After surgery and immediate therapy for breast cancer, patients still have a lot of emotional and physical healing to do.  The effects of breast cancer and treatment will continue after the initial treatment ends. 

What defines a survivor?  And what kind of future can a breast cancer survivor expect?  Well, the answer to both questions is...it depends.  Many factors contribute to how a woman feels, both emotionally and physically.

It's not uncommon for a woman to feel an emotional letdown once treatment is over.  The crisis is over, but a lingering sense of anxiety remains.  New stressors can enter the picture, too. Friends and family might have unrealistic expectations about how fast everyone concerned can return to their former lives.  Plus, after facing one of life's greatest challenges some woman find their "before" life goals no longer fit.  

Successfully negotiating the process takes courage, humor and a large measure of patience, starting with some realistic expectations. 

It's not possible to "flip a switch" and immediately go back to a former life at full throttle.  The body is in repair mode and women have to pace themselves.  In fact, it may take a year or more to regain a sufficient level of energy and sense of well being. 

While there's a huge relief in being done with treatment, it can also be frightening.  Women worry that cancer cells may remain and, without ongoing treatment, will be free to flourish and grow.  They may experience "separation anxiety" from their oncologist.  Every headache, cough or pain can take on ominous significance.  The truth is a regular schedule of follow-up visits with your primary care physician is fine, and perhaps even better for you.  According to a study published in the Journal of Clinical Oncology, there's no difference in long term outcomes between ongoing surveillance by an oncologist and a primary care physician.  And, a primary care physician's role is to take care of the whole person. 

In the first year of recovery, women need an extra level of comfort and reassurance in other areas as well. 

They must cope with the longer-term physical effects of treatment.  For instance, even after tissue sparing surgery or reconstruction, breasts usually look different than they did before.  They feel different after radiation.  Some women experience lymphedema and chronic pain in areas that have been radiated.  Mental changes, or "chemobrain," can result in problems with memory and the ability to focus.  And ongoing treatments to prevent the recurrence of breast cancer, like tamoxifen, can have their own set of effects.

Returning to sex and intimacy can be intimidating.  Some women have enormous concerns related to body image and self-esteem.   Some may have been thrown into early menopause and experience all the associated sexual issues such as vaginal dryness, reduced libido and much less or absent response in places in the body that used to be hypersensitive.  They have to relearn what works for them.

Life after breast cancer is, indeed, a different part of life and getting used to whatever it will be takes a while.  The journey's easier when women:

• Are honest and open with their loved ones about what they feel
• Lean on others for the help they need
• Learn to care for themselves the way they care for others