New stage of life involves both returning and adapting

[00:00:00] Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be "The Informed Patient" with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. What happens when cancer treatment wraps up? Today, I'm talking about that with Susan Tiffany. She's a registered nurse certified in oncology nursing who works at the Upstate Cancer Center. Welcome back to "The Informed Patient," Ms. Tiffany.

[00:00:28] Susan Tiffany, RN: Thanks, Amber. It's nice to be here.

[00:00:30] Host Amber Smith: Depending on many factors, cancer treatment may require intensive care where patients are seeing the same doctors and nurses and technicians for weeks or even months. I imagine some patients develop strong bonds with their care team, and I wonder, does that bond help with healing?

[00:00:48] Susan Tiffany, RN: It does. It gives the patient an outlet. They are often coming into the cancer center biweekly or weekly, and they get to see the staff, and they get to share their feelings. And they're scared, they're vulnerable. And it's hard to share with their family, with their loved ones. Oftentimes it's just too close. It's hard for both. It's hard for the caregiver to hear the fear in the patient's voice, whereas the staff at the cancer center are familiar with it. We're trained. We have each other. We do have meetings to discuss it. We have services for us. Spiritual care is there for us to share our concerns.

[00:01:36] Host Amber Smith: So, patients really depend on the emotional support that comes along with the medical care?

[00:01:43] Susan Tiffany, RN: Oh, definitely. Definitely. And it's surprising. It's not just the nurses. It's the administrative staff. It's the front end staff. It is the nurses. It's the medical technicians. We're all there for the patients. And it's an important role. These patients are coming in at such a vulnerable time.

Oftentimes, people will say to me, that must be a really hard job. It's so sad. Well, it's also very rewarding. And I think that the staff, when you're an oncology professional, that's what we do. We help our patients get through these very intimate times. And it's very rewarding.

[00:02:22] Host Amber Smith: So, how involved is a patient's primary care provider? When they're going through cancer treatment, if they sprain their ankle or something, do they go to their primary care provider, or does the cancer team handle everything that happens?

[00:02:40] Susan Tiffany, RN: We like to handle everything that happens. When a cancer patient is receiving treatment, it depends on the treatment, it depends on the cancer, so, if there is an infection, we would want to know about that. So, during active treatment, the oncology team, the specialist, IS the primary care doctor.

[00:02:58] Host Amber Smith: And then what happens when the patient's cancer treatment concludes?

[00:03:03] Susan Tiffany, RN: Well, it's noted that primary care doctors have much respect for the oncology doctors, during the treatment phase, and oftentimes it's a difficult transaction to return back to the primary care doctor. So collaboration with primary care is very important. It's very important to the patient because not only are we transitioning back to primary care, but the patient is also transitioning back to primary care. And that can feel threatening. That can feel as though that they're lost, that they're out there and no one's going to watch their cancer.

And so we make sure that the primary care team is well aware of all the treatment that the patient received. And late and long term side effects and surveillance, and that's really important. During cancer treatment, oftentimes routine screening can be put aside. So, not only should they be screened for their cancer, but there's also routine screening, such as colonoscopies, pap smears, mammograms, bone density. And so that's one of the things that we make sure that doesn't go missed, by communicating with the primary care.

[00:04:22] Host Amber Smith: Please tell us about the letter that you presented at a conference recently.

[00:04:28] Susan Tiffany, RN: The letter that I presented was aimed at all primary care doctors. It's a template form that tells the primary care doctor that the patient was -- it's very brief -- that they were diagnosed with cancer, a little bit about the treatment, but also what side effects that they can watch for.

In sharing this information with the primary care doctor, we are being sure that they're aware of all the side effects that could happen with their cancer treatment, such as cardiac problems, pulmonary problems, skin problems. There's so many different kinds of treatments. So we do share that with the primary care doctor.

But also one of the most important things to share with the primary care doctor is the surveillance grid: who's responsible for the mammogram? Who's going to the colonoscopy? Was there polyps before? So it's a communication about cancer surveillance and cancer screening, as well as making mention of what their treatment was.

This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with oncology nurse Susan Tiffany from the Upstate Cancer Center.

[00:05:46] Host Amber Smith: There are professional caregivers at the cancer center, or the hospital, but many patients also rely on family or friends to provide care at home. Let's talk about what that's like. Do you see this strengthening or fracturing relationships?

[00:06:01] Susan Tiffany, RN: I see it strengthening. There's a lot of support. I hear that more than not, about how supportive my husband was, my wife, family, my job. Employers have been very supportive. But there is times it's, again, talking to your significant other, your close family members, about something that's going on with you can be very intimidating to both sides. The roles change. The provider is no longer the provider. The rulemaker is no longer the rulemaker. So things change. Roles change. And we do have, at Upstate, we have a psychologist that deals with oncology.

And so we can make referrals to them. Integrative medicine can be very helpful, looking at contentment and peace. And we have spiritual care that does the same. So, we do have resources, and it can be both ways. It can strengthen a relationship, and it can hurt.

[00:07:05] Host Amber Smith: How do you counsel patients who are used to being the ones who are independent, but now they're requiring assistance, and maybe they don't like their partner or their family members seeing them feeling so bad?

[00:07:19] Susan Tiffany, RN: Well, again, we do have, we can suggest the psychologist. But also, it's a normal feeling, talking to them about how normal it is, and how it's good to let go and let people care for you.

[00:07:38] Host Amber Smith: What do you find yourself telling family and friends about how they might be able to assist their loved one?

[00:07:44] Susan Tiffany, RN: By asking about their fears. Oftentimes, that's something that we don't discuss. And so being able to ask somebody what they're afraid of opens that up to that conversation. Again, we have social workers, we have psychologists that are trained in this area. And we do have in services, so the nurses and the staff are all trained or educated, I should say, in how to respond to our patients. We know that this is a very vulnerable and stressful time.

[00:08:22] Host Amber Smith: Well, you and I have talked before about cancer survivorship and how that actually begins at the time of diagnosis. I imagine there can be some shock wrapped up in a cancer diagnosis. How do you help patients understand what's happening and what lays ahead at the moment that they find out they have cancer?

[00:08:44] Susan Tiffany, RN: Education, communication, checking in with them. It's hard. Oftentimes they don't hear what what is being said, so we try and set it up, ask them to bring in loved ones so that -- or a support person, I should say -- to come in and sit with them and take notes. Talking to them about the normalcy of fears. And then making the referrals if we feel that it's something that needs intervention. We're all trained as that, to recognize when an intervention is required or needed.

[00:09:29] Host Amber Smith: Do you see a patient's anxiety level get a little bit more manageable once they have a plan in place for when they're going to have, if it's chemo or radiation or surgery. Does that help, to know what's going to happen?

[00:09:44] Susan Tiffany, RN: It definitely helps. Knowledge is power. At first, they just have a diagnosis in the waiting period of what do I need? Do I need radiation? Chemo? And then once you hear the word chemo, that can take you back years and years, and that means death to a lot of people. So once they understand what exactly they're in for, and that's very important on the staff, on the oncologist, on the nurses, to make sure that there is no questions, and to explain to the best that we can, because that's what's going to calm their anxiety.

[00:10:23] Host Amber Smith: People who survive cancer can have anxiety about whether it's going to come back. What are some strategies you recommend for coping with that?

[00:10:34] Susan Tiffany, RN: That is very true. There's a word for that: Scan-xiety. They call it scan-xiety. And we do, again, the psychologist at Upstate is wonderful. That's a very common occurrence for cancer patients having to go back and get their scans. Acknowledging that, acknowledging that it is fearful, can help. And again, if it's interrupting with their activities of daily life, or preventing them to come in to get the scan, then we would suggest that they talk to the psychologist.

[00:11:10] Host Amber Smith: Does having a history of cancer treatment, does that impact everything medical for that person going forward?

[00:11:19] Susan Tiffany, RN: It can, because of the anxiety. So if you feel a bump, a bruise, tired, you lost a pound, you know, it can always be that reference of, is my cancer coming back?

[00:11:33] Host Amber Smith: And so once a patient is done with their cancer treatment, and they go back to their primary care provider, do they ever come back and see the cancer team for stuff after that?

[00:11:46] Susan Tiffany, RN: Sure, but that's one of the best parts about the survivorship program. When they're first diagnosed, they are treated by, of course, the oncologist, and that may go on for three to five years, depending on what the surveillance plan is.

When it is time to leave the specialist and go back to their primary care, they have the survivorship navigator that is keeping tabs on them, talking about their treatment, talking about whatever concerns are coming up, talking about surveillance. And then we touch upon wellness, living your best life going forward. This is an opportune time to make changes with your health lifestyle.

[00:12:23] Host Amber Smith: Susan Tiffany, thank you so much for making time for this interview.

[00:12:27] Susan Tiffany, RN: Thank you very much.

[00:12:29] Host Amber Smith: My guest has been Susan Tiffany from the Upstate Cancer Center. She's a registered nurse certified in oncology nursing. "The Informed Patient" is a podcast covering health, science and medicine brought to you by Upstate Medical University in Syracuse, New York and produced by Jim Howe. Find our archive of previous episodes at upstate.edu/informed. This is your host, Amber Smith, thanking you for listening.