American Cancer Society Issues New Guidelines for Breast Cancer Survivors
About 12 percent of women will develop invasive cancer in their lifetime, and thanks to advancements in treatment, many of them will survive.
We’ve done an incredible job raising awareness about breast cancer. However, we often talk about battling cancer, but not as much about life after the disease.
Now, the American Cancer Society (ACS) is taking steps to make long-term care a larger part of the conversation. It recently issued a new set of guidelines to help breast cancer survivors and their doctors better manage their health and long-term care after breast cancer.
“There are quality-of-life issues that are important, because most women with breast cancer do not die,” Carolyn D. Runowicz, MD, lead author of the new guidelines, said in a recent interview.
There are 3.1 million breast cancer survivors in the U.S., according to ACS. On average, they were 61 years old when they were diagnosed, so the new guidelines also stress the importance of managing survivors’ long-term care with aging-related health issues.
The guidelines cover everything from managing side effects and maintaining a healthy lifestyle after cancer to coordinating medical care between primary care providers and oncologists.
Overview of the New Guidelines
The new guidelines deal with breast cancer survivors’ overall physical and mental health. They cover several important quality of life issues, including:
Dealing with the Mental, Emotional and Physical Side Effects of Cancer
Women experience a range of emotions when they undergo breast cancer treatment. It often causes physical side effects like fatigue, lymphedema, pain, nerve damage and premature menopause, and emotional side effects like body image issues and sexual issues because of the physical changes the body undergoes during treatment. In addition, some people may experience anxiety or depression during and after treatment.
The ACS recommends that primary care clinicians assess survivors for signs and symptoms of these side effects. If a survivor has body image issues, for example, her doctor can suggest adaptive devices like a breast prostheses or a wig to help with these issues. If necessary, a doctor should refer the patient to get further care to deal with body image concerns after cancer. In other cases, the doctor can refer a survivor to a specialist for group therapy or sexual counseling if she is dealing with these issues after treatment. Doctors also can offer treatment options or medication for health issues like lymphedema, anxiety, depression and fatigue. Women should discuss these side effects with their primary care providers, so they can get evaluated and receive treatment as soon as possible. Regular exercise, yoga and meditation also can improve survivors’ overall well-being.
Diet & Exercise
Many of the guidelines also deal with maintaining a healthy lifestyle. ACS recommends that doctors should counsel survivors about ways to maintain a healthy weight and encourage those who are obese or overweight to avoid high-calorie foods and drinks, eat a diet high in vegetables, fruits and whole grains, limit alcohol consumption and increase their physical activity to maintain weight loss. This recommendation is important because obesity is a significant risk factor for the development of cancer.
Survivors should avoid inactivity and stay physically active as soon as possible after treatment, the ACS says. It recommends at least 150 minutes a week of moderate exercise (about 30 minutes, five days a week) or 75 minutes of vigorous aerobic activity every week, which can include walking, swimming and other exercises that increase your heart rate and cardiovascular health.
Doctors and clinicians also should encourage survivors who are regular smokers to quit and refer them to smoking cessation programs, counseling and other resources that can help them kick the habit.
The guidelines also include recommendations for coordinated care. ACS says patients should ask their oncologist for a written follow-up care plan or survivorship care plan to share with their other doctors. The plan should detail who is responsible for the patient’s cancer-related care and long-term medical care after treatment. Some patients may immediately return to their primary care doctor after treatment, while others may wait until they have little to no risk for cancer recurrence or significant side effects. Either way, studies have shown that post-cancer care provided by a primary care doctor is just as effective as specialist-led care, so it’s up to survivors to make the best decision for their long-term health.
The guidelines include recommendations for ongoing cancer screenings, as well. Survivors should continue to visit their oncologists for regular tests that monitor potential breast cancer recurrence and get screened for new primary breast cancer and other forms of cancer, including cervical, lung and endometrial cancer.
Last year, there were more than 231,000 new cases of invasive breast cancer. As we continue to make headway in early detection and treatment, we also can do more to maintain quality of life for millions of survivors. These guidelines are an important step in that direction. Every clinician and survivor should take the time to review them.
Read the complete list of new guidelines on the website of the Cancer Journal for Clinicians.