JUNE 2018 starting RADIATION

If you had a cboice, how many hours would you work a week while going through radiation? And if you work, how many weeks after surgery did it take for you to get back to work? Im presurgery with current treatment plan being 6 weeks of radiation 5 days a week. I'm hoping I can get back to work in 3 weeks. Reasonable or fantasy?

Hi Everyone!

I am doing the June rads and appreciate all your sharing. I am on 8/20 treatments as of today. I think the fatigue has arrived. But, could be stress. I get very achy after treatments. But mine is on the left side where, a year or two ago, I had dislocated shoulder, rhomboid ligament tear and then frozen shoulder...so I have a hard time holding my arm up. I am face down for the treatments. (Is anyone else? Or is everyone else?) And, I think a bit emotional (like some others have mentioned) afterwards, too - but who knows what that's from?

Also, my doctor said not to use Aloe. That Calendula was best. (Some people were reacting to the lanolin in Aquaphor, a nurse told me...)

Oneof7- I think everyone is different and it depends on the surgery. I had a lumpectomy on both sides along with sentinel node biopsy. Only the right was cancerous. The nipple-ectomy (because of Paget's disease) was a pretty long incision but as mwaucker said I came out with just a big strip of glue across it. It just looked like a really long scratch! In total I had 4 incisions on both sides and went home with the special bra from the hospital. Honestly I could have made it through work the next day if I had needed to. My surgeon recommended two weeks so that's what I took but I bounced back in a day or two and was out and about right away. As far as radiation, I've been able to work full time throughout with no issues. No real fatigue or other symptoms so far and I'm halfway finished but I am also purposely taking it easy in the evenings after work and on the weekends.

PalBuddy - I'm face up but having radiation on my right. The emotional wave I was having last week seems to be gone this week? It was about 8 when I had it the worst so you seem to be in the same place I was when it hit. This week I seem to be breezing through with no issues. Knock on wood!

Hello All,

This is my first time on this thread. I had a lumpectomy and SNB with IORT (intraoperative radiation therapy) on 5/4. I had hoped the IORT would be it for radiation, but they found unforseen DCIS on my pathology so I'm doing 5 1/2 weeks of rads with no boost (they consider the IORT as the boost). My Oncotype DX score was 9 so no chemo. I just had my 2nd rads treatment and I'm about a week into taking Tamoxifen, so far so good with both.

I'm on my back for treatment with my hands holding onto a bar over my head. I have to take huge deep breaths and hold my breath while the radiation is being administered so there is no listening to music or books because they tell me through a speaker when to inhale, hold, and exhale. My understanding is that the deep breaths put more space between my breast and heart since it's my left breast. Does anyone else have to do the breathing thing? My breast is already turning pink (I'm light skinned African-American) so I just ordered Miaderm from Amazon. I have rads in the morning before coming to work. If I end up with serious fatigue I'll change to late afternoon treatment and go home after.

Angela

Hey all- I've been following along. Just started my rads on Monday, June 25, so now I have completed 3/33. Woo-hoo very auspicious number, but into the 20s not 30s, right? Finish on August 9.

So I too had left mastectomy/ axillary nodes all removed. Am on my back on the table, holding handles above my head, and I take a deep breath and hold during treatments. I am skinny so there is not much room to miss the heart and lungs, so holding the breath keeps me still and brings the tumor bed away from those zones. It isn't hard, just takes "setting my chest" for 20 seconds or so. My RO uses aloe, suggests it 3 times a day, with Aquaphor as second choice. No skin or fatigue issues yet.

They play my Pandora station (Susan Tedeschi, BTW), and it stops whenever they give an instruction. Incredibly nice techs, very encouraging and patient, thorough. It's pretty wild, though, as the wings of the table rotate around me. I keep my eyes closed and just listen to the music. Not emotional at all, just very reassuring that this procedure makes it less likely that the little bugger will EVER come back.

All, here in my last week not feeling too well so I hadn’t felt like posting. I cannot wait to be done Monday! Hope all of you are doing well

Welcome pleasantsa. I'm getting rads to the right so no wierd brething for me. Earier some were commenting about it, I'm sure they will jump in soon.

Best.

How long after the simulation did you start rad treatments? I'm told it will be 2 weeks. I'd just like to start so I could get done.

TrailDweller - I think it really depends on the location. I had the first planning session on a Monday, 2nd one on a Wednesday and my first treatment immediatly after.

I'm at 14 of 30 and turning a little pink on the areas being zapped, but I'm having skin rashes develop in areas that are not in the line of fire (my chest and my lower back). Is anyone else seeing this?

Mrsmcg-

Here's the an overview of the article- I think that there is lots of good information to take away about other treatments. I can't tell if they are saying Aloe is bad or that it is simply ineffective. I'm using a prescribed cream, Momentasone, and I put it on right after treatment each morning and it is either working or else I'm just really resilient.

www.medscape.com

ASCO Endorses Some Complementary Therapies in Breast Cancer

Roxanne Nelson, BSN, RN

June 20, 2018

Many cancer patients use alternative medicine, including supplements, massage therapy, yoga, and accupuncture, while undergoing conventional cancer care. Such therapies are usually acceptable, but patients must be discuss such therapies with their oncologist, because interactions may occur.

That appears to be the take-home message from the recent move by the American Society of Clinical Oncology (ASCO) to endorse new guidelines issued by the Society for Integrative Oncology (SIO).

The ASCO endorsement was published online June 11 in the Journal of Clinical Oncology.

The SIO had produced an evidence-based guideline on the use of integrative therapies during and after breast cancer treatment for the management of a variety of symptoms and adverse effects. An ASCO expert panel, cochaired by Gary H. Lyman, MD, MPH, codirector of the Hutchinson Institute for Cancer Outcomes Research at the Fred Hutchinson Cancer Research Center in Seattle, Washington, and Lorenzo Cohen, PhD, director of the Integrative Medicine Program at the University of Texas MD Anderson Cancer Center, Houston, reviewed the guidelines.

The panel determined that the recommendations in the 2017 SIO guideline "are clear, thorough, and based on the most relevant scientific evidence." ASCO endorsed them with a few added discussion points.

"We know that vast the majority of cancer patients, particularly breast cancer patients, are using some type of alternative medicines," Lyman said in an interview. "They may be taking supplements, doing yoga, getting massage therapy or acupuncture, but most doctors don't talk about it. They don't ask about it, and the patient doesn't offer the information."

Lyman estimates that 60% to 80% of breast cancer patients use some type of alternative therapy, but such therapies are not entered into the medical record. That generally is not too much a cause of concern, because most of these approaches are relatively safe, he noted. "But occasionally, there may be some interaction with a supplement and standard medicine," he said.

He told Medscape Medical News, "The biggest fear is that a patient is going to stop using a known effective conventional medicine and use one of the alternative approaches instead.

"That's why we want to make sure that the doctor and patient are discussing them, the doctor knows what the patient is doing and discusses the subject in a nonjudgmental way, and then encourages the patient to report any problems or side effects they might have," he explained.

It is also important that oncologists reassure patients that they can continue to receive their regular cancer treatment along with these alternative approaches.

Review of Recent Literature

The ASCO guidelines are an endorsement of a guideline from a much smaller organization, explained Lyman. "The SIO had approached ASCO about this, and they had done a really deep review of the available literature on these therapies," he said. "ASCO formed a panel, and we did our own search and added several studies that had come out since the other work had been completed."

ASCO used a modified version of the US Preventive Services Task Force grading system to assign a grade to each therapy, as applied to a specific clinical outcome. Grades A and B indicate that a therapy is recommended for a particular indication; grade C indicates that more evidence is needed or that the net benefit is small; grades D and H indicate that a therapy is not recommended for a particular indication; and grade I indicates that the evidence is inconclusive.

Lyman noted that the ASCO panel supported almost all of the recommendations in the SIO guidelines. "Some had sufficient evidence to recommend them, and for some, there wasn't much evidence, but they didn't incur any harm, and some approaches had no evidence," he said.

Key Recommendations

Some of their key recommendations are as follows:

• Acute radiation skin reaction — aloe vera and hyaluronic acid cream should not be recommended for improving acute radiation skin reaction (grade D).
• Anxiety and stress reduction — meditation (grade A), yoga (grade , and music therapy (grade are recommended for reducing anxiety. Stress management is recommended for reducing anxiety during treatment; longer group programs are likely better than self-administered home programs or shorter programs (grade . Acupuncture, massage, and relaxation can be considered for reducing anxiety (grade C).
• Chemotherapy-induced nausea and vomiting — acupressure (grade , electroacupuncture (grade , ginger (grade C), and relaxation (grade C) can be considered as an addition to antiemetic drugs to control nausea and vomiting during chemotherapy. Glutamine should not be recommended for improving nausea and vomiting during chemotherapy (grade D).
• Depression and mood disturbance — meditation, particularly mindfulness-based stress reduction (grade A), relaxation (grade A), and yoga (grade are recommended for treating mood disturbance and depressive symptoms. Massage (grade and music therapy (grade are recommended for improving mood disturbance.
• Fatigue — hypnosis and ginseng can be considered for improving fatigue during treatment (grade C). Acupuncture and yoga can be considered for improving posttreatment fatigue (grade C). Acetyl-L-carnitine and guarana should not be recommended for improving fatigue during treatment (grade D).
• Lymphedema — low-level laser therapy, manual lymphatic drainage, and compression bandaging can be considered for improving lymphedema (grade C).
• Neuropathy — acetyl-L-carnitine is not recommended for the prevention of chemotherapy-induced peripheral neuropathy in patients with breast cancer because of the potential for harm (grade H).
• Pain — acupuncture, healing touch, hypnosis, and music therapy can be considered for the management of pain (grade C).
• Quality of Life — meditation (grade A) and yoga (grade are recommended for improving quality of life. Acupuncture, mistletoe, qigong, reflexology, and stress management can be considered for improving quality of life (grade C).
• Sleep Disturbance — gentle yoga can be considered for improving sleep (grade C).
• Vasomotor/hot flashes — acupuncture can be considered for improving hot flashes (grade C). Soy is not recommended for hot flashes because of lack of effect (grade D).

"Our hope is that this will help disseminate this good information, break down barriers, and open up dialogs between patient and doctor," Lyman said. "Hopefully, patients will have improvements in their outcomes."

All funding was provided by ASCO. Dr Lyman has relationships with Generex Biotechnology, Halozyme, G1 Therapeutics, Coherus Biosciences, and Amgen (Inst); several coauthors have also disclosed relationships with industry, as noted in the original article.

J Clin Oncol. Published online June 11, 2018. Full text

Medscape Medical News © 2018

Cite this article: ASCO Endorses Some Complementary Therapies in Breast Cancer - Medscape - Jun 20, 2018.

Since the article says Acute radiation skin reaction — aloe vera and hyaluronic acid cream should not be recommended for improving acute radiation skin reaction (grade D). I am wondering what they would recommend using. I don't think aloe does anything but make the area feel cool. When I first started radiation I talked to my RO about what to use on my skin. All she approved for me to use was aloe vera. She stated that she wanted to see my skin turn red. She said that's how she knows the radiation is working. I begged her to prescribe me silvadene, which she finally did, and I discovered gold bold healing therapy cream with some aloe in it that seems to be helping.

I have heard people mention using green tea. How is that used?

some aloe has alcohol. The one I got at Wal-Mart does not. It is 100% aloe and alcohol free. I am using emu oil but I'm only 2 treatments in.

I was told 2 weeks so calculations could be done. I actually started in 1-1/2 weeks. Thankful.

I have been in so much pain this week (compared to 1st 3 weeks) on my left side (underarm, next to boob), and this morning I think I figured out why. In the first scans there were no stickers on my underarm, but the last weeks scan I got new stickers which included one there. This morning it fell off in the shower and I looked at it and I have a nasty painful rash (not like the redness/peeling from the radiation). I have fair sensitive skin, so I’m used to getting skin contact rashes from some things, which I have occasionally gotten from bandage glue. I’ve never had anything like that on my underarm though, and all of these other stickers on my boobs and stomach hadn’t caused me any issues, so I hadn’t even thought of this possibility. Now I am putting hydrocortisone on it every few hours, which does help but wears off. Good grief. Only one more, only one more....

Pleasantsa,

I have the same position for my radiation and yes, hold my breath. I dont find it difficult, its only 30 seconds or so, twice. They let me play my iphone music and they also have a big stereo with all kinds of CDs. If you aren't wearing ear buds I dont see what the problem is listening to lusic I can still clearly hear their instructionsand its so much more therapeutic for me!