Staying Well After Breast Cancer: A Look at Survivorship

You’re not alone. The reality is that the majority of survivors have some lingering issues. And those who don’t often wonder what they can do to stay healthy.

The good news, Baptist Health Miami Cancer Institute experts say, is that there is plenty that can be done to address ongoing or new problems. There are also steps you can take to lower your risk for recurrence as well as to improve your quality of life.

Beatriz Currier, M.D., medical director of the Cancer Patient Support Center and chief of Psychosocial Oncology, Baptist Health Miami Cancer Institute

Our panel of experts recently participated in a free webinar, “Improving Quality of Life and Staying Well: A Focus on Breast Cancer.” Below, we share insights from Beatriz Currier, M.D., medical director of the Cancer Patient Support Center and chief of Psychosocial Oncology; Adrian Cristian, M.D., chief of Cancer Rehabilitation; and James Cleary, oncology exercise physiologist. You may also watch the full broadcast here. (Passcode: 1p.E&p88)

What You may be Experiencing

At any stage in their cancer journey, more than one of three people will experience some psychological issue ― among the most common are depression (in about 25% of patients), anxiety (in about 13%); and cognitive deficits (25-75% depending on where you are in treatment or post-treatment).

“Depression and anxiety are so prevalent that we routinely screen every patient when they come for a visit with their physician,” Dr. Currier says. Medication and therapy are effective in improving symptoms and quality of life, but most important, she says, is that studies now show survival rates are prolonged in patients who seek treatment for depression through talk therapy or group support therapy.

Adrian Cristian, M.D., chief of Cancer Rehabilitation at Baptist Health Miami Cancer Institute

When it comes to “chemo brain,” understand that it is a misnomer. You don’t need to have undergone chemotherapy to experience the cognitive problems often called “chemo brain.” The changes can also occur as a result of other treatment therapies.

Common cognitive dysfunctions include problems with:

• Verbal memory
• Sustainable attention (the ability to focus on a task for 20-30 minutes)
• Executive function (multitasking and problem-solving)
• Processing speed

“Up to 75% of patients, while they are going through treatment, may experience deficits in these areas,” Dr. Currier says. “The good news is that it typically is temporary and subtle. Most patients have resolution anywhere from six months to two years after completing treatment. But there are about 25% to 35% that will have it for up to two years and beyond.”

Miami Cancer Institute offers comprehensive neurocognitive assessment and treatment in its Brain Fitness Lab, and a variety of longer-term cognitive programs, including a 12-week outpatient rehabilitation program. They also recommend an alternative inexpensive virtual option, Brain HQ by Posit Science.

Self-care Strategies

Dr. Currier encourages all patients to follow eight self-care strategies for overall well-being and brain fitness. They are:

• Seek treatment for depression or anxiety which may include counseling and medication.

• Remain socially connected – visit with family and friends in a social setting two to four times a week.

• Build scheduled exercise 150 minutes per week into your routine.

• Get a good night’s sleep by practicing the 12 Steps to a Better Night's Sleep – “Think about sleep as being ground zero for mental health,” Dr. Currier says.

• Eat a nutritious, anti-inflammatory diet.

• Build better coping mechanisms through mind-body strategies.

• Engage in cognitive skills training using Brain HQ by Posit Science.

The Role of Rehabilitation and Pre-habilitation

Whether a patient would benefit from rehabilitation before, during and after treatment depends on numerous factors, including age-related changes, co-morbidities such as heart disease, diabetes or obesity, and treatment-related toxicities, Dr. Cristian says.

Toxicities related to treatments like chemotherapy could cause muscle weakness or a condition called peripheral neuropathy, affecting the nerves. Anti-hormonal therapies can leave patients with pain in joints and muscles. Surgery may cause shoulder pain, pain at the site of the surgery scar, and those who have lymph node removal may experience lymphedema, a swelling of the arm caused by the build-up of fluids that would normally flow through the lymph system. Radiation therapy may cause skin changes and pain. Many treatments result in fatigue.

The goal of rehabilitation, Dr. Cristian explains, is to maximize a patient’s level of physical function and minimize physical impairments. “There is a layering of different challenges that are unique to each patient,” he says. “All aspects of a person’s life could be affected, from their ability to work to their functioning in family roles such as raising children or taking care of an older parent, to performing daily activities like household chores or participating in their hobbies.”

While specific exercises, massage, acupuncture, the use of compression sleeves and more will strengthen muscles, improve range of motion, promote circulation and better overall cardiovascular health, Dr. Cristian says he is especially encouraged by the more recent adaptation of pre-habilitation.

“The goal of pre-habilitation is to get a patient ready for surgery,” he said. At the Institute, patients can do a pre-treatment assessment to identify pre-existing physical impairments that can worsen with cancer treatment. “We can use the window of time before surgery or before radiation begins to try and improve the general strength and endurance of the individual.”

Why Exercise?

Exercise does everything from help you maintain a healthy weight and improve endurance to decrease depression and fatigue, particularly important when going through a health crisis. Many women with a breast cancer diagnosis want to know when to begin to exercise.

 “If you let your body continuously rest, your body begins to atrophy,” Mr. Cleary explains. “The muscle mass starts to decrease, you become a little bit weaker. It makes your regular activities much harder to do. You should exercise through the entire process, but if you haven’t, it’s never too late to start.”

Ideally, everyone should be exercising a minimum of 150 minutes a week at a moderate intensity. You don’t need to be running or jogging, but you should aim for more than just a casual walk.

Mr. Cleary recommends starting somewhere. “It doesn’t matter where. It could be five minutes, it could be 10 minutes. Then each week try to add a little bit. It should be somewhat challenging, but you don’t have to overexert yourself to the point where you know you’re going to be in bed the next day.”

Miami Cancer Institute offers a survivorship exercise program, personalized to each patient, whether they have never exercised before or are a high-level athlete. “Be patient with yourself, progress gradually and keep moving,” Mr. Cleary says.

Thanks to earlier detection and advances in treatment, more women are surviving breast and other cancers. Find out more about the Institute’s Survivorship Program here.