Michael Castleman

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Breast cancer is traumatic not only for the women who develop it, but also for the men in their lives. I know. In 1991, my wife was diagnosed, and I found myself along for an unpleasant ride as she had surgery, two months of daily radiation, and six months of biweekly chemotherapy, not to mention the emotional upheaval the disease engenders.
 
 What can you do if a woman you know and love is diagnosed with breast cancer? Plenty. These tips will help both of you get through diagnosis, treatment, and recovery.
 
 


 
 Probably the most important thing a man can do is to be fully present for a woman who has cancer. She's bound to feel traumatized by her diagnosis, and you'll no doubt feel the same way. My wife had a mild case of breast cancer (small tumor, negative lymph nodes), but we were both seriously freaked out by it. I don't consider myself the most nurturing guy in the world, and when faced with bad news, I tend to do what most men do -- withdraw into myself.
 
 Don't beat yourself up for being who you are, but try not to withdraw. You don't need the medical knowledge of an oncologist, or the counseling skills of a clergyperson or psychotherapist. Just be there. Pay attention to her. Listen to her anguish. Hold her. Reassure her that you love her and will be there for her. This is not only the decent human thing to do, it also appears to boost a woman's chances of surviving the disease. Some research shows that compared with breast-cancer sufferers who feel socially isolated, those who have considerable social support survive longer.
 
 


 
 For most serious illnesses, people see two or three doctors: their family physician, a specialist in the illness, and perhaps another specialist for a second opinion.
 
 Breast cancer is different. In addition to her family doctor, a woman is certain to consult a breast surgeon (because the tumor must be removed), and then, depending on her tumor's size and aggressiveness, possibly a radiation oncologist (if she has lumpectomy) and a medical oncologist (if she has chemotherapy). That's four doctors right there. She might also want second opinions from other surgeons, and radiation and medical oncologists, so you might wind up consulting as many as 10 doctors.
 
 It's easy for women -- and the men in their lives -- to feel overwhelmed by the sheer number of doctors who get involved, and the time it takes to see them all. Worse, you have to consult all these doctors shortly after the diagnosis when you're both feeling knocked for a loop. Hang in there. The doctor-visiting lasts only for a week or two, then, after a woman and her doctors have decided how to proceed, things calm down. Go with your mate to her doctor consultations. Take a few days off work. If you just can't be there, arrange for another friend or relative to accompany her -- but try to do this yourself.
 
 


 
 You visit all these doctors, but nowadays, they rarely say: You must do this. Today, breast cancer treatment decisions are usually left up to the woman herself. She can usually choose mastectomy (removal of the entire breast), or lumpectomy (removal of just the tumor) plus radiation. With either surgical procedure, she can either have or not have chemotherapy. These decisions would be difficult under any circumstances, but in the immediate aftermath of a breast cancer diagnosis, they are doubly daunting. Expect a woman to say: I'm not a doctor! How can I decide?
 
 In addition, a breast cancer diagnosis is often depressing, and one symptom of depression is indecisiveness. So a woman may feel paralyzed, unable to decide how to treat her illness. Again, be there for her. Sit with her. Listen to her -- even if she's halfway out of her mind and making no sense. It's OK to take a week or two to decide on a treatment plan. Oncologists are virtually unanimous in the belief that there is no difference in outcome between women who have treatment immediately and those who wait a few weeks. A woman shouldn't dawdle, of course, but an extra week or two doesn't matter. It may take her that long to feel comfortable with a treatment plan.
 
 Just remember: 

 A man can help a woman weigh the pros and cons of the various options, but the decision should be hers. She's the one with the illness, so she must decide what she wants to do. In addition, any serious illness leaves people feeling stripped of control over their lives. Deciding on a treatment plan represents a small but significant step toward regaining control.
 
 Don't push your own agenda. Don't take charge. Instead, ask questions. The fundamental one deals with the type of surgery. Some breast tumors require mastectomy, but most allow a choice between mastectomy or lumpectomy. Mastectomy is quick (no extended radiation), so it appeals to women who want to get the treatment over with. On the other hand, it means losing the breast and requires more recovery time than lumpectomy. Reconstruction is usually possible, but a rebuilt breast doesn't feel like the one that was removed. How does she feel about keeping or losing her breast?
 
 The other major question involves chemotherapy. If any lymph nodes under the arm adjacent to the affected breast show cancer, the medical oncologist will recommend chemo. Chemotherapy is also an option if the nodes are all negative -- just to be sure no cancer cells have broken free and gone elsewhere in the woman's body. Chemotherapy definitely increases survival odds, but it's no fun. Most women can select one of two main regimens -- a shorter course (often three months but possibly longer), which causes nausea, vomiting (sometimes), fatigue, and total hair loss for the duration, or a longer course (often six months but possibly longer) that causes similar side effects but less hair loss. Here again, ask questions: How do you feel about chemo? Could you handle all your hair falling out?
 
 Don't tell her what to do. Instead, sympathize with the difficulty of her decision, and ask questions that help her clarify her feelings. The woman may ask you directly: If you were me, what would you do? Then, answer honestly, but add that you don't have the disease, she does, and it's not your decision, it's hers.
 
 My wife had a lumpectomy, two months of radiation, and six months of chemo. She lost about half her hair, which upset her greatly, but most other people hardly noticed. For women who experience partial hair loss, some hairdressers now specialize in cuts that cosmetically compensate. My wife visited one, got a trim, and was pleased with the result.
 
 


 
 You might be the world's greatest guy, and a woman might have a fabulously supportive family and friends, but quite often, issues come up for her that she would rather not discuss with her primary support people. That's where a support group can be a godsend. There's nothing quite like talking with people who know exactly what you're going through, because they're going through it themselves.
 
 Nowadays, it's a rare community that doesn't have a breast cancer support group. Encourage her to participate. Take over chores (cooking, childcare, etc.) to allow her to go. A few studies show that support groups extend survival. My wife went to a weekly group for several months until she became too fatigued from the chemo. [1]
 
 


 
 I went to one support group for spouses of women with breast cancer, but most of the participants' wives were much worse off than mine, so I stopped going. Instead, I talked frequently with an acquaintance whose wife had had breast cancer. He was great. There were issues I needed to sort out that I did not want to discuss with my wife. For example, even though her life was never threatened by the disease, I couldn't help having morbid fantasies of winding up a widower with two young kids. And as her lover, I had feelings about her breast and her loss of sexual energy while being treated. My buddy helped me sort out these feelings.
 
 


 
 Recovery from breast surgery takes up to a few weeks. If surgery is the only treatment a woman has, she should be feeling relatively normal within a month or so. But if she opts for radiation and/or chemotherapy, her treatment will extend for several months, possibly up to a year. Radiation typically involves brief daily treatments Monday through Friday. Chemo usually involves weekly or biweekly doctor visits, often with pills in between. She may insist on going by herself, but many women prefer to be accompanied. If so, go with her as often as possible. If you can't, arrange for someone else to be with her.
 
 The odd thing about extended breast cancer treatment is how banal the routine becomes. After a while, it's just another chore, like doing the marketing, or picking up the dry cleaning. Just about everyone remarks on how weird that feels.
 
 


 
 Radiation affects women differently. Some breeze through it with no side effects, while others become quite fatigued. As chemotherapy progresses, virtually all women feel profoundly fatigued. Chemo fatigue is cumulative. The longer the woman is in treatment, the worse it gets.
 
 My wife had no side effects from radiation, but she suffered chemo fatigue. The first month, she felt tired after the treatment, but bounced back within a few days. By the third month, she was dragging for two weeks after each treatment. And by the sixth month, her last, she spent most of her time in bed, napping or watching television.
 
 As a woman becomes more fatigued, you'll have to assume more than your share of the household chores. Be gracious about it. If you need help, recruit family and friends to lend a hand.
 
 

Support her interest in alternative therapies


 
 In addition to a support group, a good deal of evidence shows that alternative, or complementary, therapies help minimize the side effects of chemotherapy and may also help prevent breast cancer metastasis and recurrences. Some of the more intriguing findings:

A recent German study showed that exercise     helps prevent chemo-related fatigue. The woman may balk at exercising 

     she feels fatigued, but gently encourage her to take walks, or ride a bike,     or engage in any activity she feels capable of doing. Offer to exercise with     her. [2]

Many studies show that relaxation therapies     minimize the nausea of chemotherapy. Several have been studied: meditation,     biofeedback, and visualization tapes using music and imagery. They've all     helped. [3,     4, 5] Acupuncture also seems to help. [6]

An intriguing study from Japan shows that     large amounts of Japanese green tea (on the order of eight cups a day)     reduces risk of breast cancer metastasis and recurrence. Green tea is rich     in antioxidant vitamins and minerals. (Black tea, the kind Americans prefer,     such as Lipton, probably has similar benefits, but the studies to date have     looked at green tea.) Green tea is served at Japanese restaurants and sold     in Asian food stores and many grocery and health food stores, as well as     online at PlanetRx. [7]

Finally, a number of studies show that     vitamin supplementation, especially with antioxidants (vitamins C, E, the     vitamin A family of carotenoids, and the mineral selenium), improves     treatment outcomes and helps prevent recurrences of several cancers. None of     the half-dozen studies to date have involved breast cancer, but multivitamin     supplements are inexpensive, do no harm, and might help. [8,     9, 10, 11, 12]


 
 Most breast cancer is a postmenopausal disease. But my wife was one of the women who develop it premenopausally. If they opt for chemotherapy, these women are almost certain to experience drug-related menopause as a result, with all the annoyances menopause brings, primarily hot flashes and vaginal dryness. Tofu and other soy foods can help minimize hot flashes, but a woman may still have them. A commercial lubricant can help relieve vaginal dryness.
 
 


 
 After the initial shock of the diagnosis, the surgery, and the beginning of any other treatment, chances are that both you and she will feel shell-shocked and not want to do much. That's fine, but as the weeks pass, within your limits, try to have some fun. Movies are especially helpful. A woman can enjoy them even when she feels fatigued. And the power of the big screen whisks her -- and you -- out of your cancer consciousness and into another realm.
 
 My wife and I saw a tremendous number of movies while she was in treatment, and the friend who took her to several of her chemo appointments also took her to matinees afterward. Videos at home are also helpful. Toward the end of her chemo, my wife felt too tired to read, but she enjoyed videos.
 
 


 
 Fatigue doesn't end after the woman's final chemo treatment. It can take several months for her to feel back to her old self again. You may have to assume extra household chores for longer than you'd hoped.
 
 

Stay physically close even if you're not making love


 
 Breast cancer changes sex for a while. Most women lose sexual interest and energy while they're being treated. Be patient. Don't withdraw physically. In fact, cultivate physical closeness -- hugging, cuddling, holding hands, and so on. That lets her know that you still love her and find her attractive and appealing. For your own sexual needs, masturbate.
 
 For a while after mastectomy, some women feel very uncomfortable about one-breasted nakedness. You may have issues with this as well. Reassure the woman that you still love her, still desire her, and that her sex appeal goes way beyond the number of boobs on her chest. If she continues to feel upset about breast loss after a few months, discuss reconstruction. For some women, this is a positive solution.
 
 Breast cancer is now an increasingly distant memory for my wife and me. She's eight years out and healthy (knock on wood). She performs breast self-exam religiously every month and has two mammograms a year instead of the typical one. Before each mammogram, I feel a little twinge of dread, and I expect I always will.
 
 I wasn't the perfect breast cancer spouse, and I feel guilty about that. But I did my best. That's all a man can do.

1 Maunsell, E., et al. "Social Support and Survival Among Women with Breast Cancer," Cancer (1995) 76:631. Also, Spiegal, D., et al. "Effect of Psychosocial Treatment on Survival of Patients with Metastatic Breast Cancer," Lancet 10-14-89.

2 Dimeo, F., et al. "Effects of Physical Activity on the Fatigue and Psychologic Status of Cancer Patients During Chemotherapy," Cancer (1999) 82:2273.

3 Burish, T.G. and R.A. Jenkins. "Effectiveness of Biofeedback and Relaxation Training in Reducing Side Effects of Cancer Chemotherapy," Health Psychology (1992) 11:17.

4 Vasterling, J., et al. "Cognitive Distraction and Relaxation Training for the Control of Side Effects Due to Cancer Chemotherapy," Journal of Behavioral Medicine (1993) 16:65.

5 Frank, J. "Effects of Music Therapy and Guided Imagery on Chemotherapy-Induced Nausea and Vomiting." Oncology Nursing Forum (1985) 12:47.

6 "Acupuncture Curbs Chemo Nausea," Family Practice News 7-15-97.

7 Nakachi, K., et al. "Influence of Drinking Green Tea on Breast Cancer Malignancy Among Japanese Patients," Japanese Journal of Cancer Research (1998) 89:254.

8 Hu, Y.J., et al. "The Protective Role of Selenium on the Toxicity of Cisplatin-Contained Chemotherapy Regimen in Cancer Patients," Biological Trace Element Research (1997) 56:331.

9 Muscaritoli, M., et al. "Oral Glutamine in the Prevention of Chemotherapy-Induced Gastrointestinal Toxicity," European Journal of Cancer (1997) 33:319.

10 Jaakkola, K., et al. "Treatment with Antioxidant and Other Nutrients in Combination with Chemotherapy and Irradiation in Patients with Small-Cell Lung Cancer," Anticancer Research (1992) 12:599.

11 Lamm, D.L., et al. "Megadose Vitamins in Bladder Cancer: A Double-Blind Clinical Trial," Journal of Urology (1994) 151:21.

12 Gogos, C.A., et al. "Dietary Omega-3 Polyunsaturated Fatty Acids Plus Vitamin E Restore Immunodeficiency and Prolong Survival in Severely Ill Patients with Generalized Malignancy: A Randomized Controlled Trial," Cancer (1998) 82:395.

This article was written for and originally posted on The Breast Cancer Channel, one of PlanetRx.com's family of health channels. Copyright PlanetRx.com 1999

Articles

Breast cancer is traumatic not only for the women who develop it, but also for the men in their lives. I know. In 1991, my wife was diagnosed, and I found myself along for an unpleasant ride as she had surgery, two months of daily radiation, and six months of biweekly chemotherapy, not to mention the emotional upheaval the disease engenders.

Author | Michael Castleman

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What Men Can Do: Helping Women Cope with Breast Cancer