**5. Conclusion**

**Category Recommendations**

to healthcare providers

Ask about cognitive difficulties

management, routine exercise)

Assess for distress, depression, and anxiety

Consider referral for genetic counseling if:

• Ovarian cancer at any age (epithelial) • Bilateral breast cancer in the same woman

physical activity, or acupuncture for pain Suggest physical activity for neuropathic pain

Sexual health Assess for signs and symptoms of sexual or intimacy problems

• Male breast cancer • Ashkenazi Jewish ethnicity

specialist)

Assess further if the patient is at higher risk of depression

Preliminary evidence suggest that yoga is likely to improve fatigue

• Breast cancer was diagnosed before age 50 years (especially <35 years)

• Both breast and ovarian cancers in the same women or some family • Multiple breast cancers on the same side of the family (paternal or maternal)

Assess for pain and contributing factors with pain scale and history

contraindications to medication or for whom medication is ineffective

Offer nonhormonal, water-based lubricants for vaginal dryness

Osteoporosis Dual-energy X-ray absorptiometry (DEXA) scan at baseline and then every 2 years if the patient is taking aromatase inhibitors or gonadotrophin-releasing hormone (GnRH) agonists

Offer interventions such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs),

Refer to appropriate specialist once the cause of pain has been determined (e.g., lymphedema

Consider transcutaneous electrical nerve stimulation (TENS) for CIPN in survivors with

Assess for reversible contributing factors to sexual problems and treat when appropriate

Refer for psychoeducational therapy and sexual or marital counseling when appropriate

Consider acupuncture as an adjunct option to treat patients with medication-resistant CIPN

Fatigue Assess for fatigue, use severity rating scale, and treat causative factor

Monitor lipid level and provide cardiovascular monitoring as indicated

Educate patient about healthy lifestyle modification (balanced diet, exercise, smoking cessation), potential cardiac risk factors, and when to report relevant symptoms (shortness of breath or fatigue)

Assess reversible contributing factors of cognitive impairment and optimally treat when possible Refer for neurocognitive assessment and rehabilitation if there are signs of cognitive impairment Suggest self-management and coping strategies for cognitive dysfunction (relaxation, stress

Offer treatment or referral for factors affecting fatigue (mood disorder, sleep disturbance, pain, etc.) Encourage regular physical activity, refer for cognitive behavior therapy (CBT) if indicated When fatigue is present, provide education and general strategies to manage fatigue and evaluate Do not recommend methylphenidate or modafinil to manage fatigue, given insufficient evidence

Offer counseling and pharmacotherapy or refer to mental health resource as indicated

Cardiovascular health

212 Breast Cancer and Surgery

Cognitive dysfunction

Distress, depression, and anxiety

Referral for genetic counseling

Pain and chemotherapyinduced peripheral neuropathy (CIPN)

> 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 diagnosis of breast cancer provides the strength for patients to survive.

Breast cancer patients need caring of their own body to keep their health. Patients undergoing therapy require the presence of family and friends to provide care for them. After successfully undergoing therapy, breast cancer patients should always live healthily and always do a series of checks regularly in order to prevent the risk of recurring illness.

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