“For so long, the focus was on treatment, and for a lot of people, it can be a struggle as they adjust to a new normal,” says Jennifer Wojcik, a physician assistant and director of the Survivorship Program at Great Lakes Cancer Care Collaborative, a consortium of hospitals and healthcare organizations, including the University at Buffalo’s Physicians’ Group, in New York. She notes that some people may need multiple treatments that may last months or even years. “Think of it like a marathon,” says Wojcik. Even if your treatment ends, you may find yourself having to contend with residual side effects from medications, such as gastrointestinal issues, or navigate necessary precautions to make sure you keep your remaining kidney healthy if you’ve had a partial or total nephrectomy (surgical removal of the kidney). Bottom line: Kidney cancer treatment can significantly change your body and impact how you feel, so it’s important to give yourself time to heal physically and emotionally, advises Wojcik.
How New Treatments Changed the Kidney Cancer Prognosis
Today, kidney cancer treatment looks very different than it did even just a decade ago. Advancements such as targeted therapy and immunotherapy drugs have transformed the treatment and helped people live longer in some cases, according to the American Cancer Society (ACS). “There are two main ways to treat kidney cancer [now]: targeted therapy, such as TKIs [tyrosine kinase inhibitors], and immunotherapy,” says Ajjai Alva, MBBS, an oncologist and associate professor at Michigan Medicine at the University of Michigan. Targeted therapy identifies and attacks cancer cells without harming normal cells. Immunotherapy, which is also called biologic therapy, uses the body’s natural immune system to fight cancer. “A lot of the improvement in the last 10 years has been because of these two classes of drugs coming out for metastatic disease [cancer that has spread to other areas of the body] but also for earlier stages,” says Dr. Alva. According to Alva, these medications, particularly immunotherapy drugs, have dramatically changed the outlook for kidney cancer patients. “I’m a big advocate for immunotherapy; that has been a sea change,” says Alva, who explains that this class of drugs can make it possible for some people to achieve long-term remission. “It’s not [the outcome for] everybody, but a good number of patients have great stories,” says Alva. “It’s the closest to a cure in some stage 4 kidney cancer patients.”
Strategies to Help You Thrive as You Navigate Life as a Kidney Cancer Survivor
Whether your treatment has ended or is ongoing, your new focus will be on doing everything you can to stay healthy, active, and happy. Here are some key strategies that can help you thrive as you move forward in your life as a kidney cancer survivor.
1. Prioritize posttreatment checkups.
Kidney cancer can be different for each person, and posttreatment care can depend on how far the disease had progressed at the time of your diagnosis, the type of treatment you received, how well you responded to that treatment, and more factors. For some people, treatment may remove or destroy the cancer successfully, while others may need ongoing treatment to keep the cancer in check, according to the American Cancer Society (ACS). Regardless of how successful your treatment was and how stable your disease is, you will need follow-up medical appointments and continued communication with your care team. After kidney cancer treatment, your doctors will closely monitor you for signs of residual side effects, which may linger and, in some cases, even show up for the first time years after you’ve completed treatment, according to the ACS. Your doctors will also watch for any new symptoms or problems that may indicate your kidney cancer is returning or a second cancer or other disease may be developing. “If the patient had surgery for kidney cancer and now they don’t have any evidence of cancer, continuing to have regular checkups with their primary care physician and their oncologist is very important,” says Roberto Pili, MD, chief of the division of hematology/oncology and director of the Center for Nutritional Sciences and Cancer Therapeutics at the University at Buffalo department of medicine in New York and vice president of oncology services at Great Lakes Cancer Care in Buffalo. “Unfortunately, kidney cancer is a type of cancer that may come back one year, 5 years, or 10 or 20 years later.”
2. Take the long view.
Whether you’re experiencing lingering side effects after your treatment is over or your doctor has recommended multiple treatments for your kidney cancer, you may need to manage side effects for an extended period of time. For example, one of the most common side effects of both targeted therapy and immunotherapy is fatigue, which can continue after treatment. “We still do not have a clear understanding why these treatments cause fatigue, but there’s no doubt in my mind that having regular exercise can help fight feeling tired,” says Dr. Pili. Other side effects, such as diarrhea, can also persist after certain treatments end. “Diarrhea caused by TKIs typically stop when the pills are stopped, because the drugs will get out of the system,” says Alva. “But immunotherapy diarrhea will not stop when we stop the immunotherapy, because the immune system gets overheated.” Doctors often prescribe steroids to calm down your immune system and relieve diarrhea caused by immunotherapy, he says.
3. Protect your kidney health.
People whose cancer treatment involved surgery to remove part or all of the kidney will experience some level of renal function loss, says Alva. That means your remaining kidney must be kept as healthy as possible by drinking plenty of water; avoiding nonsteroidal anti-inflammatory drugs, which may impair kidney function; and paying attention to your diet. Alva recommends eating less salt and animal protein, which have been shown to stress the kidneys. The kidneys serve as a kind of filter that removes toxins. “The filtration in the kidneys really depends on the amount of fluid we have in the bodies,” Pili explains. “If there is not enough water, the kidneys need to work harder.” He advises keeping an eye on the color of your urine. “If the urine gets darker, that means it’s concentrated and the kidneys are working hard, so you want to keep the urine color a light yellow,” he says. Another way to keep your kidneys healthy is by making sure your blood pressure isn’t elevated. “We know that blood pressure can have an impact on kidney function, so if the patient has only one kidney, they want to make sure their blood pressure is controlled,” says Pili. To keep your blood pressure in check, eat a low salt diet, exercise regularly, and reduce excess weight, he advises. Exercise can be particularly important, because it can help lower blood pressure. “We know that high blood pressure has an impact on the arteries and in the heart,” says Pili. “And it can really injure, in the long term, the filtration unit in the kidneys.” Keeping your blood pressure controlled, he says, can help lower the risk of injury to the filtration units in the kidneys. Finally, be sure to reduce the amount of protein in your diet. “The protein eventually needs to be filtered out through the kidneys, so if we load too much protein in the body, we make the kidneys work too hard,” explains Pili. Talk to your dietitian about an eating plan that protects your kidney health but still provides all the nutrition you need to stay healthy.
4. Don’t forget to keep your entire mind and body healthy.
Being diagnosed with and treated for kidney cancer can understandably keep you focused on your disease. But it’s important to remember to focus on your overall health and well-being. Exercising enough, eating a healthy diet, and taking care of your emotional health are all important aspects of staying healthy and positive. “Exercise and a healthy diet can have a profound impact on our well-being and psychological health to fight the depression that many patients with cancer experience,” says Pili. “I think there is more attention now to have a more holistic approach and integrated oncology, where we are providing not just drugs to treat or cure cancer but also giving advice about nutrition, exercise, meditation, yoga, and psychological support.”
5. Find a cancer survivorship program.
These programs are designed to provide support and services to cancer survivors and help them live well after treatment. They can help you manage the physical and emotional changes after treatment and provide practical support by coordinating or recommending experts who might be important for you as a cancer survivor, such as specialists in nutrition, exercise, and mental health. “In our case we have a physician assistant [Wojcik] who is in charge and is the point person who can coordinate care with the oncologist and with the surgeon and provide different services that a patient may rely on, such as where to find a nutritionist or a place to exercise or where to get some psychological support,” says Pili. “Try to find a cancer survivorship service, and start by looking into what your facility offers,” suggests Wojcik, who notes that these programs can be invaluable as you deal with long-term side effects, incorporate nutrition and physical therapy into your treatment plan, and more. “Most of all, you’ll know you’re not alone,” she says. “I’m convinced that as the survivorship programs develops, it will demonstrate that patients live better and longer,” says Pili.
6. Don’t forgot to prioritize your mental and emotional health occasionally.
You may have to focus on staying healthy, but remember that enjoying life is a big part of that goal. So, for instance, if you are about to embark on a dream vacation or take a fun trip with friends that conflicts with a medical appointment, talk to your healthcare team about ways you may be able to work things around your plans. “In many cases, delaying treatment a week here or there may be done without significant impact,” says Wojcik.
