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After Your Breast Cancer Surgery: A Guide to Recovery

Is there anything you can do to speed your recovery after breast cancer surgery? Cancer survivors often look for information and advice from their health care providers about food choices, physical activity, and dietary supplement use to improve their quality of life and survival. This is an excerpt from the American Cancer Society's article, Nutrition and Physical Activity During and After Cancer Treatment: Answers to Common Questions. To see the full article, click on the link above.

Should I exercise during cancer treatment and recovery?

Research strongly suggests that exercise is not only safe during cancer treatment, but it can also improve physical functioning and many aspects of quality of life. Moderate exercise has been shown to improve fatigue (extreme tiredness), anxiety, and self-esteem. It also helps heart and blood vessel fitness, muscle strength, and body composition (how much of your body is made up of fat, bone, or muscle).

People getting chemotherapy and radiation who already exercise may need to do so at a lower intensity and build up more slowly than people who are not getting cancer treatment. The main goal should be to stay as active as possible and slowly increase your level of activity over time after treatment.

Are there special precautions survivors should consider?

Certain issues for cancer survivors may prevent or affect their ability to exercise. Some effects of treatment may increase the risk for exercise-related problems. For instance:

  • People with severe anemia (low red blood cell counts) should delay activity until the anemia is better.
  • Those with weak immune systems should avoid public gyms and other public places until their white blood cell counts return to safe levels.
  • People getting radiation should avoid swimming pools because chlorine may irritate the skin at the treatment area.

If you were not active before diagnosis, you should start with low-intensity activities and then slowly increase your activity level. Certain people should use extra caution to reduce their risk of falls and injuries:

  • Older people
  • Those with bone disease (cancer in the bones or thinning bones, such as osteoporosis)
  • People with arthritis
  • Anyone with nerve damage (peripheral neuropathy)

Can regular exercise reduce the risk of cancer coming back?

This has not been looked at for all types of cancer, but there have been studies of survivors of breast, colorectal, prostate, and ovarian cancers. In these studies, people with higher levels of physical activity after diagnosis lived longer and had less chance of the cancer coming back. Still, more studies are needed to see if exercise has a direct effect on cancer growth.

In the meantime, since physical activity is known to prevent heart and blood vessel disease, diabetes, and osteoporosis, cancer survivors should try to have a physically active lifestyle.

Is yoga helpful to cancer survivors?

Most of the studies of yoga in cancer have been in breast cancer patients. They have found that yoga can be helpful in terms of anxiety, depression, distress, and stress. It didn't seem to be as helpful for more physical outcomes, such as body composition, fitness, and muscle strength.

More research is needed, but to get the most benefit, it may be best to combine yoga with aerobic exercise and resistance (weight) training.

Acupuncture

In acupuncture, sterile, hair-thin needles are inserted into specific points on the skin, called acupuncture points, and then gently moved. Researchers propose that acupuncture stimulates the nervous system to release natural painkillers and immune system cells. They then travel to weakened areas of the body and relieve symptoms. Studies show that acupuncture may:

  • help relieve fatigue
  • control hot flashes
  • help decrease nausea
  • reduce vomiting
  • lessen pain

Much research is being done on how acupuncture can help relieve some of the symptoms of cancer and side effects of cancer treatment. The most thorough study of acupuncture in breast cancer patients was published in Journal of the American Medical Association in 2000. In the study, 104 women undergoing high-dose chemotherapy were given traditional anti-nausea medication. In addition to taking the medication, the women were randomly chosen to receive 5 days of electroacupuncture (acupuncture in which needles are stimulated with a mild electrical current), acupuncture without an electrical current, or no acupuncture. The women who had acupuncture had significantly fewer nausea episodes than those who didn't.

Another study, completed at Duke University and published in 2002, compared the use of acupuncture to the use of Zofran (chemical name: ondansetron), an anti-nausea medication, before breast cancer surgery to reduce the nausea that can occur after surgery. The acupuncture treatment was found to work better than Zofran at controlling nausea.

In a French study published in 2003, acupuncture was examined in the treatment of cancer-related pain. Patients treated with acupuncture had a 36% reduction in pain after 2 months of acupuncture treatments, compared with a 2% reduction in pain in the patients receiving a placebo type of acupuncture.

In one very preliminary 2004 study at Memorial Sloan-Kettering Cancer Center, acupuncture was shown to reduce post-chemotherapy fatigue by 31% in people with various types of cancer. In 2005, another preliminary study of breast cancer patients in Sweden showed that acupuncture reduced hot flashes by half. While doctors find these results encouraging, they are still very early results and require further study.

Important things to consider before trying acupuncture

  • Risk of lymphedema: Anyone who has had lymph nodes removed from under the arm should not have needles inserted into that arm. If acupuncture is used on an arm, there is a risk of lymphedema, or swelling caused by an excess of fluid in the arm. Talk to the acupuncturist about other treatments that could be used on that arm, such as aromatherapy.
  • Risk of infection: It is standard practice to use disposable, single-use, sterile needles and to swab acupuncture areas with alcohol or a similar disinfectant before using needles. Infection is always a risk, but the risk is higher if the acupuncturist does not follow this process. People who have low white blood cell counts are at an increased risk of infection during acupuncture. This is because the low white blood cell count weakens their immune systems.
  • Risk of bleeding for certain people: Because of the risk of bleeding, acupuncture should not be received by people who have bleeding disorders, low white blood cell counts, or who take blood thinners.
  • Risk of reducing chemotherapy effectiveness because of using herbal supplements. Although acupuncture sometimes incorporates the use of herbal supplements, you should NOT take herbal supplements during a course of chemotherapy. Herbal supplements can reduce the effectiveness of chemotherapy.

Diet

***Excerpt from BreastCancer.org. Click this link to read more.

Nutrition giving your body the nutrients it needs is important for everyone. When combined with exercising and maintaining a healthy weight, eating well is an excellent way to help your body stay strong and healthy.

If you're currently undergoing treatment for breast cancer or have been treated for breast cancer in the past, eating well is particularly important for you. In this section, you can read about healthy eating and what and how to eat during and after treatment.

Evening Primrose Oil for Mastalgia

A 2010 study done at the Mayo Clinic examined the utility of vitamin E and evening primrose oil in reducing the pain in cyclical mastalgia. Cyclical mastalgia is a condition in which women develop pain in breasts just before menstruation. Almost 70 percent of women who are premenopausal suffer from this disorder at some time in their lives. The authors say that a daily dose of 1,200 IU of vitamin E, 3,000 mg of evening primrose oil, or a combination of the two in the same dosages, may bring down the severity of cyclical mastalgia. Whether taken singly or in combination, Vitamin E and primrose oil need to be given for six months.

Massage therapy

Massage is a hands-on method of manipulating the soft tissues of the body using the hands, fingertips, and fists. Massage can include a variety of types of pressure and touch. A massage can be light, concentrating on the skin, or deep, focusing on the underlying layers of muscle tissue.

Studies have demonstrated that massage can offer some health benefits for people with cancer. Massage has been found to be helpful for:

  • anxiety
  • pain
  • fatigue
  • immune function

Studies have shown that massage seems to offer both physical and emotional benefits for women with breast cancer.

A 2003 study at the University of Minnesota compared the effects of massage healing touch (a practice in which the therapist's hands are above or very lightly touching the body) with the caring presence of a doctor or nurse (without any touch therapies) in 230 people who had cancer. In this study, researchers found that, while both healing touch and massage lowered anxiety and pain, massage also reduced the need for pain medicine.

In a 5-week study at the University of Miami in 2003, massage therapy and progressive muscle relaxation therapy were compared in 58 women with Stage I and II breast cancer. Both groups reported feeling less anxious, and the massage group also reported feeling less depressed. The massage group also showed increased levels of a brain chemical called dopamine, which helps produce a feeling of well-being. In addition, for the massage group, there was an increase in protective white blood cells that help boost the immune system (called natural killer cells) from the first to the last day of the study.

There is no evidence that massage can cause an existing cancer to spread.

Important things to consider before trying massage therapy

If you have breast cancer and are interested in finding a massage therapist, ask your surgeon or oncologist for recommendations. It's important to let your massage therapist know about your diagnosis, treatment, and any symptoms you may have. Massage can be very helpful. But it has the potential to cause harm. Keep these things in mind:

  • If you've just had breast surgery, you should lie on your back for a massage until your doctor decides it is safe for you to lie on your stomach.
  • Deep massage, or any type of massage that involves strong pressure, should NOT be used if you are undergoing chemotherapy and radiation. People undergoing chemotherapy may have a decrease in red and white blood cells, so with deep massage, there is a risk of bruising. Since deep massage can be taxing to a system already vulnerable from chemotherapy and radiation, it is not recommended for people currently in treatment. Light massage can be used instead.
  • If you're currently undergoing radiation, your massage therapist should avoid touching any sensitive skin in the treatment area. Massage and massage oils can make already-irritated skin feel much worse. Your therapist should also avoid touching any temporary markings in the corners of the radiation treatment field. If you don't have skin irritation in the treatment area, any massage to this area should be done very lightly through a soft towel or cloth.
  • If you have had lymph nodes removed, the massage therapist should only use very light touch on your affected arm and the area around the underarm.
  • If you have arm lymphedema, the massage therapist should avoid the affected arm and underarm areas completely. Traditional massage therapy can worsen lymphedema. A massage therapist who has experience with breast cancer patients may already know this, but it's important to make sure he or she understands.
  • If you have arm lymphedema, your arm and underarm area should be treated by a different kind of massage especially for lymphedema, called manual lymphatic drainage. Look for a physical, occupational, or massage therapist trained and certified in manual lymph drainage to treat your lymphedema.