Self-Care During HR+/HER-2- Breast Cancer Treatment


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When diagnosed early, HR+/HER-2- breast cancer has a positive prognosis. Even so, the treatment can be long and involved, so while you’re focused on navigating a world of complexities, you can easily lose your way when it comes to self-care that’s not related to cancer.

And yet, it’s essential to find time to prioritize your overall physical and mental health and wellness — something healthcare providers emphasize as well.

“[While] a third of the work we do is helping people with breast cancer get through treatment, the rest is all about getting through life,” says Sarah Donahue, MPH, a nurse practitioner who specializes in breast cancer care at the University of California San Francisco (UCSF) Breast Care Center.

“A lot of people are surprised by how much they can do while they’re on treatment,” she adds. “They can go to work, and if they have children, take good care of them.”

One place to start is to ask to be connected with a social worker. “If you don’t know who to ask, and it’s not a medical question, ask us first. If I’m not the right person, I’ll connect you to the right person,” says Chiara Leifer, LCSW, who works at the UCSF Breast Cancer Center.

1. Practice Breath Work

“I see the biggest increase in anxiety between diagnosis and when treatment actually starts,” says Leifer. One technique that can help throughout the process is a practice called box breathing. It’s an easy-to-learn technique for promoting calm and lowering stress.

You can do box breathing sitting up or lying down. Get comfortable in either position and breathe naturally for a moment or two. Once you feel settled, exhale fully, and then follow these steps.

  1. Inhale slowly and fully to a slow count of four.
  2. Hold that breath for a count of four.
  3. Exhale slowly for a count of four, completely emptying your lungs.
  4. Hold for a count of four.

Repeat three or four times, until you feel centered and relaxed.

2. Nip Breakdowns in the Bud

Be open and honest with your care team about your mood. “Are you crying a lot? Are you sleeping? Are you more worried than before? Is it getting in the way of relationships?” asks Donahue.

If you’re noticing a distressing trend, your doctor may prescribe antidepressants or antianxiety medication to help you through it and recommend seeing a mental healthcare professional. “Get a referral before you reach a crisis point,” says Leifer.

It’s particularly important to seek help from a therapist or social worker sooner rather than later, “because there can be waiting lists for getting mental health support,” says Leifer.

3. Find the Right Support Group

“Support groups can be very therapeutic,” says Leifer. You may find you can talk about aspects of having breast cancer that only other survivors or people going through treatment can fully understand. “You hear other people who have the same struggles, which makes it feel less isolating,” she says. “You feel validated.”

Many cancer centers host breast cancer support groups that are broken out into subgroups, such as for people with metastatic disease, for young people, or for men. Look for a group that meets your individual needs.

Start by asking a social worker at your cancer center about available support groups. You can also find options online through sources such as the National Breast Cancer Foundation or Susan G. Komen.

In-person groups offer the benefit of connecting face-to-face with people who can personally relate to what you’re going through. But, virtual groups are a great option if you live in a rural area or are looking to connect with a specific group of people who share your exact experiences with breast cancer.

Note: Be wary of support groups that exist exclusively on social media platforms, Leifer advises. You may get advice or responses that are inaccurate, unhelpful, or even triggering. Instead, try “finding a support group that has a professional facilitator,” she says.

If the idea of sharing your experiences with a larger group isn’t for you, pursuing individual connections, such as meeting with a therapist, might be a better option, says Leifer. The American Cancer Society also has a program called Reach to Recovery that connects breast cancer survivors with people currently undergoing treatment for one-on-one support.

4. Honor Your Sexuality

“I like to let patients know that it’s okay to be intimate while they’re being treated for cancer. It’s safe,” says Donahue. Of course, you may not be in the mood, because cancer treatment can leave you exhausted, overwhelmed, or even nauseous, she adds.

What’s more, “Once you’re on hormone therapy, vaginal dryness is a common side effect, and so is lower libido,” says Donahue. Also, she says, “If you’ve had surgery, it will change your breasts, so feeling comfortable in your body is also something to manage.”

While it can feel taboo to talk about it, don’t be afraid to speak up, says Leifer. Discussing these symptoms with your care team can help you brainstorm ways to overcome these challenges. For example, over-the-counter treatments and lubricants can help with dryness; dilators can help with vaginal atrophy; and prescription medications can stimulate libido.

The path to sexual healing includes not just medical care, of course, but also sharing feelings. That includes with your support group, where you may find other women who are going through the same struggles — and perhaps finding solutions. It also means, crucially, sharing with your romantic partner.

“Roles may change,” says Leifer. “Nobody plans for cancer. It can be hard to accept that your [partner] now needs to be a caregiver. You may not want to ask for help.”

Relationships are a two-way street. “[Your loved ones] just want you to be okay, and they may feel guilty for not spending all their time and effort on you,” says Leifer. “But, if they’re burned out, they can’t be there for you. Let them know that it’s okay — actually necessary — for them to take care of themselves, too.” Building that reciprocal trust can help you navigate any obstacles to intimacy.

5. Move Your Body

The last thing you may want to do is exercise, but physical activity “can help with energy, with mood, and with joint pain and other side effects,” says Donahue. Women who exercise regularly before, during, and after treatment are also less likely to have a recurrence of breast cancer, research shows.

Aim for 30 minutes of moderate-intensity cardiovascular activity five times a week and 20 to 30 minutes of resistance exercise (weight lifting, yoga, Pilates) twice a week. “There is evidence that for women on aromatase inhibitors, [a common estrogen blocker], resistance training reduces side effects such as joint pain,” Donahue says. “On the days you feel well enough, do your full exercise routine. When you feel tired, a short, low-key walk is fine.”

6. Don’t Brush Off Hair

You may think it’s a given that you’ll lose your hair from chemotherapy, but it’s not, says Donahue. Many cancer centers offer treatments, such as scalp cooling, that can minimize hair loss. But, it can be expensive, so it’s a personal choice and very individual. Maintaining your appearance throughout treatment and afterward may boost your self-confidence. On the other hand, says Donahue, she’s worked with plenty of women who look — and feel — beautiful wearing a scarf.

7. Try Guided Imagery

Guided imagery, a practice in which you’re prompted by a live person or recording to picture yourself in peaceful, soothing scenarios — on a favorite beach or mountain, for example — can help in those moments when stress, anxiety, and fear have you brooding about the past or fretting about the future.

Typically, the technique has you visualize the setting as well as imagine how the air may feel on your skin, the scents, what sounds you’re likely to hear, and so forth. The intense focus you bring to the practice can help ground you in the moment, which may ease regrets and worries and help put you in a relaxed state, free of stress and maybe even pain.

You can find free guided imagery audio recordings from UCSF’s Osher Center for Integrative Health, through apps such as Calm, and on YouTube.

8. Get Grounded

Grounding is a technique that can help you cope with negative emotions or stressful situations. According to Leifer, one way to practice grounding involves taking in your environment to identify:

  • Five things you can see
  • Four things you can hear
  • Three things you can touch
  • Two things you can smell
  • One thing you can taste

“Use this technique when your mind is running away with itself with anxious thoughts,” she says. “When you’re distracted, it will help you get centered again.”

9. Keep a Journal

Journaling throughout your breast cancer journey can help improve your emotional and physical well-being. Looking back on previous entries and comparing them to how you’re doing now can also help you gain a sense of perspective.

You can write each day about how you felt, write down three things that were good about that day, or even write about your dreams, says Leifer. “It’s therapeutic.” Be aware that it may bring up painful feelings, she says, “But, it can also be very cathartic.”

10. Find Your Own Path

“Patients tell me about the different sorts of integrative medicine or complementary medicine strategies that they found helpful, and I’m generally really excited about anything they can do to support mind and body,” says Donahue. “It could be aromatherapy, acupuncture, massage.”

At the end of the day, she says, it’s all about doing what you can to feel your best.

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