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Q. My boyfriend was diagnosed with cancer and is receiving treatment. However, since treatment began, he keeps out of my way as much as he can. He finds excuses not to meet me, refuses to take my calls and doesn't even reply to my short messages. Now I am worried about his cancer and feel so sad about his attitude. Can you give me some advice?

A.

This is a common concern of family and friends. There are several factors that can lead to this sudden change in relationships and personality. For patients, it often starts when they hear the words, “you have cancer.” Most of us know someone who has had cancer so hearing the words “you have cancer” brings up fear and uncertainty. A newly diagnosed patient begins to recall watching others go through it and before they have a lot of information they start to worry that the same experience is going to happen to them; especially if those they knew had difficulties.

Because a cancer diagnosis requires undergoing a lot of tests, managing an often complicated health care system, and coping with increasing financial concerns, many patients become overwhelmed and shut down emotionally to focus on the practical issues they need to address immediately. During the very time that family and friends want to help most, the patient might seem distant and pull away.

Once he or she starts treatment additional changes can happen. Some might be permanent, raising concerns about the patient’s ability to be the same partner and provider they once were. At some point though, the emotions finally come to the surface and people begin to look at what they have been going through. That is often the time they reach out to a counselor, clergy or open up with loved ones.

During all of this, family and friends are anxious themselves and try harder to help the patient, which might just push him or her further away. This adds to the confusion during a very stressful time and can escalate the distance. Since cancer also affects those who care about the patient, this is instead a good time to step back; let them know you are there but also get support for yourself. Literature and support groups for caregivers go a long way toward normalizing your experience, providing education on cancer and its side effects, and can offer new insights.

Time and time again I am reminded that cancer is a process of learning, changing, confronting and reintegrating. It’s a process for both patients and caregivers. Sometimes it feels like a roller coaster and other times like an endless journey. Relaxation exercises can help with the stress. And sometimes stepping back a bit can eventually bring caregivers and patients closer together.

Here are resources I think can be helpful to you:

Q. My father has prostate cancer and I keep seeing conflicting information about prostate cancer treatment. Are there updated treatments online anywhere?

A.

I hear this question more and more from prostate cancer patients and families who want the best treatment available. It is not infrequent that people seeking a second or third opinion get different treatment suggestions. This often creates frustration and uncertainty by patients and families as to which route to pursue.

With continued research and increasing treatment options, oncologists have many treatment choices and make suggestions based on a number of factors. Some of the most important factors are:

Type of prostate cancer: Adenocarcinoma is the most common type and accounts for 95% of all prostate cancers. Other less common types account for the other 5%.

Stage of prostate cancer: A pathologist stages the cancer based on biopsy results. For prostate cancer stages are I, II, III and IV with IV being the most advanced.

Grade of prostate cancer: Additionally, pathologists grade prostate cancer according to the Gleason score, which assigns a grade from 1 to 5 based on how the cancerous cells look compared to normal prostate cells. The grade refers to how aggressive the type of prostate cancer is.

Once these factors are determined, the surgeon/radiologist/oncologist takes into account a patient’s age, other health issues, and lifestyle to determine the best treatment options for each individual. Potential short and long-term side effects will be discussed with the patient and family at this time, which can strongly impact patient’s quality of life post treatment.

With these factors in mind, patients and families determine what treatments to pursue. Some cancer doctors prefer to be more aggressive based on their experience and others see reason to be cautious, expecting to get similar results while avoiding difficult side effects.

This is often a good time for patients and families to meet with a social worker or nurse to explore their goals post treatment and make an informed decision. Along with the links above, for more information on prostate cancer treatment options and clinical trials it can be helpful to contact the National Cancer Institute at 1-800-4-CANCER (422-6237) and speak to a cancer information specialist who can assemble a packet of information that will help you make the best informed decision for you and your loved one.

And finally, the National Comprehensive Cancer Network (NCCN) provides prostate cancer treatment guidelines.

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