Normal, Interrupted

When Kathy Flynn arrived home from work just after being diagnosed with stage four breast cancer, she made a powerful decision. Watching her then sixteen-year-old daughter, Megan, dealing with a status quo teenage crisis on the phone and listening to her then-fiancé talking about his tough workday, she decided to wait until the next morning to break the life-changing news. “I wanted to maintain some normalcy even if it was just for a few hours longer,” recalls Flynn, a nurse practitioner in women’s healthcare at Advanced Specialty Care for Women in St. Paul. “Deep in my heart, I knew I wouldn’t have the comfort of ‘normal’ for a very long time.”

Although approximately 180,000 women are diagnosed with breast cancer in the United States each year, thanks to advances in breast cancer research and treatment, the five-year survival rate for breast cancer is 89 percent, which means a lot of survivors are dealing with breast cancer as a chronic disease rather than a terminal one.

“I think there is this myth out there of ‘When I am done with treatment, I am going to stop worrying about this disease,’” says Jeanne Harkness, RN, a breast cancer nurse specialist at Park Nicollet Jane Brattain Breast Center. “In truth, that is just not likely to happen because there are other reflections and symptoms post-recovery that can come into play.”

Hot Flashes
The drop in estrogen levels prompted by some breast cancer treatments, such as tamoxifen, can lead to premature menopause, causing symptoms such as mood swings and the dreaded hot flashes, which can persist for months or even years.

As cited on breastcancer.org, a nonprofit organization dedicated to providing information about breast cancer to the public, self-help measures such as reducing caffeine, lowering the thermostat, and wearing clothing in layers might help to some degree (literally), but 10 to 15 percent of all women who experience hot flashes also seek medical advice.

“Beyond sticking your head in the freezer, there are some medications that can help,” says Harkness. Examples include low-dose antidepressants (e.g. Effexor) and blood-pressure-lowering medications (e.g. clonidine and Aldomet). “If you [have] hot flashes interfering significantly with daily routines and activities, the best next step is to see your doctor,” she says.

Cognitive Changes
Memory lapses and general mental fogginess are attributed in part to both chemotherapy and general stress that accompanies a cancer survivor’s life. “When people are going through chemotherapy, they have difficulties with what we call executive function,” says Thomas Flynn, MD, an oncologist with Minnesota Oncology Hematology, PA. “They can’t multitask, and they have difficulty remembering where they put things.”

Because not much conclusive data is available to pinpoint the causes of the cognitive changes associated with breast cancer and its treatments, there is not much sound information on what works best. Stress-reduction techniques such as exercise and relaxation might have some benefit. Keeping your mind sharp by doing mentally challenging puzzles and tasks might also help clear the cobwebs.
Sexual Difficulties
Vaginal dryness and lack of libido are two symptoms that crop up often among breast cancer survivors, but it’s not always something that is discussed candidly in clinical follow-ups. There are many reasons for the lack of libido, but the vaginal dryness is mostly related to decreased estrogen. Richard Zera, MD, Ph.D., chief of Surgical Oncology at Hennepin County Medical Center has learned a lot from his patients about how to help them manage this lesser-discussed aftereffect. “I had one patient come to me and say, ‘You can help me, but you may not know how,” he recalls. “It made me look into sexual side effects and take more proactive steps to help the women who were dealing with these challenges.”

Zera recommends various treatments according to women’s specific health status and symptoms; he talks to his patients about what is happening in their lives. Some common approaches include use of testosterone (discuss the risks with your doctor), a loss of which is thought to lead to lack of sexual desire, and vaginal estrogen and lubricants.

Depression and Anxiety
At one point during her treatment, breast cancer survivor Freda Carlson, a health promotions manager for the American Cancer Society’s Minnesota Region in Duluth, discovered that she wasn’t experiencing the normal “highs and lows.” “I felt flat, and I knew that this wasn’t right emotionally, but I also knew that I was protecting myself in terms of whether I would come through,” she says. “I talked to my doctor about it, and in the fall of 2002, I did see a therapist for a little while.”

Although psychotherapy and medications are available for treating depression symptoms, patients can also take proactive, non-medical steps that can make a difference. A regular exercise program has been shown to decrease rates of depression and fatigue, improve symptoms of lymphedema (swelling of the arm related to chemotherapy and surgery), and increase a sense of well-being in breast cancer patients specifically. Support groups have also been shown to be beneficial.

Inevitably, women who have faced breast cancer also face a fear of recurrence. “The unfortunate thing about breast cancer is that it’s sneaky, and it can come back years later,” Carlson says. “You end up going back and forth between ‘I want to know the reality of my disease’ to ‘I am alive and feel good, and that’s what matters.’”

Being “cut loose,” as Kathy Flynn refers to it being off treatments, can be a profound rite of passage for women with breast cancer. Since being diagnosed in 2002, Flynn has had one recurrence in 2006 and additional surgeries but is now in remission. Today, she is rediscovering the “normal” so cherished on the day of her first diagnosis. “I do think about it every day, but what feels good is I have also found a way just to put on my jammies and get cozy,” she says. “I am participating in the pleasures of life again, and it’s wonderful.”