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Supportive care for breast cancer
Supportive careSupportive careTreatment given to improve the quality of life of people who have a serious illness (such as cancer). helps women meet the physical, practical, emotional and spiritual challenges of breast cancer. It is an important part of cancer care. There are many programs and services available to help meet the needs and improve the quality of life of people living with cancer and their loved ones, especially after treatment has ended.
Recovering from breast cancer and adjusting to life after treatment is different for each woman, depending on the extent of the disease, the type of treatment and many other factors. The end of cancer treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with long-term side effects. A woman who has been treated for breast cancer may have the following concerns.
After breast cancer surgery, the arm and shoulder on the side where the woman had surgery can become stiff and sore. Radiation therapy can also cause changes to the flexibility of the arm and shoulder. Rehabilitation exercises after breast cancer treatment can help a woman regain and maintain movement and mobility in the arm and shoulder.
A breast prosthesis is used to restore the natural shape of the breast. The decision to use a breast prosthesis is based on the woman’s needs, desires, lifestyle and other factors.
Swelling in the breast, armpit or arm immediately following surgery is normal, and goes away in a few weeks after surgery. Lymphedema is a chronic form of swelling that occurs when lymph fluid builds up in the soft tissues of the limbs. It usually occurs in parts of the body where large numbers of lymph nodes have been removed. With breast cancer, lymphedema is caused by the removal of the lymph nodes in the armpit (axilla) area. Lymphedema can also be caused by cancer spreading to the lymph nodes.
The lymph nodeslymph nodesA small, bean-shaped mass of lymphatic tissue along lymph vessels (tubes through which lymph fluid travels in the body). Lymph nodes store lymphocytes (a type of white blood cell that fights germs, foreign substances or cancer cells) and filters bacteria and foreign substances (including cancer cell work like small filters in the body, removing abnormal cells, bacteria and foreign substances from lymph fluid. There is a greater chance that swelling or infections may develop on the side of the body from where lymph nodes are removed or damaged.
Lymphedema can occur immediately, months or even years after breast cancer treatments, such as:
- axillary lymph node dissection (ALND)
- Women who have had ALND are at risk for developing lymphedema.
- sentinel lymph node biopsy (SLNB)
- Women who have this procedure have a smaller risk of developing lymphedema than women who have had ALND because fewer lymph nodes are removed.
- radiation therapy
- Lymphedema can also occur after radiation therapy to the armpit, which can cause scarring or blockage that may slow the flow of lymph fluid.
Some women will develop permanent lymphedema. This usually occurs within 2 years of breast cancer treatment, but sometimes occurs much later.
Menopause occurs naturally as women age, usually when a woman reaches her early 50s. Menopause is caused by a drop in the levels of hormones produced by the ovaries, mainly estrogen and progesterone. Menstrual periods become irregular until the amount of estrogen becomes so low that a woman’s periods stop completely.
Women may experience treatment-induced menopause as a result of breast cancer treatment. Some chemotherapy drugs used to treat breast cancer, especially cyclophosphamide (Cytoxan, Procytox), may cause the ovaries to stop working. This is particularly true for older women who are close to natural menopause. In younger women, periods may return after chemotherapy is completed, but this may take up to a year.
Hormonal therapy for breast cancer may cause menopausal symptoms, such as changes in menstruation and hot flashes, but does not cause treatment-induced menopause.
Osteoporosis is a condition in which there is loss of bone mass (density) and bone tissue deteriorates. Bones become weak and can break easily. Osteopenia is a loss of bone mass that is not as severe as the loss with osteoporosis. A drop in estrogen levels is the most common cause of osteopenia or osteoporosis.
Women treated for breast cancer may be at a higher risk for osteoporosis. Some types of hormonal therapy for breast cancer reduce the estrogen levels in the body, which may speed up bone loss. These hormonal therapies include:
- aromatase inhibitors in post-menopausal women
- ovarian ablation (with surgery or drugs) in premenopausal women
Tamoxifen (Nolvadex, Tamofen) does not reduce estrogen levels in the body and may protect the bones in older, post-menopausal women by acting like a weaker form of estrogen. However, tamoxifen lowers bone mass and can cause osteopenia in premenopausal women.
Chemotherapy for breast cancer may also cause premature menopausemenopauseThe time in a woman’s life when her ovaries stop producing estrogen and she has not had a menstrual period for 12 months. Most women start menopause between 45 and 55 years of age. in premenopausal women, which reduces estrogen levels in the body.
Other risk factors that increase a woman’s risk of developing osteoporosis are:
- increasing age
- Women older than 65 years of age are at an increased risk.
- low calcium and vitamin D intake
- lack of physical activity and exercise
The more risk factors that a woman with breast cancer has, the greater her chance of developing osteoporosis.
Cording is a problem that may occur after breast surgery. A series of tender, painful, cord-like structures develop below the skin in the armpit area. These cords may run down the arm, and often extend past the elbow to the wrist.
The exact cause of cording is not known. The cords may be lymph channels or small veins that have been damaged during surgery. It usually occurs a few weeks after surgery. Cording can cause:
- tightness in the armpit and arm
- Some women may not be able to straighten their arm.
- problems moving the shoulder (limited range of motion of the arm and shoulder)
Treatment is given by a therapist experienced in treating lymphedema and may include daily stretching and range-of-motion exercises. In most cases, cording goes away on its own over time.
Many women experience pain after breast cancer surgery. In most cases, this pain goes away over time.
Post-mastectomy pain syndrome (PMPS) is neurological nerve pain that occurs after breast surgery and continues longer than 3 months.
PMPS is more common in women who have a mastectomy, but pain can be felt by women who have axillary lymph node dissections and breast-conserving surgery (BCS) as well. Younger women and overweight women are more at risk of developing PMPS. It may be caused by:
- damage to the nerves in the breast and armpit during surgery
- development of scar tissue in the remaining nerves
Pain may be felt in the chest, armpit and arm on the side of the surgery and includes:
- dull or aching
- stabbing, sharp or shooting
- worse with moving the shoulder or arm
Treatment for PMPS may include:
- pain medications
- anti-inflammatory drugs
- opioid analgesics
- nerve pain medications
- transcutaneous electrical nerve stimulation (TENS)
- capsaicin cream – a type of cream made from red chilli peppers
- Some studies have shown that capsaicin cream may improve pain caused by nerve damage.
Phantom breast pain is feeling pain in the breast that has been removed. A small number of women may experience phantom breast pain after a mastectomy. The brain keeps sending signals to nerves in the breast area that were cut during surgery, even though the breast is no longer there.
Women who had breast pain before mastectomy are at a greater risk of developing phantom breast pain. The symptoms of phantom breast pain may include:
- tingling ("pins and needles")
- a sense of pressure on the chest
Phantom breast pain often goes away after a period of time. Women should report phantom breast pain to their healthcare team.
Phantom breast pain is treated like PMPS.
How a person feels about or sees themselves is called self-esteem. Body image is a person’s perception of their own body. Breast cancer and its treatments can affect a woman’s self-esteem and body image. Often this is because cancer or cancer treatments may result in body changes, such as:
- the loss of a breast
- hair loss
- changes in body weight
Some of these changes can be temporary, others will last for a long time and some will be permanent.
A woman may feel differently about her body and herself as a woman after treatment for breast cancer. She may feel less like a woman or less feminine because she no longer has a breast or has lost her hair. These feelings may be a concern or cause of distress for some women. In some treatment centres, there may be group programs and individual counselling that help women deal with the problems around changes to self-esteem and body image.
Nutrition and breast cancer
Many women diagnosed with breast cancer are concerned about the role of nutrition during treatment, recovery and recurrence.
Physical activity and breast cancer survival
Research suggests that women who are physically inactive are at an increased risk of developing breast cancer. Some research studies have suggested that physical activity may reduce the risk of a breast cancer survivor dying from the disease. Other studies have shown no reduction in breast cancer mortality. More research is needed to study the role that physical activity may have in breast cancer survival.
Being obese increases a woman’s risk of breast cancer. There is growing evidence from studies that have shown that weigh gain after a breast cancer diagnosis may have a negative effect on breast cancer survival and increases the risk of recurrence. Many women gain weight during breast cancer treatment for a number of reasons.
- Regular exercise routines may be interrupted because of treatment.
- Treatment side effects like fatigue, nausea and vomiting can decrease the desire to exercise.
- Hormonal therapies and some chemotherapy drugs can cause weight gain, even if the amount of food that a woman eats does not change.
- Some treatments for breast cancer increase appetite.
- Women may spend more time at home where it is easier to eat more.
- Some women eat more when they are under stress, anxious or depressed.
Physical activity plays a role in maintaining a healthy body weight. It can prevent weight gain during treatment or help women lose weight gained during treatment.
Physical activity and breast cancer recovery
Physical activity can play a key role in recovery from breast cancer, and research has shown that it can reduce the symptoms of chemotherapy and hormonal therapy.
Other benefits of exercise after breast cancer treatment include:
- increased energy levels
- less fatigue, anxiety and depression
- stress reduction
- improved cardiovascular fitness
- higher self-esteem
- better quality of life
Breast cancer survivors can follow tips to get active to make wise choices about physical activity:
- Accumulate 30–60 minutes of physical activity every day or most days of the week to stay healthy or improve health. The time needed depends on the effort. As you progress to moderate or more vigorous activities, then you can cut down to 30 minutes, 4 times a week.
- Start slowly. Gradually build up the level of effort or intensity of activity.
- Add up activities in periods of at least 10 minutes each.
Younger women diagnosed with breast cancer may have concerns about their ability to get pregnant and have children after treatment is finished.
Breast cancer surgery or radiation therapy to the breast does not affect a woman’s ability to get pregnant. But both chemotherapy and hormone therapy for breast cancer can affect a woman’s fertility.
- Chemotherapy may damage the ovaries and cause some women to go into menopausemenopauseThe time in a woman’s life when her ovaries stop producing estrogen and she has not had a menstrual period for 12 months. Most women start menopause between 45 and 55 years of age. early. This depends on the woman’s age, which chemotherapy drugs are used and the dose given.
- Even if normal menstruation continues during treatment, or resumes after treatment is finished, fertility may be reduced or completely lost.
- hormonal therapy
- ovarian ablation
- Surgery to remove the ovaries in a premenopausal woman causes permanent menopause.
- Drugs used for ovarian ablation cause temporary menopause during the 2–5 years that women take them.
- Women on tamoxifen (Nolvadex, Tamofen) should not get pregnant.
- Studies in animals have shown that the drug can cause damage to the unborn baby.
- ovarian ablation
Women concerned about their fertility should talk to their doctors before their breast cancer treatment starts. Women who wish to preserve their fertility may be offered some or all of the following options:
- Treatment with chemotherapy combinations that are less likely to affect fertility.
- Hormonal therapy given for a shorter period of time.
- Referral to a fertility centre before starting chemotherapy or hormonal therapy.
Many women continue to have strong, supportive relationships and a satisfying sex life after breast cancer. However, breast cancer and its treatment can have an impact on a woman’s sexuality.
Facing the financial burden of cancer
The Canadian Cancer Society provides helpful information about government income programs, financial resources and other resources available to families struggling to make sense of the personal financial burden they face.