procedures, types and dates of chemotherapy and radiation therapy, and any treatment complications.

Finally, the team provides patients and primary care providers with personalized survivorship care plans, including screening and monitoring guidelines, and recommendations for continuing support and lifestyle changes. “The plan helps to facilitate discussions,” says Dr. Sanft. For example, if a patient is having memory problems, the clinic team can provide the primary care provider with strategies to help minimize forgetfulness.

Sorting out the best advice

“When I was diagnosed, I was scared to death,” says Catherine Parese, 54, who had surgery followed by chemotherapy to treat her lung cancer, and was coping with lingering weakness, fatigue, and aches in her joints and muscles. Physical therapist Scott Capozza recommended therapy to help with her knee pain, and registered dietitian Maura Harrigan provided nutritional advice.

“There’s a lot of misinformation about nutrition out there, so part of my job is clarifying what’s good information and what’s not,” says Harrigan. Survivors are sometimes afraid something they ate caused the cancer or will cause a recurrence, she says, so she gives them the facts and encourages them to focus on small changes that can have a big impact.

In addition, Parese discussed her worries with Lina Chase, LCSW. “You live scan to scan and it’s good to talk about that,” Parese says.

Support to cushion the transition

Dr. Sanft, Harrigan and Chase review cases and collaborate on the best care plan for each patient, many of whom will use the recommendations to make major lifestyle changes.

As a breast cancer survivor herself, Chase, knows that having cancer can be isolating. “Often family and friends assume that once treatments are over, the patient should be back to normal, and when that doesn’t happen, survivors often feel there’s some inadequacy within them,” she says. The clinic provides a support forum to cushion the transition from active treatment to everyday life, she says.

In the two-month period between visits, many survivors make important lifestyle changes, such as dropping weight or running a 5K race for the first time. “It’s interesting to watch patients come back for their second visit with positive results after implementing a few recommended changes,” says Dr. Sanft. “They’re impressed and proud of themselves, and that’s been one of the most rewarding aspects of the program.”

The Yale Cancer Survivorship Clinic operates on Wednesday afternoons. For more information on the clinic’s services call 203-785-CARE or visit their page on the Yale Cancer Center website.

Story by Jill Max
Photos by Robert Lisak