For cancer patients, taking a trip can be welcome therapy
If Louise Cooper isn’t teaching at Abraham Joshua Heschel Day School West in Agoura Hills, the 49-year-old West Hills resident is likely working out. If she isn’t doing that either, she is often flying to amateur athletic events in such far-flung destinations as Fiji and Nepal.
Even a 1998 diagnosis of cancer in her left breast didn’t stop her for long. Five months after she finished the radiation treatment that followed her partial mastectomy, she competed in the Badwater Ultramarathon, a grueling 135-mile run through Death Valley.
“I wasn’t going to let the cancer become the dictating factor in my life,” Cooper says. “It was important to me to keep my life as normal as possible, which meant working, traveling and working out.”
Cooper’s choices in recreation may be unusual, but her desire to travel is not. As treatments improve, more cancer patients may be asking their doctors for permission to travel long distances to see family and friends or simply take long-delayed vacations. Many oncologists are likely to give their blessings if the patient can withstand the rigors of travel.
A trip can be just what the doctor ordered, according to a British cancer patient survey published in the June issue of the Journal of Travel Medicine.
Many of the 20 patients polled by Manchester Metropolitan University senior lecturer Philippa Hunter-Jones, who led the survey, wanted to travel to feel normal again. They also cited a need for a change of scenery, a break from the treatment regimen, a chance to escape the stigma of being sick or the opportunity to be with family. Hunter-Jones concludes that taking a vacation “offers a vehicle for transcending illness.”
Although the survey findings seem “intuitively obvious,” says Dr. Jonathan Berek, chief of gynecologic oncology at UCLA’s Jonsson Comprehensive Cancer Center, they don’t apply across the board. Patients should skip a trip, he says, if it interferes with therapy or if their immune systems are compromised.
Even if patients are physically capable of traveling, they should be prepared for potential hassles related to their conditions. Among the downsides reported by survey respondents: fatigue, difficulty getting trip insurance and stares because of chemotherapy-related hair loss.
Accurate health information is crucial. At Memorial Sloan-Kettering Cancer Center in New York, cancer patients can attend a special weekly travel clinic, thought to be unique in this country, that covers diet, vaccines and other topics.
“Any patient who is actively getting chemo should not get a live vaccine,” says Dr. Gianna Zuccotti, an infectious disease specialist who launched the clinic in late 2001.
Yellow fever vaccine is probably the most common live vaccine given to travelers, Zuccotti says. The disease occurs in Africa and South America, according to the Centers for Disease Control and Prevention, although some other countries require the vaccine before entry if a traveler has been to an infected area.
If travelers go to an area in which yellow fever is prevalent, “I will write them a letter saying they cannot have the vaccine, that medically it is not wise,” Zuccotti says, adding that when patients realize the risk of traveling without the vaccine, some postpone travel.
Zuccotti also talks about the precautions that apply to all travelers but are crucial to those with weakened immune systems. These steps include avoiding food from street vendors in developing countries and drinking bottled water if municipal sources are contaminated.
She tells patients how to manage and minimize dehydration, jet lag and fatigue, which can be a greater problem for cancer patients than for others. .
Patients who have had nuclear medicine procedures (the use of radioactive materials for diagnosis and treatment) may encounter other obstacles because of increased security at airports and other public venues. Some of these patients have triggered radiation monitors in transportation facilities, says William Uffelman, a spokesman for the Society of Nuclear Medicine.
“We have suggested that physicians provide contact information on the institution’s letterhead,” Uffelman says. Travelers can carry such letters and present them to officials if they are stopped.
At Memorial Sloan-Kettering, patients who have undergone nuclear medicine procedures are given wallet cards that describe their treatment and include the hospital phone number so security officers can call for more information, says Jean St. Germain, the center’s radiation safety officer. The goal is to minimize the chances that they will have trouble getting through security systems at bridges or tollbooths, she says.
Once questions about vaccines and security are addressed, some cancer patients must overcome travel anxieties, says Anne Coscarelli, a psychologist and director of the Ted Mann Family Resource Center, which provides psychosocial support services at the UCLA cancer center.
“It’s a mixed desire,” she says. “They have a desire to go, but they are anxious that they will be OK.” A common concern: Where and how will I find a doctor if I need one?
Zuccotti reassures patients that some hotels and U.S. embassies may have a list of English-speaking doctors. Patients also can take along the directory of English-speaking doctors available from the International Assn. for Medical Assistance to Travellers (www.iamat.org), a nonprofit group that lists doctors and hospitals that have agreed to a set fee schedule.
Beyond that, Coscarelli suggests trying to focus on the trip itself.
“I frequently need to tell patients they need to maintain a fun quotient. Travel is one way to put it back in their lives.”
Healthy Traveler appears twice a month. Kathleen Doheny can be reached at kathleendoheny @earthlink.net.
