Segment 6: Recovery and Prevention Recovery and Prevention Download PDF

Another perspective

Anonymous, computer-generated comments from attendees at the Houston Colorectal Cancer Patient Meeting

Section A: Overview of patients participating in the survey

Section B: The initial diagnosis, consultation with a medical oncologist

Section C: Risks and benefits of adjuvant chemotherapy

Section D: Clinical trial participation

Section E: Recovery from chemotherapy, prevention of a second colorectal cancer

Section F: Patient grading of physicians and educational needs for patients

Section G: Bibliography

 Select excerpts from audio segment 6

DR LOVE: What do you advise your patients to expect in the months following the completion of adjuvant chemotherapy?

DR MARSHALL: The first thing I talk to them about is that recovery from any fatigue or side effects from chemotherapy takes upwards of three to six months before they shake it all off and feel back to 100 percent. So I suggest that they be patient about recovery.

Secondly, I talk about the anxiety that usually increases after they finish their chemotherapy. Since their diagnosis, they’ve been doing something about their cancer. They’ve been undergoing surgery, radiation, or chemotherapy. And now, all of a sudden, they’re left alone and left exposed and they’re not doing anything. They’re just waiting, and it’s very common for folks’ anxiety at that point to increase. So I tell patients to expect that, but I also reassure them that if they have questions or issues, we’re here to answer those questions.

Before your cancer diagnosis, if you had a pain in the belly or a pain in the leg, you didn’t spare a second thought about it. But once you’ve had a cancer diagnosis, with every pain you have, the first thought that comes to your mind is, “Oh, my God! There’s my cancer coming back.” And the answer is, no it’s not. That’s not what it is. But you can’t convince your brain. So we really try to reassure folks about that.

And then, finally, I present what I call “the five things.” These are factors that have been pretty well linked to decreasing one’s risk of having a second colon cancer. Not so much with keeping the original cancer from coming back, but from having another tumor appear.

DR LOVE: And just to clarify, patients who’ve had one colon or rectal cancer are at higher risk than the average person to get a second one?

DR MARSHALL: At least three times higher. And because of that, they must go through a different screening process. They need colonoscopies and the like more often than patients who’ve never had cancer. But these five prevention ideas are separate from the screening tests that we do routinely. These are behavioral changes.

The first, which is probably the hardest one, is a high-fiber, low-fat diet. A very good data set suggests a high-fiber, low-fat diet will prevent colorectal cancer in patients. Specifically, I tell patients it doesn’t mean you can’t go to Outback Steakhouse^®, just don’t go there every night. And try to reduce the amount of fat in your diet.

The second — perhaps equally hard — is exercise. The best guess is that we should be raising our heart rate for about 30 minutes every day. That’s a challenge for any of us. But there’s no one more motivated than a former cancer patient. So they usually make that change quite readily.

The third item is the vitamin folate, or folic acid. There is very good evidence to indicate that supplementing one’s diet with folate is a good thing, particularly for colon cancer. If you are on a high-fiber, low-fat diet, you’re getting plenty of folate — you may be killing two birds with one stone.

The fourth thing is calcium. Very good data suggest that the more calcium we can take in, over 1,300 milligrams a day, the more we decrease the likelihood of having colon cancer or dying from colon cancer.

And the last one, which is a little bit controversial but less so every year, is taking a baby aspirin a day, which is 81 milligrams.

If one looks at these five practices, interestingly, they are all linked to what we call heart-healthy behavior. It appears that what’s good for your heart — and, therefore, also good for risk of stroke — also seems to be good in preventing colon cancer.

Many of these same things have also been linked to a decreased risk of breast cancer. These “five things” are just good things to do, good ways for patients to live.