Ask CancerCare

October 2007 This Month's Topic: Coping with Breast Cancer Featured Expert: Pat Spicer, LCSW

Q. How long after completing breast cancer treatments can you still feel fatigued? Should I have any special follow-up?

A. For women who have had radiation as part of their treatment, it can take several months until their normal level of energy returns and most women report that it takes about a year after completing treatment that they begin to feel like their old selves. Remember each person's response to treatment is different so be patient with your recovery. It might be helpful to join a support group to find out ways others are managing these challenges. CancerCare offers Telephone Education Workshop (TEW) podcasts that address fatigue, including The Role of Nutrition and Exercise in Coping with Fatigue.

Fatigue is one of the most common complaints of women dealing with breast cancer. Whether it is caused by chemotherapy, radiation, taking an aromatase inhibitor or simply by stress it needs to be addressed. The first thing to do is to discuss with your doctor why you are so tired and what can be done to help.

There are some simple things you can do to help yourself:

1. Pace yourself but try to stay active; conserve your energy for your priorities and find your own comfort level
2. Take power naps, a 30-minute nap can help without disturbing your night’s sleep
3. When friends or family ask what they can do, delegate! For instance, let them drive to soccer practice or pick up the groceries
4. Try simple exercises such as walking or yoga, which can help regain energy and clear the mind

As for follow-up care, most surgeons and oncologists will continue to follow a patient at six-month intervals for the first year or two, and then on a yearly basis. Depending on whether you are continuing to take Tamoxifen or other hormonal blockers, your oncologist will schedule visits at intervals of three or six months and yearly for the next five years if you remain symptom free. Your oncologist will continue to do blood work at these visits and unless you have had bilateral surgery, you should continue to have your regularly scheduled mammograms. You can find more information though the American Cancer Society publication, What Happens After Breast Cancer Treatment?

Q. I'm 43 years old, married and facing a mastectomy. I'm insecure about how my body is going to look and being intimate with my husband. How can I maintain my femininity and a positive body image?

A. When it comes to changes in our bodies, no matter what a woman's age, those changes will challenge how we see ourselves and our perception of how others see us. This can be especially true for women who have had a mastectomy or bilateral surgery since images in the media so often place a heavy emphasis on how women look. Breast reconstruction has helped many women redefine their feelings about the loss of a breast. You might want to consult with a plastic surgeon about what options are available to you. For women who do not choose reconstruction, the use of a breast prosthesis can be a good alternative. A prosthesis can give a look of symmetry; many of the newer prostheses are made of a lighter weight material and come in special forms that can be used in swimwear and night gowns. It's important to recognize that this is a loss, and with loss comes grief. Remember that it will take time to adjust and it's a good idea to reach out for support and guidance during this time.

Treatment for breast cancer such as chemotherapy or hormonal blockers may also have side effects that can produce early menopause, vaginal dryness and a diminished desire for intimacy. Talking with your doctor about products that can reduce symptoms of dryness or discomfort can help. Opening a conversation about your concerns with your partner is an important first step. Many people don't understand the actual physical basis for diminished desire and feel they are being rejected.

How to Help Your Wife (and Yourself) Through Diagnosis, Treatment and Beyond (Rodale Inc.) by Mark Silver, is one book you and your partner might find helpful. In addition, there are several online resources that offer information addressing your concerns such as:

• American Cancer Society's "What Happens After Treatment for Breast Cancer?"
• Living Beyond Breast Cancer, www.lbbc.org
• Y-Me National Breast Cancer Organization, www.y-me.org

You can also find additional information and advice about body image and intimacy issues in our August 2007 Ask CancerCare.

Q. My mom is about to undergo chemotherapy for her breast cancer and there are so many drug regimens to choose from. Can you tell me if a test is available to determine the best course of chemo prior to her starting treatment? What else might you recommend for her to do once she begins her treatment?

A. We have received several questions about treatment options, follow up and ongoing care. CancerCare is not a medical facility; rather, we are professionally trained oncology social workers, so I will try and address your concerns generally. For any woman trying to make a decision as to what chemotherapy to be treated with, there are clinical practice guidelines established by the National Comprehensive Cancer Center (NCCN) to help physicians select the proper treatment in each individual’s case. There are also two tests available to women that can help them decide about treatment, and both tests provide information about the possible rate of recurrence of their breast cancer. The tests work with a specific type of breast cancer, estrogen receptor positive, and one such test, Oncotype DX, has been approved for payment by Medicare. Information regarding the other test is available at www.molecularprofiling.com but not does provide information whether they are approved for insurance payment. Before deciding on any treatment, make sure that your oncologist has a complete history of any additional medical problems and of any other incidences of cancer in the family. Lastly, if you have any uncertainties, seek out a second opinion.

After a diagnosis many women look for additional ways to prevent a recurrence and often explore complementary therapies as a way to help healing and promote their health. Therapies such as Yoga or mediation can provide a sense of peace and promote sleep and the ability to relax. There is little indication, however, that “natural“ remedies such as vitamins or herbs have any effect on breast cancer. If you do decide to use herbal supplements, please be sure to let your doctor know since some can be harmful when combined with chemotherapy.

For additional information and resources, please consult the Breast Cancer section of our website. Here you can find:

• TEW podcast, The Role of Targeted Therapy in the Treatment of Breast Cancer
• TEW podcast, New Diagnostic Technology in the Treatment of Breast Cancer
• Connect^® Booklet, Developments in Breast Cancer Treatment

Q. I've just started treatment for breast cancer and I need to talk about my fears and concerns with the people who are closest to me. But my family just says, "Oh, you'll be fine" and to think positively. How I can I get them to listen?

A. A diagnosis of cancer is a little like throwing a stone in the water; the ripples extend well beyond where the stone lands. Just as you are trying to deal with treatment and the concerns that go along with it, so, too, is your family. They may be anxious about how to help you and afraid they may upset you if they talk about your feelings or theirs. Much has been written about the need to remain "positive" for the person with cancer and family members are often concerned that if they express negative thoughts or concerns it will make the illness worse.

We've developed information to help address some of these communication challenges that may arise. Coping with Cancer: Tools to Help You Live and Caregiving for Your Loved One With Cancer are Connect^® Booklets that might be helpful to you and your family members. Our fact sheet, "What Can I Say to a Newly Diagnosed Loved One?" may also help your family members talk with you about your diagnosis. Another resource that many of my clients have found helpful is The Breast Cancer Companion (Avon Books, New York) by Kathy LaTour; several chapters deal with opening communication.

You might also try to set aside time to have a family meeting and allow each member an opportunity to talk about their concerns. One family I worked with used the meeting to read aloud letters they had written about their own fears and emotions, as a way to begin the discussion.

Remember, not all families can respond in ways that will be helpful. A support group might be useful to you as a way to connect with others who understand how you are feeling. CancerCare offers groups in-person, over the telephone, or online. You can also contact us at 1-800-813-HOPE (4673) to speak with an oncology social worker.

Pat Spicer, LCSW, is the Breast Cancer Program Coordinator at CancerCare. She provides individual and family counseling to women and their loved ones by telephone, online and in person as well as facilitates support groups.

The questions and answers listed above are from the October 2007 Ask CancerCare feature.  New Ask CancerCare topics are introduced every month. 

If you have additional questions about coping with breast cancer, please contact CancerCare directly for information and guidance. CancerCare provides free professional support services, including counseling, education, financial assistance and practical help. These services are provided by professional oncology social workers. If you have a specific concern or question and would like to speak with an oncology social worker, please contact us at info@cancercare.org or 1-800-813-HOPE (4673).

For questions about medical issues, please visit Cancer.net, the patient information website of the American Society of Clinical Oncology (ASCO).

Ask CancerCare Archive (questions and answers from previous months)