For some time now I've been debating about whether or not my life would've gone differently if I hadn't listened to my doctors. Would I still be able to tap dance or attend the computer classes I've started taking at the "Venice Skills Center"? Would I still be able to be a member of the MarVista Library Mystery Club? I thought I had pushed this thought to the back burner until July 11 at the Cancer Support Community-Benjamin Center's Writing Group. Scheduled as a committed group, led by facilitator Zena Bartholomew from 1-3 p.m. every Wednesday, the latest change she's instituted -using topic cards from the "GO WISH" Game (www.codalliance.org)- has given me fresh inspiration and a deeper understanding of my present circumstances.
On that fateful day, when I reached into the yellow ceramic bowl she stores the cards in before we select one, I never dreamed I'd get the one that said, "To Trust My Doctor". To give you a fuller understanding of how much that topic influenced me then I've reprinted what I wrote in class below:
To trust my doctor or not to trust my doctor? That's not a question for me because my doctors have never given me a reason not to trust them. I really don't think I'd be here if I didn't. They've been there for me every step of the way on my journey and helped me feel as though I always had someone in my corner. They've also reduced and eliminated my fears by visiting me in the hospital, emailing me when they had something to tell me and remaining consistent throughout my treatment.
I don't know if I'd have been able to face the disease with as much courage as I have without their support. Initially I was afraid of doctors, in general, the hospital, and being sick, but once I got diagnosed with Stage II A breast cancer, I lost my fears and embraced trust.
The trust I feel for my doctors has affected other parts of my life and I've opened up to others, as well, in ways I wouldn't have before. I've also learned to trust myself more and take more chances. This new openness makes me feel freer and courageous in the face of my new reality. Now when I want to go through an unknown door I do so without hesitation. As a matter of fact I embrace whatever awaits me behind that door. That doesn't mean I tread dancerously and follow dark paths it just means I allow my life to expand as it should.
Part of the reason I do that is to stay out of a rut and keep challenging myself. I want to keep changing. When I grow internally I want to change externally to match the overall shift. Trust in my own vision is the reason for that and that originated with trust in my doctors. No one told me that I'd become a different person, so I wasn't prepared for it until my doctors and other healthcare professionals explained that I had to to fight my disease. In that case it hasn't been such a bad thing. So now I don't care if I have to trust in my doctors to proceed with a new treatment or on my own path with a new hairdo, clothing style or attitude, my goal is still to reach the next level whether it's towards a healthier future or stronger, more focused life path. Wherever my trust takes me will be alright because it's coming from a good place.
Thursday, July 26, 2012
Tuesday, July 24, 2012
Cancer Support Community Recognizes Supreme Court Decision
The following is a formal statement from Cancer Support Community headquarters in Washington, D.C. regarding the Supreme Court's decision to uphold the constitutionality of the healthcare law.
The Cancer Support Community, an international nonprofit dedicated to providing support, education and hope to people affected by cancer, would like to recognize the Supreme Court’s decision today to uphold the constitutionality of the Patient Protection and Affordable Care Act (PPACA).
The PPACA contains several provisions of significance to people touched by cancer, including:
Access to health insurance for all Americans – specifically those who are currently uninsured
Elimination of lifetime coverage caps on health insurance benefits
Elimination of pre-existing condition clauses, which previously included a cancer diagnosis
Coverage of young adults up to the age of 26
Coverage for screening and preventative services, including breast, colorectal and cervical cancer screenings
"This is a step toward ensuring that all people touched by cancer will have access to the care they need in the face of a cancer diagnosis," stated Kim Thiboldeaux, President and CEO of the Cancer Support Community. "We look forward to working with our Congressional leaders and community members to ensure that the implementation of the law includes access to comprehensive, quality cancer care that includes the seamless integration of social and emotional care." To learn more about CSC national, visit Cancer Support Community
Friday, July 20, 2012
WebMD: Help is Just a Phone Call Away - By Heather Millar
The following is an article on WebMD regarding Cancer Support Community's new Open to Options™ telephone support hotline. People affected by cancer may call the helpline at 1-888-793-9355.
Friday, July 20, 2012
Remember the fog that surrounded you right after diagnosis? Remember how difficult it is to become an instant expert on your particular cancer? Remember how difficult it can be to make treatment decisions when you’re shocked, stunned, scared out of your mind? Remember forgetting exactly what you wanted to ask the minute you got into the doctor’s exam room?
We could all use a little support when navigating medical crossroads.
When I was in active treatment, I relied heavily on “Decision Services,” a pioneering program at University of California, San Francisco that helped me get ready for key doctors’ appointments, listing questions and concerns, clarifying test results, and helping me prepare for decisions that needed to be made. Now, that kind of help is available, over the phone, nationwide.
Developed in conjunction with UCSF, Open to Options™ provides professional counselors who help patients develop a concrete set of personalized questions and concerns to be raised with their doctors when a treatment decision needs to be made.
Cancer Support Community (CSC), a non-profit network offering cancer education and support, administers this new, national, toll-free call center. Patients may call the helpline (1-888-793-9355) or make an in-person appointment at one of CSC’s 13 affiliates, mostly in large urban areas.
In a pilot study funded by the Centers for Disease Control, an Open to Options™ specialist helped cancer patients with blood cancers brainstorm to create a list of questions based on their understanding of their disease, their priorities, options, and goals. The data suggested that patients experienced less stress and anxiety and had fewer regrets about their decisions when they received this sort of support. Doctors reported that the program made their interactions with patients more focused and productive.
This new program is based upon the one I found so invaluable at UCSF. If you’ve got a medical decision to make in the near future, check it out.
At the very least, take a look at CSC’s “Tips for Treatment Decision Making.” Briefly, they include:
• Learn as much as possible about your disease and your treatment options.
• Bring someone to your medical appointment to help you focus and to take notes.
• Talk through your ideas and concerns with someone you trust.
• Consult decision-making tools such as the patient guidelines created by the American Society of Clinical Oncology (ASCO).
But if it were me, I’d give Open to Options™ a call.
Friday, July 20, 2012
Remember the fog that surrounded you right after diagnosis? Remember how difficult it is to become an instant expert on your particular cancer? Remember how difficult it can be to make treatment decisions when you’re shocked, stunned, scared out of your mind? Remember forgetting exactly what you wanted to ask the minute you got into the doctor’s exam room?
We could all use a little support when navigating medical crossroads.
When I was in active treatment, I relied heavily on “Decision Services,” a pioneering program at University of California, San Francisco that helped me get ready for key doctors’ appointments, listing questions and concerns, clarifying test results, and helping me prepare for decisions that needed to be made. Now, that kind of help is available, over the phone, nationwide.
Developed in conjunction with UCSF, Open to Options™ provides professional counselors who help patients develop a concrete set of personalized questions and concerns to be raised with their doctors when a treatment decision needs to be made.
Cancer Support Community (CSC), a non-profit network offering cancer education and support, administers this new, national, toll-free call center. Patients may call the helpline (1-888-793-9355) or make an in-person appointment at one of CSC’s 13 affiliates, mostly in large urban areas.
In a pilot study funded by the Centers for Disease Control, an Open to Options™ specialist helped cancer patients with blood cancers brainstorm to create a list of questions based on their understanding of their disease, their priorities, options, and goals. The data suggested that patients experienced less stress and anxiety and had fewer regrets about their decisions when they received this sort of support. Doctors reported that the program made their interactions with patients more focused and productive.
This new program is based upon the one I found so invaluable at UCSF. If you’ve got a medical decision to make in the near future, check it out.
At the very least, take a look at CSC’s “Tips for Treatment Decision Making.” Briefly, they include:
• Learn as much as possible about your disease and your treatment options.
• Bring someone to your medical appointment to help you focus and to take notes.
• Talk through your ideas and concerns with someone you trust.
• Consult decision-making tools such as the patient guidelines created by the American Society of Clinical Oncology (ASCO).
But if it were me, I’d give Open to Options™ a call.
Getting Un-stuck from the Inside -Top 10 Tips by Regina Lark, Ph.D.
Regina Lark spoke at Cancer Support Community-Benjamin Center this past year. The following are Regina's top ten ways to reduce clutter.
I talk with a lot of people about clutter. I hear their stories about how clutter accumulates. Life transitions - birth, death, marriage, divorce, aging parents -- sometimes knocks you off your game. Many say that they just want to wake up one day completely and utterly clutter-free. Some people tell me they would almost welcome a slight house fire or some flood damage, relieving them of the burden of having to decide how to deal with the clutter.
One of the problems of having too much stuff is not knowing how to deal with the problem. A lot of folks feel stuck when it comes to taking action, or, in some cases, waging war, on the mess and chaos that comes with clutter. "Being stuck" has more to do with what you think and how you feel about the clutter, then about the actual pile of papers. Through my experience as a professional organizer and observer of the human nature, I have come to believe that our clutter could very well be the physical manifestation of negative messages we feed our brain. When we tell ourselves we are stuck (or immobile) we believe the message.
We're already at the end of the first quarter of this year that is no longer new. What is keeping you from creating or moving toward your goal? What did you start the year wanting to accomplish and how is the concept of "feeling stuck" going to make the goal elusive? I say it's high time to get un-stuck so you can accomplish what you set out to do!
And so I offer... the Top Ten Tips to help you un-stick from some of the places where you feel stuck!
1. Quiet the mind and take a deep breath. Accept the situation as it is. It is what it is right now. And it is about to change.
2. Understand these concepts: a) You are not your clutter. b) You are not lazy. c) Clearing clutter means that you have to make regular dates with yourself to get the work done.
3. We tend to look at the clutter as a monolithic whole. But it's easier to manage by looking at it in smaller chunks. So... make a list of each cluttered area in your life (be it physical or emotional) as it relates to feeling stuck. Make the list specific: what's the clutter look or feel like? how long have you had it?
4. We need to acquire knowledge about where we are at right now to make sense of how to work out of it. Drill down some more: How do you believe the clutter prevents you from creating or reaching a goal. How does the clutter make you feel stuck?
5. When have you tried to de-clutter? What time of day? How much time did you give to the task? Write about how you have tackled the problem in the past - what worked and what didn't? Do you keep trying to de-clutter the same way expecting different results?
6. Re-define for yourself the words "failure" and "success." I grew up with ideas about the definitions of success and failure. About a year after I started my professional organizing business I experienced months where growth was slow or felt non-existent. Instead of feeling like a failure I decided to re-evaluate what it meant to be a success. And so I decided that for me, a successful month for A Clear Path is the month I don't have to borrow from my dad. So far, I haven't had to borrow any money from my dad. See what I mean?
7. Clutter has a way of muffling sound, it takes up the air, left alone long enough it'll take on a musty odor. Spend quiet time creating a vision in your mind (or cut from pictures and taped to a poster board) of what your ideally cleared spaces will look like, smell like, feel like, sound like.
8. Think of tackling the clutter strategically. For every hour you take to de-clutter, you need an hour to reintegrate the stuff you intend to keep. Look at the list of your cluttered areas and figure roughly how much time you'll need for each project. Once you start the process, you'll know soon enough if you're in the ballpark.
9. Get your calendar and start making dates with yourself to clear the clutter. This is really important. Commit. Commit. Commit. Look at the big picture; be realistic. Do you have a lot of time off in the summer? Are you able to devote 2 hours every Saturday? Once a month? When do you feel most "up?" Are you a morning or night person? Schedule the sessions to give yourself every advantage.
10. Habits: To keep the clutter away you may have to change a few habits. If you habitually drop your clothes on the floor at the end of the day, you may want to change how (or where) you change into your pajamas. You may have piles of mail that's easily identified as trash for recycling. Think about sorting mail near the recycle bin before you even bring it into the space. If mail is dropped through a slot, sort it on your way to the household recycle container.
Monday, August 1, 2011
Can Reiki Help Your Chronic Pain?
By Wyatt Myers
Medically reviewed by Pat F. Bass III, MD, MPH
The practice of Reiki sounds almost too good to be true. By "laying on hands" on specific parts of your body or even just positioning hands slightly above your body, a qualified Reiki practitioner can help bring relief to your chronic pain and make you feel better than you have in years. It is an ancient Japanese technique and a form of alternative medicine also sometimes referred to as a "biofield" therapy.
In alternative medicine, Reiki is a treatment in which healing energy is channeled from the practitioner to the patient to enhance energy and reduce stress, pain, and fatigue. Practitioners say that it works by opening up a channel between healer and patient to transfer energy — a Reiki healer restores the body both physically and mentally.
During a Reiki session, muscles are relaxed, and energy flow is unblocked. This helps reduce physical tension and pain. Anxiety and stress also are reduced, helping to unblock and release emotional pain. Although you may not be completely pain-free, you feel relaxed, refreshed, and better able to cope with your condition.
Reiki and Chronic Pain: What the Research Shows
Though Reiki may sound very "new-agey," the effectiveness of this ancient treatment has been shown in some studies. "A [recent] issue of the International Journal of Behavioral Medicine reviewed 66 clinical trials on biofield therapies," says Julie Kusiak, MA, a Reiki practitioner in the integrative medicine department at Beaumont Hospital in Royal Oak, Mich. The authors of the review concluded that there was strong evidence that biofield therapies help reduce the intensity of pain in general and moderate evidence that these therapies help reduce the intensity of pain for people who are hospitalized or who have cancer, Kusiak says.
In addition, Kusiak says, a separate review article of 24 studies also showed that touch therapies were successful in reducing pain. This review article noted that the studies involving Reiki therapy seemed to have the most success.
When Reiki is examined for its impact on more specific types of pain, the results seem to hold up equally well. "Recent studies on Reiki therapy reflect a broad spectrum of its benefit for pain relief," says Kusiak. "During colonoscopy, Reiki treatment resulted in decreased anxiety and pain. With abdominal hysterectomies, the women who had Reiki therapy both before and after their procedures experienced lower anxiety and pain. Cancer patients being treated with Reiki reported lower fatigue, less pain, less anxiety, and better quality of life. And in a community of older adults, those who received Reiki therapy were documented to have reduced pain, anxiety, and depression."
Another plus about Reiki, adds Kusiak, is that it seems to be effective with very few side effects. "No serious side effects or risks have been identified in the medical literature on Reiki, and it is considered to be a very low-risk intervention," she says. "Since Reiki is facilitated either with a very light touch or with no touch — slightly off the body — it provides a therapeutic option for those who are in pain or unable to be touched."
Finding a Reiki Practitioner for Chronic Pain
If you're interested in finding a qualified practitioner of this alternative medicine, you can start by looking at Web sites such as The International Center for Reiki Training and Reiki Masters. However, Kusiak points out that standardization of the practice of Reiki is lacking in the United States, so your best bet might be to get a good reference and do some research on potential practitioners that you might be interested in.
"National standards are lacking for Reiki and other biofield therapies, so a key factor to consider would be the practitioner's level of experience and training," she says. "Ask them if they have an understanding of and experience treating your particular health concern. With serious medical concerns, you may need a practitioner who is affiliated with an integrative medicine program. Finally, as with any therapy, one needs to feel comfortable with the practitioner."
To read the original article, click here for Everyday Health.
Last Updated: 07/19/2011
Medically reviewed by Pat F. Bass III, MD, MPH
The practice of Reiki sounds almost too good to be true. By "laying on hands" on specific parts of your body or even just positioning hands slightly above your body, a qualified Reiki practitioner can help bring relief to your chronic pain and make you feel better than you have in years. It is an ancient Japanese technique and a form of alternative medicine also sometimes referred to as a "biofield" therapy.
In alternative medicine, Reiki is a treatment in which healing energy is channeled from the practitioner to the patient to enhance energy and reduce stress, pain, and fatigue. Practitioners say that it works by opening up a channel between healer and patient to transfer energy — a Reiki healer restores the body both physically and mentally.
During a Reiki session, muscles are relaxed, and energy flow is unblocked. This helps reduce physical tension and pain. Anxiety and stress also are reduced, helping to unblock and release emotional pain. Although you may not be completely pain-free, you feel relaxed, refreshed, and better able to cope with your condition.
Reiki and Chronic Pain: What the Research Shows
Though Reiki may sound very "new-agey," the effectiveness of this ancient treatment has been shown in some studies. "A [recent] issue of the International Journal of Behavioral Medicine reviewed 66 clinical trials on biofield therapies," says Julie Kusiak, MA, a Reiki practitioner in the integrative medicine department at Beaumont Hospital in Royal Oak, Mich. The authors of the review concluded that there was strong evidence that biofield therapies help reduce the intensity of pain in general and moderate evidence that these therapies help reduce the intensity of pain for people who are hospitalized or who have cancer, Kusiak says.
In addition, Kusiak says, a separate review article of 24 studies also showed that touch therapies were successful in reducing pain. This review article noted that the studies involving Reiki therapy seemed to have the most success.
When Reiki is examined for its impact on more specific types of pain, the results seem to hold up equally well. "Recent studies on Reiki therapy reflect a broad spectrum of its benefit for pain relief," says Kusiak. "During colonoscopy, Reiki treatment resulted in decreased anxiety and pain. With abdominal hysterectomies, the women who had Reiki therapy both before and after their procedures experienced lower anxiety and pain. Cancer patients being treated with Reiki reported lower fatigue, less pain, less anxiety, and better quality of life. And in a community of older adults, those who received Reiki therapy were documented to have reduced pain, anxiety, and depression."
Another plus about Reiki, adds Kusiak, is that it seems to be effective with very few side effects. "No serious side effects or risks have been identified in the medical literature on Reiki, and it is considered to be a very low-risk intervention," she says. "Since Reiki is facilitated either with a very light touch or with no touch — slightly off the body — it provides a therapeutic option for those who are in pain or unable to be touched."
Finding a Reiki Practitioner for Chronic Pain
If you're interested in finding a qualified practitioner of this alternative medicine, you can start by looking at Web sites such as The International Center for Reiki Training and Reiki Masters. However, Kusiak points out that standardization of the practice of Reiki is lacking in the United States, so your best bet might be to get a good reference and do some research on potential practitioners that you might be interested in.
"National standards are lacking for Reiki and other biofield therapies, so a key factor to consider would be the practitioner's level of experience and training," she says. "Ask them if they have an understanding of and experience treating your particular health concern. With serious medical concerns, you may need a practitioner who is affiliated with an integrative medicine program. Finally, as with any therapy, one needs to feel comfortable with the practitioner."
To read the original article, click here for Everyday Health.
Last Updated: 07/19/2011
Wednesday, July 13, 2011
Family history of cancer can be an evolving story
By Shari Roan, Los Angeles Times / For the Booster Shots blog
1:12 PM PDT, July 12, 2011
Family history is an incredibly helpful tool for doctors trying to determine a patient's risk of cancer. But one family history intake will not suffice. Rather, family history needs to updated every five or 10 years, according to the authors of a new study.
Researchers at UC Irvine looked at thousands of adults with a personal or family history of cancer and found that many changes in one's family history of breast, colorectal and prostate cancer occur between age 30 and 50. Based on their findings, the authors suggest that a patient's family history (of first- or second-degree relatives) of cancer be updated occasionally.
Family history is often used to determine how often a person should be screened for various types of cancers, the authors note. People with an increased risk due to family history may need to undergo more screening or start screening at a younger age.
"Family health history data are more likely to be collected at the initial clinic visit and are not adequately updated during follow-up visits," the authors wrote. "If a patient's family history is not updated during early and middle adulthood, the opportunity may be missed to intervene with earlier or more intensive screening that maximizes the likelihood of detecting cancer at an early, treatable stage."
The frequency of cancer screening tests has become a topic of debate in recent years as medical experts try to balance the benefits of screening against the potential risks and costs and move to personalize screening recommendations. With the increasing use of electronic health records, it may become easier to efficiently update family history records, said the author of an editorial accompanying the study. But how much family history matters when personalizing cancer screening recommendations is not clear.
"[M]uch needed evidence about the population health benefits of early and intensified cancer screening according to familial risk has yet to be developed," wrote Dr. Louise S. Acheson of Case Western Reserve University School of Medicine.
The study is published in the Journal of the American Medical Assn.
Thursday, September 16, 2010
The State University of New York at Buffalo: Breast Cancer Study
From the UB Reporter
Thoughts Matter Immediatly after Breast Cancer Diagnosis
By SARA SALDI
Published: September 16, 2010
What goes through a woman’s mind when she first hears the words, “You have breast cancer”? One in eight women will hear those words at some point in their lives and yet very little research has been conducted about women’s thoughts at this early stage before treatment or surgery.
The ways women move from becoming a “breast cancer patient” immediately after diagnosis to integrating cancer into their understanding of themselves is revealed in a new study by Robin Lally, assistant professor in the School of Nursing.
The study was published recently in Cancer Nursing, one of the nation’s top nursing journals.
“The effect of a cancer diagnosis on a woman’s self concept is not something that health care providers often consider when they are focused on the physical aspects of the disease and treatment early after diagnosis,” Lally explains.
Her study reveals how women acclimate to their diagnosis as they adapt to a new world—a foreign environment in which there are new roles and new people with a new culture and strange words.
The study found that “threatened self-integrity”—the threat to how we know ourselves—is the main concern for women as they acclimate to being “breast cancer patients” or “survivors.” The women’s self-integrity also was threatened by how they perceived others’ impressions of them and by whether they attributed developing cancer to their own actions or inaction.
From the findings, Lally has developed a theory of acclimating to breast cancer that focuses on three stages to the initial adjustment process: surveying the situation, taking action and the emerging self.
Her findings may help health providers better understand the thought process of women as they come to grips with the meaning of breast cancer in their lives as early as a week or two after discovering they have the disease.
“These women should know they are not alone in their thinking, that their initial thoughts are not abnormal; they are shared by others in the early days after being diagnosed,” Lally says.
Lally interviewed 18 women age 37 to 87 diagnosed with stage 0 to stage II breast cancer. The women were interviewed within six to 21 days after the diagnosis and were asked to think back to the day they were diagnosed with breast cancer and share their experiences.
Lally explains that essentially, women will work through a period of internal reflection about how breast cancer will affect them and those around them (“I have something that others dread”) to taking control of their immediate environments (reducing negative thoughts and using distraction) to incorporating cancer into their lives and contemplating the future.
In fact, many women in Lally’s study embraced personal change and saw the diagnosis as “a wake-up call” to appreciate life and the people in it. For the most part, women felt optimistic and hopeful that they would survive their cancer, Lally says.
At the end of the study, Lally was surprised to discover the “amount of mental energy that women expend when thinking about their diagnosis and strategies to control their environment” as a way to protect themselves from uncomfortable moments that arise when they are the “cancer patient” in social and work situations.
Thoughts Matter Immediatly after Breast Cancer Diagnosis
By SARA SALDI
Published: September 16, 2010
What goes through a woman’s mind when she first hears the words, “You have breast cancer”? One in eight women will hear those words at some point in their lives and yet very little research has been conducted about women’s thoughts at this early stage before treatment or surgery.
The ways women move from becoming a “breast cancer patient” immediately after diagnosis to integrating cancer into their understanding of themselves is revealed in a new study by Robin Lally, assistant professor in the School of Nursing.
The study was published recently in Cancer Nursing, one of the nation’s top nursing journals.
“The effect of a cancer diagnosis on a woman’s self concept is not something that health care providers often consider when they are focused on the physical aspects of the disease and treatment early after diagnosis,” Lally explains.
Her study reveals how women acclimate to their diagnosis as they adapt to a new world—a foreign environment in which there are new roles and new people with a new culture and strange words.
The study found that “threatened self-integrity”—the threat to how we know ourselves—is the main concern for women as they acclimate to being “breast cancer patients” or “survivors.” The women’s self-integrity also was threatened by how they perceived others’ impressions of them and by whether they attributed developing cancer to their own actions or inaction.
From the findings, Lally has developed a theory of acclimating to breast cancer that focuses on three stages to the initial adjustment process: surveying the situation, taking action and the emerging self.
Her findings may help health providers better understand the thought process of women as they come to grips with the meaning of breast cancer in their lives as early as a week or two after discovering they have the disease.
“These women should know they are not alone in their thinking, that their initial thoughts are not abnormal; they are shared by others in the early days after being diagnosed,” Lally says.
Lally interviewed 18 women age 37 to 87 diagnosed with stage 0 to stage II breast cancer. The women were interviewed within six to 21 days after the diagnosis and were asked to think back to the day they were diagnosed with breast cancer and share their experiences.
Lally explains that essentially, women will work through a period of internal reflection about how breast cancer will affect them and those around them (“I have something that others dread”) to taking control of their immediate environments (reducing negative thoughts and using distraction) to incorporating cancer into their lives and contemplating the future.
In fact, many women in Lally’s study embraced personal change and saw the diagnosis as “a wake-up call” to appreciate life and the people in it. For the most part, women felt optimistic and hopeful that they would survive their cancer, Lally says.
At the end of the study, Lally was surprised to discover the “amount of mental energy that women expend when thinking about their diagnosis and strategies to control their environment” as a way to protect themselves from uncomfortable moments that arise when they are the “cancer patient” in social and work situations.
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