Introduction

In the framework of the European OACCUs program carried out by the Hygiene Laboratory of the Department of Medicine at the University of Patras, a series of podcast modules have been created that can be listened to by a patient who has just completed treatment. Before you start listening to the podcasts you can also have a quick look at our Survival Guide for Patients with Cancer. Just continue scrolling!

Part 5, 15-39 years, young cancer survivors, caregivers, social and healthcare professionals, article

Part 5, 18-39, young cancer survivors, social and healthcare professionals working with YCS, article

Introduction

Every year, many people with cancer are cured. These are called "survivors" or "survivors" of cancer. During treatment, they may feel that their lives are stagnant and time is moving slowly. When treatment is complete, their life may regain its former normal rhythm and/or take on new meaning. Sometimes it can be difficult to return to daily activities and it can take time to adjust to a new way of life.

Children and adolescents with cancer

Childhood cancer is a rare, life-threatening disease. It is the leading cause of death in children due to disease and the second leading cause after accidents. However, early diagnosis, appropriate treatment, and adequate medical and nursing care lead to cure for most children. 80% of children with cancer in developed countries are cured. To date, all known treatments are accompanied by side effects. Chemotherapy, which aims to destroy cancer cells (which multiply rapidly), can cause a variety of 'side effects' due to its simultaneous action on healthy tissues (e.g. hair, skin, mucous membranes, bone marrow).

Life after treatment

When the treatment is over the feelings are mixed. It may take time to stop thinking about the disease and the treatment, and to be able to look positively to the future.

Common feelings that patients have after the treatments are completed:

relief because the treatment is over
loneliness or feelings of isolation
feelings of loss and sadness associated with reminiscing about life before the disease.
Guilt, due to not experiencing feelings of fullness and happiness
anxiety about returning to normal life
fatigue and malaise
joy and/or excitement from engaging in new activities or from a general change in lifestyle
fear of the possibility of cancer recurrence
concern about the ongoing medical monitoring process feeling insecure about the prospect of redesigning their future

Life after cancer

The experiential experience of illness does not stop with the completion of treatment. One needs to give oneself time to adapt to the changes and new circumstances. Cultivating the belief that these feelings are normal should be an important part of the approach to patients. Some people find that the weeks, months, and years after the completion of treatment are a good time to reflect on their lives. They may reassess what is important and what is satisfying, or make changes to their lifestyle. Any post-treatment interventions should be personalized and relatively easy to implement. At the same time, there should be appropriate scientific evidence.

Four pillars are important for life after treatment:

o Physical Activity

o Physical and Mental well-being

o Balanced Diet

o Living harmoniously within the natural environment.

Questions and answers about the end of treatment

The fact that we can now often talk about survival and quality of life after cancer shows that we are at a point where survival is statistically increasing and people want a return to normality and a better quality of life after cancer treatment. They wish to ask and learn how to improve their quality of life after completing their treatment.

What do we define as survival?

The concept of survival takes on an entity and meaning immediately after the diagnosis of cancer. It includes the overall management of the disease, from diagnosis to the completion of treatment and the smooth reintegration of patients into everyday life.

Who are cancer survivors?

Cancer survivors make up three broad categories of cancer patients:

Firstly, patients who have been cured of cancer, i.e. are disease-free and no longer receiving any treatment.
Secondly, patients who have been cured are disease-free and receive some maintenance treatment to reduce the chance of disease recurrence.
Finally, patients who are not disease-free but have a satisfactory survival rate. They continue to receive treatment to reduce the burden of the disease and to be able to be functional daily.

When can I consider myself fully healed?

Every patient looks forward to the day when they can finally breathe a sigh of relief to complete the treatment. But there is no one timetable those fits all. "Every cancer is different and every patient is different." Talking about your health care can help you understand your treatment process. It is undeniable that the longer a person is disease free, the more likely they are to remain that way.

What kind of care should I expect after my treatment?

After treatment you should talk to your doctor about the next steps in your care, and what to expect. Your doctor will give you a "survivorship" plan, which will include a summary of treatment, a follow-up plan, and a discussion of the effects of treatment. He or she will tell you how often you should visit, what tests need to be done, and when to schedule those tests. Your appointments with the oncologist will get shorter as time goes on. At the same time, you will need to keep an eye on your health and how you manage other health problems you may be experiencing, such as high blood pressure or diabetes.

What side effects should I expect because of the disease and the associated treatment?

There are physical problems that can be caused by either the disease or the treatment, for example problems with eating if you have been treated for head and neck cancer, or early menopause if you have had chemotherapy for breast cancer. Effects may occur during treatment and may continue after the end of treatment. For example:

· Numbness in the fingers and toes due to chemotherapy.

· Temporary suppression of the immune system, as most people's immune system will recover within 4 to 12 weeks after the end of treatment.

· Higher risk of developing heart disease or osteoporosis.

Of course, there are also the long-term side effects of treatment, which can start months to years after the end of treatment and depend on its duration and specific characteristics. The effects of radiation, such as skin changes or hair loss, can be long-term or even permanent. The good news is that, in nowadays, most side effects are often manageable and there is the possibility of partial or total recovery of the damage.

How likely is it that the disease will recur?

Many patients experience fear of recurrence of the disease. The possibility of cancer recurrence is something you should discuss with your doctor. In many cases, meeting with a psychologist may be helpful.

Is it possible that I could develop a new type of cancer?

The truth is that the risk is higher than in the general population. As a survivor of the disease, you are at risk of developing a completely new and different type of cancer because of the treatments you have had. It is very important to perform regular check-ups and be diligent about preventive screenings such as colonoscopy, gynecological examination, prostate exam, mammogram, and skin cancer screening.

What else can I do to be as healthy as possible and reduce the risk of recurrence?

Surviving cancer is a major achievement. The likelihood of it returning is a valid concern you may have. Although no action can guarantee that the disease will not return, there are many preventative measures you can take to significantly reduce your risk. Essentially, weight control or weight loss (if you are overweight) is an important first step. This should be done in conjunction with good nutrition and exercise. Also, not smoking and reducing your alcohol intake can have a measurable effect on your overall health. It is advisable to have a generally active lifestyle and to include regular physical activity in your daily routine. Finally, you should always remember to protect yourself from the sun.

What tests are required after the end of treatment and how often will I have them?

Whether and when you need tests after your treatment will be determined by your oncologist. Additional tests may be suggested based on the type of treatment you received, such as bone density measurement.

How can I manage my fear of the results when taking screening tests?

Talk to your doctor, openly and honestly about your fears and anxieties and possibly with a psychologist. Psychologists can help you manage the stress and anxiety associated with follow-up exams.

If I need to see a doctor from another specialty, what do I need to tell him or her about cancer treatment?

All the other doctors you see should know about your illness, even after the end of treatment. The oncologist will give you a survivorship care plan that summarizes your diagnosis and treatment - including medications, surgery and other treatments.

Does sleep matter?

The importance of quality sleep is paramount. Good, quality sleep of 7-8 hours every day improves health and quality of life in both sick and healthy people.

Is there a specialist adviser I can talk to or an online or in-person group that can support me?

Yes, in our country, in addition to psychologists, there are voluntary associations that provide help and support. You can find a club that suits you and share your fears and insecurities.

Will it be more difficult to get Life Insurance as a cancer survivor/survivor?

It shouldn't be, but unfortunately the law allows insurance companies to exclude people who have documented health problems before they start their insurance. However, it is advisable to investigate this further.

I am facing problems (possible racist attitudes) at work because of my history of cancer. What can I do?

Contact the labour inspectorate and report the problems you are experiencing. Do not hesitate to claim your rights. Work is a way of reintegration and employers must create the right conditions for people like you.

Will my reproductive capacity be impaired during treatment? How can I protect my fertility?

It is important that you are in contact with the oncology team that is following you, so that you are informed about the risks of infertility. There are fertility preservation options available. For women, this usually involves collecting eggs, fertilising and freezing them for use in the future if conditions allow. For men, it involves freezing sperm.

Treatment and pregnancy: Concepts incompatible?

Chemotherapy can affect your body and possibly damage your good ovarian function and as a result reducing the chance of getting pregnant. The best approach is to discuss your desire to have a child in the future with your doctor so that they can take steps to ensure that you can do so, safely for you and your unborn child.

How can my loved ones and I deal with the stress of cancer recurrence?

Feelings of this kind are perfectly normal, but there are ways to deal with them. Interacting with other patients in voluntary organizations can help. You might consider joining such a support group. If you still have concerns, do not be afraid to talk to your doctor. Sometimes having an answer can help you feel better.

Will it be difficult to return to "normality"?

When the treatment is over, not everything automatically returns to "normal". It takes time for the hair to reappear and for physical strength and well-being to return. It takes patience and knowledge of your body and your condition after treatment.

Some people do not like to see pictures of themselves during the treatment period. How do I deal with such a situation?

Former patients often report that they "don't like" to see photos from their treatment period because they make them sad! Justified to a certain extent, but..

You should be proud of your fortitude to receive this treatment, feel proud and see that this is your story of triumph, or victory over the disease and the assertion of your sacred right to Life. There is nothing sad about it, there is no sadness, in fact there is only POWER!

After my experience with the disease, will I feel fear in every aspect of my life?

The truth is, life will not look the same from now on, when you have realized how fragile it is. This fear, of the past and the return of the disease, can "haunt" your life after cancer. But even though this fear will be there, it should not overwhelm you and act as an inhibitor to your life. This fear need not "shadow" your daily life or even negatively affect your mood. Be happy and take risks in your life after the illness (whether you have experienced it or someone you love). You just have to choose to live for something bigger than this fear, such as Love and life itself.

After the experience with the disease, how will I manage companionship and love?

There may be uncomfortable conversations with your partner. After the illness and treatment, the body is different. There may be scars. The skin may be very sensitive to touch because of the radiation. The changed body image is very likely to cause anxiety and create insecurities. So yes, there will be a pattern of communication, perhaps uncomfortable at first, but necessary to make sure your partner is comfortable as well. There will perhaps be uncomfortable related conversations as well. It is imperative that discussions take place, about how the future seems to be shaping up with someone who has undergone treatment and who can never guarantee that the risk will not return. It is necessary to have discussions about what life would be like if the illness returned. There needs to be courage from both around this. At the same time, it is right that there is honesty and open communication. These will make the Love of both more "full" and more meaningful and give a new perspective to their relationship.

Will people be hesitant to ask me about the disease, even though they will have lots of questions?

It's not clear why people are reluctant to talk to you about it. Perhaps they are afraid to remind you of the painful situation. They will try to be kind to you by avoiding what they think hurts you. But friends should be helped to get to know you better, so they are not afraid to talk to you. The truth is that every cancer survivor's experience is unique and different.

Physical and mental well-being

Cancer patients experience highly stressful situations, such as frequent doctor's visits, diagnostic tests that require time and money, the recurring agony of waiting for results and the fear of death. Their activities are radically affected, their daily lives are substantially altered as they change their life habits and their priority is now to cope with the disease. Psychological support is essential because it facilitates the emotional discharge of patients and helps them to better manage anxiety, fear, depression, and any psychosomatic problems. It can also reduce the time needed for rehabilitation, reduce the number of medical visits and improve the quality of life of patients.

What is the psychological impact of cancer diagnosis and treatment?

A cancer diagnosis can be an overwhelming and traumatic experience for many people. It can cause feelings of fear, anxiety, and uncertainty about the future. Treatment can also be physically and emotionally draining and can lead to the onset of isolation moods and depressive symptomatology. In addition, the diagnosis can lead to great uncertainty and a sense of loss of control over your life. It is important to understand that these feelings are normal and common and that there are ways to manage them.

Are there common challenges that cancer survivors may face when trying to make a new start in life?

Survivors of the disease are often faced with a range of emotional and practical challenges as they try to move on with their lives. These may include difficulties in returning to work or other daily activities, challenges in relationships, financial insecurities and issues relating to body image. Many survivors may also experience a sense of loss or sadness about the changes the illness has brought about in their lives. In addition, they may experience anxiety or fear about the possibility of recurrence of the disease. This may be a cause of chronic stress for some people and may have a negative impact on their quality of life.

I'm thinking of talking to a specialist, but I'm not sure if he/she will be able to understand my situation.

Professionals working in the field of cancer patient support, whether in public hospitals or private hospitals, have undergone specialised training that allows them to put themselves in the shoes of another person. This process is known as 'empathy' and consists of the ability to 'experience' and perceive someone else's feelings or experiences as if they were in their shoes. They also have many years of experience, having supported many people with cancer. After all, cases of cancer are so common that even the people you are talking to may know someone who has had a similar experience. Finally, you can visit a support group and share your thoughts with other people who are going through the same 'journey'.

How can I manage feelings of anxiety and fear after a cancer diagnosis?

The days of treatment and recovery are a particularly stressful period. The anxiety associated with the disease is characterised by excessive, unrealistic or constant fear, worry or dread about the possibility of its recurrence or the possibility of a new variant. These worries may be intense and lead to physical symptoms such as increased heart rate, sweating and difficulty sleeping. In addition, anxiety can lead to avoidance behaviours, such as avoiding certain activities associated with the disease. It is important to note that disease-related anxiety is not the same as healthy concern about cancer recurrence, as it can significantly affect a person's quality of life. It is paramount to prioritize self-care and find healthy coping strategies, such as cultivating mindfulness, exercise, psychological therapy, and participation in support groups.

How can I deal with feelings of guilt?

"Survivor's guilt" is a common feeling and it is important to understand that it is a normal reaction to a traumatic experience. Talking with a therapist or participating in a support group can be beneficial in working through these feelings and developing coping strategies. Focus on feeling grateful about your own salvation and helping others, which can change your perspective and enhance your positive attitude toward life.

I feel a lot of guilt because I am no longer working and I feel that I am becoming a burden to others and especially to my family.

Your family is fighting for you, as you would do in a similar situation if a loved one was ill. For this reason, you should not feel guilty about the care and support you receive from them. Difficult situations are part of people's lives and are opportunities to bring out the ultimate qualities of Love and Altruism. One way to get rid of these thoughts is to ask them directly "am I tiring you"? They are sure to tell you that they enjoy taking care of you and that all they want is for you all to be healthy and loved.

How can I regain control of my life after being diagnosed with cancer?

Regaining control after a cancer diagnosis can be a challenge, but there are steps you can take to feel strong. Start by prioritizing self-care, gradually setting achievable goals, and seeking support from loved ones and mental health professionals. Still, another good idea is to focus on activities that bring you joy and satisfaction and work with health care staff and close family members to create a comprehensive plan for your care.

What is the best way to tell my children about the serious health problem I have?

It can be difficult to talk to your children about a cancer diagnosis, but it is important to be honest and open with them. Provide them with age-appropriate information and reassure them that you love and support them. It is also important to seek support from a therapist or support group, as well as other families who have had similar experiences. It is important that children believe that you will face the disease with courage, so that you can continue to be with them and love them. To them you are always their hero and they want to see you strong and brave.

How can I manage depression as a consequence of dealing with cancer?

Depression or moodiness is a common experience for cancer survivors and it is important to seek support from loved ones and mental health professionals. Engage in self-care activities such as exercise and cultivating mindfulness, and consider seeking treatment to acknowledge your feelings and develop healthy caregiving strategies to recognize and manage any physical symptoms that may be exacerbating depression.

My life after treatment: the completion of my treatment did not give me the relief I expected. How do I manage this feeling?

Life after the disease may not live up to our expectations. Feelings of depression and questions such as "How am I alive?" are common. If thoughts arise about whether someone is worth living, whether it would be better not to live, whether they are a burden to their family, or whether they are thinking about harming themselves, they should be acknowledged and addressed immediately. Externalize your concerns and fears and share them with your own people. Visit a mental health professional who will talk with you, identify and decode your feelings and work through these thoughts together. Cancer is indeed a traumatic experience, but you are not alone in this 'journey'. Some of us have our own experience with cancer, having either been diagnosed, or having a loved one who has been diagnosed and survived or failed. It is important that all of our voices, thoughts and feelings are heard, we want and have much more to say next. Our goal is therefore to live longer, to live better, to claim a new life of more quality and meaning, choosing activities that give us joy and happiness.

What kind of psychological support is available for cancer survivors?

There are a variety of psychological support options for survivors. These may include:

Group therapy can be particularly helpful as it allows the patient to become part of a community of support and understanding. Cognitive behavioural therapy and mindfulness-based therapies have been found to be effective in helping people cope with the emotional and practical challenges of cancer. These therapies, can help individuals develop coping and management skills for anxiety, depression and other emotional concerns. At the same time, they teach methods of elimination, eradication of negative thoughts and ways of accepting the new reality.

How can I overcome feelings of anger and frustration after a cancer diagnosis?

It is normal to feel anger or frustration after the diagnosis. Recognize these feelings and find healthy ways to express them, such as through writing or exercise. Focus on the things that bring you joy and happiness and try to deal with difficult situations with humor. Seek support from a trusted friend or counsellor if you need it.

How can I redefine my relationship with my partner after being diagnosed with cancer?

Communication is the key. Talk to your partner about your feelings and any changes you may be experiencing. Try to find new ways to connect with each other, either through physical contact or through shared activities. Consider seeking counselling to help you deal with any challenges together.

Tips for maintaining a healthy lifestyle after cancer treatment:

Choosing a diet rich in fruits and vegetables, lean protein and whole grains is vital for your overall well-being. Incorporate regular physical activity, such as walking and stretching, into your daily routine to maintain your strength and mobility. Don't forget to prioritise self-care, get enough sleep, and make time for activities that reduce stress.

Regarding sexual health: what are the challenges cancer survivors face and how can they maintain a healthy and satisfying sexual relationship after treatment?

Cancer survivors may experience physical changes, such as hormonal imbalances or fatigue, body image problems, low self-esteem and reduced sexual desire, which can affect their sexual health. The key to overcoming these challenges is to have open and honest communication about your needs and desires with your partner, engage in physical and emotional care, and seek support from a therapist or support group if needed.

How can I deal with the financial insecurity I am experiencing? Stressors related to finances, such as rising medical costs, loss of income and reduced ability to work often affect people after cancer treatment. It is important to prioritise your spending. Also be sure to reach out to organizations that provide financial assistance and seek support. It is important to remember that financial stress can have a significant negative impact on your mental health and therefore seeking support from a psychologist or support group may be helpful or even necessary.

How can I find meaning and purpose in my life after a cancer diagnosis?

Finding meaning and purpose in life after a cancer diagnosis can be a valuable aspect of overall recovery. Consider searching for your values and interests and setting achievable goals. Engage in activities that create feelings of joy and fulfillment and seek support from loved ones and mental health professionals. Engage in volunteering or anything that creates a passion for you, which can enhance a sense of purpose in life and well-being for both you and your loved ones.

How can spiritual quest and religion play a role in the emotional stability of a person during and after cancer treatment?

Spiritual search and religion can offer a sense of relief and hope to many survivors of the disease. Practices such as prayer, meditation, and interaction with a community of like-minded people can offer comfort and a deeper understanding of the purpose and meaning of life. This in turn produces feelings of peace and hope and enhances mental fortitude, leading to emotional well-being. For those without a strong spiritual or religious background, there are still many ways through which they can find comfort and strength during their battle with cancer. This, can include gathering and interacting with loved ones, engaging in self-care practices, finding purpose and meaning through engaging in creative activities or volunteer work, and seeking support from a therapist or support group.

What does "post-traumatic maturation" consist of? How is it expressed in cancer survivors?

Post-traumatic maturation refers to the positive changes that can occur in a person after experiencing a traumatic event, such as cancer. This may include a deeper appreciation for the goodness of life, an enhanced sense of personal strength and mental fortitude, and a strong sense of purpose in existence. Cancer survivors can experience post-traumatic maturation by focusing on personal growth, giving back to their community, and seeking support from loved ones.

Remember that it is normal to experience emotional changes after a cancer diagnosis and that help is available for this. Feel free to reach out to a mental health professional or support group and prioritise self-care to manage stress. Hence, take care of yourself and remember that your goal is to live longer, to live better.

Balanced Diet

It is very important for all people, whether they have cancer or are healthy, to enjoy a proper diet, as this helps to maintain or regain strength and energy, rebuild tissue (if needed) and enhance wellbeing. Below are some questions that address the most common concerns about nutrition after cancer treatment.

Do I need to consult a professional nutritionist about my concerns on this issue?

The disease, and its treatment approaches, can cause changes in the body that may make it difficult to eat certain foods and/or lead to major weight loss. It is advisable to inform your treatment team of any problems you are experiencing or, better still, to contact specialist clinical dietitians to have a nutritional assessment and appropriate instructions given as soon as possible, both after diagnosis and after the end of treatment.

What if a patient is underweight or overweight after completing treatment? Could increased body weight increase the risk of cancer recurrence?

After the treatments are over, the side effects that affect food intake are usually reduced and you can regain weight, provided you follow a healthy and proper diet that meets your individual needs. It has been shown through studies that, especially for certain types of cancer, such as breast or bladder cancer, if you are overweight or obese, you may be at a higher risk of the cancer recurring or developing a second, different cancer. However, because of the many proven health benefits, it is advisable to be encouraged to maintain a normal body weight.

What foods should I avoid to prevent the risk of recurrence of the disease?

Several studies have examined the relationship between high fat intake and survival after cancer, particularly breast cancer. However, the results have been conflicting. Other studies have shown that intake of harmful fats such as trans fats (or partially hydrogenated fatty acids) may be associated with increased risk. These are mainly found in hard margarines, baked goods (puff pastries), fast food and standard snacks. This is why we should all read the nutritional analysis labels on foods to avoid them as much as possible. Also, diets that are too high in fat provide a lot of calories, a condition that can lead to excess body weight, which in turn is associated with a higher risk of developing certain types of cancer and a higher risk of recurrence for those who survive breast, endometrial and bladder cancers.

What information is available on meat consumption and its association with cancer?

Some studies have associated the consumption of large amounts of red meat (>350-500 g of cooked meat) and processed meats (such as bacon, sausages and sausages) with an increased risk of colorectal cancer and certain other cancers. Other research also suggests that cooking methods, especially frying and cooking at very high temperatures (grilling), and the way meat is processed (smoking, pickling), create chemicals (potentially carcinogenic) that may increase the risk of certain types of cancer.

For these reasons, it is recommended to limit the consumption of red meat (but not to exclude it completely, as it is rich in important nutrients such as iron, zinc and certain vitamins), avoiding processed meats and replacing them with poultry, seafood and fish. And while, studies show that a healthy dietary pattern, poor in red and processed meats, is associated with higher overall survival for people with breast and prostate cancer, there is so far no research that has looked at the effect of processed meat, meat cooked at high temperatures or meat in general, on the recurrence or worsening of cancer (ongoing or developing).

What kind of diet should cancer survivors follow?

The Mediterranean diet model, which we as a people know better than anyone else, is a complete model of healthy eating that prevents chronic non-communicable diseases, including cancer, while at the same time providing a lower risk of recurrence for survivors (mainly breast and prostate). In summary, it could be said that a diet rich in vitamins, minerals, and other nutrients through the intake of fruits, vegetables, legumes, and whole grains is needed. In fact, the vegetables and fruits consumed during the day should be colourful (red, green, orange). At the same time, it would be advisable to avoid large quantities of red meat and replace it with lean poultry and fish. Finally, it is strongly recommended to limit the intake of alcohol and calorific foods (fatty and sweet).

I've heard that soy is beneficial. Is this true?

Soy consumption has not been found to have any harmful health effects. On the contrary, it appears that, because it is rich in isoflavones, it can reduce the risk of recurrence of breast cancer. However, caution should be exercised in the use of soy supplements, as little is known about their overall, and especially their long-term, health effects.

Does the cooking method affect the nutritional value of vegetables?

Cooking in general can enhance the absorption of certain nutrients, such as carotenoids, and the activity of others (such as lycopene - the antioxidant in tomatoes). Frying, using pressure cookers, or boiling, especially for long periods of time, can contribute to the loss of some vitamins and other nutrients. Steaming or cooking in the pot, and even with a little water, are the best ways of cooking to preserve the nutrients in foods.

So-called organic or organic foods may be better than conventional foods at reducing cancer risk?

It is generally accepted that organic or biological foods may be healthier because they reduce our exposure to certain chemicals (pesticides, antibiotics or growth hormones). It has also been suggested that their nutritional value may be superior to that of conventional foods, but it is not yet known whether this translates into practical health benefits.

What are the guidelines on drinking alcohol?

Cancer survivors are encouraged to make lifestyle changes to reduce the risk of a pre-existing cancer recurring or developing a new cancer. Relevant studies have shown an association between alcohol intake and the risk of cancer of the mouth, throat, larynx, larynx, esophagus, liver, colon, rectum, and breast. In addition, increased alcohol intake may be linked to lung and stomach cancer. For these reasons it is best to avoid or limit its consumption.

Does high sugar intake increase the risk of cancer?

Sugar intake has not been shown to increase the risk of cancer or make it worse. However, sugars and sugary drinks add large amounts of calories to the diet and can cause weight gain, which we know is associated with, and can affect, cancer outcomes. At the same time, most foods and beverages that are high in sugar do not provide many of the essential nutrients and can substitute for more nutritious, quality food choices. For this reason, it is recommended that you limit your intake of foods and drinks with added sugar. Current guidelines for the general population, regardless of whether or not cancer is present, recommend consumption of less than 25 grams of sugar (6 teaspoons) per day for women and up to 35 grams (9 teaspoons) for men.

How much water should I drink per day?

Healthy adult men need about 3.7 litres of fluid per day, while women need about 2.7 litres. You should remember that we already get one third of this amount from food and we need to supplement the rest. The best hydrating agent is water. But if there is a difficulty with this, ask your dietician for advice on ways to increase your total daily fluid intake.

Do cancer survivors benefit from the use of nutritional supplements?

All people, like disease survivors, should try to get the nutrients they need through food rather than through vitamin, mineral and trace mineral supplements. Supplements are used on a case-by-case basis and after assessment and always in accordance with the doctor's or dietician's instructions. Their abuse or arbitrary and indiscriminate use can cause adverse effects. There is currently no evidence that taking dietary supplements can reduce the likelihood of cancer recurrence or improve survival. The antioxidants contained in such preparations are thought to protect the body by ridding it of free radicals. Free radicals damage the genetic material of cells and are involved in the process of carcinogenesis. However, a balanced diet rich in green vegetables and fruits serves the same purpose and does so naturally.

Active lifestyle

Exercise is a valuable tool for managing mental, spiritual, and physical health. Studies have demonstrated the positive effect of exercise in suppressing stress and combating many psychosomatic diseases associated with modern lifestyles.

What is the purpose of exercise?

Biological: Regular physical activity creates healthy bones, muscles, and ligaments, helps to control body weight, reduces fat, keeps the heart and lungs working
Psychomotor: Regular physical exercise facilitates the development of movement skills and helps prevent and control negative emotions (anxiety and depression).
Psychosocial: Participation in organised exercise programmes, especially in large groups, helps self-expression, self-confidence and relieves from tension.

What types of exercise can I do?

Aerobic exercise: Every day we can enjoy aerobic programmes such as brisk walking or more intense programmes such as running, cycling, swimming, and dancing. A full programme should include high intensity activity and should take place at least two to three times per week.
Muscle Strengthening: Muscle strengthening programs aim to tone and increase muscle mass, depending on the training stimulus. Strengthening muscles at a frequency of two to three times per week is ideal.
Bone Strengthening: These programs include exercises to strengthen the bones such as resistance exercises (weights, resistance bands and jumping exercises).

What are the individual benefits of exercise in patients who have won the battle with the disease?

"Exercise offers multiple benefits for both cancer survivors and the general population." Some of these include a high level of fitness, greater muscle strength, lower body mass and less weight gain. In other words, exercise can make you stronger and stronger, just like anyone else who exercises. Exercise can also: 1. Enhance your mood, 2. Boost your confidence and 3. Reduce fatigue.

When can I start exercising?

As soon as possible. Studies show that, after a cancer diagnosis, anxiety, depression and feeling unwell or tired from the disease or treatment tend to make you less active. Complete abstinence from exercise as a long-term solution to the problem of recurring fatigue is not the appropriate solution. It is important to start some physical activity to enhance and speed up your recovery.

In other words: if you have reduced your activity level since your cancer diagnosis, now is the time to increase your exercise time and pace.

· Flexibility exercises, such as yoga or stretching: Regardless of your physical condition, you are likely to find a flexibility exercise that will work positively for you. Maintaining your mobility can help ensure that you are ready to move on to more intense exercise.

· Aerobic exercise, such as running, swimming or brisk walking: Aerobic exercise is key because it helps you burn calories and lose weight. It also builds good cardiovascular fitness, which can reduce your risk of health problems such as cardiovascular disease and diabetes. If you have balance problems, try exercises that are less likely to lead to a minor accident.

· Resistance exercises, such as weightlifting: These can help increase muscle mass, which is useful because it is not uncommon for people to lose muscle mass (and add fat) during their treatment.

What should I watch out for about exercise? Are there any risks and how could I avoid them?

The risks for cancer survivors are not very different from those for the general population. Musculoskeletal injuries, such as sprains, are the most common. It is best to have a complete physical exam and get approval from your oncologist before starting a moderate to vigorous exercise program. Contact your doctor, create an exercise program, and get started.

How often can I exercise and at what intensity?

If you are not already very active, you should not expect yourself to achieve this immediately. As with anything else, the key is to set small, achievable goals and gradually build up to that end result that you expect for yourself. Try to find an activity that you enjoy. You may wish to exercise in the company of a friend at the same fitness level. Co-exercising will likely increase your motivation. Whatever you do, don't be disappointed. Doing something is better than doing nothing!

Your body has been through a lot and you ought to respect it. You can increase your physical activity without necessarily going to a gym. Incorporate more activity into your daily routine. Here are some suggestions:

· Buy a pedometer and increase the number of steps you take every day. You can also download health and fitness apps to your mobile phone, thus gaining the ability to record your steps and your general physical activity.

· Take frequent breaks during the day to go for short walks.

· Walk around your neighbourhood after dinner. If the weather is bad, you can walk to a shopping mall.

· Tidy up your garden. Cut the grass or collect the leaves instead of using a leaf blower.

· Play games that require vigorous movement with your children, such as jump rope.

· Use an electric treadmill or indoor bike while watching TV.

· Park your car in the furthest parking spot and walk to where you are going.

· Use the stairs instead of the escalator or lift. Get off the bus or metro a few stops early. Walk the rest of the way to your final destination.

· Set up notifications on your phone to remind yourself to take a break after a short walk.

· Organise a walking group with friends.

Post-treatment examinations

The frequency of testing varies depending on the type and stage of the cancer. Usually, retesting is required every 3-6 months for the first few years and if necessary thereafter. The visits include updating the patient's history by performing a complete physical examination, reporting and regular clinical and laboratory tests.

Illustration

- Mammogram and breast ultrasound (if you are a woman)

- Monitoring control:

➢ Imaging examinations (classical radiography, tomography, scintigraphy)

➢ Blood tests

Observation of any changes in your body

The patient is the best observer of his/her body. A persistent fever, unexplained weight loss, an atypical abdominal pain, a localized bone pain, are signs that should immediately alert you for further testing.

Bibliography

Stein KD, Syrjala KL, Andrykowski MA. physical and Psychological Long-Term and Late Effects of Cancer. cancer 2008, 112(suppl 11):2577-2592

Mitchell SA. cancer survivorship in Burke CC editor. psychosocial dimensions of oncology nursing care. second edition. oncology nursing society, Pennsylvania; 2009;.125-157

Twobly R. What's in a name: Who is a cancer survivor? J Natl Cancer Inst 2004; 96(19):1414-1415

Mullan F. Seasons of survival: reflections of a physician with cancer. N Eng J Med 1985; 313 (4):270-273

Welch-Mccaffrey D, Hoffman B, Leigh SA, Loescher LJ, Meyskens FL. surviving adult cancers. part 2: psychological implications. ann inter med 1989; 111(6): 517-524

Hewit M, Greenfield S, Stovall E (eds) From cancer patient to cancer survivor: Lost in Transition, Washington DC: National Academies Press; 2006

Jacobs LA, Palmer SC, Schwartz LA, DeMichele A, Mao JJ, Carver J et al. Adult cancer survivorship: evolution, research, and planning care.CA Cancer J Clin 2009; 59 (6) :391-410.

Alfano CM, Rowland JH. Recovery issues in cancer survivorship: a new challenge for supportive care. Cancer J. 2006;12 (5): 432-435

https://www.dana-farber.org/health-library/articles/questions-about-exercise-during-and-after-cancer-treatment/

https://www.webmd.com/cancer/features/exercise-cancer-patients

https://www.mskcc.org/cancer-care/patient-education/exercise-during-after-cancer-treatment-level-1

Part 5, 18-39 years, young cancer survivors, podcast

Episode 1 - QA About Life After Therapy

The 1st podcast refers to a patient's basic introductory questions answered by a member of the healthcare staff.

Preparation of questions and answers: Ioanna Velissari, Anna Viha, Apostolos Vantarakis, Angelos Koutras
Voices: Zoi Asimakopoulou, Maria Vassilopoulou

Young cancer survivors, Podcast

Episode 2 - QA About Life After Therapy

The 2nd podcast refers to a patient's questions about his daily life issues which are answered by a member of the healthcare staff.

Preparation of questions and answers: Ioanna Velissari, Anna Viha, Apostolos Vantarakis, Angelos Koutras
Voices: Zoi Asimakopoulou, Maria Vassilopoulou

Young cancer survivors, Podcast

Episode 3 - Psychological Support in Life After Therapy

The third podcast is focusing on psychological support and how cancer survivors can navigate life once treatment is completed.
Preparation of questions and answers: Zoi Asimakopoulou, Maria Vasilopoulou, Ioanna Vellisari, Anna Viha and Apostolos Vantarakis
Voices: Zoi Asimakopoulou, Maria Vasilopoulou

Young cancer survivors, Podcast

Episode 4 - Diet in Life After Therapy

The fourth episode of this series of podcasts is touching upon the interesting topic of nutrition, more specifically a certified Clinical Dietician-Nutritionist working for lots of years with cancer patients is answering questions regarding diet after treatment for cancer has been completed.
Preparation of questions and answers: Ioanna Partsalaki, Anna Viha, Ioanna Vellisari and Apostolos Vantarakis
Voices: Zoi Asimakopoulou, Maria Vasilopoulou

Young cancer survivors, Podcast

Episode 5 - Training in Life After Therapy

In this 5th episode of the University of Patras series of podcasts, you have the opportunity to listen to a certified trainer answering questions regarding physical activity among cancer survivors.
Preparation of questions and answers: Natasa Pagoni, Ioanna Velisari, Apostolos Vantarakis and Anna Viha
Voices: Zoi Asimakopoulou, Maria Vasilopoulou

Young cancer survivors, Podcast

Episode 6 - Sexuality and Cancer

For this episode of the series, we are exploring an aspect that is sometimes been overlooked during the cancer experience and that is the impact of cancer on sexuality, fertility as well as romantic relationships. We answer questions regarding these topics in an effort to encourage not only young cancer survivors but also healthcare professionals to address these sensitive aspects with honesty and openness.
Preparation of questions and answers: Rebecca Skog (Uppsala University), Kristina Fagerkvist (Karolinska Institute) and University of Patras.
Voices: Zoi Asimakopoulou, Maria Vasilopoulou

Young cancer survivors, Podcast

Episode 7 - Questions On Education, Career Support & Work Integration in AYAs Cancer Survivors

In our final episode of this series of podcasts, we decided to pay close attention into work related concerns and thoughts that adolescent and young adult cancer survivors are confronted with during their cancer journey. We teamed up with Zoe Fragou an organizational psychologist and bussiness coach to give us her insight about the education, work integration and career support specifically for individuals with a cancer experience.
Preparation of questions and answers: Zoe Fragou
Voices: Zoi Asimakopoulou, Maria Vasilopoulou