After Treatment

I see now that you have answered the question I just posted about symptoms. When a patient also suffers from lymphedema, the psychosocial issues become compounded. Lymphedema is a daily reminder of the cancer, and causes embarrassment and social isolation. No one wants to look like a freak, and especially someone who's been through the trauma of cancer. There are many psychosocial issues that women need to be aware of when resuming their "normal" life after treatment. The diagnosis and treatment of cancer is a life-changing event like no other. Many times it changes a person's perspective of the world, changes their spirituality, changes their identity, and changes relationships. The personal meaning of cancer involves our intellect, emotions, body, and spirit. I believe that there is no part of one's life that is left untouched by the cancer experience. The journey even takes us into existential realms, transcending the present. Therefore, I don't think that a women can expect to return to the same "normal" life after their journey. Instead, I envision women integrating a "new-normal."

Many of the common psychosocial issues that women face are related to long-term side-effects of treatment. This can include side-effects such as fatigue and chemotherapy-induced menopause, body-image changes,alterations in sexuality, and cognitive dysfunction. Most of these side-effects are intertwined, fatigue affects the whole person, body and spirit, and menopause and body-image changes (mastectomy) affect sexuality.

The fatigue from treatment is a subjective sense of tiredness that often interferes with functioning and it typically is not relieved by sleep or rest. Fatigue has a detrimental effect on the woman's quality of life. In research studies, fatigue has been reported as the most distressing side-effect of cancer and its treatment. Closely associated with fatigue is a general lack of energy, difficulty concentrating, and depressed mood. A major psychosocial roadblock for a woman may be that she assumes she will quickly return to "normal" levels of energy soon after treatment has ended. It may take months to years for a woman to recapture pre-treatment energy depending upon the extent of treatment. Important for the woman is to recognize that fatigue is a normal, expected side-effect of treatment that can be treated in the following ways: delegate tasks, take time to rest (too much rest can decrease energy), stay as active as possible (exercise has been shown to increase energy and boost mood), eat a balanced and nutritious diet, drink plenty of fluids, and watch for signs of stress. Fatigue can also contribute to psychiatric disorders such as depression and anxiety and women should be astute to these symptoms and seek appropriate treatment from trained professionals.

Body-image changes range from weight loss to alopecia to loss of a body part. Our body-image makes up part of our identity; our sense of self and our sense of self-esteem. If a woman has incurred a mastectomy there will be significant changes in her body-image. Even a woman with a strong sense of self will grieve over a lost breast. Responses to body-image changes can include feelings that one's body has deceived them, feelings that one's body has been violated, feelings that one's body has betrayed them, or feelings of fear and vulnerability. The healthy self-image can be permanently damaged with treatment. Hopefully through interactions with the self, partner, and society, a woman can generate a new, positive body-image.

Changes in body-image can also include chemotherapy-induced menopause. Menopause can affect energy, mood, cognition, and impact sexuality. Drugs such as tamoxifen and the aromatase inhibitors (aromasin, arimidex) can also negatively affect healthy self-image due to their side-effect profile. Many women on aromatase inhibitors complain of arthritic type symptoms that interfere with their activities of daily living. Being on these agents also extends treatment for 5 years or more which some women find distressing. Side-effects of menopause and hormonal therapy may include decrease libido, and vaginal dryness, both interfering with sexual expression.

Sexuality is more than just sexual function. It includes feelings of intimacy, emotions, and fertility. It includes our image of our self, or body-image. Changes in sexuality occur with cancer treatment and many women do not seek medical attention for these changes. Permission should be given to women to discuss these concerns. Many women feel a loss of femininity following hormonal and body changes.

Menopause can contribute to cognitive dysfunction as well as chemotherapy. Chemotherapy-induced cognitive dysfunction is referred to as "chemo-brain" or "chemo fog." The symptoms are distressing and include memory loss, trouble concentrating, trouble finding the right words, trouble doing math, and trouble learning something new. Chemo-brain and menopause can also cause mood swings. Research continues to investigate the exact causes of chemo-brain and how long it lasts. It is important for women to know that certain things can exacerbate the symptoms including depression, anxiety, fatigue, insomnia, and certain medications. Although there is no definitive treatment it is also important for women to decrease stress levels, allow a quiet environment when needing to focus, and to try to not multi-task.

Lastly, it is not uncommon for women to suffer from anxiety or depressed mood after treatment ends. This is due to multiple factors including fatigue, changes in hormonal status, changes in body-image and sexuality, and changes in relationships. Women may also be at risk for post-traumatic stress syndrome (PTSD) that can be delayed for 6 or more months after treatment has ended. Any woman who finds herself experiencing symptoms of mood swings, overwhelming sadness, feelings of worthlessness, anxious mood, irritability, or feelings that she is reexperiencing the treatment through recollections or nightmares, should seek professional help.

One of the valuable lessons from the cancer journey is that it teaches one the value of being alive. Illness can restore a sense of living that is lost when we take life for granted. There are many psychosocial issues confronting the woman who has endured cancer and treatment. The hope is that the experience leads the woman on a path towards self-transcendence and a positive meaning for being alive.