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KNOWING YOUR BODY AND YOUR OPTIONS, D3 SOMETIMES WE JUST DANCE: Breast cancer survivor story, D5 EVERY TWO MINUTES: A woman is diagnosed with breast cancer, D7
| SUNDAY, OCTOBER 7, 2018
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BREAST CANCER SURVIVORSHIP PROGRAM HELPS SURVIVORS
‘move foward
in life’
By Anne-Gerard Flynn
Special to The Republican
Baystate medical oncologist Grace Makari-Judson has been treating breast cancer patients for 25 years. She knows their concerns continue even as their treatment becomes less institution based, and they may progress to seeing their oncologist once every six months for five years and then a nurse practitioner annually. She said this is why the Breast Cancer Survivorship Program exists. It is part of the Baystate Health Breast Network that is funded by Baystate’s annual Rays of Hope, A Walk & Run Toward the Cure of Breast Cancer, now in its 25th year. “We are thrilled that we have the opportunity to help people along the continuum,” Makari-Judson said. “It is not just about helping someone at the time of diagnosis or at the time they need their immediate treatment.” Makari-Judson is co-director of the Rays of Hope Center for Breast Cancer Research, chairs the breast network and is a professor of medicine at the University of Massachusetts Medical School-Baystate. “It was one of the first things we set up 25 years ago,” said Makari-Judson of the program that is part of the Baystate Regional Cancer Program. “We said we need a place where women could focus on not just getting their breast exam and breast imaging but also reinforcement of lifestyle. A place where we could help them manage any kind of menopause symptom in the absence of estrogen and also assess them to see if any
of the other things they are experiencing in their health may be due to late concerns related to their treatment or may be signs of breast cancer recurrence. Those things are done very well by breast specialists.” She added, “A lot of people especially when they are first diagnosed with cancer - they are sort of on overdrive and then they get through their surgery, they get through their chemotherapy, they get through their radiation and all of a sudden we say to them, ‘I only need to see you now every six months until we get to the five-year point” and it hits them what did I go through this past year?” “It is not uncommon for people to have these fears of cancer recurrence and they can’t get that out of their head, they can’t concentrate and this can happen at the six, the 12 month point,” Makari-Judson said. “We have terrific social workers and we offer relaxation therapy, guided imagery, hypnosis so people can get those thoughts out of their mind and move forward in life.” Survivors are given a booklet with a background sheet on their diagnosis and treatment with recommended follow-up care. There is a section related to health promotion topics like bone and heart health, diet and sexual health, as well as a section on genetic counseling/testing and one on additional resources. There is also a section on managing the side effects of cancer treatment. “When we recommend
who are on tamoxifen. In the post-menopausal women who are on aromatase inhibitors they get more joint pain.” She said the temptation is for women to say, “I don’t like how I feel on this medicine and and they quit, and we know from studies that show that when women quit early that impacts negatively on the process.” “We want them to be able to stay on their medications. We want them to be able to do whatever they need to do to help them to tolerate them,” Makari-Judson said. She added, “Someone who goes through natural menopause their gynecologist writes them a prescription for hormone replacement.” “How are we going to deal with hot flashes, how are we going to deal with vaginal dryness, how are we going to deal with sleep difficulty in the absence of estrogen,” she said. Makari-Judson said the survivorship booklet offers “helpful guides” based on research in terms of “what people can do” with some of the guides “related to lifestyle factors.” “We are very much believDr. Grace Makari-Judson is co-director of the Rays of Hope ers in helping people to help Center for Breast Cancer Research, chairs the Baystate Health themselves,” Makari-Judson Breast Network and is a professor of medicine at the University said. of Massachusetts Medical School-Baystate. “For example spicy foods, (ANNE-GERARD FLYNN PHOTO) caffeine, alcohol sometimes these will trigger a hot flash agnosed with breast cancer monal treatment for breast and women will say, ‘I still have the type that is estrogen cancer that is going to be for want my morning cup of coffee. I am still going to have hot receptor positive. This means a minimum of five years,” flashes afterward but at least I the hormone may aid the Makari-Judson said. recognize it and can deal with growth of cancer cells so these “Tamoxifen or aromatase it but maybe I will leave out women may be prescribed inhibitors are anti-estrogens that are effective in the afternoon coffee.’” post surgery medication that post-menopausal women. The She added, “Women who will either block the effect of menopause symptoms are exercise regularly tend to estrogen in breast tissue or tough in the younger women have less hot flashes.” prevent its production. treatment for breast cancer whether it is chemotherapy or hormone-related treatments or both, people have side effects we need to help them deal with,” Makari-Judson said. “We want them to succeed. We want them to stay on their treatment. This is extremely important in their overall outcomes.” Many women newly di-
Reductions in estrogen level, generally associated with menopause, can affect bone health and result in a variety of other symptoms such as vaginal dryness and the sudden feelings of warmth known as hot flashes. “A large percentage of breast cancer patients have hormone receptive positive cancers and they are going to be recommended a hor-
“Exercise helps sleep. It helps mood. Exercise is an important part of what we recommend,” Maraki-Judson said. “Women who exercise, stretch, do far better than women who are sedentary.” She said exercise, along with “adequate Vitamin D,” can help with joint aches experienced by some postmenopausal women taking the aromatase inhibitors, and that some women take a prescription medicine to reduce this associated pain. “There is a prescription medicine called duloxetine - and we participated in a clinical trial looking at its use - that can help reduce the joint pain,” Makari-Judson said. “People on the drug got immediate relief in the study, but at the end of the six months of the study everyone was about the same. Meaning over time people get used to the pain or it lessens and it isn’t as much of an issue, but joint pain can be a big issue in the beginning because people want to stop the meds.” Makari-Judson said survivors continue to be seen at the Baystate Breast & Wellness Center, where she works closely with nurse practitioner Gerri Lynn Smith, even after their multi-year course of hormone-related treatment ends. She added a yearly mammogram and checkup can be done together so a survivor “does not have to make more than one visit to more than one place.” “This is a big plus and the women also like knowing that they are still being cared for under the big umbrella,” Makari-Judson said.
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