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Frequently Asked Questions about Cancer Rehabilitation and the STAR Program® September 17, 2013

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STARAshley Atkinson, OTR/L, CLT-LANA, STAR/C, WCC, the STAR Program® Coordinator for McLeod Health, answers the most frequently asked questions about the program.

1. What is cancer rehabilitation?
Cancer rehabilitation is very similar to other forms of rehabilitation after a serious illness or injury. Services should include consultations with appropriate board-certified or licensed clinicians in rehabilitation medicine, including physical, occupational, and speech therapists.  Each therapist participating in the STAR Program® has been certified as STAR Clinician® or Provider. This training provides our staff with a thorough understanding of the unique rehabilitation needs of cancer survivors, based on the latest research, and new skills to help patients improve their daily function and well-being.

2. What impairments can be addressed through cancer rehabilitation?
Rehabilitation professionals can help you with a wide variety of treatment-related conditions and their symptoms, including pain, weakness, fatigue, shoulder problems, neuropathy, balance and gait problems, memory and concentration issues, swallowing and speech problems, and lymphedema.

Three of the most common side effects reported by patients, no matter what type of cancer they have been diagnosed with, are cancer-related fatigue, chemotherapy-induced peripheral neuropathy, and mild cognitive impairment, or “chemo brain.”

Cancer-related fatigue (CRF) is one of the most common and disabling problems that cancer survivors face.  There is evidence for exercise as an intervention for CRF; however, for cancer survivors who have impairments, it is important to refer them for rehabilitation therapy consultations rather than group exercise classes. This is similar to how stroke survivors and other patients with impairments are rehabilitated. The impairments need to be addressed and a therapeutic exercise program prescribed. Rehabilitation consultations should include physical therapy and occupational therapy.

Chemotherapy-induced peripheral neuropathy (CIPN) is also a common problem in many survivors.  When treating conditions such CIPN, it is important to recognize the distinction between impairment and disability. By definition, disability results from impairment (an injured part of the body that may or may not be reversible). Even when impairment, such as CIPN, is not reversible the level of disability can be decreased by rehabilitation interventions.  Disability is the primary reason for distress in cancer survivors according to recent research. Many “low-tech” interventions that an occupational therapist would prescribe — such as a smart phone, voice activated software, large handled tools, stress mats and more — can help to decrease disability in patients with CIPN. Physical therapists can help decrease disability by focusing on balance, gait and footwear (e.g., extra depth or width shoes, rocker bottom soles). Physiatrists also may play an important role in managing chronic pain and disability from CIPN and sometimes will prescribe medications or other interventions.

Many cancer survivors report that they have “chemo brain” or mild cognitive impairment (MCI). Neurocognitive rehabilitation interventions, for example in patients with post-concussive syndromes, have been well studied. Neurocognitive rehabilitation often includes helping people to decrease their level of disability by using various strategies to assist with focus, concentration, attention, memory and organizational skills. Many cancer survivors find referrals to speech-language pathologists and occupational therapists enormously helpful for “chemo brain.”

3. Am I candidate for cancer rehabilitation?
If you have any problems that you didn’t have before your cancer diagnosis, especially if they interfere with your ability to function or quality of life, you are a candidate for cancer rehabilitation.  Regardless of the stage of cancer or phase of treatment or recovery, survivors can benefit from participation in an evidence-based rehabilitation program.

4. Will my insurance cover cancer rehabilitation?
Insurance should cover costs if professionals with healthcare degrees and licenses in rehabilitation medicine offer the rehabilitation program. These include physiatrists, physical therapists, occupational therapists, and speech therapists. Other team members’ services that your insurance will usually cover (if care is delivered in a healthcare setting) include nursing and mental health. As with all insurance issues, check with your carrier about deductibles and co-pays.

5. How can I receive more information about the McLeod STAR Program®?
The STAR Program® is one more way McLeod is working to provide you with the highest quality care. We are located in the Outpatient Rehabilitation and Sports Medicine at 2439 Willwood Drive, behind McLeod Health and Fitness.  If you are interested in learning more about cancer rehabilitation, or would like to schedule an appointment, please contact me by phone at (843)777-4697 or by email at aatkinson@mcleodhealth.org .


The Role of Cancer Rehab in Oncology Survivorship August 19, 2013

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STARThe National Coalition for Cancer Survivors (NCCS) defines a ‘cancer survivor’ as being ‘from the point of diagnosis and for the balance of life.’ The National Cancer Institute (NCI) states that “survivorship covers the physical, psychosocial, and economic issues of cancer, from diagnosis until the end of life. It focuses on the health and life of a person with cancer beyond the diagnosis and treatment phases. Survivorship includes issues related to the ability to get health care and follow-up treatment, late effects of treatment, second cancers, and quality of life. Family members, friends, and caregivers are also part of the survivorship experience.”1

In 2010 there were 13.8 million Cancer Survivors in the U.S., according to the National Cancer Institute. Thanks to advancements in cancer screening, early detection, and better treatment options, this number is expected to continue to rise, with an estimated 18.1 million survivors by 2020.2   As a result, Cancer Survivorship programs are more important than ever before.

A key component of comprehensive cancer survivorship services is cancer rehabilitation care that can help survivors improve their ability to function and quality of life. Cancer treatments can cause side-effects like fatigue, difficulty with memory or concentration, muscle pain, limb swelling, weakness, balance problems, swallowing or speech issues and more that may affect your quality of life.

Yet, many cancer survivors who need cancer rehabilitation are not referred for services. For example, a study published in the Journal of Clinical Oncology evaluated 163 women with metastatic breast cancer. Of these participants, 92% had at least one physical impairment and a total of 530 impairments were identified. This study found that more than 90% of patients need cancer rehabilitation, but fewer than 30% receive it.3  Other studies also have demonstrated a significant unmet need for cancer rehabilitation services.

At McLeod, our goal is to bridge this gap between the need for cancer rehab services, and the availability of programs that are designed to meet the unique needs of cancer survivors.  We are proud to be the first in the region to offer the nationally recognized STAR Program® (Survivorship, Training and Rehabilitation) to patients diagnosed with cancer.  The STAR Program® provides patients with comprehensive, individualized cancer rehabilitation treatment, based on the latest evidence and research.

The McLeod STAR program is offered by a group of trained medical experts from physical and occupational therapy, speech pathology, oncology, social work, infusion, radiation oncology, breast health services, and pastoral care who work with each patient to develop a personalized rehabilitation plan.

The Benefits of Cancer Rehabilitation include:

  • Decrease in Pain
  • Reduction in Fatigue
  • Increase in Energy and Endurance
  • Improvements in Balance and Walking
  • Improvements in Swallowing, Eating and Speech Problems
  • Increased Strength
  • Management of Swelling caused by Lymphedema
  • Improvements with Memory and Concentration
  • Improved Mood and Quality of Life

If you are interested in learning more about cancer rehabilitation, or would like to schedule an appointment, please call (843)777-4697.

Ashley Atkinson, OTR/L, CLT-LANA, STAR/C, WCC
STAR Program® Coordinator

1.  http://www.cancer.gov/dictionary?CdrID=445089

2.  Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst 2011;103(2):117-128

3.  Cheville AL, Troxel AB, Basford JR, Kornblith AB. Prevalence and treatment patterns of physical impairments in patients with metastatic breast cancer. J Clin Oncol. 2008 Jun 1;26(16):2621-9.

Changing the Face of Cancer Care February 18, 2013

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The face of cancer care is changing as a result of a desire by survivors to be known as more than a medical record number, a recipient of treatments or a cancer patient.  It is the acknowledgement and realization from the cancer care community that is bringing about this change. These medical professionals including myself understand how cancer takes a toll that extends well beyond the conclusion of treatment

As a team, we are engaged in learning about cancer care plans and how they will be used by patients. Our goal is to provide patients with information about their treatments and follow-up care, survivorship and psychosocial support programs, nurse navigation support to assist patients with understanding their treatment options, cancer rehabilitation, etc.

McLeod sits at the cusp of advancing its cancer program and making it more meaningful to our patients and community. It is exciting to be a part of these plans/changes in the world of cancer care. In the spirit of providing patients with additional healing opportunities, the McLeod Cancer Program recently entered into a partnership with Central Carolina Technical College to offer the first school and hospital clinical rotations for massage therapy students in the state of South Carolina. In January, these students began offering hand and arm massage once a week to our chemotherapy infusion patients during their treatment appointments.

Massage is an evidence based program in cancer care and research has shown the benefits to cancer patients. For me, as a cancer survivor, the beauty of massage is best stated by Tracy Walton, a researcher, award winning educator, and specialist in massage and cancer care, “by touching a body, we touch every event it has experienced. For a few brief moments we touch all of a patient’s stories in our hands. We witness someone’s experience of their own flesh, through some of the most powerful means possible: the contact of our hands, the acceptance of the body without judgment, and the occasional listening ear. With these gestures, we reach across the isolation of the human experience and hold another person’s legend. In massage therapy, we show up and ask, in so many ways, what it is like to be another human being. In doing so, we build a bridge that may heal us both.”

If you would like to learn more about massage in cancer care, the following are some resources that will offer more information:

  • Medicine Hands: Massage Therapy for People with Cancer
  • Journal – Supportive Care in Cancer
  • TracyWalton.com
  • Touch Research Institute Studies of Massage and Cancer Patients – University of Miami School of Medicine.

Please remember the next meeting of Shelby’s Group is Thursday, February 21, 2013, at 6:00 p.m. at the McLeod Resource Center. At this meeting, we will also have a Special Guest, Kathi Miller from Summerville. She will be sharing the work of love/art she makes. Kathi is a Breast Cancer Survivor and is also Betty Anne’s cousin. In addition, Betty Anne and Betsy Johnson will share an item they have created as well.


The Promise of Hope October 9, 2012

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Often, after meeting with a patient in my role as an Oncology Social Worker for McLeod, I walk the patient back out to the waiting room. Recently, as I was escorting a patient out I noticed that the waiting room was full of patients waiting to be seen by their oncologist. The patients were sitting there, perhaps in pain or with their blood pressure steadily rising as they waited with apprehension. They were a silent group of strangers all bound by cancer as their connection to one another. I’m sure they were wishing they could be somewhere else when suddenly the waiting room came alive.

In that space where cancer takes center stage, hope, happiness/joy, and laughter trumped cancer on this day as there in the waiting room sat two small children giving a beautiful rendition of “Twinkle, Twinkle Little Star.” These cherubs were oblivious to the fear, worry, and illness surrounding them. As they finished singing, there was applause, laughter, and calls for encores which the children gladly offered even bowing after each performance. The waiting room resonated with life, hope, and the promise that no matter what, life has a way to give us hope even in the midst of illness.

Hope can come in many ways including seeing a beautiful sunset, listening to great music, completing treatment, holding a grandchild, reading an uplifting poem, or having your hair grow back. There is hope in friendships, family, and laughter as well as in sharing a common bond. You can see hope in celebrations of birthdays and holidays, in art, in spirituality, and in the smile of a stranger.

For those of us who have been touched by cancer the promise of hope allows us not to be defined by cancer…instead we define ourselves in spite of cancer.

All My Best,

By the way, the next meeting of Shelby’s Group is Thursday, October 18, 2012, at 6:00 p.m. at the McLeod Resource Room, 927 E. Day Street. Harriet Jeffords, Director of McLeod Rehabilitation Services and a Breast Cancer Survivor, will speak to the group about the role of rehab in cancer care. Please consider joining us and remember new members are always welcome!

Helping You Navigate Prostate Cancer June 26, 2012

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Kaycie Lockamy
McLeod Cancer Nurse Navigator

The word cancer is a Greek word for crab. The origin of the word cancer is credited to the Greek physician Hippocrates who used the term carcinos and carcinoma to describe tumors. In the Greek language, the word crab was “most likely applied to the illness because of the finger like spreading projections from cancer called to mind the shape of a crab.”

For the patient diagnosed with cancer hearing the word has little to do with the above definition. Instead, initially, it conjures an overwhelming fear of the unknown and thoughts of death.  It is at this time that the patient is suddenly thrust into a world of medical appointments, tests, and decision making about treatments. It is also at this point that a patient can benefit from the support of a nurse who understands their disease and can help them navigate through their cancer treatment. As a Nurse Navigator with McLeod Cancer Services, this is the role I serve for patients diagnosed with prostate cancer.

The following are some facts about the prostate that you might find interesting:
•    The prostate, although a small gland (about the size of a walnut), can sometimes cause a man serious problems.
•    One out of every six men will be diagnosed with prostate cancer in their lifetime.
•    The good thing about prostate cancer — if there REALLY CAN BE a good thing about prostate cancer — is that if it is caught early enough (and most of the time, it is) there is a good chance it can be cured.
•    The prostate gland is found only in men. However, if you are a woman who has a husband, father, grandfather, uncle, or friend who has been diagnosed with prostate cancer, it still affects you, just indirectly.

In regards to the body, the prostate sits just below the bladder and directly in front of the rectum. In young men, the prostate is usually the size of a walnut, but it can grow as a man ages and can be as large as a golf ball or larger in older men. Some men, when their prostates grow larger have issues with urinating (hesitancy, urgency, flow) and obtaining and maintaining an erection.

Before a male child is born, the prostate begins to develop and continues to grow until adulthood. This growth occurs due to the male’s sex hormones, such as testosterone. Usually, the prostate grows relatively slowly as long as these hormones are still being made. Several types of cancers can be found in the prostate, but the majority of them are adenocarcinomas, cancer that occurs in the gland cells. These adenocarcinomas are slow growing; however some grow more quickly than others and can spread rapidly to other organs. Prostate cancer likes to take up residence in the bones of its host, so it will likely spread to the pelvic bones first.

Once you or someone you love has been diagnosed with prostate cancer there are decisions that need to be made in regards to treatment. There are several options one can consider when diagnosed with cancer that can be discussed with your healthcare team.

If you or someone you know has been diagnosed with prostate cancer and you want more information on this disease and its treatment options, please feel free to contact me, Monday through Friday from 8:00 a.m. to 4:30 p.m. at (843)777-6339 or by email at klockamy@mcleodhealth.org.


The Healing Properties of Art May 16, 2012

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In an article titled “The Healing Qualities of Artistic Expression, the Role of Creative Process and Serious Illness,” Lee Crawford, MEd, RCC, BCATR, writes about the healing role of art for patients who face a life threatening illness.  She states that “the field of medicine acknowledges and supports the value of creative approaches in health and wellness for patients.” In fact, the practice of art therapy has been declared a “mind-body intervention” by the National Institutes of Health Office of Alternative Medicine (National Institute of Health 1994), Washington, DC. (Malchiodi, 1999)

The following are a couple of the highlights from this article:

  • “Through art-making, a person can reveal the story of their illness, the psychosocial issues and beliefs linked to the illness, and how to cope with physiological symptoms associated with cancer.”
  • “Imagery can be used to assist a patient to express emotions and the psychosocial issues of serious illness or cancer. Art making encourages a patient’s ability to cope and a means to reduce stress which may have a positive impact on the physiological progression of the disease.”

As members of Shelby’s group and other cancer survivors continue on their journey to healing both physically and emotionally, it is comforting to know that there are many proven Integrative Medicine modalities that can enhance our ability to heal and among those is art.

The next meeting of Shelby’s Group is Thursday, May 17, 2012, at the McLeod Resource Center at 6:00 p.m. We are fortunate to have as a guest presenter, Sandy Griffin, both a psychologist and an artist, who will offer us a presentation on the healing properties of art that promises to be both informative and interactive.

I hope to see you there and for those who have contemplated coming to our group at some point and have not yet come we would love to have you!


The Role of Social Work in Oncology March 13, 2012

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March is Social Work Month. In celebration of this month, I would
like to share with you the role of Social Work in Oncology. As I thought
about this subject, I remembered my first meeting with Shelby and her
comments to me after we had spoken for a while at her doctor’s office.
Shelby turned to me and said that she wished there had been a Social Worker
available to provide the emotional support and guidance she needed during
her cancer treatment and after completion of treatment. Recently, another
newly diagnosed cancer survivor came to see me at my office for some
guidance and made the same comments.

Social Workers because of their training have a unique set of skills that
in the Oncology setting enhances the care of the patient. The following is
a quote from Social Worker Kathy Gurland, LCSW, who is a Cancer Navigation
Consultant. She passionately writes about the role of Social Work in the
field of Oncology:

“This essential member of your healthcare team may be your greatest ally
when you face a diagnosis.  Clinical Social Workers are licensed mental
health professionals held to high ethical standards who must pass a state
licensing exam after completing their master’s in social work (MSW) degree.
The required coursework for an MSW covers a broad theoretical foundation
and field practicum experience in a variety of settings with culturally
diverse and vulnerable populations. Oncology Social Workers, specialists
within the social work field, are clinically trained to provide diversified
support for cancer patients and their families during diagnosis, treatment,
and survivorship.  They are also trained in end of life care and

Gurland goes on to say that “because cancer has an impact on every aspect
of patients’ and their loved ones’ lives, an Oncology Social Worker views
individuals in a holistic way and with a strengths perspective. They also
take into account the whole person in his or her environment and use what
is called a ‘bio- psychosocial assessment’ to identify an individual’s
needs. These needs may include but are not limited to physical, emotional,
spiritual, cultural, financial, sexual, recreational, relationship, safety,
legal, family, and caregiving.”

According to the 2007 Institute of Medicine Report “Cancer Care for the
Whole Patient,”   we should all remember: “Today, it is not possible to
deliver good-quality cancer care without addressing patients’ psychosocial
health needs. And, it is your social worker who can address those needs.”

I want to take this opportunity to honor all McLeod Social Workers who at
one time or another will serve in different roles as they assist patients.
These staff members are often seen as advocates, teachers
(psycho-education), confidants, problem solvers, counselors, liaisons,
resource guides, collaborators, and consistent sources of support. The
theme for Social Work Month this year is “Social Work Matters,” so my words
of wisdom to all Social Workers at McLeod and beyond is to keep your
passion alive and always remember why you went into the field of Social

Shelby’s Group will meet this coming Thursday, March 15 at 6:00 p.m. at the
McLeod Resource Center. Please join us and bring a friend. See you there!


Shelby’s Group: Recurrence and Coping October 18, 2011

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Recently, I had a breast cancer survivor call me as she was worried about a recurrence and questioning each and every sensation in her body. This topic has been raised and discussed in our group often as fear of recurrence evokes anxiety for all of us who have experienced cancer. We rely on our treatments to reassure us that our cancer has been sent on its way to remission.

Year ago, I recall meeting a stranger at a grocery store in Columbia. I told her how much I liked her stylish haircut (having just moved to the area and recently finished my treatments, I wanted to do something stylish with my hair as I was pleased once again that I had hair). In talking to this woman I learned that she was a five-year breast cancer survivor, and she cut and styled her own hair — something that I was not about to do! After sharing this with me, she added, “You know I had not thought about my cancer in a long time.” You may ask why I’m describing this encounter? Simply put, barring any setbacks we will be like the survivor I encountered and the fear of recurrence will no longer take center stage.

As we complete our cancer treatment, we are usually filled with a sense of relief. However, it is at this time that we may begin to feel anxious and have fears that the cancer may return. These feelings are quite normal during the first years after completing treatment. One of the keys to coping with this fear is to be aware that we are not in control of whether the cancer returns or not, but we can control how we let fear impact our daily life.

Here are some suggestions from cancer.net for coping with fear of recurrence:

  • Accept that you will experience this fear and that you are not alone.
  • Find a way to manage the anxiety created by the fear.
  • Know that the fears lessen as time passes.
  • Try not to worry alone — talk to someone, join a group, or write down your thoughts in a diary or journal. Give worry time limits for example only 10 minutes a day.
  • Talk to your doctor about regular follow-up care; find out more about cancer treatment plans and summaries (previously discussed in a blog) and remember to think of yourself and your doctor as partners in charge of your care.
  • Be a well informed patient and become familiar with the fact that most cancers have a predictable pattern of recurrence.
  • Focus on becoming healthier: eat healthy, exercise, and get enough sleep.
  • Reduce stress by enjoying time with family and friends; walking; laughing; reading a funny book or watching a wacky movie; finding humor in as many situations as possible; joining a support group; and getting rid of clutter in your life

Is this easy? No, but it is worth a try!

Just a quick reminder: Shelby’s Group meets again this Thursday, October 20, 2011, at the McLeod Resource Center at 6:00 p.m. Please consider joining us for a night of sharing with others.



Happy Birthday! September 13, 2011

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Shelby’s Group just had a birthday! In August, we celebrated our first year as a group, and it has been a privilege for me to serve as a facilitator and to be a member of this special group of ladies.

During the past year, our members have bonded as they have shared their fears, frustrations, humor, resiliency, laughter, and support for one another as well as encouraging those new members who joined us.

We were also honored to receive interesting educational presentations by our phenomenal and talented McLeod staff. We thank again each and every one of them for taking the time to share their knowledge with us. These presenters included Ashley Atkinson, Senior Lymphedema Therapist; McLeod Oncologist Rajesh Bajaj; Radiologist Dr. Bruce White; McLeod Radiation Oncologist Dr. Rhett Spencer; Pathologist Dr. Sharon Mitchell; and McLeod Chaplain Rev. Stuart Harrell. In addition, we want to thank Denise Richbourg for sharing the American Cancer Society’s Look Good Feel Better program with us.

I also personally want to thank each group member for their commitment to making Shelby’s Group a reality and for being available for those breast cancer survivors (whether beginning their journey, being treated, or having finished treatment) in their time of need and support.

We meet again this Thursday, September 15, 2011, at the McLeod Resource Center at 6:00 p.m. Please consider joining us for a night of sharing.

To life,


Defining Cancer Survivorship June 13, 2011

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June is National Cancer Survivorship Month and as McLeod prepares to honor survivors with its Cancer Survivor’s Day Celebration on Saturday, June 18, I thought that as a cancer “survivor” I would review the definition and information of survivorship.

Wikipedia defines a cancer survivor as “an individual with cancer of any type, current or past, who still lives.” The National Coalition for Cancer Survivorship believes a person diagnosed with cancer is a survivor from the time of diagnosis and for the balance of their life.

Some people reject the term survivor as being “a narrow definition of highly variable human experiences.” Yet others believe that the “idea of survivorship emphasizes and values longevity of life after diagnosis, while overlooking issues of quality of life.” Alternatives to the word survivor include “alivers” and “thrivers” which place emphasis on living as well as you possibly can despite limitations and disability.

We know that those of us who have experienced cancer often will have physical and psychosocial challenges. “These effects vary from person to person and statistics show that cancer survivors suffer from more psychological distress than those who have never experienced cancer (5.6% compared to 3.0%). Serious psychological distress is seen 40% more in cancer survivors of 5 years or longer than in those who have never experienced cancer. In addition, around 10% of cancer survivors develop depressive disorder, others experience an adjustment disorder, and many are fearful that their cancer could recur (9 in 10 patients).”

The medical challenges experienced by survivors can include among others: cancer- related fatigue, long-term side effects from cancer and treatments, and temporary or persistent cognitive problems (chemo brain). In a nutshell, cancer survivors frequently need medical monitoring and complementary modalities to address the psychosocial effects of cancer.

I also reviewed the definition of the word survive in the Merrian Webster Dictionary and one definition caught my eye. This definition comes from Latin and the word is supervivere = the word super and the word vivere which means to live. As survivors, we often reflect on our cancer journey by evaluating our priorities, looking within for our strengths and ways to cope, dwelling on cancer and how it has changed our lives, and assessing our fears and finding how best to manage those. We now reflect on what really matters in our lives and how we should move forward. And, we review passions we may have had in the past and make those a priority and goal. We also take a hard look at our lives as we get a second chance to live.

For me, survivorship is about living and making a difference. It is about living in spite of the fears and the aches and pain. It is about taking the time to enjoy life fully and enjoying every opportunity to celebrate life. I invite you to share a comment on what it means for you to be a survivor.

I hope you all plan to attend the 19th Annual McLeod Cancer Survivor’s Day Celebration this Saturday! The event will begin at 9:30 a.m. in the McLeod Medical Plaza Conference Center. All cancer survivors in the region are welcome to attend whether you are newly diagnosed or you have been a survivor for 20 plus years.

In addition, our breast cancer support group, Shelby’s Group, meets this Thursday, June 16, at 6:00 p.m. at the McLeod Resource Center. Our guest will be Stuart Harrell, Assistant Director of McLeod Pastoral Care, as we explore Spirituality and Healing. Come join us!