OncoLife Care Plan

You received the following treatments for Breast Cancer

Lymph Node Removal (Dissection)
Mastectomy
Bevacizumab (Avastin®)
Anastrozole (Arimidex®)
Had Stem Cell BMT Autologous
Radiation treatment for breast cancer after lumpectomy
Radiation for metastasis to the brain or spinal cord
Radiation for metastasis to the lung
X-ray based - Conformal Radiotherapy

What's In Your Care Plan

Your Summary

Follow Up Care For Breast Cancer

Surgery Side Effects

Lymph Node Removal (Dissection)
Mastectomy

Risks Related to Medications

Autologous Stem Cell or Bone Marrow Transplant
Risk of Developing Osteoporosis
Understanding Chemo-Brain
Fertility Concerns for Female Survivors
Side Effects While Taking Aromatase Inhibitors
Sexuality Concerns for Female Survivors
What We Do Not Know

Side Effects of Radiation

Radiation for Breast Cancer (After Lumpectomy)
Brain
Spinal Cord
Heart / Cardiovascular
Lung
Bone
Skin
Lymph Nodes

Healthy Living After Cancer

General Cancer Screening for Women after Breast Cancer
Genetic Risk
Fatigue

Surgery Side Effects

Lymph Node Removal (Dissection)

Key Takeaways

Report any signs of swelling in the at-risk part of your body to your healthcare provider promptly. A Certified Lymphedema Therapist should be consulted at the first sign of swelling so that treatment can be started.
Follow the instructions given to you to decrease the risk of developing or worsening lymphedema.

Mastectomy

Key Takeaways

Report any signs of swelling in the arm/hand on the side of your surgery. You should be seen by a certified lymphedema therapist if you develop any signs of swelling.
If you had a single mastectomy, you should have a mammogram on your remaining breast each year.
Report pain in the breast or chest wall to your healthcare provider.
Ask for a referral for physical therapy if you are having trouble moving your shoulder.

Risks Related to Medications

Autologous Stem Cell or Bone Marrow Transplant

Key Takeaways

A healthy lifestyle is an important part of reducing your risk for complications related to transplant and your underlying cancer diagnosis. Avoid smoking, exercise regularly, and eat a healthy diet.
Follow your team’s recommendations for routine exams and laboratory testing.
Have a flu shot annually.
Talk with your health care provider about re-vaccination (pneumococcal pneumonia, measles/mumps/rubella, shingles) after an autologous bone marrow transplant.
DEXA scans are recommended one year after transplant for patients with myeloma or lymphoma. If you have another diagnosis, talk to your provider about if you need a DEXA scan after transplant.

Risk of Developing Osteoporosis

Key Takeaways

Avoid smoking, caffeine, and excessive alcohol intake.
Perform weight-bearing and strength training exercises 2-3 times per week.
Calcium intake of 1000-1200mg per day plus Vitamin D 800iu to 1000iu per day (ideally from food sources, and supplements when your diet is not sufficient).
Consider screening with DEXA scan.

Understanding Chemo-Brain

Key Takeaways

There is no proven treatment for chemo brain, but cognitive rehabilitation/brain games, avoiding becoming fatigued, regular exercise, and a healthy diet can be helpful.
Create reminders by making lists, using to-do apps or alarms on a phone to help you stay on track.
If you believe you are experiencing chemo brain, you should consult your care provider to rule out other health issues including thyroid problems, depression, and anxiety.

Fertility Concerns for Female Survivors

Key Takeaways

If you want to get pregnant, you should consider consulting with a fertility specialist familiar with cancer survivors.
If you are pregnant, talk with your provider about whether or not you should be followed by a high-risk obstetrician.
You should be aware that it is possible to get pregnant even after you have stopped having periods. Treatments such as chemotherapy and radiation may be dangerous to an unborn baby. Therefore, if you were pre-menopausal before beginning cancer treatment, you should use birth control during cancer treatment, even if your periods have stopped.

Side Effects While Taking Aromatase Inhibitors

Key Takeaways

You may experience hot flashes and other symptoms of menopause, as well as, aching in your muscles, joints or bones. Let your healthcare provider know if these symptoms become troublesome.
Discuss side effects with your oncology team, as many of these are manageable. Optimal therapy can last 5-10 years, so management of side effects is critical to helping you stay on therapy.

Sexuality Concerns for Female Survivors

Key Takeaways

Many anti-cancer medicines are associated with vaginal dryness, painful intercourse, reduced sexual desire, and the ability to achieve orgasm. Many of these issues are caused by the sudden onset of menopause, which can occur with cancer therapy. OncoLink’s article on Vaginal Dryness and Painful Intercourse provides product suggestions and tips.
In addition, you may experience other symptoms of menopause, such as hot flashes, mood swings, fatigue, and irritability. Research has found that exercise, yoga, and acupuncture can help lessen menopausal symptoms.
Talk to your healthcare team about tips to manage these issues.
Open communication with your healthcare team and partner is essential for regaining your sexuality and resolving issues. You may also consider talking with a therapist experienced in working with cancer survivors.

What We Do Not Know

Key Takeaways

Many cancer treatments today have not been available long enough to know what issues they may cause in the years after treatment.
Always let your healthcare team know if you notice any new or worsening symptoms. Remember, you know your body best.
Periodically look for new information about your treatment and talk to your healthcare team to see if they have anything new to report.

Side Effects of Radiation

Long term effects of radiation therapy vary greatly depending on the areas included in the field of radiation and the radiation techniques that were used, as these continue to develop and improve. One issue that is consistent across all tissues is the possibility of developing a second cancer in or near the radiation field. Secondary cancers develop as a result of the exposure of healthy tissue to radiation. Newer radiation techniques are designed to limit this exposure, but it is not always possible to prevent all exposure and still achieve the desired outcomes.

Radiation for Breast Cancer (After Lumpectomy)

Key Takeaways

You should have a mammogram 6-12 months after you are done radiation treatment, and then yearly.
If you are having arm pain, weakness, or swelling, see a physical or occupational therapist for management.
Call your provider right away for new arm swelling, redness, or pain, especially with fever.

Brain

Key Takeaways

You may have memory loss or changes in how well your brain works. If you notice any changes in your memory, contact your provider.
If you are having trouble walking or balancing, you may benefit from working with a physical/occupational therapist.
If you are having any new symptoms that you suspect may be related to hormone levels, talk with your provider.

Spinal Cord

Key Takeaways

You should call your provider right away if you are having any new back pain, trouble holding your bowels or bladder (incontinence), weakness, or suddenly not being able to move your arms or legs. You may need a radiology test to figure out what is causing these symptoms.
If you are having shock-like pains in the arms or legs, your provider may suggest you see a neurologist.
If you have any new curvature of the spine, you should be seen by an orthopedist.

Heart / Cardiovascular

Key Takeaways

At your yearly physical, your provider should listen to your heart, check your blood pressure, and you should also have your cholesterol and blood sugar levels checked with a blood test.
If you are at high risk of heart failure your provider may suggest that you have an EGK or echocardiogram every 2 years.

Lung

Key Takeaways

Get a flu vaccine every year and a pneumococcal vaccine every 5 years.
Smoking can further damage your lungs. You should not start smoking. If you do smoke, ask your provider for help with quitting.
Contact your provider right away if you have a new or worsening cough, wheezing, shortness of breath, difficulty breathing, or if you cough up blood.

Bone

Key Takeaways

If you are having pain after any trauma, such as a fall or car accident, you should be evaluated for damage to your bones.
If you develop arthritis, you may be given medications to decrease pain and inflammation.
Working with a physical or occupational therapist may also be helpful.

Skin

Key Takeaways

The area of skin that was affected by radiation may be more sensitive. The skin will likely always be drier. Care for your skin using mild soaps and moisturizers. Use sunscreen daily to prevent sunburns.
Contact your provider if you have any changes to your skin.

Lymph Nodes

Key Takeaways

Radiation can increase your risk of lymphedema (swelling). Talk to your provider if you are having any new swelling. A Certified Lymphedema Therapist should be consulted at the first sign of swelling for best outcomes.
Radiation and/or surgery can damage nerves, which can be worsened by scar formation and result in neuropathic pain (shooting or burning pain). You may need to see a pain specialist to manage neuropathic pain.

Healthy Living After Cancer

Survivors often wonder what steps they can take to live healthier after cancer. There is no supplement or specific food you can eat to assure good health, but there are things you can do to live healthier, prevent other diseases, and detect any subsequent cancers early.

In addition to medical problems and screening, cancer survivors also sometimes have issues with insurance, employment, relationships, sexual functioning, fertility, and emotional issues because of their treatment and we will discuss those in this care plan.

No matter what, it is important to have a plan for who will provide your cancer-focused follow up care (an oncologist, survivorship doctor or primary care doctor). You have taken the first step by developing a survivorship plan of care. If you would like to find a survivorship doctor to review your care plan you can contact cancer centers in your area to see if they have a survivor's clinic or search for a clinic on OncoLink's survivorship clinic list.

Genetic Risk

Key Takeaways

If you are concerned that your family may have such a mutation, you should consult with a genetic counselor.