CARO is excited to begin offering breast cancer survivorship care.

You have finished treatment, now what? Many patients express concerns about what comes next. At CARO, we want to partner with you as you make the transition from active treatment to living beyond your diagnosis. We are committed to supporting you on this journey.

After completing radiation, you will return for your one-month follow-up visit and meet with our nurse practitioner who is experienced in radiation and medical oncology as well as survivorship care. At this visit, you will be given a personalized treatment summary and breast care plan. The treatment summary will detail your journey from the time of diagnosis to completion of treatment. Our nurse practitioner will review this in detail and answer any questions you may have. This useful tool provides you a succinct, easy-to-access overview of your diagnosis, treatment, and follow-up care plan.

During this visit, we will discuss the potential long-term physical effects of treatment and appropriate management. We will also highlight living beyond your diagnosis and provide many helpful resources for emotional, social, and sexual health. At this visit, we invite you to ask questions, address any fears, celebrate the end of treatment, or anything in between. Our goal is to meet you where you are, walk alongside you in this journey, and provide resources to help you be your best self and live your best life!

Survivorship Information

Survivorship Information

What is axillary cording or webbing?
Axillary cording or webbing are ropelike structures or “cords” that form under your arm that may cause pain, tightness, or difficulty raising your arm. These cords usually start at or near the surgical scar under your arm.

Why does axillary cording occur?
Many experts believe that cording is a result of trauma to the underarm and chest wall from surgery that leads to inflammation, scarring, and hardening of the surrounding tissue.

What are the signs of cording?

  • Tightness and pain under your arm
  • Difficulty raising your arm overhead
  • Feeling ropelike structures under your arm

How is cording managed?

  • Stretching and flexibility exercises
  • Specialized massage by a trained therapist

How long does it last?
Cording usually resolves after several therapy sessions and with continued stretching at home. It can recur but usually does not. It is important to continue stretching and flexibility exercises even after symptoms resolve.

Additional resources:

*Be sure to consult with your physician or provider before beginning exercises after surgery.

After cancer treatment, you may experience many different emotions. Just as you need to care for your body, you also need to care for your emotional and mental health. As each person’s life and cancer experience is unique, so are the emotions you may feel after completing therapy. Below are some common feelings you may experience and strategies for management. Remember you are unique and how you cope will be different from others. Determine what works best for you.

Difficulty with concentration or memory.

  • Write things down or make yourself notes.
  • Keep a calendar.
  • Stick to a daily routine.
  • Talk through the steps of a task while completing it. This may help improve concentration.
  • Repeat information you want to remember. This may help your mind hold onto the information.
  • Exercise your mind. Read or do word puzzles. Keep your brain active.

Fear of recurrence.

  • Be informed about your follow-up care and surveillance.
  • Express your fears to your provider, family, or friend. Talking through fear often reduces anxiety and helps you to let go. If you prefer, journal your thoughts and fears privately.
  • Find ways to relax, perhaps meditation, reading, massage, or taking a walk.
  • Exercise and be active. This may help refocus your mind.

Anxiety and Depression. After treatment ends, you may feel alone or miss the reassurance of seeing your care team regularly. Perhaps you feel pressure to move on and return to “normal.” Maybe you are struggling with self-confidence or body image. This can lead to depression and anxiety. Depression is more than feeling down or sad. If you have the following symptoms for more than two weeks, talk to your provider and get the help you need.

Symptoms:

  • Feeling worthless or hopeless.
  • Loss of interest in activities you used to enjoy.
  • Withdrawing from others.
  • Feeling sad most day and crying often.
  • Increased irritability and moodiness.
  • Trouble sleeping or wanting to sleep all the time.
  • Feeling tired all the time.
  • Loss of appetite or overeating.
  • Thoughts of dying or harming yourself.

 Management:

  • Be patient and gentle with yourself. It will take time to adjust to your new normal.
  • Discuss your feelings and concerns with your provider.
  • Cognitive-behavioral therapy (talk therapy) can be very beneficial. Consider talking to a counselor or psychiatrist.
  • Join a support group. There are many options include local face-to-face groups, individual support, and online groups.
  • If you are overwhelmed, divide large chores into smaller individual chores and do one thing at a time as you can.
  • Ask for help if you need it. Oftentimes, your family and friends want to support you but are not sure how.
  • Exercise regularly as this will often boost your mood.

 Free Individual and Group Support:

Local Counseling:

  • The Samaritan Counseling Center | www.tsccenter.org | 334.262.7787 | 2911 Zelda Rd, Montgomery, AL 36106
  • Fitzpatrick and Watson Counseling | 334.546.2222 | 600 Interstate Park Drive Suite 609, Montgomery AL 36109
  •  Gardenia Cove Mental Health | www.gardeniacove.com | 334.954.6010 | 6719 Taylor Circle, Montgomery, AL 36117
  • Alabama Mental Health Authority | www.mamha.org | 334.279.7830 | Locations in Montgomery, Prattville, and Wetumpka

 Other Helpful Resources:

Maintaining a healthy weight and being active are important during and after cancer treatment as both have been shown to improve tolerance of cancer treatment and reduce the risk of cancer recurrence and development of secondary cancers. In contrast, obesity is linked to an increased risk of certain types of cancer and also known to increase the risk of heart disease, diabetes, and other serious health problems.

What is a healthy weight?
An easy way to know if you are at a healthy weight is to determine your BMI using a BMI calculator which is easily accessible on the CDC’s website. A healthy weight is a BMI of 18.5 to 24.9.

How do I maintain a healthy weight?

  • Track your calories utilizing resources such as choosemyplate.gov or mobile phone apps such as My Fitness Pal.
  • Limit red meats (hamburger/steak), processed meats (deli/canned meats), and packaged foods. Limit refined sugar such as candy, cookies, soda, and juices. Limit or avoid fried foods and fast foods.
  • Increase intake of fresh vegetables and 100% whole grains such as brown rice, whole-grain breads, and cereals. The American Cancer Society recommends 2.5 cups of fresh, non-starch vegetables per day.
  • Be active. Exercise helps combat fatigue, anxiety, and depression and improves physical function and quality of life. The American Cancer Society recommends 20-30 minutes of moderate-intensity exercise 3-5 times per week. Examples include brisk walking, yoga, water aerobics, gardening, and biking on level ground. Intensity of exercise should be adjusted to your current activity level. For example, begin by walking 10 minutes, three times per week gradually increasing time and pace.
  • Limit alcohol intake to no more than one drink per day for women and two drinks per day for men. One drink is defined as 12 oz of beer, 5 oz of wine, or 1.5oz of 80-proof liquor.

What about sugar?
The belief that sugar “feeds” cancer is common. The truth is that all cells, including cancer cells, use sugar (glucose) as fuel. Glucose comes from carbohydrate containing foods, even healthy foods like fruits, vegetables, and whole grains. If there are not enough carbohydrates in your diet, your body will use a special process to make glucose from protein to fuel itself. Considering this, the connection between sugar and cancer is indirect meaning high sugar foods can lead to weight gain and excess body fat which has been linked to increased risk of certain cancers.

Should I eat only organic foods?
Choosing to eat only organic foods is a personal decision. However, studies confirm that eating a diet rich in fruits and vegetables, either organic or conventional, lowers the risk of cancer. While eating foods that contain pesticides may slightly increase your risk of cancer, it is more important to consume plenty of fruits and vegetables than to eat organic only.

Can I take supplements?
If you are planning to take any form of dietary supplementation, discuss this with your provider first. Many supplements are not well studied and it is unclear if they will interfere with cancer treatment or not. There are some studies that suggest large doses of antioxidants such as vitamins A, C, and E may keep cancer cells from being destroyed. Generally speaking, nutrients in whole foods are preferred to high dose supplementation.

Resources:

Emotional Concerns

  • You may have a decreased desire or become less interested in sex.
  • You or your partner may be nervous about resuming sexual activity, afraid that it could cause harm or pain.
  • You may find it difficult to transition from a patient/caregiver relationship.
  • You may struggle with body image or changes to your appearance after treatment or you may be nervous about how your partner will respond.
  • You may be experiencing anxiety or depression.

Physical Concerns

  • Decreased or loss of sensation after surgery.
  • Vaginal dryness or tightness.
  • Pain with intercourse.
  • Decreased libido or sex drive. 

Strategies for Improving Sexual Desire and Function

  • Communication is key. Discuss your feelings and experiences with your partner, be open about changes you are experiencing and how that makes you feel. Discuss each other’s expectations.
  • If you struggle with body image, work at getting back a positive view of yourself. If you need help, reach out to other survivors or seek counseling. There are many resources available. Remember you are a strong, beautiful survivor!
  • Intimacy and sexual activity after treatment are not harmful to you or your partner. Cancer is not contagious and cannot be transmitted during intercourse or other sexual activity. Once you have completed treatment, your partner will not cause any harm touching previously affected areas. Ex. Mastectomy site, reconstructed breast.
  • Try new approaches. Your body has changed and some areas may now be less sensitive. What worked before may no longer be pleasurable. Sex and intimacy are more than intercourse, consider alternative activities.
  • Don’t rush. Create a relaxed environment. Wear what makes you comfortable.
  • Use a vaginal moisturizer such as Replens Long-Lasting Vaginal Moisturizer two times per week. After 12 weeks of regular use, the vagina becomes more moist and elastic, much like women taking estrogen. Use a water based personal lubricant during intercourse. This can help alleviate vaginal dryness and pain during intercourse.
  • If you experience pain during intercourse, you may benefit from the use of a vaginal dilator and performing Kegel or pelvic floor exercises. Do NOT push through the pain during intercourse. Discuss solutions with your provider.

Helpful Resources for Sexual Health

What is lymphedema?
Lymphedema is an abnormal buildup of fluid in the tissues that results in swelling. It most commonly occurs in the arms and legs.

Why does lymphedema occur?
Lymphedema occurs when the lymph system (the vessels and nodes that carry lymph fluid) is blocked or interrupted. Lymph nodes may be removed at the time of breast surgery causing disruption and swelling.

What are the signs of lymphedema?
Swelling in the affected breast, arm, hand, or fingers. A feeling of heaviness or tightness. Decreased mobility. Aching or discomfort.

How is lymphedema treated?

  • Specialized massage by a trained therapist
  • Compression sleeves and gloves
  • Specialized wrapping techniques
  • Therapeutic exercises

It is important to treat lymphedema promptly. If left untreated, the tissues can harden and reduce function and mobility on the affected side.

What precautions are needed?

  • Keep the skin clean and dry.
  • Avoid wearing tight clothing and jewelry.
  • Avoid trauma as this can increase the risk of lymphedema.
  • Avoid heavy lifting with the affected arm. Do not carry a heavy purse or bag on the affected side.
  • Avoid blood draws, injections, and blood pressure checks on the affected side if possible.

Additional resources:

What is axillary cording or webbing?
Axillary cording or webbing are ropelike structures or “cords” that form under your arm that may cause pain, tightness, or difficulty raising your arm. These cords usually start at or near the surgical scar under your arm.

Why does axillary cording occur?
Many experts believe that cording is a result of trauma to the underarm and chest wall from surgery that leads to inflammation, scarring, and hardening of the surrounding tissue.

What are the signs of cording?

  • Tightness and pain under your arm
  • Difficulty raising your arm overhead
  • Feeling ropelike structures under your arm

How is cording managed?

  • Stretching and flexibility exercises
  • Specialized massage by a trained therapist

How long does it last?
Cording usually resolves after several therapy sessions and with continued stretching at home. It can recur but usually does not. It is important to continue stretching and flexibility exercises even after symptoms resolve.

Additional resources:

*Be sure to consult with your physician or provider before beginning exercises after surgery.

After cancer treatment, you may experience many different emotions. Just as you need to care for your body, you also need to care for your emotional and mental health. As each person’s life and cancer experience is unique, so are the emotions you may feel after completing therapy. Below are some common feelings you may experience and strategies for management. Remember you are unique and how you cope will be different from others. Determine what works best for you.

Difficulty with concentration or memory.

  • Write things down or make yourself notes.
  • Keep a calendar.
  • Stick to a daily routine.
  • Talk through the steps of a task while completing it. This may help improve concentration.
  • Repeat information you want to remember. This may help your mind hold onto the information.
  • Exercise your mind. Read or do word puzzles. Keep your brain active.

Fear of recurrence.

  • Be informed about your follow-up care and surveillance.
  • Express your fears to your provider, family, or friend. Talking through fear often reduces anxiety and helps you to let go. If you prefer, journal your thoughts and fears privately.
  • Find ways to relax, perhaps meditation, reading, massage, or taking a walk.
  • Exercise and be active. This may help refocus your mind.

Anxiety and Depression. After treatment ends, you may feel alone or miss the reassurance of seeing your care team regularly. Perhaps you feel pressure to move on and return to “normal.” Maybe you are struggling with self-confidence or body image. This can lead to depression and anxiety. Depression is more than feeling down or sad. If you have the following symptoms for more than 2 weeks, talk to your provider and get the help you need.

Symptoms:

  • Feeling worthless or hopeless.
  • Loss of interest in activities you used to enjoy.
  • Withdrawing from others.
  • Feeling sad most day and crying often.
  • Increased irritability and moodiness.
  • Trouble sleeping or wanting to sleep all the time.
  • Feeling tired all the time.
  • Loss of appetite or overeating.
  • Thoughts of dying or harming yourself.

 Management:

  • Be patient and gentle with yourself. It will take time to adjust to your new normal.
  • Discuss your feelings and concerns with your provider.
  • Cognitive-behavioral therapy (talk therapy) can be very beneficial. Consider talking to a counselor or psychiatrist.
  • Join a support group. There are many options include local face-to-face groups, individual support, and online groups.
  • If you are overwhelmed, divide large chores into smaller individual chores and do one thing at a time as you can.
  • Ask for help if you need it. Oftentimes, your family and friends want to support you but are not sure how.
  • Exercise regularly as this will often boost your mood.

 Free Individual and Group Support:

Local Counseling:

  • The Samaritan Counseling Center | www.tsccenter.org | 334.262.7787 | 2911 Zelda Rd, Montgomery, AL 36106
  • Fitzpatrick and Watson Counseling | 334.546.2222 | 600 Interstate Park Drive Suite 609, Montgomery AL 36109
  • Gardenia Cove Mental Health | www.gardeniacove.com | 334.954.6010 | 6719 Taylor Circle, Montgomery, AL 36117
  • Alabama Mental Health Authority | www.mamha.org | 334.279.7830 | Locations in Montgomery, Prattville, and Wetumpka

 Other Helpful Resources:

Maintaining a healthy weight and being active are important during and after cancer treatment as both have been shown to improve tolerance of cancer treatment and reduce the risk of cancer recurrence and development of secondary cancers. In contrast, obesity is linked to an increased risk of certain types of cancer and also known to increase the risk of heart disease, diabetes, and other serious health problems.

What is a healthy weight?
An easy way to know if you are at a healthy weight is to determine your BMI using a BMI calculator which is easily accessible on the CDC’s website. A healthy weight is a BMI of 18.5 to 24.9.

How do I maintain a healthy weight?

  • Track your calories utilizing resources such as choosemyplate.gov or mobile phone apps such as my fitness pal.
  • Limit red meats (hamburger/steak), processed meats (deli/canned meats), and packaged foods. Limit refined sugar such as candy, cookies, soda, and juices. Limit or avoid fried foods and fast foods.
  • Increase intake of fresh vegetables and 100% whole grains such as brown rice, whole-grain breads, and cereals. The American Cancer Society recommends 2.5 cups of fresh, non-starch vegetables per day.
  • Be active. Exercise helps combat fatigue, anxiety, and depression and improves physical function and quality of life. The American Cancer Society recommends 20-30 minutes of moderate-intensity exercise 3-5 times per week. Examples include brisk walking, yoga, water aerobics, gardening, and biking on level ground. Intensity of exercise should be adjusted to your current activity level. For example, begin by walking 10 minutes, 3 times per week gradually increasing time and pace.
  • Limit alcohol intake to no more than 1 drink per day for women and 2 drinks per day for men. 1 drink is defined as 12 oz of beer, 5 oz of wine, or 1.5oz of 80-proof liquor.

What about sugar?
The belief that sugar “feeds” cancer is common. The truth is that all cells, including cancer cells, use sugar (glucose) as fuel. Glucose comes from carbohydrate containing foods, even healthy foods like fruits, vegetables, and whole grains. If there are not enough carbohydrates in your diet, your body will use a special process to make glucose from protein to fuel itself. Considering this, the connection between sugar and cancer is indirect meaning high sugar foods can lead to weight gain and excess body fat which has been linked to increased risk of certain cancers.

Should I eat only organic foods?
Choosing to eat only organic foods is a personal decision. However, studies confirm that eating a diet rich in fruits and vegetables, either organic or conventional, lowers the risk of cancer. While eating foods that contain pesticides may slightly increase your risk of cancer, it is more important to consume plenty of fruits and vegetables than to eat organic only.

Can I take supplements?
If you are planning to take any form of dietary supplementation, discuss this with your provider first. Many supplements are not well studied and it is unclear if they will interfere with cancer treatment or not. There are some studies that suggest large doses of antioxidants such as vitamins A, C and E may keep cancer cells from being destroyed. Generally speaking, nutrients in whole foods are preferred to high dose supplementation.

Resources:

Emotional Concerns

  • You may have a decreased desire or become less interested in sex.
  • You or your partner may be nervous about resuming sexual activity, afraid that it could cause harm or pain.
  • You may find it difficult to transition from a patient/caregiver relationship.
  • You may struggle with body image or changes to your appearance after treatment or you may be nervous about how your partner will respond.
  • You may be experiencing anxiety or depression.

Physical Concerns

  • Decreased or loss of sensation after surgery.
  • Vaginal dryness or tightness.
  • Pain with intercourse.
  • Decreased libido or sex drive. 

Strategies for Improving Sexual Desire and Function

  • Communication is key. Discuss your feelings and experiences with your partner, be open about changes you are experiencing and how that makes you feel. Discuss each other’s expectations.
  • If you struggle with body image, work at getting back a positive view of yourself. If you need help, reach out to other survivors or seek counseling. There are many resources available. Remember you are a strong, beautiful survivor!
  • Intimacy and sexual activity after treatment are not harmful to you or your partner. Cancer is not contagious and cannot be transmitted during intercourse or other sexual activity. Once you have completed treatment, your partner will not cause any harm touching previously affected areas. Ex. Mastectomy site, reconstructed breast.
  • Try new approaches. Your body has changed and some areas may now be less sensitive. What worked before may no longer be pleasurable. Sex and intimacy are more than intercourse, consider alternative activities.
  • Don’t rush. Create a relaxed environment. Wear what makes you comfortable.
  • Use a vaginal moisturizer such as Replens long-lasting vaginal moisturizer two times per week. After 12 weeks of regular use, the vagina becomes more moist and elastic, much like women taking estrogen. Use a water based personal lubricant during intercourse. This can help alleviate vaginal dryness and pain during intercourse.
  • If you experience pain during intercourse, you may benefit from the use of a vaginal dilator and performing Kegel or pelvic floor exercises. Do NOT push through the pain during intercourse. Discuss solutions with your provider.

Helpful Resources for Sexual Health

What is lymphedema?
Lymphedema is an abnormal buildup of fluid in the tissues that results in swelling. It most commonly occurs in the arms and legs.

Why does lymphedema occur?
Lymphedema occurs when the lymph system (the vessels and nodes that carry lymph fluid) is blocked or interrupted. Lymph nodes may be removed at the time of breast surgery causing disruption and swelling.

What are the signs of lymphedema?
Swelling in the affected breast, arm, hand, or fingers. A feeling of heaviness or tightness. Decreased mobility. Aching or discomfort.

How is lymphedema treated?

  • Specialized massage by a trained therapist
  • Compression sleeves and gloves
  • Specialized wrapping techniques
  • Therapeutic exercises

It is important to treat lymphedema promptly. If left untreated, the tissues can harden and reduce function and mobility on the affected side.

What precautions are needed?

  • Keep the skin clean and dry.
  • Avoid wearing tight clothing and jewelry.
  • Avoid trauma as this can increase the risk of lymphedema.
  • Avoid heavy lifting with the affected arm. Do not carry a heavy purse or bag on the affected side.
  • Avoid blood draws, injections, and blood pressure checks on the affected side if possible.

Additional resources: