Q&A with Julie Silver, MD, on wellness after cancer treatment
Breast cancer survivor Julie K. Silver, MD, is assistant professor at Harvard Medical School and on the medical staff at Dana-Farber Cancer Institute in Boston. She has written and edited more than a dozen books, including After Cancer Treatment: Heal Better, Faster, Stronger and Super Healing. Silver has also received The American Cancer Society’s Lane Adams Quality of Life Award, recognizing individuals who have made a difference in the lives of people living with cancer. She spoke with freelance writer Melissa Gaskill.
What are the key issues for cancer survivors in terms of healing after treatment?
You go into treatment feeling much better than when you finish. It is important to focus on how to physically recover as well as possible. There is an important idea in survivorship called accepting a “new normal,” but I tell people to try and heal as well as possible before doing that. It is vital not to accept more pain, fatigue and disability than you have to. There is the potential to improve health at most stages of treatment. Studies are showing, for instance, that women who exercise during chemotherapy for breast cancer actually feel better and have more endurance.
Describe your own healing process after cancer.
When I underwent chemotherapy and surgery for breast cancer, I realized how devastating those treatments were to my body. I focused on how to recover as well as possible. It took three years to really feel optimal. You can work at healing every day, but there are parts of recovery that simply take time. The expectation with technology is that things happen instantaneously. But healing needs to take place at the right speed. You don’t want to force it; you want to facilitate it.
Explain your concept of a “healing zone.” What defines that healing window, and is it finite?
The healing zone is that place and time period where there is the opportunity to recover more fully. It can last, as in my experience, three years, or more. Many people don’t heal as optimally as they can. They live with more pain, disability and fatigue than they really need to. Many people think of healing as a journey, and you want the safest and quickest passage possible.
So many different factors define that window, including your baseline health, type of cancer and type of treatment. It’s a metaphorical term, really, to explain that period of time when there is the possibility that your body will recover further. There is a limit to how long you can keep gaining strength. Most people are not at that limit; they can still improve their health.
The three most important components of healing are building strength and endurance through therapeutic exercise, eating a healing diet and allowing your body to rest well.
How do you individualize the healing process?
First, look at where you are; then set short-term or four-week goals, and then long-term or six-month goals. Determine goals that will work for you based on your lifestyle and current situation. One of the nice things about healing is that almost anyone can do it at home. It is very empowering. At the same time, I do encourage people to check with their doctors about the kinds of things they are doing in their healing plans.
What’s important for survivors to know about pain management?
With pain that is not due to cancer itself, it is important to get rid of it, if possible. Cancer survivors often see pain as a signal that the cancer is back and spreading, while in fact that may not be true. So alleviating it not only has the effect of making someone feel better, but emotionally they have less to worry about. It is important to be aggressive about treating pain to help someone function better and to relieve that big worry.
I do recommend looking at complementary approaches, focusing on those that have been studied and have efficacy. We call that integrative medicine, and it includes acupuncture, massage, meditation and imagery, all of which have proven therapeutic value.
Quality and quantity of sleep are important. Fatigue is the most common complaint in cancer survivors, and how long and well you sleep has a big impact on how you feel and your energy level. Are you sleeping seven or eight hours a night without interruption, and if not, what is keeping you up — pain, anxiety, hot flashes? Talk to your doctor. Don’t underestimate the value of sleep. It boosts your immune system and helps you recover as fully as possible. At the same time, if you have been diagnosed with cancer, there are nights you won’t sleep that well because it is stressful. That is normal.
What about mental health?
Everyone has things they worry about. But cancer can intensify worry and anxiety, and even contribute to depression. Mood swings are normal when undergoing treatment, but you don’t want prolonged periods of feeling sad or anxious, and there are medical interventions that can help. Stress can impede healing, so make sure you are alleviating pain, eating a good diet and working on exercises to build strength and endurance.
How can setting priorities for recovery help a cancer survivor, and how should a survivor establish those priorities?
The three most important components of healing are building strength and endurance through therapeutic exercise, eating a healing diet and allowing your body to rest well. Then there are other things that facilitate healing, such as alleviating pain and reducing stress. However, when someone has been through a serious illness, they are tired and don’t have a lot of energy. If you focus on the most important components, it doesn’t feel overwhelming and impossible to achieve.
You can work at healing every day, but there are parts of recovery that simply take time. The expectation with technology is that things happen instantaneously. But healing needs to take place at the right speed. You don’t want to force it; you want to facilitate it.
How do you advise cancer survivors to incorporate traditional medicine with complementary and alternative approaches into the healing process?
Alternative means “instead of,” and I never recommend that survivors go strictly with alternative approaches instead of traditional medicine. With cancer, traditional medicine can prolong lives. What I do recommend is looking at complementary approaches, focusing on those that have been studied and have efficacy. We call that integrative medicine, and it includes acupuncture, massage, meditation and imagery, all of which have proven therapeutic value.
One of the big themes in both of my books (After Cancer Treatment and Super Healing) is resilience. People tend to be extremely resilient. They can face very difficult circumstances and still find things in life that are meaningful.