Recovering from breast cancer means more than good clinical outcomes. The overarching goal is good quality of life, which means balancing clinical outcomes with treatment toxicities while preserving a positive body image, good sexual health and, for patients who want it, the opportunity for biological children.
“Local therapy can cause pain and lymphedema while systemic treatment can cause both long term and late effects,” said N. Lynn Henry, MD, PhD, Daniel F. Hayes, MD, Breast Cancer Research Professor and Breast Oncology Section Head, University of Michigan Rogel Cancer Center. “There is a balance between outcomes and toxicities that we must optimize for every patient.”
Dr. Henry presented during an Educational Session on “Accelerating Recovery After Breast Cancer” on Tuesday, Dec. 8. Under-treatment may improve quality of life, Dr. Henry noted, but can negatively affect disease outcomes, while over-treatment increases toxicity and reduces quality of life.
Treatment-associated lymphedema can often be reduced using compression garments and physical therapy, while acupuncture and duloxetine have shown benefit for peripheral neuropathy. Systemic toxicities such as menopausal symptoms can be addressed with a variety of pharmacologic, cognitive behavioral, and treatment-adjustment approaches.
Up to 90% of cancer survivors report body image and sexual health problems. Breast cancer survivors are particularly affected because breasts are an integral part of grooming and appearance, added Ann H. Partridge, MD, MPH, Director of the Adult Survivorship Program at Dana-Farber Cancer Institute.
“Body image and sexual health are real issues for our patients, especially our younger patients,” she said. “We need to help women choose their surgery wisely, and encourage reconstruction if a woman chooses mastectomy and make it happen as early as possible.”
Sexual health is a vital quality of life issue, Dr. Partridge continued. Breast cancer and treatment elevate risk for sexual dysfunction. Sixty percent of breast cancer survivors meet criteria for sexual dysfunction, but only seven percent get support from their clinicians.
Younger women have more challenges, especially if partner support is lacking.
“This is something we can do something about,” Dr. Partridge said. “There are checklists and questionnaires that don’t take up a lot of our time. Or you can do a simple inquiry when you see your patient. You can treat or you can know who you can refer to in your center, system, and community to help your patients with these sensitive and important issues.”
Fertility after treatment is another issue that is too-often ignored. Breast cancer survivors have a 65% reduced likelihood of pregnancy compared to the general population, said Kathryn J. Ruddy, MD, MPH, Professor of Oncology, Mayo Clinic, and more than half of patients 40 and younger have concerns about fertility.
“Many young women have not completed their desire for biological children after a breast cancer diagnosis,” Dr. Ruddy said. “They should be referred to reproductive endocrinology early and we should continue to discuss reproduction during and after treatment.”
The best approach to oncofertility is to ask, she continued. Embryo and oocyte cryopreservation are gold standard fertility preservation methods. Some women opt for both.
Other options include cryopreservation of ovarian tissue and a gonadotropin-releasing hormone agonist (GNRHa) to suppress ovarian cycling to protect against treatment cytotoxicity. Resumption of menses is used as a surrogate for preserved ovarian function and possible fertility.
Sperm cryopreservation may be appropriate for male breast cancer patients concerned about future biological children, she added.
Barbara Jacoby is an award winning blogger that has contributed her writings to multiple online publications that have touched readers worldwide.