Patti Rosa was minutes into her first yoga class when she felt the after-effects of breast cancer.
After a year of chemotherapy and radiation, and no physical activity, Rosa's body was no longer flexible. She could not touch her toes.
"I sat down, stretched my legs, reached out and I hit a brick wall,'' the 64-year-old Las Vegas resident said after a recent meeting with a Nevada Cancer Institute corporate wellness coordinator. "I kept thinking, 'This can't be my body.'''
To help breast cancer survivors who are trying to transition into somewhat normal life activities such as exercise, and out of the pricking and prodding of lab technicians, daily chemotherapy treatments and weekly doctor visits, the Nevada Cancer Institute has created a Survivorship Clinic at its main campus in Summerlin.
The clinic, currently exclusive to its breast cancer survivors, is aimed at helping survivors with the physical and mental post-treatment effects of cancer.
"As we (clinicians) go through treatment with the patients, we address much more of the physical problems; but there's so much going on emotionally that we don't necessarily take time to address those things,'' said Dr. Karen Milligan, a medical oncologist who heads the institute's Survivorship Clinic. "This program is geared toward bringing everything together to help patients make adjustments. The bigger challenges are physical, but there are psychological and social challenges.''
Like Rosa, patients taking part in the clinic meet with an advanced nurse practitioner and undergo a comprehensive evaluation to help plan their after-cancer treatment for the next five to 15 years, Milligan said.
The nurse practitioner looks for any side effects to drugs or other treatments and screens for other cancers, Milligan said. The nurse practitioner is also looking for signs of depression, she said.
Patients then meet with the cancer institute's resident dietitian, Amy Patton, and Hilary Meade, its corporate wellness coordinator, for dietary and exercise plans.
Those plans are individualized to help with weight gain and loss issues and to help prevent lymphedema, swelling that occurs in the arms and legs when there's a blockage in the lymphatic system.
Patients also meet with a social worker, Milligan said.
"What comes out of this is a care plan and treatment summary which we have the ability to send out to the patient's primary care doctor so that they will have a record of what has happened, what we've done and our long-term recommendations.''
Although the Nevada Cancer Institute's survivorship program is believed to be the first in Nevada, it is not a new concept across the country. Last week, as part of a collaboration between the National Coalition for Cancer Survivorship, UCLA's Jonsson Comprehensive Cancer Center and WellPoint, a subsidiary of Blue Cross and Blue Shield, a cancer survivorship program was piloted in five states.
Breast and colorectal cancer survivors, and their physicians, in Nevada, California, Colorado, Maine and New Hampshire are receiving letters and kits that promote understanding of post-treatment effects of cancer.
Genentech, a California-based biotechnology company, is also part of the collaboration.
The pilot program is an effort to encourage oncologists to summarize with their patients and primary care physicians what's needed so that the patient has a road map to stay healthy, said Dr. Patricia Ganz, director of the UCLA Cancer Survivorship Center.
"Very often patients will continue to be followed by their oncologist, but over time that visit becomes much more social. While the oncologist is paying attention to any signs of cancer recurrence, they don't tend to pay attention to other health problems the patient may have acquired due to the cancer treatment,'' Ganz said. "Those treatments are often very complicated; and some of the drugs, radiation and surgery could lead to long-term problems."
Ganz said in such cases the primary care physician is a huge factor. Because the patient's primary care physician doesn't always get treatment summaries, they might not pick up on delayed effects.
Linah Lubin, a spokeswoman for the National Coalition for Cancer Survivorship, said the pilot program comes in response to a 2005 Institute of Medicine report: From Cancer Patient to Cancer Survivor.
The 506-page report concluded that many cancer survivors are lost in transition from active treatment to survivorship. They have few clues about how to manage their follow-up care and about the physical and mental health problems that may result from their treatment.
The pilot program is expected to expand to other cancer types throughout the country.
The Nevada Cancer Institute's program, which started in November, has enrolled 30 to 35 patients.
The institute also plans to expand the survivorship clinic to address other cancers, hopefully within this calendar year, Milligan said.
The cancer institute also plans to extend the program to noninstitute patients in the near future.
Rosa believes the program will help her become flexible again.
"Cancer is something different. I tried to stay healthy and always said, 'I'm never going to get it because of my health.' But it wasn't until after I had it that I realized how human we are, how frail we are and how vulnerable our bodies are.''
Contact reporter Annette Wells at awells @reviewjournal.com or 702-383-0283.
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