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Breast Cancer: Making the Right Choices for You
Long Term Follow Up
Some doctors take care of your breast cancer and when treatment is done
send you back to your referring physician. Their involvement with you
ends when treatment ends. From a continuity of care perspective as well
as peace of mind it is better to be cared for by professionals who will
continue to see you for the rest of your life. Though we hope that your
breast cancer does not reoccur there is a possibility that it might. Having
the same health care team who treated you from the start continue to follow
you at designated intervals to ensure that you remain well and healthy
is a smart thing. Ask the center what their protocol is for following
patients after their treatment is completed. You have been through a life
threatening experience and need to continue to be seen, screened and evaluated
by the people who are intimately familiar with your history and treatment
that was done.
Psychological support for you and your family
Being diagnosed with breast cancer is devastating. Though some people
don't openly express how they feel it is impossible to not be upset when
told you have breast cancer. Those who love you are distressed too. Having
ready access to professionals who can offer guidance, support, and help
you and your family develop coping skills will make your breast cancer
treatment go more smoothly for everyone. Ask the facility if they offer
such services. You want to talk with professionals who have extensive
experience with breast cancer patients and their families, who are familiar
with the treatment you will be receiving and know the doctors and nurses
involved in your care. This provides for a better integrated approach
to getting you well again physically and emotionally. A few facilities
offer private counseling and psychotherapy. Most also have breast cancer
support groups who generally meet monthly and are facilitated by a social
worker or nurse. Some facilities also offer special support programs for
family members including husbands and young children.
Survivor support
When confronted with a diagnosis of breast cancer your initial thought
may be that you are alone in this battle. Feel assured you are not. There
are 1.3 million women who are breast cancer survivors living in the United
States today. Many breast centers arrange for a breast cancer survivor
to talk with women who are newly diagnosed with this disease. The American
Cancer Society offers as a free service a program called "Reach to Recovery."
This program matches newly diagnosed women with women who are of the same
or similar culture, ethnicity, and clinical condition (for example matching
a 40 something yr. old with stage II breast cancer who is having a mastectomy
and chemotherapy with a woman who is also in her forties and had the same
treatment modality in the past and has completed her treatment at least
a year ago.) This program is designed to help address the emotional needs
you will be feeling. There is great benefit talking to someone who has
been through what you are about to go through. Some breast centers have
taken this program a step further and arrange for their own breast cancer
survivor volunteers to also contact the patient. These survivor volunteers
are very familiar with your situation because they have received their
care from the same team of professionals you are receiving care from now.
(Hopkins offers such a program. Though it is fairly new it has already
proven to be very beneficial for our patients and their families.) Different
facilities and doctors have sometimes different ways of doing certain
types of treatments. Having a survivor who is familiar with the treatment
program you are going to be receiving makes it easier to talk with and
gain insight from her. This survivor volunteer becomes an extension of
your breast cancer health care team. Ask the facility you are considering
going to if they offer such a program and how it is organized. There are
some facilities who discourage having newly diagnosed patients talk with
women who have been previously diagnosed and treated. The belief in such
situations is that the survivor may in some way negatively influence the
patient in her decision making process. Health care professionals need
to recognize the value of new patients talking with patients who have
had similar treatment in the past and allow them time to exchange information.
It is a patient's right to gain as much insight and understanding about
her disease and its treatment as she can. This is one additional method
it accomplish this goal.... and an additional way for you to evaluate
the breast center you are considering.
Lymphedema prevention and management
A few patients, after having lymph nodes removed as part of their breast
cancer surgery, develop lymphedema. This results in problems with swelling
of their arm and hand on the side where their surgery was done. One way
to prevent this from occurring is to be proactive in its management. Check
to see if the breast center you are considering to going to offers a "lymphedema
prevention and management program." Such centers will have a certified
occupational therapist or physical therapist become certified and credentialled
in lymphedema management. The therapist will see the patient prior to
her surgery and teach her special exercises to do to help prevent the
occurrence of lymphedema developing. She also will help in managing the
problem should it occur anyway. A few breast centers also offer special
support programs for lymphedema patients. Though lymphedema only occurs
occasionally, knowing that the breast center offers programs designed
to prevent it and manage it is a sign of the comprehensiveness of their
services.
Rehabilitation medicine
Having breast cancer surgery, whether it be a mastectomy or lumpectomy
with lymph node removal results in temporary difficulty with range of
motion to your affected arm. It is smart to learn in advance of the surgery
the best exercises to do to prevent range of motion problems from occurring.
Some breast centers offer as part of their preoperative management and
preparation a program specifically for this. It is usually conducted by
the Rehabilitation and Physical Medicine Department which works in a coordinated
manner with the breast center staff.. Patients are trained in appropriate
exercises to do by a physical therapist or occupational therapist. Patients
who are experiencing problems with gaining their full range of motion
back after their surgery are also seen by the same therapist. She works
with the patient to restore her physical abilities to what they were before.
Most patients do not need assistance after surgery if they have been trained
well and follow the prescribed exercise program shown to them. It is good
to know that such programs exist though should you be in need of these
special services.
Continued education programs and seminars
When your treatment is over you will still want to stay on top of whatever
is the latest treatment programs and research discoveries being made about
breast cancer. Your continued good health may be dependent on it. For
most women they thirst for information and want to learn as much as they
can-- it may make a difference for their own health or for someone in
their family who they care about. Check to see what type of continued
educational programs the facility offers related to breast cancer. Examples
of seminars that might be offered include: hormone replacement therapy
after breast cancer treatment; breast cancer gene research findings; the
latest in breast reconstruction; coping with fear of reoccurrence of breast
cancer. Though your treatment may be over the disease and its long term
effects may continue. You will want to stay informed and should expect
the center where you received your care to help in keeping you updated
at routine intervals.
Other cancer screening programs for you and your family
Breast cancer, though it may be happening to you, effects your entire
family. Usually a diagnosis of breast cancer is a surprise. This is the
time to check out your health in general and that of your family's to
make sure that there are no other surprises. Men at a minimum should be
checked for colon cancer and prostate cancer. Women need to be also checked
for colon cancer and uterine cancer. Take this opportunity to commit to
yourself and your family to be properly screened for these types of cancers
and others that may apply due to family history or lifestyle. See what
types of cancer screening programs are offered at the facility where you
plan to receive your care. Your family will thank you and you will thank
yourself for having had the screening done. The outcome for everyone will
be a healthier future.
Image recovery
There are side effects, physical ones and psychological ones, that can
take a toll on us as women when we are treated for breast cancer. For
some of us we may lose a breast; for others we might lose our hair; many
will lose both. These are symbols of femininity for many and are devastating
to experience. Being prepared for these loses is a good way to adjust
and cope. Some facilities offer on site or have an affiliation with an
"Image Recovery" service. These places are sometimes referred to as mastectomy
supply shops, wig shops, or called by some other name. Their purpose is
to help restore (as in the case with a breast prosthesis) or temporarily
replace (with a wig) that which is lost from your self image. If you anticipate
needing a breast prosthesis be sure to be fitted by someone who is a certified
fitter. This individual would have taken a special course to learn how
to properly fit a woman for a breast prosthesis. An improper fit can result
in poor body alignment, back pain, and lack of confidence in one's appearance.
Check to see what the facility has to offer and go and visit it if possible.
Many of them also offer special classes in make up and hair styling too
as additional ways to improve our self image and help us to feel good
about our appearance. Remember, you need to not just physically heal but
also emotionally heal. Your treatments will go smoother if you can feel
confident in the way you look during and after therapy.
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