Scheduling Treatment During the Summer

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Facing breast cancer treatment is hard in any season, but in the summer it can be more complicated: What about that family vacation you planned months ago, even before you were diagnosed? Or, if you didn't have plans before, should you take some time away now, to build up your energy reserves for treatments to come?

If you've just been diagnosed with breast cancer or will be receiving treatment over the summer, talk to your doctor before you make any changes to your vacation plans. In many cases, you can adjust your treatment schedule so you have the freedom to enjoy summer fun.

Scheduling your vacation: Before, after, or during treatment

You may be able to postpone the start of your treatment until you've returned from vacation. Or you might decide to take a relaxing trip after your treatment is complete.

If you're planning a post-treatment getaway, don't book it too close to the end of your treatment. Occasionally, treatment may end later than originally expected. For example, a dose of chemotherapy might be delayed by low blood counts, or radiation may be delayed because of problems with the radiation machine.

If you do go away before, after, or in the midst of treatment, be prepared. Make sure you take important phone numbers with you. Ask your doctor for the name of a doctor in the area where you're going in case of emergency. Also, make sure you take enough of the medications you need: hormonal therapies, something for nausea, discomfort, skin irritation, etc.

If you're receiving treatment as part of a clinical trial, the treatment schedule can be somewhat rigid. Ask your doctor how much wiggle room is in the schedule, and work around it.

Scheduling local treatment: Surgery and radiation

Surgery: It's often possible to delay surgery for several weeks if the cancer is not very aggressive, says Susan M. Domchek, M.D., medical oncologist at the Abramson Cancer Center, University of Pennsylvania Health System. Even if you'd rather not postpone surgery, you may be able to get away soon afterwards if you've had a shorter-recovery procedure, such as a lumpectomy with sentinel lymph node dissection.

"How soon you can go on vacation depends on whether or not you are having a full lymph node dissection or reconstruction," Dr. Domchek says. She explains that it's difficult, but not impossible, to travel and stay elsewhere while surgical drains are in place. Autologous reconstruction methods — those that use your own tissues from another part of your body — have a longer recovery time, so it's less practical to book a vacation right after that.

Keep in mind that time away immediately after a big surgery will be a time of recovery. It's not going to be a carefree time to be outside, active, and independent. If you're planning to go away, stick to a familiar place where you know you'll be comfortable and near medical help if you need it.

It will likely take about a week after surgery for the pathology report to be ready. Some people may welcome a vacation as a distraction from waiting for the report, and some may find it hard to relax while they wait. Keep this in mind and do what feels right for you.

To best understand your options for when to have surgery, talk with your surgeon about your own individual situation.

Radiation: To get the most benefit from radiation therapy, once you start your treatment, it's essential to keep to a continuous schedule and complete a full course. This typically means receiving treatment once a day, 5 days a week, for 5 to 7 weeks. Rather than interrupting your treatment, it's better to postpone the start of your treatment to allow for your vacation plans.

If you've already started treatment, the radiation therapy schedule can limit your opportunities for a relaxing getaway. But try asking the staff at your treatment center for an early Friday session followed by one late on Monday, to provide you with time for a long weekend break.

Another way to free you up on a Friday — if your radiation oncologist is willing — is to get two treatments in one day (Monday, Tuesday, Wednesday, or Thursday) that same week, separated by 4 to 6 hours. Then you will have Friday free and can take a long weekend.

If the final day of your radiation therapy falls on a Monday, and you'd rather be done the Friday before, ask your doctor if you can finish your treatment with two radiation doses on that Friday.

Scheduling systemic treatment: Chemotherapy, hormonal therapy, and targeted therapy

Treatments you get after surgery to lower your risk of the breast cancer coming back should start as soon as possible after surgery. Still, ask your doctor whether you can adjust your start date to suit your vacation plans. Find out how frequently you will receive chemotherapy, hormonal therapy, or targeted therapy and set the date to start when you get back from vacation. A week or two delay is usually acceptable.

According to Dr. Domchek, timing is more flexible with treatment for metastatic disease. "Pick your vacation dates, let your oncologist know, and usually you can work around this," she says.

If you have disease that is progressing and causing symptoms, then it's probably best to move ahead with treatment and plan time away later on.

Having chemotherapy or targeted therapy in another location is an option worth exploring only when you'll be gone for an extended time. This requires careful planning and collaboration between your doctors in both places.

Chemotherapy tips: If you're currently undergoing chemotherapy, pay attention to the pattern of how it affects you between treatment cycles. For example, if you get chemotherapy every 3 weeks, you may feel well enough during the third week after treatment to take a vacation.

Some chemotherapy drugs are given as a pill (orally). If you are taking oral chemotherapy and you're tolerating it well, you might be able to continue the medication while on vacation.

Targeted therapy tips: Different targeted therapies are given in different ways, so how they impact your plans will depend on what drug you are taking. Herceptin (chemical name: trastuzumab) is given intravenously (through a needle in a vein), while Tykerb (chemical name: lapatinib), a newer therapy, is taken in pill form. Another targeted therapy, Avastin (chemical name: bevacizumab), is given intravenously.

Either way, it's possible to adjust the schedule. "Herceptin can be given every week or every 3 weeks," Dr. Domchek says, "and it is certainly possible to skip a week or two, depending on how you are doing."

Side effects of Herceptin are usually mild, so you'll probably feel well enough to leave for vacation within a few days of your treatment. Once you know how you'll react, you can come up with a vacation plan that works best for you.

If you aren't able to adjust your treatment to accomodate a vacation

You may not be able — or feel well enough — to take that long summer vacation right now. It's important to let your loved ones know how you're feeling. Tell them you'd prefer a shorter vacation and some relaxing rest time at home. Make sure vacation expectations are realistic. Delegate food shopping and preparations, housework, and laundry to someone else. Build in time for lots of sleep, delicious dinners, and fun conversations.

Let your family know that you're looking forward to taking a vacation next summer, or in a different season. Vacation spots can be less crowded in the fall or winter. And you can take a winter vacation in a part of the world that's having summer!

What about the tickets you paid for months ago or the rental house lease you signed? Is that money lost? Did you get travel insurance just in case?

Many doctors are happy to write letters explaining your limitations on your behalf to help you get a refund. Dr. Domchek cautions that your chances of getting refunds may depend on the travel agency, airline, or realty firm handling the arrangements. "Most people have pretty good luck," she says, adding that social workers in cancer centers often help with this problem as well.

Plan a summer that's right for YOU

The most important thing to remember is that you need to do what feels right for you this summer. If you feel that you just need to get away from it all for a while, see if you can start chemotherapy or radiation a week or two later than planned. If you focus on YOUR needs and let your loved ones and doctors know your desires and limits, they will be able to help you make this a relaxing and enjoyable summer season.

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