Colorectal Cancer

Survivorship

Cancer survivorship is usually defined as starting at the time of diagnosis. As such, survivorship involves psychosocial issues you face during treatment and follow-up care after you have completed treatment.

Psychosocial Issues

Colorectal cancer and its treatment bring new challenges to everyday living. Even when treatment is successful, “normal life” has a different meaning, and maintaining a healthy physical and emotional lifestyle is vital to coping with the day-to-day matters of being a colorectal cancer survivor. Getting proper nutrition, engaging in regular exercise and getting enough rest can help keep you physically healthy. Be sure to take the following steps to be emotionally healthy as well.

 

Express yourself
Any cancer diagnosis causes substantial emotional reactions, which fluctuate throughout treatment and beyond, from fear and uncertainty when dealing with treatment decisions, to anger at the loss of control, to joy when hearing positive test results. Allow yourself to express your emotions freely, no matter what they are.

Be alert to depression
For some people, the emotional distress of colon or rectal cancer becomes more serious, and depression may develop. Depression can occur any time, but it is most likely to occur during times of unrelieved symptoms or side effects, which can have a substantial impact on your daily activities and a subsequent negative effect on your emotional health. In addition to talking to your doctor about ways to relieve these side effects, be alert to the signs and symptoms of depression.

 

Signs and Symptoms of Depression

Depression is more complex than feeling sad or hopeless; rather, it is a disorder consisting primarily of a depressed mood and loss of interest or pleasure in normal activities. Call your doctor if you have experienced at least five of the following symptoms every day for at least 2 weeks:

  • Persistent sad, anxious, or “numb” feeling
  • Loss of interest or pleasure in once-enjoyed hobbies and activities
  • Feelings of hopelessness
  • Feelings of guilt, worthlessness, helplessness
  • Fatigue and loss of energy
  • Difficulty concentrating, remembering, making decisions
  • Sleep problems
  • Changes in appetite and/or weight
  • Thoughts of death or suicide or suicide attempts
  • Restlessness, irritability
  • Social withdrawal
  • Repeated episodes of crying

Manage stress
Discovering ways to best manage stress will strengthen your coping abilities. Explore various ways to reduce stress to find the one that best meets your needs. Some possibilities are meditation; guided imagery; muscle relaxation; yoga; and ordinary “escapes,” such as reading, television, and games.

Set priorities
At no other time is it more important to set priorities. Priorities differ among people, and you should listen only to yourself in setting them. Some people prefer to maintain their daily routine and continue working, as it makes them feel “normal.” Others prefer to pursue more enjoyable activities and devote more time to travel, hobbies, or being with family and friends. Becoming a volunteer in the community helps some people gain perspective as well as a sense of purpose, and many find support and comfort in spirituality. Think about what matters most to you and spend most of your time doing it.

Maintain relationships
Maintaining strong relationships with important people in your life may be difficult, as you may feel like others don’t understand what you’re going through. Colorectal cancer also poses unique challenges because it involves bodily functions that are usually kept private, and talking about the cancer and its effects can be embarrassing. Your friends may avoid seeing you or talking with you because they don’t know what to say or are afraid they will say the wrong thing. Reach out to family and friends. Tell them about your fears — and happiness — so they can better understand your experience and become comfortable talking with you. Also, admit that you may need help some times, and let your friends and family help.

Intimate relationships may also present a challenge. Cancer and its treatment affect how you feel about yourself and your body and how you relate intimately to your spouse or significant other. This is especially true if you have radiation therapy to the pelvic area or an ostomy. Open communication with your spouse or significant other is essential to maintaining a good intimate relationship. You and your partner should share concerns and fears and talk about ways to feel intimate with each other in ways that may be different than before your diagnosis.

Get support
Coping with colorectal cancer is a challenge no one should have to face alone. Talking with other people with the disease can help you learn more about the disease itself, treatment options, resources, and how to cope; can provide emotional support; and can make you feel less alone. Support groups may not be for everyone, but they can provide a wide variety of benefits for people living with colon or rectal cancer (Table 1).

Your doctor or nurse should be able to provide you with a list of local support groups in your area. Many online support groups and Listservs are also available; online support offers the advantage of being available all the time and is preferred by people who would rather not talk face-to-face or who do not feel well enough to go to a local group meeting.

Become involved
Many colorectal cancer survivors have found strength in “giving back” by becoming involved in advocacy groups. These groups organize events to heighten awareness of colorectal cancer, raise funds for research, and campaign for better laws or coverage of screening and treatment. A simple way to be involved is to encourage family and friends to be screened for colorectal cancer.

Follow-up after Treatment

Your cancer care does not end after you have completed treatment. If your treatment was successful in eliminating all signs of cancer, routine follow-up with your oncologist (also called surveillance) is important because it allows for the early detection of recurrence, should that happen. The earlier recurrence is detected, the greater the likelihood that treatment will be effective.

Colorectal cancer does not recur in everyone, but recurrence is most common within the first 5 years after completion of treatment. Because of that, your follow-up visits will be scheduled more frequently during that period, and your doctor will request physical examinations, blood work, imaging studies, and colonoscopy on the basis of the type of cancer you have (colon or rectal cancer), your individual risk for recurrence and the time from completion of treatment. Your doctor will discuss your follow-up schedule.

If you have metastatic disease, your oncologist will follow you closely to monitor treatment response and adjust treatment as necessary.

It is important to remember to maintain a regular schedule of office visits with your primary care health care provider. Ask your oncologist for a cancer treatment summary so that your primary care provider knows your complete health history. Depending on the treatments you received, it may be even more important than usual to have your blood pressure and cholesterol and glucose levels monitored and to have evaluations for late effects of treatment.

Because a history of cancer is a slight risk factor for other cancers, be sure to follow recommended cancer screening for prostate, breast, and cervical cancer, as appropriate. In addition, you should continue to have routine screening for colorectal cancer, as your risk for another colorectal cancer is higher than average. You should also receive flu and pneumonia vaccines as recommended by your primary health care provider.

No one wants to hear a diagnosis of colorectal cancer. But when faced with this challenge, most people embark on the cancer journey determined to live their life to the fullest. Be one of them.

Table 1. Benefits of Support Groups

Feeling of belonging
Place to express feelings
Sense of acceptance through sharing a common experience
Avoidance of social isolation
Discovery of resources
Acquire knowledge of disease and related issues

Table 2. Questions to Ask Your Doctors About Follow-up

What is the most appropriate follow-up plan for me?
How often do you recommend office visits?
How often do I need a colonoscopy or sigmoidoscopy?
Is there anything I can do to prevent the recurrence of polyps?
What are the signs and symptoms of a possible recurrence?
Are there any long-term effects of treatment that should be monitored?
Will you help me complete a cancer treatment summary for my primary health care provider?

Additional Sources of Information

 

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