Wellness plans

A wellness plan that includes healthy habits and regular medical care helps survivors of childhood cancer live healthy lives and reduce the impact of late effects of cancer treatment. Healthy habits include eating well, being physically active, maintaining a healthy body weight, limiting alcohol, not smoking, protecting yourself from the sun and having regular health exams by someone familiar with your cancer history and treatment.

Healthy habits can help you:

• regain or build strength and endurance
• deal with side effects like fatigue, weight loss or gain and sleep problems
• manage stress
• reduce the risk of developing other health problems

Just as your cancer treatment plan and experience were unique to you, your wellness plan will also be yours alone. Your healthcare team can help you develop a wellness plan that fits your needs, preferences and fitness level. What’s important is that you understand your wellness plan and are comfortable following it.

A plan can make you feel better and more in control of your health. It can also help to reduce your risk of cancer.

Follow-up care is an important part of managing your healthcare after treatment. In the early years after treatment, it allows your doctor to monitor your progress and recovery. It gives you and your family an opportunity to talk to your healthcare team about any concerns that you have after treatment. As you grow older, follow-up can help with the transition from child to adult care, and it can help you learn more about how to maintain your health.

Follow-up care is particularly important for childhood cancer survivors because of the possibility of late effects from treatment. Many of these are easy to detect and treat, but they can happen a long time after treatment. This is why it is important for childhood cancer survivors to have follow-up for the rest of their lives.

Make sure you see a doctor who is experienced in late effects after childhood cancer. Healthcare professionals are always learning more about the late effects of treatment for childhood cancer, so recommendations for follow-up can change. Most of the major childhood cancer treatment centres will have a childhood survivor follow-up clinic. If there isn’t anyone qualified near to where you live, you may want to arrange to have a meeting over the phone with experts at a childhood survivor follow-up clinic. Another option might be to travel to the follow-up clinic once a year or when necessary. In between appointments your local follow-up doctor can connect with the experts when necessary.

To get the most out of follow-up care, it’s important to have a good written summary of your treatment, including any complications you had during your treatment, and what follow-up care is recommended into your adult life. Get a copy of your records as soon as possible. Getting your records later on can be very difficult.

Find out more about follow up and watching for late effects.

Eating well will help your recovery by allowing your body to regain strength and rebuild healthy cells. It will also help you feel better overall and help you get back to your usual activities.

Cancer survivors also need to eat well because they may be at increased risk for other health conditions, such as heart disease, type 2 diabetes and weakening of the bones (called osteoporosis). Healthy eating and maintaining a healthy body weight can lower your risk of these and other conditions, including the risk of developing some types of cancer.

Many people wonder if changing the way that they eat, such as cutting out all red meat or eating vegetarian, can prevent cancer from returning. For now, research hasn’t answered this question. But we do know that a healthy diet can help prevent some cancers from developing in the first place.

Try to include healthy foods and eating habits as part of your daily routine. Canada’s Food Guide can help you make healthy food choices. Eat a diet high in vegetables and fruit and low in fat, salt and sugar. Check with your healthcare team about any food or diet restrictions that you may need to continue after treatment. If you are overweight or underweight it may be helpful to talk to a registered dietitian. Obesity can be a late effect of childhood cancer.

Getting some light to moderate exercise (such as walking, biking or swimming) every day has many health benefits and being physically active often improves your quality of life. As part of your wellness plan, exercise can help improve your mood, improve your sleep, boost your self-esteem and reduce fatigue and stress. It is also an important part of helping you maintain a healthy body weight after cancer treatment. A healthy lifestyle promotes better overall health and can decrease your risk for certain cancers in the future.

Surviving cancer can change how you feel about taking risks. Going through an experience like cancer as a child can make you more aware of how fragile life is. It can scare you, and make you afraid of taking any risks after surviving cancer. Or, coping with cancer and coming out the other side can also make you feel extremely lucky and ready to take on anything with a no-fear attitude.

Teenagers can often be rebellious as they test out life as an adult. Teens who have survived cancer are already at risk for serious health problems such as cancer and heart disease, so experimenting with smoking, alcohol or drugs has extra health risks.

Childhood cancer survivors may have increased risk of heart problems, premature emphysema, lung fibrosis and second cancers depending on their diagnosis and specific treatments received. Smoking makes these risks worse. If you were treated with certain drugs, such as bleomycin (Blenoxane), carmustine (BiCNU, BCNU) or lomustine (CCNU) or if you had radiation therapy to the chest, or both, then you have an increased risk of lung problems. It is very dangerous to smoke if your lungs are already damaged from treatment.

Some survivors may not be aware of their increased risk for heart problems. Other survivors may think that their treatment was so long ago that they don’t have to worry about its effects. Some survivors may not have good decision-making skills due to surgery, radiation or chemotherapy to the brain. Other things such as peer pressure or fearlessness can also cause a teen or young adult cancer survivor to start smoking.

If you don’t smoke, don’t start. If you do smoke, get help to quit. Talk to your follow-up doctor about the effects of smoking and tobacco use. Some survivors may smoke because of depression. If you are depressed, talk to your follow-up doctor about getting help.

Limit how much alcohol you drink. All alcohols (beer, wine and spirits) can increase your risk of certain cancers and can damage organs such as the liver. Childhood cancer survivors may already have damaged organs from chemotherapy and radiation therapy. Exposure to alcohol, or other drugs, can increase that damage.

Some childhood cancer survivors are infertile after treatment. In most cases, it’s hard for the healthcare team to say whether you will be able to get pregnant or father a child. They can only use the evidence available to give you their best estimate of your future fertility. Your fertility potential is not known for sure unless you seek the advice of a fertility specialist. If you are having sex and don’t want a pregnancy, you need to take every precaution to prevent one.

Even if you don’t have the risk of an unwanted pregnancy, you still need to protect yourself from sexually transmitted infections (STIs). There are many different types of STIs that you can become infected with from any sexual touching, not just intercourse. HPV is the most common sexually transmitted infection. More than 40 types of HPV are transmitted through sexual intercourse, genital skin-to-skin contact and oral sex. Use a condom to make any type of sexual intercourse or contact safer and to reduce the risk of pregnancy. Make sure your immunizations, such as the HPV vaccine, are up to date.

Cancer treatments put you at greater risk from ultraviolet radiation. Certain drugs make your skin more sensitive to sunlight. Skin that has been treated with radiation is also more sensitive, can burn more easily and is at increased risk for developing skin cancer.

The best way to lower your risk of developing skin cancer is to protect yourself from ultraviolet (UV) radiation. Check the daily UV Index. Try to reduce your time in the sun between 11 a.m. and 3 p.m., when the sun’s rays are at their strongest, or any time of the day when the UV Index is 3 or more.

Seek shade or create your own shade. Cover up as much of your skin as you can with tightly woven or UV-protective labelled clothing. Wear a hat with a wide brim that covers your head, face, ears and neck. Wear close-fitting sunglasses in a wraparound style with UVA and UVB protection. Apply a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 30.

Find out more about being safe in the sun.

When our body goes through very difficult and painful experiences, so does our mind. If we don’t release these strong emotions in some way, it can cause all sorts of physical and psychological problems.

Survivors need to be able to recognize stress, anxiety and depression and get any help needed. Different people reduce stress in different ways. Examples include exercise, religion, reading, counselling or spending time with other survivors. Others may need stronger supports and sometimes medicines. Asking for help is a sign of great strength and willingness to use whatever help necessary for a healthy mind and body.

It is also important to strengthen self-esteem. Some ideas for improving your self-esteem include:

• Be physically active. Exercise can help to release chemicals in the body that make you feel better.
• Make your own space. This may mean decorating your room or even a box or journal where you can keep your own belongings, such as music, books or writings.
• Try not to compare yourself to others.
• Find out what things you enjoy, what makes you happy and do it. This may be writing, dancing, singing, sports or reading.
• Say positive things about yourself.
• Surround yourself with positive and supportive people.
• Make a list of your successes.
• List your goals for the future and how you plan to achieve them.
• Try to laugh at yourself and have a good sense of humour.