Physical trial of radiation therapy, chemo mirrored by emotional toll
“Cure” is a loaded term in the breast-cancer world.
Professionals discussing therapy typically don't use the word, said Dr. Jane M. Raymond, an oncologist at Allegheny General Hospital in the North Side.
“Even in the very earliest stages, there's a chance it can come back” much later — even 25 years on — she said. “That's why we're slow to use ‘cure.' … Breast cancer is very sneaky like that.”
For many patients, the lingering threat of recurrence rests atop a list of psychological, emotional and physical hurdles that last well beyond chemotherapy and radiation. Mental challenges can be the most daunting, survivors said.
“You do get a little paranoid, wondering if it's going to different parts of the body,” said Deborah Mason, 57, of East Liberty, who underwent a mastectomy and breast reconstruction but avoided chemotherapy and radiation.
She said “everything was spinning around in circles” upon her diagnosis. That's when patients begin to worry about mortality, surgery and prolonged treatments, social workers said.
“It's like riding a roller-coaster when you're diagnosed,” as emotions rocket from hopelessness and fear to denial, said Cancer Caring Center worker Wendy Myers. Avoid emotional valleys, and “you're going to be OK.”
The physical trial begins with treatment. Hours-long chemotherapy sessions can produce hair loss, spur early menopause, blacken fingernails and dull taste buds. Women often feel fatigued and are bogged down with nausea or diarrhea.
Separately, radiation therapy can lead to heart complications, undercut white blood cell counts or leave patients short of breath.
“There's different needs at each stage,” Myers said. Although mental anguish can feel worse than the physical battle, she said, one may drive the other.
“You're talking about her breast, something that's very personal, very intimate to her personally but also in a relationship with a partner,” said Angela Ford, a support group facilitator with the Cancer Caring Center in Bloomfield. “... It affects her whole sense of who she is as a woman.”
Longer-term side effects from treatments can include trouble with concentration, persistent fatigue and difficulty reaching for or carrying heavier items. Some women take the hormonal drug tamoxifen, risking hot flashes, sexual side effects or blood clots. Others feel numbness in their extremities.
No matter the nuances of individual cases, surviving breast cancer means regular screenings for life. Checks for returning cancer, especially in the first few years, can boil into serious stress tests for patients. They may shed tears of relief when results come back negative.
“I feel really bad that I make everybody anxious,” said Raymond, who might suggest patients are cured in cases when the recurrence odds are miniscule.
Dr. Dwight Heron, at UPMC, agreed that's reasonable. Many patients who reach the five-year mark are, in effect, cured with comprehensive therapy, he said.
“Generally, we talk about cure for most malignancies if you pass the five-year mark,” said Heron, the director of radiation oncology services at UPMC Cancer Centers.
Survivor Sharon Herring-Turner, 61, of Perry Hilltop said thoughts of recurrence persist. She keeps herself occupied with work, gardening and self-help books. She advises others: “Fight.”
“I would say to be very positive about it,” said Herring-Turner, a patient of Raymond's. “... Have that will to live. I want to be here for my two kids when they get married and have grandkids.”