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Wednesday, September 23, 2015

"After You Hear It's Cancer" (John Leifer)

TITLE: After You Hear It's Cancer: A Guide to Navigating the Difficult Journey Ahead
AUTHOR: John Leifer (with Lori Lindstrom Leifer)
PUBLISHER: Lanham, MD: Bowman and Littlefield, 2015, (320 pages).

The C word strikes fear initially. Once it has sunk in, the emotions are often mixed with both confusion as well as moments of clarity about what life is really about. Calling it a "life changing experience," author John Leifer shares from the heart about his journey with his wife, who was diagnosed with malignant breast cancer. Like what his wife felt about encountering cancer for the first time, the feeling is one of being overwhelmed and shut down. Making decisions about what to do next becomes an even greater challenge with stress and anxiety swirling around. Quoting Karen Sepucha of Harvard Medical School, it is a common scenario that even those who had overcome past challenges will find it difficult to help themselves. That is why people with cancer need support. That is why families of cancer patients need help. That is why books like this is a valuable resource to help deal with the difficult path carved by the news of cancer.

In writing this book, senior health executive and author John Leifer hopes to empower readers toward better decision making when hearing news about cancer. He guides us through the experiences of ten individuals plus his wife Lori, to give us a first person account of the long and difficult journey. He leads us through the BEFORE-DURING-AFTER phases of cancer treatments.

The BEFORE stage starts with the initial diagnosis and treatment planning. Get the accurate diagnosis. Be aware of the five categories of cancer, and to seek expert advice on which is directly affecting the patient. Learn about the different test types: Physical; Lab; Diagnostic Imaging; Biopsy; genetic Testing. Identify the actual cancer type. Find the stage as accurately as possible. Without the initial diagnosis, it is hard to work out prognosis (predicting the development and working out the next best steps). Learn as much as possible and if needed, find out how much truth physicians are keeping from us. Finding the right doctor is one of the most important decisions ever to make. Know the role of the oncologist, the clinic's reputation, the health system, the cancer specialist hospitals, and so on. Make sense of the treatments before choosing the most appropriate. Understand the place and purpose of clinical trials and adjust our expectations accordingly. Often, a second opinion is needed.

The DURING stage is a result of the decisions made earlier. At this point, the path has already been set. Emotionally it will be a roller-coaster experience. There will be times where things seem to be getting worse and also times when hope sings louder than all. There will be anxiety and depression interrupted by periodic times of gladness for family and friends. Leifer perceptively points out that some people do encounter greater difficulty than most. They would need additional support to walk them through the various distress levels. Some positive helps include:

  • Physical exercise to help deal with body and emotional stresses
  • Quietness and Contemplation to strengthen our inner selves
  • Journaling to express our state of mind and emotions
  • Gratitude for our blessings and gladness for support groups
We learn about how to minimize the side effects of treatment, like fatigue, hair loss, physical pain, appetite, and others. At the same time, we get many tips about what to eat. The ABCs of nutrition is one example. Often, patients need guidance on the best menu for their daily needs. Pain as a "fifth vital sign" is actually a sign of health and well-being. Leifer finds it helpful to know the following about pain.

"It is usually a signal that body tissue is being injured in some way, and it generally disappears when the injury heals. Chronic pain may range from mild to severe, and is present to some degree for longer periods of time (generally lasting longer than three to six months). Because pain is unique to each individual, a person’s pain cannot be evaluated by someone else."
Other considerations include the other 3 Cs: Costs, Complementary therapies, and Caregivers.

At the AFTER phase, the case is often whether the treatment is sufficient or insufficient. Either way, it demands different ways of dealing with it. When insufficient, patients need to work with their doctors again on the next steps. With cancer often an incurable disease, no treatment is ever guaranteed. For some, cancer will never go away, no matter the treatment. The "Middle Stage" of cancer is a way of describing a person's journey mid-way through cancer. At this stage, it can go either way: For better or for worse. It is a delicate place to be in, with hope and disappointment keeping each other at bay. There are notes about life after surviving cancer. There are difficult decisions to make about lifestyle changes. Some may need to slow down their pace of life. Others go on to palliative or hospice care. The final chapter about the end of life can look depressing at first, but it is an extremely practical way to deal with a real problem.

I find the last chapter particularly touching, with the author's wife, Lori writing a brief note about her own journey through cancer treatment. It is not giving advice. It is about the sharing of her struggles and the hope that she gives that makes it so inspiring. The authors do not write this book from an ivory tower perspective. They have shared with us their stories of how cancer had impacted their lives, what we can learn from their experiences, how we can deal with our own situations, and many more. This book is one of the best guides I have ever read with regards to cancer treatments and dealing with them. From beginning to end, from diagnosis to prognosis, before, during, and after the treatment, almost every stone was turned to reveal the deep seated complexities. Cancer is not simply a six letter word to be feared. It is a life-changer. It is test of human resilience. It is an opportunity for us to find out the worst of the disease and the best of the human spirit. Take heart. You don't have to fear the C word. The human spirit is more formidable.

Rating: 5 stars of 5.


This book is provided to me courtesy of Bowman and Littlefield via NetGalley in exchange for an honest review. All opinions offered above are mine unless otherwise stated or implied.

1 comment:

  1. Dr Yap,

    Lori and I are grateful for your kind and very comprehensive review of our new book. Thank you so very much!

    John Leifer