By Julie Gralow, MD
Director of Breast Medical Oncology,
Seattle Cancer Care Alliance
Q: I have recently been diagnosed with breast cancer. Are there any steps I can take now that will help ensure that I get the most from my treatment moving forward?
A: Yes. Here are 10 key steps that can be helpful as you plan treatment.
1. Get specifics about your diagnosis and treatment.
To maximize your time with your providers, bring your questions—in writing—to your appointments. Ask for copies of your test results and keep a notebook of all results. Keep a list of questions that arise between visits so that you don’t forget to ask them, and take notes of the answers. Above all, make informed decisions; learn as much as you can about your diagnosis and treatment.
2. Spend time choosing your doctor. Breast cancer specialists who work at dedicated cancer centers offer specific expertise as well as access to the latest treatments that are part of clinical studies. Such centers can also provide other specialty services, usually under one roof, such as physical therapy, nutrition, and social work.
3. Get the support you need for talking about your diagnosis. Breaking the news to your friends and family that you’ve been diagnosed with breast cancer can be just as difficult as first hearing the news yourself from your doctor. You may feel concerned about upsetting your family and friends or worried about how they will react. Even after you have shared the news, at times you may find it difficult to communicate openly. Sometimes it’s uncomfortable to ask for help, answer questions about how you’re doing, or tell well-meaning relatives and friends that you need some time and space for yourself. If available at your hospital, request to meet with a social worker to discuss any emotional support or resource referrals you might need. A local support group for women with breast cancer may help considerably. Ask your hospital or clinic about appropriate resources in your area.
4. Seek help in navigating financial issues, if necessary. Your hospital or clinic should have a social worker, patient navigator, or financial services department to help you manage financial issues and deal with private insurance companies, Medicare, and Medicaid. If you have concerns, request an appointment.
5. Talk to your doctor about coping with menopause symptoms. Breast cancer patients who have undergone chemotherapy or ovary removal or who have had to discontinue hormone replacement therapy upon diagnosis may experience symptoms of menopause. Talk to your doctor about how to safely minimize menopausal symptoms.
6. Get good nutrition. Cancer treatment may influence your ability to taste and smell, and it may alter your digestion. Foods that you normally enjoy may not be appealing during treatment while, paradoxically, foods that normally don’t appeal to you might taste better. You may prefer and tolerate more cooked versus raw vegetables, so a vegetable stew or soup may be more appealing than a salad. You may have more energy and less nausea if you eat smaller amounts of foods more frequently rather than eating three big meals per day.
Try not to gain weight by overindulging and blowing your calorie budget. Help fight the cancer by eating more vegetables, fruits, whole grains, nuts, seeds, and legumes such as black beans and lentils. Choose a rainbow of colorful whole foods—like deep green spinach, dark blue blueberries, bright orange carrots, deep red tomatoes, and so on—to ensure that you get a variety of anticancer nutrients. Alcohol is usually to be avoided during treatment, but if you do drink, limit your intake to no more than three drinks per week. Recent studies have shown an association between alcohol and increased risk of breast cancer.
7. Take steps to prevent lymphedema. Lymphedema is a side effect of breast cancer treatment that involves swelling of the soft tissues of the arm, hand, or chest wall. It isn’t life threatening, but it must be treated to avoid getting worse. The swelling may be accompanied by numbness, discomfort, and infection. There’s no reliable way to assess your risk of lymphedema, but by taking proper precautions you can greatly reduce your chances of developing the condition. Ask your doctor about scheduling physical therapy if you notice symptoms, or consider seeing a physical therapist even before symptoms begin, to minimize their chance of developing in the first place.
8. Get exercise. Gentle exercise during treatment, such as regular walks, can help with both the mental and the physical effects of treatment. After treatment is completed, increasing your exercise gradually will help improve your fatigue and rebuild muscle tone. Getting your circulation going may also help with “chemo brain”—the mental fogginess noticed by some patients during and after chemotherapy—and it can certainly improve your mood and your outlook on life. Try yoga, tai chi, swimming, or water aerobics. Be physically active for at least 30 minutes every day. If you are having difficulty exercising or aren’t sure what to do, request a referral from your medical provider to a physical therapist.
9. Bone up on bone health. Keeping your bones healthy throughout your life is important; however, if you’re a woman who’s been diagnosed with breast cancer, bone health is especially important. Research shows that some breast cancer treatments can lead to bone loss. Plus, women are about twice as likely as men to develop osteoporosis after age 50. Talk to your healthcare team about specific recommendations for keeping bones healthy, about taking calcium and vitamin D, and about appropriate weight-bearing exercises to help keep bones strong.
10. Treatment and work. Some people are able to work throughout their cancer treatment. Yet for some, reducing one’s work capacity or taking a break altogether may be necessary. If you take time off and then return to work shortly after your treatment ends, you may find that it helps you maintain your identity and even boosts your self-esteem, not to mention your income. You may want to talk with your employer about options such as flextime, job sharing, or telecommuting (working from home). Options like these may help your mind and body ease back into the demands of your job. Try to be patient and take care of yourself as you return to your “normal” life.
Here are some excellent sources for additional information:
American Society of Clinical Oncology,
National Cancer Institute,
Susan G. Komen for the Cure,
Seattle Cancer Care Alliance,
Julie Gralow, MD, is a medical oncologist who specializes in treating women with breast cancer. Dr. Gralow received her undergraduate degree from Stanford University and her medical degree from the University of Southern California. Her clinical expertise lies in investigational breast cancer treatments, chemotherapy, hormonal therapy, and biologically targeted therapies. Dr. Gralow is a Fellow of the American College of Physicians and has been recognized by numerous awards and honors, including the American Society of Clinical Oncology Statesman Award (2008) and as Seattle magazine’s Best Doctor (2007, 2008, and 2009).