OncoLife Care Plan

You received the following treatments for Breast Cancer

Lumpectomy
Sentinel Node Biopsy
Cyclophosphamide (Cytoxan®, Neosar®)
Doxorubicin (Adriamycin®, Rubex®)
Tamoxifen (Nolvadex®)
Radiation treatment for breast cancer after lumpectomy
X-ray based radiation- IMRT

Information from your oncology office

What's In Your Care Plan

Your Summary

Follow Up Care For Breast Cancer

Surgery Side Effects

Sentinel Node Biopsy
Lumpectomy

Risks Related to Medications

Risk of Developing Cataracts
Risk of Bladder or Urinary Tract Toxicities
Risk of Developing Bladder Cancer
Risk for Cardiac (Heart) Problems Related to Anthracycline Chemotherapies
Risk of Developing Osteoporosis
Skin Changes
Understanding Chemo-Brain
Fertility Concerns for Female Survivors
Side Effects While Taking Tamoxifen
Sexuality Concerns for Female Survivors
Risk of Developing a Secondary Cancer
What We Do Not Know

Side Effects of Radiation

Radiation for Breast Cancer (After Lumpectomy)
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

Sentinel Node Biopsy

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.
Follow the precautions given to reduce your risk of developing or worsening lymphedema.

Lumpectomy

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.
You will have a mammogram 6-12 months after treatment is done and then annually.
Report any pain or changes in the breast or chest wall to your healthcare provider.
Ask to work with a physical therapist if you are having trouble moving your shoulder or arm.

Risks Related to Medications

Risk of Developing Cataracts

Key Takeaways

Have an eye exam by an ophthalmologist every few years.
See your doctor if you experience any cataract symptoms.
- Blurry vision.
- Light sensitivity.
- Poor night vision.
- Double vision in one eye.
- Seeing halos around objects.
- Needing brighter light to read.
- Fading or yellowing of colors.

Risk of Bladder or Urinary Tract Toxicities

Key Takeaways

Avoid alcohol and smoking.
Report the following symptoms to your healthcare provider:
- Pain when urinating.
- Urinary hesitancy – starting and stopping while urinating.
- Urinating frequently:
  - Urinating more than 5 times per day.
  - Getting up in the middle of the night to urinate.
- Seeing blood in your urine.

Risk of Developing Bladder Cancer

Key Takeaways

Avoid alcohol and smoking.
Report the following symptoms to your healthcare provider:
- Pain when urinating.
- Urinary hesitancy – starting and stopping while urinating.
- Urinating frequently.
- Seeing blood in your urine.

Risk for Cardiac (Heart) Problems Related to Anthracycline Chemotherapies

Key Takeaways

Maintain a healthy lifestyle:
- Avoid smoking and drug use.
- Maintain a healthy weight.
- Exercise regularly & eat a well-balanced diet.
See your healthcare provider for a physical exam, that includes a cardiac exam, several times in the first year after therapy and annually thereafter.
- If you develop new or worsening symptoms, you should have further testing with cardiac blood work and echocardiogram.
- Any abnormalities should be evaluated by a cardiologist with oncology experience.
- Manage your other health problems, including blood pressure, cholesterol level, and blood sugar.
Report the following symptoms to your healthcare provider:
- Shortness of breath (with or without exertion).
- Difficulty breathing when lying down.
- Chest pain/heartburn.
- Palpitations.
- Dizziness/lightheadedness.
- Swelling of the arms or legs.
- If you received chemotherapy under age 25, report symptoms of nausea and vomiting.

Risk of Developing Osteoporosis

Key Takeaways

Avoid smoking, caffeine, and excessive alcohol intake.
Perform weight-bearing and strength training exercise 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.

Skin Changes

Key Takeaways

Care for your skin with mild soaps and hydrating lotions.
Protect your skin from sun damage.

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 to 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 Tamoxifen

Key Takeaways

You may experience hot flashes and other symptoms of menopause. Let your healthcare provider know if these symptoms become troublesome.
There is a small risk of developing endometrial cancer. Be sure to report any irregular vaginal bleeding or pelvic pain/pressure promptly.
There is a small risk of developing blood clots (typically in the in leg or lung). Notify your healthcare provider immediately if you experience any leg pain, warmth, swelling of one leg, fever, shortness of breath that comes on you very quickly, racing heart, or chest pain.
Discuss side effects with your oncology team, as many of these are manageable. Optimal therapy can last 5 years, so management of side effects is critical to helping you stay on therapy.

Sexuality Concerns for Female Survivors

Key Takeaways

Chemotherapy agents 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 all show benefits in relieving 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.

Risk of Developing a Secondary Cancer

Key Takeaways

There is a small risk of developing a blood cancer years after your treatment is completed.
Report the following symptoms to your healthcare provider promptly:
- more tired or weaker than usual.
- shortness of breath.
- loss of appetite.
- weight loss.
- chills, fever, night sweats.
- painless swelling of a lymph node.
- easily bruising, nose bleeds, bleeding from the gums.
Your provider will monitor your labs closely. Consider having a complete blood count with differential checked annually by your healthcare provider if you received high-risk therapies.

What We Do Not Know

Key Takeaways

Many cancer treatments today have not been available long enough to determine what effects they may cause in 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, you may see a physical or occupational therapist for management.
Call your provider right away for new arm swelling, redness, or pain, especially with fever.

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 a yearly EGK or echocardiogram.

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 about help with quitting.
Contact your provider right away if you have a new or worsening cough, shortness of breath or 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 any 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. Care for your skin using mild soaps and moisturizers. Use sunscreen daily to prevent burns.
Contact your provider if you have any changes to your skin.

Lymph Nodes

Key Takeaways

Radiation can increase your risk of lymphedema. 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. 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.