Wednesday, April 1, 2015

Can the Mommy Wars end for a bit? Apparently QUALITY of time matters over QUANTITY

My latest on Divorced Moms. I'd write some explanation but this one says it all.

Quality Over Quantity Matters Most For Parenting Our Kids- Yay!
by Lizzy Smith                     
March 31, 2015
Share on Tumblr
Fotolia_79454325_XS.jpgA few weeks ago, I was having a conversation with my very conservative friend, Michael. He said that it was optimal that there be a stay at home mom when there are children involved. Not just a stay-at home parent, but a stay at home mom. Why? Because women are more nurturing.

I had to correct him. I am not so nurturing. I love my children, I enjoy spending time with them, and there is nothing more important to me than my daughters. I'll walk over hot coals for them, or slay dragons. However, nurturing I am not. And, the guilt for moms who can't stay home with their children, or who simply don't want to, is overwhelming.

Living in Utah, the Mommy Wars are alive and well, at least in my neighborhood. There is a general thought that women should be at home with their children because of a divine gender role. Those who work because they want to are generally selfish; those that must work are pitied. And having never been that stay-at-home mom, this mindset has generally made me feel angry and guilty. Was there something wrong with me that simply being a mom wasn't enough? Did my need for the mental stimulation that working provided make me fundamentally flawed? I confess that, guilt aside, the balancing act of career, children, husband, home and Me (yes, somehow in all that, I still mattered, too) was crushing. Clearly I was failing everyone, most notably my children. Stuck in pre school or after school activities or summer camps. Bad mom. Guilt. Failure.

Well let's just push that all aside! A new study being published in the April issue of the Journal of Marriage And Family says that U.S. parents are spending more time with their children than any other parents in the world. Say what? And the amount of time that parents spend with their children between ages three and 11 matters not at all. And it has minimal effects on adolescents.

How do they measure "success" in parenting? By their academics, behavior and emotional well-being.

Oh.My.Gosh. I can let go of some of that guilt right now, color me happy.

What the study does show is harmful is a mother's stress level, especially when trying to juggle work commitments and the time they are (or want to be) spending with their children. And what matters most is a mom's education level and income.

So let me get this straight... If a working mom attempts to come home in a calm(er) manner and set aside stress and enjoy some quality time with her children, that counts. Many other studies show that eating together, especially at a dinner table, has huge benefits. Talking with our children, perhaps spending one-on-one time with them, say, once per week is a Big Fat YES. A little strict parenting isn't such a bad thing, in fact, it's generally good. Knowing our kids, smiling and laughing with them, and generally engaging with them-- these are things that truly matter.

In my neighborhood of mostly stay at home moms, I have often observed that they don't seem to actually spend more time with their children than most working moms I know. Their kids walk home from school without any adult supervision, and I often see very small children (like under two years old) who are playing in the streets (not kidding here) without any adult in the vicinity. So while there may be a mom in the home, are the children really getting that much more time with her? I say no. Studies say no. I love validation! (And, honestly, when my children were younger, they wanted to be with their peers playing far more than they wanted to be hanging out with me running errands or cleaning the house anyway.)

Keep reading...

How does Angelina Jolie's efforts to prevent cancer affect this myeloma warrior?

An article I wrote for www.myelomacrowd.org.

The Angelina Effect On Fighting Cancer & Sharing Your Tale

BY LIZZY SMITH

For the second time, Angelina Jolie, actress, director, writer, humanitarian, wife and mother, is opting for surgery as a preventative measure against cancer. She announced her decision in via the New York Times, explaining that she had her ovaries and Fallopian tubes removed to prevent ovarian cancer. Just two years prior, she had bilateral mastectomies to prevent breast cancer. Angelina’s decision to go public, she explained, was to inform women of their options.

The dialog has begun on cancer prevention and the lengths one may go to avoid it. But what impact does Angelina and her going public, have on multiple myeloma patients? Or at least this myeloma patient, anyway.

First, while there is no preventative surgery to ward off myeloma, there is a whole range of mindsets on how far one might go to fight their cancer. From “all the way” to “quality of life” and everything in between. So how hard will we fight to save our own life?

Second, how and when do we go public with our diagnosis, treatment and progress?

And, lastly, when we do share such private information with others, what should we expect from them?

Fighting cancer isn’t easy. The side effects of drugs, treatments and surgery can be incredibly difficult. Upset stomachs and hair loss are just the beginning. Some have the mental, emotional and physical strength to fight hard. But to do that, one also needs a good support system and the dollars required to pay for staggering out-of-pocket costs and travel expenses often required to research and select best options. This approach is not for everyone.

I often hear from cancer warriors that have decided to opt for quality of life. Many have already decided that there are certain procedures that they simply wouldn’t do if it came down to it. Quality of life is more important, some say.

I have taken the opposite approach. I have young children and I love living. From Day 1 of my diagnosis, I decided that I would fight hard and win, and spit on cancer and stomp on it. I suppose I’m lucky that I don’t have depression. It’s an emotion I literally know nothing about. When I get upset or afraid, I do something fun to bring my energy back to center. I go hang gliding or go on a trip or do anything to distract myself. Sound overly-simplistic? It’s not, but it works for me.

iguazu falls

A few weeks ago, I was in Iguazu Falls, Argentina, home of the longest waterfalls in the world. It was one of the most amazing things I’ve ever seen. As part of the trip, I got on a boat with about 30 other tourists and we went under those falls without any protection minus life jackets. Being pounded by the insane force of the water was exhilarating. I literally have never felt anything like it and for the several minutes we were under the falls, I laughed and screamed and, well, LIVED. I didn’t think about myeloma, cancer, side effects or anything. In fact, it wasn’t until that evening when I had to pull out my Revlimid and Lovenox injectable that I remembered that I’m a myeloma survivor. And on that entire trip, I barely thought about cancer at all. Mental breaks and unique experiences give me the strength to press forward. I’m a fighter and I’ll keep my boxing gloves on. Is everyone like me? Of course not but I recommend that on those tough days, you try doing something far outside your comfort zone that will bring you joy. It helps immensely. Get out, breathe, live.

The next question is who and when do we share our diagnosis with? At the beginning, I told almost no one. I had to tell my then-husband (who I left the day I was diagnosed), who then told all kinds of people. I was angry– it wasn’t his story to tell, it was MINE. I also told my parents, employer, and a few close friends. Notably, I did not tell my children, almost no one else in my family, and I certainly didn’t go and announce it on Facebook. I had spent so much time in my prior life portraying an image of perfection– immaculate home, great job, awesome kids, beautiful dogs, and a happy marriage. To all of a sudden announce that it was all a sham and I had CANCER was just too much. I also knew inside that I was going to win this challenge and I didn’t need to see pity, doubt or sorrow in anyone’s eyes. When I lost my hair, I never went out without my wig. It was important to me to look well because, well, if I didn’t look sick, certainly I couldn’t be “that sick.” It was my way of emotionally coping and winning.

On the flip side, a good friend was diagnosed with stage III colon cancer just a month after I was diagnosed and she went on Facebook and told everyone. Which one of us was right? We both were. Sharing this news is your decision, on your terms. Never second guess what you decide. It took me a solid year before I felt comfortable starting a blog and sharing these details with anyone. It was time, it was the right decision for me.

These days, I share my myeloma journey openly. Advocacy and awareness is my life’s passion. To the extent that I can help others with my story, I will continue doing so.

As part of our journey, it is also imperative that we tell others around us when we’re having a bad day or we need help. Just a few days ago, I had to remind my daughter that I was tired because I was having a Dex crash day. I think she forgot that I was taking any medications because she simply doesn’t see it.

And, lastly, as one who may be a caregiver, supporter, family or friend of someone with cancer, what should you do? Listen, support, love. If you’re able, take the cancer survivor’s children for an afternoon to give her a rest. Take a hot dinner over to the family. Offer to drive to him to a doctor’s appointment. Get him out of the house to do something fun. Know that we cancer survivors aren’t “normal.” We struggle with physical and emotional fatigue. We can be really cranky. And we have limitations that are real.

The Angelina Effect on me is huge. I’m going to fight with everything I have. And I’ve decide to share my journey and advocate for myeloma awareness, treatments and cures. For those that select a different approach, that’s ok, too. There truly is no right answer.

To view the article in its entirety, click here.

Tuesday, March 31, 2015

Thanks to Twitter, American Airlines finally gets it right (for this cancer patient)

Before leaving for our trip to Buenos Aires, Argentina, I had a doctor's appointment. Turns out, I could not take such a long break from treatment. So I spent $700 changing our return flights so we left a day early and I could go straight from the airport to my chemo treatment at Huntsman Cancer Institute in Salt Lake City. After spending 10 days in Argentina, Brazil, Paraguay and Uruguay with a million different moving parts, flights, tour groups, buses, and you name it, everything went without a hitch. We boarded our American Airlines return flight in Buenos Aires, flew to Dallas, then got on the connection to Salt Lake City. All looked fabulous.

And then as we were sitting on our flight, all buckled and ready, the flight attendant announced that American Airlines' baggage handler had rammed the truck into the plane and it was too damaged to fly. We all needed to get off the plane and wait for a new plane. She thought maybe 30 minutes. Right. Big Fat Liar. I immediately called customer service and there was another flight that left almost three hours later. Lucky me, because I didn't trust a word out of American Airlines' mouth and got on the phone immediately, we got on that one.

I got to Huntsman four hours late, almost didn't get my appointment at all, and caused all kinds of employees to have to work late.

I emailed American Airlines. I paid $700 for a flight that American Airlines did not deliver on and it was their fault. Sweet rep sent me a $100 travel voucher. I was outraged. I almost emailed them back and then it hit me: Go public. I do Twitter! And so I complained to the world via Twitter. American Airlines was failing cancer warriors by not living up to the flights and money I had spent. It took a week but I got an email yesterday: $700 travel voucher. Better!

Lesson learned: Going public works. Failing customer service reps don't get to hid behind anonymous incompetence. I highly recommend it if you must. And American Airlines finally made good. I am satisfied.

Thursday, March 26, 2015

I should have dumped him sooner but I felt sorry for him

Liz Lizette Smith Nielsen's photo.

Today I am sitting in clinic getting Aridia (three hours) via IV, then Carfilzomib (30 minutes), a pregnancy test so I can get my Revlimid filled (so absurd that at 47 years old, Celgene still requires a monthly pregnancy test so they will dispense my medication), and having loads of time to write and blog and catch up on Facebook. This is day 2 of 3 days that I will spend in clinic THIS WEEK ALONE. Yesterday I was here for hours getting IVIG via IV to strengthen my immune system. My white blood cell counts are really low and I am sick all the dang time and I am so very tired of it. So this will hopefully help out. And then tomorrow, it's day 2 of Carfilzomib. This drug is administered via IV twice per week. This week, it's Thursday and Friday and each appointment takes about an hour minimum. Sigh. I'd rather be outside hiking the canyons. Or doing laundry.

Being a myeloma warrior is a very time consuming process. It's not painful, but side effects suck and the total fatigue of sitting for so many drugs, filling drug prescriptions, and taking them is making me a little crazy.

Anyway, interesting conversation with my extremely wise 14-year old daughter yesterday. She had a boyfriend for a few weeks. Having a boyfriend (at least for my daughter at this young age) means that the two of them see each other at school and basically everyone knows that they like each other most. They also text and Snapchat from home. I do not allow my daughter to go on real dates, not until she's older. Anyway, she decided for a myriad of reasons that she didn't want to be in a relationship anymore so she broke it off with him.

"I'm so mad at myself," she said yesterday in the car while we were driving to tutoring. "I never wanted to be in a relationship with him at all. He was just really nice and I felt sorry for him."

Oh, wow, the "sorry" thing. What a great teaching moment and I'm so happy we have the kind of mommy-daughter relationship in which she would confide in me at all. And I'd much rather her learn about this stuff at 14 years old than at 38 years old like I did.

"You must always put your best interests first, ESPECIALLY when it comes to boys," I said.

"Did you ever do this?" she asked.

Uh oh, this one wasn't a pretty answer. "Yes," I said. "With Daddy. I never loved him, I did like him because I didn't know about the alcohol. And he was really into me. I didn't want to hurt his feelings and break up with him, or even continue going out with him at all. And then look what happened, I married him. It didn't work so well."

My daughter, who loves her dad and misses him like crazy, said, "OK I don't want to talk about that anymore."

"I agree. I'm really sorry. But I always want to be truthful with you when you ask a question," I said.

Truth can be really hard to hear. Painful. Awful. So much easier to lie. But I simply won't do it. I won't offer up info that's awful, but if someone asks, I'm telling the truth. Always. It's that important with building character and trust.

Next question. "Have you ever really been in love with a guy?" she asked. Of course, I wouldn't be getting married again if I didn't love Bill. I loved David, and I loved Todd insane amounts, I said. I cried forever when it ended. It took me a good solid five years before I felt OK with that relationship's demise.

"Love is amazing when you find the right boy," I said. "It also hurts a lot sometimes. But it's worth it."

And then we moved on to another topic. I love being a mom sometimes.

A great story about Kerrie, a divorced mom who rebuilds her life from the ground up

Divorced Mom Success Story: Meet Kerrie. Her Guest Post On Health
by Lizzy Smith                    
March 26, 2015
Share on Tumblr
Fotolia_79554844_XS.jpgI love a good story about divorced moms moving forward in their lives in ways that they could not (or did not) do during their failing marriages. One such story is of my friend Kerrie. She was a stay at home wife and mom with three very young children. Her marriage was a tough one and they eventually split. All of a sudden, Kerrie found herself single, without a job, and wondering how she was going to support her family.

She enrolled in a local cosmetology school. That's how we met. At the time, I was completely bald, just having completed some very tough chemo treatments and two stem cell transplants to fight multiple myeloma. I was desperate to stimulate hair growth and I started going to a hair school near my home for scalp massages aimed at doing just that. I met Kelsey, who still does my hair today and is one of my favorite friends. My hair started growing back super curly and Kelsey, twice each week, would massage my scalp (yum!), and dry and flat iron my hair into submission. One of her fellow students was Kerrie. One day we started up a conversation, exchanged phone numbers, and started meeting up for coffee or lunch.

Kerrie graduated from school and decided she wanted to help others achieve health and wellness instead of doing hair. She had become passionate about alternative health methods in her quest to stay healthy, fight of illness, and heal emotionally. Today, she has her own office space and conducts wellness seminars. I'm so proud of her success. 

So recently I asked her to write a guest post about health. Here it is. Enjoy!

Prevention is key to optimal health: It starts with sleep, nutrition & exercise
By Kerrie Percey (with Joni Luke)
I don’t know about you, but if there is anything I do NOT have time for as a mom, it’s being sick. I know from personal experience that life doesn’t stop for us to recover, whether it be from illness, stress, or emotional trauma. We may feel fatigue, depression, and more but life continues and expectations and responsibilities never end. So many of us moms, especially we have children at home that depend on us, we have additional things to think about, like homework, science projects, dance lessons, sports…the list goes on. And if you’re like me, none of those things are yours, they all belong to your kids.

But if we don’t find time to take care of our needs first, it makes recovery, health, healing and fighting disease that much harder.

So then what can we do to stay on our toes? Prevent.

What if our bodies were able to avoid being acidic – which only leads to being even susceptible to disease and illness? What if we were getting a restful sleep every night? What would it feel like to have more of the energy we need to accomplish the most important things on our list?

Keep reading...

Tuesday, March 24, 2015

Divorced Moms column: Spring is here! Now it's time (for me) to refresh, renew, rejuvenate, celebrate

From Divorced Moms. Spring is my favorite time of year! Ok, so is Fall. Let's call it a tie. Regardless, I'm on a mission to clean, purge, refresh, rejuvenate and celebrate. For real. Celebrate LIFE, LOVE, RENEWAL. Like my upcoming wedding (in October), the fact that I'm still alive, and that I have the energy and ability to LIVE, LOVE, hang with my children, explore the world, and find meaning. Despite some pretty big life challenges, I am a warrior and survivor.

One of the most amazing feelings for me is "newness." I love fresh, happy, and whimsical. If I were a major brand, I'd be Kate Spade because it encompasses all of those attributes. I love the smell of flowers, lemons, and lavender. I love yellow, apple green and orange. Citrus. And so I am on a quest each day to toss out the old, clean, organize, replace and breathe. So zen, calming, peaceful, joyful and happy. So today's column is about how I'm attempting to accomplish that.

And now I'm off to get some exercise, outside, smelling fresh air and getting a little of that vitamin D I write about. Happy Tuesday!

Spring Cleaning: 12 Ways To Refresh, Rejuvenate & Celebrate 
by Lizzy Smith                    
March 24, 2015
Share on Tumblr                     
The weather is warming up, Spring Break is around the corner, and I'm feeling an insatiable desire to clean, celebrate and rejuvenate. I made a list and I started working on it last week. Here goes:

1. Closet Purge - cost $0
Last week, I went through our closets and purged, purged and then purged some more. In my nine-year old daughter's bedroom, I took two enormous trash bags to a re-sell shop and scored $50, just like that! Between my 14-year old daughter and my closets, six huge bags of clothes went to a different re-sell shop. Hello $200! I also re-organized those closets, putting shoes on new shoe-racks on the back of our doors, placing ski clothes in bins, and dividing drawers using shoeboxes. I seriously feel like I have taken a major shower when it was over.

2. Scrub Down - cost $0
I cleaned and scrubbed our bathrooms. I went through drawers and cabinets, re-organized and tossed out tons of stuff. And then I rubbed the floors down with lavender oil. Next, it was our bedrooms. I vacuumed, had the carpets professionally cleaned, re-organized, dusted, and rubbed lemon essential oils around the windows. Oh my, it smells delicious around here, which is so rejuvenating and calming.

3. Handbag Swap - cost $0
I switched out my black and cream-colored handbag for my bright green Kate Spade bag. I love the daily pop of color.

4. Shopping! - cost after the $250 I earned from selling clothes to a re-sell shop $400
Because my youngest daughter grows like a weed, I basically started from scratch on her summer wardrobe. And for my older daughter and I, it was time for a refresh. Shorts, sundresses, flip-flops and swimsuits. Bold, fun and happy colors (think apple green, bright yellows and soft pinks), along with super bling-y flip-flops. Since I sold so many clothes back, it was amazing how far $250 stretched. I started at Ross (three pairs of flip-flops for just $13 each), Old Navy (clearance rack for shorts at just $4 each), Walmart (they had an entire section where everything was $3), and Target for my daughters. I splurged on a few fun items at Anthropology and Free People for me, two stores that I am obsessed with these days. My favorite purchase so far is a navy blue floral sundress ($28 from Old Navy) and a bright orange lace retro-sixties top ($12 from Ross).

5. Spa Day - $120 for facial and lunch; Botox $550
Not long ago, I met a new friend who is a fellow myeloma survivor and just a few years younger than I am. Together, we are going to get facials and lunch next week. After loads of chemo, doctor appointments, and more drugs than one should ever need to take, we deserve it. Plus, my skin is tired and dry. I'm also getting a Botox refresh on my forehead, something I did for the first time back in December.

6. Power Walks - cost $0
Because the weather is beautiful here these days (knock on wood), I've re-started my outdoor walks. Fresh air, vitamin-D, and a good workout that doesn't take place inside is amazing. I am constantly on the prowl for new hiking trails and I discovered a new canyon nearby on a random drive. I'm heading there in just a few hours to check it out on foot.

7. Vacation Time - $1,200 (2 adults, 1 child), not including air, for seven days
I'm a big huge fan of education and school. But I'm also incredibly tired of homework, structure, and more homework. Thus, Spring Break is one of my favorite times of year and many months ago I found killer deals on a cruise and booked it. We leave in ten days and I'm counting the minutes until I can sit at the pool and worry about absolutely nothing. Truth is, cruises are not my favorite way to travel. There is too much food and when in port, it's a bit like a cattle call. That said, when traveling with children, it's a great way to travel. But if that doesn't fit the budget, there are stay-cations (vacation near home) where you can rent a hotel and explore your city like a tourist. Or, consider spending Spring Break doing something unique in your own neighborhood every day, like a hike, a local museum, trying out a new recipe, or walking animals at the homeless shelter. If you're really brave and have the cash, do something really "out there" like skydiving (this is on my short list). Anything new, fresh, and that puts a smile on your face is a great way to welcome in a new season.

Keep reading...

Thursday, March 19, 2015

From Myeloma Crowd: This is chemo brain

From Myeloma Crowd.

Don't forget!

And This Is Chemo Brain. We’re Not Making It Up!      

BY LIZZY SMITH

Just a week ago, someone asked me what chemo brain was like. Here’s an example. I’m in my car purchasing drinks for my daughters at the drive-thru at Beans & Brew. The barista tells me the total, I get the money out of my handbag and then I pick up my phone and start calling my best friend.
“Mom! You haven’t paid yet. Are you kidding?” my 14-year old daughter, Morgan, said.

I looked at her confused, then looked at my hand and there it was- the money. I forgot to pay.
Just minutes later, my nine-year old stops me as I’m driving home. “Mom, we are supposed to be going to the orthodontist!”

Oh, yes, why am I driving home?

We all laugh at crazy mom. Hahahaha.

There are conversations I’ve had with people that I don’t remember. I supposedly promise my children I’ll bring them lunch to school. I don’t remember that either. I put things on my phone calendar but I often forget to look at my calendar.

It’s not so awful that I can’t drive, travel, or enjoy life. But I’ve long stopped trying to hide the fact that I fish for names, can’t remember words, and show up for events on the wrong day. It’s just one more thing to blame on cancer. “Sorry, I have chemo brain!” I’m apt to say. And it’s not like I’m making it up. It’s true. It’s real. And it’s sometimes really annoying. Oh well, I’m alive!

But chemo brain isn’t simply forgetfulness. Heck, we all forget things, even if we don’t have cancer, dementia or Alzheimer’s. But it’s a fuzzy feeling that is often exacerbated by fatigue (thanks, myeloma and meds!). It’s not feeling sharp. When my daughter talks to me too fast and then someone else starts talking to me at the same time, I just can’t do it. I want to put my hands over my ears and scream “STOP!” I feel like 300 people are screaming at me at the same time. Sometimes even trying to remember things takes more energy than I have so I simply don’t. Some days (not all!), I have to really concentrate. Like my bedtime routine takes forever– take meds, put jammies on, wash face, put on lots of essential oils, turn on my electric heating pad, put my children to bed, read to my youngest child, brush teeth, get lunches ready in the morning… I finally made a list so that when chemo brain rages, I don’t have to “think,” I can just “do.” Just go down my trusty To Do list and give my cognitive thinking skills a rest.

So today when I stumble on an article in OncLive (Chemobrain—It’s Real, It’s Complex, and the Science Is Still Evolving), I am relieved. Just in case someone doubts me, I can send them a link and say I’m not making this up!

Apparently, chemo brain is most intense during treatment. However, since many of us myeloma survivors are in long-term treatment, we may not get the “benefit” of going back to baseline of how we were before illness.

But according to the study, some 30-percent of cancer patients also experience other emotional ailments associated with chemo brain, including depression, anxiety and distress during treatment. 30 to 60-percent also have insomnia, and poor concentration and memory.

No kidding! We cancer patients have been saying this all along. Now we have validation.

I found this example in the article very interesting:
In an early study exploring functional changes in the brain due to chemotherapy, [the researcher] asked twin, 60-year-old females, one of whom had been treated with chemotherapy, to perform a series of tasks while undergoing MRI. The resulting images documented areas of hyperactivity in the chemotherapy-treated twin relative to the untreated twin, which the authors interpreted as areas of deficits due to chemotherapy. Findings of several functional brain imaging studies have been reviewed and relative to “controls,” individuals treated with chemotherapy have been found to exhibit functional differences, including both areas of hyper- and hypoactivity during tasks, as well as differences in brain activity while the brain is at rest. 
In addition, structural differences have been noted as well. [Researchers] compared brain images of women with breast cancer, some of whom received chemotherapy and some did not, and found decreases in volume and density of both white and grey matter in the group treated with chemotherapy. Chemotherapy-related reductions in grey matter have also been correlated with impairment in cognitive abilities.
So what is someone with chemo brain to do? If you’re looking for a magic pill, it doesn’t exist. Exercise and socialization helps. For me, I write myself a lot of notes and try to do better with looking at my calendar many times a day. I tell people I have chemo brain and that’s why I forget stuff. And, well, I move forward in life, enjoy and make apologies when I mess up.
Here’s what the article says about help:
Healthcare professionals are urged to validate patient concerns, provide education, and to assess for contributing factors, including medications, depression, anxiety, pain, fatigue, substance abuse, and sleep disturbance. Although most patients eventually return to pretreatment baseline, a subset report significant impairment in quality of life, independence, and self-confidence. One of the most important things friends, family and caregivers can do is to provide emotional support by listening to the patient’s concerns and validating the existence of chemobrain. It is common for families, coworkers, and friends (and sometimes even healthcare professionals) to not understand that the emotional, physical, or cognitive effects of cancer treatment may linger after treatment has ended.