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Breast Cancer: Post Treatment 0 - 6 Months: Medical Care

Overview

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FOR ADDITIONAL INFORMATION, SEE THE LINKS AT THE END OF THIS ARTICLE

Now that treatment is over

  • it is time for healing to begin. Your breast is likely raw if you just finished radiation treatment. If you had chemotherapy, it is likely that your hair is gone. You have either gained or lost weight. In fact, you likely feel worse at the end of treatment than you did when you were first diagnosed.
  • It will take longer than expected to return to feeling normal - and much longer than you wish.

Expect physical exhaustion and ongoing symptoms after the end of treatment. You may experience:

  • Fatigue continues, possibly for at least as long as the time between diagnosis and end of treatment. For tips about coping with fatigue, see: Fatigue And How To Deal With It
  • Swelling in the arm (lymphedema) develops. There are steps to take to prevent lymphedema, or to lessen the effects if it does occur. See How to Prevent and Control Lymphedema
  • After chemo, you have aches and pains such as muscle stiffness and joint pain
  • Menopausal symptoms such as vaginal dryness or hot flashes. 
    • Anti-depressants and other drugs may reduce the frequency and intensity of hot flashes.
    • For vaginal dryness, ask your doctor about a combination of vaginal moisturizer and a lubricant. Also ask if he or she recommends a particular brand.
  • Arthritis. 
  • Headaches.
  • Your breast and surrounding area continue to be sensitive.
  • Numbness in the chest wall, arm and/or armpit.
  • Limited arm or shoulder motion.
  • Uniary track infections. (Drink a lot of cranberry juice. Call your doctor right away if you develop painful urination.)
  • Body image problems.
  • Emotional disturbances affecting mood. (For information about coping with various emotions, click here).
  • If sexuality is a problem, give it time until it returns to normal. In the meantime, there are other ways of enjoying intimate physical contact. (To learn more, click here.)
  • For specifics, see:

Get a cancer follow-up plan.

  • The National Cancer Institute recommends that everyone should have a follow-up plan. If you do not have a follow-up plan, get one from your cancer doctor or from a nearby Survivor clinic at an NCI certified cancer center. You can locate an NCI certified cancer center at: cissecure.nci.nih.gov/factsheet offsite link. Your insurance is likely to cover these services.
  • A follow-up plan describes your diagnosis and treatment. It also tells you and your non-cancer doctors what to look for that could be a long term result of your treatment or indicate a return of your breast cancer.  To learn about a follow up plan, click here.

Comply with drug regimens. Saving money should not be the only factor when determining where to purchase medications. For information, see: How To Comply With Drug Regimens. Save $ When Purchasing. Store And Dispose Of Drugs

Ask your cancer doctor when to call if any of the symptoms you have been warned about appear, or if other symptoms show up. Report all unanticipated changes in your health to primary care physician as well as to your oncologist. The symptoms could relate to your breast cancer, or to something else entirely.  An update by fax or email will do.   

Speaking of your doctors:

  • Decide which of your doctors is in charge of your overall health. It could be your primary care doctor, your gynecologist or one of your oncologists. Be sure he or she agrees to the position. Make sure all doctors report notes about each appointment to your primary doctor.
  • Prepare for follow-up visits with your doctors.
    • There are likely to be follow up visits with each of your oncologists during this period of time. There are usually also periodic imaging tests.
    • It is important to show up for all follow-up appointments and tests.
    • As with all doctor appointments, it is advisable to prepare for your appointments. For instance:
    • Keep track of your symptoms, if any. (We provide a Symptoms Chart to make it easier).
    • Keep track of questions as they arise so you don't forget them. (You can do that on our Prioritizer. Then, before you go to the appointment, you can reorder your questions to your priority with the click of a button).
  • If you haven't already, learn how to maximize your time with your doctor.
  • If you didn’t like your experience with your oncologist, and can’t get over glitches in your relationship, consider changing doctors. Your oncologist will be in your life for a long time – possibly for the rest of your life.
  • Depending on what works for you, consider seeing all your doctors on one day, or purposefully spreading visits so you have set occasions to ask questions and talk about symptoms that don’t seem serious enough for an immediate call.
  • NOTE: It is advisable to keep your own copy of your medical records for future reference and in case you see a new doctor.

If you are overweight, lose the extra weight.

  • Studies show that women who are overweight or obese have an increased risk for recurrence of breast cancer.
  • As you know, the key to weight loss is to consistently burn more calories than you consume by eating and drinking. Studies show this is not so easy because we tend to underestimate the amount of calories we consume and overestimate the amount of exercise.
  • A simple solution is to keep a food diary. It doesn't have to be fancy. American Cancer Society tells you how to construct and keep a diary. Click here offsite link.

Exercise can help to resolve physical and emotional dificulties.  

  • Speak with your doctor about what exercise you can and cannot do, and when. There are recommended exercises for after breast surgery.
  • Consider asking for a referral to a phsyical rehabilitation program or to a physical therapist. Either or both may be covered by health insurance.
  • Click here for information about exercises after breast surgery.

Take precautions. Women who had breast cancer are at increased risk for developing a second breast cancer. 

  • Give yourself a breast exam monthly.
    • Most recurrences are identified by women doing their own breast exam.
    • If you have a question how to give yourself an exam, see the American Cancer Society web site: "How To Perform A Breast Exam" at www.cancer.org. offsite link
    • If you find anything suspicious, call your cancer doctor right away. It may not be anything. If it is, the earlier you find out, the better.
  • Review your breast cancer follow-up plan which describes actions to take and symptoms to watch for. (If you didn’t get one, ask your oncologist for one.)
    • Read the plan carefully to be sure you understand what it says.
    • Ask about any parts of the plan that are not clear to you.
    • Give a copy of the cancer follow-up plan to your primary care doctor.
    • Report unanticipated changes in your health to both your oncologist and primary care physician.
    • Keep all appointments noted in the follow-up plan. There is a reason each one is there. “Feeling great without symptoms” is not a reason to miss a follow-up appointment (nor is a symptom you fear may be a recurrence).

Adopt a cancer prevention diet and lifestyle. For instance,

  • If you smoke quit. It helps reduce the odds that cancer will reappear. You’ll also reduce your risk of heart disease and other smoking related illnesses.
  • If you are overweight, now is a good time to lose the extra weight..
  • To learn more, click here

Take care of your mouth.

  • Infections can easily spread from your mouth through the rest of your body.
  • Practice good oral hygiene. Brush your teeth after every meal with a soft toothbrush and at bedtime. Use a toothpaste with flouride in it. Floss at least once a day.
  • Infections in the mouth can also affect healing. Check your mouth every day for changes or problems. For instance, look for bleeding or a sticky, white film, lumps, soreness or swelling. Call your dentist if any of these symptoms appear. They may indicate infection.
  • See your dentist regularly, at least two times a year.  For more information about oral care, click here.
  • NOTE: A healthy diet will help prevent tooth decay.  Avoid foods that are high in sugar content. 

Learn which symptoms that may appear should prompt a call to your doctor. Report unanticipated changes in your health to both your oncologist and primary care physician. 

If your tumor was estrogen-receptor-positive;

  • it is likely that your cancer doctor will recommend that you start hormonal therapy.
  • Hormonal therapies are systemic treatments. They treat the whole body. For women who are estrogen-receptor-positive, estrogen stimulates the growth of cancer cells. Hormonal therapies aim to reduce or eliminate the possibility that estrogen will gain access to any cancer cells.
  • Tamoxifen has historically been the most commonly prescribed hormonal therapy but there are other treatments to consider. Discuss the pros and cons of each treatment with your cancer doctor. He or she will alert you to side effects to watch for and tips for coping with each.
  • To learn more about hormone therapies, see the American Cancer Society: www.cancer.org. offsite link

Discuss gene testing with your ongologist.

  • There are two genes which increase the risk of breast cancer returning. If you have not been tested, speak with your oncologist about whether to do it now. If you have the gene, you may want to consider taking such steps as having a bilateral mastectomy (having both breasts removed).
  • According to the American Cancer Society: Doctors will sometimes suggest patients have genetic testing if others in their family have had a certain disease. If you have any of the following, you might consider genetic testing for yourself:
  • Several first-degree relatives (mother, father, sister, brother) with cancer, especially the same type of cancer.
  • Family members who developed cancer at a young age.
  • Close relatives with rare cancers.
  • A known genetic mutation in the family (from one or more family members who had genetic testing).
  • The American Cancer Society has an extensive discussion about gene therapy, including what genetic testing is, who should get it, payment, what happens during the process (including counseling), and what to do if the test shows you have an increased risk. To learn more, click here offsite link.

Continue to see your primary care doctor and other specialists that don't relate to breast cancer.

  • Your primary care doctor is charged with overseeing your entire medical condition, helping you keep your system in maximum disease fighting shape, and for being on the lookout for health conditions.
  • If your relationship with a doctor is not ideal, try to fix it. If it becomes difficult for you, consider looking for another doctor.
  • Prepare for follow up visits with your doctors as follows:
    • Keep track of your symptoms, if any. Survivorship A to Z provides a Symptoms Diary to help. (A push of a button turns it into an easy to read graph to save precious time with your doctor).
    • Keep an ongoing list of questions and concerns so you don't have to try to remember things when you're under the pressure of a short period of time with the doctor. We provide a Prioritizer to help.

With respect to drugs:

  • Comply with drug regimens. Don't take a drug holiday without checking with your doctor first.
  • Save money when purchasing drugs. For instance, shop around.
  • Store and dispose of drugs safely.

Consider complimentary treatments.

  • Complementary treatments such as massage or Yoga can help you feel in control.
  • Complementary studies are now being studied by the National Cancer Institute’s Center For The Study Of Complementary Medicines. For information about any treatment you want to consider, check www.nccam.nih.gov offsite link or call 888.644.6226 (Monday-Friday 8 – 5). Be particularly careful about treatments that you ingest or otherwise take into your body.
  • If a treatment seems too good to be true, it likely is. For example, a diet or treatment which promises to prevent the recurrence of breast cancer. Watch for fraudulent treatments at Quackwatch.com
  • Keep in mind that if a treatment didn't work, there are alternatives to consider.

Consider getting a pet. In addition to helping you feel good, a pet may prolong your life.

  • Studies show that pets are good for your physical and mental health. They can be particularly helpful in reducing stress levels during this time of transition.
  • If you own a dog, walking the dog will help you get back to exercising. 
  • The pet does not have to be a dog or a cat to have beneficial effects.
  • For information about choosing the right pet for you, care for the pet when you can't take care of it, how not to become sick from your pet, how to travel, and much more, see Pets 101

Bring humor into your life. "A laugh a day keeps the doctor away" -- or at least makes you feel better. To learn how to bring humor into your life, click here.

Don’t let a fear of recurrence keep you from taking any of the steps described in this article. (For information about dealing with emotions such as fear, see Breast Cancer: 0 - 6 Months: Emotional Well Being)

In case of an emergency or disaster: 

Advance planning

  • If you haven’t already, now is the time to assure that you keep control of your medical care even if something happens and you become unable to speak for yourself. The documents you’ll need to think about are called Advance Healthcare Directives and Advance Mental Health Directives. They are free and easy to execute. For more information.  (While you are at it, a Will helps keep control over what happens to your assets if you die. Our article includes information about how to get an inexpensive or free Will. Click here.)

Finances  While treatment may be over, medical expenses may linger or new ones may be incurred. See: How To Maximize Use Of Your Health Insurance and Breast Cancer: Post Treatment: Finances

For more information, see:


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