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| Keep copies of your medical records. |
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Since problems resulting from treatment can come up years afterward, it’s
important to keep records of the treatment and to have continued contact with
somebody who knows about its delayed effects. Making copies and filing these
in a safe place is very important. You might want to keep one copy in a safe
deposit box.
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| Don’t let your health insurance lapse. |
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Your company can’t drop your policy because of your illness. But many insurance companies won’t take on someone who’s had a life-threatening illness, and others will take you on but exclude coverage in the area of your illness. If you change jobs and go from one company’s coverage to another, you’ll probably be all right (but make certain of this before you accept the new job). If you quit for a while, make sure you keep up your insurance on your own. It’s costly, but not nearly as costly as having no coverage if you get a recurrence.
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| Cancer is considered a disability under the Americans with Disabilities Act. |
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One of the hardest questions is whether to tell employers and co-workers about
your cancer. There are pros and cons either way. US federal law prohibits federal
employers, or employers who get a federal grant or federal financial assistance,
from discriminating against the handicapped or anyone mistakenly thought to be
handicapped. Under the Americans with Disabilities Act, any employer with 15
or more employees is prohibited from discriminating against qualified applicants
and employees because of any disability. You can get more information from the
National Coalition for Cancer Survivors.
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| The truth about blood tests, X-rays, and scans. |
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There isn’t a lot we can do to detect recurrent cancer, aside from regular
checkups and mammograms. Unlike primary cancers, recurrent cancers do not have
a better prognosis when they are detected early. Many doctors still do blood
tests every three to six months. This may include a blood count (CBC) as well
as CEA, CA 15-3, CA 27.29, and liver blood tests. Many patients and physicians
assume that using these tests to find metastases early improves outcomes. Unfortunately,
we have lots of data that this is not true. This also holds true for the routine
use of bone scans, chest X-rays, and CAT scans. Surveillance
guidelines issued by the American Society of Clinical Oncology and the National Comprehensive
Cancer Network advise a physical exam every six months and a mammogram every
six months for a year or two and then once a year. If you are taking tamoxifen,
you should also have a yearly pelvic exam.
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| Be open with your doctor about how you are feeling. |
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It is important to discuss carefully with your doctor how you are feeling physically.
Your doctor will be very alert to symptoms such as persistent and unusual pain
in your legs or back (which can indicate metastases to the vertebrae, leg bones,
or spinal cord), a persistent dry cough (which may indicate lung metastases),
or pain under your right ribs and unexplained loss of appetite (which can be
a sign of liver metastases)
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| Time affects the likelihood of recurrence. |
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With breast cancer, unlike some other cancers, we can’t be sure that
if it hasn’t recurred within a few years, it won’t. It’s usually
a slow-growing cancer, and there are people who have had recurrences 10 or even
20 years after the original diagnosis. However, the longer you go without a recurrence,
the less likely you are to have one. So going 10 years without cancer coming
back should give you reason for optimism, if not certainty.
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| New studies can’t change the treatment you chose. |
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You will probably one day hear a news story about a risk factor or new
treatment and start wondering if it was the alcohol or birth control pills (or
whatever happens to be on today’s “hit list”) that you used
that caused your cancer. Or you may regret the treatment decision you made, thinking:
With this new information, maybe I would have done things differently. Remember,
what is past is past. You can’t change the choices you made. You have to
comfort yourself with the realization that you probably got the best treatment
that was available at the time you were diagnosed. If there are improvements
in treatments now, that’s wonderful — but you can’t waste your
energy on what might have been. Read the newspapers and keep informed if you’re
interested, but don’t use it to torture yourself about what might have
been.
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