Quality of Life

Once you are considered a survivor, you still have a significant amount of care ahead of you—taking care of yourself, and recuperating. After cancer, you may find that a lot of elements of your life have changed, particularly your quality of life. Part of taking care of yourself is paying attention to your emotions and feelings that may arise. Also, taking care of your body by eating well, exercising, sleeping, and achieving balance and eliminating or reducing stress will help you stay healthy and feel like your old self, and improving the quality of your life.

EMOTIONS AND BREAST CANCER

Part of being a cancer survivor is that you may have some residual emotions after your experience. You may have anxiety or stress over what the future holds; you may have anxiety regarding your financial situation, or about going back to work. Also, you may experience depression. Know that you can always contact your doctor and discuss these issues, and he or she may recommend counseling, joining a support group, or possible medication. There are solutions to alleviate your stress and worry.

BODY IMAGE AND SEXUALITY AFTER BREAST CANCER

Experiencing breast cancer can have short-term or long-term effects on your body. Short-term effects such as hair loss are difficult, but can be alleviated by using a wig or a scarf while your hair grows back. Other more long-term effects, such as a single or double mastectomy, can be more devastating to your body image.

Hormone changes in the body may affect your interest in sex, or may also increase your chances of early menopause. You should be honest and open with your spouse or significant other with your feelings, and you can also seek solace in a support group or with a counselor. You can always discuss options with your doctor to alleviate any of these symptoms.

FOLLOW-UP CARE

After your cancer treatment is over, you still need to schedule your follow-up care. The best approach is to speak with your doctor to develop what is called a “survivorship plan.” This can be a schedule of doctor’s visits, or scheduled tests. Your doctor may suggest a specific exercise regimen or a diet. This will help put you on the right track to proactively manage your own care, and to know what to expect as a survivor.

EXERCISE

Regular exercise has many benefits, as it can help relieve stress, improve your mood, and give you more energy. Also, you may be able to lose weight and reduce your risk for other diseases such as diabetes or heart issues. Consult your doctor before beginning an exercise regimen to ensure that you are healthy enough to start. Going for a walk or a run can help blow off steam and can be a fun activity to do with your friends or family. Remember to start small and build up gradually; don’t tackle a marathon, start by walking around the block.

STRESS, FEAR AND CONCERNS

As a cancer survivor, you will encounter new challenges in your new life. Many of these challenges, which can vary from physical, to social, to financial, can cause you some stress or anxiety. You may have a fear of recurrence of the cancer. There are other issues you may have to address as well. Thankfully, there are many programs, approaches and tools that you can employ to face and address these challenges.

CONCERN FOR FAMILY MEMBERS

After surviving breast cancer, you may be concerned for your family members and the risk of your family members having breast cancer as well. Although it is unclear if the cause is genetic, your family members may have an increased risk of having breast cancer due to genetics or living similar lifestyles. The younger that you were diagnosed, the higher the risk of another family member having cancer as well. Also, if two members in one family were diagnosed with breast cancer or ovarian cancer, then there is a higher risk for there to be a gene mutation.

Deciding to proceed with genetic testing for you or your family members is a big decision. This decision can also lead to other concerns. Your doctor can refer you to a genetic counselor to guide you through this process and inform you of all the risks and benefits of opting for this testing.

You can discuss the risks with your mother, sisters and daughters, as well as the men in your family. Although male breast cancer is rare, it is a possibility. Your family members may opt to be screened or tested for cancer or for gene mutations. Once again, healthy living that involves exercise and eating well is always a great precaution to take to lower your risk of cancer.

COPING WITH STRESS

Experiencing and surviving cancer can cause significant stress. Even after your treatment is over, you may experience residual stress, or stress in relation to your new life as a survivor. Either way, there are many proactive ways in which you can deal with this stress. These ways include seeking out a support group, mindfulness meditation, exercise and psychotherapy.

There are many support groups that exist, both in-person and online, or via telephone. By interacting with those who may have had the same experiences as you, you may be able to reduce your stress or anxiety, or learn ways in which to cope with your stress. Mindfulness meditation can help you learn to relax and control your thought process, which may help with anxiety. Also, exercise is a great outlet in which to focus your energy, and it may make you feel better and in more control of your body. Counseling, or psychotherapy, provides you with the opportunity to speak with someone, as well as the ability to gain a few helpful techniques to manage your stress.

FEAR OF RECURRENCE

A common fear for breast cancer survivors is the fear of recurrence. Recurrence can occur where the original breast cancer was found, which is called local recurrence, or it can be found elsewhere in your body, which is called metastasis or distant occurrence. If you notice a change in your body, the local recurrence can be found via an exam or via a mammogram. Local recurrences can occur within the first five years of your diagnosis, where the risk of metastasis can vary, depending upon your treatment and diagnosis.

Your risk of getting a new breast cancer is higher than for someone who has not had breast cancer. If a new tumor is found, this is called a second primary breast cancer, which is unrelated to the first tumor; whereas a recurrence would be the return of the first breast cancer. Those who opt for a lumpectomy for their first breast cancer are also at risk for getting a second primary cancer in either breast. However, if a woman had a mastectomy for their first breast cancer, she is only at risk for getting cancer in the remaining breast.

Unfortunately, preventative surgery does not improve the rates of survival for breast cancer survival, including the mastectomy of the healthy breast. A prophylactic mastectomy is only recommended for women with the BRCA1/2 gene mutation, or women who have had radiation therapy to their breast or chest wall. These women should consult with their doctor regarding treatment options and possibilities.

In addition, those with a BRCA1 or BRCA2 gene mutation have a higher risk of a second primary breast cancer; this is about 40-65 percent lifetime risk for women with a BRCA1/2 mutation. Also, there is a higher risk of ovarian cancer with this gene as well. Women with this mutation should speak with their doctor regarding preventative measures to reduce the risk of any type cancer.

RETURNING TO WORK

During your treatment, you may be unable to work and have to take leave or work part-time. Once you feel ready to return to work, speak with your doctor to determine both a realistic timeframe to return to work, as well as to determine if you will be able to work part-time or full-time.

Returning to work may help you socially and mentally, and get you out of the house and back into your routine. Some people may not be able to work full-time, or may not be able to or want to return to their previous job. You can use career counselors and career resources to determine what you would like to do, or what would be a better job for you at this point in your life. Your human resources representatives at your current job can help accommodate your needs and help you transition back to work.

SUPPORT FOR COPING WITH CHALLENGES

You can find support to help you as you face these new challenges. Support groups, both in-person and online can help, along with speaking with a therapist. Also, getting involved with other survivors and possibly giving back through volunteer work to help other cancer survivors may help you as well.


Post-Treatment Health Concerns

Pregnancy after breast cancer

Chemotherapy can change your body, and can possibly affect your ovaries and your chance of becoming pregnant. The best approach is to discuss your desire to have a child in the future so that your doctor can take steps to ensure that you will be able to do so. In addition, the timing of your possible pregnancy post-treatment is important as well.

Cancer concerns after treatment

After treatment, your primary worry may be that the cancer can come back, or you can have a secondary cancer. Being proactive, keeping a schedule of checkups and appointments, and communicating with your doctor will help you be proactive in your survivorship care.

Follow-up care after treatment

After your treatment, you should speak to your doctor regarding the next steps in your care, as well as what to expect. Your doctor will be able to provide you with a survivorship plan, which will let you know how often you should have checkups, what scans or tests you need, and when to schedule those tests. Having this plan will make you feel more confident and proactive during a time which can be full of uncertainty.

Can I lower my risk of cancer coming back?

Surviving cancer is a major feat. Ensuring that it doesn’t return is a valid concern that survivors may have. Although no one activity or action can guarantee that cancer will not return, there are several proactive things you can do to try to minimize your risk as much as possible. Essentially, controlling your weight or losing weight if you are overweight is a great first step. This is in conjunction with eating well and exercising. Also, not smoking and reducing your alcohol intake can have a great impact on your overall health and reduces the risk of cancer returning.

Second cancers after breast cancer

Breast cancer survivors are susceptible to having cancer again, which is called a “recurrence” and they are also susceptible to possibly getting another type of unrelated cancer, which is called a “secondary cancer.” The most common secondary cancer for breast cancer survivors is a cancer in the opposite breast from the breast that had cancer. Other secondary cancer types are: salivary gland cancer; esophagus cancer; stomach cancer; colon cancer; uterine cancer; ovarian cancer; thyroid cancer; soft tissue cancer (sarcoma); melanoma of the skin; and myeloid leukemia (AML).

There are a few other factors that may increase the risk of secondary cancers. Some genetic risk factors, such as having the BRCA gene, increase the risk of having breast or ovarian cancer. Lung cancer is also a risk for women who had a mastectomy and then had radiation therapy afterwards. This can be exacerbated by smoking. Also, the risk of sarcomas of blood vessels (angiosarcomas), bone (osteosarcomas), and other connective tissues in areas that were treated is increased with radiation therapy. Radiation therapy is also carries a higher risk of leukemia and myelodysplastic syndrome.

Menopausal therapy after treatment

In order to reduce the adverse effects of menopause, such as hot flashes, doctors often prescribe PHT, which consists of female hormones. However, studies have found that taking PHT can increase the likelihood of cancer recurrence in breast cancer survivors, so it is not recommended. Patients should discuss alternate treatments with their doctor to ease the symptoms of menopause, which can include eating soy products, other medications, or acupuncture.

Late side effects of cancer treatment

Once you have completed your cancer treatment, there might be some late side effects from this treatment. Side effects may affect the part of the body that was treated, as well as other parts that may not have been directly treated. These effects are described below.

Bone loss

Chemotherapy, hormone treatment and other treatments may cause your bones to become thinner. The only way to monitor this is to keep up with your regularly-scheduled doctor’s appointments, where you may have tests to determine if you have had any bone loss. Eating well, exercising, and not smoking and limiting alcohol will help reduce the risk of bone loss.

Brain changes

Chemotherapy drugs and radiation can affect your brain, leading to problems with memory, poor concentration, processing delays and inhibited mobility. Any of these issues can be addressed with the help of your doctor, who may encourage you to work with a physical therapist, an occupational therapist or other appropriate specialist.

Endocrine system changes

Your endocrine system can also be affected through your cancer treatment. The endocrine system is comprised of organs and glands that control bodily functions such as growth, sexual development, reproduction, sleep and metabolism. Again, working with your doctor to pinpoint the problem and then developing a plan of action is the best way to address any endocrine system changes.

Eye problems

After cancer treatment, there is the risk of developing cataracts or dry eye syndrome, which can be treated by an ophthalmologist through drugs or possible surgery.

Hearing loss

Hearing loss is another consideration, which can be addressed by an audiologist.

Heart problems

Chemotherapy and cancer drugs may cause changes to the heart.  Talk with your doctor about this, as you began to plan your treatment.  Also, eating well, exercising, maintaining a healthy weight and not smoking can help with your heart health.

Joint changes

You may experience joint changes, which is the result of scar tissue, weakness and bone loss. Or your range of motion for a particular part of your body may change; this is even more specific to a body part that received radiation. Your doctor may suggest physical therapy or another solution to alleviate your pain or increase your range of motion.

Lung problems

Another side effect of cancer treatment is having lung problems, such as issues breathing or coughing. This is even more likely if you have had radiation to your chest area. Your doctor may prescribe steroids, oxygen therapy, or a regimen of exercise to lose weight.

Lymphedema

If you had radiation to your lymph nodes or if your lymph nodes were damaged during surgery to remove your lymph nodes, you may be more likely to develop lymphedema. Lymphedema occurs when lymph fluid does not drain properly and accumulates, causing swelling. This can develop during your treatment, after treatment, even years after treatment. Swelling may start slowly in your arm or leg, or can affect your head or neck. Your doctor can address this issue and suggest therapies such as lymphatic massage, wearing compression garments, or exercise to manage and treat lymphedema.

Mouth changes

Treatment can also affect your mouth, through dry mouth, cavities, and gum and teeth issues. Frequent checkups with your dentist post-treatment will ensure that your mouth and teeth are consistently monitored.

Managing fatigue
How to recognize fatigue

Fatigue can be difficult to recognize. It is a general feeling of exhaustion, even if you haven’t done too much that day. Fatigue can also make you disinterested in participating in other activities. Instead of being temporarily tired, these symptoms may continue for weeks. Symptoms include little energy; disinterest in normal activities; difficulty concentrating or speaking; and sleeping a lot.

Possible causes of fatigue

Many cancer treatments can cause fatigue. Surgery and anesthesia can inhibit your body’s natural rhythms, not to mention medication, discomfort, etc. Radiation can sap your energy and when concentrated on a bone, it can reduce your blood cell count, which can make you fatigued.  Hormonal therapies mimic menopause, which can cause hot flashes, which may disrupt your sleep. Targeted therapy medicines, such as chemotherapy, can reduce the number of immune cells that are produced, which can increase your likelihood of having an infection, which can contribute to fatigue. Also, pain medications may reduce the quality of your sleep, which will make you tired; steroids can lead to weight gain and muscle loss, which can also contribute to fatigue.

Fatigue and depression

Fatigue is a side effect of cancer, but depression can be a side effect as well. Fatigue can lead to depression too. Also, the possibility of entering menopause up to ten years earlier than normal can lower your hormone levels and lead to postpartum depression. Either way, if you are not sure if you are depressed, fatigued, or a combination of both, you should see your doctor to identify the problem and find a viable solution. This solution may include a referral to a psychiatrist, medication, talk therapy, or a combination of all three.

Ways to manage fatigue

There are many ways to manage fatigue. First, there are complimentary and holistic medicine techniques, from acupuncture to yoga, which can be used to manage fatigue. Exercise, such as walking, is also a great way to combat fatigue. Eating a healthy diet and eating enough nutritious food will help as well. Depending on the cause of your fatigue, certain medicines may help alleviate your symptoms. Other ways include integrating naps into your day, sticking to a sleeping/waking schedule, and tracking how you feel daily in a journal.

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