Role of a Breast Cancer Husband

Western statistics reveal that nearly seven out of ten marriages touched by breast cancer do not survive and ultimately lead to divorce. With the incidence of breast cancer increasing in young Indian women, this problem will soon be evident here as well. In fact, during my tenure in Bangalore, I did come across a few patients who were deserted by their families after their diagnosis of Breast Cancer.

Although there is no magic formula for a couple to weather this difficult period, but some of these points can help husbands support their wives during their Breast Cancer treatment.

  1. Stand by her during the treatment & tell her that you ‘love’ her

In a marriage or any intimate relationship, silence is not golden. The strong silent type need not apply for the position of husband, lover, best friend, confidante and supporter of a woman with breast cancer. Your bride, your wife, needs and wants to hear from you. Actions may speak louder than words, and you may take all the right actions, but speaking words brings comfort, reassurance and knowledge of your inner feelings. She cannot read your mind. Being there for her is more than physical or economic security. Words have meaning. And the three most important words in the English language at this time, at this moment, when together you are facing her mortality, are: “I love you.”

  1. Involve her in the decision making

It is not easy for a lady to deal with the diagnosis of breast cancer. Often it has been seen in India that husbands and family members make clinical and personal decisions on their behalf. Although these ladies appreciate some of the decisions but they would love to be part of others, which involve their future.

A simple example is deciding between a mastectomy & breast conservation surgery. Family members err towards the side of mastectomy but in reality a lot of young patients actually want breast conservation surgery. It always helps to consult them in private and then take a collective decision.

  1. Go to Her Appointments

It is not what you do when you accompany her to treatment, but rather the act itself that speaks volumes to her. It also gives you some sense of empowerment. You are more than a helpless spectator cursing the damned disease. You have joined the battle.

  1. Sometimes humor helps

Funny, it does. There’s even a study to prove it, by psychologist Sharon Manne of the Fox Chase Cancer Center in Philadelphia. Couples who laughed at cancer coped better with the stress of treatment. We know that the act of laughing is itself healing. It makes us feel better and helps us get better.

  1. Continue to enjoy as a couple – she is NOT invalid

Treatment can be grueling and tiring, but you both need to live your life as fully as possible. Continue to enjoy what you enjoy individually and as a couple, particularly the latter. Don’t let cancer put an end to your personal and social life.

 

If you follow these simple steps, you can also become a Proud Husband of a Breast Cancer Survivor

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Article By:

Dr. Rohan Khandelwal

Consultant, Breast Oncosurgeon

W Pratiksha Hospital

Sporadic, Familial and Hereditary Breast Cancer Definitions

This is in continuation to my previous post ‘Criteria for Genetic Testing in Breast Cancer’. It is important for both patients and healthcare professionals to understand these definitions and their implications.

Sporadic Breast Cancer

Sporadic breast cancer is breast cancer with no other family history of breast carcinoma through two generations including siblings, offspring, parents, and both maternal and paternal aunts, uncles, and grandparents.

These patients do not require genetic testing for BRCA genes and risk-reduction procedures.

Familial Breast Cancer

Familial breast cancer is breast cancer with a family history of one or more first or second-degree relatives with breast cancer that does not fit the hereditary breast cancer definition given later. It is important to note that a patient with one or more first degree relatives with breast cancer in this familial breast cancer category has a substantial excess lifetime risk of breast cancer when compared with patients in the general population, who do not have affected first-degree relatives. A study found that risk ratios for breast cancer increased with increasing number of first-degree relatives involved (1.80, 2.93, and 3.90, respectively, for one, two, and three first-degree relatives).

As yet, genetic and environmental causes of familial (as opposed to hereditary) cancer are incompletely described. Some cases that demonstrate a familial pattern are found on germline testing to have BRCA1 or BRCA2 mutations, and it is difficult to know exactly where to set the threshold for genetic testing. However, quantitative risk assessment of breast cancer is extremely useful for the familial category of at-risk women and guides medical decision-making about chemoprevention, high-risk surveillance using breast magnetic resonance imaging (MRI), and prophylactic mastectomy.

Patients with increased risk should undergo the BRCA test and if they test positive, they should be counselled about risk reduction techniques.

Hereditary Breast Cancer

Hereditary breast cancer is characterized by a significantly earlier age of onset of breast cancer (before 45 years of age), bilateral breast cancer, a greater frequency of multiple primary cancers such as cancers of the breast and ovary in the HBOC syndrome(Hereditary Breast and Ovarian Cancer Syndrome), and an autosomal dominant inheritance pattern for cancer susceptibility (multiple family members with breast or ovarian cancer).

These patients should undergo BRCA testing and should be counselled about the various risk reduction techniques (which I will be discussing in my next post).

Taxols / Taxanes

Taxols are anti-cancer chemotherapy drugs. Taxols are classified as “plant alkaloids,  “taxanes”.

Taxols are used for the treatment of Breast Cancer

How are Taxols given:

  • Taxols are given as an injection or infusion into the vein (intravenous, IV).
  • Taxols are irritants and can cause inflammation of the vein through which it is given (thrombophlebitis).  If the medication escapes from the vein it can cause tissue damage.
  • There is no pill form of Taxol.
  • The amount of Taxol and the schedule that it is given will receive depend on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated.  Your doctor will determine your dose and schedule.

Taxol Side Effects:

Important things to remember about Taxol side effects include:

  • Most people do not experience all of the Taxol side effects listed.
  • Taxol side effects are often predictable in terms of their onset and duration.
  • Taxol side effects are almost always reversible and will go away after treatment is complete.
  • There are many options to help minimize or prevent Taxol side effects.
  • There is no relationship between the presence or severity of Taxol side effects and the effectiveness of the medication.
  • The Taxol side effects and their severity vary depending on how much of the drug is given, and/or the schedule in which it is given.

The following Taxol side effects are common (occurring in greater than 30%) for patients taking Taxols:

  • Low blood counts:  Your white and red blood cells and platelets may temporarily decrease.  This can put you at increased risk for infection, anemia and/or bleeding.
  • Hair loss
  • Arthralgias & myalgias, pain in the joints and muscles. Usually temporary occurring 2 to 3 days after Taxol, and resolves within a few days.
  • Peripheral neuropathy (numbness and tingling of the hands and feet)
  • Nausea & vomiting (usually mild)
  • Diarrhoea
  • Mouth sores
  • Hypersensitivity reaction – fever, facial flushing, chills, shortness of breath, or hives after Taxol is given.  The majority of these reactions occur within the first 10 minutes of an infusion.  Notify your healthcare provider immediately (premedication regimen has significantly decreased the incidence of this reaction).

The following are less common side effects (occurring in 10-29%) for patients receiving Taxols:

  • Swelling of the feet or ankles (edema).
  • Increases in blood tests measuring liver function.  These return to normal once treatment is discontinued. (see liver problems).
  • Low blood pressure (occurring during the first 3 hours of infusion).
Darkening of nail beds following taxol/ taxanes. Fortunately, this is a reversible side effect.

Darkening of nail beds following taxol/ taxanes. Fortunately, this is a reversible side effect.

  • Darkening of the skin
  • Nail changes (discoloration of nail beds – rare) 
  •  

When To Contact Your Doctor or Health Care Provider:

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

  • Fever of 100.4° F (38° C), chills (possible signs of infection)
  • Shortness of breath, wheezing, difficulty breathing, closing up of the throat, swelling of facial features, hives (possible allergic reaction).

The following symptoms require medical attention, but are not an emergency.  Contact your health care provider within 24 hours of noticing any of the following:

  • If you notice any redness or pain at the site of injection
  • Nausea (interferes with ability to eat and unrelieved with prescribed medication)
  • Vomiting (vomiting more than 4-5 times in a 24 hour period)
  • Diarrhea (4-6 episodes in a 24-hour period)
  • Unusual bleeding or bruising
  • Black or tarry stools, or blood in your stools or urine
  • Extreme fatigue (unable to carry on self-care activities)
  • Mouth sores (painful redness, swelling or ulcers)
  • Yellowing of the skin or eyes
  • Swelling of the feet or ankles.  Sudden weight gain
  • Signs of infection such as redness or swelling, pain on swallowing, coughing up mucous, or painful urination.

Always inform your health care provider if you experience any unusual symptoms.

Taxol Precautions:

  • Do not receive any kind of immunization or vaccination without your doctor’s approval while taking Taxol.
  • Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment.  Pregnancy category D (Taxol may be hazardous to the fetus.  Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
  • For both men and women: Do not conceive a child (get pregnant) while taking Taxol. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
  • Do not breast feed while taking Taxol.

Taxol Self Care Tips:

  • Taxol, or the medications that you take with Taxol may cause you to feel dizzy or drowsy. Do not operate any heavy machinery until you know how you respond to Taxol.
  • If you notice any redness or pain at the injection site, place a warm compress, and notify your healthcare provider.
  • Drink at least two to three litres of fluid every 24 hours, unless you are instructed otherwise.
  • You may be at risk of infection so try to avoid crowds or people with colds and those not feeling well, and report fever or any other signs of infection immediately to your health care provider.
  • Wash your hands often.
  • To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water.
  • Use an electric razor and a soft toothbrush to minimize bleeding.
  • Avoid contact sports or activities that could cause injury.
  • Taxol causes little nausea.  But if you should experience nausea, take anti-nausea medications as prescribed by your doctor, and eat small frequent meals.  Sucking on lozenges and chewing gum may also help.
  • Acetaminophen or ibuprophen may help relieve discomfort from fever, headache and/or generalized aches and pains.  However, be sure to talk with your doctor before taking it.
  • You may experience drowsiness or dizziness; avoid driving or engaging in tasks that require alertness until your response to the drug is known.
  • Taxol will make you sensitive to sunlight. You must wear sunglasses when outside, and avoid sun exposure. Wear protective clothing, and also wear SPF 15 (or higher) sun block.
  • In general, drinking alcoholic beverages should be kept to a minimum or avoided completely.  You should discuss this with your doctor.
  • Get plenty of rest.
  • Maintain good nutrition.
  • If you experience symptoms or side effects, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing While Taking Taxol:

You will be checked regularly by your health care professional while you are taking Taxol, to monitor side effects and check your response to therapy.  Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.