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Five Questions About Life After Breast Cancer With Dr. Hoover

October 27, 2017

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Dr. Susan Hoover
Dr. Susan Hoover

After fighting breast cancer many women wonder when they will get back to "normal" or even if they will ever get back to their old life. Dr. Susan Hoover, a surgical oncologist in the Breast Oncology Program at Moffitt Cancer Center, answers five questions about life after breast cancer.

1. What’s the most common question women ask after breast cancer treatment ends?

Two of the most common questions women ask after breast cancer treatment ends is typically, “when will my life be normal again?” and “am I cured?” If a woman has undergone chemotherapy it is not uncommon for it to take upwards of one year before she is feeling back to normal with improved overall endurance and strength, as chemotherapy can induce fatigue and exercise intolerance. In addition, physical side effects from chemotherapy such as hair loss can take, depending on the woman, a few months before they might feel comfortable without wearing a wig or a hat, but of course, this depends on the individual. In terms of curing women with breast cancer, there certainly is a subset of patients who are definitely cured, the problem is knowing for sure which patients are cured and which patients will likely relapse. Certainly stage of breast cancer can give some statistical predictability to a patient's overall outcome, but there are clearly patients who defy those statistics. And add to that the newer treatments that are revolutionary and state-of-the-art which is frequent in the world of breast cancer care, and we have a recipe for likely curing more breast cancer patients over time.

2. What are some tips for patients when trying to find their new normal (after their hospital visits end and they go back to their regular routine)? How can caregivers and family support them?

Studies have shown that breast cancer patients, after completion of therapy, seek to move on and return to a "normal way of life." Studies show that a desire for "normality" is a key factor in coping with breast cancer. Reminders of cancer were found to cause fear and increased insecurity. Therefore, when searching for one’s "new norm," it is important to take it one day at a time and find coping mechanisms that work, which will be different from patient to patient. For some, it may be finding enjoyment in activities they engaged in prior to diagnosis, taking time for appreciating life and expressing gratitude, volunteering, etc. Of prime importance, studies have shown that accepting the disease as a part of one’s life is a key to effective coping. Equally important is one’s partner’s acceptance of the disease as well. Studies suggest women focusing on mental strength to allow them to move on with life.

3. Are there ways to manage "chemo brain?" Does it ever go away? 

According to the National Cancer Institute, 12.4 percent of women in the U.S. will be diagnosed with breast cancer, which translates into 1 in 8 women. It is the most common cancer in women and accounts for the second most common cause of cancer deaths in women next to lung cancer. There are an estimated 3.2 million women in the United States living with breast cancer, and the mortality rates from breast cancer have declined steadily since 1990.  Many of these women received chemotherapy as part of their treatment and are living with the long-term side effects that can occur and impact a woman’s quality-of-life. Chemo brain is one of these entities and can encompass a variety of symptoms such as memory loss, inability to concentrate, difficulty in thinking, as well as a diminishment of other brain-related demands.  It is not exactly known how many breast cancer patients experience chemo brain, however many studies have looked at the cognitive dysfunction that can occur in breast cancer patients who have undergone chemotherapy.

One such study showed that 75 percent of women studied suffered from a cognitive impairment on neuropsychological tests. Other studies have substantiated that patients who've undergone chemotherapy can show a greater decline over time in cognitive function as compared to those who have never received chemotherapy. If a woman experiences chemo brain, studies have shown that it can affect quality of life as it applies to their daily living, performance in the workplace and can also have psychological effects on the woman facing these cognitive impairments and can cause feelings of dependence, being scared and emotionally drained. Not all women experience long-term chemo brain or permanent ramifications from chemo brain. This may be due to more recent evidence suggesting that chemo brain may be a more complex problem caused not only by the administration of chemotherapy but also potentially due to ramifications from surgery, anesthesia, hormonal therapy, menopause, anxiety, depression, fatigue, genetic predisposition, and other medical conditions the woman may have at baseline.

4. In regards to body image, what advice do you have? Are there certain bras that offer the best support and are there options for covering up scars from surgery?

In terms of body image, studies have shown substantial psychological ramifications for women undergoing mastectomy as many of them face concerns of disfigurement and distress as a result of losing their breast(s). Breasts are also commonly emphasized by society as a symbol of sexuality and femininity, which may be one factor as to why women seek breast reconstruction, which has become increasingly popular to remedy some of the psychological ramifications of mastectomy. There is a multitude of reconstructive options available that allow women with different body shapes and sizes as well as those who have undergone various types of breast cancer treatment, such as radiation therapy, to have the option for reconstruction. Of course, if a woman chooses not to have reconstruction then she can certainly elect to use a prosthetic within her bra. There are bras specially designed to accommodate the breast prostheses. Data shows that patients undergoing a mastectomy with reconstruction had worse body image than patients undergoing breast-conserving surgery/lumpectomy. While those who underwent mastectomy with reconstruction appeared to have fewer issues with body image than those that underwent removal of the breast without reconstruction.

Body image issues after breast cancer surgery can adversely affect quality of life and psychosocial functioning for some patients. Data shows that body image issues appear to be most prevalent in the immediate post-operative period with suggestion that these difficulties may decrease or at least stay stable after approximately two years. Management of body image issues is best addressed through mental health professionals, which is offered at Moffitt. As might be expected, younger women with breast cancer often receive more aggressive therapies including more radical surgeries and often radiation therapy. Research has found that younger women who undergo more radical surgery such as mastectomy with removal of lymph nodes and reconstruction report a higher negative body image then those who are able to conserve their breasts as in lumpectomy. This negative body image can translate into greater sexual difficulties. In addition, body image issues with cancer treatment are not solely driven by surgery but also are the result of treatment such as chemotherapy that often results in hair loss, weight gain and menopausal symptoms, which can be distressing to any woman especially those who are younger. Data also shows that women who are not satisfied with their body image after breast cancer treatment are considerably more likely to experience sexual dysfunction.

5. How long should you wait to start an exercise routine after treatment ends?

When one should start exercising depends on what treatments the patient has received. For example, with some surgeries for breast cancer, the patient may be asked to wait several weeks before gingerly entering back into an exercise routine. Timing is best determined by one's healthcare provider. That said, it is becoming more well-established that moderate levels of physical activity in patients with breast cancer may improve quality of life, decrease breast cancer recurrence and possibly improve overall survival from breast cancer. For example, 30 minutes of physical activity every day, five days a week, or 75 minutes weekly of intense exercise, may significantly reduce risk of breast cancer recurrence and breast cancer death. Avoiding weight gain after diagnosis and striving to maintain a healthy bodyweight can also go a long way in terms of possibly affecting outcomes after a breast cancer diagnosis. Data shows that women who are overweight or obese appear to have poorer survival rates.

To learn more about resources and support groups available to breast cancer patients at Moffitt, click here.

Five Questions With is an occasional series featuring Moffitt team members, patients and volunteers.