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Articles by G van Londen, MD

Dr. van Londen is a cancer provider/medical oncologist and a cancer survivor. Born and raised in The Netherlands, she has migrated to the USA where she completed a medical residency, as well as fellowships in medical oncology and geriatric medicine. She has practiced medicine in the USA for nearly 20 years at a large health care system in Pittsburgh, PA, USA. Her background has prepared her to handle diverse and complicated cases. She specializes in: 1) Treating newly diagnosed, older breast cancer patients by performing a geriatric assessment and creating a personalized, multidisciplinary treatment plan that aims to respect patient’s preferences and desire for independence. 2) Cancer survivorship care to prevent/support the late/long-term post-treatment needs of cancer survivors of any gender and tumor type (and their caregivers). Together with a village of various supportive care providers, she performs clinical, research, and educational activities to empower cancer survivors (and their caregivers and providers) to support the post-treatment emotional, physical, and functional needs of cancer survivors. The content of this domain is protected. Entries and replies are not endorsements. Views are mine. No COI.
Let It Go…!

Let It Go…!

The above picture shows the Freedom Sculpture by an artist, Zenos Frudakis, who stated:

“I wanted to create a sculpture almost anyone, regardless of their background, could look at and instantly recognize that it is about the idea of struggling to break free. This sculpture is about the struggle for achievement of freedom through the creative process”.

Like it or not, we are all human, and part of that definition means that we are creatures whose existence is framed by emotion. Happy, sad, indifferent, scared, lonely, calm or agitated, and the list goes on. The very thing that we share, emotion, is also very unique to each person and experience. There is never a right or wrong feeling; only how we act on those emotions! When we pay attention, when we acknowledge our innermost emotions and give them expression, we are helping ourselves to expand and invite healing to come and dwell with us. That is often easier said than done, especially if we are struggling to ‘be strong’ to recover and heal from your cancer journey.

It is difficult to say what will help us as an individual to acknowledge and face our deepest emotions. There is no defined path; we must each find our own way. Our journeys, while sometimes similar to another’s, are unique. But just as we share these emotions, we can also share tools for coping. One such tool is suggested through art. Mediums such as music, visual art, poetry, literature, drama and nature can heighten our self-awareness and at times, even reach beyond to our unconscious to promote healing from within.

Catharsis is the process of releasing, and thereby providing relief from, strong or repressed emotions.

So allow yourself the time to make or enjoy art that touches you – e.g. listen to music, watch a movie, walk along the outdoor path. See the beauty of what surrounds you and allow it to gently nudge the emotions that dwell within you to the surface. Let the healing begin from within.

“I’m not sure whose story I have been telling. I’m not sure if it is mine, or if it’s some character’s I have yet to meet. I’m not sure of anything. All I know is that, at any moment, life will surprise me. It will bring me to my knees, and when it does, I will remind myself, I will remind myself that I am my father. And I am my father’s father. I am my mother. And I am my mother’s mother. And while it may be easy to wallow in the tragedies that shape our lives, and while it’s natural to focus on those unspeakable moments that bring us to our knees, we must remind ourselves that if we get up, if we take the story a little bit farther…if we go far enough, there’s love”.

                                                                               Excerpt from Life Itself.

Medication Adherence

Medication Adherence

Medication non-adherence is defined as not being able/willing to start, continuously take, or prematurely stop taking the prescribed medication.

A growing number of medications prescribed for a variety of cancer types are now being self-administrated at home, either by mouth or as an injection. These medications are taken to reduce the cancer recurrence risk and/or to treat cancer cancer.  These medications only work when they are taken as directed. Rough estimates for chronic diseases in general project that only half of all patients take their medications as directed. These same numbers also seem to include cancer medications. Additionally,  adherence to non-cancer medications for chronic disease may also drop in the first year following cancer treatment.

Reasons for non-adherence can be multiple:

  • Logistical barriers, such as access to a pharmacy, insurance coverage and affordability, and difficulties in obtaining refill requests.
  • Change in an individual’s belief of the benefits and risks of continuing cancer medications.
  • An individual’s ability to tolerate side-effects.

You may feel embarrassed to tell your doctor that you are not taking your medications in the manner they were prescribed. Keep in mind that everyone’s personal circumstances and drug kinetics differ. Cancer medication only works as well as you are able to take it, and not being able to follow your care plan may make you concerned about the cancer treatment’s ability to control the disease.

Life happens, and sometimes we all miss a scheduled dose. It is probably okay; check with your provider or the drug reference materials provided by your pharmacist to determine what you need to do (i.e. skip the dose, catch up on a dose, etc.). It is a great idea to make use of a daily pill box. It gives you visual proof of whether or not you have already taken, or still need to take your prescription.

If you find that you have consistent issues with not being able or willing to take your medications, then you should talk with your provider so that he (or she) can help you find a solution that works. Your provider may recommend remedies to allow you to tolerate it better, changes of the dosage, frequency, or delivery method of your medication, or even switch to another medication. It is never recommended that you experiment on your own by adjusting the dosage. Talk to your provider!

The power of suggestion can be strong! Sometimes, selecting a start date may allow you to prepare yourself physically, mentally, and spiritually and develop a positive and focused approach to a new treatment course.

Adherence to your medication regime is recognized as a challenge by the medical community. Finding the right solution is often a very individualized approach that requires open communication between you and your provider. Remember that these challenges are not unique to you alone and that  remedies that optimize medication adherence are being explored on many levels. If you would like to contribute, you may want to explore research studies available near you that seek to find interventions at the patient level that support medication adherence.

Who is a Cancer Survivor?

Who is a Cancer Survivor?

The definition of a cancer survivor remains debated. The National Coalition for Cancer Survivorship (NCCS) defines a cancer survivor as “An individual from the time of diagnosis, through the balance of his or her life”, and in their most recent version of their definition they include “impacted family members, friends, and caregivers”. Dr. Feuerstein (Editor of The Journal of Cancer Survivorship) proposed a working definition “From completion of primary treatment up to end-of-life”. Calls have been made to make the definition more transparent and be more respectful of persons who have lived past cancer.

Regardless of the definition you relate to, there is some good news! Medical advancements in cancer detection and treatment have made huge advancements in the last few decades, as described in the Pulitzer Prize winning book and documentary “Emperor of all Maladies”. These medical advancements have resulted in improved cancer outcomes and an ongoing increase in the number and longevity of many  persons with a history of cancer. Cancer researchers around the globe continue to work hard to allow ongoing improvements in cancer care and project positive outcomes (within the next ten years), as well as improving the quality of cancer survivorship care.  That means you can worry less and focus more on the things and people that are important and meaningful to you!

So what does this mean for you? For starters, seek and develop a good relationship with a primary care physician that you feel comfortable with and that will be your companion and advisor as you make the journey towards optimum health.

Lets get the conversation started! What is your definition of a cancer survivor?

Are You Searching Your Medical Symptoms on the Internet?

Are You Searching Your Medical Symptoms on the Internet?

As a cancer survivor, you may have lost trust in your body. When you notice things happening in your body, you may become concerned that it signals that your cancer has returned, or you have developed a new cancer or a treatment complication. You may turn to an internet search to research your symptoms, which may only further increase your level of concern and lack of sleep! You may not know when to reach out for help and which one of your multiple providers to call.

When educating my patients about the seemingly endless list of sign and symptoms of cancer recurrence, I prefer to avoid specifically identifying them. Instead, I advise my patients the following: if you should develop symptoms that are not acute (meaning life threatening or intense, i.e. a stroke, heart attack or an severe belly pain) and these non-acute symptoms last for one or two weeks, and these are either new symptoms or chronic ones that are different now, then it may be advisable to reach out to a provider whom you feel comfortable speaking with. Ideally, your cancer provider since they may be more skilled to evaluate whether it may or may not be related to cancer. This provider can advise you several things that usually translate to one of following messages:

  • This does not sound suspicious, please see your PCP for assessment and management.
  • This sounds a bit concerning. Why don’t we do some testing (like labs or scans) and have you come into the office to discuss the results.
  • Most commonly, you may be told that your symptom is real, but not yet specific enough to be diagnosed. In this case, you may be prescribed an empiric therapy such as medication to support your symptom(s) and be scheduled for a later reevaluation. Most commonly the symptom(s) will resolve and were therefore likely not related to cancer.

It is most important to remember that you are not alone! You are part of a team; you are the “monitor”, since you know best what is happening with your body. Your medical providers can help you make sense of your symptoms.

Optimize Bone Health and Reduce Fracture Risk

Optimize Bone Health and Reduce Fracture Risk

Cancer (treatments) may expedite the loss of bone mass and increase your fracture risk.

Calcium and Vitamin D are essential for bone health. Supplements may not be able to fully prevent fractures and may increase the risk for heart disease. Unless recommended/prescribed by your health care provider, and until we know more and understand better, your diet may be the preferred route to get (the bulk of) your daily Calcium/Vitamin D intake. The National Osteoporosis Foundation has created information on daily requirements and natural sources of Calcium and Vitamin D.

Your provider may recommend exercises (to prevent falls and/or strengthen your bone), a blood draw (to evaluate the need for a vitamin D boost), as well as a bone density test* (to evaluate the need for medications).

*Not to be confused with a nuclear bone scan used to detect cancer..

This site does not provide binding advice. Please communicate with your provider(s) before making any changes to your care plan. The content of this domain is protected. Entries and replies are not endorsements. Views are mine. No Conflict of Interest.

Which Vitamin Source?

Which Vitamin Source?

Dietary Supplements and Mortality Rate in Older Women The Iowa Women’s Health Study (JAMA 2011)

Do Cruciferous Vegetables Really Fight Cancer? (NYT 2018)

Bottom line – until we know more and understand better, it may be preferable to get your vitamins from a large variety of dietary sources rather than pills (unless specifically recommended/prescribed by your health care provider).

What is Cancer Survivorship

What is Cancer Survivorship

As you enter the post-cancer treatment phase, you may….

  • “Look better”, but you likely still have more healing to do – physically, functionally – but also emotionally and spiritually. Being told “you have cancer” and having to put your life unexpectedly and urgently on hold to undergo life-saving treatments can be traumatizing.
  • Feel alone, since it may be hard for others to understand you, especially if they haven’t experienced it themselves.
  • Feel like you are riding an emotional rollercoaster.
  • Notice that your priorities in life are changing, perhaps even rearranging!
  • Find yourself trying to balance your health and healing while minimizing disruption to your home, work, and financial status.
  • Have lost trust in your body, wondering “what will happen next?”, and be searching for ways that allow you to heal and stay healthy.
  • Be uncertain and concerned about what the future may hold for you and for your loved ones.
  • Find yourself spending hours on “Google” trying to answer your many questions, only to discover that you have even more questions!
  • Yearn to renew your pre cancer self and embrace the feeling of wholeness that may have been lost in your journey.

This juggling can be overwhelming, confusing, and stressful. You may have a large team of health care providers, but you may not always know what to do or where to direct your questions, your concerns and your needs. Your providers may not always have the time to work with you in finding the answers that you need, or the specific skills to support you and as a result, you may feel lost or abandoned in your journey.

Even though the field of cancer research and treatment field has made huge advancements towards the prevention, diagnosis, and survival of cancer patients over the last few decades, the post-treatment phase has been relatively undervalued and under-explored until recently. But the “times they are a changing” and that means good news for survivors, caregivers, and providers as well.

As a first step, to facilitate the transition of cancer survivors into the post-treatment phase [From Cancer Patient to Cancer Survivor: Lost in Transition (IOM 2005)], large organizations such as LIVESTRONG, National Coalition for Cancer Survivorship, Office of Cancer Survivorship at National Cancer Institute(https://cancercontrol.cancer.gov/ocs/), and American College of Surgeonshave identified the following five essential elements and recommend that providers incorporate these elements as an integral part of the post treatment care plan:

  • Surveillance (watch for cancer recurrence)
  • Screening (for new cancers)
  • Assessment and management of the effects of cancer treatment(s)
  • Adoption of positive health behaviors
  • Care coordination between health providers

These areas represent only the first steps to assuring successful survivorship for both patients, their families and health care providers; more improvements in cancer survivorship continue to emerge as recognition of the post treatment phase evolves.

This informational site hopes to help you to navigate your unique survivorship journey and to empower you to regain control and better care for yourself.

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