Being a breast onco-surgeon, I come across a lot of women who are on follow up after completing their cancer therapy. Just meeting these wonderful ladies, understanding the struggles they have undergone and how they have emerged and grown as a person makes me proud. As we doctors treat a patient and share the journey of a patient through surgery, chemotherapy, radiotherapy, knowing our patient’s weaknesses, strengths, their personal and family life, there is a very special bond we form with each of our patients. This is the reason that each breast cancer survivor is very special to me.
There is immense satisfaction in seeing an old patient of ours on follow up and knowing she is alright and doing well. And there is also a lot of concern we feel for any patient who has issues on follow up. I may not fully understand how this entire journey feels, but I do get glimpses into their lives and today I am writing for all my such special patients.
With newer developments in the treatment of Breast cancer, better screening tools, more effective chemotherapy, and radiotherapy and advanced surgical techniques, more and more women are surviving. This is a welcome sign, but it also poses newer challenges to the doctors in terms of managing long term complications of breast cancer and its treatment. It also brings in the issues of social and psychological wellbeing of these patients and their rehabilitation back to their normal lives. The transition from being a “Patient” to a “Survivor” is often not easy and needs a lot of support. These patients need to be well educated about the red signal signs and long-term complications that can arise and be counselled enough to not dwell on it too much and be able to lead normal lives.
Important components of a survivorship care programme should be:
- Detail summary of diagnosis, treatment received (including dose and schedule of chemotherapy and radiotherapy).
- Properly explained a follow-up care plan.
- Healthy lifestyle recommendations.
- Explain about signs and symptoms of a recurrence.
- Lymphedema prevention and management and re-enforcing it at every visit.
- Explain the long-term effect of treatment like cardiovascular issues, bone health, increased risk of second primary malignancies (SPMs).
- Address issues regarding the adverse effect of adjuvant hormonal therapy and failure of adherence and compliance.
- Address issues regarding sexuality and fertility preservation.
- Symptoms secondary to treatment protocols (eg, fatigue, insomnia, pain, cognition).
- Options of secondary reconstruction after mastectomy or external prosthesis.
- Psycho-social well-being
All these issues need to be addressed not just once, but at every follow-up visit. With more awareness, I am hoping that more centres have a robust survivorship programme and more primary care physicians can also be involved in it.
Signing off with a message to all the breast cancer survivors: “ It’s OK to be scared, It’s OK to ask for help, It’s all OK, because you are not all alone, and you will emerge.”
Dr. Neha Choudhary, Consultant – Breast Cancer, Oncology, Narayana Superspeciality Hospital, Howrah