After Breast Cancer, Challenges Remain
"You get through the tornado, and then afterward you say, 'Good heavens, what happened to me?'"
That's how Hester Hill Schnipper, L.C.S.W., describes the feeling women may have when the acute phase of breast cancer treatment ends and the road to survivorship begins. Schnipper knows the feeling well. She's a clinical oncology social work specialist in Boston, author of After Breast Cancer—and a two-time breast cancer survivor.
When treatment is over and you can catch your breath, anxiety about your life, your health, and your future can surface. "You look in the mirror and say, 'Who is this? This is not the person I have lived inside all these years. Everything is different,'" Schnipper says.
Support is missing
One thing that's missing is the constant support of health care providers you had during treatment. As a result, Susan Brown, R.N., manager of health education for Susan G. Komen for the Cure, a group that fights breast cancer, says the post-treatment phase may find women feeling alone and misunderstood.
Family and friends "think a woman should be relaxed and back to normal, but really it can be a time of more anxiety," Brown says. The old way of life may have given way to a "new normal." Fear of recurrence joins with initial fatigue, hair loss, and perhaps discomfort from breast reconstruction.
Schnipper says it generally takes at least as long as the total duration of treatment—months at best—to feel physically well again. Other aspects of recovery may take longer. "The first thing I say to women is that you will get through this," she says. "As hard as it seems now, you will feel much better a year or two from now, both physically and emotionally."
Here are some tips for proactive post-treatment recovery:
Confront checkups with awareness. The first five years after treatment are filled with exams, screenings, and fear the cancer will return. The first mammogram can be especially trying, Schnipper says. "Take a friend or meet someone later on that day." And Brown says you should make sure you know before treatment ends exactly who will manage your after-care.
Consider changes in diet. No specific diet targets breast cancer, but weight plays a role. "We do know that being overweight increases a person's risk for breast cancer," says Brown. Try to get less than 20 percent of your calories from fat, and avoid alcohol. A well-balanced diet rich in fruits, vegetables, healthy fats, and whole grains can help you look and feel better. A healthy diet can also take off pounds, a common side effect of chemotherapy.
Exercise for energy and your future. "The more exercise you do the better," says Brown. "Physical activity seems to reduce a person's risk of getting breast cancer initially and also decreases the risk for recurrence." A University of Missouri study found exercise can speed recovery and help patients better manage side effects.
Find the right support group. The best group for you is likely one that's focused on your phase of recovery. It's important to keep searching if the first group doesn't click. Younger women may find it doubly important to reach out, since friends may be at a very different life stage. A support group can be the best place to share stories that provide a sense of belonging.
Manage relationship issues. Schnipper says there is no evidence that marriages often end in divorce after breast cancer. Some marriages do not survive, but experts say it's usually because the relationship was already rocky. Partners must work through any issues of sexuality that occur.
Schnipper advises patients to realize their mates are also stressed. The two of you must approach breast cancer like any serious problem that requires honest communication and patience.
How to avoid lymphedema
Lymphedema is a familiar side effect of breast cancer treatment. Lymph nodes in the armpit are often removed surgically or affected by radiation. Lymph vessels can become blocked, causing swelling. Studies show that perhaps half of all survivors experience at least one episode of swelling. Up to 30 percent experience persistent swelling.
In a recent study of young survivors, Ohio researchers and survivor Electra Paskett, Ph.D., found that lymphedema can affect how women view their lives. It can restrict movement and cause pain, discomfort, and embarrassment. Getting quick medical help for heaviness or swelling in an arm or hand can help prevent recurrence.
Tips for prevention:
Wear gloves for house or garden work.
Don't carry heavy bags or a purse on that arm.
Wear a compression sleeve when flying.
Avoid blood pressure checks on that arm.
Don't cut cuticles.
Use insect repellent and sunscreen.
Avoid tight jewelry or clothing.