Survivorship FAQs
- Q: What is Vitamin D?
- Q: What is osteoporosis?
- Q. What is a second cancer? What are the causes of second cancers?
- Q. Is treatment available for cancer survivors dealing with sexual problems?
- Q. Where can I turn for help and information about my rights and responsibilities concerning health insurance?
- Q. What is a Survivorship Care Plan?
- Q. What are the after-effects of cancer treatment?
- Q. What protections does the Americans with Disabilities Act provide in regard to employment?
Q: What is Vitamin D?
Vitamin D (cholecalciferol) is a fat-soluble vitamin that helps maintain blood levels of calcium by increasing absorption from food and reducing urinary calcium loss. Both functions help keep calcium in the body and therefore spare the calcium that is stored in bones. Though the overall effect of vitamin D on the bones is complicated, it is certainly necessary for healthy bones and teeth.
While Vitamin D is present in some foods, it is also produced by the human body during exposure to the ultraviolet rays of the sun. However, seasonal changes, latitude, time of day, cloud cover, smog and sunscreen can all affect UV exposure. Vitamin D deficiency is more common in northern latitudes, making vitamin D supplementation more important for residents of those areas.
Vitamin D plays a role in immunity and blood cell formation and also helps cells differentiate - a process that may reduce the risk of cancer. From various studies, researchers have hypothesized that vitamin D may protect people from multiple sclerosis, autoimmune arthritis and juvenile diabetes. Vitamin D is also necessary for maintenance of adequate blood levels of insulin. Vitamin D receptors have been found in the pancreas, and some evidence suggests that supplements may increase insulin secretion for some people with adult-onset diabetes.
Q: What is osteoporosis?
Osteoporosis is a condition that causes weakening of bone and increased likelihood of sustaining a fracture. Osteoporosis can affect any bone in the body. The diagnosis of osteoporosis is made by measuring bone density. This is often done with a DEXA scan. For a DEXA scan you lie on a soft table and a machine moves over you without touching you. Pills and liquids are not necessary, there is no noise, it is painless and it takes a few minutes. People who are diagnosed with osteoporosis will be treated to modify their condition in an effort to prevent fractures.
Osteoporosis is common as we age. About one-third of women over the age of 65 have the diagnosis of osteoporosis. The diagnosis of osteoporosis means that your bone density is at least 2.5 standard deviations below the ideal peak bone mass found in young adults. Osteoporosis is considered severe if you have also sustained a fracture as a result of weak bone.
The two most common reasons people tend to get osteoporosis are low peak bone mass at the time of skeletal maturity or accelerated bone loss at the time of menopause. An individual reaches her highest bone mass at the time of skeletal maturity and loses bone steadily thereafter. Therefore, it is of utmost importance that young people take steps to ensure they develop as much healthy bone as possible. Once bone loss begins, it is also important to ensure the rate of bone loss is slow. The amount of bone loss can accelerate at the time of menopause. Some people will benefit by taking medications to prevent this bone loss.
Quick Facts on Bone Health
- At some point in early adulthood people reach peak bone density. Throughout life, some bone cells are made as some are depleted.
- At the time of peak bone density more cells are being made than are depleted, but as people age, the balance shifts so that more bone cells are lost than replaced.
- If bone loss is severe enough it can lead to osteoporosis, or porous, easily broken bones.
- Bone density tests are painless and use small amounts of radiation to give a measurement of the amount of minerals in the bones. These tests show how much bone has been lost and give doctors an idea of how likely a patient is to develop osteoporosis.
Q. What is a second cancer? What are the causes of second cancers?
A second cancer is a malignancy that develops in someone who has survived an earlier cancer. Formally referred to as second primary neoplasms, second cancers are also described as late effects of the original disease or of the treatment used to cure it.
Some second cancers result from the risk factors responsible for the original disease, such as a genetic vulnerability or simply aging. Some second cancers are caused by radiation or chemotherapy treatments that damage normal cells or suppress the patient's immune system.
Scientists do not fully understand why chemotherapy causes some cancer survivors to develop new malignancies. They believe radiation's role in second cancers is influenced by:
- the kind of radiation exposure the patient receives
- how much radiation the patient receives
- how old the patient is at the time of treatment
- the patient's personal and family medical history
A patient who has had cancer should be aware of the risk of developing a second cancer. However, patients should not refuse or discontinue treatment for fear of developing a second malignancy. The benefits of cancer treatment far outweigh the risk of developing a new cancer. Also, it is important to know that most people will not get a second cancer.
Q. Is treatment available for cancer survivors dealing with sexual problems?
In general, a wide variety of treatments are available for patients with sexual dysfunction after cancer. Patients can learn to adapt to changes in sexual function by reading books, pamphlets, and internet resources or listening to and watching videos and CD-ROMs. Health professionals who specialize in sexual dysfunction can provide patients with these resources as well as information on national organizations that may provide support. Some patients may need medical intervention such as hormone replacement, medications, medical devices or surgery. Patients who have more serious problems may need sexual counseling on an individual basis, with a partner or in a group. Patients and their partners should discuss treatment options with their doctor or other qualified health professional.
Q. Where I can turn for help and information about my rights and responsibilities concerning health insurance?
It is always best to first ask your insurance company or your employer for help answering your questions or solving your insurance problems. If this does not work, though, there are other resources.
Your state insurance commissioner's office is always a good place to turn for help in understanding state laws and programs; in additional, personnel may be able to direct you to other sources of assistance. They also can help you determine whether your plan is one that is under their jurisdiction.
The Washington State Office of the Insurance Commissioner can be reached via the following:
Washington Office of the Insurance Commissioner
P.O. Box 40256
Olympia, WA 98504-0256
Phone: (800) 562-6900 (in state)
(360) 753-3613
Fax: (360) 407-0186
www.insurance.wa.gov
The United States Department of Labor regulates health plans offered by many large employers. For more information try www.dol.gov.
The Centers for Medicare & Medicaid Services (CMS) runs the Medicare program and works with states on Medicaid programs. The CMS web page can be found at www.cms.gov.
Finally, many consumer groups such as the National Coalition for Cancer Survivorship may offer assistance. For very complicated problems, you may need to consult a lawyer or another expert for professional advice and help. Or you may want to ask a friend to help you make some of these calls, gather information, and keep track of the paperwork. If a professional is needed, make sure he or she has expertise in health insurance (not all lawyers or accountants do). Health insurance can be complicated and frustrating, but you are not alone. Be persistent and take advantage of the help that is available to you.
References
What Cancer Survivors Need to Know About Health Insurance, by Kimberly J. Calder, MPS and Karen Pollitz, MPP. Published by the National Coalition for Cancer Survivorship. (2006), 34 pages.
Q. What is a Survivorship Care Plan?
In order for a health-care provider to determine follow-up care, it is important for each cancer survivor to have Survivorship Care Plan, which includes a summary of the treatment that was given. The Survivorship Care Plan, also known as a treatment summary, should be kept in a safe place, and a copy should be given to all health-care providers involved in the survivor's care.
A Survivorship Care Plan typically includes a summary of treatment and problems during cancer care, along with follow-up care recommendations.
The summary of care may consist of the following:
- Diagnostic tests and results related to the cancer diagnosis and treatment
- Tumor characteristics, including sites(s), stage, grade, hormone status and biomarker results
- Details of treatment
Type of treatment (surgery, chemotherapy, radiation, transplantation, hormone therapy, gene therapy, doses and cycles ) Dates of treatment Indicators of response Side effects and problems during treatment
- Support services provided (psychological, nutritional, other)
- Contact information for treating institutions and key individual providers
- Name of key point of contact and coordinator of continuing care
A brief outline of the follow-up care may consist of the following:
- Likely course of recovery from treatment toxicities
- Need for ongoing health maintenance/adjuvant therapy
- Recommended cancer screening and other periodic testing/examination
- Possible late and long-term effects of treatment and their symptoms
- Possible psychological effects (marital/partner relationships, sexual functioning, work, parenting) and potential need for psychological support
- Information on possible insurance, employment and financial consequences
- Specific recommendations for lifestyle changes to promote health
- Genetic counseling and testing
- Known effective chemoprevention strategies
- Resources to assist in the management of adverse outcomes and facilitate follow-up
Q. What are the after-effects of cancer treatment?
Long-term effects develop during treatment, are lingering or chronic (meaning they do not go away) and continue for years after treatments are over. Many long-term effects, such as anemia and anxiety, tend to resolve over time. Some long-term effects can be permanent, including limb loss, sexual problems and lymphedema (swelling in a limb due to blockage of the lymph system).
Late effects are delayed and can surface months to years after treatment ends. Usually, the earlier these problems are identified, the easier they are to treat. Some late effects are long-lasting or permanent, including certain types of heart disease or lung disease, osteoporosis (loss of bone density), depression and second cancers. After-effects of cancer and its treatment can be classified broadly into three categories:
- Physical — such as heart or lung problems
- Emotional — such as worry, fear or depression
- Practical — such as problems with work or health insurance
After-effects can range from very mild to very serious and vary from one survivor to the next. Doctors cannot always predict which after-effects will occur, or how serious or long-lasting they will be. You may not suffer any significant after-effects at all.
If after-effects do occur, this does not mean that your health-care team gave you the wrong treatment. After-effects are sometimes an unavoidable consequence of curing cancer. However, treatment can help you manage symptoms and live a full and happy life.
Q. What protections does the Americans with Disabilities Act provide in regards to employment?
The Americans with Disabilities Act (ADA) is the most comprehensive civil rights legislation adopted to prohibit discrimination against people with disabilities. Public and private businesses, state and local government agencies, private entities offering public accommodations and services, transportation and utilities are required to comply with the law. The ADA was signed into law in 1990, extending civil rights protections to individuals with physical or mental disabilities in the area of Employment (Title I).
Title I of the Americans with Disabilities Act requires employers of 15 or more employees to provide an equal opportunity to qualified individuals. It prohibits discrimination in various aspects of employment. Title I restricts employers from asking applicants about health conditions before a job offer.
Title I of the ADA further discusses discrimination and requires employers to make reasonable accommodations. Employers are obligated to provide accommodations to the known physical or mental limitations of applicants or employees that are due to the disability. This means that employees might be obligated to tell the employer about the disability and how it limits functioning in order to receive accommodations.
In addition, employers are not required to provide accommodations to employees who are not qualified, that is, unable to perform the essential functions of the job with or without reasonable accommodations. What this means is that employers are not obligated to hire unqualified applicants nor keep employees who cannot perform the skills needed to do the main parts of the job.
Who is responsible for enforcement of Title I?
The U.S. Equal Employment Opportunity Commission (EEOC) enforces Title I of the ADA. Complaints under Title I must be filed with the EEOC within 180 days of the date of the discrimination, or 300 days if the charge is files with a designated State or local fair employment practice agency. Lawsuits can only be filed in Federal court after an individual has received a 'right to sue' letter from the EEOC. To locate an office, look under the U.S. Government in the telephone directory, or call (800) 669-4000 (voice) or (800) 669-6820 (TDD).
Employers can get free technical assistance and information about how to accommodate a specific employee with a disability by contacting the Job Accommodation Network to identify other organizations offering information and technical assistance.