W EL L N ESS Continued from cover Family Caregivers Need to Be Attentive to Their Needs, as Well as the Patient’s “When a patient receives a diagnosis of cancer, the family gets the diagnosis, too,” says Anne Coscarelli, PhD, director of the Simms/Mann-UCLA Center for Integrative Oncology, which helps patients and family members focus on wellness during cancer treatment and recovery. “It’s important to address their concerns, and to make sure that the health and well- being of the caregiver is maintained.” everything else they have the stress of dealing with prostate cancer,” says William Aronson, MD, UCLA professor of urology and IMPACT regional medical director. “To have a nurse assisting with things like making appointments, filling prescriptions, making sure they have transportation and referring them for psychological counseling when needed is extremely valuable.” In his role as medical director, Dr. Aronson oversees the prostate-cancer care for the program’s patients, reviewing cases with the nurse case managers and ensuring that patients are directed to specialists in their area as needed. “We carefully screen all of the physicians we sign up, and we make sure our patients are receiving state-of-the-art care,” he says. Laura Baybridge, the program’s original administrator, says that beyond their work with the patients, the nurse case managers have helped to ensure that all IMPACT physicians are meeting the highest standards of prostate-cancer treatment. “Low-income patients living in the most remote sections of the state are getting the same quality of services you would receive at UCLA or any of the other top-tier medical centers across the country,” says Baybridge, currently the chief administrative officer for the UCLA Department of Urology. “And bringing the care for IMPACT patients up to the highest standards raises the level of care for these physicians’ other patients as well.” For more information about the IMPACT program, go to: www.california-impact.org Caregivers often are called on to perform wide-ranging tasks for their loved ones, Dr. Coscarelli notes. Depending on the condition of the patient, these can include assistance with activities of daily living, such as feeding, bathing and dressing, as well as household tasks, such as shopping for groceries, preparing meals, cleaning the home and doing laundry. They also might be asked to tend to legal responsibilities and issues of financial management, and may need to provide transportation to appointments. And there often are healthcare responsibilities such as bandaging, managing medications and treatment for side effects — and knowing when to call the doctor. “Caregivers often worry about whether or not they are sufficiently prepared,” Dr. Coscarelli says. “With everything they are taking on, they also have physical limitations of their own, particularly with an older spouse. In the case of adult children, they may have their own children and family, as well as work responsibilities. And they also are dealing with the emotional response that comes when someone you love is sick. When the diagnosis is serious, there also is the fear of abandonment, of losing someone who may be your closest confidant.” practices. Among other things, caregivers are encouraged to keep up their physical fitness, attend to their own doctor’s appointments and engage in enjoyable activities, including those that keep them socially connected. “We urge them to figure out what it is that only they can do and what others can help with,” Dr. Coscarelli says. “Then, they should have a list handy of what others can do when they call and offer to help, whether it’s bringing a meal, grocery shopping, picking up kids from school or driving the patient to a chemotherapy appointment.” The Simms/Mann center also emphasizes the importance of open communication between caregivers and their loved ones, including a discussion of needs and sharing feelings about the illness and changing roles. “For some people, there can be a positive side to caregiving — a sense of purpose and meaning despite all of the distress that goes with the illness,” Dr. Coscarelli says. “We tell caregivers that it’s normal to feel distress and some negative emotions, and that feelings at both ends of the continuum can coexist. Ideally, you find outlets for the distress that allows you to bring your best self to the experience.” To view a video about caregiver self-care, go to: uclahealth.org/caregivers For more information about the Simms/Mann UCLA Center for Integrative Oncology, go to: simmsmanncenter.ucla.edu At the Simms/Mann center, family caregivers are encouraged to take proactive steps to avoid the negative outcomes that are often associated with the caregiving experience, including fatigue and reductions in sleep, increased social isolation and declines in pleasurable activities, depression and poor health Vital Signs Summer 2017 Vol. 75 7