What happens when you finish treatment for early breast cancer?

24 Apr 2023

By Luan Lawrenson-Woods

We talk to Medical Oncologist, Dr Sanjeev Kumar, about what you can expect after treatment for early breast cancer, and what supportive care may be available to help you take a proactive approach to life beyond treatment.

How regularly would someone see their oncologist after finishing initial, intensive treatment for early breast cancer, and for how long?

“This is really contingent on the biology of their breast cancer and the type of breast cancer they have, as well as the risk of recurrence associated with their breast cancer.” Dr Sanjeev adds, “How worried we are about the patient and how toxic the treatment is that they're having going forward will also predicate how often we see them and determine how frequently their reviews are in our clinics.”

Similarly, how long a patient sees their oncologist for follow-up appointments will depend upon these factors as well as how they tolerate any ongoing treatment, such as a hormone or HER2-directed therapy.

“We will see patients through their highest-risk period for recurrence,” says Dr Sanjeev. He acknowledges that these timeframes might sound arbitrary but reassures “it’s based on data of thousands and thousands of patients and patterns of recurrence that we see”.


What are the most common potential long-term effects of treatment for early breast cancer?

“Once again, it's dependent on the biology of your breast cancer, the type of breast cancer that you've got, and what your treatment is on an ongoing basis that'll determine your risks of long-term toxicity and the nature of your long-term toxicities. The most physically obvious one related to chemotherapy would be hair loss and the steady path to hair regrowth.”

“Fatigue in long-term follow-up has continued to be an issue for a lot of my patients that has impeded their pathway to returning to the workforce. Exercise physiology and exercise is my best way of combating it, and I provide all my patients with exercise prescriptions to try to deal with that.”

“Insomnia has been a massive issue with my patients. It starts during the intensive treatment phase when patients are taking high-dose steroids, but then that pattern of insomnia continues well into the post-intensive treatment phase. I often engage sleep physicians, get patients to have sleep studies and get psychologists involved to try to deal with sleep because sleep is fundamental to how we function.”

Fertility is a concern for younger patients.

“Fertility is a long-term issue that really haunts a lot of my younger patients. Before administering treatment that could potentially harm or reduce someone's fertility, having open lines of communication about fertility and reproductive health from day one is important.”

“We worry about the cardiac toxicity of treatment and the ramifications of potential cardiac complications. We're collecting data from patients (that have consented) with the ultimate aim of improving the heart health of women receiving potentially heart toxic medications as a part of their cancer treatment.”

“Another kind of long-term toxicity is peripheral neuropathy, or nerve damage to the tips of the fingers and the tips of the toes, that can happen with a particular weekly chemotherapy. And that's a long-term toxicity that really worries patients. I just want to say prevention is best as opposed to dealing with peripheral neuropathy.” This is particularly important because neuropathy can continue to get worse after the initial symptoms present. Patients must tell their team as soon as they experience any symptoms.

“Psychological health and well-being cannot be ignored,” adds Dr Sanjeev. “Then there are menopausal symptoms of long-term hormone therapy which is another long-term toxicity that we can’t minimise.” Symptoms like hot flushes can be helped with acupuncture or medication.

“There's a preconception that you're going to lose weight during your chemotherapy, but the preconception is wrong. Particularly in women who receive cytotoxic chemotherapy. There's a huge steroid burden there and most women gain weight during treatment. So, I equip them with diet and lifestyle mechanisms and, as I said, I give my patients exercise prescriptions. It makes them feel so much better and ameliorates some of that inevitable weight gain that happens during chemotherapy. That not only improves their long-term outcomes in terms of metabolic health but in a small way it also reduces their risk of breast cancer recurrence.”


How to cope with fear of recurrence

The two centres that Dr Sanjeev works out of offer clinical psychology support to patients. Mindfulness training has also resonated with many of his patients.

“Instilling that sense of calm that comes with mindfulness in dealing with any irrational or worrisome thoughts about recurrence of cancer has been really helpful in dealing with them and providing patients with a kind of proactive pathway forward, allowing them to pursue a survivorship pathway rather than a pathway of fear and angst.”

Minimizing unnecessary interventions with spaced-out appointments based on an individualised follow-up schedule can help. “Because often that fear is rattled by constant ongoing and unnecessary follow-up appointments.”

As you approach the end of your intensive treatment, Dr Sanjeev suggests you speak to your team about how to monitor your health and what you should look out for and escalate for further investigation, and to avoid online “fearmongering”. Find a GP that you can trust and see at short notice. “Your first port of call will be that primary health care provider. Primary health care providers can call us directly if there are any concerns to ask for advice.”


How can women prepare to move on from intensive treatment into the follow-up phase?

“There are two ways I get women to prepare for transitioning from the intensive phase of treatment to the less intensive. During the intensive phase of treatment often the second component of treatment is a little less toxic than the first component. Again, that's contingent on the oncologist and treatment schedule. What I try and do is push women to re-enter the workplace in whatever context they can and feel physically and psychologically comfortable to do. COVID isn't as much of an issue as it was before, and I’m not ignoring that, but re-entering the workplace is feeling a little bit safer. It is one way of reclaiming that sense of normality. And then regaining and re-entering the world of physical fitness and well-being, I think, is a fantastic coping strategy.”

Chris O’Brien Lifehouse has an integrative physician and a survivorship oncologist that can assist Dr Sanjeev’s patients.

“It can be a bubble being in cancer treatment and being caught in that world of toxicity management. It takes you away from the realities of daily life but having the support of a network of supportive care physicians, nurses and psychologists really helps you to reintegrate back into life.”

Supportive care from exercise physiologists, massage therapists and acupuncturists, he says, “not only heals and helps patients deal with the toxicities of the treatment that I'm giving them, but also equips them with lifestyle mechanisms to help them move beyond their intensive phase of treatment.” Not everyone will have access to a survivorship oncologist or integrative physician, but you can still access supportive care once intensive treatment ends through your GP.

“We’ve got to entrust our primary health care providers to provide the first point of approach. And then you can talk to your breast care nurse, who can be a conduit to us.”

Sue Woodall’s tips on how to have a conversation about cancer at work and things that can help you return to work after your treatment.

Specialist Nurse, Amy O’Donnell, offers some advice on what you can do to help with the overwhelm after a cancer diagnosis.

Check out our ‘round up’ of Pink Hope resources to help you deal with some of the long-term side effects of breast cancer treatment. 

This article has been reviewed by Dr Sanjeev Kumar, a Medical Oncologist at Chris O’Brien Lifehouse, Royal Prince Alfred Hospital and Westmead Breast Cancer Institute. Dr Kumar holds an honorary Clinical Research Associate position at Garvan Institute of Medical Research, is on the Board of Directors for the Australasian Society for Breast Diseases and a Conjoint Lecturer with the University of New South Wales.

This content is brought to you in partnership with Eli Lilly Australia and developed independently by the team at Pink Hope in consultation with medical experts.