“Trust your gut” is not just an adage for Stephanie Seban — doing so saved her life.

At age 39, Seban is living with metastatic breast cancer and, she says, thriving. But it took learning that she had been misdiagnosed and received the wrong treatment for nearly five years, firing her oncologist and keeping faith to get herself to this place.

“When doctors give patients daunting statistics and messages based on fear, we (patients) harbor those messages and play them on repeat,” Seban said in an interview with Heal®. “Why not give us some hope to cling to? If we have to hear the worst-case scenario, why not also offer the best case?”

Seban focuses on the importance of obtaining second opinions; she attributes the problems related to her initial therapy to an inaccurate laboratory analysis. “My life has been altered by someone having a bad morning,” she said. “Maybe the pathologist who studied my tumor didn’t sleep enough the night before or perhaps they didn’t have their morning coffee. And their tragic mistake forever changed the course of my life.”

Seban’s initial cancer diagnosis came as a shock. In 2011, she had finally settled into her career as a teacher. Plus, she had picked up a second job working in high-end retail to help make ends meet in costly Los Angeles. “I was really busy working seven days a week,” she said. “Essentially, I was burning out.”

Seban didn’t notice any symptoms other than feeling a lump in her right breast. However, she dismissed it as a random premenstrual lump that would eventually go away. It didn’t.

Months later, a friend took a picture of the lump. Seeing it from that point of view, Seban realized she needed to get it checked. “My gynecologist was forthcoming,” she recalled. “She said, ‘I want to be honest with you. A cyst is usually soft and round, and this is not soft and round. I want you to go get a biopsy and mammogram.’”

She followed her gynecologist’s orders and was told her results would be ready in a week. But the next day her doctor called, telling her she needed to come in as soon as possible. “That’s when I asked if it was cancer,” Seban said. “I don’t remember much. It was surreal. You hear the word cancer and equate it to death. I (received a diagnosis) Monday and was in surgery on Wednesday. I got thrown into this cancer land.”

The diagnosis: stage 2 estrogen receptor—positive, HER2-positive breast cancer. While waiting for her insurance company to approve a positron emission tomography (PET) scan, Seban underwent a lumpectomy, followed by two surgeries to check for clear margins, making sure that no cancer cells were found near the edges of the healthy tissue. During a lymph node dissection, her doctor removed 22 lymph nodes — 13 had cancer. “We knew it had spread beyond the breast, but when I did the PET scan after the surgeries, that’s when a stage 2 diagnosis turned into stage 4,” she said. “They saw that I had a spot on my iliac bone.”

Seban didn’t rush into chemotherapy. She packed up her life and moved to Atlanta for six months to be with her mom. In Atlanta, she saw an oncologist who recommended a regimen of chemotherapy and Herceptin (trastuzumab), which targets HER2. “I asked him, ‘Have you seen good results with just Herceptin? And he said yes,” Seban recalls. She began Herceptin, but a scan conducted a few months later revealed it wasn’t working.

Acting on the advice of family and friends, Seban continued eastward. She traveled to New York City, where she would be treated by an oncologist at one of the city’s major cancer centers. “I knew on my first visit that it wasn’t going to be an easy appointment,” she said. “I looked like death on paper. But I made a promise to myself that day that no matter what she told me, I was going to continue to believe that I was going to be OK.”

Seban was given a 15 percent chance of beating her stage 4 cancer. Her first chemotherapy treatment was on Valentine’s Day 2012. For 3 years, she received different regimens containing Navelbine (vinorelbine), tamoxifen, leuprolide, Herceptin and Perjeta (pertuzumab), which also targets HER2. “It was a roller-coaster ride for a few years, but I was stable,” Seban said.

Then she noticed a new tumor growing in the same location as the first. Seban’s oncologist started her on T-DM1; Kadcyla (ado-trastuzumab emtansine), which was then a newer drug that targets HER2 positive breast cancer. But the tumor kept growing and became inflammatory. “I didn’t know what, but I knew something wasn’t right. It was like I had a monster growing outside of my breast,” she said.

Just before the summer of 2015, Seban recalled, her oncologist told her that the drugs were not working. Shortly afterward, Seban suffered a panic attack so severe that she drove herself to an emergency room, thinking she was having a heart attack. “I couldn’t breathe. I was sweating. I literally thought I was dying,” she said. “On my way to the hospital, I thought to myself, ‘OK, I talked to my mom today, my dad; everyone’s good. This is it.’”

Fearful of having another panic attack, Seban locked herself in her apartment for almost the entire summer. She prayed constantly, asking God to show her signs so that she could do whatever she needed to do to save her life.

STEPHANIE SEBAN is an advocate for other women with breast cancer and runs her brand, Thrive Gang.

Seban then came across the book “Radical Remission: Surviving Cancer Against All Odds,” which presents the findings of Kelly A. Turner, Ph.D., a researcher and counselor in integrative oncology who traveled throughout the world to speak with holistic healers and patients with cancer who survived years after conventional treatment failed. “This book saved my life,” Seban said.

After reading it, she wanted to learn more about Chinese medicine. A friend told her about George Y. C. Wong, Ph.D., and an email later, she met with him in Queens, New York, and began taking a personalized concoction of herbs. She didn’t know it at the time, but this encounter changed the course of her treatment and her life.

Wong advised Seban to contact Patrick I. Borgen, M.D., chair of the Department of Surgery at Maimonides Medical Center in

Brooklyn, New York. She brushed off the advice several times but then felt compelled to reach out to Borgen.

During her first appointment with him, which her mom flew in to attend, Borgen asked, “Has your oncologist biopsied your new mass?” The answer was no. Borgen strongly recommended she ask her oncologist to conduct a biopsy of the new tumor; if the cancer had changed, that might explain why she wasn’t responding to treatment.

Her oncologist told Seban a biopsy wasn’t necessary and that she would be starting her on a chemotherapy regimen known as CMF — cyclophosphamide, methotrexate and fluorouracil. Seban began consulting with Borgen before meeting with her oncologist, and he suggested that Seban enter a clinical trial at The University of Texas MD Anderson Cancer Center in Houston. When her oncologist dismissed that advice, Seban decided to put her faith in Borgen.

“In that moment, I knew he was my guy,” Seban said. “He was thinking outside of the box, and he was willing to fight for me.”

Seban never began CMF or saw that oncologist again. Borgen performed a biopsy, and a week later, he revealed that testing on an archived sample showed that her original tumor was never HER2 positive — it was HER2 negative.

“Here I was sick as a dog. I had one doctor whom I had built rapport with telling me there was nothing she could do for me,” Seban said. “And Dr. Borgen told me he believed 10,000 percent (that) I was going to beat this. In my darkest hour, he renewed my hope.”

Borgen felt that stones had been left unturned. “I worked with George Wong for many, many, many years, and with (Seban’s) type of breast cancer — what we thought (she) had &mdash; I’d seen traditional Chinese medicines be effective. I didn’t think we were even close to the end of our road,” he said.

It was go time, Seban said. She didn’t have time to be angry. She chose to head back to Los Angeles, where Borgen connected her with oncologists at University of California, Los Angeles (UCLA), Jonsson Comprehensive Cancer Center.

Her new oncologist performed fluorescence in situ hybridization, commonly referred to as a FISH test, which proved that her tumor did not change; she had always been HER2 negative. He put her on Arimidex (anastrozole), leuprolide, and what was then a newly approved CDK 4/6 inhibitor, Ibrance (palbociclib). Her oncologist monitored the cancer via scans.

“It got really bad before it got better,” Seban recalled. The cancer had metastasized to both of her lungs, which began to fill with fluid. She spent every other day in the hospital to undergo a thoracentesis. After several weeks, the fluid began to go away, her breathing improved, and scans revealed the disease was stable.

Seban then faced her next big decision — this time in her personal life. Her boyfriend, who lived in New York, asked her to move in with him. “I was afraid because I finally felt safe at UCLA,” she says. “I had a doctor, and they knew how to treat me properly. But I thought, ‘I’m not going to live my life around cancer.’ I had found love. Even my oncologist said ‘Go!’”

In April 2018, Seban followed her heart and moved across the country for the third time, and she now sees an oncologist at Weill Cornell Medicine in New York City. Once a month, she receives a regimen of Faslodex (fulvestrant), Ibrance, Arimidex and leuprolide. “I live my life like anyone else who is living their life, except I have to check in and take pills,” Seban said.

SEBAN uses a combination of traditional and complemetary therapies to treat her cancer and follows a vegan lifestyle.

Life with metastatic disease isn’t easy, but Seban focuses on gratitude. “Your mind-set is everything,” she said, “but a ‘fearless’ mind-set is not an easy place to get to. I had to practice — I still do every single day &mdash; to get my mind right. I make Post-it notes and stick them around my house with messages like ‘Thank you for my perfect health.’”

Cancer has also changed Seban’s relationship with food and exercise. She follows a vegan lifestyle and continues using Chinese herbs and taking supplements. Her regular workout routine includes yoga and jumping on a trampoline. Meditation, acupuncture and prayer help her keep a clear head.

Seban never returned to teaching. She serves as a mentor for other women with breast cancer and runs her brand, Thrive Gang, which offers handmade gifts and apparel for people with cancer. She is also writing a book called “The Thriver’s Guide: How to Heal and Live Your Best Life Beyond Cancer.” Borgen will pen the foreword.

Seban is thankful that she followed her gut instinct. “Recently, I had the revelation that throughout this journey, I have continuously been guided by something much bigger than myself,” she said. “I have never just done what I was told. Not to say I’m rebellious, but I let my own intuition, thoughts and feelings play a big role in my treatment. I never really was just a yes-girl. And thank God I wasn’t, because otherwise I wouldn’t be here.”

Articles

Feature

Stephanie Seban explains the hurdles she faced as she received the wrong treatment for nearly five years.

An Eight-Year Metastatic Breast Cancer 'Thriver' Shares How She Overcame a Misdiagnosis

Here’s a healthy way to have dessert for breakfast! This crisp is lightly sweetened with pure maple syrup and topped with nutritious nuts and oats, with no added fat or refined sugar. The topping contains a good amount of protein, fiber and heart-healthy fat, and the peaches provide cancer-fighting antioxidants and fiber. It’s good for anyone with ongoing digestive issues like nausea, heartburn or a sensitive stomach. You can substitute any fruit you like; strawberries, raspberries or blueberries also work wonderfully in this dish. Top this delicious crisp with Greek yogurt for added protein.

295 calories; 16 g fat (1 g saturated fat); 0 mg cholesterol; 35 g carbohydrate; 6 g fiber; 7 g protein.

Heat the oven to 375 F. In an oven-safe container, combine the fruit, 1 ½ tablespoons of the maple syrup, lemon juice and cornstarch. Spread the mixture so it covers the bottom of the pan.

To make the topping, place the pecans, walnuts and oats in a food processor. Process until crumbly. Mix with the cinnamon, sea salt and remaining syrup. Spread the topping over the fruit mixture. Place in the oven and cook for 20 to 25 minutes, or until the topping is browned and the fruit is softened.

 If peaches are not in season, buy frozen peaches and thaw them the night before. You may have to increase the cooking time by 5 minutes if they are not completely thawed.

Egg salad is a versatile food for those who need a high-calorie option that is easy to chew and swallow. Eggs supply a good amount of high-quality protein, and avocados provide a rich source of heart-healthy monounsaturated fat. The mixture can be eaten by itself or added to a sandwich, salad greens, a wrap, crackers or crudités.

In a bowl, combine all the ingredients and mash lightly with a fork. Serve with bread, crackers, salad or brown rice.

219 calories; 18 g fat (3 g saturated); 186 mg cholesterol; 275 mg sodium; 8 g carbohydrate; 6 g total fiber; 8 g protein.

A rainbow of colors makes this dish as beautiful as is flavorful. Instead of using all rice noodles or pasta, it includes vegetable noodles, which are a much healthier alternative. High in fiber and antioxidants, this dish is packed with cancer-fighting phytonutrients. If you do not have a spiralizer, most grocery stores carry spiralized noodles, or you can thinly slice the vegetables. Pair this Asian-inspired meal with cabbage slaw or kale salad for a nutritious and delicious dinner. Because red beets produce a deeper red color, golden beets can be substituted to lighten the color of the meal, if desired. The recipe’s fiber content helps with constipation, and its flavorful sauce helps people with ongoing taste issues.

1/4 cup plus 1 tablespoon olive oil, divided

Cook the rice noodles according to directions on the box.

To make the dressing, combine 1/4 cup of the olive oil, peanut butter, rice vinegar, garlic, ginger, soy sauce, honey, lemon juice

In a large skillet, heat the 1 tablespoon olive oil. When hot, add the zucchini, squash beet and red bell pepper. Cook for three to four minutes, sautéing and adding 2 to 3 tablespoons of water, until softened. Add the edamame and cook for one additional minute. Remove from the heat.

Combine with the cooked noodles and toss with the reserved dressing.

382 calories; 17 g fat (4 g saturated); 0 mg cholesterol; 50 g carbohydrate; 5 g fiber; 9 g protein.

Jessica Iannotta, a registered dietitian and certified specialist in oncology nutrition, is the chief operating officer at Savor Health, a global disease-specific nutrition platform designed to address the needs of people with chronic medical conditions. She oversees all operations including clinical and culinary operations ranging from menu development to evidence-based website content.

Iannotta studied nutrition at Cornell University and obtained her master’s degree through the University of Medicine and Dentistry of New Jersey.

Body

Breakfast, lunch and dinner options that require minimal prep work and time.

A Taste for Wellness: Meals in Under 45 Minutes

Competition and challenge are nothing out of the ordinary for 

. At the age of 15, she took home five Olympic medals in 1992 and went on to win two more in 1996 making her the most decorated Olympic gymnast in American history.

But it wasn’t until 2011 that she faced her biggest obstacle: stage 2 germ cell 

 — a rare form of the disease. A new mother to a 1-year-old son and running her own business, Shannon Miller Enterprises, with a focus on health and fitness, the now 42-year-old felt she was too busy to slow down. In an interview with Heal®, Miller, now cancer-free, shares her diagnosis and life after the disease.

Heal®: How was your ovarian cancer found?

Miller: My diagnosis was really kind of out of the blue. I would tell you at the time that I didn’t have any symptoms, but what I would later come to find out was that I was having three of the primary ovarian cancer symptoms. But I didn’t know that they were anything important to think about. When you think about things like bloating and stomach pains, women pretty much have those every month and so you don’t think a lot about that. I lost about six pounds in a month. But I had just finished nursing my son. I thought I was losing baby weight. I did not associate that with something negative.

It was late in 2010, I went to a regular doctor’s appointment. And one that I admit I was ready to call and cancel because I was really busy. I was overwhelmed at work. I thought I could push it off. As I was waiting on hold, I thought better of it. I felt guilt. Here I was, an advocate of women’s health and I was not walking the walk. It was at that appointment, in about 15 minutes, that I found out that I had a baseball-sized cyst on my left ovary. And my world changed forever. I didn’t know at that point that it was cancer. So I entered that wait-and-observe phase that is so excruciating, and by January I was sitting with an oncologist hearing that it could be cancer and I was immediately scheduled for surgery.

When I found out that it was ovarian cancer it wasn’t a call back for an office visit. I went into surgery not knowing what I would wake up to. Was this mass benign? Malignant? Had it spread? When I woke up from surgery I saw my doctor and my husband, who both had smiles, and so I thought maybe it’s OK. That’s when I found out it was cancer. It was a rare form of ovarian cancer. But what I focused on was they had caught it early, which for those who are familiar with ovarian cancer we know that doesn’t happen often enough. We turned our sights to recovery at that point. It wasn’t until a couple weeks later that we found out it was a higher-grade malignancy than they originally thought and now I would have to go through an aggressive chemotherapy regimen called BEP (bleomycin, etoposide and cisplatin) and that would give me the best chance of non-recurrence.

SHANNON MILLER was the keynote speaker at the Ovarian Cancer™ Heroes event held in Honolulu, Hawaii, on March 15, 2019.

What types of side effects did you experience?

Cancer treatment is not easy by any stretch of the imagination. There are so many questions and so few answers. I learned about the treatment and I think reverted to some of that competitive mentality. “OK, I’ve got a goal. I don’t know exactly where I’m going to end up, but I know what the plan is, and I know what I can get up and do every day.” And part of that was chemotherapy.

I went in with that mental attitude, but it was tough. That first week I was back in the hospital. I couldn’t keep down food or water. I went through 10 or 11 nausea medications and not even one of them phased me. I think the nausea for me was the biggest difficulty. Certainly, losing my hair was tough. I think that’s tough for all of us. It is to some degree losing your identity because it’s not just your hair, it’s your eyelashes and eyebrows. I remember looking in the mirror and seeing this very pale face looking back and I had to constantly remind myself that this is not a symbol of my sickness. This is a symbol that I am doing everything that I can to get and remain healthy.

Other than that, the neuropathy in my hands which I still tend to deal with today. Chemo brain — not being able to find words at a certain time and when my job is finding words, speaking in front of people, commentary and analysis, which means I have to have a great deal of information. But I’ll take it. I’m here, and I get to get up each day.

Did you suffer from any emotional side effects?

(Cancer) is a very scary experience. It tries you in many different ways. As a young mom, you’re already scared of everything. And so, to add a cancer diagnosis on top of that and wonder if my son is going to have a mother. And then beyond that, “when” I get through this, what will be the ramifications for him? You come face to face with your own mortality and I had really never thought about that before.

Your mother is also a cancer survivor. Can you discuss that and any advice she gave you?

My mother was diagnosed in 2008 with cervical cancer. It was shocking to all of us in the family. It was my first real glimpse into what someone faces before, during and after a diagnosis that is so life-altering. Here’s my mom — and mom is invincible, I mean mom is just supposed to be there &mdash; and at that point it was just terrifying to think that we could lose her.

I remember calling her on my last day of chemotherapy. I thought it would be better than what I felt. I still just felt the same. I was so sick and so tired, and nothing had changed. And she said look, “Let’s talk about other things today. And I want you to call me back in two weeks and then we will talk about how you’re feeling. You have to understand that this is not going to happen overnight. It is a process and you just have to take it one day at a time. You did not win an Olympic medal in a day. It took you 10 years to get there.” Two weeks later I called her, and I said “Mom, I don’t feel great, but I feel better. I think it’s going to be OK.”

Has your perspective changed after cancer?

I learned a lot through my cancer experience. I’m still learning. I feel like I am still on my journey. But I think the silver lining — I’m one of those (people) who always tries to find the silver lining &mdash; is I try to find the blessing in every experience. Even the most difficult ones. The blessing that I have received is just a reminder to stop and smell the roses. I have lived my life so fast-paced I was never one to dwell on difficulties, but I also wasn’t one to dwell on successes. I just try to enjoy every moment as much as possible.

Listen to the CURE® Talks Cancer Shannon Miller podcast here.

People

The seven-time Olympic medalist found strength in her competitive spirit through cancer.

Shannon Miller: Stop and Smell the Roses

In a multisite clinical trial, researchers examined the use of Keytruda (pembrolizumab), an immunotherapy agent. They enrolled 50 patients with Merkel cell carcinoma, a rare type of skin cancer that tends to grow fast and spread quickly.

After receiving Keytruda as first-line therapy, 28 patients saw their cancers shrink or disappear. The results lasted for two years after the first dose for almost all the patients, the researchers wrote. The team calculated a two-year survival rate of more than 68%, according to the findings published in the Journal of Clinical Oncology.

Typically, patients with this disease receive standard of care chemotherapy, but these results show an increase in progression-free survival with Keytruda.

Grade 3 or greater treatment-related side effects occurred in 14 (28%) of 50 patients and led to treatment discontinuation in seven (14%) patients, including one treatment-related death.

“Pembrolizumab demonstrated durable tumor control, a generally manageable safety profile and favorable OS (overall survival) compared with historical data from patients treated with first-line chemotherapy,” the researchers wrote.

Snippets

Immunotherapy may be giving hope to people living with rare skin cancer.

Keytruda Extends Progression-Free Survival in Patients with Merkel Cell Carcinoma

In August 2005, Hurricane Katrina devastated thousands of people along the Gulf Coast. Jamie Aten, Ph.D., a disaster psychologist, had moved with his wife and young daughter to south Mississippi just six days prior. Although their world was shaken, they survived that natural disaster.

Then, eight years later, in July 2013, he received a stage 4 colon cancer diagnosis. Aten used his experience from Katrina and other tragic events, such as the Tuscaloosa, Alabama, tornadoes, the Deepwater Horizon oil spill and the Haiti earthquake, to see him through. In an interview with Heal®, Aten shares the lessons learned, which he has chronicled in his new book, 

A Walking Disaster: What Surviving Katrina and Cancer Taught Me About Faith and Resilience

®: Can you provide a brief overview of what readers can expect from 

I share my story of going through stage 4 colon cancer, which was a yearlong battle of treatments. I draw from my experience before this as a Hurricane Katrina survivor. I share experiences from that and then the parallels of going through a mass disaster and then a personal disaster. I share not only my experience but also those of people I’ve helped and learned from, as well as the research that I’ve been doing in this area for 14 years.

What was the lesson you learned from surviving Hurricane Katrina and colon cancer?

By holding on to hope and faith, I was able to find meaning. In many ways, going through cancer helped me understand some nuances and some differences that I don’t think I would have learned just from studying other disaster survivors — one of those being that since going through cancer, I am grateful that I am currently almost five years with no evidence of disease. One thing I didn’t understand, for instance, was that when Katrina went over my community, it went over in less than an hour, but with cancer, that situation was hovering over me directly for over a year and in some ways still hovers over me, with the thought of “What if this comes back?” I realized not just that I needed to go back to the way life was before but also how important it was to find a new normal.

Where were you in life when you received your diagnosis?

I was 35 at the time and had moved from south Mississippi to the Chicago area to teach at Wheaton College, where I started the Humanitarian Disaster Institute, the country’s first faith-based academic disaster research center. I had three young daughters, who are now 9, 12 and 15, so it was really hard to be a young dad with a young family and thinking, “How do we make it through this time of cancer?”

Did you share the news with your daughters?

That was one of the hardest conversations I ever had to have. My wife and I both felt that we needed to talk to them about it, because there was no hiding that I was sick. That summer I took oral chemotherapy twice a day and radiation five days a week, and then I had a major surgery to remove the tumor that had spread to a mass on my pelvis. After that I had to have six more months of drip chemotherapy. One of the things that was hard for me was to approach this in a way of being realistic yet balanced with optimism. We tried to take a developmental approach to understand what they understood about cancer and let them know what we knew so far. One of the other things that I feel was extremely important was giving space to our children after telling them this news (so they could figure out their) questions. For instance, one of my daughters asked, “Is cancer contagious?” I can’t imagine, if we hadn’t created that space, what that would have meant for the next year — she might have thought it was contagious to someone in the family &mdash; and how additionally stressful that would have been.

What kind of side effects did you experience?

A major challenge for me was that a lot of my identity had always been as the helper (and suddenly) I was the helpee — the person who needed the help. I had bad chemo brain during that time, and I was ill from the chemotherapy and had trouble keeping food down. At times my energy was low. After my surgery, I was bedridden for a month and needed someone to help me use the restroom because I was so weak. Even after I finished my treatments, it took me eight months before I got back to a more normal way in terms of my thinking and physicality.

JAMIE ATEN, Ph.D., says it was difficult for him to become the “helpee” because he was used to being the “helper.”

Did your professional experience prepare you for cancer?

I remember early on, my oncologist was delivering the news, and he asked, “What do you do?” And I said that I direct this disaster institute, and he paused for a moment, and he said, “You’re in for your own personal disaster.” That was useful, because with disasters, I know that there tends to be stages that you go through. There are things that you can plan but also know that those plans are rapidly changing, and it’s the people around you who are more important than the plan that you have in place. I was able to apply some of those ideas to my own life, and I even learned things from other disaster survivors that I was able to use to help myself cope — for example, learning to let some of the pain wash over me versus fighting it. Another example: I had a lot of people who were incredibly wonderful helpers, but I also had some people, even though their heart was in the right place, say things that were quite hurtful. … I had worked in enough disaster zones with enough people to know that often people’s motivations are good, but they don’t know what to say because they are anxious and nervous, and then they end up putting their foot in their mouth. Because I had experience in that, it made it easier to be able to forgive them and move on without letting it weigh me down further.

How do you feel about the term “survivor?”

I like the word “survivor” because one of things that I hadn’t realized was that there is a difference between surviving and survivorship. With a mass disaster, it was (obvious that I was) helping people survive these catastrophic events, whereas I didn’t realize until a year or two out from my last treatment that I was struggling with some things, such as survivor’s guilt. I had lost three people close to me to a similar type of cancer, and I still have heath issues. I had to come to terms with having a colostomy. When I first had that colostomy, it made me feel like psychologically, cancer had already won, but now I have been able to come to see that this colostomy is one of the things that helped save my life. But that wasn’t automatic.

A few years ago, I had the opportunity to be the keynote speaker at Fred Hutchinson Cancer Research Center’s Survivorship Conference. Being there helped me see the differences about surviving. For instance, I learned that it can take a while to recover, and (recovering) doesn’t cancel out the pain or suffering that you have been through.

Do you have any advice for other survivors?

Don’t go through this alone. Often when we are hurting and find out news, such as a cancer diagnosis, a lot of (us) tend to isolate or withdraw from others, but I have found that when we are hurting is when we need people the most. Rather than letting this pain and these wounds serve as walls that keep others at arm’s distance, we instead need to use them as doors that let others into our lives to experience us in a more true and authentic way. That social support is very key to coping with such a traumatic experience.

As a psychologist, I’ve always been aware of burnout and stress and the impact it has on us. But going through cancer has taught me to focus more on finding a good rhythm or just pure balance. I think it’s OK to have a time when we are busy. I like to think of it more like surfing. It’s OK to ride the wave and be busy, but we need to know and recognize when we need to come down from the wave and maybe even get off the board for a period of time.

A Walking Disaster: What Surviving Katrina and Cancer Taught Me about Faith and Resilience can be purchased online, including at Templeton Press (templetonpress.org) and Jamie Aten’s website (jamieaten.com).

Book Shelf

A disaster psychologist sees parallels between surviving Hurricane Katrina and surviving stage 4 colon cancer.

Let the Pain Wash Over: Surviving Natural and Personal Disasters

Even before Chris Irwin learned that a painless lump on his neck was stage 4 head and neck cancer he worked to stay in good shape. He exercised almost daily and paid reasonable, though not obsessive, attention to nutrition.

Since 2012, when Irwin faced an intense six-month regimen of almost daily radiation and weekly chemotherapy that wiped out his cancer, working out has taken on even more importance. Now 52, Irwin performs a range of physical activities, including weight training and swimming.

“The day after I had my feeding tube inserted, I went and ran five miles because I was determined to not let it stop me,” he says. “When my wife at the time saw me running, she cried because she couldn’t believe how strong I was trying to be.”

Irwin relied on the feeding tube for about three months because swallowing became unbearably painful, he says. Since then, his dietary choices have become even more deliberate. He now shuns fast food; packs his diet with berries, almonds, walnuts, garlic and honey; and opts for fish and chicken over red meat.

Irwin is one of an estimated 16.9 million cancer survivors living in the United States, according to the National Cancer Institute. That population is projected to increase almost 30 percent to 21.7 million over the next decade.

Patients with cancer and survivors generally can enhance their well-being and lower health risks by making the twin pillars of a nutritious diet and regular exercise part of their lifestyle, experts say.

“One is just as important as the other,” says Lidia Schapira, M.D., director of the cancer survivorship program at the Stanford Cancer Institute and an associate professor of medicine at the Stanford University Medical School. “The big picture is that, for people living with cancer (and) for cancer survivors, exercise and nutrition really matter.”

Eating foods rich in nutrients, such as protein, carbohydrates, vitamins and minerals, along with drinking plenty of water, can help people maintain a healthy weight, increase energy and strength, heal faster and feel better overall.

Physical activity has benefits, too. It improves heart health, boosts muscle strength and endurance, and reduces anxiety and fatigue, according to the American Society of Clinical Oncology’s patient website, Cancer.Net, for which Schapira serves as editor-in-chief.

Patients who exercised after any cancer diagnosis had a lower relative risk of cancer mortality and recurrence compared with those who exercised less or not at all, according to the results of a 2017 study in Epidemiologic Reviews. The findings also showed that patients who stayed or became more physically active were likely to face fewer or less severe side effects from treatment than less active or inactive patients.

For Irwin, the value of exercising after cancer made sense instinctively. “Our bodies were not made to be sedentary. They were made to move,” says Irwin, who lives in California, where he works as director of operations for a security company. His varied regimen also includes squat thrusts, a Philippine martial art and — his most recent addition &mdash; yoga. He works out 25 to 90 minutes daily, five or six times a week.

Survivors should aim for 150 minutes of exercise each week, including strength training on at least two days, according to the American Cancer Society, which also recommends that survivors talk with their care team about a suitable exercise plan.

For survivors who feel a lack of stamina and strength after a prolonged period of inactivity, the American Society of Clinical Oncology recommends a daily 10-minute walk to kick-start the exercise habit. People also can turn everyday activities and chores into exercise opportunities, such as taking stairs whenever possible, running errands on foot or

It may help to consult a certified health and fitness professional. The American College of Sports Medicine is a good resource for finding one certified as a cancer exercise trainer.

Ideally, an exercise program for survivors should hit on four broad areas: strength, cardiovascular health, range of motion and flexibility and balance, says Andrea Leonard, a certified personal trainer and founder and president of the Portland, Oregon-based Cancer Exercise Training Institute. “The variables are how much, how often and how intense,” she says. Leonard, 53, is a 35-year thyroid cancer survivor who has had 23 close relatives receive cancer diagnoses, including both parents.

She recommends exercises that improve balance to help survivors address neuropathy-related problems. A basic balance exercise starts off with both feet on the ground and hands on a counter or the back of a sturdy chair for support, then raising one foot off the floor at a time. If that is easy, try standing with one foot raised without holding on to the chair or counter, she says. For a more challenging balance exercise, move one leg to the front, side and back while balancing on the other leg.

Cardiovascular workouts can strengthen the heart and lungs, which may be weakened by chemotherapy and radiation. These include walking, climbing stairs, dancing and riding a stationary bike, as well as swimming if the person’s immune system is not compromised and there is no skin irritation from radiation, Leonard says. Strength training can bolster bones made fragile by treatment-related osteoporosis.

“Shoot to exercise until you feel mild discomfort but never pain. Pain is not a good sign,” Leonard says. However, she adds, there is no cookie-cutter plan for exercising after a diagnosis, because each person has a unique mix of health history, type and stage of cancer, fitness level and response to treatment.

A plant-based — but not necessarily vegetarian &mdash; diet can help survivors rebuild strength after treatment and reduce their risk of other chronic health problems, such as obesity, heart disease and diabetes, Schapira says.

“Choose a diet rich in vegetables, whole grains, fruits and beans,” says Kate Allen, RDN, LDN, an outpatient clinical dietitian at Moffitt Cancer Center in Tampa, Florida. “Choose the whole forms of foods as much as possible. Aim for variety, bright color (and) strong flavors on your plate for the benefits of phytonutrients, which are naturally occurring plant chemicals that have possible anti-cancer benefits.”

Limit red meat, including beef, pork and lamb, to 18 ounces or less a week, and avoid regular consumption of processed meat, such as bacon and hot dogs, recommends the American Institute for Cancer Research. The latest research findings show that exceeding 18 ounces of red meat weekly increases the risk of colorectal cancers, according to the institute. Likewise, stomach and colorectal cancer risks rise with regularly eating any amount of processed meat, which is preserved by smoking, salting, curing or adding other preservatives.

Avoid processed foods with added salt or foods preserved with salt, says Allen, whose advice reflects the institute’s guidelines. She also advises survivors to steer clear of foods that are high in empty calories and lead to weight gain. These can include sugary beverages and sugar-added foods, refined starchy foods and fast food.

A tailored diet will also ease treatment-related side effects. For example, diarrhea can be mitigated with a low-fiber diet, Allen says, and small, frequent meals might be easier to handle for patients who feel full after eating a small amount of food or have nausea and fatigue.

Paying new or renewed attention to diet and exercise can help survivors regain the sense of control that a cancer diagnosis often steals, Schapira says. That benefit is an easily overlooked but important aspect of improving physical and mental health.

Kate Beland can attest to that — exercise plays a major role in her life as a cancer survivor. “It’s a sense of control in a very uncontrollable situation, and for me, that was huge,” says Beland, a runner, skier and writer.

The 44-year-old married mother of three received a diagnosis of stage 3 melanoma of her hip in April 2015, one week after she ran the Boston Marathon for her first and only time. Cancer also developed in two lymph nodes in her groin; two successful surgeries removed it all. Beland, who lives in Portsmouth, New Hampshire, and once managed a health club, says that resuming physical activity fairly early in her recovery was slow going at first but helped control the swelling she experienced as a side effect of her lymphadenectomy, a surgical procedure to remove lymph nodes.

Because of her lymphedema, she is more conscientious about cutting back on breads and processed starches, staying hydrated and having a mix of plant-based foods and protein in her meals. Beland runs or strength trains five or six days a week. On winter weekends, she skis with her family. She spends a little more time stretching and clearing her head than she did before her surgery. “Physically, I needed to be active and to do everything just to get my mobility back and heal my body,” Beland says. “But mentally, it would have been a lot harder. Running was the tool I needed to cope. It was like going to church for me.”

Of course, not every survivor is a runner. Carlene Igras’ go-to exercise is a brisk walk. A retired middle-school teacher, Igras had a hysterectomy and six chemotherapy rounds over four months in 2017 after learning that March that she had stage 1A ovarian cancer. “I was always a really healthy person, so this kind of knocked me back,” says Igras, 63. To rebound, she makes a point of going for daily 30-minute power walks, even in the tropical heat of summer in her adopted hometown of Vero Beach, Florida.

She says walking even during treatment helped minimize the fatigue that chemotherapy brought on. Recently, she started doing yoga at home, aiming for three sessions a week. She cut out fast food, junk food and fried and greasy food. “Your whole mindset changes when this kind of thing happens to you,” Igras says. “It’s like, what can I do to try to keep my body healthy?”

KATE BELAND combines plant-based foods and protein in her meals. She tries to exercise at least five days a week.

Survivors find that physical activity and sound nutrition lower health risks and boost well-being.

Taking Back Control: Exercise and Nutrition Boost Survivor Well-Being

Kidney cancer survivors who follow recommendations for physical activity experience improved quality of life, but few individuals adhere to the guidelines, according to recent findings.

Cancer survivors should engage in 150 minutes of moderate or 75 minutes of vigorous aerobic activity weekly, or an equivalent combination, according to the American Cancer Society and the American College of Sports Medicine. Both groups also recommend at least two days a week of strength training that hits all muscle groups.

The study, published in Psycho-Oncology, surveyed 703 kidney cancer survivors using a provincial registry in Canada to determine how often the combined guidelines were met and if they were associated with quality of life.

Most survivors were men, had localized kidney cancer and were more than five years out from their initial diagnosis. The average age was 65; average body mass index, 28.5.

Researchers learned that 65.1 percent of the participants met neither guideline, 15.9 percent met only the aerobic guideline, 10.1 percent met both guidelines and 8.8 percent met only the strength training guideline.

Those who met both guidelines experienced better quality of life compared with those who met just one, and meeting at least one guideline was better than none.

“Our study suggests that exercise programs should target both aerobic and strength exercise for additional (quality of life) benefits in (kidney cancer survivors),” the researchers wrote.

Findings Confirm Exercise Benefit for Kidney Cancer Survivors

Breast cancer survivors may find symptom relief through at-home acupressure, according to study findings published in 

Researchers from the University of Michigan Rogel Cancer Center in Ann Arbor examined 288 women, all breast cancer survivors, who reported symptoms in addition to fatigue. They were asked weekly about anxiety, depression, fatigue, pain and sleep quality.

The participants were assigned to either acupressure or usual care, which included sleep-management strategies. Those in the acupressure group were taught how to find and stimulate the relevant point and performed the technique once a day at home for six weeks.

Acupressure, a type of complementary therapy, involves applying pressure with fingers, thumbs or a device to specific points on the body. The study used two types of acupressure: relaxing and stimulating acupressure, which involve different points.

Both techniques were more effective than usual care for reducing anxiety, severity of pain and pain that interfered with daily life. However, relaxing acupressure was better than the stimulating type and usual care for improving depressive symptoms and sleep, the researchers said. Easing depressive symptoms also led to higher-quality sleep, which accounted for about 20 percent of the improvement in fatigue.

The researchers noted that the advantages of acupressure include the ability to perform it at home with minimal side effects, although some women reported minor bruising at the acupressure sites.

Breast cancer survivors may find symptom relief through at-home acupressure, according to study findings.

Spring 2019 | Heal