Cancer is a group of diseases defined by abnormal growth that begins destroying healthy tissue. As of just a few years ago, scientists placed a person's lifetime risk of developing cancer at 38.5 percent, but thanks to better detection and treatments cancer survivors are living longer, healthier lives after diagnoses. That's great news. But that's not the whole story, because even with the best medical treatments, many cancer survivors may need long-term care. Read on for more on the different types of care available, some common psychological effects of cancer, and answers to frequently asked questions.
Risk factors for cancer are defined as either factor known to increase cancer risk or factors which may increase tumor risk.
The following factors are known to increase cancer risk:
- Cigarette smoking and tobacco use
- Immunosuppressive medications after an organ transplant
Some factors which may increase tumor risk include:
- Physical activity
- Environmental risk factors
Some of the types of cancer include:
- Breast cancer
- Lung cancer
- Prostate cancer
- Bladder cancer
- Ovarian cancer
- Penile cancer
- Non-Hodgkin lymphoma
- Bladder cancer
- Pancreas cancer
- Stomach cancer
- Non-small cell lung cancer
- Ovarian cancer
- Colorectal cancer
- Cervical cancer
- Skin cancer
- Bronchial cancer
Tobacco use is the greatest risk factor for terminal cancer worldwide. Tobacco use includes tobacco smoking, smokeless tobacco use, and secondhand smoke. Tobacco smoking is known to cause a variety of cancers including lung cancer, esophagus cancer, larynx cancer (voice box), mouth cancer, throat cancer, kidney cancer, among others.
Second-hand smoke (also called environmental tobacco smoke) is known to cause cancer in individuals who do not smoke.
A variety of infectious agents are known to increase one’s risk of developing cancer. These include various bacteria, viruses, and parasites. One way in which an infectious agent is thought to cause cancer is by Interfering with normal signals in the body which keep abnormal cell growth under control.
Another way that infectious agents are thought to cause cancer is by weakening the immune system so that an individual is more susceptible to other cancer-causing agents. It has also been identified that some infectious agents may cause chronic inflammation in the body which eventually may lead to cancer as well.
Ionizing radiation is another risk factor known to cause cancer. Ionizing radiation refers to radiation with specific wavelengths that is capable of damaging one’s genetic DNA resulting in cancer.
Ionizing radiation includes radon, x-rays, gamma rays, and other forms of high-energy radiation. Lower-energy, non-ionizing forms of radiation, such as visible light and the energy from cell phones and electromagnetic fields, do not damage DNA and have not been found to cause cancer.
Immunosuppressive medications after an organ transplant
Immunosuppressive medications are thought to cause cancer by suppressing one’s immune system leaving one vulnerable to abnormal cells (cancer cells) in the body which are then free to grow and divide unchecked. These medications are given after an organ transplant to prevent one’s body from rejecting foreign tissue in the donor organ they have received.
Eating a healthy balanced diet high in vegetables, fruit, and fiber and low in salt, processed foods, and red meat has been shown to be effective in reducing one’s risk of developing cancer. In addition, eating a healthy diet helps reduce the risk of obesity which is the second largest preventable cause of cancer.
It is not clear exactly how alcohol increases one’s cancer risk. It is thought that alcohol may do this in a variety of ways depending on the type of cancer that results.
Alcohol may cause cancer by:
- Causing damage to cells of the body
- Interfering with the absorption of folate and other nutrients
- Increasing one’s risk of obesity
- Causing increased levels of estrogen and other hormones
- Decreasing the body’s ability to neutralize and get rid of harmful chemicals from the body
- Working with other chemicals such as tobacco to weaken body tissues allowing harmful substances to enter the body which may cause cancer
Sedentary behavior has been linked to increased rates of cancer. This may be true even if a person is physically active during other parts of the day and week. Research also suggests that physical activity is beneficial for cancer survivors by helping cancer survivors reduce weight gain, fatigue, depression, and cancer recurrence and progression while improving mental health and physical and social functioning as well as increasing the likelihood of survival (prognosis).
Obesity may also increase one’s cancer risk. Excess fat cells appear to increase levels of various hormones and growth factors in the body which affects how cells in our body work. Obesity has been linked to two of the most common types of cancer, namely breast cancer and bowel cancer, as well as three of the most difficult forms of cancer to treat including esophageal, gallbladder, and pancreatic cancers.
Research has shown that there is an increased risk of colon cancer in individuals who have type 2 diabetes. These individuals are also more likely to die from colon cancer than are individuals who do not have diabetes. In addition, type 2 diabetes and certain types of cancer have certain risk factors in common such as:
- Increased age
Environmental risk factors
A number of environmental factors are known to cause cancer or are associated with increased cancer rates. These chemicals may be found in the air we breathe or the water we drink and include substances such as asbestos, cigarette smoke, pesticides, radon gas, and industrial waste products. Ultraviolet radiation from the sun is also known to cause skin cancer.
Although it may be overwhelming to realize all the possible causes of cancer, it is encouraging to know there are several things one can do to prevent cancer:
- Get off the couch and move around for 30 minutes a day, even if it's just a slow stroll
- Keep sugar out of your diet as much as possible
- Eat a wide variety of vegetables, and eat lots of them
- Avoid consuming processed meats and limit consumption of red meats (beef, pork, lamb)
- Limit alcoholic beverages to one or two drinks per day
- Keep processed, salty foods to a minimum
- Cut out tobacco use
Signs and symptoms of cancer
Early recognition of the signs and symptoms of cancer are critical in helping an individual obtain prompt treatment early which can significantly increase one’s chances of survival while reducing disability.
First of all, it is helpful to identify what is meant by “signs and symptoms”. A sign refers to an objective observation that someone else may also see and notice. An example of a sign may be a mole, a protruding lump, or blood in one’s urine.
A symptom refers to a subjective observation made by the individual experiencing the particular symptom that usually others cannot see. For example, an individual may be experiencing fatigue, however, this is not recognized by one’s family and friends until it becomes severe and debilitating.
The signs and symptoms of cancer that one may experience are varied and depend both on the body systems affected and if the disease has spread to other sites in the body. Common signs and symptoms include:
- Lump or area of thickening that can be felt under the skin
- Weight changes, including unintended loss or gain
- Skin changes, such as yellowing, darkening or redness of the skin, sores that do not heal, or changes in existing moles
- Changes in bladder or bowel habits
- A persistent cough or trouble breathing
- Difficulty swallowing
- Persistent indigestion or discomfort after eating
- Persistent, unexplained muscle or joint pain
- Persistent, unexplained fevers or night sweats
- Unexplained bleeding or bruising
Early detection and screening
Early detection and screening are two important interventions against cancer that work hand-in-hand. Both are important for improving an individual’s chance of recovery and long-term survival from cancer. Early detection requires one to be aware of the signs and symptoms of cancer and to seek medical attention promptly should they discover any of these signs and symptoms.
Screening refers to an important intervention in which various exams, tests, and other procedures are performed in order to identify potential cancer development as soon as possible, ideally in its earliest stages. Screening is of particular importance in high-risk individuals such as individuals who have a family history of a particular type of cancer or those who have been exposed to tumor risk factors known to cause cancer such as asbestos.
Physical care needs
The physical care needs of an individual who has cancer or who is a cancer survivor are as varied as the types of cancer that exist and the many body systems that can be altered by the disease. Other factors that also play a role in what physical effects an individual will experience include how advanced the cancer was when it was discovered, where it spread to in the body before and during treatment, and if all cancer was successfully removed with treatment.
One’s age and any pre-existing health conditions will also result in more complex physical care needs after a cancer diagnosis and subsequent treatment. Cancer treatments may include chemotherapy with a variety of medications, radiation therapy, and various surgical interventions.
Physical care needs during and after treatment are wide-ranging and depend on what stage of cancer treatment an individual is in, how well one is tolerating and responding to cancer treatment. If the disease is not treatable, physical care needs will center around hospice care and keeping an individual as comfortable as possible in the last stage of life.
If an individual has successfully completed treatment and is currently cancer free, they may be able to return home, however, varying degrees of fatigue and weakness are common following cancer treatment. You may need to do some home modifications to help your loved one climb stairs or safely move around the bathroom. Handrails and bath equipment such as a shower chair may be required to help prevent falls in the bathroom. Financial assistance to make these needed home improvements is available for older adults through various programs.
An individual may also require some assistance with dressing, eating, toileting, getting around safely, and medication administration as well as meal preparation and laundry. If the individual received any cancer treatment, there may be dressing changes and wounds that need to be assessed regularly as well.
Once an individual’s physical care needs have been identified, the next step is to determine if these needs can be met at home with the help of a caregiver and/or the assistance of various home health care services. Home health care services may be paid for by Medicare if other skilled care is also required. Otherwise, these services are typically paid for through private pay, long-term care insurance, or private insurance. However, once an individual qualifies for and chooses hospice care, home health care services are provided under the Medicare hospice benefit.
If an individual cannot return home after a cancer diagnosis and/or treatment or their care needs can no longer be met at home, an individual and their family will need to consider other long-term care options.
Psychological effects of cancer
Both an individual with cancer and their family may require assistance addressing emotional and psychological needs that result when a diagnosis of cancer is received. The support needed also depends on the prognosis (likelihood of survival) and the treatment options available.
For individuals with cancer who are eligible for Medicare, mental health services are covered including services received outside of a hospital and through cancer hospital outpatient departments, however, the cost of these services may include copayments, coinsurance, and deductibles.
Once an individual elects to receive hospice care, both the individual with cancer and their family are eligible to receive emotional and spiritual support through qualified professionals on the hospice team. Support is also available through various organizations online, by phone, and in-person.
Providing care for an individual with cancer presents unique stressors and challenges for a caregiver. Often a caregiver puts their own physical, emotional, spiritual, and personal care needs aside during this time but this can result in burnout, fatigue, and even illness for the caregiver. In order to provide the best care possible to an individual with cancer, a caregiver must, first of all, ensure their own needs are being met during this difficult time.
The National Cancer Institute (NIH) provides the following tips for cancer caregivers:
Be prepared for the challenges of caregiving.
- It is common for a grown child to find themselves in the caregiver role with a parent who is now dependent on them to help meet their needs. Conversely, a loved one may only want help from their spouse or partner and not their children.
- Ask for help. What things do you want to do and are you able to do? What can you ask others to do?
- Be prepared for some people to not help. There are many reasons why others cannot or do not help with caregiving. See the link regarding tips above for a better understanding of why some people are unable or unwilling to help.
Take care of yourself.
- Make time for yourself to relax and tend to your personal life
- Find ways to “keep up your routine” to reduce stress
- Find an “outlet” or way of dealing with your thoughts and emotions. Seek out support groups in-person, by phone or online
- Learn more about your loved one’s cancer
- Try to eat healthy foods
- Watch out for anxiety and depression.
- Tend to your own medical needs.
Learn how to give cancer care long-distance.
- Make a list of contacts near your loved one that you can call in a crisis or any time of day.
- Find out what services and supports are available where your loved one lives and contact them as needed.
- Provide the healthcare team and other local contacts with home, work, and cell phone numbers in case of emergency.
- Ask a local friend or family member to update you daily by email.
- Use online methods of connecting with your loved one and local contacts such as FaceTime or Skype.
- If traveling to see your loved one, leave enough time to rest when you return home before returning to work.
Regardless of whether an individual is being cared for in a cancer hospital, at home, or in long-term care, the national cancer institute notes that a time may come when a physician determines that an individual is in the terminal stages of the disease and hospice care may be recommended.
Hospice care refers to a model of providing compassionate quality care to individuals who are facing the end of life as the result of a terminal illness or life-threatening injury.
At the heart of this model is the belief that individuals have the right to die with dignity while remaining pain-free. It also recognizes the need for families to be supported during this time as well. End-of-life care is provided by a team of professionals whose goal is to provide expert medical care including pain management while addressing the unique emotional and spiritual needs of both the individual who is dying and their family. Hospice facilities may include hospice houses, hospitals, or an inpatient residential cancer center. While hospice care may be provided to an individual in any setting including long-term care facilities, 93.8% of hospice care happens at home.
To qualify for the Medicare hospice benefit, two physicians must determine that an individual has six months or less remaining to live. Eligibility must also be reassessed at regular intervals, however, there is no limit to the number of days of hospice care that may be provided under this benefit.
When an individual chooses hospice care, they are indicating that they are no longer looking to cure their condition but instead want to pursue end-of-life care options. An individual may also opt for hospice care when a physician determines that their condition is terminal rather than curable.
Once an individual and their family have decided that they want to pursue hospice care, a hospice team is assigned to the individual to help them develop a plan of care going forward. It is important to note that once an individual and family have decided to pursue hospice care, the following medical care and services are no longer covered by Medicare:
- Treatment intended to cure one’s terminal illness and/or related conditions
- Prescription anti-cancer drug to cure an illness or disease
- Care from any hospice provider set up by someone other than the hospice medical team
- Living accommodations
- Care that is unrelated to one’s terminal illness and related conditions
- Other medical care that is not arranged by one’s hospice team
Medicare does not pay for room and board in a facility outside of one’s home during hospice care, however, short-term stays in an inpatient facility are covered if one’s hospice team has determined these services are required.
Hospice services that Medicare will cover as part the overall plan of care developed by one’s hospice team include:
- Doctor services
- Nursing care
- Medical equipment
- Medical supplies
- Prescriptions for symptom control or pain relief
- Physical therapy services
- Occupational therapy services
- Speech-language pathology services
- Social work services
- Dietary counseling
- Grief and loss counseling for you and your family
- Short-term inpatient care
- Any other Medicare-covered services needed to manage one’s pain and other symptoms related to one’s terminal illness and related conditions as recommended by the hospice team
The most important thing for individuals and families receiving hospice care to remember is that if an individual with cancer needs additional services or wants to change services, it is essential that they speak to their hospice team first. Some services that Medicare does not usually cover may be covered if the hospice team determines they are necessary and arranges for these services. If an individual or family member selects services without consulting the hospice team first, they may have to pay for the entire cost of a service themselves. Arranging needed services through an individual’s hospice care team can save thousands of dollars in out-of-pocket costs.
For more detailed information about Medicare and Medicaid hospice care coverage and eligibility, please refer to the information provided here.
If an individual with cancer is being cared for at home, the caregiver, who may be a spouse or family member, may benefit from respite care services at some point during the care trajectory.
As discussed earlier, it is imperative that caregivers take care of themselves and ensure that their own needs are met before they are able to provide adequate care for an individual with cancer. Respite services may be provided in one’s own home for just a few hours or respite care may be provided in a facility for a number of days depending on the caregiver’s needs. Short-term respite care is covered by Medicare if an individual’s physician has determined that they have less than 6 months to live and the individual and their family chooses to receive hospice care.
If an individual is unable to remain at home due to increased care needs, the individual and their family will need to consider other living accommodations such as assisted living facilities, nursing homes, or skilled nursing facilities (SNF).
Although assisted living facilities do not usually provide medical care services to residents, an increasing number of assisted living facilities are beginning to provide more services to allow an individual to “age in place“ without having to move once they require increased levels of care. This may include providing certain medical services and/or allowing hospice team members to come into a facility to provide this care for an individual.
It is important to find out what services are provided in an assisted living facility that you may be considering and what the cost of services may be. Most assisted living facilities
Payment for assisted living is usually through private pay, long-term care insurance, or private insurance. Assisted living is not covered by Medicare. Medicaid may cover some of the costs of assisted living through Medicaid waivers although these plans are limited and vary by state.
Selecting a nursing home to care for an individual with cancer who is no longer able to live at home may be a good option depending on one’s medical care needs. Nursing homes are able to provide room and board as well as ongoing medical care including assessment, medication administration, injections, wound management, and pain management in addition to assisting the individual with activities of daily living (ADLs) such as bathing, dressing, toileting, eating, and mobilizing.
It is also possible for members of the hospice team to come into some nursing homes to provide care for an individual once agreements between the hospice team and nursing home have been signed. When considering a nursing home, it is important to confirm with both the hospice team and the nursing home that such arrangements are possible prior to admission. Palliative or end-of-life care can also be provided in a nursing home often in collaboration with the individual’s assigned hospice team.
Payment for nursing home care is usually through private pay, long-term care insurance, or private insurance. Medicare with pay for up to 100 days of nursing home care after an individual has had a 3-day hospital stay and only if they require skilled care. Medicaid will also help pay for nursing home care if an individual qualifies based on their income. Other programs that may provide financial assistance include programs through The Department of Veterans Affairs (VA) and the Program of All-Inclusive Care for the Elderly (PACE).
Skilled nursing facilities
Skilled nursing facilities (or SNFs) are primarily designed to provide ongoing treatment, highly skilled medical care, and rehabilitation services for a cancer patient who has recently been discharged from a hospital. Unless an individual is actively pursuing curative treatment and rehabilitation in hopes of regaining function, this would not likely be the type of facility that an individual would choose once they have opted for hospice care.
However, if an individual is leaving a hospital after an acute medical event or after treatment for complications from cancer treatment and is pursuing active cancer treatment, then care in an SNF may be a good choice if an individual requires more complex medical care. In addition, Medicare will cover medical care for a cancer patient in a skilled SNF following a 3-day hospital stay as long as the individual has not opted for hospice care.
Knowing what care options and services are available and how these services may be paid for can help reduce some of the stress and uncertainty faced by individuals and their families who are living with a cancer diagnosis.
1. Why does my doctor want me to quit taking supplements when I’m receiving my cancer treatments. They’re all natural supplements that I bought at the health food store so they’re just like eating food, aren’t they?
The reason your doctor wants you to quit taking your natural supplements, for now, is that they can sometimes interfere with the treatments that you are receiving. Supplements are not the same as food. Once you have finished your cancer treatments, you should ask your doctor if it would be acceptable to resume taking your supplements again.
2. My husband has prostate cancer and now the doctor says it has moved to his bones. He’s been having more pain lately and I’m worried they won’t be able to control it. Is it possible to treat all cancer pain or do people sometimes have to suffer?
There are different kinds of pain and nerve blocking medications that are very effective for treating bone pain and other kinds of cancer pain. The key to managing cancer pain is ensuring that you are working with a medical care team who is knowledgeable and comfortable treating cancer pain since the dosage of pain medication required for pain control for your husband may be much higher than is normally recommended for patients without cancer pain.
Patients with cancer pain do not need to suffer, however, it may take a few days to find the right medication and the right dose that works to keep your husband comfortable.
3. I’m wondering if there’s any point in cleaning up my diet and starting to eat healthy now. I was just diagnosed with colon cancer. I heard that a healthy diet can help slow the growth of cancer. Is that true?
Yes, it is true that it is beneficial to begin eating a healthier diet even after one has been diagnosed with cancer. Reducing one’s intake of sugar, salt, alcohol, and processed foods can significantly improve one’s health. This will potentially make you healthier and better able to tolerate your cancer treatments. In addition, research shows that eating a healthy diet may also “starve” cancerous cell so that cancer cells grow much more slowly.
4. Is it normal for my mom to be so tired after her chemo treatments? The doctor told us that the treatments could make her tired but she sleeps all day it seems after her treatments. She has no appetite either and doesn’t eat. Is this normal or should I be concerned?
Unfortunately, this is not unusual for people going through cancer treatment like your mom. Chemotherapy can have a variety of effects on people depending on a number of factors including how healthy the individual was before they were diagnosed, their age, the type of medication being used and the dose, and the frequency of treatments as well as other medications and treatments your mom may be receiving.
However, it is important for you to advocate for your mom by letting the doctor know how tired she is after her treatments. The doctor may decide to alter her treatment regimen because of this. It is also important that your mom
Proximity of care is very important when considering options
Research care options that are nearby when thinking about the next step for your loved ones.
Leona J. Werezak RN, BSN, MN is a registered nurse and adjunct nursing professor. She has 24 years experience working in a variety of healthcare settings including such remote locations as the Arctic Circle. Her research in early stage dementia was published in the Canadian Journal of Nursing Research and re-published in their 40th anniversary issue which showcased exceptional research published since the journal began. Her work in dementia care has also been published in the Journal of Gerontological Nursing. She currently teaches surgical nursing care on a thoracic/vascular unit to baccalaureate nursing students. Her clinical work with nursing students involves extensive work with older adults who have multiple chronic health conditions.