Caring for the breast cancer survivor’s health and well-being

Abstract

The breast cancer care continuum entails detection, diagnosis, treatment, and survivorship. During this time, focus on the whole woman and medical concerns beyond the breast cancer diagnosis itself is essential. In this comprehensive review, we critically review and evaluate recent evidence regarding several topics pertinent to and specific for the woman living with a prior history of breast cancer. More specifically, we discuss the most recent recommendations for contraceptive options including long-acting reversible contraception and emergency contraception, fertility and pregnancy considerations during and after breast cancer treatment, management of menopausal vasomotors symptoms and vulvovaginal atrophy which often occurs even in young women during treatment for breast cancer. The need to directly query the patient about these concerns is emphasized. Our focus is on non-systemic hormones and non-hormonal options. Our holistic approach to the care of the breast cancer survivor includes such preventive health issues as sexual and bone health,which are important in optimizing quality of life. We also discuss strategies for breast cancer recurrence surveillance in the setting of a prior breast cancer diagnosis. This review is intended for primary care practitioners as well as specialists caring for female breast cancer survivors and includes key points for evidence-based best practice recommendations.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Breast cancer; Contraception; Vasomotor symptoms; Vulvovaginal atrophy; Sexual health; Osteopenia; Osteoporosis; Breast cancer recurrence; Breast cancer surveillance Core tip: Caring for women with breast cancer at the time of diagnosis, during, and after treatment goes well beyond addressing the breast cancer alone. Holistic care includes safe, effective and convenient contraceptive options;local progestin intrauterine contraception may present an option for some breast cancer survivors. Discussion regarding the effects of chemotherapy on future fertility and pregnancy is an important part of survivorship care for women in child-bearing years. Addressing the effects of breast cancer treatment including vasomotor symptoms, vulvovaginal atrophy and sexual well-being is vital for all breast cancer survivors, but especially important in the setting of adjuvant therapy with aromatase inhibitors.

Caring for breast cancer survivors in primary care

“…Casey and colleagues suggest that these women should be asked about their reproductive life plan and be offered appropriate contraceptive options. 19 For women who need contraception options during and after breast cancer treatment, the US medical eligibility criteria for contraceptive use is the reference of choice. 20 Vasomotor symptoms are the most commonly reported symptom among menopausal women, and breast cancer survivors are no different.…”

“…29 Reduced bone mineral density Ovarian failure related to treatment or prolonged exposure to endocrine therapy can reduce bone mineral density. 19 Estrogen supplementation is not appropriate treatment because it could stimulate breast cancer. However, other typical treatments, such as calcium, vitamin D supplementation, weight-bearing exercise, smoking cessation, and bisphosphonates, are warranted per the current standard of Remove clothing on the trunk and arms.…”

“…Bone density scans are recommended every 12 to 24 months to assess patients for bone density changes related to aromatase inhibitor therapy. 19 Upper extremity lymphedema Surgical removal of axillary lymph nodes can lead to upper extremity lymphedema at any time after surgery-typically within 3 years, although it can occur years later. 14,30,31 Overall incidence ranges from 10% to 50% in women who underwent complete axillary lymph node dissection to 5% to 20% in women who underwent more limited sentinel lymph node biopsy.…”

“…Data now suggest that women can achieve a healthy pregnancy after breast cancer treatment, without negatively affecting their disease-free or overall survival, regardless of hormone receptor status. 19,35 For premenopausal women who do not desire future pregnancy, hormone-free contraception options include permanent sterilization (male or female), copper intrauterine devices, or barrier methods. Amenorrhea and elevated follicle-stimulating hormone levels are unreliable indicators of infertility in women who have received chemotherapy.…”

Risk-benefit perception of pregnancy among breast cancer survivors

“…Professional caregivers indicate fertility preservation should be discussed at the time of diagnosis for women who desire a pregnancy after breast cancer treatment (Casey et al, 2014;Raphael, Trudeau, & Chan, 2015). Many projects to promote fertility preservation were developed worldwide among young cancer patients (Garvelink et al, 2013;Ronn & Holzer, 2015).…”