My wife, who handles our finances, has been diagnosed with cancer. How can we be sure our finances are managed properly?


Rand Spero Certified Financial Planner and President of Street Smart Financial LLC in Lexington, Mass. Photo courtesy of Rand Spero

RAND SPERO: The stress of handling your finances when your wife faces a serious cancer diagnosis can add pressure to an already uncertain and unsettling situation—especially as you adjust to the news of the diagnosis and your new roles as patient and caregiver.

Ask your wife if you can help handle the finances. Without putting stress on her, sit down and discuss the responsibilities, such as what bills need to be paid when and the accounts she uses. Ask what tasks are most important, such as paying your mortgage, and prioritize from there. It’s also important to simplify. For example, you may want to use fewer credit cards to minimize the number of bills you have and set up automatic payments.

Have your name added to her accounts so you can make payments, view information, and deposit or withdraw funds. Ask your wife to grant you power of attorney, which gives you the legal authority to make financial decisions for her if she no longer can. You also need to check with your bank or financial institution to determine if they require additional forms to be completed. Meet with your estate attorney to review your will to be sure it still reflects her wishes—especially if your financial situation changes. For example, your wife’s assets may have been bequeathed to your children, but with the financial hardship during her cancer treatment, her assets might now need to be designated to you.

If you need help taking on this role, you could check with your wife’s hospital and local patient advocacy groups to see if they offer financial planning assistance. You also could meet with a trusted financial planner to talk about budgeting and evaluate how your wife’s cancer diagnosis will affect your financial picture. A consultation with a financial adviser could cost $100 to $300 per hour and will likely require at least two sessions. You also may decide to enlist a trustworthy family member to help.

As you make this transition, you and your wife should remember that your finances don’t need to be perfect. But neglecting your finances altogether could lead to substantial interest payments or worse. Address the important details, such as paying your credit card with the highest interest rate, but don’t get upset if couponing falls by the wayside. You just want to get things done.

MANAGING YOUR FINANCES // Cancer Financial Assistance Coalition lists resources for financial assistance. // The American Cancer Society shares tips for finding a financial planner. // The National Association of Personal Financial Advisors provides a database of financial advisers who have signed a fiduciary oath.

I am undergoing radiation therapy. What’s the best way to take care of my skin?


Manjeet Chadha Associate Chairman of Radiation Oncology at Mount Sinai Beth Israel in New York City. Photo courtesy of Rebecca Spitz

MANJEET CHADHA: Skin reaction is one of the most common side effects of radiation therapy. Skin irritation occurs only over the area of the body that’s being targeted during therapy. Fortunately, most skin reactions abate within weeks or months after the end of treatment.

Mild to moderate skin reactions are most common. Mild effects are similar to sunburn, causing the skin to turn pinkish-red or very dark. You may experience discomfort, itching, swelling and pain. Your skin also may peel. In rare instances, radiation therapy may result in severe skin reactions, such as blisters and weeping. Severe skin reactions may cause more pain and greater risk of bleeding and infection because the protective layer of skin is missing.

To minimize your risk of developing side effects, your medical team will provide you with special instructions. Keep your skin clean using unscented soap products, such as Ivory or Dove. You should avoid using scented hygiene products, which can cause more irritation. Wear loose-fitting cotton clothing over the part of the body that is undergoing radiation treatment. Cotton is a good option because it’s a soft, breathable fabric. Topical products such as pure aloe gel and calendula can help soothe, hydrate and maintain the integrity of your skin. Your medical team may prescribe other remedies, such as topical steroids, pain medication and antibiotics.

Late permanent skin damage, which is less common than temporary side effects, could develop months or years after treatment. These chronic effects include firm skin texture and leathery feel, dilated blood vessels near the surface of the skin, permanent hair loss and permanent changes in skin color in the affected area only.

The intensity of radiation-related skin effects may be influenced by obesity and skin folds in the area being treated, simultaneous administration of radiation therapy and chemotherapy, poor nutrition and smoking.

While you’re undergoing radiation therapy, your medical team should evaluate your skin reaction at least once a week and more often if your reaction is deemed more severe. Discuss potential side effects with your medical team before starting treatment and regularly throughout treatment.

YOUR SKIN AND RADIATION THERAPY // Memorial Sloan Kettering Cancer Center offers information on types of skin reactions and how to manage them. // Oncology Nursing Society defines the effects of radiation on skin and lists treatment options. // University of Iowa Hospitals & Clinics discusses what to expect during treatment.

As a cancer survivor, I am still unable to sleep soundly at night. What do you recommend?


Michael R. Irwin Cousins Professor of Psychiatry and Biobehavioral Sciences at David Geffen School of Medicine at University of California, Los Angeles. Photo courtesy of UCLA

MICHAEL R. IRWIN: Insomnia rates are two to three times greater for cancer survivors than for the general population. The disorder—marked by difficulty falling asleep, waking up multiple times through the night or waking up early and being unable to fall back to sleep—can increase the risk of cancer recurrence and mortality.

Many cancer patients experience anxiety and depression during their diagnosis and treatment. As a result—and possibly because of physical discomfort and side effects of treatment—a patient could develop insomnia. Anxiety over fear of recurrence could cause insomnia even after a person has no evidence of disease. Once you’ve developed an unhealthy sleep habit, it can be difficult to reverse.

Most people gravitate toward medications to help them sleep. Sleep medications, such as Ativan (lorazepam) or any other benzodiazepine, can produce substantial difficulties in attention and concentration, increased risk of falls, and other side effects.

However, cognitive behavioral therapy (CBT)—a form of treatment that focuses on examining the relationships between thoughts, feelings and behaviors—may help you learn how to change the behaviors that may contribute to your insomnia. To start CBT, find a certified behavioral sleep medicine specialist through the American Academy of Sleep Medicine or the Society of Behavioral Sleep Medicine.

In the meantime, you can adopt CBT techniques for insomnia. For example, when you can’t sleep for more than 10 minutes, get out of bed and do something that’s calming, such as reading in a dim setting, until you feel sleepy. Avoid using electronic media, such as computers, smartphones and tablets, because exposure to excessive light at night can disrupt sleep or worsen a sleep disorder.

You may want to try to exercise regularly. Mind-and-body practices such as meditation, yoga and tai chi can help reduce stress and improve your sleep. One study showed that cancer survivors who attended two 75-minute yoga sessions for four weeks saw improvement in their insomnia.

Avoid napping during the day, which can disturb sleep patterns. Maintaining a regular sleep-wake schedule of going to sleep and waking up at the same times every day also can help—as well as using the bedroom only for sleep and sex, and removing the TV from your room. Limit caffeine and alcohol, which can cause you to wake up during the night and make you feel less rested.

OVERCOMING INSOMNIA // National Sleep Foundation provides tips for developing healthy sleep habits. // The National Cancer Institute sheds light on treatment-related causes of sleep disturbances for cancer patients. // The Dana-Farber Cancer Institute shares information on integrative therapies, such as yoga and meditation.