Sorry your hands, fingers, and feet are numb, but look on the bright side — you're alive!  Have you heard or ever thought that before?  Maybe you’ve heard one of your patient’s say that these side effects just come with the territory.  My question to you is - How often do we underestimate the effects of chemotherapy-induced peripheral neuropathy (CIPN)? 

Often, we hear our patients complain of the tingling and numbness in the hands and feet, but I know it can be more than that.  I recently had the privilege of taking care of a particular patient that opened my eyes to the effects of CIPN.  I can remember her telling me her story and expressing to me how the quality of her life changed significantly after her treatment for cancer.  The things she once loved to do she couldn't, thanks to CIPN.  She had to give up on her hobbies that she enjoyed.  She had to depend on others to drive her because she was afraid that she wouldn't be able to feel the pedals in the car and cause a wreck.  She couldn't sleep well because the sheets touching her feet caused pain. Her activities of daily living were much more than a chore.  She told me if she knew it would have been this bad she might have thought twice about taking the treatment that saved her life.  It was then that the light bulb went off.  Are we "blowing off” patient's CIPN?  I realized that although they may be grateful to be alive, is that the quality of life worth living?

Chemotherapy-induced peripheral neuropathy is characterized by damage to the nervous system that is a direct result of the medications associated with chemotherapy.  Studies state that 30-100% of patients can experience CIPN, depending on the agent, dose, and other factors.  Chemotherapy-induced peripheral neuropathy can affect patients walking, picking things up, driving, hobbies, relationships, work, writing, exercise, sleep and sexual activity.  It can disturb every aspect of a patients' quality of life. 

Understanding the effects of CIPN is imperative to be able to care for our patients better.  Many times, patients do not want to mention the numbness or pain they have been experiencing, because they don't want to delay or stop the treatment for fear of prolonging their treatment schedule or not receiving the full benefits of therapy.  Other times physicians fail to recognize the symptoms promptly. As a healthcare provider, we need to be proactive during and after treatment. It is imperative that we assess our patients.  Ask specific questions — what symptoms are you having? Is it one side or both?  How much of the extremity is involved?  How severe and distressing is each symptom? Are the symptoms constant or do they come and go?  How are your activities of daily living being affected?   Finding out the answers to specific questions can help guide physicians in treatment decisions.

What can patients do if they suffer from CIPN?  Unfortunately, there is not an easy fix, but patients do have options that can improve their neuropathy.  Because physicians are focused on controlling a patient’s pain, medical management is most often the first step for patients.  Treatment may include prescribing Cymbalta, Lyrica, or Gabapentin. There are alternative therapies such as acupuncture, massage, and reflexology that may ease their pain from neuropathy.  Patients may also benefit from Physical Therapy by improving balance, walking, and learning to use an assistive device. Occupational Therapy can also help patients with their activities of daily living, improving their fine motor skills, and teaching them how to use adaptive equipment.  They may also benefit from exercise programs such as water exercise, a strength & balance class, Tai Chi, and yoga.  Although patients survived their cancer, giving them their quality of life back should be a priority for those that are suffering from CIPN.

Articles

Understanding the effects of chemotherapy-induced peripheral neuropathy (CIPN) is imperative to be able to care for our patients better. 

How Can We Help Patients Who Suffer from CIPN?

I am so tired — a phrase that I often hear from cancer survivors.  Do they just need to take it easy and take a few more naps? How is it possible to be so tired that putting one foot in front of the other takes every bit of energy out of you or just a simple task seems so impossible?  Could it be cancer-related fatigue (CRF)?

“Cancer-related fatigue is a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning

.”  Studies have shown that 70-90% of patients will have CRF at some point in their cancer journey.  It can be one of the most debilitating side effects from cancer treatment. Are you talking and listening to your patients about their fatigue?

Often, we tell our patients the most logical thing we can come up with - rest often and don’t overdo it.  Despite rest, cancer-related fatigue may not improve.  CRF can be attributed to multiple causes, such as anemia, decreased nutrition, hypothyroidism, medications, pain, stress, depression, and/or insomnia.  As a healthcare provider, we need to treat CRF using a multidisciplinary approach.

Simple lifestyle modifications can help improve management of CRF, such as exercise, diet, improving sleep, managing stress and getting support.  First and for most, patients need to understand their treatment didn’t happen overnight, and their body needs time to build back stamina.  Doing a little bit each day, and adding to when possible, can help with CRF. 

Giving your patients the following simple suggestions can help them manage their cancer-related fatigue better:

Decrease in physical activity can lead to tiredness and lack of energy. It is recommended that cancer survivors exercise at least 150 minutes per week doing moderate intensity exercise — which means sweating a little and elevating their heart rate. 150 minutes can be an overwhelming number, but breaking that time down into smaller time frames is important for those that suffer from CRF. Don’t do too much too soon!  Encourage them to find a workout buddy to keep them motivated. Remind patients they need to check with their physician before starting an exercise program. 

Good nutrition is good fuel for the body.  With the proper nutrition patients can feel better and have more overall energy.  Treatment can pose challenges with eating — taste changes, feeling of fullness, swallowing difficulties and smells that can trigger nausea make it hard to find the proper food to fuel the body. Many health organizations have dietitians available to talk with patients to help make suggestions on nutrition.  If one is not available there are many good websites with helpful information, such as 

Grocery shopping can also bring its own challenges.  Patients need to plan ahead and go shopping when it’s a good time for them.  If the patient doesn’t have the energy to go encourage them to ask for help. Another good idea is to see if their local grocery store offers delivery.  

Smaller meals and snacking throughout the day can help fuel the body.  Most importantly, have them keep things simple and well balanced, and make sure to drink enough fluids to help cope with their fatigue.

This is a hard one for anyone, but can be more difficult for cancer patients.  It’s easier said than done - let go of the worries!  Having a range of emotions is normal, but patients need to remember to be gentle with themselves.  Having them be mindful of what they can control versus what they can’t, will help alleviate some of the stressors. 

Another great tool is mindfulness meditation.  Meditating can help patients learn to be in the present, and not think about the future or the past.  Some patients find meditation to be difficult.  However, the more they practice meditating, the easier it gets. 

Sleep can be another factor in managing stress.  Taking long afternoon naps can make going to bed at night harder.  Have patients try to get into a healthy bedtime routine.  Trying things that can relax them before bedtime can be beneficial, such as gentle yoga.

Finally, if something is bothering your patient, they need to know that it is ok to ask.  With a diagnosis of cancer, life doesn’t stop.  Patients can become overwhelmed and may need to seek professional help, such as a licensed professional counselor or attend a support group. 

Life isn’t a marathon!  Pace, plan, and prioritize.  Patients need to know their limits and do the best they can each day.  Have them keep a journal to see if they can find a pattern with their fatigue. This might help them understand how to plan each day and be able to see what may trigger their fatigue. Deciding what activities are most important to them that day, can help make planning the day easier.  Slow and steady is better than fast and furious!

It is human nature to be so hard on ourselves that we think we ‘should’ be doing this or that.  Patients need to give themselves permission to be where they are in their journey.  Asking for help does not make them weak. Many times, family and friends will ask what can they do for the patient.  Now is the time for them to take advantage of the extra help that is offered.  Also, patients should be specific when asking for help.  Don’t be afraid to tell someone how they can help you.  Allowing others to help can ease the burden and help patients conserve energy.

It is key that patients be honest and open with their healthcare providers about their fatigue.  There might be an underlying medical issue making the fatigue worse.  Ask your patient what activities they would like to be doing that they aren’t able to do? Try to grasp how the fatigue is affecting the patient can help healthcare providers have a better understanding of the severity of the problem.

Do they have sudden weakness in one extremity, dizziness, light headedness, sudden falls, new onset of shortness of breath, chest pain, or bleeding?  Some of the symptoms may not be related to CRF and my need further testing.  

The first thing about helping patients suffering from cancer-related fatigue is knowing the problem exists. CRF can start pretreatment, last through treatment, and beyond. It is impeccable that we understand the severity of the fatigue our patients are suffering from.  Many patients don’t bring the topic up because they believe it’s a normal thing. Be an advocate for your patients by starting the conversation and listening to them. 

 National Comprehensive Cancer Network (NCCN). NCCN clinical practice guidelines in oncology: cancer-related fatigue V.2; 22017. Available at: 

https://www.nccn.org/professionals/physician_gls/PDF/fatigue.pdf

Many patients complain of feeling so tired. What can we do to help those suffering from fatigue?

If I Wasn't So Tired

Cancer Survivors Day is a great way to celebrate life after diagnosis. Cancer doesn’t always have to be about the negativity that surrounds it. There are many milestones to celebrate as a survivor, such as completion of chemotherapy or radiation, the first visit after treatment, to the first scan after diagnosis. It may even be a cancerversary. We can’t forget about those fighting with metastatic disease either. However big or small the milestone, it’s worth a celebration. Did you know that the first Sunday in June is designated National Cancer Survivors Day? What did you do for the survivors in your life?

 Annual 24 Hours in the Canyon Bike Race that starts with a survivor send-off, when all the bike-riders can see who they are riding for. This part of the weekend is absolutely my favorite. As we were enjoying the beauty of Palo Duro Canyon and celebrating those beside us, I caught myself emotionally overwhelmed. As I made my way around to talk to everyone, I had to stop and think about what a blessing that each one of the survivors are to me. I had countless conversations but one thing was common: they were so grateful and appreciative of this event that honored them.

Many wouldn’t think much of this part of the event, but it gave all of the survivors a chance to celebrate. I often hear the phrase: "Cancer has given me more than it took from me." Cancer, in my opinion, is one of the most powerful and proficient teachers. Although many of us do not want the teacher, we all learn from it. But what can you learn from a survivor? 

Survivors are another great teacher in life. As oncology nurses, we get so focused on fixing the problem and don’t always take the time for the little things in life. As I stood back trying to take a group picture of this amazing group of survivors, I caught myself with tears rolling down my cheeks and at a loss for words. My mind was telling me to look — look at all the survivors that have touched my life one way or another. Look at this strong group of fighters. I saw the small pediatric survivors in the front row with the biggest smiles on their face, and the older survivors in the back with that same big smile. Each survivor’s smile was unique. What did those smiles represent? To some, they represented a moment of not thinking about treatment. To others, the smiles represented the opportunity to say thank you for being recognized. 

As I look back at this group picture I don’t see “CANCER”, I see a group of people that have one common thread celebrating more than "CANCER." It’s what you make of it and how you learn from it. It’s about meeting people and knowing that you are not alone. It’s about surviving that minute or hour or day. Whatever the milestone was for that smile it couldn’t have warmed my heart any more. So, as you start planning things for next year, keep in mind the first Sunday in June is one worth celebrating for your patients. 

What milestones do you celebrate with your oncology patients?

Cancer Survivors Day

I had the privilege of attending the recognition breakfast for Oncology Certified Nurses at ONS Congress in Denver this May.  I left that breakfast so inspired, yet heartbroken at the same time. The keynote speaker, Suleika Jaouad, had such an inspiring story to share. At the age of 22, she was diagnosed with myelodysplastic syndrome and acute myeloid leukemia.  She shared the story of her struggles and what it was like to be diagnosed at such a young age. After the breakfast, I left with one question heavy on my mind, "How can I make a difference to young adult cancer survivors?"

I have a hard time associating cancer with the 20 to 30-year-olds. Maybe it’s just my wishful thinking that it doesn’t happen to them.  According to cancer.gov, "about 70,000 young people, ages 15-39, are diagnosed with cancer each year in the United States. That is 6 times the number of cases diagnosed in children ages 0-14." And there are over 1 million young adult cancer survivors living today in the United States.

I know for me, at the age of 22, I was having the time of my life and trying to pursue my dreams. Cancer was the last thing that would have crossed my mind at that age. I did a lot of reflecting after I heard Suleika’s story. How do you begin to handle the devastating news of cancer, much less at such a young age? How do you deal with all the social awkwardness? How do you cope while your friends are out partying or going on dates, while you are struggling just to stay alive?  What about medical bills and insurance? What about a future family? What about your career? Her life was completely interrupted by cancer.

Suleika talked about one of her recent writing assignments with incarcerated prisoners and compared her cancer journey to it. Much like a prison system, Suleika described her cancer as being "inCANCERated". This analogy stuck with me. Much like prisoners, cancer survivors must adapt to this new world with cancer.  The psychological effects are similar between the two of them: patients go through denial, anger, bargaining, depression and acceptance, just like prisoners.  They may have a lack of or limited support from their family and friends. They may also feel cut off from the rest of society. So what happens when they are released back into the "real" world?

Young adult survivors must find a way to adapt to the world after cancer. At first, they may be excited that the treatment is over. Then reality may hit, the uncomfortable feeling that not going to the doctor as often could give them a sense of uncertainty. With surviving comes unanswered questions and feelings of worry, sadness, and confusion. All of these may play a big role with them.

With much of their life to live, how well are we educating young adult survivors about the long-term effects of cancer treatment? Suleika stated, "Survivorship is such an important part of the treatment process." We as nurses need to be proactive. We need to educate ourselves and educate them as much as possible. I encourage you to listen to them, learn from them, be there for them, and get them connected with age-appropriate support groups. Go online and learn about all the different organizations out there just for them. The National Cancer Institute offers a list of organizations that offer support. Know that when treatment is over we still need to be there for them. As she so eloquently stated, “travel where the silence is.”

As a young adult with cancer you may feel like a prisoner in your own world. How can nurses help this age group?

InCANCERated

Often, I get asked, "Why did you want to be an oncology nurse?," followed by, "That must be a depressing job," and ending with, "I am so sorry." Truth be told, this isn’t what I wanted to be when I grew up. I had all the dreams in the world to work in NICU. I have yet to meet an oncology nurse that said, "I knew that’s what I wanted to be." Someone once said that you don’t choose to be an oncology nurse, it chooses you — and I couldn’t agree more. In my case, the oncology floor was the only floor that had openings at the time I applied for my first job out of nursing school. The rest, as they say, is history. I wouldn’t want to work with any other patients.

I hear from survivors, "If it wasn’t for my nurse I wouldn’t have made it." I personally believe being their nurse is the bigger reward. Oncology patients have a special place in my heart and always will. You are there when they are having good days and bad days. You hear the great news and the unimaginable news. We see patients fight for their life and yet they take the time to appreciate those that have helped them through it. My patients have taught me the value of every day, and that we are not guaranteed the next. It’s a special relationship and a treasured one. Do you have that "special" patient or patients that have inspired you to be the nurse you are today? Or even a fellow oncology nurse that helped to shape you? Let me tell you about mine:

I remember my first night off orientation like it was yesterday. As I walked into this patient’s room, it was a calming place amidst the havoc of the hospital. Here was a pleasant gentleman with leukemia fighting to stay alive. I went in to do my head to toe assessment and to administer his evening meds. I learned more from this patient than he will ever know. He never asked, "Why me?." It was always "Why not me?." We talked about life, his kids, and his beliefs. As I was leaving his room in the gentlest voice I heard, "God bless you and thank you for all you do." Here this patient, on the verge of dying, took the time to thank me. I was so humbled by him.

Several weeks later, I entered another patient’s room to find a spunky lady. She was so full of life and made me laugh like I hadn’t laughed in a long time. Her attitude was exceptional. She acted like her stay in the hospital was just a minor bump in the road. She wanted to get out as fast as she could because she had a life to live. Her metastatic cancer wasn’t going to stop her. Our paths would cross years down the road and what a blessing it was to see her and her daughter again. Not only did she teach me about living life to the fullest and not letting anything stop me, her daughter showed me how to be strong through the difficulties of life. These two ladies taught me to laugh at myself even in the bad times, and get out in the world and live every day to the fullest!

Every nurse has that mentor that impacted their career. I will never forget the night I received report from Nurse Patti.  I was scared to death because I had heard so many horror stories about her. I wanted to make sure that when she reported that next morning, I had crossed all my t’s and dotted all my i’s. I wanted her to know I took better care of these patients than she could have ever imagined. I wanted to show her that I did the job to her standards. I have a special relationship with Patti to this day and I tell her all the time, "I want to be like you when I grow up." Patti taught me more than any instructor. She taught me the real world of oncology nursing. She showed me that it’s okay to be compassionate and loving to your patient. She also showed me that it’s ok to show your human side — give your patient that human touch, the hug that cost nothing, an ear to listen, a shoulder to cry on, and the tears we shed when our patients don’t get the news they deserve. Patti has inspired me to be the best nurse even when I didn’t think I had it in me.

Oncology nurses are unique and woven from a different cloth. Every day we impact patients and make a difference in their lives. We all have qualities that are not taught but learned from our experiences. We are compassionate. We are advocates for our patients. We are not afraid of the human touch, but most of all we are there to nurture each patient we encounter. The list of patients that have touched me is never-ending. They all have a special place in my heart. As we celebrate this month, try to reflect on all those patients you have touched and those that have touched you. Pull out those special cards or gifts that you received and reflect on the job you have done. If it wasn’t for them, you may not be the nurse you are today. I also have two challenges for you:

Reach out to those nurses who have mentored you and thank them for how they helped shape you.

Try to find a new oncology nurse that you can help shape and mentor. We, as seasoned oncology nurses, have a wealth of knowledge through our experiences that need to be shared. Even though it might just be easier or faster if we do it, it’s important to be the "Nurse Patti" to new oncology nurses.

In short, who inspires you and who are you inspiring?

Who has shaped you to become the nurse you are today?

Inspired by You

"Words can inspire. And words can destroy. Choose yours well." — Robin Sharma

Do you paid attention to your choice of words while talking with your patients? Sometimes we get so complacent with our jobs that we become desensitized to the situations that lie in front of us. When working with patients we need to be aware of this more than ever, and I believe it is more important with the oncology population.

As health care providers, we need to remember that the situation the patient is in may be the first time they are experiencing it. Patients may not understand the terminology, testing or treatment for their cancer. This is a time when we as nurses can connect to patients and become their biggest advocate. Step back and put yourself in their shoes. How would you feel?

Imagine yourself going through everyday life and one day you wake up and find something abnormal on your body. This recently happened to myself and the first thing I wanted to do was ignore it — maybe that’s just the nurse in me, but after a couple of weeks when thing did not change, I decided I better get it checked. There are several things that I learned about my experience, that maybe I need to be more aware of and so should you.

I had gone to the doctor’s office and he did confirm that what I was feeling was not normal. Just the confirmation of that made my mind race. I quickly learned how powerful your mind is and how it can take you to the worst place first. Before I had even left the exam room I had self-diagnosed myself and the diagnosis was not good! I proceeded to the check out and the sweet receptionist made the appointment for further testing. As she was handing my appointment she sweetly said, “I will be praying for you.” In my mind, I was asking, “Why are you going to pray for me? What did the doctor told you that he didn’t tell me?” Is it not fun how a common gesture can be interpreted the wrong way when put in a stressful circumstance?

As I went in for the test, my anxiety and stress levels were off the chart, and here I am an oncology nurse that knows what the testing is about. I had no idea the emotions that come with the situation. As I was waiting for them to call me back I kept thinking to myself 

What if this isn’t the news I want to hear?

 and then I quickly tried to reassure myself everything was going to be ok. They called me back and the testing began.

The technician was making small talk, but what I will remember is her choice of words and her facial expressions. I just wanted to get the test done and find out what it was. She was very polite, but her choice of wording made my mind go back to those dark thoughts. Could it have been that she had been at her job for several years or maybe this was just run of the mill for her? To me, it was the first time that I had to go through it.

I went on for more testing and was again faced with bad choice of words. When the doctor came in to tell me that it was “essentially negative,” I wasn’t sure how to react. What do you mean "essentially"? I was grasping at every word he was saying, but still cautiously waiting for the next words to come out. I asked and made sure what I was hearing was what he meant (thank goodness everything did come back negative).

Oncology patients are faced with so many different challenges than other patients. They are just trying to stay alive while getting rid of their cancer so they can live to tell their story. When we are trying to be helpful maybe we should pay close attention to our choice of words and even facial expressions. How many times do you tell patients “Oh, everything looks good on your blood work”? Would it be better to show them the labs and the normal range instead of just saying it "looks good"? Go the extra mile next time. Pay attention to their needs. This may be the first time they are experiencing this. Take the time to explain, give them comfort, and listen to them.

Does your choice of word matter to your patients?

Choice of Words Do Matter

How many times do you hear from patients, “If only I could get a good night’s sleep”? How often do you tell yourself that? What does that truly mean? Does a good night’s sleep mean six hours, eight hours, or more in a night? There are many research papers on this subject and they all vary on recommended sleep time duration, but most recommend that we should get anywhere from 17 hours of sleep a night for newborns and 7-8 hours for adults. Even though these are recommendations for sleep duration, each individual is the only one that can determine how much sleep is needed. Are your patients (or you) getting enough sleep?

We live in a society where everything is at our fingertips and we are always on the go.  We can shop, research, and do just about everything within minutes. I think this has lead us to be a "quick fix" society. Maybe we should try to slow things down, take time to turn everything off, and focus on what matters most — a good night’s sleep! Just like our computers and smartphones need time to backup and update, so do our bodies.

It’s amazing what a good night sleep can do for your body. While you are sleeping, your body temperature lowers, blood pressure drops, and brain waves slow down, giving your heart and vascular system time to rest. Blood flow moves to the muscles and tissue, giving them time to repair. Sleep also helps us regulate the appetite hormones — it suppresses ghrelin and stimulates leptin which controls the appetite. Your immune system relies on sleep to stay healthy. Just think about those times when you aren’t feeling so well and all you want to do is sleep. It’s your body’s way of telling you what it needs. Sleeping also helps your brain to work properly, by forming new pathways to help you learn and remember information. Pay attention to your mood, energy and health after a poor night’s sleep versus a good one.

Take a moment and ask yourself this question: "Is sleep a priority for me?" I know sometimes that is hard for me to do and maybe even tougher for those going through cancer treatment. If you are like me, you might just need to do one more thing before you head off to bed that leads into maybe 10 more things. For patients with cancer, they may have 10 things racing through their mind. Either way it puts you to bed later and has you waking up groggy. With sleep being a vital indicator of overall health and well-being, we should make it a priority. Did you know that we spend over 1/3 of our lives sleeping? Research states those who get 7 hours or more of sleep a night are healthier and live longer. Whereas those that suffer from chronic insomnia have negative consequences such as depression, anxiety, irritability, physical pain, cognitive problems, impaired work performance, health and immunity problems.

But, how can you achieve a great night sleep when you have problems sleeping? There are several medical conditions that can infringe on our sleep -- insomnia, sleep apnea, restless leg syndrome, anxiety, and maybe even hot flashes. If you add in emotional distress that patients with cancer can suffer from, it’s no wonder why they aren’t getting a good night’s sleep.  According to the National Cancer Institute, up to half of cancer patients don’t sleep well at some point. How often are we talking to our patients about their sleep? Do you have any recommendations that you share with your patients? How often does a physician prescribe medication to help with sleep? Although sleep medication can be beneficial to patients at certain times, there are also other ways to train our bodies for a better night’s sleep.

Making sleep a priority can be easy with good "sleep hygiene." Sleep hygiene is much like dental hygiene that requires nightly and daily rituals for consistently good hygiene. Follow these tips to help you achieve a good night’s sleep.

Practice a relaxing bedtime ritual. Just like babies have a bed time routine, so should adults. A warm bath, a few minutes of reading, meditation, or listening to music can help initiate good sleep.

Wait until you are sleepy before going to bed. You must train your brain to have a strong learned association between bed and sleep. If you can’t sleep get up and out of bed.

Stick to a sleep schedule, even on weekends and holidays.

Manage your clock — set the alarm clock and turn the clock around so if you should wake up you are not clock watching which can lead to great frustration and anxiety. Trust that you set the alarm and not worry about the time.

Evaluate your bedroom for ideal temperature, sound and light. Make sure you have a comfortable mattress and pillows.

Turn off all electronical devices at least one hour before going to bed. If possible put your phone on "Do Not Disturb" mode when you go to bed so you are not tempted to check it during the night. Try keeping all the electronics out of the bedroom. The bed should only be used for sleep and intimacy.

Don’t take naps after 3pm. Taking naps decrease the urge to sleep.

Exercise daily, but avoid strenuous exercise within six hours of your bedtime.

Avoid alcohol and caffeine before bedtime. Caffeine has a long half-life and alcohol will limit deep sleep.

Avoid large meals and beverages late at night. This may help limit the trips to the bathroom.

Avoid medication at bedtime that delay or disrupt your sleep, if possible. Be sure to talk to your physician about your options.

Remember you won’t sleep until you close your eyes. Relax, clear your mind and listen to your body.

So, the next time you hear a patient say, "I feel tired when I wake up," chances are they aren’t getting enough sleep. Try recommending the list above to help them get in a better sleep habit.

Are you, and your patients, getting enough sleep every night? A good night's sleep can contribute to better health.

We All Need A Little Beauty Sleep

How do you react when someone says this to you? Sometimes "sorry" is just not enough to fix the pain. Over the last year, I have lost five extended family members — that’s more than I wanted, and each of them from different circumstances. Every time I was lost for words to say to the immediate family. The first thing that comes to my mind is “I am sorry” and that probably is the last thing they want to hear. Or is it enough? How do you respond to people grieving?

I can remember one of my patients telling me “I am going to die of this cancer, but I am not going to let this cancer live for me.” I was taken back because I didn’t know how to respond. I didn’t want to acknowledge that yes, the cancer would probably take her life since it was stage IV, but at the same time I didn’t want to lie to her. I remember just sitting there with her and saying, “I am sorry”. Her response was “Honey there is nothing to be sorry about.” Thinking about it makes me emotional because that was probably not what she wanted to hear from me. Was she just looking for a safe person to talk to? Did she just want someone to understand her?

How can we prepare ourselves when we are thrown into these types of situations and taken by surprise? Can we even mentally prepare ourselves? Just because we work in a healthcare environment does not guarantee that we know what to say or how to respond to people who are grieving. We as humans have the same fears and helpless feelings when it comes to people we care about that are grieving. We sometimes avoid people because we don’t know what to say. I was talking with a hospice nurse the other day and I was telling her that I was having such a hard time finding the perfect thing to say in these types of situations. She said to me there is rarely a time when someone we know is not facing grief. We grieve because we lost our car keys, we lost our dog, we lost our phone, our body image changed due to surgery, or we lose a loved one — it is all some form of grief. No matter what type of grief someone is facing we all want to be understood. We want them to acknowledge how bad or hurtful that event was.

She also told me about a seminar that she went to where the speaker spoke about how we all have our own buckets. For a minute, I want you to think of my patient. Imagine that she is holding a bucket in her hand and in this bucket, she has all her feelings that she has experienced because of her situation. In her bucket she might have anger, fear, guilt, blame, resentment, worry and maybe even despair. Now picture your bucket in front of you. What type of feeling would you have in your bucket because of her situation? I think for me I was afraid, because I didn’t know what to say and maybe I thought if I said something I would be in a sink hole that I couldn’t get out of.  What I didn’t realize is her bucket was FULL! No matter what I said or did, she didn’t have room in her bucket for my feelings. What I should have done was get in her bucket and listen to her. People that are grieving need a safe person, someone that will allow them to talk out their situation and just listen. 

I hear from patients that have gone through surgery that has caused body image issues that they were not prepared for the outcome. They tend not to see themselves the same as before the surgery. Losing something that is part of us can do more to our mental status than we know. I don’t think that these patients want someone to say, “I understand”, when we ourselves haven’t gone through what they have been through. These patients just want someone to acknowledge their pain. Something as simple as “that must really hurt” could help them cope. What they don’t need is explanations thrown at them. 

So, next time you find yourself in any of these situations remember that there is a healing process. Give each patient comfort — just listen! Don’t try to pour your feelings into their bucket. Focus – focus on what they are saying before you try to talk to them. Timing – it’s not the words you say, but the timing of your words. We all have our own buckets and let’s not just pour everything out onto others, but learn to have a listening ear.

Is saying "sorry" enough when someone is grieving? As a nurse, how can you help a grieving patient or family?

Can You Just Listen to Me?

Have you ever stopped to think about all the days and the months that we celebrate something? There are birthdays, anniversaries, Doctors Day, Nurses Week, Valentine’s Day, National Donut Day, and the list goes on and on. Why are there so many days to celebrate, and how many dates/months can one person remember? Plus, who comes up with all of these? Really, do we need a National Junk Food Day (July 21 in case you were wondering)? Which one’s do you choose to celebrate or partake in? If you’re like me, we end up celebrating a lot of these.

As an Oncology Nurse, I naturally lean more to those days that apply to my field of practice, but I manage to throw in a few extra for good measure. Did you know that February is Cancer Prevention Month? When I really stop and think about it, I am working with people that already have cancer — do they care about prevention of cancer? Isn’t that an oxymoron?

I am sure that we all have patients that have said “getting cancer was the best blessing in my life.” It’s their aha moment when they may decide to change their habits and lifestyle. I find myself talking to patients about screenings, awareness, and healthy lifestyle choices more than I have in any other time in my career. Every time I talk about making choices that lead to a healthy lifestyle, I think to myself, “I personally need to work at this.” I really don’t want to be one of those people that say “do as I say, not as I do!”

Just like everything else in life, being healthy and focusing on you is a work in progress. There is no time like the present to focus on cancer prevention - and what a great month to pick to do that, right? I have seen this statistic quoted in numerous places, and it bears repeating. Two-thirds of cancers can be prevented by diet and exercise alone. TWO-THIRDS — that is huge!

Working in healthcare, our schedules tend to go south really quickly. There are emergencies that happen, phone calls to return, and patients to work in.  As a result, how many times have you said or heard your co-workers say “I just don’t have time to eat healthy” or “I just didn’t have time to eat lunch today because I was too busy?” Some days may seem like that, but they don’t have to be. It takes some preparation and dedication in order to combat those excuses. So, how can we eat healthier on the job in order to set a good example and help in cancer prevention? 

First of all, education is key! I have recently been educating myself more on this topic by listening to a variety of podcasts, reading several articles, and talking with the dietitian at our Survivorship Center about cancer prevention and healthy eating.  There are so many good tips and tricks on this topic that we could go on for days! In the essence of time, I have put together a top ten list to help you kick start your journey to a healthier you. 

Remove the candy or chocolate bowl from your desk or other nearby location - Out of sight, out of mind.  

Don’t drink your calories (sodas or energy drinks).  Stay hydrated — drink your water!

Eat a healthy breakfast at home and try to eat at regular intervals throughout the day.

Stock up on healthy snacks. The best and worst habits usually start at the grocery store.

Pack your lunch, but try not to be a desk-diner.

We are easily influenced by the people around us, so get your coworkers on board with eating healthy.

Get up and move!  Try not to sit too much. 

Eat your fruits and vegetables, and limit processed meats. Also, be sure to include whole grains in your diet. 

Practice saying “No thanks” — to the unhealthy temptations. Goodness knows we have plenty of days to celebrate.

Moderation is the KEY — Last year we had a cardiologist give a talk on Heart Health and he said “Eat cake on your birthday, not everyday.” 

Remember, you must start somewhere, and now is the time!  I recently went to a survivorship conference and one of the presenters said “10% of something, is better than 10% of nothing!” Start by focusing on one thing — that is you!

Two-thirds of cancers can be prevented by diet and exercise alone. Now is the time to focus on cancer prevention.

Eating Healthy on the Job

Perception — a way of regarding, understanding or interpreting something; a mental impression.

How do you respond when someone asks you “What is your profession?” Are you just a nurse or are you a nurse with a BSN, OCN, or caring nurse? In Kelley Johnson’s monologue in the 2016 Miss America pageant she talked about how she would tell her patient that she was just a nurse, but what her patient taught her was that she was more than just a nurse. Just because she had those two letters — RN – after her name she was much more than that.  It’s all in perception! Just as that patient  taught her that she was more than a nurse, we need to help patients understand that they are not defined by their disease, stage or treatment type. They are all cancer survivors from the moment they receive their diagnosis. 

What happens when someone hears the words “You have cancer”? Do they automatically assume it’s a death sentence or is it something less serious? Even with all the developments in modern medicine people still dread it more than any other disease, I think. Is cancer more serious than the number one leading cause of death worldwide, heart disease?

Patient perceptions play a huge part in the diagnosis and treatment of cancer. When patients have a preconception of what procedures may be involved in the diagnosis to the treatment of cancer they may tend to put off seeking medical help. Some may believe that they are immune to cancer and others believe that no matter what they do they are going to get cancer. An individual’s beliefs about cancer can have a huge impact on how they cope with it.

When the patient receives that medical confirmation that they have cancer do they differentiate it as a “little bit of cancer” or “Is it just cancer?” How important is the provider-patient relationship in this process? Does stage matter in the way nurses take care of the patient?  I know that stage does matter to a physician treating the cancer, but do nurses treat the patient differently?

I honestly have never thought about this until recently when someone asked me if I treat patients differently based on their stage of diagnosis. At my prior job, working in a busy clinic, cancer was cancer to me. It didn’t matter if you had Stage I or Stage IV, I treated them all the same. Now that I am in the survivorship role I hear “Oh I don’t qualify because I just had a little bit of cancer and didn’t have to go through chemotherapy and/or radiation.” My first question is what makes this patient feel like they don’t qualify just because they didn’t receive chemotherapy and/or radiation? Do they feel less important than those that receive more treatment for their cancer?

I believe it starts with how the information is presented and what information is given to the patient from the physician. I also think it is more important than ever for nurses to be an advocate for the patient. Explain to them that it doesn’t matter if it is stage I or stage IV they are considered a survivor. It is the role of the nurse that is going to make a difference in how this patient perceives their cancer journey. So, the next time you hear “Oh, I don’t qualify” be sure to educate your patient like Kelly’s patient did her, that they are not defined by their treatment and qualify for survivorship services.      

How do cancer survivors perceive their cancer?

Perception

Pam McMillan a native to the Texas Panhandle is a registered nurse, wife and mother.  During her career she has developed a passion for serving those suffering from cancer.  Her current role is leading the survivorship program on behalf of the Harrington Cancer and Health Foundation. She continues to serve those individuals and families across the region that are affected by cancer.  Follow her on Twitter @pammo10

Pam McMillan, RN, OCN