Life After Cancer
Life After Cancer is a publication from NIHSeniorHealth's Web site, which features basic health and wellness information for older adults from the National Institutes of Health.
Click here to visit the Life After Cancer Web site.
Who is a Cancer Survivor?
Follow-up care after cancer treatment ends is very important because it helps to identify changes in your health. Your follow-up care depends on the type of cancer and the type of treatment you had, as well as your overall health.
The effects of cancer treatment vary among patients. Some side effects continue after treatment is over, while some can develop after treatment has ended. Many older adults have other health conditions such as diabetes, heart disease, and osteoporosis. Sometimes it is hard to tell if physical changes are the effects of cancer or its treatment, or are caused by other health conditions or simply the result of getting older.
Some of the most common problems that older cancer survivors report are
- memory and concentration problems
- pain and nervous system problems
- mouth or teeth problems
- weight gain or loss
- bladder and bowel problems
Physical Changes - Fatigue
Fatigue, or feeling extremely tired, is the most common complaint during the first year after cancer treatment ends. Cancer-related fatigue is different from everyday fatigue. Rest or sleep does not help it. For some survivors, fatigue is mild and temporary, but for others it can last for months after treatment and makes going about daily activities difficult.
Doctors do not know the exact cause of treatment-related fatigue, but many factors may contribute. The causes seem to be different for people who are undergoing treatment than for those who have finished treatment.
Fatigue during treatment can be caused by cancer therapy. Chemotherapy, radiation therapy, and other therapies may cause fatigue. Other problems such as anemia (having too few red blood cells), stress, poor nutrition, lack of exercise, and depression may be linked to this type of fatigue. Researchers are still learning about what may cause fatigue to linger after treatment ends.
What can you do about fatigue? The best thing you can do for fatigue is talk to your doctor or health care professionals about it so you can get the help you need to deal with it. Ask them about the medications you are taking and if they could affect your energy level. Talk to them about how to manage any pain, nausea, or depression you may have. They may also be able to suggest medications or nutritional supplements that may help lessen your fatigue.
Here are some other ways you can manage or cope with your fatigue.
Plan your day so that you balance rest and activity. Be active at the time of day when you feel most alert and energetic. Take short breaks or naps throughout the day, rather than one long rest period. Too much rest can decrease your energy level.
Save your energy. For example, change the way you do things. Sit on a stool while you cook or do dishes. Take rest breaks between activities. Decide which activities are more important and which ones aren't. Try to let go of things that don't matter as much now.
Let others help you. Don't be afraid to ask your family or friends to help with the things you find tiring or hard to do. This may be a task such as preparing meals, doing housework, or running errands.
Think about joining a support group. Talking about your feelings with others who have had the same problem may help you find new ways to cope.
Physical Changes - Memory, Pain, and Nervous System Problems
After cancer treatment, some people find that they can't pay attention or remember things the way they used to, have pain that remains, or have problems with damage to their nervous system. These changes may be side effects of treatment.
Some survivors notice that they can't focus on the job at hand or they have trouble remembering details like names and dates. Sometimes it takes them longer to finish tasks, because their thinking and processing seems to be slower. For older adults, it can be hard to tell whether changes in memory and concentration are because they are getting older or are the result of treatment.
These changes, sometimes called "chemobrain", can begin during cancer treatment or they can occur much later. The exact causes are unknown, but people who have had chemotherapy or who have had radiation to the head seem to be more likely to experience these problems.
The best thing you can do about memory and concentration problems is to talk with your doctor. Discuss whether medications you are taking, depression, problems sleeping, or anxiety could be contributing to your problems. If these problems last for a long time, your doctor may suggest that you see a specialist who can help you.
Here are some ideas that can help with your memory and concentration.
- Jot it down. Write down your appointments, important dates, and phone numbers. Make lists and write down plans for your day
- Put small signs around the house to remind you of things to do, such as locking the doors.
- When doing a task with several steps, such as cooking, whisper each step to yourself.
- Repeat what you want to remember. Saying it a couple of times can help your mind hold on to the information.
Some people have a lot of pain after cancer treatment, while others have less. Some types of pain associated with cancer include pain from surgery and pain or numbness in the hands or feet caused by nerve injury following some treatments.
Another type of pain is called phantom pain. If you have had a limb or breast removed, you may still feel pain or unusual feelings that seem to be coming from the absent (phantom) body part.
Many older adults are reluctant to ask for help to relieve their pain. Some may believe that pain is just part of having cancer and of aging, or fear that taking pain medications will cause drug addiction. Some think that mentioning pain or discomfort makes them a problem for caregivers. Others are afraid that their doctor won't focus on curing the cancer if they spend their time treating pain.
But you don't have to be in pain. Controlling your pain is a way to help you feel better and stay active. And newer medications made available in this past decade have helped control pain due to cancer better than ever before.
Talk to your doctor. Describe your pain as clearly as possible and point out where it hurts. Describe how it feels -- sharp, throbbing, etc. Explain how often it occurs, how long it lasts, and what seems to trigger it, make it worse, or lessen the pain. Explain how the pain affects your daily life.
It may be useful to keep a "pain diary" or record of your pain that includes
- the time of day you experienced the pain
- how much pain you had -- usually based on a scale of 0-10, where "0" is no pain and "10" is the worst pain imaginable
- the activity you were doing when you felt the pain
- how well medications worked to relieve your pain.
Based on the severity of your pain and what seems to be causing it, your doctor may recommend pain-relief or other types of medications, physical therapy, or other things that may help control your pain such as relaxation techniques, acupuncture, or meditation.
Nervous system problems
Sometimes cancer treatment can cause damage to your nervous system or problems with nerve functions. This is called neuropathy and the severity and symptoms vary widely from person to person.
Neuropathy can occur at any age, but it is more common in older adults. It can also be caused or made worse by other conditions that are a concern for older adults, including diabetes, kidney failure, and malnutrition.
Most people first notice symptoms, such as tingling or numbness, in their hands or feet. Other common symptoms include sudden or sharp pain sensations, loss of sensation of touch, loss of balance or difficulty walking, trouble picking up objects or buttoning clothes, and being more -- or less -- sensitive to heat and cold.
Symptoms can start during or after treatment. Symptoms can improve over time, but it may take up to a year or more. If you start to notice these types of symptoms, talk to your doctor or health care professionals right away. They may suggest medications or pain patches to help alleviate symptoms, or other approaches such as physical therapy.
Here are some steps you can take to help manage nervous system changes.
- Pay attention when handling knives, scissors, or sharp objects. Neuropathy can reduce pain sensation, so you could get a wound and not feel it.
- Avoid falls. Pay attention when you walk and if necessary, use a cane to help steady yourself. Remove objects that you could trip over.
- Wear shoes with rubber soles.
- Avoid extreme heat or cold. Wear gloves and hats when needed.
Physical Changes - Other Changes
Some survivors experience other side effects related to their treatment that may include swelling, problems with their mouth and teeth, changes in their weight, and bladder and bowel problems.
Swelling, called lymphedema, occurs when lymph fluids build up just under the skin. It can occur after radiation or surgery to treat any type of cancer. It is most often associated with treatment of breast cancer, melanoma, prostate cancer, lymphoma, and cancers of the female or male reproductive organs.
Lymphedema most often occurs in the arms and legs, but it can happen in other parts of the body including the face, neck, abdomen, and genitals. Other conditions, such as heart disease, also can cause these symptoms.
Symptoms of lymphedema include swelling or a heavy feeling in an area like your arm, leg, or abdomen; a tight feeling in the skin; or an itching or burning feeling in the legs. If you experience any of these symptoms, tell your doctor. The chance of improving lymphedema is better if treatment begins early.
Here are some things that might help prevent or relieve lymphedema.
- Watch for signs of swelling or infection (redness, pain, heat, and fever). Tell your doctor if your arm or leg is painful or swollen.
- Avoid getting cuts, insect bites, or sunburn in the affected area.
- Keep your skin clean and use lotion to keep it moist.
- Wear loose-fitting clothing on your arms and legs.
The goal of lymphedema treatment is to control the swelling and to keep other problems from developing or getting worse. Your doctor may suggest keeping your arm or leg raised above your chest for periods of time, wearing compression bandages, or special types of massages. Under a doctor's guidance, some forms of exercise may also help control lymphedema.
Mouth and Teeth Problems
Many cancer survivors develop problems with their mouth or teeth. Radiation or surgery to the head and neck can cause problems with your teeth and gums, the lining of your mouth, and glands that make saliva. Certain types of chemotherapy can cause the same problems as well as dry mouth, cavities, and a change in the sense of taste.
The advice to help prevent and relieve mouth and teeth problems is the same for cancer survivors as for people who have not had cancer. Brush your teeth and gums after every meal and at bedtime, and floss your teeth daily. If you have dentures, clean them after every meal and have them checked to make sure they fit well.
Another tip is to avoid foods that may irritate your mouth. For example, sharp or crunchy foods such as chips could scrape or cut your mouth. Foods that are spicy or high in acid, such as citrus fruits and juices, tobacco products, and alcoholic drinks also can bother your mouth.
Weight Loss or Gain
Many cancer patients experience changes in their weight during treatment. Among survivors, weight gain is a more common issue than weight loss. Certain kinds of chemotherapy and medicines contribute to this problem.
Sometimes the added pounds stay on even when treatment ends. Breast cancer survivors who received certain types of chemotherapy gain weight in a different way -- they may even lose muscle and gain fat tissue. Unfortunately, the usual ways people try to lose weight may not work for them.
If you are having trouble losing weight after treatment ends, ask your doctor about talking with a nutritionist who can help you plan a healthy diet. Your doctor may suggest exercises that can help you regain muscle tone. Stay positive and focus on the fact that treatment is over and you are trying to get stronger.
Some cancer survivors have no desire to eat and they lose weight. To improve your appetite, focus on making foods more appealing to eat. Try the foods you liked before treatment and add some fruit or flavorings to improve the taste. Several small meals throughout the day may be easier to manage than three larger ones.
Bladder and Bowel Problems
Bladder and bowel problems are among the most upsetting issues people face after cancer treatment. People often feel ashamed or fearful to go out in public because they worry about having an "accident." This loss of control can happen after treatment for bladder, prostate, colon, rectal, ovarian, or other gynecologic or abdominal cancers.
Some surgeries to treat cancer may leave a patient with little or no bladder or bowel control. The opposite problem can happen with some medicines that cause constipation. For some people the problems improve over time, but others may experience long-term issues.
It is very important to tell your doctor about any changes in your bladder or bowel habits. Several things may help, such as medications, changes in diet or fluid intake, and exercises. Joining a support group also may be helpful, especially for survivors who have an ostomy (an opening in the body to pass waste material).
Physical Changes - Effects on Intimacy
For many older adults, intimacy remains an important need. Cancer and cancer treatment can have a major impact on intimacy and sexual function. For example, more than 60 percent of prostate cancer survivors are 65 years of age and older. Research has indicated that sexual impairment may affect 60 to 80 percent of these men, depending on the type of therapy they received.
For both men and women, some side effects of cancer treatment may inhibit intimacy. Problems are often caused by physical changes, such as erectile dysfunction or incontinence which can occur after prostate surgery. Other problems are due to emotional issues like changes in body image because of scarring or the loss of a breast.
Other emotional issues including depression, anxiety, and stress between you and your partner can play a role. Factors associated with other medical conditions such as pain or certain medications also may contribute.
Often, sexual problems will not get better on their own, so it is important to talk with your doctor. He or she can suggest a treatment depending on the type of problem and its cause. A variety of things may help, including medications, devices, surgery, exercises to strengthen genital muscles, or counseling. Talking to your partner about your fears and needs, and listening to his or her concerns, can be an important first step to recovering a sense of intimacy.
Changes in Emotions and Relationships
Just as cancer affects your physical health, it can affect the way you feel and act. It can affect the way you relate to your loved ones and coworkers and how they react to you. Surviving cancer also involves taking care of your emotions and relationships.
Changes in Emotions and Relationships - Emotions
Each person's experience with cancer is different, and the feelings and fears that you have are unique. Some typical emotions experienced by cancer survivors are fear, depression, stress, and loneliness.
Worrying that the cancer may come back is one of the most common fears among cancer survivors. As time goes by, this fear may lessen.
Long-term survivors are usually considered those who have had no signs of cancer five years after their initial diagnosis, when cancer recurrence becomes less likely. However, years after treatment, some events such as follow-up doctor's visits, symptoms similar to the ones you had before, or the illness of a family member can trigger concerns.
Finding ways to cope with the fear of your cancer recurring can help you feel better. It is important to stay positive and focus on what you can do now to stay as healthy as possible. Learning about your cancer and what you can do to take care of your body can give you a sense of control.
Acknowledging your feelings of fear, anger, or sadness can help you sort them out and may help you let them go. Talk about your concerns with family, friends, other cancer survivors, or a counselor. You can also sort out your feelings by thinking about them or writing them down.
Being as active as possible can help you focus on other things and take your mind off cancer and the worries it brings. Get out of the house and participate in activities that you enjoy. Take a walk or get some other type of exercise. Many other health benefits also have been attributed to exercise.
After treatment is over, feelings of anger and sadness may linger. For many survivors, these feelings lessen over time, but for others these feelings worsen and can interfere with their daily life. They may develop a condition called depression.
Although depression can affect anyone and is common among cancer survivors, older survivors are at a greater risk of developing depression than those who are younger. Some older adults lack social support often because they do not live near family members or have experienced loss of family or friends.
It is important for you to talk to your doctor about your feelings. If you are depressed, your doctor may prescribe medication or refer you to a therapist who is an expert in depression.
These are some signs that may indicate you need professional help for depression.
- feelings of worry, sadness, or hopelessness that don't go away
- feeling overwhelmed or out of control for long periods of time
- crying for a long time or many times a day
- thinking about hurting or killing yourself
- loss of interest in usual activities
There are also physical signs of depression, which include unintended weight gain or loss not due to treatment, sleep problems, and fatigue that doesn't get better.
Some cancer survivors feel stressed when they try to get their life back to normal after treatment ends. When you were diagnosed, you may have focused on getting better and put concerns such as those about family and finances aside. Now that treatment is over, you may feel pressured and overwhelmed as these issues begin to resurface.
Finding ways to reduce or control the stress in your life can make you feel better. Many survivors have found exercise, meditation, and relaxation techniques helpful. Taking time for yourself and devoting time to doing activities that you enjoy, such as reading, gardening, or listening to music, can also relieve stress.
Many cancer survivors feel as if others can't understand what they've been through, which makes it hard to relate to other people and can lead to loneliness. Friends and family might be unsure of how to help, and others may feel uncomfortable around you because they are afraid of cancer.
Joining a cancer support group could help you cope with the emotions that you have after cancer. By talking with other cancer survivors and listening to their experiences, you may learn new ways to deal with the problems that you are facing. Being in a group may also help you feel less alone.
There are many types of support groups for cancer survivors. Some focus on one type of cancer, while others are open to those with any cancer. Some groups include both cancer survivors and family members. Support groups may be led by health professionals or by other cancer survivors. You might need to visit one or two different support groups to find the right one for you.
Changes in Emotions and Relationships - Relationships
Cancer involves not only the patient, but also family, friends, and coworkers. This is as true after treatment as it is when treatment is going on. It's normal to notice changes in the relationships you have with the people in your life.
When treatment is over, your loved ones may expect you to be enthusiastic about getting on with your life. They may not understand that recovery takes time. Some may give you too much attention, while others may avoid you or hide their feelings because they think you have had enough to deal with.
Your loved ones also have been through a difficult time and may feel the need to resume a normal life. For example, if you did the gardening before cancer, your spouse may expect you to begin again. If you don't feel up to it, tell them and don't feel pressured to do more than you can handle.
At other times, you may expect more from your loved ones than you receive. For instance, you may still need your family's support and may expect your children or grandchildren to be as attentive as they were during your treatment, but they may not call as often as you think they should. It is important to keep the lines of communication open and give yourself time to adjust to changes. If you need more support, call your friends or family instead of waiting for them to call you.
Sometimes it's necessary to seek outside help. Ask your doctor to refer you to a counselor who can help you communicate with your loved ones. Join a support group if you feel that talking with other survivors who have gone through similar experiences would be helpful. Support groups are also available for loved ones of cancer survivors.
Many survivors age 60 and older are still working. Some may need to work, while others enjoy being around people and staying busy. Returning to work after cancer treatment is over can help you feel that your life is getting back to normal.
Just like your loved ones, friends at work may respond to you in different ways. Some may be very supportive, while others may be uncomfortable and try to avoid you. Think about the best approach for you to deal with their reactions.
Many survivors find it helpful to plan what they will say about their cancer. Some are open about discussing it, but others don't want to focus on it. You should choose what is right for you.
Frequently Asked Questions
Contact: John Amundsen, Communications Specialist | ALA Office for Literacy and Outreach Services | (312) 280-2140; email@example.com
CHICAGO – The American Library Association (ALA) has launched a Web page with resources and tools to help libraries celebrate the inaugural National Bookmobile Day, Wednesday April 14, 2010, part of National Library Week.
The page, www.ala.org/bookmobiles, features sample publicity materials including a press release, letter-to-the-editor, and proclamations for library staff and supporters to use in their communities. Also included on the page are downloadable National Bookmobile Day logos, bookmark templates, a customizable flyer, and links to National Bookmobile Day on social networking sites.
In addition, the toolkit also has links to the National Bookmobile Day community in ALA Connect, where librarians can collaborate and share ideas on promoting the event. Participating libraries can share ideas and stories on how they celebrate the contribution of bookmobiles and direct-delivery outreach.
Part of National Library Week, National Bookmobile Day is a national observance sponsored by the American Library Association (ALA), the Association for Bookmobile and Outreach Services (ABOS), and the Association for Rural and Small Libraries (ARSL).
For more information on National Bookmobile Day, please contact John Amundsen, Communications Specialist, ALA Office for Literacy and Outreach Services, at (312) 280-2140, or email firstname.lastname@example.org.
Submitted by Brigid Cahalan, Older Adult and Disability Services Specialist
The New York Public Library, email@example.com
The New York Public Library has recently had the pleasure of hosting eleven programs featuring author/computer teacher Abby Stokes speaking on the topic of Demystifying Computers. A former puppeteer and actor, Ms. Stokes knows how to masterfully connect with an audience: she specializes in enlightening the uninitiated and emboldening the cyberphobe. Since public libraries have become the place to use computers for free—and learn to use them if necessary—we librarians can all use advice on teaching older adults, and computer neophytes of any age, with sensitivity and respect. I’ve asked Abby if she would put together a list of tips, so take a look:
TEN TIPS FOR TEACHING COMPUTER SKILLS TO OLDER ADULTS
By Abby Stokes
There are unique obstacles to teaching technology to a generation that not only wasn’t born with a computer mouse in their hand, but clearly remembers when telephones were rotary dial. As a “younger” baby boomer, the transition to computers came a lot easier for me than it did for my mother. But, if she is any example, anyone can learn to use a computer with gentle, patient, and creative guidance.
There are three motivating factors that inspire most silver surfers to take on the challenge of the computer – the Internet, e-mail, and a desire to not be left behind. Keeping those three objectives in mind, here are my 10 tips on how to successfully bring the computer fearful onboard and, hopefully, enjoy the experience the computer and Internet have to offer:
1) Watch Your Language. You probably shouldn’t cuss at the computer or your student, but that’s not what I mean. Be aware of the words you chose. You’ll lose someone in the first 5 minutes if you speak computer jargon. They don’t need to know computer terms in order to use the computer, so avoid tech talk unless absolutely necessary.
2) What Turns Them On? Before sitting down in front of the computer ask your student what interests them. You want to be able to dazzle them what the Internet has to offer specific to their needs and interests. What questions would they like answered? What are their hobbies? What is their family into that they would like to know more about?
3) Slow And Steady Wins The Race. Most seniors are not in a rush - you shouldn’t be either. Assume that you are always going too fast. Take your cues not from the agenda you’ve set for the lesson, but instead the look in the eyes of your student. Eyebrows raised in surprise are good. A furrowed brow and a glazed look are bad. When you see the latter, you need to back up and figure out where you lost your student and start again from there.
4) Shake It Up. Before you even turn on the computer have your student put both hands on the monitor and shake it a little. Take the mouse in your hand and swing it by its tail. It reassures the fearful to know that the computer is just a big plastic box and nothing more. A little levity, with the intimidated, goes a long way.
5) Play Wingman. Your student should start in the driver’s seat from the get go. They do all the hands-on controlling of the experience starting with turning the computer on. Think basic, basic, basic and assume they don’t know anything, but can learn everything.
6) Conquer The Mouse. Any activity on the computer can be broken down into step-by-step instructions to be practiced until the steps become habitual. But, until the mouse is conquered, a newbie can’t practice the steps. Your first teaching session may just be about hand position, single-clicking, double-clicking, and clicking and dragging. The best way to practice all of these skills is by playing Solitaire. (I kid you not.) Be patient, reassuring, and sing their praises when they get it right.
7) Take A Break. There’s a limit to how much anyone can absorb. No matter how far you’ve gotten, stop after 45 minutes. Use a 15 minute break to talk about the importance of good posture while on the computer, what websites you find fun, or chat about the weather. You’ll know you can return to the lesson as you see your student relax.
8) A 3-Step Method. Repetition helps us remember. Do everything three times. The first time they do it is hands on. The second time they do it is to take notes. The third time they do it is to follow their notes to be sure the notes are clear without you guiding them. Example: To access the Internet and visit a new website: With their hand on the mouse you instruct them to 1) double click on the icon to access the Internet. Next have them 2) single click in the website address box to highlight and 3) type in a website address. Lastly they should 4) depress and release the Enter/Return key. Four simple steps. Do it, write it, and do it again.
9) It’s Not Their Fault. When the time comes, and it will, that a website is hard to navigate, place blame where it belongs. Shame on web designers and computer manufacturers. This could all be much easier if those who designed the computer and the Internet took into consideration user issues. Relieve your student from feeling inadequate by pointing out the flaws in design and usability.
10) Give homework. Inspire your student to get on the computer for just 15 minutes a day to practice what you’ve worked on together. It is through short, daily visits to the computer that they will be able to conquer the beast.
Abby Stokes is the author “Is This Thing On?” A Computer Handbook for Late Bloomers, Technophobes, and the Kicking & Screaming www.abbyandme.com.
By Rachel A. Gut, Outreach Services Manager, Dayton Metro Library, Dayton, OH
As amazing as it is to those of us in the field, not everyone in our profession understands the importance of Outreach; while it seems most important that the directors and boards of trustees be aware of our value, each member of the library team needs to know how Outreach services are building the future of the library every day. City councils, library boards, directors and staff need to know why what we do matters for them; too many times we advocate for our patrons and services, but don’t show what we are doing for the library as a whole. Outreach is expensive, and sometimes seen as an unnecessary indulgence. How are we relevant to the overall library, the overall community? Outreach provides 3 major commodities that all libraries need: great PR, new patrons, and high visibility in the community.
Great Public Relations
Outreach typically serves those who would not get library service any other way and are a wonderfully endless source of feel good stories. Who wants to read an article about how many items the North branch checked out? People will read a story about the bookmobile staff building early literacy skills in at risk children in head start centers, and the amazing increase in local KRAL scores. No matter how big or small a library’s outreach services department, there are plenty of heart warming stories about lives being changed because of the services offered. Even the demographics of Outreach are becoming more impressive; currently 15% of the US population is disabled, 12.5% (and rising!) are over the age of 65, 11% are new immigrants, and 6.5% are under the age of 5. That’s a lot of people, many of whom can and will vote in every election. There aren’t many directors who can ignore a ready pool of dedicated voters. Collect both the stories and the statistics, and keep them both in front of the director and board as often as you can. If they will let you, give a monthly report in any format about the Outreach services. This shows your accountability for the resources allotted to you, and makes them see the value to the community and library. Continually evaluate your services for efficiency; are you doing the most you can with what you have been given for the community you have been directed to serve? Are there ways you could do it better with new or different technology? Directors and boards know they have to be as lean as possible; by showing the value you provide for the money, you are telling them the need for Outreach Services in a language they understand.
Outreach is designed to bring in new patrons; it’s right there in the name. Reach out and bring them in. No matter what type of program, Outreach brings the library to people who had no previous service. In some programs, Outreach creates new patrons that can eventually be filtered to a stationary library; in others it provides for those who could never use a typical library. Either way, more people are using the library services and more items are being checked out. Both of those are quantifiable ways to show worth, especially to governing agencies charged with dividing the public money for public benefit. We are outgoing people, both literally and in personality; outreach staff can suggest ways additional ways to advocate for the library as a whole. Gently remind your director and board that you have the easy means to reach these patrons; instead of waiting and hoping that they will come to a library and pick up literature about your funding and the upcoming ballot issue, you can take that information directly to them. Just make sure you do it within the guidelines of the law!
High Visibility in the Community
If the library is going to compete with the police, fire and schools for public dollars, it better be very visible in the community. Outreach provides the booth at the county fair, the bookmobile in the summer festival parade, and the daily recognition of a rolling billboard on Main Street. Outreach brings program flyers, material lists and a sampling of library services where the community is, and directs the community back to the stationary library for more. Spend a little time figuring out what it would cost for the kind of publicity you provide and give that information to your director. Look for ways to track the number of people who come to the library in response to an outreach initiative. This is not easy to do; Dayton Metro Library offers an incentive program, paid for with grant money, in which a child who attends a bookmobile program gets a coupon for new, free books when they bring it into a branch. This has encouraged new patronage at DML libraries, which is one of the goals of the bookmobile program, and has provided a way to track the quantity of new patrons brought in by Outreach. Communicate these realities to your board, director and staff frequently and in as many different ways as you can. Invite them and other staff to spend time in Outreach; offer to do a job exchange or job shadow program if possible. Ask to speak to staff at department and branch staff meetings, and tell them all that Outreach is doing. Present both the numbers and the feel good stories; together they present an accurate and comprehensive picture of Outreach’s value to the library and community. Every library has different ways of communicating with staff and patrons; use your website and intranet, newsletter, bulletin board, and whatever else you have to advertise for Outreach. Each time circulation hits a new high or patron numbers are up, publicly celebrate, and include the staff, director and board in the invitation. Although those outside of the Outreach department will never fully understand what we do or how we do it, they can know how very valuable we are to the library, and what we provide beyond basic library services.