Empowering Wellness: Navigating Sexual Health and Lifestyle After Breast Cancer

Scientific gatherings and music festivals are both significant congregations of similar-minded individuals convened to observe experts exhibiting their talents, but beyond that, they usually lack substantial similarities. Hence, a distinct session named, “Sex, Drugs, Rock and Roll” at the 2024 San Antonio Breast Cancer Symposium (SABCS), occurring from December 10-13, might appear rather out of context. 

However, just as music festivals highlight artists needing greater visibility, this specialized session addressed survivorship themes that frequently remain unnoticed. After receiving a breast cancer diagnosis, patients often have inquiries regarding the impacts of supplements, physical activity, and nutrition on their prognosis or symptoms. They may also undergo shifts in their sexual self-perception that they find challenging to communicate with their healthcare provider. 

“This session is rooted in information [and] inquiries that pertain to the everyday experiences of those with cancer—for researchers, for physicians, and for patient advocates,” stated session moderator Christine Ambrosone, PhD, from Roswell Park Comprehensive Cancer Center. “We’ve gathered individuals who can discuss the advantages [and] possibly the disadvantages of several modifiable aspects.” 

Sex(ual Health and Intimacy During Breast Cancer Treatment)

Therapy for breast cancer can impact a patient’s physical, emotional, and mental wellbeing in numerous ways. Sexual health intersects with all these dimensions, yet it is not frequently addressed between patients and their healthcare providers, according to Don S. Dizon, MD, from the Brown University Health Cancer Institute. When patients notice alterations in their sexual health post-diagnosis, those modifications can include various components, Dizon elaborated. 

“[Sexual health] is a complex, multi-faceted issue,” Dizon stated. “If I pose this question to this audience, ‘how many of you are experiencing issues with intercourse,’ I will receive one type of response. If I inquire, ‘how many of you are facing challenges with your partner regarding intimacy,’ I would receive a markedly distinct response.” 

In terms of physical symptoms, women undergoing endocrine therapy frequently encounter vaginal dryness and discomfort during sexual intercourse. If healthcare providers acknowledge these concerns, they can recommend or prescribe solutions such as vaginal moisturizers, topical anesthetics, and dilator therapy, according to Dizon. 

Yet, difficulties related to sexual health often delve deeper, Dizon explained, influencing emotional and mental dimensions of intimacy. In one study, the proportion of women who regarded their chest as an element of their sexuality diminished significantly after breast cancer surgery, notably plummeting from 95% to 47% among those undergoing mastectomy without breast reconstruction. 

Moreover, women often report a decreased libido during breast cancer treatment, but Dizon stressed that a dip in sexual desire can stem from various reasons. He suggested certain pharmacological agents in addition to relationship and intimacy counseling as potential measures. 

“After battling cancer, everyone deserves to enjoy a sex life,” Dizon concluded.  

Drugs (and Supplements to Mitigate Symptoms)

Sexual side effects aren’t the solely experienced symptoms during breast cancer treatment. For additional concerns—including pain, fatigue, and nausea—patients occasionally resort to holistic remedies like cannabis or dietary supplements. 

Heather Greenlee, ND, PhD, MPH, from Fred Hutch Cancer Center, assessed what is known—and unknown—regarding the interaction of holistic therapies with breast cancer treatment. The antioxidant properties of melatonin and multivitamins can potentially diminish the effectiveness of certain treatments that function by inducing oxidative stress. Fish oil and omega-3 fatty acids could elevate the bleeding risk for patients with breast cancer, and some supplements are currently undergoing investigation for potential estrogen-like effects. 

Greenlee therefore emphasized the necessity for patients to communicate with their oncologist regarding any holistic treatments they are utilizing, which can be challenging concerning substances like cannabis that carry significant stigma. Research indicates that 42% of breast cancer patients report using cannabis to relieve their symptoms. Nonetheless, Greenlee showed that only about 22% of patients disclose cannabis use to their doctors overall, and this figure drops to 11% in jurisdictions where medical marijuana is prohibited. 

“When we consider interactions and safety understanding, we really need an environment where patients can engage in honest conversations with [physicians] about their practices,” Greenlee noted. 

In accordance with recent directives from the American Society of Clinical Oncology (ASCO), cannabis may alleviate treatment-related nausea and vomiting when coupled with other antiemetic medications; however, the evidence does not endorse cannabis use for treating any additional symptoms. Greenlee also stated that there is no credible evidence that cannabis can enhance breast cancer outcomes. 

Regarding supplements, the Society for Integrative Oncology and ASCO have published clinical practice guidelines outlining which supplements and other holistic approaches may or may not alleviate treatment-related pain, fatigue, and nausea. For breast cancer patients, integrating ginger into standard antiemetics might be suggested to assist with nausea and vomiting, ginseng may be recommended to address fatigue, and lavender aromatherapy could help alleviate anxiety. Greenlee also discussed supplements found ineffective by the guidelines—like aloe vera for radiation-induced skin reactions, guarana for fatigue, and soy for hot flashes—or even detrimental, such as acetyl-l-carnitine for peripheral neuropathy. 

“[The catalog of supplements we can endorse] is relatively brief, but we hope it will expand over time as we obtain more robust data,” Greenlee added. “Simultaneously, there exists a wide array of other non-pharmacologic strategies that can be equally effective or even more beneficial than dietary supplements.” 

Rock(ing, and Other Exercise Plans for Patients)

Whether you’re rocking out to your beloved tune, gliding on the waves in a kayak, or attempting a new yoga position, increasing your movement and

Reducing sitting time can significantly aid individuals battling breast cancer, as stated by Rikki Cannioto, PhD, EdD, affiliated with Roswell Park Comprehensive Cancer Center.

The U.S. Centers for Disease Control and Prevention (CDC) advise that adults engage in at least 150 to 300 minutes of moderate physical activity or 75 to 150 minutes of intense exercise each week, along with two days of muscle-strengthening activities. Nevertheless, a progress report from the National Institutes of Health (NIH) revealed that merely 14% of female cancer survivors and 13% of all cancer survivors aged 65 or older achieve the CDC’s recommendations. Alarmingly, 40% to 60% of those who have survived cancer are entirely sedentary.

Cannioto examined data indicating that exercise interventions during treatment can alleviate side effects and enhance overall well-being; however, until recently, the impact of exercise on treatment outcomes remained uncertain. Alongside her colleagues, she conducted a meta-analysis that amalgamated outcome data from three separate studies concerning exercise interventions during breast cancer treatment. In comparison to physical inactivity, adhering to CDC recommendations correlated with a 48.5% reduction in mortality and a 31% decrease in recurrence risk.

“This is significant because, so far, the connection between physical activity post-diagnosis and breast cancer recurrence has not been thoroughly established in existing literature,” Cannioto remarked. “Very few studies specifically investigate whether compliance with federal physical activity guidelines is linked to survival.”

However, even if fulfilling the CDC recommendations isn’t feasible, any degree of physical activity shows advantages against inactivity. Cannioto highlighted that there’s no minimum requirement for daily steps or weekly physical activity to lower all-cause mortality. Notably, the most substantial benefits were observed when transitioning from sedentary behavior to engaging in even a modest level of activity.

“The essential message of increasing movement and reducing sitting during the day is crucial,” Cannioto stated. “Some physical activity is preferable to none, and individuals who sit less and partake in any form of moderate-to-vigorous activity can experience some health benefits.”

Roll(s, and Other Dietary Considerations)

Numerous patients diagnosed with cancer frequently inquire about appropriate dietary and beverage choices, clarified Lawrence H. Kushi, ScD, from the Kaiser Permanente Northern California Division of Research.

Popular eating patterns such as the Mediterranean diet and Dietary Approaches to Stop Hypertension (DASH) attract patients due to their broad health assertions, yet do they truly enhance breast cancer outcomes? Kushi and his team assessed the relationship between adherence to four distinct dietary quality indices—the American Cancer Society Nutrition Guidelines, Mediterranean diet, DASH, and 2015 Healthy Eating Index—with mortality rates.

For every dietary index, a progressively higher level of adherence was significantly linked to reduced risks of breast cancer-specific and all-cause mortality, a conclusion that has since been corroborated by multiple independent studies, according to Kushi.

“There’s substantial evidence indicating that dietary habits can affect overall mortality risk and outcomes following breast cancer; the evidence is expanding,” Kushi noted.

Some patients might also have inquiries regarding alcohol consumption. Although drinking is a recognized risk factor for the onset of breast cancer and at least five additional cancer types, there is limited understanding of how alcohol intake impacts outcomes following a breast cancer diagnosis, Kushi explained.

Kushi and his colleagues found no significant differences in breast cancer recurrence rates between nondrinkers and those who drink occasionally or regularly. Nonetheless, Kushi highlighted a systematic review indicating a weak correlation between alcohol consumption and recurrence risk, particularly among postmenopausal women. He stressed that further research is necessary in this domain to draw definitive conclusions.