29 July 2022
Tessa Miller
A breast cancer diagnosis can be a life-changing event. During and after treatment, people with breast cancer deal with physical and emotional changes that might include fatigue, nausea, stress, menopausal symptoms (in females), sexual side effects, and poor body image. Additionally, monitoring for recurrence of cancer can be worrisome, but is a crucial part of post-treatment care.
Here's what to know about living with breast cancer during treatment and in the months and years after treatment.
During Treatment
Breast cancer treatment comes with a long list of side effects that vary depending on the type of treatment (surgery, chemotherapy, radiation, hormone therapy, targeted therapy, or immunotherapy), but almost always include fatigue and nausea.
Fatigue
This is the most common side effect of cancer treatment.¹ It differs from regular fatigue in that it doesn't resolve with resting or taking it easy; instead, cancer-related fatigue feels consuming and affects daily activities. It can even continue for some time after treatment is completed.
If you're experiencing fatigue during breast cancer treatment, tell your healthcare provider. Your provider can order tests to check for an underlying cause like anemia, which can be exacerbated by cancer itself or by cancer treatments.¹
Doctors may also suggest pain-management adjustments, nutritional changes, and ways to help you sleep better and longer. And while it may feel counterintuitive to exercise, three to five hours per week of moderate physical activity has been shown to help the effects of cancer-related fatigue.¹
Nausea
This is another common side effect of breast cancer treatment, especially when receiving chemotherapy. It is important that you speak to your healthcare provider about managing nausea, as it can lead to vomiting, which can then lead to dehydration and malnutrition.²
There are several medications that doctors prescribe, called antiemetics, that work to reduce nausea. Some people may also want to ask about medical cannabis, which has potential benefits for reducing nausea and increasing appetite.³ Additionally, some may find relief via ginger tea, chews, or lozenges.²
Mental Health Effects
Breast cancer treatment is not only physically taxing but also mentally challenging. It's normal for women and men with breast cancer to feel stressed, anxious, and depressed.⁴,⁵ You might question the success of your treatment, feel isolated due to a lack of social support, or worry about the cost of treatment.⁴,⁶ So while it's important to take care of your physical self and manage the side effects of treatment, don't forget about your mental healthcare needs.
Many people with breast cancer find support through therapy (look for a therapist who specializes in cancer or chronic illness), mental health medication, breast cancer support groups, writing or journaling, making art, gentle exercising if you're able, and meditation or other mindfulness practices.⁷ If you are feeling helpless or are thinking about self harm, reach out to your care team immediately or call the U.S.-based mental health hotline by dialing 988.
After Treatment
People with breast cancer require care after their treatment is completed to keep an eye on cancer coming back. Further, treatment side effects can linger or new ones—known as late side effects—can show up months or even years after treatment.
Follow-up Care and Monitoring for Recurrence
The American Society of Clinical Oncology (ASCO) recommends standard exams and procedures to monitor for the recurrence of breast cancer.
Women
Recommendations for women include a physical exam every three to six months for three years following the completion of treatment, then every six to twelve months for the next two years, and once every year after that.⁹
During this exam, your doctor will check your breasts or chest (depending on if you've undergone a mastectomy), chest wall, and underarms. Your doctor should also check for bone tenderness and bone density, any lung changes, abdominal pain or tenderness, cardiac changes, neurological changes, and perform a gynecologic exam. A gynecologic exam is especially important for breast cancer patients who were treated with tamoxifen, a hormone therapy that can increase the chances of endometrial cancer.⁹
Next is a mammogram. Following breast cancer treatment, women typically receive a diagnostic mammogram every year for three to five years; after that, they can usually switch to screening mammograms. If you've had a mastectomy, mammography might not be recommended; instead, your doctor will rely on a physical examination and may recommend MRI.⁹
Other tests, including X-rays, CT scans, and PET scans, are not standard after breast cancer treatment in patients who are asymptomatic. However, these tests may be recommended in patients who have symptoms or if standard follow-up procedures suggest a recurrence of cancer.⁹
Early Menopause
Menopausal symptoms are common after breast cancer treatment and may include hot flashes, night sweats, vaginal changes including dryness, trouble sleeping, emotional and mood changes, incontinence, and osteoporosis.¹⁰ If you're experiencing any of these symptoms after breast cancer treatment, it's important to talk to your doctor.
Hormone-replacement therapy (HRT) is not usually recommended for early menopause or menopausal symptoms after breast cancer treatment as it can increase the chances of recurrence. Instead, doctors recommend lifestyle changes and complementary therapies.
Sometimes antidepressants, including SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin and norepinephrine reuptake inhibitors), are recommended to help reduce hot flashes, though they also come with their own set of side effects.¹¹ Importantly, post-treatment menopausal symptoms often go away on their own over time.
Sexual Side Effects
After breast cancer treatment, women can experience sexual side effects—both mental and physical. These may include:¹²
- Loss of libido or desire
- Vaginal dryness
- Pain during intercourse
- Changes in self-esteem
Many suffer in silence due to embarrassment, shame, not knowing who to turn to for help, or not understanding what kind of help exists. They may think addressing their sexual health is "frivolous" or wasting their doctors' time. (It is neither--sexual wellbeing is closely linked with quality of life after breast cancer.) Healthcare providers, too, need to do a better job making space for these important conversations.¹²
For physical side effects, including dryness and discomfort, your doctor will be able to recommend treatments such as vaginal moisturizers or lubricants and vaginal dilators.
Your doctor may recommend pelvic floor therapy, a kind of physical therapy that targets the muscles supporting your urinary and reproductive organs.¹³
Just as important as tending to physical side effects is caring for emotional ones. Behavior interventions that can help breast cancer patients after treatment include in-person or online sexual health programs, support groups, and therapy. These tools assist by educating patients about their "new" bodies, teaching them how to communicate with partners, helping them re-discover what feels good, reducing anxiety and distress surrounding sex, and increasing self-esteem.¹⁴
Body Image
Breast cancer can have a negative impact on body image, especially in women who've undergone mastectomies (breast removal surgery). After mastectomy, some women report negative emotions about the appearance of scars, feeling less attractive than before surgery, incomplete, less feminine, or less sexually desirable.¹⁴
The severity of these feelings can depend on a person's culture, support system, how they felt about themselves before surgery, their partner's attitude, and societal pressures or expectations. Women who undergo mastectomy also make highly personal and often stressful decisions about whether to have breast reconstructive surgery, wear a prosthesis or padding, or "go flat" (mastectomy without reconstruction or prosthesis).¹⁵
It's normal to wrestle with confusing feelings after breast removal surgery, which is why connecting with other people who've had a mastectomy can be so helpful. Having a support system that understands what you're going through is invaluable. Additionally, an experienced therapist can guide mastectomy patients as they sort out their own thoughts and feelings from those of society.
It can also be affirming to find new ways of connecting with your body. Examples include dancing, swimming, running, yoga, walking, meditation, painting or photographing a self portrait, riding a bike, taking a bath, or viewing your body in a mirror without judgment. Perhaps most important is for mastectomy patients to treat themselves with kindness and compassion as they navigate their changing bodies.
Recap
During breast cancer treatment, fatigue, nausea, and stress are among the most disruptive side effects. And even when treatment is complete, women and men may experience various side effects from treatment and may need follow-up exams and procedures to monitor for the recurrence of breast cancer. Thankfully, there are many tools available to help with the physical and emotional effects of breast cancer duing and after treatment.
Sources:
National Cancer Institute (USA)
Yours sincerely
Frank Short
