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Coping with the Long-Term Side Effects of Breast Cancer Treatment


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Treatment for breast cancer may trigger a variety of side effects that typically subside as treatment ends. Unfortunately, some symptoms linger for some individuals, while other effects may begin later. Medical oncologist and epidemiologist Kathy J. Helzlsouer, MD, MHS, says that the best way to cope with any side effect is to be alert and to remember that there are explanations and often treatments for the symptoms you may face.

“You have to be especially careful that you are not attributing something to cancer or its treatment when it could be something else,” says Dr. Helzlsouer, director of the Center for Prevention and Research at Mercy Medical Center in Baltimore, MD. “The key thing is to get symptoms sorted out. See what is going on and what is correctable.”

Dr. Helzlsouer shares a story about a woman she had treated for breast cancer years ago who had been doing extremely well when she noticed she was a bit more tired than usual. “Her astute internist thought he should look a little further,” she says. “He found she had a mild cardiomyopathy – a weakness of the heart muscle – which was readily corrected with medication. She’s doing very well again.”

Heart disease is a high risk for all women and may be made worse by treatments.

Once someone has been treated for cancer, it’s always like there is “an elephant in the room,” Dr. Helzlsouer explains, referring to a lingering anxiety over recurrence. “There is always the fear that the cancer is back. Many things that come up, however, are due to other underlying health problems, and these things often can be corrected.”

Fatigue is a common problem, even years after treatment. Heart disease is a high risk for all women and may be made worse by treatments, so possible cardiovascular problems should always be checked with fatigue. Thyroid problems and sleep apnea should be checked as well.

There is hope for relief from fatigue, even for women with no discernable medical condition, Dr. Helzlsouer says. “We found that a program we developed that focuses on relaxation techniques, exercise, diet, and attitudes (shifting to the positive) was very helpful, reducing fatigue by about 40 percent.”

Other long-term side effects may include the muscle aches resulting from hormone therapy that some women take, which usually go away when therapy ends, or cognitive effects from chemotherapy, which also often improve with time. Lymphedema (swelling of the arm on the side of the surgery) and depression are other possibilities. Dr. Helzlsouer suggests being vigilant of early signs of these conditions and seeing your healthcare provider. With good interventions early on, many of these problems can be controlled or reversed.

“Sexuality is another big issue that is largely unaddressed,” says Dr. Helzlsouer. “If your healthcare provider is uncomfortable discussing these issues with you, however, you should find a specialist to help.”

Such a specialist is Michael Krychman, MD, CM, author of 100 Questions & Answers for Women Living with Cancer: A Practical Guide for Survivorship, certified sex counselor, medical director of Sexual Medicine at Hoag Hospital, and obstetrician/gynecologist who heads the Southern California Center for Sexual Health and Survivorship Medicine in Newport, CA. According to Dr. Krychman, up to 90 percent of breast cancer survivors have sexual complaints at one time or another. These complaints include everything from sexual pain because of dryness, to lowered libido, to fear of rejection, and everything in between. While many women trace these complaints to treatment, an underlying psychological concern may be change in body image. “You can overcome these problems,” he says.

Dr. Krychman follows a holistic approach with his patients, he says, working closely with physical therapists and acupuncturists, so it’s not just about medication. “It’s about mindfulness training and acupuncture. It’s about becoming re-educated and dispelling a lot of myths,” he says.

There are many interventions women can try, according to Dr. Krychman. Like Dr. Helzlsouer, Dr. Krychman suggests that women seek out specialists who can help. “Quality of life, sexuality, and sensuality are very important issues for breast cancer survivors,” he says.

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Excerpted with permission from Breast Cancer Network of Strength®, www.networkofstrength.org.

Breast Cancer Network of Strength provides immediate emotional relief for women with breast cancer through the YourShoes™ 24/7 breast cancer support center staffed by breast cancer survivors, with interpreters in 150 languages. Call (800) 221-2141 or visit www.networkofstrength.org.

This article was published in Coping® with Cancer magazine, November/December 2009.