Recipes provided by the Dana-Farber Cancer Institute in Boston

1⁄2 teaspoon unsweetened shredded coconut, toasted

1⁄2 teaspoon chocolate shavings or cocoa powder

Add 1⁄4 cup almond milk and cocoa powder in a bowl. Whisk well to combine.

Add remaining almond milk, maple syrup, cinnamon, salt and vanilla extract. Whisk to combine. 

Cover and place in fridge. Stir after 3 hours. Let chill overnight.

Garnish with raspberries, mint, toasted coconut, and chocolate shavings.

1⁄4 cup skim milk (or unsweetened almond milk)

Wash sweet potatoes and pierce with a fork. Bake them for about an hour.

Cool sweet potatoes, then slice in half, scoop flesh into a large bowl and mash.

Preheat oven to 350° F and lightly grease baking sheets.

In a large bowl, combine sweet potato puree, ground flax seed, milk, oil, vanilla and brown sugar.

Sift flour, spices, baking soda, and salt; stir until incorporated.

Fold in oats, almonds and dried cranberries.

Scoop onto baking sheet and bake for 12-15 minutes.

1 (15 1⁄2 ounces) can black beans, rinsed and drained

1⁄2 cup mini chocolate chips, divided into 2 portions of

Preheat oven to 350° F. Lightly grease 9-by-9-inch square baking pan with oil.

In a blender, puree black beans in olive oil. Then add eggs, cocoa, agave/maple syrup and vanilla. Melt half of the chocolate chips and add to the blender. Blend until smooth.

In a small bowl, whisk together the flour and baking powder. Add to the blender and pulse until just incorporated. 

Stir in the remaining chocolate chips and pour into prepared pan. Sprinkle walnuts on top.

Bake about 20 minutes, until surface looks somewhat matte. 

Let cool at least 15 minutes before cutting and removing from the pan.

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Articles

Treat yourself without the guilt! Here are three delicious — and most importantly nutritious — desserts to try at home when you are craving something sweet.

Satisfy the Sweet Tooth With Cancer-Friendly Recipes

Some may think that when a cancer survivor finishes treatment, cancer is left behind. However, long-lasting side effects can have an effect on the daily lives of survivors and their families. 

After treatments such as chemotherapy and radiation have ended, many cancer survivors may be left with infertility struggles and unable to grow their family.

 after treatment ends. Unfortunately, many survivors might not
have been given an option to preserve fertility — such as banking sperm or freezing eggs — due to a lack of conversation with their oncologist before
treatment.

One survivor featured recalls a brief discussion with her oncologist but was so worried about surviving treatment that she did not think about long-lasting side effects. At times she wishes she would have asked more questions about preserving fertility.

 treatment can also affect quality of life. Certain cancer types and treatments may lead to side effects such as dry mouth or increased risk for cavities. In this issue, we talk with an expert about why this happens and what survivors can do to mitigate it.

Robert Atteberry, three-time cancer survivor

, about how he found motivation during survivorship to compete in Ironman races, marathons, half marathons,10K and 5K races. 

He says he couldn’t have done it without family, friends and his mantra, “Go! Go! Go!” He advises other cancer survivors to put their mind to what they want, and never give up.

And we never forget the recipes. In this issue, we are giving you three desserts that are sure to satisfy the sweet tooth, without the unhealthy ingredients.

We hope you find this issue informative and inspirational.

From fertility issues to oral side effects, cancer survivors may face health complications after treatment ends.

Dealing With Cancer's Side Effects and Finding Motivation

Bouncing back from a cancer diagnosis can be difficult during survivorship, but Robert Atteberry, 50, of Clarkston, Michigan, did it three times, and has since competed in multiple marathons and Ironman races.

Atteberry received his first cancer diagnosis in 2012 after turning 40. He was feeling sick and was continuously being treated for sinus infections without getting better. After a visit with a different physician, he received a diagnosis of diffuse large B-cell lymphoma in his sinuses. He finished treatment with chemotherapy, but something still felt off.

“I got out of (treatment) and I didn’t feel right,” he recalled in an interview with 

®. “I started feeling like I couldn’t even go out. I wanted to go out and run; I couldn’t do it. And next thing you know, I wasn’t walking or talking.”

After visits to sleep specialists and psychiatrists, he underwent an MRI, which is when he received his second cancer diagnosis — brain cancer. The doctor gave him only two years to live. 

But another doctor at the University of Michigan gave him hope, saying, “I’m going to keep you alive.”

After the second treatment, Atteberry started walking and talking again. When he was finally sent home from treatment, he started going out for walks. He hasn’t stopped — and has done much more than walking.

During survivorship he has competed in six Ironman races, including five Ironman 70.3 events, which includes a 1.2-mile swim, 56-mile bike race and 13.1-run, and one full Ironman, which includes a 2.4-mile swim, 112-mile bike race and 26.2- mile run. Additionally, he has competed in a few marathons, half marathons and many 10Ks and 5Ks.

These races have become part of a life Atteberry loves — one that six years earlier, during his brain cancer diagnosis, he didn’t think he would have. “I have not stopped training. I have not stopped doing major events,” he said. “And I love every single day of my life now.”

Atteberry had competed in triathlons before receiving any cancer diagnoses but regained a passion and purpose for them after physical therapy following brain cancer treatment. Because he wasn’t walking at his regular pace yet, he began swimming. 

That started it all, he said. After that, he started walking, running and biking — and didn’t stop.

“I never really thought about it. I just did it,” he recalled.

Training for these races during survivorship was incredibly hard, Atteberry said. But he had help from friends who competed with him; he never felt like he wouldn’t make it because he always had someone next to him. 

That someone next to him was friend of over 25 years, James Collins.

“It’s amazing how many friends and family members that help make it OK” he said. “It’s just an amazing process. It’s awesome. I have an amazing wife that saved me, all the appointments, helping with the pain and never letting me give up. She and our boys mean the world to me.”

Also getting him through is his mantra: Go! Go! Go! The phrase came to him during brain cancer treatment; he would say it to himself. Then his physical therapists began encouraging him with it as well. 

Later, his four children started saying it and it would appear on team T-shirts at each of his races. It also became the title of his book, “Go! Go! Go! Rise, Fall and Rise Again: The Story of Cancer.”

“Go! Go! Go! is what got me through and is what gets me through each and every day,” Atteberry explained. It got him through his brain cancer treatment, physical therapy, training for the triathlons and a third cancer diagnosis last year.

During a self-examination, Atteberry felt a lump on his genitals and decided to get it checked. He received his third cancer diagnosis — testicular cancer. He went through six treatments to rid himself of that cancer and extra treatment to make sure it did not spread to his brain. 

In December 2021, he was told he was in remission.

However, the first two diagnoses didn’t stop him and neither would the third. Atteberry continues to train for and compete in triathlons. His most recent events were the Ironman 70.3 Michigan, which he did not fully finish, but he did complete the Detroit International Half Marathon, and is ready for even more in 2023. He said he will never give up competing and that no cancer survivor should give up on themselves either.

“Never give up. Never ever,” he concluded. “There’s always something. Not everybody has to go out and run, but do something that makes you motivated. It’s so important to go, go, go.”

Robert Atteberry never gave up, even after three cancer diagnoses, and has found a motivation and passion for competing in triathlons during survivorship.

Triathlons Helped Three-Time Cancer Survivor 'Love Every Single Day' of His Life

Cancer survivors can face many side effects from treatment; unfortunately, some are not manageable. However, others, such as dry mouth, can be counteracted by practicing good oral hygiene.

® spoke with Dr. David R. Dean, director of oral medicine at the Fred Hutchinson Cancer Center in Seattle, about risk factors for developing oral problems, effect on quality of life and what cancer survivors can do.

Developing oral side effects is extremely common in some types of cancer, specifically head and neck cancers. The radia- tion levels are so intense that damage to salivary glands (which produce saliva that aids digestion, keeps the mouth moist and supports healthy teeth) can result, Dean explained.

Survivors with certain immune-related issues from cancer therapy also can be at risk for oral side effects. This includes those who have had a bone marrow transplant or peripheral blood stem cell transplant and may develop graft versus host disease (a condition that occurs when donor bone marrow or stem cells attack the recipient), which can also affect the salivary glands. 

Immunotherapy and chemotherapy also may cause oral side effects in survivorship.

Dean noted that the most common oral side effect cancer survivors experience is dry mouth. This can greatly affect quality of life because survivors can find it hard to talk and socialize. Eating may become difficult as well, so some individuals may lack the nutrition they need.


“The dry mouth issue, which is probably the one that comes up the most often for people, affects quality of life because just in general the mouth is less comfortable — it can make it more challenging to speak, eat and swallow,” he explained. Decreased saliva also increases risk for cavities which can lead to pain, increased need for dental work or even loss of teeth. “It’s just one more thing on top of every other aspect of survivorship, which can be pretty tough,” Dean added.

If someone has ended treatment or is undergoing treatment through survivorship, maintaining daily oral hygiene can decrease the likelihood of many of these side effects, Dean said.

His top oral hygiene tip is to keep up with daily brushing and flossing; this will help combat dry mouth, and symptoms that come with it such as tooth decay. 

Survivors should also have what Dean called a “dental home” — a dentist or clinic they can go to consistently. The dentist should know their cancer and treatment history to personalize treatment for survivors and help them understand risks they face. 

A dentist can also help to screen for oral cancer, which can be more likely in survivors of certain cancers, and other late effects of cancer therapy, he added.

“Having somebody who knows your mouth well and can provide a general screening to supplement all the things that the medical team is already doing really helps a lot,” he said.

Dean added that oral hygiene is an area that can be controlled, which is important for cancer survivors to do to avoid pain or discomfort.

“It’s important to try and minimize any pain and suffering related to preventable causes,” he said. “It’s something where there can be some control. (Cancer survivors) feel like they can actively focus on oral hygiene and that it is likely to make a difference, as opposed to something where it’s excessively hard to prevent complication.”

It is important for survivors to maintain healthy oral hygiene because they face increased risk of dental problems.

Brush Up on Oral Hygiene After Cancer

Most videos on YouTube about cancer rehabilitation were of low quality and did not provide sufficient information for cancer survivors, according to a recent study. The research highlights the need for survivors to better understand how to find reliable, personalized sources.

, investigated the quality, reliability and accuracy of cancer rehabilitation videos on YouTube. Researchers used the keywords “cancer rehabilitation” and “oncology rehabilitation,” and 53 of the first 200 videos met criteria
of high quality and reliability — most others were of low quality. 

Of note, high-quality videos ran longer, had more views and scored higher on reliability.

® spoke with Nicole Reilley Dosey, network manager of outpatient therapy services, including oncology rehab, lymphedema and pelvic health services, at Allegheny Health Network in Jefferson Hills, Pennsylvania, about the challenges cancer survivors face when searching for beneficial, reliable resources on the internet.

“There is a variety of information out there covering a lot of different perspectives, from the patient’s experiences to professional advice,” she said. “When doing my own research, the biggest concern was reliable sources with good content.”

It can be challenging for cancer survivors to search YouTube and Google to find a video or article that is reliable, informative and tailored to their needs. Reilley Dosey noted that not every video on the internet is for every cancer survivor, and rehabilitation or exercise therapy is often tailored to specific side effects, treatments or diagnoses.

Prior to researching online, cancer survivors should better understand what they are looking for. If they want exercises to help with lymphedema (swelling, usually of the arms and legs), then that should be the search term — not just “cancer rehabilitation,” which can lead anywhere and may not be beneficial.

“We like to make (cancer rehabilitation) individualized,” she explained. “Such as what was the person’s level (of exercise) before, where are they in the spectrum of survivorship, what are their goals. So it does become challenging for the patient to deter- mine what direction to go and what resources to look for.”

Although not everything online is untrustworthy or dangerous, cancer survivors should be cautious and understand what is dependable versus what is not. Reilley Dosey highlighted that some of the most reliable informa- tion comes from reputable institutions — cancer centers, hospitals, survivorship clinics and advocacy groups. 

It is also important for survivors to talk with their care team about what rehabilitation they should be doing, so they can better know what to look for in their search — the care team should be able to offer resources as well.

“One of the best resources is your local cancer center, to find out if they offer oncology rehabilitation or oncology exercise programs,” she concluded. “When getting started with an exercise program, having a health care profes- sional trained in oncology exercise will help you obtain better outcomes. Support groups are another great resource. There are so many platforms today from in-person to virtual that offer valuable information and programs.
Do your research, but don’t wait; go out there and start moving.”

For more news on cancer updates, research and education, don’t forget to 

The internet is flooded with information for cancer survivors, and it is vital they recognize the reliable sources from those that are not.

Finding the Right Cancer-Related Information

About a week after his wedding in June 2021, 31-year-old Andrew Garcia received a diagnosis of rhabdomyosarcoma (a rare cancer that forms in soft tissue) after what was initially an evaluation of a cut on his hand. After the diagnosis came a whirlwind of discussions about treatments he would need, including surgery, chemotherapy and radiation.

“It felt like life stopped for me,” he recalls. “I didn’t feel like there was much I could do.”

Before treatment started, his oncology team discussed fertility preservation and he was referred to a fertility clinic. 

“At that time, fertility was the last thing on my mind,” Andrew says. “I didn’t realize that chemo could make me infertile.”

He successfully completed treatment and continues with routine observation to watch for signs of cancer recurrence. Now he and his wife, Cassie, both of Alexandria, Virginia, are trying to pursue the next phase of their lives — parenthood.

“We grieved the beginning of our marriage,” Cassie shares. “We didn’t get to take a honeymoon yet. The first year he was sick; I was his caregiver, there was work. Ultimately, it has brought us closer together.”

After completing treatment for a cancer diagnosis, survivors may feel they have moved beyond one of the most difficult seasons of life. However, for many, the end of treatment marks the start of a new struggle: the path to parenthood. A cancer diagnosis and subsequent treatment can leave long-lasting side effects, making conception a challenge, and for some survivors, an unexpected consequence. 

Many survivors struggling with fertility feel like cancer has taken one more important thing away from them — a sentiment echoed by the Garcias on their journey to parenthood.

Fertility can be affected by many factors including type of treatment received, baseline fertility status, age and other medical conditions. The exact number of people living with infertility due to cancer treatment may never be known but has become more common with cancer cure rates increasing over the years.

Cancer treatments do not universally cause infertility, but many can affect fertility. At the time of diagnosis, a patient may not even be thinking about fertility, or how this health status change could affect the prospect of parenthood. This is especially true in instances of aggressive cancer that requires quickly starting chemotherapy.

Surgery, radiation, chemotherapy and hormonal treatments can lead to infertility for men and women, depending upon their diagnosis. For example, if surgical removal of reproductive organs, such as the ovaries, uterus, cervix or testicles, is required, fertility can be permanently affected. 

Infertility can also result from radiation treatments provided in the pelvic region.

Additionally, chemotherapy medications or hormonal treatments may temporarily or permanently stop egg production and induce menopause in women. In men, chemotherapy is known to stop or reduce sperm production.

Unfortunately for many, there is no discussion of fertility before treatment starts, and it becomes something else for which those living with cancer, as well as survivors, must advocate for. 

 should be happening from the beginning and continue through treatment and survivorship. 

Adriana Sosa, 41, of Castro Valley, California, recalls only a brief discussion about fertility when she received her breast cancer diagnosis in 2015. At the time of her diagnosis, she had a 3-year-old son. 

“My oncologist was worried because I was so young and had just one child,” she says. “He talked about, what were my plans for the future? Did I want more kids? He was asking questions I didn’t know how to answer.” 

She recalls that she was more focused on surviving breast cancer for the sake of her son. “I have to be fine for him. If I can’t have kids again, so be it.”

Sosa began treatment, which included hormone therapy and surgical removal of her ovaries. Her son is now 12, and at times she wishes she had asked more questions about how she could have preserved fertility. 

Her advice to others facing a comparable situation is: “Think out loud. Whatever is in your head, say it. You’re the only one who can advocate for yourself.”

Dr. Pascale Salem, a medical oncologist at SSM Health St. Joseph Hospital in Lake St. Louis, Missouri, makes a point of having conversations about fertility when discussing treatment options with patients. She recognizes the importance of patients being fully informed about what can happen and wants to do her part to support fertility preservation where possible. 

“There is a pressure for people to start chemotherapy as quickly as possible,” she explains. “But there is time to let fertility preservation take place.”

These conversations take place as often as needed for the patient to feel comfortable with the plan and meet directly with experts in this field. She wants patients to have the opportunity to ask questions and have time to seek fertility preservation assistance.

Without adequate conversations between oncologists and their patients, there can be upset and struggles as someone transitions into cancer survivorship and wishes to start a family. 

Jessica Gorman, an associate professor in the College of Public Health and Human Sciences at Oregon State University in Corvallis, states that many young cancer survivors “are unaware that their cancer treatment was going to affect their fertility. They often state that they weren’t well-informed about their fertility options.”

Gorman also discussed the impact infertility has on mental health, especially for women, given societal expectations of motherhood. She says cancer survivors have told her that “the idea of not having kids is as hard as, or even harder, than getting the cancer diagnosis. It’s a huge loss.”

Options for fertility preservation and timing for these interventions can be different for men and women. Depending on the cancer diagnosis, there may not be much time for prioritizing fertility preservation. 

Dr. Akanksha Mehta, a urologist at the Emory Winship Cancer Institute in Atlanta, understands that time is pressing in such situations. She works closely with the Emory Reproductive Center to preserve fertility for cancer survivors.

“When I get a referral, I’ll see that patient as soon as possible. I’ll either see him in person, in the office or with a telemedicine visit. I like patients to understand how the process works,” she says. “Someone needs to continue to follow them even after treatment is done. Many treatments can lower testosterone, and someone needs to follow that as well.”

Mehta’s patients are men, and her approach to fertility preservation includes a recommendation to have one or two sperm deposits frozen for future use. Sperm quality is the best when the sample is collected before starting chemotherapy medications. 

“Fertility should be a consideration from day one,” she adds.

For women, the process is often more complicated and usually requires additional weeks of planning. 

Egg harvesting from the ovaries may be recommended to help preserve fertility. This is typically done with injections of hormonal ovarian stimulation medications. Hormone levels and the number of egg follicles are monitored with regular ultrasounds. When the follicles reach the appropriate size, a trigger shot is administered, allowing the eggs to be released and harvested a few days later. The eggs can then be fertilized with sperm to form embryos for frozen storage, or they can be frozen without being fertilized.

Previously, egg harvesting could take months, as it needed to be timed with the natural menstrual cycle. With newer medications and procedures, the process now takes two to three weeks. 

Although the process is quicker, the cost of the procedure and storing the frozen eggs or embryos can be prohibitive for many patients. Everyone’s financial responsibility can differ, and it can cost tens of thousands of dollars for fertility preservation.

The price tag associated with fertility treatments has been an issue faced by the Garcias. They both have insurance that helps cover the cost of some, but not all, medications and procedures associated with in vitro fertilization (IVF).

“Insurance doesn’t cover everything,” says Cassie. “It covers 50% of the cost of the embryo transfer but doesn’t cover the cost of thawing the embryo. It feels like insurance companies say they cover infertility treatments, but then pick and choose what they want to cover. They don’t cover the cost of moving the embryos from one fertility clinic to another, or the monthly cost of storing the embryos.”

At this time, they have spent over $20,000 on their journey to parenthood.

Additional fertility preservation treatments may be offered, such as surgically moving the ovaries to the side to decrease their risk of radiation exposure (called ovarian transposition), or even removal of ovarian tissue to be frozen and transplanted later when treatment is finished. Ovarian cryopreservation is still experimental, but may be a treatment choice for those who receive diagnoses during childhood.

Maresa King, 35, of Irvine, California, struggled with infertility during and after treatment for breast cancer. She and her husband decided to go through IVF after understanding the effects chemotherapy would have on her fertility. But because she was on disability, only making 60% of her annual salary, they decided to take out a loan to cover the costs.

However, her treatment and the cancer were so aggressive that the oncologist only gave her one shot at it. They were able to retrieve 12 eggs; however, she was told the quality was “really bad.” Three were able to be frozen. 

After undergoing IVF treatment, during a six-month break from cancer treatment, two were successful and King was pregnant with twins. 

Unfortunately, due to pregnancy complications, only one lived. 

“After that, the doctor told me, ‘You’re done. You can’t have kids on your own. The possibility of ever having kids on your own is about 1%,” she says. “We counted our blessings and understood that was our only shot.”

But it was not. With a 1% chance, King was able to conceive naturally. Her pregnancy went well, and she has since given birth — however, one lasting side effect she did experience from chemotherapy was shortness of breath.

“I was very shocked and in disbelief that I was actually pregnant. Then anxiety took over because I didn’t believe things would work out and I would go on to have a healthy pregnancy, especially with everything that happened with my first pregnancy. Eventually all I had left to do was have faith and pray that God would allow me to get through it and bring to this world a healthy baby,” King shares.

For some cancer survivors, the path to parenthood may be difficult. There may be multiple options available, though, for those who wish to become parents. In addition to procedures such as IVF, other options can include surrogacy, IVF with donor eggs or adoption.

During this journey, it is important for cancer survivors to be their own advocate. Survivors will need the support of their oncology team not only to treat their disease, but also to live their life beyond cancer while on the path to parenthood.

Feature

Fertility may be affected due to cancer treatment, altering the way survivors move on to their next phase of life — parenthood. 

Heal Winter 2022

Satisfy the Sweet Tooth With Cancer-Friendly Recipes

Dealing With Cancer's Side Effects and Finding Motivation

Triathlons Helped Three-Time Cancer Survivor 'Love Every Single Day' of His Life

Brush Up on Oral Hygiene After Cancer

Finding the Right Cancer-Related Information

Fertility Discussions Help Cancer Survivors Preserve the Next Phase of Their Life

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