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Melanie Cole (Host):  Because of treatment advances, many cancer survivors can look forward to leading normal lifespans but many also face fears about recurrence, new cancers and even the potential long-term side effects from the same therapies that helped save their lives. My guest today is Leann Perkins. She is a nurse practitioner in Oncology at Greenville Health System. Welcome to the show, Leann. Let’s speak about cancer survivors and what do you hear them say are some of their biggest fears after the diagnosis of cancer itself, during treatment and beyond?  

LeAnn Perkins (Guest):  Hi. Thank you. During treatment, of course ,fears are the side effects that they’re going to experience and also the side effects they are experiencing--acute issues such as maybe nausea or maybe fatigue. But later, they have fears of course of reoccurrence after they have finished all of their treatments. I think we sometimes refer to that as a “new normal”. Some of the patients call it their “new normal” in that now that they’ve had cancer everything that comes up in their body they have to question is this cancer or should I be concerned about this in a different way than if I had never been exposed to cancer.

Melanie: Let’s talk about survivorship and what that word really means. If you make it through your treatment, you get through that and you’re look toward your quality of life now and, as you say, those fears that everything you feel or every new little anything makes you a little bit scared. How do you define that new normal and what is survivorship?

Leann: Used to be that people would hear that if they had been a cancer survivor for five years that they had a decreased risk of reoccurrence. Somewhere along the way, a lot of our patients have gotten in their mind that if they’ve made it to five years then they’re good, they don’t have to worry about cancer again; whereas, others have not necessarily heard that or they think that they’re considered a cancer survivor after five years. Really, you’re a cancer survivor from the time that you are diagnosed because you are surviving. In our clinic, we think of you as a cancer survivor right away and up until for the whole rest of your life. With most cancers, we can’t really say that there is absolutely no risk of it ever coming back. We have to just be realistic about that. In our Lifetime Clinic, we follow our patients forever and help keep those fears at bay. Also, as far as quality of life, certainly, there are patients who are left with issues such as neuropathy or fatigue or fears that could maybe even disable them from being able to continue functioning in their normal lives. We have to screen for long-term effects but also for reoccurrences or for secondary cancers because we know that people who get cancer can have a tendency to develop another cancer. We screen and make recommendations for secondary independent cancers. Also, they have fears about their families.  Their relationships have changed. There are oftentimes sexual dysfunctions or issues within the family that are different than what it was before they had cancer. Lastly, about that same point is genetics. We also have a genetic counseling department and we like to revisit that every few years and see if this is something that is looking like it is running in the family or do we need to consider genetic testing so that their family knows what they need to think about as far as their own personal screening for cancer.

Melanie:  Leann, in response to this growing body of research on what cancer survivors need as their lives go on, Greenville Health System has launched a clinic dedicated to the ongoing care of cancer survivors. Tell us a little bit about this Lifetime Clinic.

Leann:  Our Lifetime Clinic is mixed in in a department in the cancer institute called “The Center for Integrative Oncology and Survivorship”. In this department, we also have a dietician. We have a social worker. We have an oncology rehab program that’s 12 weeks of exercise for our patients that’s a free service. They can meet with a dietician; they can meet with the social worker about distress. We also have a smoking cessation program. We have lots of other integrative services available to our patients. In addition, we have in this clinic what we call “The Lifetime Clinic”. After patients have maybe made it 3-5 years, maybe they don’t need to follow their medical oncologist, surgical oncologist or radiation oncologist any longer in an acute setting. Our doctors can refer the patients here to CIOS, to the Lifetime Clinic and the 3 nurse practitioners in this department will follow them for the rest of their lives. We will screen for future cancers and also as well do their exams for any reoccurrences. If they have problems or concerns between office visits and they call us, then we bring them in quickly to find out what’s going on – is it something we need to be concerned about. Not only do we look at future reoccurrence or future cancers we also take a look at lifestyle. Is there anything we need to do about smoking, about nutrition, about exercise, about genetics? On every visit, we try to address all of those lifestyle issues and help decrease the risk of cancer in the future or reoccurrences by managing lifestyle.

Melanie:  What a wonderful program for people that have been diagnosed with cancer. Leann, how do you deal with the mental and emotional health of the situation? As you say, you rescreen on a needed basis, but some cancer patients might want to be rescreened every month to see if things are coming back. I can see where this would take a mental toll on these patients. How do you deal with that with them?

Leann:  For the most part, after they’ve gotten a few years out, maybe they’re not quite so fearful as time is passing. We follow national guidelines – the NCCN guidelines. We follow those guidelines screening our patients appropriately and we discuss with the patients, “This is what is recommended. This is what we are looking for”. Some patients are at a 3 month follow up; some are at a 6 month follow up; and some are at a 1 year follow up. I think just education about what we are looking for and what they can look for in themselves and then contact us, if they have changes. Depending on what their cancer was, we tell them, “These are the symptoms that you would be looking for. This is what you would do. You would call us if you find these symptoms. We will bring you in, do a physical exam and if there is any testing needed, any scans needed, blood work – then we will order those”. If there ever is a problem, a reoccurrence or a concern then we immediately connect them back to their medical oncologist or their surgical oncologist so that they can get the appropriate treatment.

Melanie:  What about the families of your cancer patients? How are they involved in the Lifetime Clinic at Greenville Health System?

Leann:  We welcome all of our families to come along with their loved one. Probably, half of our patients bring a spouse or maybe an adult child with them as their support. We have a very supportive department and we involve them as much as they want to be involved. Our social work department has the nice support group. We have a kid’s camp and all kinds of support for the family that we can connect them as they see fit.

Melanie:  In just the last few minutes, give your best advice, doing what you do for a living and working so beautifully with people, for people who are newly diagnosed with cancer and what they can expect from coming to the Lifetime Clinic and throughout their treatment and care.

Leann:  The patients who are newly diagnosed can come to our clinic in a different way. In that section of our clinic, we don’t call “The Lifetime Clinic”. Our Lifetime Clinic is for long-term follow up whereas our clinic - the Center for Integrative Oncology and Survivorship--we also have a clinic where we will bring patients in who are newly diagnosed and help them. We will connect them with a social worker, if they need it; with the dietician if they are having issues with eating. If they’re having any secondary effects, we can make recommendations. Also, just educate them even more in a team with our medical oncologists, radiation oncologists, the other nurse practitioners in our other offices. We just work as a team to help them manage their side effects and deal with the issues they are going through, while going through treatment and while more in that acute state. We also do distress screening at the beginning and along the way while they’re going through treatment. Then, we get them connected with our social worker who handles all of the distress scores that are high and contacts the patient. We just figure out what each patient needs and we try to just deal with their issues individually because each patient is so different.

Melanie:  Wrap it up for us about the Lifetime Clinic. Tell us about your team.

Leann:  We have 3 nurse practitioners. One sees the gynecology oncology patients. We have a nurse practitioner who does all medical oncology but especially handles all of the breast cancer patients. That is me. Then, we have another nurse practitioner who sees a variety of all other cancers. We have 2 nurse navigators who work with us to help connect us with the patients. They’re there at all times during the visit and also if the patient needs anything in between. We also connect the patients with any specialty services that they may be having issues that could be helped by a specialty service such as physical therapy or sexual health, or whatever the issue is. We have 2 medical assistants who also stay in contact with the patients. We work as a pretty close group. If the patient comes in at any time in the Lifetime Clinic and they’re having issues with nutrition or maybe distress and need to see the social worker or maybe we’ve found that they have a new diagnosis in their family and need genetic counseling, then we plug them in with those departments or with those people in this department as well. That’s kind of how our team works.

Melanie:  Thank you so much and we applaud all the great work that you’re doing there, Leann. Thanks so much for being with us today. You’re listening to Inside Health with Greenville Health System and for more information you can go to GHS.org. That’s GHS.org. This is Melanie Cole. Thanks so much for listening.