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After breast cancer treatment, a woman can be exhausted both mentally and physically. Foremost in her mind would be her prognosis (chance of survival). She would also be worried about her recovery from her surgery and chemotherapy and whether she is fit to resume her role as a mother, housewife or worker. Physically she would be exhausted from the effects of surgery, radiotherapy and chemotherapy treatment.
Mental Rehabilitation
- A woman should be fully aware of her prognosis i.e. chance of survival. E.g. a stage I breast cancer patient has a 80% chance of surviving 5 years compared to a 60% chance for a stage II breast cancer. (It is important to note that a woman without breast cancer and of the same age does not have a 100% chance either). Knowing her prognosis will calm a woman and allow her to ‘pickup the pieces’ and carry on her life and assume her place in home, workplace and society.
- She should not miss her medical reviews with her doctors. This will enable any recurrence to be detected earlier and treated promptly. The follow up schedule is usually 3 to 4 monthly first 2 years, 6 monthly third to fifth year and annually thereafter. Blood and diagnostic imaging tests are performed either 6 monthly or annually.
- Her spouse, children, family and friends should be involved in her rehabilitation. We live in communities and encouragement and help from others will enable a woman to heal faster and recover stronger from her disease and treatment.
- She should consider joining support groups to listen to how other women cope with their disease and to find mutual support.
- She should consider changing her lifestyle to improve her health and reduce her chance of recurrence. This would include changing her diet. She should increase intake of fluids, vegetables, fruits, nuts, soya products and cut down on salt, saturated fats, red meat and roasted meat. She should do more exercise e.g. 30mins of brisk walking, jogging or swimming 3 times per week. Low fat and meat diet and physical activity are both associated with lower risk of breast cancer. She should take time off to relax and reduce the level of stress in her life. This is a difficult factor to quantify and has not been proven to prolong the survival of breast cancer patients.
Physical Rehabilitation
As with any major surgery, women after breast cancer operation usually feel weak physically and may take up to 6 to 8 weeks to fully recover their strength, vitality and health.
- Surgical wounds on the breast and armpit usually heal within 2 weeks. Pain slowly subsides.
- Shoulder stiffness on the side of surgery is due to axillary surgery to remove the lymph glands. With daily graduated exercises most women can overcome this stiffness and regain back full range of movement within a few weeks.
- Lopsidedness due to the loss of a breast can be overcome by wearing an external prosthesis in the bra. In the first few months when the wound is still tender, a prosthesis made up of cloth with cotton wool is used. Later on a permanent silicon prosthesis made in the shape of a breast is used
- Lymphoedema or swelling of the arm on the side of surgery. This usually starts off as a swelling on the back of the hand and forearm. If neglected the swelling gets bigger and spreads up into the upper arm. It also becomes permanent and is unsightly.
The cause of the swelling is due to accumulation of lymphatic fluid in the arm. One reason would be a recurrence of the cancer in the armpit blocking the lymphatic drainage. This is uncommon. The more common reason is that lymphatic drainage is affected as a result of removal of the lymph nodes. Thus with overuse of the arm, lymphatic fluid can accumulate leading to a swollen arm.
Fortunately the incidence of arm swelling is low, less than 5%. It can be prevented by simple measures, which include:
- Avoid over-using the arm
- Avoid impeding the lymphatic drainage e.g. tight clothing
- Avoid any procedures e.g. blood taking
- Avoid infection of the arm
- Encourage lymphatic drainage by exercises daily or by wearing compression stockings
The patient should discuss with her doctor in detail ways to avoid arm swelling and also to seek her doctor’s help quickly if she notices any arm swelling.
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