“I see pharmacological interventions in your future” is a paraphrasing of what my oncologist told me at my last doctor’s visit.
So let me back up a bit. I had my “eight-years-since-finishing-chemo” appointment with my oncologist last week. Things went the way they’ve been going for a while. He was very pleased with how things have been going and that made me feel very positive.
Certainly, I have my share of stressors churning at the moment, but most of them are not health-related. Most.
When my oncologist reviewed my bone density reports, however, he made the same prediction that he has during my previous two visits with him (see his quote above). The issue is that my bone scan in 2019 showed osteopenia, which I have to say is pretty weird given my lifestyle, which includes a lot of strength training. We both thought that perhaps it was an issue with the way the numbers were calculated.
Unfortunately, my 2024 bone scan showed a significant loss of bone compared to 2019. Enough to really concern my oncologist and befuddle us both.
So despite my living the lifestyle that medical guidelines say I’m “supposed to” live in order to stay healthy and strong, it’s still not good enough.
This harkens back to what I experienced after being diagnosed with breast cancer. It seemed like I had done everything I could to lessen my chances of getting cancer, including things that should have been protective, but there I was, a breast cancer patient, and a young one at that (which, I later learned, what one of the reasons the risk factors didn’t necessarily apply to me, but I didn’t know that at the time).
It drove my perfectionistic mind haywire.
It brought on feelings of helplessness and even despair.
The only thing that gave me a bit of a lift was learning to meditate. Meditation imparted a sense that I had a teensy bit of control, if not on the situation, at least in the way that I reacted to it.
I got through that period of my life, brushed myself off and went on. And for a while, I was feeling blessed.
But cancer treatments have long-term effects. And the repercussions of being pushed through menopause and being on endocrine therapy eventually caught up to me. Physical movements that used to be easy started to hurt. I lost muscle mass…and apparently, I lost bone too. I felt like I was treading water with a weight tied around me.
Never good enough.
So I am bearing down and reworking my diet and exercise program even more. And to be honest, this is also an opportunity to shed some of my perfectionistic tendencies. While I want to feel like I am doing everything I can to help stop my bone loss and avoid taking medication for it, I need to learn to give myself grace. Sometimes even doing everything “right” will not be 100% successful, and I have to be okay with that.
It used to be that people undergoing chemotherapy for cancer were told to be careful with physical activity and restrict themselves to low- and moderate-intensity exercise. Even when I was going through cancer treatment eight years ago, there was concern about how much weight I was lifting for fear of eliciting lymphedema, although by that time, exercise was more encouraged.
I am so glad that our understanding of exercise and cancer has changed! This evolution in thinking is exemplified by a case study that was recently published in the journal Lifestyle Medicine (Rolle & Crane, 2025). The lead author and PhD student in Public Health at U of Miami, LaShae Rolle (age 27), was also a competitive powerlifter who was diagnosed with stage 2B estrogen receptor-positive breast cancer in 2024.
For LaShae, exercise was an integral part of her life, something to which I can relate. She worked with her team to create training sessions that aligned appropriately with her cancer treatments which consisted of four cycles of chemo following a mastectomy.
Remarkably, by modifying her workouts as needed, LaShae was able to maintain 93% of her squat strength (408 lbs of her 441-lb one-repetition maximum (1RM)) and 87% of both her bench press (254 lbs of her 292-lb 1RM) and deadlift (430 lbs of her 497-lb 1RM). This is so impressive considering that throughout her chemo treatment she was still able to squat and deadlift over 400 lbs!
Not surprisingly, attempting to train at high-intensity on the day following her first infusion (!) resulted in severe dizziness and fatigue. By the 3rd and 4th cycles of her chemo, Rolle found that delaying intense exercises for about a week following her infusions allowed her to train more effectively. Note that her chemo cycles were three weeks apart, allowing sufficient time to recover.
Yes, you can train vigorously during chemotherapy!
Why keep training during chemotherapy? There is a rapidly increasing body of research that demonstrates the critical role that physical activity plays in recovery from cancer treatment and avoiding recurrence. Unfortunately, for people who view exercise as a chore or burden, being urged to maintain an exercise program while they’re undergoing something as punishing as chemotherapy may feel like an additional punishment.
But the benefits of exercising throughout treatment, as appropriate, are irrefutable. For those who haven’t previously exercised, it’s important to begin slowly, finding physical activities that are enjoyable and rewarding, eventually ramping up the challenge to include cardiovascular exercise, strength training, balance work and flexibility training.
For those for whom workouts are an integral part of their lives, being encouraged to continue exercising as we have prior to cancer is psychologically uplifting. I’ve written in earlier posts that working out was one of the few things that I could do that gave me a sense of control in the out-of-control landscape of a cancer diagnosis. It helped me feel “normal” when I felt anything but, and that was such an important part of mentally getting through treatment.
Bottom line: Participating in your regular exercise routine during chemotherapy is doable, with modifications, and the physical activity can help you get through the treatment process. While LaShae Rolle did experience treatment side effects, she was able to work around those to limit the amount of strength she lost during chemo to an impressive degree.
REFERENCES
Research Article:
Rolle LD & Crane TE (2025) Exercising Through Breast Cancer: A Case Study on Strength Training During Active Treatment. Lifestyle Medicine, 6, e70034. https://doi.org/10.1002/lim2.70034
For anyone who’s been wondering, it is true that I did not post last Monday.
There was so much going on at home, including cleaning and prepping for out-of-town guests who were coming in for my eldest child’s university graduation that was taking place over the weekend.
I had so much to do that I knew trying to squeeze out a post would pile on even more pressure on top of what I was already feeling.
At the same time, I have a strong sense of responsibility that keeps me on track with all the things that I need to accomplish. This has been a very good thing that helped me establish a lot of healthy habits.
Can you tell when you’ve got pressure building up? And do you know when to slow down? (Photo by Wim van ‘t Einde on Unsplash)
However, I’ve been mindfully reconsidering some of the rules that I’ve made for myself. Missing last week’s post was an opportunity to gently relax my stringent requirements for consistency, since what I really needed was a break.
It felt good to give myself permission to release at least one responsibility. And as soon as I made the decision to take a break for that one Monday, I realized how much my overworked self deserved that tiny bit of grace.
It also reminded me of going through chemo. Several infusions in, once the terror of unknown side effects had ebbed, I found myself relaxing into my chemo seat, knowing that chemo gave me an excuse to release all my “shoulds”. Don’t get me wrong, I wanted nothing to do with chemo and couldn’t wait for my treatment to finally be done. But there was also that strange relief that at least I could use the infusions as a reason for people to not expect too much of me.
It wasn’t until very recently that someone asked me whether I had been burned-out even before my cancer diagnosis. I realized that I had been under so much stress at work with responsibilities at home too, that all the anxiety associated with that was only relieved by getting cancer.
“Relieved by getting cancer”!!! What a ridiculous statement, and yet so true and telling. Sometimes we barrel forwards carrying so much responsibility (and, yes, guilt) that we don’t stop to question whether there’s a way to do this without driving ourselves into the ground.
And that, my friends, is why I’m forcing myself to stop pausing from time to time to reevaluate whether my expectations for myself are reasonable. No, that doesn’t mean practicing “deleterious self-care” that can be harmful–for the record, eating half a box of donuts in bed while binge-watching an entire season of a Netflix series does not qualify as true “self-care”, no matter what Instagram is trying to get you to believe.
Rather, I’m noticing where I am applying pressure on myself in a way that ultimately may have negative effects. It’s all about finding a healthy balance.
And so, there was no post last Monday. My hope for you is that you also take a break when it’s beneficial for you to do so. Have a great week!
Many cancer patients complain of feelings of helplessness after their diagnosis, and I can certainly relate to that. As a result, I’m particularly interested in research that explores whether patients can gain control over the success of their treatments.
The most recent study I’ve come across includes breast cancer patients undergoing treatment at Yale and Dana Farber Cancer Centers.
This study appeared in the Journal of Clinical Oncology(Sanft et al., 2023). Researchers examined the effect of diet and exercise on “relative dose intensity” (RDI), which is the relationship between the amount of chemotherapy delivered to the patient compared to the standard amount prescribed. Low RDI means that there was a reduction in the chemotherapy the patient received and is generally associated with a poorer outcome. Dose reductions result from the patient’s difficulty in tolerating the drug.
The researchers also looked for “pathologic complete response” (pCR), which is “the lack of all signs of cancer in tissue samples removed during surgery or biopsy after treatment with radiation or chemotherapy” (definition from cancer.gov). This was for women receiving neoadjuvant chemotherapy, which is chemotherapy administered prior to surgery.
Yep, once again we come back to diet and exercise, even during chemo. (Photo by Yulissa Tagle on Unsplash)
The subjects of this study were women recently diagnosed with stage I-III breast cancer, who either received the “usual care” or a diet and exercise intervention. Those in the intervention group received nutritional counseling with a focus on a plant-based diet. The physical activity included counseling and support for maintaining a home-based exercise program that included strength training (2x/week) and brisk walking (150 min/week of moderate intensity or 75 min/week of vigorous intensity).
What the research confirmed first was that the subjects in the intervention group were able to increase their exercise and diet quality, which showed that it was feasible to make lifestyle improvements even in the midst of chemotherapy.
However, in this study, the RDI for both groups (“usual care” and diet & exercise intervention) ended up being similar, but also quite high, which meant that women in both groups completed most of their treatment. The researchers noted that the study should be re-run with patients who were at greater risk of not being able to complete all their chemo to see how much of an effect improved diet and exercise would have, especially since exercise has been shown in other studies to have a positive effect on patient outcomes.
But a striking difference was seen for women receiving neoadjuvant (prior to surgery) chemotherapy in that the rates of pCR (disappearance of cancer in the tissues) were 53% for women in the intervention group versus 28% for women receiving usual care. That suggests that the intervention enabled the chemotherapy to be more effective.
There are many physical activities you can choose from–clifftop not required. (Photo by Sigmund on Unsplash)
The researchers stated the following in summarizing their study: “Given that pCR is an accepted predictor of recurrence and mortality, our findings could provide oncologists with a supportive care intervention that affects the ability to potentially improve survival outcomes” (Sanft et al., 2023, J Clin Oncol). And this is very good news indeed.
The take-home message here is not surprising, and it’s good advice for life in general: no matter what your current lifestyle, prioritizing a healthier diet (emphasis on whole foods, plant-based, less processing, etc.) and engaging in regular cardiovascular and strength training exercise will improve your quality of life. It is always worth the effort.
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REFERENCE: Sanft et al. (2023) Randomized Trial of Exercise and Nutrition on Chemotherapy Completion and Pathologic Complete Response in Women With Breast Cancer: The Lifestyle, Exercise, and Nutrition Early After Diagnosis Study. J Clin Oncol, 41: 5285–5295. https://doi.org/10.1200%2FJCO.23.00871. [This paper is Open Access and can also be found in PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10691793/]
With as much sophisticated research as has been done on cancer, it still remains a confounding disease and much of the treatment may seem to be, for lack of a better word, medieval.
So it shouldn’t seem surprising that cancer patients also reach out for less conventional therapy to help themselves through the treatment process.
First, a clarification of terms used in this post:
Acupuncture is utilized as a non-standard treatment (for those who can take more poking)
Conventional medicine: chemotherapy, radiation, surgery, immunotherapy, etc., prescribed by your medical team.
Complementary medicine: non-standard treatment used in conjunction with conventional treatment; also called Integrative Medicine.
Alternative medicine: non-standard treatment used instead of conventional treatment.
Therefore, generally speaking, what distinguishes complementary from alternative medicine is whether it’s used with standard medical treatment.
According to a study (Crudup et al., 2021) that was presented at the 2021 Annual Meeting of the American Society of Clinical Oncology (ASCO), 73% of breast cancer patient participants stated that they employed complementary therapies in their treatment. However, while oncologists were supportive of such therapies, they were not aware of the extent to which their patients utilized them and thought that only 43% of their patients did.
Patients get more benefit from spiritual practices than most oncologists realize
Furthermore, oncologists felt that counseling, support groups, exercise, etc. were the most effective non-standard therapies, in contrast to patients who found great benefit in meditation, mindfulness and spiritual practices. While two-thirds of both patients and oncologists felt that complementary medicine improved quality of life, a majority of patients also felt that it improved their outcomes.
Wayne Jonas, MD, a co-author of this study, says: “Cancer is a complex disease that affects every component of a patient’s life. While conventional medicine is effective for curing disease, it can fall short in helping patients heal. Patients are turning to these therapies to look for hope and to improve their quality of life and well-being after diagnosis… .”
What types of therapies do these include? The website “Cancer Health” provides examples of some complementary treatments (see here for an explanation of each):
Acupuncture Aromatherapy Art Therapy Biofeedback Cannabis Herbal Therapies Labyrinth Walking Massage Meditation Music/Dance Therapy Qigong Spirituality Tai Chi Traditional Medicine (Ayurvedic, Chinese, etc.) Vitamins and Supplements Yoga
[This list is by no means exhaustive.]
I used a number of these complementary therapies myself and can attest to the important role they played in my recovery. As Dr. Jonas points out above, conventional treatments “can fall short in helping patients heal” [emphasis mine], whereas non-standard therapies seem to focus on that aspect.
I believe that these additional therapies, particularly more spiritual ones, are what give us hope throughout the cancer experience. Patients should be encouraged to seek out additional, complementary therapies to help themselves move through treatment, fully supported by their oncologists and ideally also guided by them.
Did you rely on complementary or alternative treatments to help you through your cancer journey?
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REFERENCES
Original Research
Abstract for presentation:
Crudup et al. (2021) Awareness, perceptions, and usage of whole person integrative oncology practices: Similarities and differences between breast cancer patients and oncologists. Presented at 2021 Annual Meeting of the American Society of Clinical Oncology (ASCO), https://meetings.asco.org/abstracts-presentations/200685
This post continues what I started in the last post…a few things about breast cancer that I wasn’t aware of at the time of my diagnosis. Knowing the following would have made things a little less stressful:
1. Lumpectomy is a relatively uncomplicated surgery. I wish someone had explained this to me because I was a total wreck going into surgery (which happened to be the only surgery that I had ever had up to that point, making everything 10 times worse). Although I had decided against a full mastectomy, I was still so afraid of what a lumpectomy would entail, what I’d look like and how long it would take me to recover from losing a chunk of flesh.
The reality was…I was back at work the next week. No drainage tubes, no need for heavy analgesics — just a couple of ibuprofin the night after surgery because skipping coffee that morning resulted in a headache, but that was it. It was even hard to tell that I’d had my lump excised. Wish I could go back to my earlier self and tell her not to worry.
Stethoscopes are emotionless. Oncologists can seem to be too, but that’s by design.
2. Doctors are not in a hurry to give you good news. I think there’s a general feeling among medical professionals that there’s so much that can go poorly during cancer treatment that your doc isn’t going to go out of their way to pump you full of optimism. They probably practice keeping an emotionless face as they deliver all sorts of news, both good and bad. As a patient, however, I watched every flicker on my oncologist’s face for an indication of how things were “really” going. I feared that there was something he wasn’t telling me.
It wasn’t until perhaps a year or so later when I was expressing my fears to him about possible abnormalities inside my body that he uttered the phrase, “but you have your health”…and I was taken aback because I had never heard him sound so positive. It was almost a shock to hear him confirm that I was actually considered healthy.
3. Don’t expect things to be the same as before. Accepting that part of your life has changed will make it much easier to go on. This took me a while to appreciate because I was expecting to get back to doing and feeling everything the same as before my diagnosis.
But chemo (and eventually, age) pushed me through menopause, and I had to come to grips with, say, a high-intensity interval workout requiring more recovery time and that I had trouble remembering people’s names. Once I got to that point of acceptance, life after cancer treatment became easier, although it did take a number of years to get there.
4. Hair takes a while to grow back in. The reason I created posts with photographs that illustrated the cancer journey that my hair went through (here and here) was because I could not find good photos on the internet documenting the process. I did see images of a woman a few weeks after stopping chemo with little stubs already visible, but that was not my experience and it made my anxiety over my slow regrowth even worse.
Walking around with no hair was getting old and I was getting more desperate by the day to see evidence of sprouts!
If you’ve ever googled your chemo drug name + “hair loss”, you understand the fear: the first search result is usually a law office gathering info on behalf of cancer patients whose hair never grew back!
It took a number of months before my folicles woke up and actually started growing. I remember the moment that I finally saw growth on the front of my head and it was as if the heavens had opened up and divine light poured out onto me. Seriously. I would have avoided a lot of stress if someone had just told me that it’s gonna be a while.
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Ok, ok, to be fair, my oncologist did urge patience with the regrowth but I was a jumbled mess of nerves and was feeling overwhelmed. All the internet propaganda about both (1) other women having much faster regrowth, or (2) otherwomen never getting their hair back terrified me. Note to self: when feeling desperate, stay off the internet!
After a few years of wondering what the heck is going on with my head, I joined a Memory and Attention Adaptation Training (MAAT) class generously provided by my cancer center (which I’ll be posting about on a later date).
This is gratifying on two levels: first, that I can learn new strategies for dealing with the memory issues and distractibility that have been plaguing me since finishing breast cancer treatment five years ago; and second, and perhaps more important to me emotionally, that what I am experiencing is REAL. It’s officially termed Chemotherapy Related Cognitive Impairment (CRCI) or, informally, chemo brain.
I’ve been told that “you’re imagining this” (I’m not) or “you’ve always been like this” (I haven’t) or “just focus harder” (I AM!!!) or even “this is just an excuse” (Argh! No!), coming from people who have been annoyed by my memory lapses.
Chemo brain spends a lot of time just wandering around without an idea of how to get anywhere.
My brain isn’t lazy. As a matter of fact, it’s the opposite problem. My brain is too busy.
In the MAAT class, we learned of a study from the University of British Columbia (UBC) by Kam et al. (2016, Clin Neurophysiol) that examined what happens inside those brains that suffer cognitive impairment from cancer treatment, even years later. In that published study, the experimental group consisted of nineteen breast cancer survivors. All had undergone chemotherapy for early stage breast cancer and had subsequently self-reported cognitive issues.
Researchers at UBC compared these survivors against twelve (non-cancer) control subjects in a task that required sustained attention. All the participants’ brains were monitored via electroencephalogram (EEG) both while working on the task and while at rest.
The results were vindicating for me and, I’m sure, for others experiencing this. Normal brains cycle through periods of focus and periods of “wandering”. However, as the UBC researchers stated in a summary of their results (published here): “We found that chemo brain is a chronically wandering brain, they’re essentially stuck in a shut out mode.”
This was true even when the breast cancer survivors thought that they were focusing. Furthermore, the survivors’ brains exhibited activity even when they were instructed to relax.
Great. We know that chemo brain is an undeniable fact for some cancer survivors and can last for years — in this study, up to three years. However, for me and some of the people in my MAAT class, it’s been five years and we’re still dealing with this, which is frustrating. What can be done about it?
When anxiety and chemo brain collide, you get a confused goat tangled up in a rope. That would be me.
It won’t come as a surprise — anxiety makes everything worse, and that holds true for chemo brain too. As mentioned above, I’ll discuss this in greater detail in a later post, but basically, a main focus of the MAAT class is learning to handle stressors in an effort to relieve anxiety.
So now that I know that what I’m experiencing is a real thing, a large part of combatting it is what I’m already trying to do — mindfulness, meditation, yoga and similar sensible self-care. And while it might seem aggravating that even with all that practice I’m still dealing with this, I’m actually bouyed by the fact that every bit of mindfulness helps. The reality is, I’ve made a monumental amount of progress from where I was when I started, five years ago.
And that keeps me going. Where would I be if I wasn’t trying?
The published study: Kam JWY, Brenner CA, Handy TC, Boyd LA, Liu-Ambrose T, Lim HJ, Hayden S, Campbell KL (2016) Sustained attention abnormalities in breast cancer survivors with cognitive deficits post chemotherapy: An electrophysiological study, Clinical Neurophysiology, 127, 369-378. https://doi.org/10.1016/j.clinph.2015.03.007 Please note that the above study is not available free online at this time. For a pdf free of charge, contact one of the authors (email address next to their name at link above) or your local university library. Due to copyright issues, I am unable to distribute the full document myself.
As we close out October, otherwise known as “Breast Cancer Awareness Month”, I wanted to share a video of a webinar about advances in the fight against breast cancer, offered through the Yale Alumni Health Network, led by Dr. Jamie Wells.
The speakers included Dr. David Mankoff (from UPenn) and Drs. Lajos Pusztai, Maryam Lustberg and Eric Winer (all from Yale) as they talked about research being done on hormone-positive, HER2 receptor positive and triple negative breast cancers. I’ve pasted in the Vimeo clip from Twitter, but also offer my simplified synopsis below. If you have the time to watch (~45 min for the talks, then interesting Q&As for about 20 minutes), I highly recommend the video!
— YALE ALUMNI HEALTH NETWORK (YAHN) (@YaleHealthSIG) October 28, 2022
In the midst of the discussions, it was heartening to hear that the doctors placed a lot of emphasis on both health disparities in different populations and also the search for treatments that would not severely impact a patient’s quality-of-life. These are two important topics. I appreciated that they acknowledged that we cannot make advances in the disease if we are leaving behind large numbers of people for whom treatment is inaccessible, and that a treatment is not viable if it successfully treats the cancer but damages the patient in other ways.
The best overall news is that since 1990, deaths from breast cancer have decreased by a third. That’s a significant improvement within the past 30 or so years, even though the prevalence of the disease is increasing. Dr. Mankoff noted that the survival rate improvements are due not simply to earlier detection, but also to advances in the treatments.
HORMONE-POSITIVE BREAST CANCER
Dr. Lustberg spoke about hormone-positive breast cancers and started with a quick explanation of the history of such cancers, and then explained how current-day personalized medicine (genomic profiling) can identify the patients who might be spared chemo based on the characteristics of their tumors, and how targeted therapies improve survival rates. She experienced some audio issues towards the very end of her talk, but not much information was lost.
She acknowledged that the “most effective drug is one you can take”, stating that there’s been an effort to try to understand the toxicity of various treatments. If the drug’s side effects are too negative, patients will have a hard time continuing to take it. She noted the importance of keeping the patient involved in the decision making process, something that all of us who have been through this can applaud. It’s too easy for oncologists to forget that they’re treating a human being who will be dealing with the concequences of heavy treatments.
HER2+ BREAST CANCER
Dr. Winer discussed HER2-targeted therapy, noting that prior to the year 2000, it was considered one of the most aggressive forms of breast cancer with common recurrences, after which the prognosis for survival was poor. As a HER2+ cancer suvivor, I am so thankful that this is no longer the case! The landscape changed with the introduction of monoclonal antibody drugs such as Herceptin, and the development of additional drugs, should Herceptin stop working, has given patients with this type of cancer much more hope for a full recovery.
Two of these new drugs for metastatic HER2+ cancer are “antibody drug conjugates” (T-DM1 and trastuzumab deruxtucan). Dr. Winer described them as Trojan Horses, as they can deliver the chemotherapy with which they’re paired directly into the cell, greatly decreasing side effects to the patient.
It’s so refreshing to hear the words “cancer” and “cure” used together in the same sentence. We are making serious progress now!
Perhaps most important, Dr. Winer actually used the word “cured” when talking about the outcomes for early stage HER2+ cancers, something that is truly remarkable. This is especially true for women with stage I cancers.
Many patients with stage II & III cancers receive the drugs prior to surgery, which can decrease the need for mastectomies and complete removal of the lymph nodes. In addition, pre-surgical treatment can guide the medical team in adjusting later therapies, based on how the tumor reacts to early drug administration.
Finally, Dr. Winer spoke of the stark disparities in cancer care, noting that black women are twice as likely to die from breast cancer as white women. Eliminating these disparities is his number one-rated area of importance for where to focus future efforts, something I strongly support.
TRIPLE NEGATIVE BREAST CANCER
Dr. Pusztai spoke of Triple Negative Breast Cancer (TNBC), and having lost several friends to this specific type of cancer, I was very interested in treatment advances that have been made. He described the differences beween TNBC and hormone positive breast cancers, noting that it’s likely that these two diseases orginated from completely different cell types, suggesting that these are different diseases and should be viewed as such.
It was exciting to learn that most of the patients with early stage TNBC disease are able to be cured (again, that beautiful word!). We now have both better treatment strategies and new drugs, and success rates are improving year by year. Dr. Pusztai emphasized the benefits of completing chemotherapy prior to surgery, going against our strong impulse to “get the cancer out” first. With the drug-first strategy, medical teams can adjust the post-operative treatments as needed.
The thing that was so amazing to me was that the recurrence-free rate of survival was 85-90% with these “modern regimens” for early stage disease. That’s impressive!
Next on the horizon is fine-tuning the right balance of drugs for patients, given that chemotherapies are still toxic.
There’s still a lot to be done, but all of this makes me feel so hopeful for a future in which a cancer diagnosis is something that we don’t have to fear.
Dr. Pusztai stated that he felt we already have the drugs with which to cure “at least some” of the metastatic TNBC patients, especially for those who are diagnosed at stage IV (rather than having earlier-stage disease that was treated and later metastasized). The idea is to utilize existing drugs but apply them using the new treatment strategies that have been developed. However, Dr. Pusztai stressed that new drugs are also being developed.
Q&As
There were a range of excellent questions that began at about the 45-minute mark, but as mentioned above, I enjoyed hearing the admissions by the doctors that they considered quality of life to be a very important factor in whether or not to continue medications, and they acknowledged that it is the patient who should have the control to balance their risks against their treatment options. Other questions included recurrence in hormone-positive cancers, development of drug resistance, genetic testing, continuation of care (“risk-stratified follow-up care”) and second opinions.
Dr. Winer commented that within a decade he felt we will have all the treatment we need to prevent and cure breast cancer in most patients, so again, he stressed that the focus must turn to making that treatment available to everyone, regardless of who they are.
LAST BUT NOT LEAST…
Dr. Winer admitted that many doctors, in treating patients, end up “taking over people’s lives and medicalizing their lives”. His approach, therefore, is “to try to provide therapy without making someone either unhappy or feeling like they are attached with a leash to their doctor’s office.” While there was some discussion related to this, I appreciated that doctors are actually thinking about this and want to allow patients to “live their lives”.
Finally, I was amused by the doctors’ admissions that even they found the drug names to be unpronounceable. It’s true that in my own treatment, I usually stuck to the easiest name to pronounce…I can’t imagine having to use those names on a daily basis!
Since we’re halfway through October – Breast Cancer Awareness Month – this is a good opportunity to remind everyone who’s had a cancer diagnosis that you’re still in control.
That might be very different from what you’re feeling. The whole thing with cancer is the sense that your life is out of control. Even your most faithful ally, your body, seems to be out to get you, growing a tumor behind your back.
Does it feel like someone else is controlling everything in your life?
That’s to say nothing of how your weekly schedule gets highjacked with oncological appointments, radiation treatments and days recovering from chemo. Then there’s the onslaught of new medical terms, the many pills that you’re supposed to take, even the practically unpronounceable chemotherapy drug names (what kind of a suffix is “-ib”???).
If anything, this might feel like the most out-of-control time of your life. When you’re slapped with a difficult treatment plan, you want it all to stop, but your oncologist tells you, “we won’t let you skip an infusion or stop taking your medication.”
That sense of being forced to do something (especially when it’s unpleasant) can open the floodgates to a deluge of anxiety on top of the fear and frustration that you might already feel about your cancer treatment. No one wants to feel like they have no say in a matter that affects them so deeply and personally.
This life is yours…and so are decisions about your cancer treatment.
But remember this: you always have a choice. Even though your medical team might not be phrasing it that way, you are still in control.
Perhaps this tiny acknowledgement may relax some of that perceived pressure and actually make it easier to continue. Your cancer treatment choices remain yours to make, so allow that realization to help you to step back, get perspective and weigh your options. When you demand space for yourself, you have room to think and it’s easier to act in your own best interest.
So, breathe. You’re still calling all the shots.
And, hey, medical team: maybe stop being so pushy and remind those cancer patients that they get to make the decisions about their treatment and their lives. It would go a long way towards helping your patients feel better about their treatment plans, like they’re part of the team instead of a prisoner of their situation.
From what I can tell, the loss of body odor following cancer chemotherapy isn’t widely acknowledged within the medical community, but it’s certainly something that many of us have experienced.
This is NOT what you think of when someone says, “sweaty armpit”!
Based on what I’ve read, this might be a result of the weedwhacking effect that chemo drugs have on our microbiomes. Regardless, the result has been positive for those of us who find that we don’t have to worry about being smelly.
However, I happened to catch an interview on National Public Radio (aka NPR) that helped make more sense of what was actually going on, even though it was a bit of a killjoy. Listen to it here, where you can also find a full write-up of the piece.
Basically, that sweaty stink that we find repugnant is from a compound produced by bacteria living on the skin. One species of these bacteria that’s associated with an onion-like odor is Staphylococcus hominis.
Our stinky sweat may offer some protection from stuff like MRSA, shown on this CDC photo. They might look like cute fuzzy purple balls, but in the age of antibiotic-resistant bacteria, they’re potential killers.
And unfortunately, these smelly microbes are very beneficial, helping protect humans from things like eczema and MRSA (antibiotic-resistant Staphylococcus aureus). As one of the researchers puts it, sweat is an “antibiotic juice” that forms a protective layer on our skin as it dries.
Yeah, I know what you’re thinking: cancer is miserable enough, and you HAD to take away this one little thing (loss of body odor) that was the only perk to chemo?
Well, as mentioned above, I’m not qualified to definitively say that it’s the chemo that kills the skin microbes and makes you not smell. I’ve been unable to find research studies that examine the effects of chemotherapy on your skin’s microscopic residents. Nonetheless, I’ve tried to contact the researchers mentioned in the NPR story to see if they’ve had any experience with chemotherapy and loss of body odor in cancer patients. If they reply, I’ll report back to you.
For now, if you’re happy being odorless, keep enjoying it.
Frantic Shanti 