A look at survival

Brain fog. depression Fatigue. lymphedema. Congratulations, you are a breast cancer survivor. On the one hand, if you’re one of the 3 million breast cancer survivors living in the United States today, you have every reason to celebrate. On the other hand, you may wonder why you don’t feel better when you’ve just beaten a life-threatening illness.

I am not. The reality is that most survivors have some lingering problems. And those who don’t often wonder what they can do to stay healthy.

Beatrice Currier, MD, medical director of the Cancer Patient Support Center and chief of psychosocial oncology, Miami Cancer Institute.

The good news, according to experts at the Cancer Institute of Miami, part of Baptist Health, is that there is much that can be done to address current or emerging problems. There are also steps you can take to reduce your risk of relapse as well as improve your quality of life.

Our panel of experts recently participated in a free webinar entitled “Improving Quality of Life and Maintaining Health: A Focus on Breast Cancer.” Below we share the views of Beatrice Currier, MD, Medical Director of the Cancer Support Center and Chief of Psychosocial Oncology; Adrian Christian, MD, Chief of Cancer Rehabilitation; and James Cleary, oncology exercise physiologist. You can also see the full program here. (Access code: 1p.E&p88)

What you may be experiencing

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

“Depression and anxiety are so common that we routinely screen all patients when they come to see their doctor,” says Dr. Currier. Medication and therapy are effective in improving symptoms and quality of life, but more importantly, he says, studies now show that survival rates are prolonged in patients who seek treatment for depression through talk therapy or supportive group therapy.

Adrian Christian, MD, Chief of Cancer Rehabilitation; and James Cleary, Oncology Exercise Physiologist, Miami Cancer Institute.

When it comes to “chemo-brain”, you should understand that this is a misnomer. You don’t have to have had chemotherapy to experience the cognitive problems often referred to as “chemo-brain.” Changes may also occur as a result of other medical therapies.

The most common cognitive dysfunctions include problems with:

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

“Up to 75 percent of patients may experience deficits in these areas while on treatment,” says Dr. Currier. “The good news is that it’s usually temporary and unnoticeable. Most patients have remission between six months and two years after completing treatment. But there are between 25% and 35% who will have it for two years or more.”

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

self-care strategies

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

  • Seek treatment for depression or anxiety, which may include counseling and medication
  • Stay social: Visit family and friends in a social setting two to four times a week
  • Incorporate an exercise program of 150 minutes a week into your routine
  • Get a good night’s sleep by putting the 10 rules of sleep hygiene into practice: “Think of sleep as ground zero for mental health,” says Dr. Currier.
  • Eat a nutritious, anti-inflammatory diet
  • Build better coping mechanisms through mind-body strategies
  • Engage in cognitive skills training with Brain HQ from Posit Science.”

The role of rehabilitation and rehabilitation

Whether a patient benefits 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 drug-related toxicity, Dr. Christian says.

Toxicity associated with treatments such as chemotherapy can cause muscle weakness or a condition called peripheral neuropathy, which affects the nerves. Antihormonal therapies can leave patients with joint and muscle pain. Surgery can cause pain in the shoulder, pain at the site of the surgical scar and in patients undergoing removal of

lymph nodes may experience lymphedema, a swelling of the arm caused by the accumulation of fluids that normally flow through the lymphatic system. Radiation therapy can cause skin changes and pain. Many treatments cause fatigue.

The goal of rehabilitation, Dr. Christian explains, is to maximize the patient’s level of physical function and minimize physical impairment. “There are a number of different challenges that are unique to each patient,” he says. “All aspects of a person’s life can be affected, from their ability to work to their functioning in family roles such as raising children or caring for an elderly parent, carrying out daily activities such as housework or participating in their hobbies.

Although specific exercises, massage, acupuncture and the use of compression sleeves, among others, strengthen muscles, improve range of motion, promote circulation and improve overall cardiovascular health, Dr. Christian says he feels particularly optimistic about the most – the new adaptation of rehabilitation.

“The goal of rehab is to prepare the patient for surgery,” he says. At the Institute, patients can receive a pre-treatment assessment to identify existing physical impairments that may be worsened by cancer treatment. “We can use the window of time before surgery or before radiation starts to try to improve a person’s overall strength and endurance.”

Why the exercise?

Exercise does everything from helping you maintain a healthy weight and improving stamina to reducing depression and fatigue—especially important when you’re going through a health crisis. Many women diagnosed with breast cancer want to know when they should start exercising.

“If you let your body rest all the time, your body starts to atrophy,” explains Mr Cleary. “Your muscle mass starts to decrease, you get a little leaner. This makes your regular activities much more difficult to perform. You have to train throughout the process, but if you haven’t, it’s never too late to start.”

Ideally, everyone should exercise at least 150 minutes a week at a moderate intensity. Running or jogging isn’t necessary, but aim for more than just a walk.

Mr. Cleary recommends starting somewhere. “Never mind where. It could be five minutes or ten minutes. Then each week try to add a little more. It should be challenging, but you don’t have to push yourself too hard to the point where you know you’re going to be in bed the next day.”

Miami Cancer Institute offers a survivorship exercise program customized for each patient, whether you’ve never exercised before or are a top athlete. “Be patient with yourself, make gradual progress and keep moving,” says Mr Cleary.

Thanks to early detection and advances in treatment, more women are surviving breast and other cancers. Learn about the Institute’s Survival Program.

Tags: breast cancer, Miami Cancer Institute

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