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From Stage IV to Cancer Free
Pam Brown—chef-owner of Garden Café on the Green, Woodstock's much-loved vegan restaurant—had always prided herself on exercising every day, doing yoga, and eating vegan since 1967 ("I was a raging hippie," she says). So Brown was shocked when, in October 2013, she was diagnosed with Stage IV, very metastasized ovarian cancer. "I'd been living the ideal healthy lifestyle, except for the extreme amount of work and stress, which is definitely a factor in this," says Brown. Her surgeon said the tumor was like a bag of peas that had burst open and spread everywhere, all the way up to her lungs. "They said, 'Here's what's going to happen—you're going to have a complete hysterectomy, you're going to go through chemotherapy, lose your hair, the whole deal.' My attitude was 'Let's just get this all done.' There's more pain in resisting things than in accepting what's going on."
Naturally petite and energetic, Brown was a wasted 78 pounds when she went into surgery (about 20 pounds below her normal weight). She spent the next six months at home, going to St. Peter's Hospital in Albany for chemo every week for 18 weeks. Her doctor told her to eat meat because her tumor-ravaged body needed protein. Instead, she says, "I ate eggs, dairy, and fish—none of which I enjoyed—but I was grateful to the animals. I'd thank them as I'd eat it." Brown tried alternative therapies like cannabis oil and herbs ("I figured it couldn't hurt") and forced herself out of bed to walk the treadmill. A parade of "amazing people" came to her house with food; to help with her medical expenses, a friend started a Gofundme site that raised $25,000 from her community in four days.
Today Brown is cancer free, but she understands that it could come back at any time. ("They don't declare remission. I get a blood test every month.") She has her battle scars—painful nerve damage, fingernails that fell off, dental issues from the chemo. Back to her vegan diet and back to work (though working a little bit less), she's convinced that a foundation of good health contributed to her recovery. "Sometimes I think, oh my God, I had cancer but I'm still here. I'm amazed and blessed that I'm here."
Postcancer: A Survival Guide
Like Kuklis, Brown is entering a different stage of cancer called survivorship—a relatively new term that's used mainly to describe the post-treatment phase. New regulation requires all patients ending their cancer treatment because they've been "cured" to have a survivorship plan. Developed with their doctor, these are living plans that include a patient's diagnosis and treatment history as well as a complete blueprint for care going forward—recommended screenings, physical therapy, nutritional therapy, and the like. Perhaps the most profound change in oncology today is a movement to apply the principles of survivorship to the entire journey of cancer care. Says Cassese, "In the old days, when people spoke to patients of palliative care, it was the equivalent of hospice. There's growing enthusiasm around changing the name [palliative care] to survivorship care, focusing on treating the whole person and relieving all symptoms, be they pain, stress, fatigue, insomnia. It's all about quality of life."
Meanwhile, Health Quest is working on bolstering its cancer rehab through a program called STAR, or "survivorship training and rehabilitation"; about 50 health-care providers are undergoing the training. "As cancer is becoming a chronic problem that people can live with, it's really critical to look at how we treat these patients," says thoracic surgeon Cliff Connery, MD, FAC, medical director of the Dyson Center for Cancer Care at Vassar Brothers Hospital, and Health Quest's director of thoracic oncology and surgery. "How much do we beat them up when we're trying to cure the cancer? What sort of side effects do they have?" Connery works mainly with lung cancer patients, who typically have a lower chance of survival—though with newly recommended low-dose CT scan screenings for those at high risk for lung cancer, this prognosis may be changing. (Stay tuned for next month's article on the evolving world of lung cancer care.)
Keeping the C-Word at Bay
For people looking to survive cancer by never getting it in the first place, the obvious adages ring true. Don't smoke. Eat your vegetables. Exercise. Keep your weight in the normal range (obesity is a cancer risk factor). And at physical exams, be your own best advocate by talking to your doctor about screenings. Regular mammograms, colonoscopies, and the like, administered at the recommended times, can catch cancer earlier and dramatically increase chances of survival. Those with a family history and other high-risk individuals need to be extra vigilant. "Every day I talk to someone who skipped an exam—by three months, six months, a year—and got bad news," says Cassese. "There's no way to get that back. We want to catch it as soon as we humanly can. If someone can catch a lung cancer early enough that it can be treated with surgery, it makes all the difference in their survival."