Post-cancer - Starting Anew

Ezer Mitzion starts new cancer survivorship program in response to growing need among survivors for physical and emotional long-term follow up care.

Hank Lowry was 65 when he was diagnosed with prostate cancer. He was treated with medication and underwent radiation therapy as well as chemotherapy. Following his treatment, he was kept under medical supervision. Five years after it was diagnosed, the growth had not returned and the doctors declared that he had recovered from the cancer. After that, he routinely visited his family physician and once a year he did a blood test that examines the functioning of his prostate.

However, as sometimes happens, Lavri did not continue with his annual check-ups. One day, some seven years after completing the cancer treatment, he visited the doctor and complained about a sharp pain in his back. A physical examination revealed his condition to be satisfactory except for the back pains. His prostate functions were tested and were normal. But Lavri began to develop an anxiety that the incessant pain was the sign of the return of a cancerous growth. He did not speak to his family or his doctor about his fears. Only when he realized that it was not cancer did his emotional state return to normal.

An article in the American Journal of Nursing in April 2007, which mentions Lowry's case, recommend a nursing and treatment regimen be set up for cancer survivors so as to lessen their fear of a return of the growth, a fear which accompanies most of them for the rest of their lives.

Cancer has become the leading cause of death in the past decade in Western countries but at the same time improved medications and advanced medical technology have led to an increase in survivors. Dealing with the unique difficulties faced by patients - mostly the fear that the malignant growth will return and actual side-effects caused by the disease and treatment of it - pose new challenges for public health systems.

In the United States, the need for opening clinics specifically for those who have recovered from cancer has already been understood. A new initiative of this kind is now about to begin in Israel. The Ezer Mitzion organization will launch its "Starting Anew" center - the first cancer survivorship clinic in Israel.

"Today there are medical rehabilitation programs for people recuperating from heart attacks and strokes," says Dr. Bracha Zisser, the organization's director. "We thought it is important to establish a similar program for those recuperating from cancer. Children who have recovered from cancer are under medical supervision for many years but adults who recover for the most part go to see an oncologist only during the first few years after the cancer is eradicated. Later, they don't have the resources or the time to deal with the possible side-effects of the treatment and there is no one who can respond to their fears about the cancer returning."

At the planned facility at Ezer Mitzion's Oranit center in Petah Tikva, every cancer survivor is eligible for a five-hour visit once a year. During his visit, each patient will meet a family physician, a psychologist, a dietitian, a social worker and a sexologist. The center also plans to offer complementary medical services including yoga, shiatsu, dancing, reflexology, naturopathy and guided imagery.

Closing the gap

According to the accepted definition in the world, cancer survivors are patients who have not had a recurrence of the growth five years after it was diagnosed. In the center's initial stage, it will cater to people aged 25 or above who have recovered from breast cancer, prostate cancer, intestinal cancer and cancer of the blood or lymph glands. Eventually it will open its services to patients who have survived other forms of cancer.

In preparation for the center's formation, Ezer Mitzion conducted a survey with the assistance of market-research firms Shiluv and Markerwise in which the needs of Israeli patients recovering from cancer were studied. In-depth interviews were held with seven people recuperating from prostate cancer, intestinal cancer and lymphoma, all of whom discussed the challenges they coped with during their recuperation period including body image and sexuality, fertility, employment changes and more.

The center will be headed by Dr. Tzahi Gur, a family physician who previously headed the Clalit Health Services in the Jordan Valley. In recent years, he has visited cancer recovery clinics in the U.S. in preparation for the establishment of the Petah Tikva center. "There is no specialization in the world for treating those people who have recovered from cancer," he says. "Our intention is to develop a unique clinic whose outreach will be wide."

The special difficulties of cancer survivors were outlined in a study carried out at the Rambam Medical Center in Haifa and conducted by Prof. Eliezer Robinson, chairman of the Israel Cancer Association. The survey included 104 survivors; more than half of them reported having difficulties associated with the illness. Some 55 percent had fertility problems; 44 percent had a decreased sexual drive; 37 percent required someone to assist them with daily functions; 36 percent needed to change careers because of the challenges of the illness; 31 percent reported that their income had diminished; and 30 percent said they believe their advancement at work was hampered by the illness. Almost one-third of them suffered from depression, 16 percent suffered from difficulties in relationships, and seven percent reported they had separated or been divorced from their partners as a result of the cancer. The findings were published in 2009.

Studies also reveal the emotional damage typical of cancer survivors, including post-traumatic stress disorder. Researchers from the Soroka Medical Center and Ben-Gurion University of the Negev reported in November 2003 that they had found symptoms of post-traumatic stress disorder among patients who had recovered from lymphoma.

"We know about a large number of medical situations that are typical of patients who have recovered from cancer," Gur says. "For example, among those who recover from intestinal cancer, there is a high percentage of people with heart problems and diabetes, while among those who recover from lymphoma there is a high rate of depression. There are cancer patients who underwent chemotherapy which prevents them from swimming for the first few years after receiving treatment because of the fear they will contract pneumonia. There is no one in the medical establishment [in Israel] who is aware of these dangers."

The center's steering committee includes several senior Israeli oncologists. It is headed by Dr. Yitzhak Yaniv, director of the Hematology-Oncology Clinic at Schneider Children's Hospital, and other member include Prof. Moshe Mittelman of Ichilov Hospital, Dr. Bella Kaufman and Prof. Adi Shani of Sheba Medical Center at Tel Hashomer, Prof. Baruch Klein of Assuta Hospital and Dr. Nicky Lieberman of the Clalit Health Services.

Changing the protocol

The Ezer Mizion staff also plan to establish a databank of cancer survivors in Israel, so as to follow later side effects that are connected with the illness. "If we find a side-effect that is characteristic of a certain group of people who were treated with a specific medication, the doctors will be able to recommend a change of the accepted protocol for medical treatment," Zisser says.

Those who go to the center will receive individual attention but the staff at Ezer Mitzion is also looking into the establishment of support groups for those who have recovered as well as an online forum. Patient will have to pay out of pocket, with a charge of NIS 250 for the first visit of five hours and NIS 600 for each subsequent treatment. A discount will be given to those who agree to fill in research questionnaires. Ezer Mitzion and Clalit Health Services are at advanced stages of negotiations over granting an additional reduction to members of Clalit.

In the medical establishment there has been increased awareness in the past few months of cancer survivors. The Health Ministry estimates some 200,000 people in Israel have survived cancer while the Israel Cancer Association puts the figure at 300,000. Prof Gadi Renart, head of the Cancer Control Center at Clalit recently sent notices to family physicians in an effort to raise awareness of possible side effects typical of cancer survivors that they should be on the lookout for. The Israel Cancer Association has recently started support groups and other programming for cancer survivors.