Survivorship

Now that your physical treatment is over, you will enter a new phase of your recovery. Finishing your treatments is only one step to your recovery. You are now entering the next stage of your recovery which is just as important but a little less dramatic.

All the side effects of having had cancer need to be addressed. With some women there are a few issues and with others there are a multitude. Some are relatively easy to improve and others will take hard work.

I would like women to feel more educated and empowered about their ongoing healthcare and have put together some information below to help you Your life will not be the same and I would like to help you deal with the “new normal”.

The New Normal:

This includes physical, social and psychological changes. I ask my patient to fill out a quality of life questionnaire at the end of treatment to try and target issues that result from treatment . We can then make a treatment plan to tackle these.

Physical:

You will have changes in your body after treatment. Some of them will improve with time or can be modified and some are permanent. This is a guide to help you improve physically post surgery.

Breast Surgery:

Pain - Most women will find they have occasional pain and twinges in their breast post surgery. This is usually due to scar tissue pulling on the small nerves that run across the chest wall. Radiotherapy will thicken the scar tissue and make the pulling worse. It is for this reason that massage of the breast post surgery and post radiotherapy is so important. As the scar tissue is stretched, the nerves are pulled less often and the pain will settle. Please see the section on Post Operative Scar Care. You will need to massage the scar daily for the first year with hydrating cream such as MooGoo. After this you can do it less often depending on your symptoms. As radiotherapy effects continue for years (it is also protecting you during this time), you may find that the symptoms will start up again and you will need to restart massage until they resolve again. The massage will also improve the skin quality, lumpiness and the scar. If you have issues with continuing pain, please tell me as there are many therapies we can use to treat it.

Scarring- Massage improves the appearance and also the feel of the scar. Scars can become hypertrophic or raised or even keloid where the scar overgrows the original scar site. Bio oil, rosehip oil, silicone tape and laser treatments can be beneficial. If you have a problem with your scar, please discuss it with me.

Armpit (axilla): Common issues after surgery to the armpit include altered sensation, pins and needles, pain down the arm and in the armpit. This usually occurs right after surgery and improves with time. Massage, gentle stretching and special “nerve calming” medication can be used to help this settle. Please let me know so that I can help.

Mobility- It is very important to do the exercises that are given to you after surgery as they will keep your arm and shoulder moving. You should get complete movement back in your arm and shoulder after your surgery. If you find that you don’t or that there is a band of scar tissue, called “cording” , keeping your arm from complete movement, I have a team of physiotherapists who will use a combination of exercise, massage and laser to get you back to normal.

Lymphoedema- Swelling in your arm after axillary surgery. Prevention is the best form of attack. A lymphoedema prevention course, the wearing of a compression sleeve during treatments, massage, laser, regular exercise- these can all help. If you should develop swelling in your arm, even if it is many years after your surgery, please let me know so it can be treated as soon as possible to prevent it from becoming worse and improve the symptoms.

Appearance- Even with the most advanced plastic techniques and with every care taken at the time of surgery, multiple factors can result in a less than perfect cosmetic result. . In addition, there is often a size difference and “droop” difference between your breast that has had surgery and radiotherapy and the opposite breast. This can occur immediately or some time after your original surgery , for example as radiotherapy effects increase or if you gain weight and asymmetry becomes more pronounced

If this is an issue, please know that there are many options now to improve your result including lipofilling to fill out defects, mastopexy , and reduction to improve the size match between breasts ( see MASTOPEXY, LIPOFILLING, BREAST REDUCTION).

Chemotherapy effects:

These are many and occur during your treatment but also beyond. There are al sorts of treatments that can be used to help you through these.

Breast cancer network Australia and Breast cancer .org have very good sections on how to manage chemotherapy effects during chemotherapy. Also try Cancer Australia.gov.au and cancer.net

The main things my patients complain about after chemotherapy are:

Tiredness- Everyone is tired after chemotherapy. Please allow yourself time to recover. Exercise is one of the most positive steps you can make. Start out slowly- the Encore programme (www.ywcaencore.org.au), half an hour walk a day, yoga, swimming and build up from there.

“Chemobrain”- The technical term is cognitive impairment. Up to 70% of women find this is an issue at some point. Although it usually spontaneously settles in the year after finishing chemotherapy, using online therapies such as brain training will speed up recovery and will help prevent permanent effects. Try online brain training such as BrainHQ (www.brainhq.com).

Tingling in fingertips and toes – B vitamin supplement will help your nerves repair faster. Follow the recommended dose

Menopause symptoms– These are due to oestrogen suppression-. Symptoms include hot flushes, insomnia, depression, vaginal dryness, loss of libido, bone density loss, musculoskeletal pains. The list goes on. The good news is there are interventions that can be used to help with all of these symptoms. I recommend a menopause clinic visit if there are multiple symptoms to be improved.

Musculoskeletal symptoms: Anti-inflammatories, paracetamol and yoga

Vasomotor symptoms: exercise, acupuncture;for more serious symptoms prescription medication such as clonidine, gabapentin, SSRIs

Vaginal dryness- simple lubricants, lignocaine gel, Mona Lisa laser ( see the vaginal dryness information sheet)

Loss of libido – psychosocial issues: support to cancer survivors and their partners on the internet (www.rekindleonline.org.au).
Physical issues: testosterone gel

Psychological :

Counseling:

Once you get through your treatments, you will take stock of your life. It is normal to feel depressed- it is almost an anticlimax after what you have been through. Please do not feel that you need to cope with this on your own. Talking about it can be very important.

Common things women say to me after their treatment:

“Am I going to feel like this forever?”

“Why do I feel depressed?”

“Is this it? I have finished all my treatments but I am not back to normal”

“Is this normal”?

A breast cancer diagnosis is a life changing, emotional experience. I would recommend that everyone with a breast cancer diagnosis consider at least one counseling session to help process the experience. I have a wonderful group of counselors who work specifically with patients with a cancer diagnosis. Counseling can be invaluable to help with the stress and fear of diagnosis, living with a diagnosis of breast cancer, and to deal with the effect of cancer on the family unit, both partners and children.

Support groups: There are a lot of support groups out there to fit every need. Please think about joining one. A problem shared is a problem halved.

Fear of Cancer Recurrence:

70% of cancers experience moderate to severe symptoms. It can impair quality of life and increase psychological distress.

Younger patients are particularly vulnerable

Talking about it is an important first step.

See the ” 10 ways to manage fear after diagnosis” information sheet

Social:

A diagnosis of cancer may change the way you feel about friends, family and work. People are always trying to be helpful and connect. Often the “helpful” stories are not helpful. It is all right to say “I only want to hear happy endings”.

Reassessing your life: Most women reassess their lives after this life-changing event. This is a very positive step in your life. You may find that there is nothing you wish to change but now is the time to check.

Question your life:

Do I like what I am doing? Is it fulfilling me? Am I taking care of myself?

Change your life if appropriate: Do the thing you have always wanted to do but were too afraid to try.

Do you hate your job? Are you working too many hours? Are you not taking care of yourself? Now is the time to address this.