**4. Caring for following treatment for breast cancer patients**

Breast cancer patients who have recovered still have risk to relapse again. Study in the UK showed that after 5 years of adjuvant endocrine therapy, breast cancer recurrences continued to occur steadily throughout from 5 to 20 years [27]. After undergoing therapy, breast cancer patients follow a series of follow-ups. Some follow-ups are doctor visit, mammogram screening, pelvic exams, and bone density test. Completed of follow up assesment breast cancer patients on **Table 3**.

mammography, and screening for other cancers should be done according to population guidelines Management of the long-term effects of cancer and its treatment addresses common issues of pain, fatigue, lymphedema, distress, and medication side effect. Health promotion emphasizes the benefits of active lifestyle change in cancer survivors, with an emphasis on physical activity [28]. Completed task after treatment breast cancer is shown in **Tables 3**–**5**.

Cardiac imaging Not recommended after completion of anthracycline (epirubicin, doxorubicin) or trastuzumab therapy unless there are symptoms

Every 3–6 months  for  years  1–3  after  treatment,  every  6–12  months  for 

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regional  nodes, arms  for  lymphedema,  and  common  sites  of  distant  spread

radiation therapy is complete, can be performed every 6 months in select cases,

History  to  focus  on  symptoms  of  distant  (bone,  lung,  liver,  brain) 

Examination  focuses  on  surgical  scar,  breasts,  chest wall, 

no routine imaging of a reconstructed breast is needed

Annual  gynecologic  examination  for  patients  taking  tamoxifen

years  4  and  5, and  then  annually

Breast self-examination Monthly breast self-examination is recommended in this higher-risk group Mammography Annually, starting 1 year after initial mammogram but at least 6 months after

Screen for other cancers As for average-risk individuals, unless family suggests otherwise

Not recommended

Not recommended

**Table 3.** Surveillance and screening for asymptomatic breast cancer survivors.

and  local  recurrence

Caring in breast cancer patients after treatment can be given by group like in Canada there is CanIMPACT (Canadian Team to Improve Community-Based Cancer Care along the Continuum) [31]. Similar teams from either the health team or from community groups are needed by breast

Breast cancer patients are likely to heal. Once cured, there are those who can survive, but there is a relapse. Every woman is at risk of breast cancer. Prevention is done by breastfeeding

cancer patients to survive.

before the age of 35 years [32].

**Maneuver Recommendation**

Primary care visit with history and physical examination

**Do**

**Do not do**

imaging

Other tests:

Breast magnetic resonance

Complete blood counts Liver function tests

Source: Sisler et al. [28].

abdomen, or bone Tumor markers

Routine imaging of the chest,

After breast surgery, physical changes can make some women less comfortable with their bodies. There may be a loss of sensation in the affected breast. Other treatments for breast cancer, such as chemotherapy, can change your hormone levels and affect sexual interest and/ or response. Partner may worry about how to express love physically and emotionally after treatment, especially after surgery. But breast cancer can be a growth experience for couples especially when partners take part in decision-making and go along to treatments [29, 30].

From the review of research, Sisler showed that after breast cancer treatment, the survivorship care involves four main tasks: surveillance and screening, management of long-term effect, health promotion, and care condition. Surveillance for recurrence involves only annual


**Table 3.** Surveillance and screening for asymptomatic breast cancer survivors.

Palliative care starts at diagnosis and continues throughout all stages of the disease. The best palliative care occurs when patients and their families work together with the healthcare team [25].

Caring for this period can occur when there is good communication between patient, family, and health teams. Caring can be achieved if the patient can show some communication skills. For patient, tips to help promote good communication patient with healthcare team are:

**b.** Ask healthcare team to explain if you do not understand an explanation, description, or

**d.** Keep track of symptoms and side effects. Write down what they are, how often they occur,

For the treatment of breast cancer, the physical symptoms of breast cancer patients affect the needs and fulfillment of the physical, psychological, social, and spiritual aspects [16]. The success of AI therapy depends on patients' ability to adhere to treatment recommendations [26].

The breast cancer patients need friends, which receive the shortcomings, and more attention. During therapy patients should have realistic expectations and interpersonal relationships, remain active in activities, support family and community, and improve their spirituality. The

Breast cancer patients who have recovered still have risk to relapse again. Study in the UK showed that after 5 years of adjuvant endocrine therapy, breast cancer recurrences continued to occur steadily throughout from 5 to 20 years [27]. After undergoing therapy, breast cancer patients follow a series of follow-ups. Some follow-ups are doctor visit, mammogram screening, pelvic exams, and bone density test. Completed of follow up assesment breast cancer

After breast surgery, physical changes can make some women less comfortable with their bodies. There may be a loss of sensation in the affected breast. Other treatments for breast cancer, such as chemotherapy, can change your hormone levels and affect sexual interest and/ or response. Partner may worry about how to express love physically and emotionally after treatment, especially after surgery. But breast cancer can be a growth experience for couples especially when partners take part in decision-making and go along to treatments [29, 30].

From the review of research, Sisler showed that after breast cancer treatment, the survivorship care involves four main tasks: surveillance and screening, management of long-term effect, health promotion, and care condition. Surveillance for recurrence involves only annual

patient's condition enhances the survival abilities of patients undergoing therapy.

**4. Caring for following treatment for breast cancer patients**

**a.** Ask the doctor to explain the diagnosis, treatment plan, and prognosis.

**c.** Tell the doctors and nurses about any pain, discomfort, or other side effects.

unfamiliar medical word.

210 Breast Cancer and Surgery

and how severe they are.

patients on **Table 3**.

**e.** Do not be afraid to ask questions.

mammography, and screening for other cancers should be done according to population guidelines Management of the long-term effects of cancer and its treatment addresses common issues of pain, fatigue, lymphedema, distress, and medication side effect. Health promotion emphasizes the benefits of active lifestyle change in cancer survivors, with an emphasis on physical activity [28]. Completed task after treatment breast cancer is shown in **Tables 3**–**5**.

Caring in breast cancer patients after treatment can be given by group like in Canada there is CanIMPACT (Canadian Team to Improve Community-Based Cancer Care along the Continuum) [31]. Similar teams from either the health team or from community groups are needed by breast cancer patients to survive.

Breast cancer patients are likely to heal. Once cured, there are those who can survive, but there is a relapse. Every woman is at risk of breast cancer. Prevention is done by breastfeeding before the age of 35 years [32].


**5. Conclusion**

Source: Sisler et al. [28].

**Category Recommendation**

**Category Recommendations**

menopause

menopausal symptoms

infertility specialist promptly

Assess for body image concerns

Premature menopause, menopausal symptoms

Body image concerns

Source: Sisler et al. [28].

diagnosis

Limit alcohol

**Table 5.** Health promotion for breast cancer survivors.

Breast cancer occurs in most women who get married late or are not breastfeeding. Acceptance of breast cancer diagnosis affects a person's ability to survive. Caring given since the diagno-

Counsel patients who are overweight or obese to change dietary habits and increase physical

Offer selective norepinephrine reuptake inhibitors (SNRIs), selective serotonin reuptake inhibitors (SSRIs), or gabapentin and lifestyle modifications to help vasomotor symptoms of premature

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Consider tailored patient education interventions and consultations when appropriate to decrease

Lymphedema Counsel weight loss for overweight or obese patients to prevent or reduce lymphedema risk

Infertility Refer survivors of childbearing age experiencing infertility to reproductive endocrinology and

Educate survivors about lymphedema sign and symptoms and assess for lymphedema

Aim for at least 150 min of moderate or 75 min of vigorous physical activity weekly

sis of breast cancer provides the strength for patients to survive.

Weight management Counsel patients to achieve and maintain a healthy weight

Consider CBT or routine exercise for treatment

Refer if symptoms are suggestive of lymphedema

Refer to psychosocial resources as indicated

activity to promote and maintain weight loss

**Table 4.** Assessment and management of long-term effects of breast cancer and its treatments.

Physical activity Counsel patients to avoid inactivity and return to daily activities as soon as possible after

Nutrition Counsel patients to have a dietary pattern high in vegetables, fruits, whole grains, and legumes; low in saturated fats; limited in processed and red meats

Counselor supplements only if deficiencies are demonstrated Smoking cessation Counsel patients to avoid smoking; offer or refer for cessation counseling and resources

Include strength training exercise at least 2 days/week


**Table 4.** Assessment and management of long-term effects of breast cancer and its treatments.


**Table 5.** Health promotion for breast cancer survivors.
