A Focus on Survivorship

Dr. Patricia Ganz discusses quality of life for women during and after breast cancer treatment.

BCRF’s Dr. Patricia Ganz is a pioneer in the assessment of quality of life in cancer patients. Over the years, her research has focused on quality of care and the late medical effects of treatment in women with breast cancer, which range from fatigue to cognitive function.

As Director of Cancer Prevention and Control Research at UCLA’s Jonsson Comprehensive Cancer Center, Dr. Ganz and her associates are examining these effects and the immunological and physiological mechanisms underlying these issues as well as exploring strategies to improve cognitive changes, reduce stress and help better outcomes for younger and older women.  A BCRF grantee since 2001, she serves on our Scientific Advisory Board.

We recently had an opportunity to speak with Dr. Ganz about her research and life after breast cancer.

How has breast cancer survivorship changed in the last 10 – 20 years?

When I started my career, in the 1980s, only about 50 percent of women with breast cancer could expect to live five years after a diagnosis. Most tumors were very large, discovered by the woman herself, and had spread to the lymph nodes. Recurrence was common after a mastectomy, which was the standard surgical procedure.

Today, more than half of all cancers are less than an inch in size when discovered (usually by mammography) and have not spread outside the breast. The most common primary treatment is breast-conserving surgery with radiation. Not all women require chemotherapy after the surgery anymore, and most women are treated with some form of hormonal, or endocrine, therapy for five to 10 years. These women can expect a normal life expectancy, comparable to other women their age.

Even women with larger tumors are benefiting from new targeted therapies. The five-year survival for breast cancer is now close to 90 percent, and we have nearly three million breast cancer survivors alive in the United States today.

What are the most significant or persistent challenges of life after breast cancer?

Common problems after breast cancer treatment include fatigue, cognitive changes, pain, and fear of recurrence. Some women experience changes in body image, and many women report difficulties with sexuality and intimacy, especially due to vaginal dryness and lack of interest. Younger women, in particular, experience more disruption, with the onset of early menopause, potential infertility and increased depressive symptoms and anxiety.

How has research impacted the quality of life for cancer survivors?

A lot of research has been conducted with breast cancer patients and survivors, with many efforts focused on helping to manage symptoms (e.g., hot flashes, vaginal dryness, fatigue, insomnia, cognitive complaints) as well as trying to personalize the treatments to avoid unnecessary treatments that may be toxic and for certain patients not always unnecessary. Many efforts have also focused on improving psychosocial wellbeing in these survivors to help enhance their quality of life and recovery after treatment.

As a result of these research efforts, we can now manage post-treatment insomnia, mood changes and hot flashes much better than before. Ongoing research focused on cognitive complaints and fatigue is also showing some good strategies for handling these problems that occur in about 25 percent of breast cancer survivors.

What can patients do to restore and maintain quality of life after therapy?

It is very important for patients to maintain good communication with their oncology team and ask for help if symptoms are persistent or troublesome during and after treatment. Don’t try to grin and bear it. Waiting to talk about sexual concerns or pain can delay interventions that could be helpful.

Similarly, getting help for anxiety and fear of recurrence should not be put on hold. Support groups and counseling from mental health professionals who have experience taking care of cancer patients are very helpful. Unfortunately, friends and family think everything is over and fine when treatment ends but, for the survivor, the physical and psychosocial aftereffects of treatment are lifelong. Getting professional help can facilitate the journey to recovery and restoration to the new normal.