Lifestyle Therapy for Breast Cancer Survivors

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Wear a pink polo, throw a pink ribbon in your hair, and call/text/email/tweet your friends and family members to check their boobs in the shower for any lumps and bumps. October is Breast Cancer Awareness Month! Lifestyle therapy can help those who want to decrease their risk of developing breast cancer and those who have been diagnosed and are navigating the many different changes in their lifestyles that come along with treatment. 

Lifestyle Therapy to Reduce Risk

CDC lists the following things you can do to reduce your risk of breast cancer: 

Lifestyle therapy can help you work on any or all of these goals.  

Lifestyle Therapy to Cope with Diagnosis/Prognosis

During medical treatment of breast cancer, especially chemotherapy, you will experience many lifestyle changes. You may find yourself feeling fatigued all the time, in pain, and having difficulty participating in your everyday necessary tasks. Suddenly, picking up your kids from school seems impossible or choosing whether to go out to dinner with friends becomes a long internal battle because your appearance has changed. 

Lifestyle therapy can help you work on your goals for self-esteem, self-image, diet changes, energy conservation, activity pacing, role changes from caregiver to caregivee, just to name a few. Your treatment sessions will be individualized to your physical, emotional, psychological capabilities so that you may get back to participating in your best life as independently as possible. Take a look at the case example below to get a better picture. 

Lifestyle Therapy Case Study: Joy

Background

Joy is a 38-year-old project manager at Sony and blog writer who lives in a two-story house with her husband and two children. She lives in Culver City and walks to work after dropping her kids off at the local elementary school. Joy loves her job as a project manager and finds managing teams, guiding teammates to work together, and bringing big projects to fruition highly satisfying. After work, she picks up her children on the way home, plays with them out in the nearby park or in their backyard, and helps with homework. Her husband is an engineer who works in Venice and enjoys cooking meals for their family. He likes to help the kids with their math and history homework. Joy enjoys spending time outdoors with her family hiking, camping, and laying out on the beach as well as taking her children to museums and other places of interest with her husband on the weekends. She writes about her family's adventures on a blog that she shares with her extended family, who live far away. She has no family history of cancer.

Joy's husband is the one who notices a small lump in her right breast. After she goes to the doctor's office to get it checked out and biopsy results are returned, the doctor asks Joy to sit down. She explains that Joy has Stage IIA breast cancer, that the bump in her right breast is 1.5 cm of cancerous tissue and has spread to one of the axillary lymph nodes in her armpit. She lays out Joy's options for her, and after discussing with her husband, Joy decides to undergo a lumpectomy of the tumor in her right breast, biopsy of the affected axillary lymph node, and chemotherapy and radiation to prevent reoccurence,

Getting the diagnosis

In the first week of treatment, the normally energetic and happy Joy begins to feel fatigued. Her radiation schedule is 5 days a week for 5-6 weeks, and the chemo schedule is 4 weeks on and 2 weeks off for a total of 6 months. Joy's daily life is turned upside down - mundane tasks begin to feel not so mundane. She has a harder time waking up in the morning, getting in to work becomes difficult, and she is afraid that her co-workers will notice. She loves her job and is worried that something bad might happen to it if she continues to get worse. Walking to and from work is no longer enjoyable, but she still forces herself to do it because she wants to maintain a level of normalcy for her children. She can not do as much on the weekends as she used to and sometimes needs to sit out of her family adventures. She signs up for lifestyle therapy because she is frustrated and anxious about how all of this is affecting her family. 

Lifestyle Therapy for Joy

Initial Eval: Determining Priorities 

During the initial evaluation, Joy discusses her habits, routines, and every day activities. With the guidance of the lifestyle therapist (LT), Joy determines that 1. getting dressed every day, 2. continuing to work, and 3. spending quality time with her family are her highest priority goals to work on. 

Evaluating Strengths and Weaknesses 

For each priority, Joy works with her lifestyle therapist to assess how her physicality, emotional state, habits, routines, and activities are affecting her priorities. She lists the pros and cons associated with each priority below: 

  1. Getting dressed every day: Con - 8/10 fatigue (10 being the worst), short of breath, dizzy, not enough time. Pro - can pick out clothing quickly in the morning, supportive husband, helpful children
  2. Continuing to work: Con - fatigue, decreased concentration and memory, anxiety about losing job. Pro - love my job, kind boss, supportive team members, communicate well, type fast, people person 
  3. Spending quality time with family: Con - fatigue with outdoor activities, shortness of breath. Pro - supportive husband, energetic children, can sit for longer than stand and walk

Creating Smart Goals

Joy learned how to write SMART goals to maximize her ability to achieve them. Joy decides that setting weekly goals would be the best for her. Here are her short term goals (STGs): 

  1. This week, I will utilize at least one energy conservation technique to get dressed every day.
  2. This week, I will identify 3 ways for me to continue working while feeling less fatigue at the end of the day. 
  3. This week, I will identify 3 ways for me to spend quality time with my family that does not deplete me but is still enjoyable to my family. 

Her long term (3 month) goals (LTGs) are: 

  1. By October, I will be able to get dressed every day with 3/10 fatigue or less. 
  2. By October, I will be able to work with less than 5/10 fatigue at the end of the day.
  3. By October, I will at least be able to spend 5 hours each weekend with my family. 

Exploring Solutions

With each treatment session, Joy and her LT work towards her long term goals by tackling her weekly short-term goals. By taking into account Joy's preferences, habits, routines, values, and thought processes, the LT provides education on various energy conservation techniques, such as setting up her clothes the day before, placing clothes on a chair near the bed, asking her family members to help pick out clothes or assist with buttons or clasps, sitting down to get dressed to decrease fatigue and dizziness, and utilizing breathing techniques to prevent shortness of breath. The LT recommends different memory and concentration hacks that will work well for her, such as using post its, keeping a small notebook with her at all times, using an app on her phone, asking coworkers to email her instead of only verbally telling her. In the end, Joy is the one who determines which of these strategies she is interested in trying and includes them in her new weekly goals.

To reach her goals, 20% of the work is done during LT sessions, and 80% is done at home with trial and error.  

Modifying Goals 

As mentioned above, Joy modifies her goals each week depending on whether she reached the previous one or not. By August, one month after starting LT, Joy had already reached her long-term goal 1 (LTG1) and decided to create a new LTG involving pain management because she was feeling back pain and headaches during her on-cycles of chemo. Joy reaches her LTG2 in October and modifies it from 5/10 fatigue to 3/10 fatigue at the end of day. She becomes more comfortable with talking to her boss about her condition and is relieved to find that her boss is extremely supportive. Joy eventually makes an STG to ask her boss if she can work from home, and her boss kindly allows her to call in to meetings instead of staying in the office and running from one conference room to the next all day. Joy also reaches her LTG3 by October, but decides not to modify that goal or create a new goal, and keeps it in maintenance. Every 3 months, Joy and her LT check in on all of her goals, past and present, and modify her current goals accordingly. 

 

There are a million solutions in this world to reaching goals, but there is only a handful that truly work for you. To better understand what works for you...