Healthy Breast Cancer Survivorship
by Kenneth D. Miller, MD and Melissa Camp, MD, MPH with Kathy Steligo
Breast cancer and treatment are behind you and you’re a member of the cancer survivors’ club. You may feel a wonderful sense of relief and closure. At the same time, you may feel sad and maybe anxious that you’ll no longer have the frequent interactions and constant monitoring of your health care team, particularly if you’ve built a strong bond with them.
Life won’t necessarily be exactly as it was before, however, because the experience will likely have changed your perspective. Despite the hardships, breast cancer can be a life-changing gift that forces you to look at life in a different way. You have the power to determine what that change will be. It may involve holding on to things that are familiar or opening yourself to new ideas; you may reassess your priorities and make positive changes in your life. Breast cancer may have shown you an inner strength that you didn’t know you had and a newfound self-confidence and motivation to make the most of every day. This is the “new normal” that survivors often describe. Some survivors also talk about “post-traumatic growth syndrome,” which describes this personal growth during or after the challenge of cancer.
Overcoming Uncertainty about the Future
Whether you’re a “glass half full” or a “glass half empty” type of person, you may feel anxious and uncertain about breast cancer returning. As you move into your life beyond breast cancer, certain things may trigger unease. You may worry that every follow-up scan and test may find a new tumor. Media stories about breast cancer, the anniversary of your diagnosis, or hearing about someone else who has been diagnosed may also make you feel vulnerable, while every headache, cough, or ache that develops may seem ominous. It’s important to understand the signs of recurrence so that you can alert your physician as soon as possible if any of them occur. Remember that many of these symptoms can be caused by other conditions as well. Although recurrence is always a possibility, most survivors never need breast cancer treatment again.
Identifying these emotional triggers and talking about them can help you preemptively address them and minimize the effect they have on your life. Share your fears with your family. Talk in person or online with members of your support group, who can give you the benefit of their experience. Discuss your worries with your health care team, and be honest about what you don’t understand or what you fear. Just having the conversation can make a positive difference, but they can’t help you if you’re not vocal about issues that concern you.
Having a Survivorship Care Plan that clearly describes your follow-up monitoring and care can help you feel less vulnerable, enabling you to focus on the present and avoid worrying about things that may never happen. Living with hope is empowering. Living with fear and uncertainty compromises your physical well-being and your ability to enjoy life and to make plans for the future. Realize that you’ve done everything that can be done to beat your breast cancer, so that you can now focus on living your life and enjoying each day. If you can’t seem to shake your fear that breast cancer will return, speak to a therapist about cognitive behavioral therapy, which can help reduce your anxiety and replace negative thought patterns with positive ones.
Moving in the Right Direction
Taking charge of your health is the best thing you can do for your overall mental and physical well-being. Studies suggest that maintaining a healthy lifestyle has a more significant impact on longevity than intensely screening for recurrence.
Give Your Body the Nutrition It Needs
Eating nutritionally balanced meals is something you can do to improve your overall health, no matter your age. If you’re not sure where to begin or how to revamp otherwise less-than-healthy eating habits, visit choosemyplate.gov or consult with a nutritionist who can help you create an easy-to-follow plan. Many informative books are available, but avoid the ones that promote fad diets.
- Choose a primarily plant-based diet that includes a variety of fruits, vegetables, whole grains, beans, legumes, nuts, seeds, and lean protein.
- Eat mostly whole foods, rather than prepackaged, processed, or fast foods.
- Limit your intake of meat and other animal products, which are high in saturated fats.
- Avoid or limit sugary sodas and presweetened beverages.
- Consume healthy fats, including avocado, olive, canola, and sunflower oils, but do so in moderation, because all oils are high in calories. Limit use of coconut and palm oils, which are highly saturated.
- Enjoy fatty fish (salmon, anchovies, sardines, trout, and others) twice weekly.
- Keep snacking to a minimum. When you do snack, have fresh fruit or vegetables, a handful of nuts, or low-fat yogurt instead of cookies or chips.
- Season foods with herbs and spices. Limit salt and salty foods.
- Avoid drinking alcohol or limit consumption to one glass or less per day.
- Read nutrition and ingredient labels, and make good choices.
Maintain a Healthy Weight
Whether you were slim or heavy before your diagnosis, you may have gained weight as a result of being treated with chemotherapy, steroids, or hormonal therapies. Being overweight or obese not only affects your overall health but also increases the likelihood of having a recurrence. You’re more likely to gain weight if you become post-menopausal within a year of your diagnosis.
Nearly two-thirds of women who are treated with chemotherapy gain weight. This may be surprising, considering that the stereotypical image of patients who take chemo is that they’re extremely thin. Weight gain during chemotherapy depends on how long you take the medication and the level of steroids that you need to decrease the risk of an allergic reaction or to minimize nausea and other side effects. On average, women gain 5 to 6 pounds while on chemotherapy, compared to no weight gain in women who are treated with surgery alone or tamoxifen. Added pounds may also result from high-calorie comfort foods that you may have indulged in during your treatment and less physical activity if you were fatigued or felt ill much of the time. You may also weigh more now if your treatment brought on early menopause.
Losing weight can take time, and it isn’t always easy. Experts recommend healthy eating and regular physical activity to lose one or two pounds per week. Avoid fad diets that promise rapid weight loss; research shows that you’re more likely to keep weight off when you lose it slowly and steadily.
Stay Physically Active
Exercise is beneficial for both mind and body. Always check with your doctor before starting an exercise program. Although physical activity generally improves overall immune system response, it may not be recommended if your immune system is suppressed from medication or other reasons. Exercise can also be of benefit if you have lymphedema. A certified lymphedema therapist can show you how to gradually increase your upper body strength without increasing fluids in your arm.
- If you’re not used to being active, begin with a 10-minute daily walk and gradually increase your time and distance.
- Strive for 150 minutes of moderate exercise or 75 minutes of vigorous activity each week, and include strength training at least two to three days per week.
- Incorporate exercise into your daily activities such as park away from your destination and then walk to it.
- Exercise with a friend or a group to stay motivated.
- Change up your exercise routine periodically, so that your muscles don’t get used to what you do.
- If you feel fatigued, try scheduling exercise at a time during the day when your energy level is at its highest.
Don’t Smoke, Vape, or Chew Tobacco
Tobacco in any form, including secondhand smoke, carries dangerous carcinogens. Continuing to smoke after your diagnosis can have dire consequences: your risk of dying from breast or other cancers, respiratory disease, or cardiovascular disease is greater than the risk of survivors who have never been smokers. Talk to your doctor or contact the American Lung Association (lung.org) if you need help.
Get Enough Sleep
More and more research shows that getting enough quality sleep is vital for mental health, physical health, and quality of life.
Insomnia is twice as common among breast cancer patients and survivors as it is in the general population. Stress, anxiety, side effects of medications, and other health conditions can keep you awake. This is problematic because, in addition to feeling tired and experiencing reduced concentration and memory, losing sleep can decrease the effectiveness of your immune system against disease. Some studies have found that reduced sleep may be a risk factor for developing breast cancer, and that not getting the recommended seven to eight hours of daily sleep may affect survival after diagnosis.
Try the following tips to make it easier to fall asleep and stay asleep:
- Open your curtains or go outside to get some exposure to natural light every day.
- Exercise regularly, but not within two or three hours before bedtime.
- Nap for no more than 20 to 30 minutes, and never in the late afternoon or evening.
- Avoid alcohol and caffeine, especially in the evening.
- Go to bed at about the same time.
- Avoid tobacco products; nicotine is a stimulant.
- Avoid using electronic and mobile devices two to three hours before bedtime. They emit blue light that reduces melatonin, a hormone that makes you sleepy.
- If you can’t get to sleep, get up and do something relaxing until you feel sleepy again.
You may be free of breast cancer, but you’ll still need follow-up care once your treatment has ended. Follow-up care is important to manage any persistent treatment side effects and to treat any long-term or late side effects that develop, including lymphedema, thickening of the lung (fibrosis) from radiation therapy, or heart problems from chemotherapy or from anti-HER2 trastuzumab. National guidelines recommend that you continue to be monitored by your oncologist for at least three years after your primary treatment. All other care related to your overall health should transition back to your primary care physician.
Follow-up visits to your doctor also increase the chance of detecting any recurrence early on and screen for other cancers. Routine lab tests and imaging aren’t generally recommended to screen for recurrence because they often reflect false positive results and they don’t improve survival outcomes or quality of life in women who don’t have symptoms, a regular mammography is recommended if you still have your natural breast(s).
Compared to someone who has never had breast cancer, if you’re a breast cancer survivor, you have a higher risk for another diagnosis in either breast. You also have elevated risk for colon, uterine, ovarian, thyroid, melanoma, and other cancers. So, in addition to screening for a breast cancer recurrence, it’s important that you’re routinely screened for these cancers as well. You may need additional or more frequent testing and follow-up if you’re at high risk.
Your Survivorship Care Plan
Everyone who completes cancer treatment should have a Survivorship Care Plan that details their diagnosis and treatment and outlines long-term follow-up care. Ideally, your doctor should prepare and discuss this report when your treatment ends. Ask for it, if your doctor doesn’t provide it, or use the American Society of Clinical Oncology’s easy-to-use online tool (cancer.net), and ask your physician to complete it.
Dr. Kenneth Miller, a medical oncologist at the Alvin & Lois Lapidus Cancer Institute at Sinai Hospital of Baltimore, MD, is the past director of outpatient oncology at the University of Maryland’s Greenebaum Cancer Center. He is the editor of Choices in Breast Cancer Treatment: Medical Specialists and Cancer Survivors Tell You What You Need to Know. Dr. Melissa Camp is a breast surgicaloncologist at Johns Hopkins Hospital and the Johns Hopkins Breast Center in Baltimore, MD. Freelance writer Kathy Steligo, a two-time breast cancer survivor, is the author of The Breast Reconstruction Guidebook and the coauthor of Confronting Chronic Pain and Confronting Hereditary Breast and Ovarian Cancer.
This article was excerpted from The Breast Cancer Book: A Trusted Guide for You and Your Loved Ones, A Johns Hopkins Press Health Book