Life after treatments

After going through the difficult stages of diagnosis and treatment, you finally arrive at a long-awaited step: the end of treatment! But it’s not all over yet. There’s still the recovery phase. It’s important to know that this emotional stage also comes with its share of difficulties. You can prepare for these challenges by learning what to expect and seeking support if you feel the need.

Psychologically, you’ll probably experience a lot of emotions. You may be happy and relieved to have completed treatment, but you may also be very anxious, scared and lost about what comes next. In brief, post-treatment involves a transition and adaptation phase. Accept that you may not feel good emotionally. This is normal. Be patient: take the time to understand what you’ve been through and let the dust settle.

It is normal to feel disoriented after cancer treatment. Here are some examples of feelings that you may have:

• Worry, and even fear, that the cancer will come back
• Loneliness and isolation since you are no longer seeing your healthcare team
• Anger for various reasons and situations related to the illness and treatment
• Grief for what you have lost

You may be unsettled by the state of your body and general health. Spending time with family and friends is very beneficial to support you during this period of recovery. Psychological support is very important.

In the following sections, you will find information on various topics to consider during the post-treatment phase.

Rehabilitation

Cancer treatment can affect your physical, cognitive, emotional and psychological abilities. Be comfortable asking for support so you can gradually resume your activities. Many professionals can help you in this recovery: nutritionists, occupational therapists, physiotherapists, chiropractors, recreational therapists, rehabilitation nurses, social workers, psychologists, spiritual care professionals, vocational rehabilitation counsellors, etc.

Be patient! Rehabilitation can take some time.

Here are links to rehabilitation exercises you can do at home to help your physical recovery.

Educational video series on the prevention of musculoskeletal complications following breast cancer treatment.

My Active Health program

Chemotherapy and hormone therapy can affect your cognitive abilities (thinking, reasoning, perception, judgment, learning, attention and memory). The type of treatment and the dose you have received can influence how much your concentration and intellectual abilities are affected. Also, remember each person reacts differently to treatment. Cognitive problems can also be caused by factors not directly related to the cancer itself, such as fatigue, sleep issues, stress, age and lack of minerals.

Here are some tips for cognitive recovery:

• Physical activity is a good way to keep your mind sharp.
• Rest will help reduce your stress, as will yoga and meditation.
• Activities like reading, doing crosswords and puzzles, playing a musical instrument, drawing or trying new hobbies will stimulate your brain.
• Talking with your family about how you feel about cognitive problems. They can support you and may be able to help you find solutions.
• Asking your employer for support will help you with the tasks that are now more difficult.
• Talking with your healthcare team. A family member could go along to make note of any suggestions and advice.

Symptoms can be very mild and often disappear on their own within days or months after treatment. If you or a member of your family observe differences in your cognitive abilities that persist over time, do not hesitate to tell your doctor. She or he will assess your cognitive functions, determine the cause, suggest solutions or refer you to a specialist who will help you regain your abilities. 

Here are a few options that your doctor may suggest:

• Cognitive re-education can help you relearn how to think, reason and remember things. It will help you regain your self-confidence and improve your quality of life.
• Medication may help you to improve your cognitive ability.
• Follow-up occupational therapy can help you resume your daily activities.
• Vocational rehabilitation can improve your skills for the job market.
• Psychosocial help may support you and your family.

Nutrition

A healthy and balanced diet is recommended to help you recover from your treatments. Your body needs to regain its strength. Studies have shown that eating well helps reduce the risk of recurrence and protects against cardiovascular disease and diabetes.

To feel better and resume your daily activities, choose a diet rich in fruits and vegetables and low in fat. A healthy diet should include three balanced meals a day, containing at least one serving from three of the food groups: fruits and vegetables, grain products, meat and meat alternatives. This diet will help you meet your nutritional needs and recover better.

Here are a few nutritional tips for a speedy recovery:

• Get enough protein, which will speed up healing after surgery, help you rebuild strength and invigorate the immune system to prevent infection. Protein is found in meats, legumes, dairy products, nuts and eggs.
• Drink nutritious beverages, such as milk, fruit juices or Ensure-type nutritional supplements, which will increase your energy reserves.
• Stay well hydrated.
• If your appetite has decreased, opt for several small meals a day of nutritious, high-protein foods.

About dietary supplements

Fruits and vegetables contain all the vitamins and antioxidants the body needs to function properly. So, it’s a good idea to eat plenty of them. That way, you won’t have to take supplements. Talk to your healthcare team if you wish to take supplements and vitamins. They might want you to do blood tests to find out which supplements would be good for you. If you want to try a non-traditional diet, you should also talk to your healthcare team to make sure it is safe.

What about soy?

Many women question soy consumption and the possibility that it may promote the growth of cancer cells. While it is true that soy contains phytoestrogens, plant-based molecules that resemble estrogen, these are 100 to 1,000 times less effective at binding to the estrogen receptors than natural hormones are. 

Studies with conflicting results have been published on the protective or harmful effect of soybeans. Nutritionists believe that moderate consumption of soy and its derivatives is safe for women. However, phytoestrogen supplements are not recommended. Many studies are underway to ensure the safety of these supplements and whether they have a beneficial role.

Resources

https://meetinglibrary.asco.org/record/80307/edbook#fulltext

Regaining a healthy body weight

Chemotherapy can cause weight loss, while hormone therapy and decreased physical activity during treatment can lead to weight gain. In some cases, the opposite of both can be true. After your treatment, it is recommended you return to a healthy weight for faster recovery, better quality of life and lower risk of recurrence.

Don’t hesitate to discuss this with your healthcare team. They can refer you to specialists who will support you in getting back into shape. A nutritionist can suggest a balanced menu to help you return to your healthy weight.

After receiving breast cancer care, many people live with the fear that the cancer will recur. This is completely normal and understandable. And it will normally diminish over time.

This fear may be rekindled by certain events, like follow-up visits, the appearance of pain, the “anniversary” dates of diagnosis or surgery, or learning that someone close to you has cancer.

The following can help you cope with this anxiety:

• Talk with your doctor. She or he will tell you about the risk of recurrence and what symptoms to watch for. More regular follow-up visits may be reassuring to you.
• Discuss your concerns with your family and friends, in support groups or with a psychologist. Verbalizing your fear will help you cope with it. A diary is another good way to get your fears out.
• Use relaxation techniques, like yoga, meditation, massage, qigong, music therapy and art therapy, to help you relax.
• Manage the symptoms that are bothering you. Talk with your doctor about ways to improve your sleep, reduce pain associated with surgery or lymphedema.
• Take care of yourself. Improving your eating habits, getting regular physical activity, and sleeping enough can increase your energy. It’s a good idea to cut down on alcohol, which is a depressant that may feed your worries. 

If anxiety persists and affects your daily functioning, talk with your doctor. Most hospitals have a psychosocial oncology department or support service. Professionals will help you get the support you need.

• A psychologist can help you manage your anxiety.
• Your doctor can prescribe antidepressants.

Although its primary biological role is breastfeeding infants, for some women, the breast is significant in terms of aesthetics, seduction and sexuality. Breast cancer treatment and its side effects can alter your body and the image you have of it. You may feel like a stranger to yourself because of breast removal, hair loss, weight gain or loss, decreased energy or libido, etc. All these changes may be difficult to cope with, and you may experience a wide range of emotions, leading to anxiety and psychological distress.

Here are some suggestions to help you live better with your new body:

• Talking about your experience will help you cope with your emotions.
• Your spouse, family and friends will probably be very supportive. Don’t hesitate to confide in them.
• There are support groups for women who have similar concerns. Joining these groups to discuss your experiences may help you feel less alone.
• Do not hesitate to ask for support from a psychologist.
• Ask a hairdresser or beautician for advice on how to find a look you like.
• Remember that breast reconstruction is a personal choice. It’s totally fine not to consider breast reconstruction, opting instead for an external prosthesis that fits into a bra, or for nothing at all. Learn about the options available to help you feel good about your body.
• Your doctor and healthcare team can help you through this process.
• Give yourself time to experience your emotions and accept your new image.

Returning to work is motivating for some women because it means things getting back to normal. For others, it’s a scary step. You are in the best position to know if you are ready to go back to work.

Plan your return to work carefully so it is easy and worry-free. Involve your healthcare team and employer in supporting you and making it easier.

Discuss your return to work with your healthcare team:

• They will help you assess your capacities and advise you about when is the right time.
• They can guide you toward appropriate resources to improve your capacities (rehabilitation programs, social workers, exercise programs, etc.).
• Your doctor can also advise you about the hours and tasks you will be able to do once you’re back at work.
• Your doctor may need to fill out forms (for your employer and insurance company).
• Discuss going back to work with your employer. They may be able to help you with accommodation measures. Your energy may be lower or you may have physical limitations. Discuss the possibility of a gradual return or a lighter workload that would be adapted to your condition. Some companies have an employee program and may be able to offer you support.

Here are some tips to help you return to work:

• Try to maintain good relations with your workplace during your treatment, if you feel able to do so. Keeping in touch with your coworkers may make it easier for you to go back to work.
• Assess your capacity to return to work, including your energy, cognitive ability and emotional state. Your healthcare team can help you with this assessment.
• Identify any barriers you may encounter when you go back to work. Consider possible solutions and discuss them with your care providers and work team.
• Identify people who could support you at work to help you do your job as well, efficiently and safely as possible. You don’t have to wait until you are 100% recovered to return to work. It may take some time before you are fully recovered.
• Establish a formal work plan and submit it to your manager. Include your concerns about going back to work.

Some survivors may face discrimination when they return to work (layoff, demotion, denial of illness benefits and time off for medical appointments, conflict with coworkers, etc.). Be aware that such discrimination is illegal and that you are protected and have rights.