The Importance of Self-Care for Caregivers

Relaxing walkby Mary Hesdorffer, NP, Executive Director of the Meso Foundation

Mesothelioma caregivers are the unsung heroes in the war against meso. Those of us intimately involved in healthcare know that exam time with doctors is limited. Billing is based upon a construct of ideas and the caregiver does not fit into this for- profit medical system. As healthcare professionals, we see the caregivers in the exam room, often times struggling with emotional or physical problems, and perhaps we acknowledge their difficulties, but the focus remains on the needs of the patient. The caregiver is left to their own devices with little or no respite in the horizon during the continuum of the illness.

Knowing the difficulty of the role, I would like to encourage all caregivers to take advantage of the support services provided by the Meso Foundation. The Foundation provides several different options for caregivers to receive the help they need. They can participate in online or telephone support groups, or find individual support through the Foundation’s Meso Connect program. All services provided by the Meso Foundation, including those for caregivers, are very meso specific and include others who find themselves in the “trenches,” and who can empathize and share tips learned along the way.

For many complex reasons, caregivers, and society as a whole, tend to elevate the patient to a status of perfection, which can make it extremely difficult to maintain a healthy relationship. Caregivers assume their role most frequently because they love the patient, and they need to dig deeply to rekindle the intimacy that they enjoyed before the diagnosis. Intimacy involves sharing and caring. Real conversations need to take place, where caregivers can also express their fears, anger or disappointment regarding the disease and the changes it has brought to their lives. Caregivers also need to find the joys of daily living, as they are here in the present and should not lose these precious days wallowing in despair. A night out or watching a movie together with their loved one at home can do wonders to transport a caregiver from their daily struggles.

A caregiver needs care as well. Self-care means finding an activity that helps with relaxation and allows the ability to refocus on personal needs to renew and be able to provide the high intensity care that this disease demands. If money is tight, there are many activities that have little or no cost involved. I would suggest ways to take a break from current duties. A visit to a museum, sitting in a beautiful garden, yoga, tai chi or some other calming exercise can help soothe frayed nerves and encourage healing from within. It is ok to say no to unreasonable demands and to carve out some personal time. In order to provide care, caregivers must also be cared for – it is a two way street.

This disease is a lived experience by the caregiver as well as the patient. It is not unusual to feel sad and anxious during this time. Talk therapy and sometimes medication can be beneficial. It is not a reflection of any weakness when a caregiver requires a personal intervention. No one was born with an intact set of coping skills. These skills are developed along the way and they are often not sufficient to help during this time. A trained therapist can aid in exploring and strengthening coping skills and provide a safe place for a caregiver to share struggles and find ways to cope better in their role.

It can be especially rewarding for caregivers to step back a bit from the role and focus on why they are caring for the patient. Sometimes, it seems that caregivers are living a double life, perhaps as a spouse as well as a caregiver. They should avoid becoming too focused on the medical aspects of care, as this may result in distance from the emotional connection that is vital to the caregiver-patient relationship. It is important to take time to reflect, rest, and engage in activities that bring pleasure without guilt. Engaging with and accepting assistance from friends and family can ease the burden. When others offer to help, caregivers must think about what they need as well as the needs of their loved one. They should dedicate 30 minutes to an hour each day to self-care.

The Meso Foundation has a full staff as well as volunteers to help our caregivers. I personally am available to speak to you and assist you on this journey. You can also visit curemeso.org to view the caregiver resources available at the Meso Foundation.

Update on Mesothelioma: A CancerCare Teleconference

CancerCare Update on MesotheliomaOn Monday, June 30 from 4:30-5:30PM Eastern Time, CancerCare is hosting a free mesothelioma teleconference workshop. The teleconference, titled Update on Mesothelioma, will feature a panel of experts to discuss numerous topics related to the disease. Registrants will be able to listen in on the phone or through a live stream online.

The Update on Mesothelioma teleconference will cover topics including mesothelioma treatment choices; the role of clinical trials; managing side effects, discomfort and pain; communicating with your health care team; quality of life and life style concerns; and physical activity and nutrition issues and tips. Questions for the panel of experts will also be accepted.

The panel of experts consists of four individuals: Richard J. Gralla, MD, FACP, Professor of Medicine, Albert Einstein College of Medicine; Lee M. Krug, MD, Director of the Mesothelioma Program, Associate Attending Physician, Division of Thoracic Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center; Mary Hesdorffer, MS, APRN-BC, Nurse Practitioner, Executive Director, Mesothelioma Applied Research Foundation; and Winfield Boerckel, MSW, MBA, Director of Social Service – Long Island, Lung Cancer Program Coordinator, CancerCare.

Mary Hesdorffer, MS, APRN-BC, is an expert nurse practitioner with over 16 years of experience in mesothelioma treatment and dozens of published articles in a variety of scientific journals. She is the executive director of the Meso Foundation and the first line of help for patients and caregivers faced with a mesothelioma diagnosis.

Lee M. Krug, MD, is an Associate Attending Physician in the Division of Thoracic Oncology, Department of Medicine at Memorial Sloan-Kettering Cancer Center in New York, New York, where he completed a fellowship and chief fellowship in medical oncology. Dr. Krug is the Director of the Mesothelioma Program at Memorial Sloan-Kettering Cancer Center. He is also the chair of the board of directors of the Meso Foundation.

To register for the free Update on Mesothelioma teleconference workshop, visit CancerCare.org.

Looking for Inspiration

Running on treadmillby Mary Hesdorffer, NP, Executive Director of the Meso Foundation

I found myself on the treadmill looking for inspiration to go the extra mile. Two miles into it and I am running out of steam. I am not an ESPN fan, which means that I have to take inspiration from another source. Into my mind pops up the image of Joe Friedberg, MD.

Of course, I wonder, who else would channel Joe Friedberg while on a treadmill? Am I losing it?

As you know, Joe is a champion in the field of mesothelioma, toughing it out in the operating room with a grueling procedure, which has recently reported some promising results. I recalled a conversation with Joe when he suggested that to complete a pleurectomy decortication, one has to be totally committed to going the extra mile (as these operations last up to 8 hours) and one has to be willing to persevere through fatigue, and physical and mental challenges.

There has been much debate about surgery – extrapleural pneumonectomy (EPP) vs. pleurectomy decortication (PD) vs. those who believe that surgery should not be offered to patients with mesothelioma, and advocate for palliative care only.

I think about Joe in these debates, and his honesty and lack of bravado when he simply states that “we don’t know what is the best surgical option to offer patients and that all surgery in this disease is experimental.” Though the uncertainty is unsettling, the honesty is refreshing.

Recently, Dr. Friedberg and his team at UPENN have launched a new clinical trial that will randomize patients to either a pleurectomy decortication or a pleurectomy decortication coupled with photodynamic therapy. Joe has spent many years championing photodynamic therapy as an adjuvant therapy to his pleurectomy decortication surgery, making this clinical trial a one-of-a-kind move to get closer to the truth.

Doing 3 miles on a treadmill no longer seems daunting.

Here is why Joe’s courage is so important and why I hope others follow in his footsteps. It is well-known among researchers that most surgical studies have an inherent bias to them. In other words, a surgeon’s excellent numbers may be produced not only by their skill, but also by choosing to operate on patients who have the best chance to tolerate the surgery and do well after. The fact is, surgery often results in a surgical remission, but unfortunately, in mesothelioma, the cancer generally returns after a certain period of time. To extend the remission, surgeons use specific adjuvant therapies to lengthen the time to progression and, of course, create the best case scenario to prevent the return of disease. This is the crux of the discussion about what will kill the cells that are waiting like seeds in a garden ready to sprout into recurrent disease.

I am appalled to hear so many surgeons in this disease state quite frankly that their approach works and there is no need to do a randomized trial which will eliminate bias from their results. Worse yet are those surgeons who boast that their patients do better in their hands, with their procedure yet when I scour the literature there are no published reports in scientific journals. In academic medicine there is a phrase “If it isn’t published, it never happened.” In other words it is expected that you submit your results to a peer reviewed journal to demonstrate that your outcomes are accepted by your peers and your data has been analyzed by, and scrutinized by unbiased reviewers who are experts in the field of surgery. There is no room for arrogance when we are losing patients in these procedures. We need to know what is the true statistical difference. The gold standard is to compare a new hypothesis and test it against the standard to see if this really is a significant improvement.

Dr. Friedberg has reported some impressive results with his combination of pleurectomy decortication combined with photodynamic therapy, and now he’s willing to take a step further to understand if there is a difference between patients undergoing pleurectomy decortication alone from those getting both the surgery and the adjuvant therapy.

This is what the mesothelioma community needs – “proof of the pudding.” We truly do not know what is better so we need to strip back the notion of “my treatment works, and I don’t need to prove it.” Randomized clinical trials can help us find a gold standard of treatment for mesothelioma.

I guess, what that means is that I, too, should be going the extra mile on this treadmill. Mile 4, here I come.

A Look at the Advancing Breakthrough Therapies for Patients Act

Mary at Friends of Cancer Researchby Mary Hesdorffer, NP, Executive Director, Mesothelioma Applied Research Foundation

The Advancing Breakthrough Therapies for Patients Act was first introduced in the Senate by Senators Bennet ( D-CO), Hatch (R-UT) and Burr (R-NC). Two months later, Congresswoman DeGette (D-CO) and Congressman Bilbray (R-CA) introduced the act in the House of Representatives. The bills, which received bipartisan support, were included as an amendment to the Food and Drug Administration’s Safety and Innovation Act (FDASIA), the latest iteration of the Prescription Drug User Fee bill, and in July of 2012, the breakthrough therapy designation was signed into law.

As a result of this law, a new drug may be designated as a breakthrough therapy if it is intended to treat a serious or life-threatening disease, and if preliminary clinical evidence suggests it provides a substantial improvement over existing therapies. Once a breakthrough therapy designation is granted, the FDA and drug sponsor work together to determine the most efficient path forward. In just two years, 178 requests for breakthrough designation have been submitted, 44 designations have been granted, and 6 drugs have been approved within the program.

On May 6 of this year, Mary Hesdorffer, the executive director of the Meso Foundation, and Melinda Kotzian, its chief executive officer, attended the congressional briefing titled Friends of Cancer Research, which focused on evaluating the progress of this program.

The panel agreed that the next task will be to streamline the process. This will eliminate applications that absolutely do not meet the criteria for breakthrough designation.

Janet Woodcock, MD, director, of the Center for Drug Evaluation and Research within Food and Drug Administration, stated that they “are not planning on moving drugs through this process that offer only incremental progress, but those that demonstrate a substantial benefit.”

Two representatives of the pharmaceutical industry shared their companies’ experience in gaining the first designation under this act. They noted that the time and commitment of all parties involved made this process work.

Dr. Woodcock cautioned that sequestration had an impact on the financing of this program. It will take more funding to continue operating the Breakthrough Therapies program at the present level, but she hopes that streamlining the process will allow for a more drugs to reach the patients in need.

Caregiver Burnout: The Unspoken Suffering of the Caregiver

Caregiverby Mary Hesdorffer, NP, Executive Director of the Meso Foundation

Speak to any caregiver and they will share with you the rewards of caring for a loved one when tragedy strikes. In the beginning, the tasks are met and the list items ticked off one by one. It feels good to be unselfish; the endorphins are sending us messages that we have become the noble self that we had hoped one day to become.

Months go by and the caregiver looks up and thinks ‘Oh my God, will this ever end? Where am I in this process and how did I lose my way?’ The caregiver is not a machine. No human being is programmed to be on high alert 24/7, ready to handle any emergent situation that arises. The caregiver is the unselfish, ever giving angel of mercy residing in the home of a cancer patient. Friends and family can see the signs of burn out, but the caregiver wears this as a badge of pride often until “something gives.” It may manifest as an emotional outburst or extreme exhaustion may take over, and all of a sudden, the world of the caregiver has crumbled.

If you are caregiving for a spouse, stop what you are doing now and sit down with your loved one and tell each other why you came together and why you have stayed together. Yes, caregiving may be somewhere on the list, but my hunch is that it is not one of the top reasons why you are together. Despite the diagnosis of cancer, a patient and a caregiver can still find joy in their relationship and, yes, even a laugh or two. Come back into the 20th century, spend a dollar and get Amazon Prime or Netflix, and look for those comedies that will make you both laugh out loud. Laughter is the best medicine, both for the caregiver and for the patient. Walking into the home of a cancer patient should not feel like walking into a church or a museum, but a place where a living, breathing human resides.

Caregivers, take 30 minutes each day for you. Do this early in the journey. In academics, we call it protected time. Whatever activity you choose should be strictly for your benefit. If you can take a bit more, join friends for lunch, or better yet, go to an exercise class. Invite them for dinner so you both can enjoy socialization and stimulating conversation that does not revolve around “when the next treatment is scheduled” or “have you taken your medicine yet?”

Let’s get the conversation going. Please let us know what works or has worked for you during this stressful time. Caring for the caregiver should be a priority, as few realize that the caregiver is also suffering during this cancer journey.