BREAST CANCER TREATMENT will inevitably change how your body looks. Some of the changes are obvious, such as hair loss, but others are only seen by you, such as your surgical scars. These body changes can be unnerving. Many women also gain weight because of chemotherapy and the menopause, and all of these changes can be a daily reminder that you have had breast cancer. We want to help you cope with the changes that your body goes through, and this chapter will cover everything from why you are more likely to gain weight than lose it, to body image and how to get used to being a different shape and size.
Weight gain during and after breast cancer treatment is common, due to the side effects (physical and mental) of treatment. Hormone therapy (see Chapter 13) can bring on the menopause (Chapter 16), and weight gain is a well-known side effect. Chemotherapy (Chapter 10) can make you feel lethargic, and because you are spending more time in hospital than women who just had surgery and radiotherapy, you may end up eating a lot of junk food in hospital cafés. Chemotherapy can also make you feel sick, and many women constantly snack to relieve this. Visitors bring you chocolate as a treat, and, finally, having cancer is miserable so it’s tempting to comfort eat.
Here’s the dilemma. On the one hand, cancer treatment is really tough, so you shouldn’t beat yourself up if you put on a bit of weight. On the other hand, research has shown that the more overweight you are, the more likely you are to get a recurrence of your breast cancer. If you gain a lot of weight during cancer treatment it can be very hard to lose it afterwards. It also increases your risk of developing heart disease, high blood pressure and type 2 diabetes. Though we realise that this is easier said than done, you can keep your weight under control by being sensible about what and how much you eat, and being as active as you can. We go through this in more detail in Chapter 18.
Not everyone gains weight during treatment. There is no better way of controlling your weight than watching what you eat and increasing the amount of activity you do each day. Despite this, you may find it impossible to shift the extra pounds, and it can be hard to learn to accept your new body, especially with all the other changes that have happened. Be kind to yourself, and we hope you will learn to love your body at its new shape and weight.
The hospital unit where Trish had her chemo provided excellent home-made cakes, but she felt she had to ‘earn’ the treat by doing a long power walk before her treatment!
Liz suffered with very bad sickness during chemo, and would lose 2–3kg in the first few days which she put back on again before the next treatment.
One of the most common side effects of cancer and its treatment is fatigue. This is different from simply feeling tired. Fatigue can influence your mood, your relationship and your ability to work (both inside and outside the home), not to mention restricting your ability to go out and socialise.
Everyone gets tired from time to time – after strenuous activity, at the end of a long day or after a visit to certain relatives. Fatigue happens when (for example):
● You have tiredness that is not related to physical exertion.
● Your tiredness rarely goes away or keeps returning, however much rest or sleep you have.
● You feel weak, as if (as Trish’s mum used to say) you ‘couldn’t pull the skin off a rice pudding’.
● You are sleeping more than usual and/or have difficulty sleeping.
● Your tiredness is associated with feeling confused, lacking concentration or inability to focus your thoughts.
● You feel irritable, sad or depressed as well as tired.
If you have any of the above symptoms, tell your doctor. They may want to do some simple tests to make sure nothing else is wrong. A blood test can find a treatable cause, such as anaemia, an under-active thyroid or even heart failure (though this is not common).
The most likely cause, however, is that the fatigue is a side effect of your cancer treatment, perhaps combined with you becoming deconditioned (out of shape, with loss of muscle strength, flexibility and balance) as a result of being ill. Your GP may be able to change your current medication (for example, some antihistamines have a strong sedative effect while others don’t), or you may need treatment for depression (see Chapter 4 for advice on this).
It can help to keep a diary of when the fatigue occurs and what it feels like. Are there any ‘triggers’? Are you worse on days when you do less exercise or more exercise? Is your fatigue linked to alcohol? Is the fatigue associated with pain? (If so, ask for a review of your painkillers.) If your fatigue is simply because you have had cancer, it can be hard to treat. Karen Mullin and her colleagues recently reviewed all the research literature on this condition for Lancet Oncology (2017; 3: 961). They found that both exercise therapy and psychological therapy were effective in reducing fatigue and that, compared to these, medication was less effective.
If just the thought of exercise is exhausting, use ‘baby steps’: it doesn’t matter how little you do, just do something and build from that. Walk to the nearest lamp post and back. Tomorrow, try two and build the distance gradually. You could also try some strengthening exercises to tighten and tone your muscles. Use two tins of food (such as baked beans) as hand weights; curl them up to your chin and then slowly down to touch your thighs and repeat 10 times. If your home has stairs, step up onto the first step and down again. Repeat 10 times. If 10 is too easy, try 20. If 10 is too hard, try 5. We talk more about exercise in Chapter 18.
Psychological therapy includes mindfulness and cognitive behavioural therapy, which we cover in Chapter 14. It’s important to be open to the possibility that a physical condition like fatigue may respond to mental ‘exercises’. Yoga (described here) can include both physical exercise and mindfulness techniques.
At the same time as trying to improve your stamina, develop tactics to live within your means. Ask for help and prioritise tasks (and people). Plan your day so you have a balance of physical activity, something socially strenuous and rests in between. If a heavy day is coming up, plan a rest day the day before and after. Stop activities before you become too tired – you simply won’t be able to ‘push through it’.
As we explain in Chapter 18, we recommend that you eat sensibly, with a focus on eating the right amount of healthy, fresh food.
Finally, don’t feel bad if you can’t finish things you would have achieved easily before cancer or if you become ‘dependent’ on friends and neighbours. And play the cancer card when necessary.
Breast cancer treatment can make you look and feel very different. As well as possible weight gain, you will have scars from your biopsies and surgeries and your breasts may be a different shape, be numb to the touch or you may no longer have them. Radiotherapy may have left you with skin damage, and if you lost your hair during chemotherapy, you may have to cope with having hair that grows back with a different texture or colour.
No wonder many women feel ugly, lop-sided, unfeminine, unfit, incomplete – even freakish – after treatment. On top of this, few women are 100 per cent happy with their bodies before they get cancer. You may not want to look in a mirror, get undressed in front of your partner or show your scars in a communal changing room. This reaction is normal and understandable, but please be assured that those feelings do improve in time. Research has shown that at two years after diagnosis, only 15–30 per cent of women still have concerns. Long-term problems with body image are more common in younger women, those who are overweight and those who have had more radical surgery or a delayed reconstruction.
The charity Breast Cancer Care has an excellent guide ‘Your body, intimacy and sex’ which says:
Research has shown that the sooner you confront the physical changes to your body, the easier you may find it to gain confidence in the way you look … If you have a partner, letting them see the surgical scars and changes to your body sooner may also make being intimate easier in the long term. The first few times you look at yourself might make you feel unhappy and shocked, and you may want to avoid looking at yourself again. However, the initial intense feelings you may have will lessen over time as you get more used to how you look now.
The tips below, which are mentioned in the guide, are adapted from ‘Intimacy and sexuality for cancer patients and their partners’ (available at sexualadviceassociation.co.uk). You should work through this sequence slowly. There’s no hurry – and nothing will be gained from trying to force the pace if you’re finding it difficult.
● Start fully clothed. Put on an outfit you like, and look at yourself in a full-length mirror. Pick out three things you really like about yourself.
● Now try it in underwear. Find a comfortable set of underwear (or a swimsuit) and practice looking at yourself with most of your flesh showing. Is it really that bad? This is more than most people are even going to see of you.
● The naked view. When you feel ready, move on to looking at your naked body in a full-length mirror. Describe what you see. Think about what you like about your body – and about what makes you feel awkward or uncomfortable.
● Focus on the changes. When you can look at your whole body naked, you are ready to start exploring what’s happened to your body. Look at your scars and breast reconstruction. Touch them so you get used to how they feel.
● Keep doing all of the above. The more often you look at and feel your body, the less different it will seem.
Here are some additional tips from us on how to improve your body image:
● Work on your weight. You won’t be able to bring back a breast or a nipple that’s been removed, but you can take control of your body size. We know it’s not easy – but it’s not impossible.
● Work on your fitness. Knowing your body is strong and healthy can help you appreciate what it can do for you, and by toning up muscle, you will look better too. Keeping fit will also reduce the risk of recurrence (see Chapter 18).
● Try mindfulness exercises. You can train your mind to stop focusing on negative thoughts (see Chapter 14).
● Treat yourself. Have a manicure, a pedicure or a massage. Buy a new lipstick. Get a really good haircut. These little things can really help you feel good.
● Think about body art. In addition to a conventional nipple tattoo (designed to make your nipple look like a normal nipple), you may want to have an artistic tattoo to cover your scars. This can be really empowering. Remember that a tattoo is permanent and it can become infected, so think carefully before choosing this option. For ideas, see the US website P.ink or the tattoo section of Breast Cancer Care.
● Ask to be referred for counselling or psychotherapy. If your body image problems are severe, you may need professional help to move forward. Most therapists will use a variant of cognitive behavioural therapy with some success.
● Plan and work on a new ‘look’. Perhaps get your hair restyled or recoloured (wait at least six months after the end of chemo to do this). Go clothes shopping with a friend and reinvent yourself. Try stuff on that you wouldn’t have tried before. The ‘Look Good Feel Better’ programme (see Chapter 14) can help you experiment with make-up. Be bold. Have fun. You’re different now – own it.
On a final note, here’s a quote from Breast Cancer Care’s policy report ‘My body, myself’, written by a young woman who had had a mastectomy:
Dear Body
I wasn’t always happy with you. I wanted longer legs, a flatter tummy, firmer arms. But recently we’ve been through a lot, you and I. We’ve faced cancer, together. We lost our right breast. Our hair fell out. But we got through it. And now I’ve learned to love and accept you for what you are. Not perfect, but beautifully imperfect. You are my body. And I’m proud of you.