Treating the Breast Cancer Survivor as Well as Her Disease (Women's Health Matters article) (Web resource; WHM resource) Author: Patricia Nicholson Organization: Women's College Hospital, Women's Health Matters It’s time to start treating women with breast cancer not only as patients, but also as future survivors – right from the outset. Dr. Patricia Ganz, director of prevention and control research at the University of California Los Angeles’s Jonsson Comprehensive Cancer Center, believes that integrating survivor care into breast cancer treatment could improve quality of life for many women. Dr. Ganz, a leading expert on quality of life after breast cancer, delivered the 2009 F.M. Hill Lecture – an annual event honouring Dr. F. Marguerite Hill, former physician-in-chief at Women’s College Hospital – on this topic on Nov. 18. More survivors Thanks to factors such as earlier detection and better treatments, survival rates for breast cancer have increased steadily in recent decades. Five-year survival rates for early-stage breast cancer are now over 90 per cent, so there are more and more former breast cancer patients out there. ‘For a woman diagnosed today with stage one disease, she can expect a normal life expectancy,’ Dr. Ganz said. However, she can also expect a long and complex treatment regimen that may involve surgery, chemotherapy, radiation and drugs, and may require her to see several different specialists. And she can expect to be coping with the long-term after-effects of both her cancer and her treatment. ‘Now we are faced with millions of women who have had breast cancer, millions who are diagnosed across the world with breast cancer each year. And our treatments are very complex, multimodal, often quite toxic, and poorly co-ordinated,’ Dr. Ganz said. ‘Women will often pay a very high up-front cost for long-term survival.’ That cost can include not only time and money, but also interpersonal, human and existential costs. Life after treatment ‘Many of my studies have found that depression and psychological distress really heighten once treatment is over,’ Dr. Ganz said, explaining that women are often so focused on getting through their treatment that these reactions often surface later. Many women also find that they suffer from persistent fatigue long after their treatment has ended, Dr. Ganz said. After-effects of chemotherapy can include premature menopause, weight gain, osteoporosis, cognitive dysfunction, cardiac problems and lower quality of life. ‘We need to do a better job co-ordinating post-treatment care,’ she said. ‘We need to do a better job monitoring the late effects.’ These are women who were otherwise pretty healthy when they were diagnosed with breast cancer, Dr. Ganz said. They then went through some challenging treatments, and eventually were left with these symptoms. ‘The symptoms contribute significantly to their decreased physical and mental health,’ she said. ‘My strategy in thinking about how can we make quality of life better for these women is to focus on the symptoms.’ Studies on these late effects of cancer treatment have been limited. Traditionally, post-treatment care has not been well-planned, and focused mainly on surveillance for recurrence of the cancer. ‘Most of the women who are going to be treated for this disease are going to be fearing recurrence, and that’s something very genuine,’ Dr. Ganz said. ‘But they don’t have recurrence. They don’t have cancer. What they have are the sequelae of the treatment, and you have to listen to them carefully.’ Palliation, prevention and health promotion Dr. Ganz advocates a survivorship care plan based on what she calls ‘the three Ps,’ which are palliation, prevention and health promotion. Although many people associate palliative care with end-of-life care, Dr. Ganz said that in fact palliative care is about reducing the severity of disease symptoms, and about preventing and relieving suffering in order to improve quality of life. Prevention for breast cancer survivors means systematic, ongoing followup to screen not only for cancer recurrence, but also for late-onset complications of treatments. These can include cataracts, osteoporosis and heart disease. Health promotion is about trying to decrease the risk of developing other conditions. ‘Most women with breast cancer are going to die from other diseases: heart disease, diabetes, stroke, things like that. But it’s not on their radar screen. They think cancer is the worst thing that could happen to them,’ Dr. Ganz said. ‘We need to find strategies to integrate this into our followup care.’ She stressed the need to think about survivor care from the outset, and to incorporate it into cancer care. ‘I think that getting survivorship into the treatment planning is going to be the next frontier in breast cancer survivorship research,’ she said. Version française :  Cliquez ici pour voir la description en français Purpose:  Consumer information/support; Health information Information Source:  Hospital/Clinic Geographic Origin:  Canada Language of Resource:  English Groups:  Adult women Last Reviewed by Women's Health Matters:  November 26, 2009