Advice From Our Experts

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Every week, Indiana University Health Ball Memorial Hospital experts provide columns addressing frequently asked questions and timely health topics in a Q&A format. The advice can touch on who should take advantage of free local screenings, what people should do to avoid the flu or simple tips to lead a healthy life. Below are actual 'ask the experts' questions that have been published and refer to Cancer Services.

The IU Health Ball Memorial Cancer Center Boutique

What is a breast prosthesis?

A breast prosthesis or breast form is an artificial breast that is used after a surgery in which the breast has been fully or partially removed.

Why do I need a breast prosthesis?

Many women dealing with breast cancer undergo surgery that changes their physical appearance. The common types of surgery include:

• Lumpectomy: the surgical removal of a breast lump/lesion
• Mastectomy: the surgical removal of the breast tissue and underlying muscle

A breast prosthesis is weighted and helps keep the body symmetrical when an imbalance is caused by breast surgery. When the body is not properly aligned back, shoulder, and neck discomfort may result. A breast prosthesis will help restore the body’s natural balance and posture.

How soon after surgery can I be fitted for my breast prosthesis?

You may make an appointment to be fitted as soon as you receive permission from your physician.

Do I need a prescription for my breast prosthesis?

No, The Cancer Center Boutique Manager at IU Health Ball Memorial Hospital will obtain the prescription from your physician.

Will insurance cover my prosthesis?

Medicare pays for a new form every 2 years, and 4 – 6 bras yearly. Most insurance companies follow this timeline.

Do I pay any money up front?

No, manager at IU Health Ball Memorial Cancer Center Boutiquw will file all the paperwork with the appropriate companies. Any remaining balance will be billed to you after insurance settles.

What if I gain/lose weight?

If there is a body change, insurance companies may pay to replace the form before the 2-year timeline.

What if I don’t have insurance or Medicaid?

Talk with the Mary Whitenack, manager, IU Health Ball Memorial Cancer Center Boutique, at 765.751.5302.

Grief

Are 'bereavement,' 'grief,' and 'mourning' one and the same thing?

No, but they are closely related. Bereavement is the event of a loved one being snatched away from us by death. Grief is our emotional response to losing someone or something important and dear to us. Mourning is the outward expression of grief, like wearing black.

How do I recognize grief?

Grief is a journey that has been likened to wilderness, because of its unfamiliarity and harshness. Each individual’s journey will be unique, and yet there are certain similarities, as far as physical and emotional experiences are concerned. Some physical reactions could include headache, fatigue, restlessness, upset stomach, dry mouth, and tightness in chest. Emotional responses could include shock, disbelief, numbness, anger, guilt, sadness, apathy, loneliness, emptiness, or even relief in some cases. Changes in behavior could include disturbed sleep and appetite, crying easily, social withdrawal, increased use of alcohol and drugs.

If I am the 'rock' in the family, is it okay for me to grieve?

Yes, it is absolutely necessary for you to be able to grieve too, even if you have always been the 'rock.' Your grief is something you must allow yourself to experience and express, so that you can find ways to heal. If you neglect your own grief, it will keep impacting your life, trying to get your attention.

Do I need to hide my grief from my children?

No. It is really important to share the truth about the death with them in an age-appropriate way. This will set an example to them of how to share honestly and openly with you, in the future. Also, it is okay to share your sadness with them, and cry in front of them, thus modeling to them that it is alright to cry when one is sad, and giving them permission to do the same when they need to.

Can I get support and help for my grief at the Cancer Center?

Yes. An Adult Grief Group is held twice a year at the IU Health Ball Memorial Cancer Center. It is organized by IU Health Hospice, and is open to the community. All you need to do to register is call 765.747.4273. There is a one-time charge of $10, irrespective of whether you are registering only yourself, or several family members.

Each group runs for six consecutive Wednesday evenings, 6 pm – 7:30 pm. In addition, there is a one-session Holiday Grief Group, just as we launch into the Holiday season. You can also find this information in the local newspaper, just before each group begins. If your loved one received treatment at the IU Health Ball Memorial Cancer Center, you are also entitled to free one on one grief counseling and support through the cancer counseling services.

Community Education

How do I know which cancer screenings are appropriate for me?

The American Cancer Society has created general guidelines for when cancer screenings may be appropriate. You can obtain a personal checklist by contacting our Coordinator of Community Education at 765.741.2938. We encourage you to bring this checklist to your next doctor’s appointment and discuss the recommendations with him/her. It is important to note these are general guidelines and your doctor may recommend additional screenings or a different schedule based on your individual needs.

Does the IU Health Ball Memorial Cancer Center provide cancer screenings?

The IU Health Ball Memorial Cancer Center strives to educate the community about the importance of early detection and to make free cancer screenings available to them. Each January, along with local gynecologists' offices, the IU Health Ball Memorial Cancer Center offers a free cervical cancer screening. May is skin cancer awareness month, and several free skin cancer screenings are offered throughout East Central Indiana during May. These screenings require pre-registration.

To learn about dates and to set up an appointment, please call 765.741.2938. Free colorectal cancer screening kits can be obtained at any time through the IU Health Ball Memorial Cancer Center by calling 765.741.2938.

Does the IU Health Ball Memorial Cancer Center have staff that can come to my church, group, business, or school to provide information/education about cancer?

Yes! The IU Health Ball Memorial Cancer Center is happy to provide speakers free of charge to both adult and youth groups. We can cater a program to your specific needs and audience. To inquire about a speaker, please call 765.741.2938.

Complementary and Alternative Medicine

What is the difference between the processes of approval for drugs versus herbs?

• Drug products—manufacturers must obtain FDA approval by providing evidence that a drug is both safe and effective before it can be sold and have continuous evaluation of the product by the FDA.
• Herbal products—Assumed safe until proven otherwise. FDA has to prove that the product is not safe in order to restrict its use or remove it from the market.

What is Complementary Alternative Medicine?

Complementary Alternative Medicine is a broad domain of healing resources that encompasses as health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period. CAM includes all such practices and ideas self-defined by their users as preventing or treating illness or promoting health and well being. National Institute of Health, Office of Alternative Medicine Complimentary and Alternative Medicine (CAM) practices are used to complement mainstream medicine, as opposed to alternative therapies, which are thought of as substitutes for mainstream medical approaches.

They are used to help patients prevent illness, decrease or prevent the impact of treatment side effects and symptoms, control and cure disease, as well as reduce stress.

CAM methods encompass more well-known approaches such as counseling, support groups, guided imagery, nutritional counseling, meditation/relaxation and psychotherapy, as well as less widely used but valid approaches such as therapeutic touch/massage, prayer therapy, art and music therapy, acupuncture, yoga, and herbal medicine.
Who Uses CAM?

David Eisenberg (1997)—More women (49%) than men (38%), aged 35 – 49 years, college education (51% vs. 36%), higher incomes > $50,000, more common in West.

What are CAM Red Flags?

• Claims that the treatment can “cure” all types of cancer
• Treatments that are only available from only one individual or clinic, treatments that are only available outside of the U.S.
• "Secret" formulas
• Claims that the treatment cannot be used in combination with conventional medical care
• Claims that the treatment/physician/theory is being suppressed by the government, pharmaceutical companies or medical establishment
• Testimonials from patients without scientific backup
• "References" from popular magazines and newspapers rather than recognized scientific journals

Nutrition

If our genes determine cancer risk, how can diet help prevent cancer?

Damage to the genes that control cell growth can be either inherited or acquired during life. Certain types of mutations or genetic damage can increase the risk of cancer. Nutrients in the diet can protect DNA from being damaged. Physical activity, weight control, and diet might delay or prevent the development of cancer in people with an increased genetic risk for cancer. The many interactions between diet and genetic factors are an important and complex topic, and a great deal of research is under way in this area.

Does being overweight increase cancer risk?

Yes. Being overweight or obese is linked with an increased risk of cancers of the breast (among postmenopausal women), colon, endometrium, esophagus, kidney, and possibly other sites as well. Although research on whether losing weight reduces cancer risk is limited, some research suggests that weight loss does reduce the risk of breast cancer. Because of other proven health benefits, people who are overweight are encouraged to lose weight. Avoiding excessive weight gain in adulthood is important not only to reduce cancer risk, but also to reduce the risk of other chronic diseases.

What are antioxidants and phytochemicals, and what do they have to do with cancer?

The body appears to use certain nutrients in vegetables and fruits to protect against damage to tissues that occurs constantly as a result of normal metabolism (oxidation). Such damage is linked with increased cancer risk, and antioxidant nutrients are thought to protect against cancer. Antioxidants include vitamin C, vitamin E, carotenoids, and many other phytochemicals. The term phytochemicals refers to a wide variety of compounds made by plants. Some have either antioxidant or hormone-like actions both in plants and in people who eat them. Studies suggest that people who eat more vegetables and fruits may have a lower risk for some types of cancer and increased survival rate after cancer diagnosis. Eat a variety of fruits and vegetables prepared fresh or lightly steamed every day.

What is dietary fiber, and can it prevent cancer?

Dietary fiber includes a wide variety of plant carbohydrates that are not digestible by humans. Specific categories of fiber are "soluble" (like oat bran) or "insoluble" (like wheat bran and cellulose). Soluble fiber helps to reduce blood cholesterol, thereby lowering the risk of coronary heart disease. Good sources of fiber are beans, vegetables, whole grains, and fruits. Links between fiber and cancer risk are weak, but eating these foods is still recommended because they contain other nutrients that may help reduce cancer risk and because of their other health benefits. Also, a diet high in fiber is associated with an efficient gastrointestinal tract, which may also reduce the risk of developing cancers of the digestive organs.

Can I get the nutritional equivalent of vegetables and fruits in a pill?

No. Many healthful compounds are found in vegetables and fruits, and these compounds most likely work in combination to exert their beneficial effect. There are also likely to be important, but as of yet unidentified, components of whole foods that are not included in supplements. The small amount of dried powder in the pills that are represented as being equivalent to vegetables and fruits often contains only a small fraction of the levels contained in the whole foods. Food is the best source of vitamins and minerals. Supplements may be helpful for some people, but there is no proof at this time that supplements can reduce cancer risk. Some high-dose supplements may actually increase cancer risk.

Genetic Testing

What is genetic testing for cancer?

For some individuals, genetic testing is a way to learn about their risk for certain types of cancer. Genetic testing includes counseling and a simple blood test that will be analyzed for a particular gene alteration that may be associated with a hereditary cancer. Cancers that are known to have a hereditary tendency include breast, ovarian, colorectal and melanoma. This type of testing can provide you and your family with information about your risk of developing cancer. The test may provide you with some peace of mind, knowing your risks of developing cancer are not as great as you believed or alert you that you need higher medical surveillance or treatment due to carrying an altered gene.

How do I know if the cancer in my family is hereditary?

If a certain cancer, of any type, seems to run in the family or if you have multiple family members with the same type of cancer you may have a higher risk of developing cancer. Also, if family members have had breast cancer younger than age 50, you have two or more close relatives with colon cancer younger than age 60, or a family member has had both breast and ovarian cancer; you may also have an increased risk of developing certain types of cancer.

Why would the test be beneficial to me?

It all starts with your genes, which are the instructions for how our bodies grow and develop. Genes come in pairs and when you are born, one set is passed down from your father and the other set is passed down from your mother. Genes are important because they provide a blueprint of your health. A person may or may not inherit a mutation, or cancer causing gene. A mutation raises a person’s risk for cancer. There are some characteristics of hereditary cancers that may help you determine if you or other family members may have a higher risk of developing cancer. With genetic testing, those risks can be better determined.

For more information on Genetic Testing available locally, call the IU Health Ball Memorial Cancer Center at 765.751.1449.

Social Services

How do I go about getting financial assistance for the cost of treatment, especially if I have no insurance?

A Social Worker at the IU Health Ball Memorial Cancer Center can provide assistance with contacting the financial counselors available and initiate the process of applying for financial assistance programs through the hospital and/or state assistance programs.

Treatment will require several trips to the IU Health Ball Memorial Cancer Center and at times I may have difficulty finding someone to transport me to and from my doctor appointments and treatments times. What assistance is available?

The Social Worker can assist with referrals to various transportation agencies that service Delaware and surrounding counties.

During the journey from diagnosis to treatment to recovery, thoughts and questions can come to mind regarding being prepared and the "what ifs." What services are available to answer these common questions and/or concerns?

The Social Worker can provide written material regarding advance directives and can complete a Living Will or Health Care Representative Form with you. This can give peace of mind and ensure that your wishes are communicated.

During my treatment process, medications can be very expensive even with prescription drug insurance. What assistance can be available?

The IU Health Ball Memorial Cancer Center Social Worker can provide information on Co-pay relief programs or other drug assistance programs that individuals may benefit from.

Are there Community Support Programs available to assist me with various needs during my treatment process?

The IU Health Ball Memorial Cancer Center Social Worker can refer you to several different organizations (i.e. American Cancer Society, Lifestreams, Careline and Meals on Wheels).

Radiation Therapy

Why is my treatment delivered over a period of time rather than all at once?

Normal cells react differently to radiation than cancerous cells. Normal tissue is usually able to recover from radiation damage in the interim between what are called fractionated treatments while cancerous tissue usually takes longer to recover. Therefore, delivering radiation treatments over a period of time will have a greater impact on the death of cancerous cells.

What is IMRT?

IMRT is able to dynamically shape or conform radiation beams to the size, shape and location of a tumor, matching the radiation dose to the contour of a tumor while minimizing the impact on surrounding healthy tissue or organs.

How does IMRT differ from conventional radiation therapy treatments?

Rather than being treated with a single, large, uniform beam, the patient is treated with many very small beams, each of which can vary in intensity. IMRT delivers a relatively uniform radiation dose to a tumor and protects sensitive, surrounding tissue by minimizing its exposure to damaging radiation.

What should I expect for my external beam treatments?

To be most effective, radiation therapy must be aimed precisely at the same target or targets each and every time treatment is given. The process of measuring your body and marking your skin to help your team direct the beams of radiation safely and exactly to their intended locations is called CT simulation. Once you have finished with the simulation, your radiation oncologist and other members of the treatment team review the information they obtained during simulation along with your previous medical tests to develop a treatment plan. Sophisticated treatment-planning computer software is used to help design the best possible treatment plan. After reviewing all of this information, your doctor will write a prescription that outlines exactly how much radiation you will receive and to what parts of your body. When you undergo external beam radiation therapy treatment, each session is painless, just like getting an X-ray. The radiation is directed at your tumor from a machine (a linear accelerator) located away from your body. External beam radiation is noninvasive, unlike surgery which is an invasive process. Treatments are usually scheduled five days a week, Monday through Friday, and continue for one to 10 weeks. The number of radiation treatments you will need depends on the size, location and type of cancer you have, the intent of the treatment, your general health and other medical treatments you may be receiving. The radiation therapist will give you your external beam treatment following your radiation oncologist’s instructions. It will take 15 – 20 minutes for you to be positioned for treatment and for the equipment to be set up. If an immobilization device was made during simulation, it will be used during every treatment to make sure that you are in the exact same position every day. Once you are positioned correctly, the therapist will leave the room and go into the control room next door to closely monitor you on a television screen while giving the radiation. There is a microphone in the treatment room so you can always talk with the therapist if you have any concerns. The machine can be stopped at any time if you are feeling sick or uncomfortable. The radiation therapist may move the treatment machine and treatment table to target the radiation beam to the exact area of the tumor. The machine might make noises during treatment that sound like clicking, knocking or whirring, but the radiation therapist is in complete control of the machine at all times.

I have heard that radiation burns, is that true?

Most of the radiation given by the treatment machine goes beneath the skin surface. Even so, the radiated skin can become first slightly reddened and irritated, and later dry and itchy. A few patients may develop moist open patches in the radiated skin and especially any skin folds. You will need to watch your skin closely and report any changes you notice. Some skin reactions can be uncomfortable. Tylenol® or ibuprofen may help. If you need something stronger or need help with your skin care, ask to speak with a nurse.

Are patients radioactive after a seed implant for prostate cancer?

Almost all of the radiation energy is absorbed into the prostate gland. It is nevertheless recommended that small children and pregnant women not sit on the patient's lap for an extended period of time for several months after treatment. Other normal activities such as hugging children, sleeping with a spouse, or sitting around a table are fine. Risk to pets from sitting on a patient's lap is extremely low.

Hospice

What is hospice?

Hospice (IU Health Ball Memorial Hospice in particular) offers quality, compassionate care for people facing a life-limiting illness and those who love them. Hospice care involves a team approach to expert physical, emotional and spiritual support designed to meet their (and their caregiver’s) needs and wishes.

Who qualifies for hospice?

Hospice is available for people with a life limiting illness measured in weeks or months. Hospice focuses on caring, not curing and, is provided in the person’s place of residence which may be their home, a nursing home, or assisted living facility. It may include short term hospitalization for symptom management. Services are available to people of any age, religion, race and illness.

Who pays for hospice?

Hospice care is covered under Medicare, Medicaid, most private insurance plans, HMOs and other managed care organizations. IU Health Ball Memorial Hospice provides compassionate, end of life care for anyone who needs it and qualifies.

Do you only provide service in Delaware County?

IU Health Ball Memorial Hospice provides care to residents in all of Delaware County and all or portions of Randolph, Henry, Madison, Grant, Blackford, Jay and Wayne counties.

Cancer Exercise

Is exercise safe for patients going through treatment?

Exercise can be completely safe as long as you are exercising at a level that is appropriate for you and the treatment you are going through. This must be determined by a team comprised of your doctor and an exercise physiologist that is trained in the field of cancer. During treatment, it is important that you are monitored during exercise by an exercise physiologist that knows your specific cancer and health history to ensure that you are safe. Exercise is greatly beneficial, but if done incorrectly or at a very high intensity, can have risks. Be sure to consult with your doctor and an exercise physiologist before beginning any kind of exercise program.

If I am feeling fatigued from my treatments, won’t exercise make me more fatigued?

Cancer and cancer treatments cause a type of fatigue known as Cancer Related Fatigue (CRF). Cancer Related Fatigue is a type of fatigue that does not respond to rest. Of course, it is important to get the proper amount of sleep and rest, but exercising at moderate levels is more useful at reducing this type of fatigue than an excessive amount of rest. The key is to keep exercise at a low to moderate level of intensity to boost your energy levels. If you do very strenuous exercise, you may feel more fatigued.

Will my insurance pay for exercise classes?

The exercise program is a newer program, so it is currently not covered by insurance. The cost of The Cancer Exercise Program is $25 per month (8 exercise sessions) and this includes the initial evaluation, education classes, and twice weekly exercise monitored exercise sessions. If you have financial concerns, arrangements can be made to accommodate you.

Should I wait until I am finished with treatment before starting exercise?

No, exercise can begin safely and with much benefit at the start of your treatment or even right after diagnosis. You will want approval from your doctor and supervision, of course. Exercise will help increase energy levels that would otherwise decrease with treatment and maintain muscular strength and endurance. Also, exercise has been shown to help patients tolerate their treatment better and maintain a stronger immune system.

What types of exercise are the best?

This is dependent on your specific situation, cancer diagnosis, and health status. If you are very weak and fatigued, seated exercise and light weight training may be best for you. If you are more active and slightly-moderately fatigued, walking may be a great exercise for you. Also, it is very important that you find an exercise that you enjoy so that you are more likely to stick to your exercise routine. A trained exercise physiologist can help you to determine the best type of exercise for you. Always keep in mind that exercise is not "one size fits all," and a type of exercise that is good for one person may not be good for another person.

I would like to learn more about The Cancer Exercise Program and find out if it is right for me, where do I start?

Contact 765.751.5304.

Patient Education, Navigation and Support

I’ve just been diagnosed with cancer, now what?

A diagnosis of cancer and its ensuing treatment have a tremendous physical and emotional impact on patients and families. An individual's ability to understand and cope with the changes that occur after a cancer diagnosis can be improved by access to relevant and understandable information.

I have so many questions who can I contact?

The IU Health Ball Memorial Cancer Center has a full-time educational coordinator available to meet your information and support needs. There are a variety of support groups, education and specialty programs available to patients FREE of charge. The IU Health Ball Memorial Cancer Center has a variety of books, videos, brochures, and other resources available to assist patients and their families in learning more about their diagnosis, treatment options, and available services. If you have questions, need answers or need to speak to someone about your diagnosis, treatment, or what to expect, please call 765.751.1400.

What types of services are available to patients?

• Weekly and monthly education programs
• Personal appointment to discuss individual family needs, concerns, information and navigation regarding our services and programs
• Resource materials, such as brochures, videos and books
• Various support programs
• A CancerHelp computer that can print information from the National Cancer Institute and is updated monthly
• Individualized support for patient and family members

Medications and Herbal Supplements

Should I report an adverse effect to a drug, dietary or herbal supplement?

Yes, the FDA and industry need to be aware of adverse events that occur with these products to assure product safety. It is encouraged to report an adverse effect even if you are not sure that the product was the cause and even if you do not visit a doctor or clinic.

Ways to report: Call the FDA at 800.FDA.1088 or Fax the FDA at 800.FDA.0178 or contact a healthcare professional (i.e., your pharmacist) for additional help with this process.
Does your physician and/or pharmacist want to know if you are taking herbal or dietary supplements?

Yes, herbal and dietary supplements should be treated as drugs and included on the drug list provided to your physicians and pharmacists. The healthcare professionals can then make sure drugs they are prescribing or dispensing are not going to negatively interact with what you are already taking.

When a product claims that it is "natural" does this mean it is safe?

Natural does not mean the product is safe. Many of the chemotherapy drugs we utilize today originally came from natural products such as trees or other plants. Chemotherapy is safe when dosed appropriately and closely monitored but can be dangerously toxic if used inappropriately. The same concept applies to "natural" herbs and dietary supplements.

What tips do you have when considering a herbal or dietary supplement?

A drug list for your physician or pharmacist should include herbals and dietary supplements, avoid "special blend" or "proprietary blend" products. Buy products only from trusted manufacturers. Never assume something is safe because it is on the shelf. If it sounds too good to be true, it probably is!