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THE MATCH GAME

They're in every department — in the emergency room, in cardiology, pediatrics, the family care centers, and on all the floors. They used to be called "interns" but now they're known as PGYs, which stands for postgraduate year. The training of some residents can be for only one year (PGY-1) while for others, the curricula may last as long as five, depending upon the specialty. They come to Ohio Health through programs that match applicants with the hospital and specialty.

"Matching has become increasingly challenging," observes Dr. Pam Boyer, Director of Medical Education at Riverside. "Students are more interested in high tech specialties like radiology and anesthesiology than in primary care and internal medicine." Unlike the family-oriented specialties which require long and unpredictable hours, "they want a more defined and clear-cut schedule. And they're looking to balance work with family life."

Ohio Health and particularly Grant, has been able to bridge the gap, however. Nationally, 21 percent of the family practice residency slots went unfilled in [2003? 2004?], while in the central region, of which Ohio is part, 28 percent remained empty. Across all 24 specialties, about one-third of the total vacant positions in were in family practice. Yet Grant was able to fill all 12 of its PGY-1 family practice positions.

Dr. Dave Hamilton, Executive Director of Medical Education at Grant, attributes the success to a vigorous recruiting program and a strong sense of community among the staff. "We produced a CD-ROM that was designed by residents, faculty, and staff,"" he says. "Along with photographs and biographic descriptions of everyone, we had segments about every aspect of the program, from doing rounds on the floors to softball games. Residents talked about what they learned at Grant." All applicants expressing an interest in Grant's program receive a copy of the CD.

He also points to an especially rigorous training agenda. "Our program is unique because we don't have internal medicine residencies. So family medicine provides the primary care. Our residents learn more about the care of critically ill people than in other settings." Although they must work must harder, "they feel the superior training has given them an edge in their careers."

Like Riverside and Grant, Doctors Hospital relies on word of mouth to draw high-quality residents. "We travel to medical schools and meet the students one-on-one," explains Melissa Kaufman, Administrative Director, Department of Medical Education at Doctors. Because Doctors is an osteopathic hospital, "the guidelines are somewhat different." Implemented by the National Residency Matching Programs (NRMP), the Electronic Residency Application Service (ERAS) matches medical students nationwide and is used at Riverside and Grant. Applicants for residency at Doctors go through the National Matching Services (NMS).

Both MD and DO applicants can apply for residencies at all Ohio Health hospitals. And regardless of their specialty, they do double duty. Days often begin at 6AM and end after 9 at night, a non-stop blend of classes, teaching rounds, and supervised patient consultations. They may also be on call on certain nights, which means they stay at the hospital where there's a lounge to catch a brief nap or take a quick shower.

Although recent Accreditation Council for Graduate Medical Education (AGME) rulings limited residents' workweeks to 80 hours, "that's still a lot," adds Dr. Boyer. "Along with diagnosis and procedures, residents are learning professional development and ethics. We also teach them to recognize the impact of sleep deprivation and the signs of stress in themselves and in others."

Communications skills — with patients, other residents, and staff - are also emphasized. "We're looking for people who are well-rounded, humanistic and team players, along with being lifelong learners," she continues. It also helps if they drink a lot of coffee.

ENHANCED SECURITY AT RIVERSIDE: MONITORING THE "HUMAN SHOW"

Hospitals are for healing and providing support. But they can also be happy hunting grounds for criminal activity. "People are at their most vulnerable," observes Chuck Smith, Director of Security and Protective Services. "They aren't as aware, leaving things like purses unattended and vehicles unlocked."

But the good news is that a newly enhanced security system at Riverside and Grant not only connects OhioHealth with its more than 20 neighborhood health centers but provides an upgraded monitoring of Riverside itself. The latter includes over 200 cameras which digitally record the comings and goings of everyone, and continue to perform such minutia as zooming in on license plates. "This represents a huge improvement," he adds. "Rather than spending hours plowing through reel after reel of videotape, we can punch in a time and immediately pinpoint an incident and see what's going on." This makes crime-solving easier and frees up investigators for other tasks.

Alarms at the various healthcare satellites go through a central system at Riverside. Problems can range from someone being locked out of their car to a stuck elevator to more serious matters, such as assault. "We have an interface with the fire and police departments," continues Chuck. "So they can quickly handle matters within their purview." And it's non-stop: "We get something like 10,000 calls a month for service and over 160,000 calls relating to suspicious activity." Fortunately most are of the routine variety: "When something happens, people don't know who to call, so they contact us."

A visit to Riverside's new security control center allays any fears that Big Brother is watching you in particular — unless you're doing something wrong, of course. (There's also a control center at Grant.) Sixteen large-screen color TVs hang clustered above a dozen computers; some of the TVs have split-screen images of several departments. Usually two security specialists are on deck, either working at the keyboard or on the phone. They barely glance at the TVs, although occasionally an employee in the know will wave at the camera. "Before, the monitors were much smaller, in black-and-white," he points out. "Color is cheaper and of much better quality." The larger center also allows space for the hospital's expansion. For instance, several cameras have been added because of the new emergency department and the McConnell Heart Center.

Enhanced security makes the hospital safer for visitors and employees. "By taking a proactive approach, we help deter and solve crime."

NEW SYSTEM AT DOCTORS TRACKS MORE THAN NUMBERS

It seems amazing, but crunching numbers can actually help with the treatment of patients. TSI, a software package just instituted at Doctors, provides support for both financial and clinical decisions. "Along with answering such questions as, 'How much does a tonsillectomy cost?' we can identify the most effective treatment of conditions such as congestive heart failure," observes Nathan VanLaningham, Vice-President of Finance at Doctors. TSI also assesses profitability issues, such as evaluating changes in third-party contracts, and their impact on net revenue.

But TSI's effect on how medicine is practiced is its most intriguing aspect. "Medicine is both an art and a science," he continues, and TSI assists with the latter. By bringing expenses from a general ledger system and patient data from the hospital information system, ""it marries the data so costs are correctly allocated to every single procedure."

TSI also tracks diagnosis data on patients. For example, "if two patients have the same severity of illness and one goes home recovered while the other is readmitted after three days with no improvement, we need to understand the differences in practice patterns that caused the discrepancy in patient outcomes."" This kind of information can be used by the medical staff to develop the most effective treatment plans for a particular condition and/or stage of illness. Such guidelines and other innovations of the medical staff, "will benefit both patients and stewardship of hospital resources."

Cardiology is the first department to use TSI, with the goal of hospitalwide implementation over the next several months. Along with information on contracts, the system will gather data on charges, costs, and codes for patients, groups, physicians, drugs, and procedures as well as accounts payable and other financial statistics. "We'll be able to estimate reimbursements and identify costs," states Nathan.

Once the initial data and budgeted targets are plugged into the system, all information will be reviewed and validated by the clinicians and department managers. Then cost data for services provided will be developed by the OhioHealth decision support team, with results and reporting shared with the medical staff and throughout the organization. This will enable clinical department managers to not only better utilize their budgets but to also accurately allocate resources.

"TSI is a powerful tool that will help us not only track when we get paid, but what it costs us to provide the service. It may change the way we do business." Not to mention giving the patients the benefits of evidence-based decision-making.

RIVERSIDE: BACKING UP NEUROSCIENCE

The Riverside Neuroscience Institute is growing! In addition to a new Spine Center, the current 12 bed Neuro Critical Care Unit is expanding to 18 beds, and an Epilepsy Monitoring Unit is being added to what has become "a very high-quality, fast growth area, " states Donna Hanly RN, Director of Critical Care and Neuroscience. ""We have more Neuroscience physicians, care for more Neuroscience patients and do more Neuroscience procedures than any other hospital in Central Ohio."

Although the ability to closely monitor and manage their patients' progress is good news for the neurosurgeons, neurologists, orthopedic surgeons, highly trained nurses and other skilled personnel, patients really benefit. Now all spine and neurological patients will be treated in specialized locations. "They will receive immediate, specialized care and directly benefit from dedicated resources and specially trained staff," Hanly continues.

Focus is on total care, "from the initial consultation, when the patient first comes to see us, through the recovery period, " she adds. Treatments encompass the phases of critical, intermediate, and acute care as well as preventative, conservative, surgical, post-surgical, and rehabilitative services. "We use a comprehensive approach, from diagnosis and treatment, to health and prevention." Patient education is another area of focus.

According to the American Academy of Orthopedic Surgeons, nearly 12 million physician and/or emergency room visits are made each year because of back problems. Of the $16-plus billion spent annually on the management of back pain, over half of that is on surgical care. Riverside has responded to the growing demand for treatment of patients with back pain.

Patients also benefit from cutting-edge technology such as clot retrieval for stroke patients. Riverside just garnered the JCAHO Disease-Specific Certification for Stroke — the first hospital with such designation in Ohio — and offers a full range of therapies such as immediate administration of the "clot buster" tPA which can greatly decrease the devastating effects of a stroke. The Neuro Critical Care Unit will also be utilized for patient with aneurysms, brain tumor surgeries, head traumas, and related disorders.

The Epilepsy Monitoring Unit, which will open in October, will add to Riverside's neuroscience comprehensive care by providing diagnostic and therapeutic treatment options for patients with epilepsy. "Our goal is to be the best place in the country for patients who need spine, stroke, or care for any neurologic disorder," concludes Hanly. "We're continually striving to improve customer service and quality and consistency of care.""

Profile: E. Antonio Chiocca, MD, PhD

This noted young brain surgeon plans to grow clinical and research faculty to distinguish OSU's new Department of Neurological Surgery as the "best in the Midwest."

Unlike most of us, the expression "it's not brain surgery," does not apply to internationally recognized researcher E. Antonio Chiocca, MD, PhD. As chair of the recently created Department of Neurological Surgery at The Ohio State University, he has been hailed as a leading investigator in the use of gene therapies for brain tumors and other central nervous system disorders. Additionally he's the Dardinger Family Professor of Neurosurgical Oncology at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.

The native of Padua, Italy meets challenges head-on. One of the main focuses of his research is on glioblastoma multiforme, a cancerous tumor which attack the brain. "This type of cancer affects 18,000 Americans a year, and there's very little effective therapy," he says. "We're working with different kinds of research, such as viruses that will turn into drugs and seek out and destroy cancer cells."

Early (Phase I) clinical trials on humans have shown engineered viruses to be safe in attempts to kill certain types of cancer, including glioblastoma. But much intelligence still needs to be gathered. "The human brain is so much larger than any idealized model system that we use in the laboratory," he explains. "It's like going from a Mom-and-Pop corner store to a huge industrial factory."

He's also matching wits with gene therapy and stem cell biology. "With cancer, genes have gone awry. So we try to replace good genes back in the brain," through drugs and other therapies. And while only being used in preliminary research in the laboratory, "stem cells show promise in delivering various therapies."

When OSU lured Chiocca from his positions as associate professor of neurosurgery at Harvard Medical School and co-director of the peripheral nerve service at Massachusetts General Hospital, he was intrigued. Ohio State offered the opportunity to mold a department and bring in his own research lab and team members. Although "a place like Harvard is great on its own," he was enticed by a chance to make a real difference at OSU "and contribute to the body of knowledge with the potential of becoming one of the best treatment centers in the world."

Plus "Ohio State has a long tradition of excellence," says Chiocca, who came to the U.S. at age 19 to study biological sciences at the University of Texas - El Paso. He received his medical degree from the medical school in Houston as well as his doctorate from the graduate school of biomedical sciences. "A lot of the original grading and classification in addition to the early treatment of brain aneurisms originated at Ohio State." Previously a division of the Department of Surgery since 1951, Neurological Surgery originally focused on patients with central nervous system abnormalities and injuries; and spine surgery and treatment for brain tumors, trauma, and cerebrovascular disease.

The new department offers even more comprehensive care, and he credits OSU Medical Center leaders and faculty for fostering a strong atmosphere of learning and research. "Dr. Sanfilippo and others have brought a vision of growth.""

His colleagues agree that expansion is a smart move. "We are fortunate to bring a great physician-scientist and energetic young leader like Nino Chiocca to OSU Medical Center," comments Fred Sanfilippo, MD, PhD, senior vice-president for Health Sciences and dean of the College of Medicine and Public Health. "He will strengthen our missions in the growing subspecialty of neurological surgery, along with our emphasis on interdisciplinary collaborations."

The department, which currently has three tenure-track faculty in addition to clinical faculty, is expected to grow quickly, with enhanced educational and clinical training opportunities for students and residents, and a "positive influence on disciplines ranging from anesthesiology to rehabilitation," adds Sanfilippo. They work closely with the Dardinger Neuro-Oncology Center, which Chiocca co-chairs with Herbert Newton, MD, director of the Division of Neuro-Oncology. Opened in late 2004, the Esther L. Dardinger Neuro-Oncology Center came about as a result of funding specificall earmarked to expand research and treatment for patients with brain and other cancers affecting the central nervous systems

"The resulting multidisciplinary research will increase partnership opportunities with industry to convert research discoveries into new therapeutics and technology."

For patients, this translates into extended services for what's already being used: the minimally invasive gamma knife, which focuses on tumors and vascular malformations of the brain; and the blood-brain barrier disruption treatment, a procedure enhancing delivery of chemotherapy to tumor sites. "We're the only ones in central Ohio who use the gamma knife," observes Chiocca. Other services in-place, such as the Ohio Spine Center, which provides managed treatment of back pain, and the Spinal Cord Injury Program, a multi-year National Institutes of Health project, will be joined by increasingly sophisticated research and treatments for trauma, spine surgery and movement and vascular disorders. The Dardinger Center focuses on both clinical work and research.

Chiocca brings his own acumen to the brain trust. Among other things, he specializes in the removal of peripheral nerve tumors (including schwannomas and neurofibromas). These benign, encapsulated growths can cause lifelong pain and disability. Although "many doctors don't believe they can be taken out safely," he has successfully excised approximately 80 of these tumors from patients. He's also performed nerve grafting operations for traumatized or otherwise injured motor nerves and has used peripheral nerve stimulation to alleviate neuropathic pain.

Still in his 40s and married, with three children under the age of 6, Chiocca has a lot on his mind. On any given day, he will see patients, do clinical research, work with neurosurgery residents, and consult with medical and other organizations about various work-related issues. As principal investigator on over a dozen research projects, many of which are funded by the National Institutes of Health, he also probes into new treatments for brain tumors and other therapies. His results are evident in more than 100 published articles and book chapters and six patents (with two others pending). And, at any moment, his beeper can go off, indicating an urgent patient-care situation requiring an immediate decision.

Yet he's found the time to become acquainted with Columbus and Ohio State. ""This area is like a hidden jewel," he observes. "There's a lot to do, as with a big city, yet it's small enough to get around easily." Another contrast: "At Harvard, everyone turned out for rowing championships, but no one showed up for football. At Ohio State, it's the exact opposite." (Point of reference: Ohio State does have talented men's and women's rowing teams that win awards in Big Ten championships.)

Chiocca finds his chosen field to be exciting and, so to speak, a perpetual cranium teaser. "The brain represents one of the last frontiers in our knowledge and has a lot of redundant pathways," he reflects. "If one part is damaged, plasticity ensues and other brain areas learn to take over, depending upon where in the brain damage has taken place." And unlike other parts of the body, where the physiology is well-known, "We're just starting in the brain with tools and techniques like imaging, stem cell biology, and genetic knowledge.

"My hope is to help make Ohio State the best place in the Midwest for research," he continues. "We want to create a department that provides top-notch care and contributes to — or maybe even finds — a cure for brain cancer."

Staying the Course, Going the Distance

A cancer diagnosis can mean many changes for the person affected and for his or her caregiver. Family members and friends can ease the burden, and a variety of resources are available to help.

One in two American men and one in three American women are likely to develop cancer in their lifetime, according to the American Cancer Society. The sheer number of people with cancer is also expected to rise. Cancer is mainly a disease of aging-nearly 80 percent of all cancers are diagnosed at age 55 or older-so as the U.S. population ages, and as people live longer, the number of those with cancer is expected to rise.

"To be either a cancer patient or a caregiver will likely become an even more common experience," says Pat Schmitt, program director of JamesCare for Life at The Ohio State University Arthur G. James Cancer Hospital and Richard J. Solove Research.

"Facing cancer with a loved one can be an extremely challenging experience, but it can also be a life-transforming event. What most people want to know is how to stay the course and go the distance."

The goal is take the challenges posed by cancer, and integrate them into one's own life.

Sifting Through Options

"Cancer doesn't just happen to the patient; it's truly a family illness," says Diane Blum, Executive Director of Cancer Care in New York City, a national non-profit organization that provides free counseling, education and referrals. "It affects you emotionally, financially and socially." Unlike a broken leg, or even heart surgery, which may involve a few weeks or months of recuperation and then life returns to normal, cancer is a disease that can keep on giving.

"When someone is newly diagnosed, the initial reaction is shock," Schmitt says. "Many decisions must be made, including which treatments to opt for and whether to participate in clinical trials."

The person's treatment might involve surgery or chemotherapy or radiation, or a combination these, says Schmitt. "There will be questions about the duration and frequency of treatments and the side effects. These not only affect the patient's life, they affect the caregivers as well."

Then there are money and insurance questions - how to finance the care and still stay afloat. "Having money doesn't keep you from getting cancer, but it does allow for more choices," Blum says. People with limited resources and little or no health insurance may feel constrained and restricted to a certain doctor, hospital or treatment that is within their budget or covered by their plan.

"Finances often dictate where patients end up and what kind of care they get," adds Chris Rhoades, MD, assistant professor of clinical internal medicine at the Arthur G. James Cancer Hospital at Ohio State. "The diagnosis is often more advanced in African-Americans," he says, due to their socioeconomic status and a lack of resources that allow for early detection.

And there are practical concerns. For example, who will take the person for treatment? Does the person have adequate sick time? Can the caregiver adjust his or her work schedule? Who will carry out the routine tasks-cooking, cleaning, running errands, bill paying-previously handled by the person undergoing care?

To complicate matters, the health-care system continues to place greater emphasis on outpatient care, according to People Living With Cancer (PLWC), a Web site sponsored by the American Society of Clinical Oncology (ASCO). Caregivers are expected to do more in the home, with family members performing tasks previously done by health-care professionals.

"Family members often ask themselves, 'Do I have what it takes? Am I doing the right thing? I'm not a doctor or nurse, and I don't want to hurt my loved one,'" Schmitt says. "There's a level of competence and self-confidence that must develop."

New caregivers might feel that they should be independent and self-sufficient. "Family members tend to tell others that they're fine, when they're really not, especially at first," says Susan Scritchfield, coordinator for Consumer Health Education at The James Cancer Hospital. "We're trained to be self-sufficient when in fact we really do need help."

Family members may fall into the trap of trying to accomplish everything. "There's so much to do, so many responsibilities," says Dominick Bonanno, program coordinator at Cancer Care, in a telephone education workshop sponsored by the National Center for Complementary and Alternative Medicine at the National Institutes of Health and ASCO. Family members who stop caring for themselves are prone to "exhaustion and depression and may feel under so much pressure that they burn out," he says.

One Step at a Time

An effective way to cope with a diagnosis of cancer, experts agree, is to take each decision one step at a time. Family members can help the ill person deal with a system that, says Scritchfield, "speaks a whole new language." Along with raising questions the patient hasn't thought of, family members can help gather and assess information, suggest alternatives for second opinions and serve as liaison between the person with cancer and the health-care team.

"Each family has its own way of dealing with things," says Scritchfield. "Some work better as individuals, while others make group decisions. But broadening the base of help and support is essential, both in the initial phase and down the road." In other words, it's best to not do this alone.

Families can also help with decisions related to clinical trials. "People are either worried about an experimental drug's side effects or don't understand how trials are done, or they know that although there are no guarantees, the new treatment may help them," says Cheryl Kefauver, a clinical research nurse at the OSU CCC-James. "Even though it's ultimately the patient's decision, I try to involve families as much as possible." With the knowledge and support of the family, a person may feel more comfortable about joining a clinical trial.

Families should also discuss questions of insurance and money. "One of the biggest concerns, especially with married couples, is 'Am I going to leave the other person in debt?'" Kefauver says. "The James Cancer Hospital has an entire department that deals with financial issues. When a patient is on a clinical trial, they make sure that patients are billed only for care not covered by the trial." Tests and treatments related to the clinical trial are generally paid for by the study itself and are not the responsibility of the patient.

Even if family members cannot contribute financially, they can help investigate options for care. Organizations such as the Division of Consumer Affairs at the Ohio Department of Insurance, the Columbus Cancer Clinic and the American Cancer Society can guide families through the confusing maze of pre-approval requirements and other procedures. Patients can also request that their insurance company assign a case manager to help them deal with questions about benefits, home care and other options.

There are also alternatives for the uninsured: "You can work directly with the hospital and the clinic," Blum says, to set up arrangements for treatments and a feasible payment plan. In certain instances, pharmaceutical companies provide drugs at greatly reduced cost for compassionate use.

Caregiving 101

With treatment and financial decisions made, day-to-day demands come forward. Patients must be taken to therapy and gotten home again; drugs must be administered and symptoms monitored. Caregivers may need to make time for training in certain home-care procedures. According to Bonanno, the average caregiver spends about 20 hours a week aiding the ill person, often in addition to a full-time job and doing the cooking and laundry.

The American Cancer Society notes that 63 percent of people with cancer are alive five years after diagnosis. Many of these are disease free and perhaps even cured; others are in remission or undergoing treatment. For those with advanced cancer, the care setting can shift from home, to a hospital, to a nursing home, to a hospice. But no matter the setting, says Bonanno, "caregivers remain caregivers." Even with health-care staff available, caregivers continue to serve as advocates and to provide support for their loved one.

""Despite all this," Schmitt says, "people can return to their lives and settle into a normal routine. It may be different from the 'old' normal routine, but it will enable a couple or family to live day-to-day with the comfort that comes from some measure of predictability."

Employed caregivers can begin integrating these changes into their life and developing a routine by taking advantage of the Family and Medical Leave Act. This law requires companies with 50 or more workers to provide up to twelve weeks of unpaid, job-protected leave to care for a seriously ill family member. Employee benefits are continued, and employers can allow an intermittent or reduced work schedule and can extend the leave.

Adjusting to cancer can also test family relationships. "Some families are great in responding during a time of need, while in others, there's a lack," Rhoades says. For example, an elderly patient who lives alone may have more difficulty than someone with a spouse, children and siblings. Members of some families are geographically far-flung. "Cancer can unify or divide a family," Rhoades says, with the latter commonly occurring when one member-who usually lives the closest-becoming the primary caregiver.

According to PLWC, a cancer diagnosis often shifts family dynamics. The caregiver may have to shoulder additional jobs, such as house and yard work and juggle finances. If the patient can no longer work, the spouse may need to find a job. Add in caregiving, and the spouse or other family member may feel besieged. At the same time, the person with cancer can feel guilty for being a "burden" and frustrated by his or her dependence on others.

"A husband can see his wife suffering and may ask, 'Why her and not me?'" Schmitt says. He may develop survivor's guilt and compensate by being overprotective. He may even fail to include the patient in treatment decisions.

Getting Off on the Right Foot

Caregivers can take steps to offset such pressures. They can begin by restoring a semblance of their former lives. They can plan for the necessity of taking time for themselves, then use that time to do things they enjoy without guilt. "Don't be afraid to ask for help," Scritchfield says. Accept offers that come from extended family, friends, neighbors and members of one's church, mosque, or synagogue. Something as simple as cooking a meal, driving once a week to a treatment, or spending time with the person while the caregiver goes shopping or to a movie greatly eases the chance of burnout.

"Caregivers tend to fall into the trap of being superhuman," Schmitt says. "They become isolated and put their lives on hold. Caregivers need time away from the cancer."

Burnout's warning signs include exhaustion, sleeplessness, irritability, forgetfulness, withdrawal from friends and leisure activities. Their own health may decline. To avoid burnout, Schmitt recommends stress-reduction activities such as meditation, exercise, eating well and getting adequate sleep.

"The loved one with cancer might also desire some time to themselves and encourage the caregiver to keep in their normal routines as much as possible.

Caregivers should discuss feelings, problems and possible solutions with family. "There needs to be an open dialogue," Rhoades says. Family members should come to a consensus about treatment and the division of responsibility for caregiving needs.

Couples often experience changes in their relationship. "If something's not quite right between them, or if there's an unresolved issue, cancer can bring the problem to the forefront," Rhoades says. "I've seen seemingly happily married couples split following a diagnosis." On the other hand, he says, "It's resulted in the reconciliation of divorced people, who come to see things in a completely different light."

Sexual adjustments may be needed, as well. "Most treatments take away desire, possibly for months or more," Rhoades says. "Partners need to be able to adapt and honestly communicate their needs and concerns with each other." He recommends counseling and patience: "The person had a brush with death and may never be the same."

The person will also have his or her own way of dealing with cancer and may be reluctant to share feelings. "Loved ones need to be open-minded and really listen to what the person is saying," Scritchfield says. "It takes time for the person to adjust. You can say: 'Something sounds different with you and I care about you, so do you want to talk about this?'"

The process can extend over years. If the cancer recurs, decisions may be required for additional treatment, possibly through a clinical trial, possibly for palliative or end-of-life care. Again, the one-day-at-a-time approach is best: "It's a roller-coaster ride," says Bonanno. "One week the patient's struggling in the hospital, the next he or she is doing well. Any reduction in stress, however small, can reduce a sense of helplessness."

A Journey of Healing and Growth

Hard as it may be to believe, "there is a silver lining," Schmitt says. "Caregivers are sharing a healing journey through a challenging life event and recognizing strengths they thought they never had. There's a special kind of intimacy that develops during this vulnerable period." Helping a loved one cope with cancer can renew a caregiver's appreciation for their loved one and add value to their time together. "The things they postponed, they start doing," Schmitt says.

Along with a sense of personal growth, many caregivers become more aware of their own health. "Family members may come in for a consultation with a genetic counselor to learn more about their own cancer risk," says Ilene Comeras, a research nurse in cancer genetics at The James Cancer Hospital. "We do a complete family history to see if they are at an increased risk for cancer or have a hereditary pattern of cancer." Actual genetic testing may or may not be recommended, depending upon their family history. Also, she says, "there are options for cancer prevention for those who'd rather not be tested."

Without doubt, coping with cancer is a challenge. But the challenge is not insurmountable, no one need face it alone. There are many resources that can help (begin with those listed in the sidebar). And one should never give up hope. "People with cancer are living longer, better, more comfortable lives," Schmitt says. "Family and friends can provide education and support and add immeasurably to the quality of life for both the caregiver and the person with cancer."

 
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