"What's next?" is one of the most common questions asked by anyone who is diagnosed with cancer. In the immediate days and weeks following a cancer diagnosis, "what's next?" will focus on treatment options, such as surgery, chemotherapy, and radiation therapy. You'll figure out what to ask your doctor and how to plan your next steps.

For people who are a little further into their cancer care plan, "what's next" may mean "for the rest of my life." It's not uncommon to feel a sense of letdown after treatment ends. Without the structure of regularly scheduled treatment appointments and reporting to clinic for blood tests, many people feel lost.

Questions, Questions

Compounding these stresses are questions about your medical future. How often do you need to see your oncologist? How will you be monitored to make sure cancer is caught early if it comes back? How will you be monitored for any long-term side effects from your cancer or it's treatment? Will your primary care doctor understand what you've been through? The questions are endless.

A Guide for Finding Answers

A noted group of cancer experts, some of the best in the world, have come together to publish a comprehensive cancer survivorship report to help answer these, and many other, questions. The entire report is available online and outlines the key components of a good long-term care plan for cancer survivors, such as:

• Addressing employment concerns of cancer survivors
• Improving access to adequate and affordable health care
• Prevention of recurrent and new cancers and other late effects of cancer care
• Good coordination between specialists and primary helath care providers to make sure all of the cancer survivor's health needs are met
• Identifying psychosocial and mental health needs and care plans for survivors
• Connecting survivors with supportive services, if needed

If you are a cancer survivor, and remember that "cancer survivor" includes anyone diagnosed with cancer, from the moment of diagnosis onward, this report can be a terrific guide. It can help you figure out what you need, physically, mentally, and emotionally, and how to get it from your cancer care and primary health care teams.

Chemotherapy is a life-saving medical option for many people diagnosed with cancer. Even so, it can cause very serious, even life-threatening side effects. For this reason, it's important that clear standards be followed for how chemotherapy is given and how the health of people receiving it is monitored before, during, and after chemotherapy.

The American Society of Clinical Oncology and the Oncology Nursing Society have come together to produce the Chemotherapy Administration Safety Standards. This is a very important step forward in creating the safest possible treatments for cancer.

The final list includes 31 safety standards and covers important aspects of giving chemotherapy including:

• Careful review of each patient's clinical (medical) information
• Selection of the treatment option
• Treatment planning
• Informed consent from the patient; informed consent is the formal way of making sure that each patient understands and accepts the risks and benefits of the treatment options and agrees with the treatment plan
• How the treatment is ordered, for example, whether this is done electronically or with a written prescription
• How the chemotherapy medication is prepared; usually, this refers to how it is prepared in the pharmacy
• Assessment, or keeping track of, how well the treatment plan is being followed (compliance); this means making sure medications are given as planned, and on the part of the patient, that medications are taken as prescribed
• Administration and monitoring; this refers to what actually happens in the clinic each time chemotherapy is given
• Assessment of response, which means tracking how well the patient is doing after chemotherapy is given and making sure the cancer itself is responding as expected
• Toxicity monitoring, which means tracking all of the negative side effects of treatment, such as low blood counts, nausea, or fatigue.

This may not seem like such a big deal or maybe feels like a "mere formality". However, these guidelines are much more important than many people realize. Most of the cancer care in the United States, roughly 80%, is given in small community oncology clinics. Because of this, there can be a lot of variation in the safety standards around how chemotherapy is given.

By creating a standardized set of safety guidelines that are available to every oncologist in the country, The American Society of Clinical Oncology and the Oncology Nursing Society have taken a positive step toward making sure every single person treated for cancer is treated as safely as possible.

If you're interested, you can see a full set of the guidelines, for yourself. You can even print them out and take them to your next appointment. If you have questions about the guidelines and what they mean for you, your doctor can get you the information you need to make informed choices about your cancer care.

Colonscopy is the gold standard for detecting colon cancer. There is no doubt that colonoscopy saves lives. Even so, researchers are always looking for ways to make this test even better. This is because the more effectively colonoscopy screening can detect the smallest tumors or pre-cancerous colon growths, the more likely it is that these growths will be caught and removed early, before they have spread.

New research has found that a type of colonoscopy testing called high-definition colonoscopy is superior to regular colonoscopy for finding colon growths that can develop into colon cancer. Results from the largest head-to-head comparison of regular vs. high-definition colonoscopy screening are clear: High-def colonoscopy should be the screening of the future.

Your Next Steps

If you're of average risk for colon cancer, health experts recommend that you begin colonoscopy screening at age 50. If you are above-average risk, for example because you have inflammatory bowel disease (IBD) or a genetic condition that increases risk, you likely need to begin colonoscopy screening much earlier and undergo it more often. Here are some steps you can take to take control of your colon health:

• Do not use these latest study results on high-def colonoscopy as an excuse to avoid getting this test altogether. Your doctor may not have access to this sort of test quite yet, but regular colonoscopy is still the single best way to detect colon cancer early, before it has spread and when it is easiest to treat and cure.
• Learn what you need to do to prepare for a colonoscopy. A little planning will help you have a sense of control over your health and your health care choices.
• Learn what happens during a colonscopy. Knowing what to expect can ease your fears significantly.
• Learn how to remove the dread and fear of colonoscopy. Nobody looks forward to getting a colonoscopy, but it likely is not as bad as you think.
• Focus on the future. Focusing on the fact that getting a colonscopy can save your life and keep you cancer-free can make it easier to pick up the phone and call your doctor to ask about this important screening.

Inflammatory bowel disease (IBD) refers to a group of conditions that cause pain and damage in the gastrointestinal tract. Crohn's disease and ulcerative colitis are the two most common inflammatory bowel diseases. Symptoms of these conditions include abdominal pain, weight loss, fever, rectal bleeding, blood in the stools, diarrhea, and skin and eye irritation.

One of the most important things to know about IBD is that having it can significantly increase your risk of developing colon cancer. It's a scary thought, and it seems completely unfair that in addition to the pain and suffering that can come with IBD itself, comes a higher risk of a potentially life-threatening cancer.

Fortunately, there something you can do to greatly increase the odds that if you do develop colon cancer, you will survive and thrive after your diagnosis. The latest research on this topic shows that regular colonoscopy screening can mean the difference between life and death for people with a history of IBD who develop colon cancer.

By The Numbers

Researchers tracked 149 people with IBD who developed colorectal cancer. They compared the survival rates after colorectal cancer diagnosis among those who had colonoscopies in the past vs. people who had not had colonoscopies.

The 5 year survival rate after colorectal cancer among the people with IBD who had undergone colonoscopy screening was 100%. Among the people with IBD who had not undergone colonoscopy as part of their medical care, the 5 years after diagnosis was 74%. Over the long-term, only one person in the colonoscopy group died specifically due to colorectal cancer. In the group of people with IBD who did not undergo colonoscopy, 29 people died due to colorectal cancer over the long-term.

The Bottom Line

If you have IBD, it is very, very important that you undergo colonoscopy testing regularly. While colonoscopy can seem unpleasant and sometimes may cause some pain for people with IBD, it is much less unpleasant than being diagnosed with, or dying of, colon cancer. Colonoscopy allows your doctor to find any colon cancer cells or small tumors very early, when they can be removed before they spread. This improves survival and makes it less likely that you'll need additional, aggressive treatment for cancer.

Facing Your Fears

If you have IBD, the following steps can help you face your fears about colonoscopy:

• Make an appointment to talk to your doctor specifically about how often you need colonoscopy screening. If your regular, primary care doctor doesn't have a specific plan for you or doesn't take your concerns seriously, ask for a referral to a gastroenterologist so you can make sure you get exactly what you need.
• Learn what you need to do to prepare for a colonoscopy. A little planning will help you have a sense of control over your health and your health care choices.
• Learn what happens during a colonscopy. Knowing what to expect can ease your fears significantly.
• Learn specific steps you can take to make colonoscopy easier on yourself. While nobody looks forward to getting a colonoscopy, it likely is not as bad as you may imagine
• Focus on the future. Focusing on the fact that getting a colonscopy can save your life and keep you healthy and cancer-free can make it easier to pick up the phone and make that important appointment with your doctor.