Healing Your Invisible Scars With Mental Health Support

Dr. Marisa Weiss: Hello everyone. I'm Dr. Marisa Weiss. Thank you all for joining us to talk about mental health and breast cancer. Society has come a long way in bringing awareness to mental health issues, but this topic can still be difficult for some people to talk about, which is exactly why we're all here today. Whether you're feeling anxious, depressed, resentful, scared, defeated, depleted, frustrated, disappointed, lonely, or any other emotion, let's continue to move past the stigma and normalize this part of having cancer.

I'm the chief medical officer of Breastcancer.org and an oncologist, but I'm also a breast cancer survivor myself, and I know what it feels like to walk through the world while bearing those invisible scars of breast cancer. The emotional struggles can really sneak into everyday life and it's exhausting at times, but there is hope. Today we're going to talk about different options for getting help and feeling better. There is no perfect solution for everyone. Some things will work, others won't. And it can take time to see the benefits, but it's worth trying to figure out and try new ideas. Your quality of life is worth it.

First, I want to thank our generous sponsor, Pfizer, for making our work on mental health possible, including today's event. 

We're fortunate to have a group of fantastic speakers whom you'll hear from shortly. Dr. Ting Bao is the co-director of the Zakim Center for Integrative Therapies and Healthy Living at Dana-Farber Cancer Institute. She's a board certified medical oncologist and medical acupuncturist and integrative medicine physician. She has led a number of clinical trials research, studying acupuncture and yoga to improve cancer patients' quality of life and to address treatment and disease related symptoms.

For more than 25 years, Susan Glaser has been a senior clinical social worker at Memorial Sloan Kettering Cancer Center with special training in psychoanalytic psychotherapy, sex therapy, and mindfulness practice. She works specifically with breast cancer patients and families to support them at every stage of treatment.

Bethany Adair is a mindful coach, metastatic breast cancer thriver, and author of My Guru Cancer. She'll be sharing the mindset tool she practices and teaches for finding peace, joy, and gratitude in the midst of life's biggest challenges.

Rhonda Schaller is an author, professor, and assistant VP, vice president, in the division of student affairs at Pratt Institute. She co-leads the Mindfulness Collaboratory at Pratt. In addition to being an expert in mindfulness, Rhonda shares her wisdom and compassion as an active member of the Breastcancer.org community. We're thrilled for Rhonda to have her lead us in a meditation later in the program. 

And thank you all for being here.

One aspect of dealing with mental health issues that lead to even more stress is that our family and friends simply may not understand or we don't want to burden them with our emotions. This can happen at every phase of someone's experience with cancer. What people see on the outside can be drastically different from how we are all feeling on the inside. 

How many of you see yourself in one of these photos? 

And now? Whether it's because we're trying to put on a happy face to protect our loved ones or because they can't relate or can't understand or we're saving our energy for something else, we often hide our struggles beneath the surface.

This picture is from Instagram. It's created by an account called The Cancer Patient, which uses pop culture and humor to talk about the realities of cancer. Most of us can relate to this scenario where you as the person with cancer end up consoling your friends and families about managing their emotions. I mean, you all know that relationship dynamics are an important piece of the mental health puzzle, and we'll be talking about that more in a bit.

Before we introduce our speakers, I wanted to share what you answered before we asked, what has been the most beneficial for your own mental health? More than 900 of you gave your responses, and here are the results. Keep in mind these people were able to pick more than one answer. What they said was individual therapy or counseling got the most votes followed by group support, then meditation and exercise. It was interesting to see that antidepressants or antianxiety medications came in just a little higher than cannabis. We'll hear more today about the research behind yoga and acupuncture. Hopefully some of you will find one or more new things to try after this webinar and to find calm and feel better.

Now I'm thrilled to introduce Dr. Ting Bao and Susan Glaser. And I'd like to thank all of you again for who submitted questions for this discussion. 

Susan, I want to start with a question we received asking what feelings are expected and normal after a breast cancer diagnosis and what could indicate that someone needs urgent help for their mental health?

Susan Glaser: Well, there's no right or wrong way to feel after getting a diagnosis. That's first and foremost. Often people describe it like a rollercoaster. So there may be moments of okay-ness and then there could be any of the feelings you described or other ones. So emotions can change moment by moment, hour by hour. Someone can look at you cross-eyed and you have a bad rest of the day, you're in tears. I've heard people say they're on the subway doing nothing, looking down, and all of a sudden they start to cry.

So it's very common to feel overwhelmed. That's one thing people feel often with a diagnosis. The information comes at you from all ends, appointments, making decisions. Usually that feeling lessens when you have a treatment plan and you have a focus, I've got to get through treatment, I've got to get on to the next cycle of treatment. Looking after your mental health is tantamount. It's very important. Stress and anxiety comes and goes. For some people it doesn't go, but it's also very common if you talk to people in the waiting room or in a support group or look at some of the chats, everyone is feeling it. So do not be afraid to admit that you're feeling stressed and anxious.

Dr. Marisa Weiss: Yeah, I mean when you think about all the attention you pay to your physical health-

Susan Glaser: That's right.

Dr. Marisa Weiss: ... all the interventions, the surgery and the radiation and the medicines, and-

Susan Glaser: They're so busy with all of that.

Dr. Marisa Weiss: Yeah, and yet, we don't have a chance to really address our mental health.

Susan Glaser: That's right.

Dr. Marisa Weiss: And it can be so overwhelming to know where to start with getting help.

Susan Glaser: That's right.

Dr. Marisa Weiss: Yeah. I was going to ask Dr. Bao, can you give us an overview of different types of mind-body therapies and how they are used in combination with conventional forms of treatment?

Dr. Ting Bao: Sure, happy to. So thank you for having me here. So basically mind-body therapies are a diverse range of practice that recognize the link between physical and psychological health. And all the study has shown it has really offered significant benefits for patients and all of us. So basically, it typically falls into two categories. One is the practitioner-led practice such as meditation, yoga or tai chi, and later on you can do them on your own. And also the other category is provider-administered therapy such as acupuncture and massage. So highly effective and with minimum side effects. So basically it can be readily integrated into conventional anti-cancer treatment, mainly to help reduce symptoms and also improve overall wellbeing.

Dr. Marisa Weiss: Wow. And of course all of these things are called practices.

Dr. Ting Bao: Yes.

Dr. Marisa Weiss: And one of the things that we all learn, the experts I'm sure will, in their everyday practice, say that what you practice gets stronger. And none of us are perfect and we're all trying to learn how to get through life with better quality of life and hopefully longer life and all that. So all these new things you're introducing us to are things that we'll be practicing. Dr. Bao, what does research tell us about practices like yoga, meditation, and acupuncture? And how exactly are they helpful and how much time does someone need to spend in order to get the benefits?

Dr. Ting Bao: Sure. Great question. So one by one. Yoga, basically, you can preferably start with a yoga instructor, then later on do it on your own. And then there has been lots of research on yoga for cancer patients, and the benefit really shows in a number of areas. One is sleep. There is a large randomized control trial, more than 400 patients randomized to yoga group versus usual care, and their sleep quality, duration, all those are so much better in yoga group. So yoga can be used to help sleep, help with pain. For breast cancer, aromatase inhibitor-induced joint muscle pain, there's some studies that show yoga can help with that. Anxiety, depression. So yoga has been shown to reduce anxiety and depression and some studies even show it reduces hot flashes.

And in terms of how often, so most studies were done basically, usually it's like two to three times per week, instructor-led and then daily on your own if possible. But don't let that deter you. So basically a little bit is better than nothing. Two times per week is fine. And then ultimately, most study is like eight to 12 weeks a session and then you should be able to see the difference. In fact, most people can tell the difference. In terms of meditation-

Dr. Marisa Weiss: Yeah, that's also important.

Dr. Ting Bao: Yeah. Go ahead.

Dr. Marisa Weiss: Yeah, I was going to say that when you do yoga and do these physical things, you want to ask the yoga instructor when you're working with them to be mindful of the surgeries you've had or aches and pains you might have so that you don't stress out those parts. You don't want to get injured. You want to get stronger and not get injured. So you want them to develop some kind of personalized approach to these new techniques. That's very useful.

Dr. Ting Bao: Exactly. So at the beginning it may be good to have an instructor or start with a group, but then gradually, usually you do that and then do self-practice yoga.

And meditation is amazing. Basically it's a practice focus on the awareness of the present moment. Forget about the past, forget about the future, just focus on the present. Lots of research has been done in this area and I would say most research has been done in something called mindfulness-based intervention. So it's basically usually once per week for six to nine weeks intervention class. It's about a 60 to 90 minutes class and it's a group of up to 20 people with the instructor.

And the instructor would teach the attendees, participants, meditation, yoga, mindfulness, bringing mindfulness into daily activity, et cetera, coping skills. And then after the session, anxiety, depression significantly decreased to the point Society for Integrative Oncology and American Society of Clinical Oncology put together a guideline recommending oncology professionals recommend patients with anxiety, depression to do mindfulness-based intervention.

And then also some studies show mindfulness-based intervention helps with sleep, decrease hot flashes, and reduce pain. And then it's not the same as the daily meditation. So sometimes people don't really have the time to do MBSR, like a mindfulness-based intervention. So they can start with daily meditation. And in that case it's usually a different study, you look at it, I would say at least seven minutes per day, preferably daily. And then you should be able to tell the difference, it can help sleep.

And lastly, I'm an acupuncturist, so there's lots of study done on acupuncture. I would say the benefit is mainly primarily shown in pain. In my acupuncture clinic, it's like half of the patients came to me for pain, especially aromatase inhibitor-induced joint muscle pain. A large trial basically shows it reduces the pain. And also chemo-induced nausea, vomiting, there's plenty of data that shows that benefit. Hot flashes, also anxiety, depression, and fatigue.

In terms of the frequency, I would say usually it's like starting at least once per week for four to six weeks and then you can space it out. I do acupuncture research. I know that not everyone responds to acupuncture. So if you try four to six weeks, it doesn't work, maybe this is not for you. And then there's plenty of other integrated oncology practice you can do.

Dr. Marisa Weiss: Yeah, and maybe it's not right for you at the particular time with the symptoms that you have or the mindset. And it's amazing to me, your mind is your most powerful organ. And the same mind that produces all these really uncomfortable feelings ... And by the way, I listed all those uncomfortable, difficult feelings, but you can also have it mixed in there, gratitude, love, hope, but they can be poisoned by or sort of polluted by these other negative feelings. But if you take the same mind and train it and harness it to apply it to things like meditation, like Dr. Bao is saying and Susan will be sharing in a minute with us and our other speakers, then that's where the hope is, is that there's a lot we can learn. There's a lot of power that you have in your mind that you can train and redirect in other ways that are going to help you.

Susan, for people who are interested in working with a therapist, is it important to find a therapist who has experience specifically with people with breast cancer? And how do you know if someone is the right or wrong fit for you?

Susan Glaser: Great questions. I get asked that all the time. Finding the right therapist is a process and it takes a dedicated effort, especially if you have never been in therapy before. So things to consider is are they licensed? I personally don't think someone needs to have been a breast cancer or a cancer survivor to do the therapy for you, but I think there needs to be a connection to the person and an understanding. I've heard people say, "I talked to my therapist and when I told them I had breast cancer, they said, 'Oh, you poor thing.'" That's probably not the type of therapist you want who's going to be emotional along with you.

So you want to know about do they take your health insurance if that's an issue. Does my insurance cover the therapy? Are there limits to how many sessions I can take? Find out what their experience is, what training they have. Are they experienced in dealing with breast cancer and cancer in general or in serious illness? That might be fine. Find out about their fees. If you can't afford it, it's not going to work out. Are there charges for mixed sessions? Because sometimes being on treatment makes you unable to make appointments at the last minute. Where are they located? Do you have to travel far? Do they offer virtual sessions because that can be helpful if you're in treatment? What kind of therapy they're likely to provide for you, you can ask that without having to pay for it. You should ask them what can they do for you?

And remember that choosing a therapist is very personal. Cousin Charlotte loves her therapist, doesn't mean that you have to go to the same therapist. Or you do go, but doesn't mean you have to like that person or want to work with them. So there's no one good therapist that fits all.

Dr. Marisa Weiss: Right. For sure. And of course, you want them to be available when you're available. If you're a working person, having a job and kids and the laundry and everything else, find someone who can meet up with you for a session when you're available.

Susan Glaser: That's right. That's right. And there are people like that. You just may have to look for them.

Dr. Marisa Weiss: Right. And as a follow-up, what do you think about the therapy apps, like the apps on your phone? What do you think about them?

Susan Glaser: I think that's also a great question, very hot topic. You have to be really careful about the apps because a lot of the creators, excuse me, do not have clinical training. They have technical training. So before you download an app that you feel connected to, make sure it's vetted by an appropriate source. I know the American Psychiatric Association has an app advisor and I would suggest going on some big website to find out what they say about that app.

Think about the information you give these apps. You want to be really careful about sharing personal information without knowing much about the app. There are good apps for relaxation and meditation, very good apps and those you can just Google good apps and you'll find a list of them. There are great search apps for therapists and for therapist directories where you can filter out information about their location, do they take insurance, and so on and so forth. Something like Psychology Today, Alma, Zencare and GoodTherapy are reputable sources to help you find a therapist. But I would be very careful about some of these mobile apps that say, "We can cure anxiety." If it sounds too good to be true, it usually is too good to be true.

Dr. Marisa Weiss: Right. And when you're feeling down and out, you're vulnerable.

Susan Glaser: That's right.

Dr. Marisa Weiss: And when you need something and something shows up and says it's going to help you, you're seduced by it, you're persuaded by it and you got to be careful because, as you mentioned, your privacy is really important. And one reason why these scars are invisible is because we do conceal them. We are very selective in whom we share our anguish with.

One of the things that really can be an every day, every night reality, Susan, I was going to say, as you know, this is your work every day, is the fear of recurrence or the fear of progression for people who are living with metastatic disease. This fear can be paralyzing, it can intrude and pollute. Do you have any tips for living in the present and feeling positive about the future when this fear or anxiety takes hold? Let's say it's Breast Cancer Awareness Month and every single channel, every single everywhere, you're hearing stories about the worst case scenarios or your biggest fear is everywhere.

Susan Glaser: That's right. We call this actually every mole a melanoma.

Dr. Marisa Weiss: What was that?

Susan Glaser: We call it every mole a melanoma.

Dr. Marisa Weiss: Oh, every mole a melanoma.

Susan Glaser: When you're diagnosed with cancer, all of a sudden your headache feels, oh my gosh, it could be a brain tumor. This is so common. It is a universal concern and it is very important for you to find a forum for you to feel normalized and to be able to talk about this.

The other thing that would be really helpful is to find yourself a healthcare team that can take your calls and your portal messages and help allay your fears and then connect you to a support that's right for you. That's how you get into the here and now. The thing I always say is, your head and your feet need to be in the same place. Very often my feet are on the floor, I'm at work, but I'm thinking about home or I'm thinking about six months from now. Really what you want to do is try to alert the friends and loved ones around you, when they see you get foggy in your head, they need to say, "Come back to the present time. Let's think about today. Let's think about dinner." Let's not think about six months from now. That's a practice. That's a practice.

Dr. Marisa Weiss: Yes it is. And I don't know what it is about human nature, but once anyone finds out that you've been diagnosed with breast cancer, people you hardly know have to share a terrible story with you.

Susan Glaser: A terrible story.

Dr. Marisa Weiss: And I tell my patients, I say, whenever you see the story about to come down like a freight train at you just put your hand up like this and say, "Thank you so much for caring, but I cannot hear another story right now."

Susan Glaser: That's right.

Dr. Marisa Weiss: Because it's just usually a huge burden and it triggers your fear of recurrence and it's really about their own need to unload their discomfort on you, back to the meme that we saw on a slide deck. But generally speaking, that's just good to know that just be prepared that people are going to come at you with all kinds of-

Susan Glaser: And feel entitled to say, "Stop. If this doesn't have a happy ending, I can't hear it."

Dr. Marisa Weiss: Right. I mean, I remember when I was diagnosed, I got chased down by a surgeon I work with who needed to leave messages everywhere telling me about some horrible scenario, someone who had a diagnosis like mine. And then it was, came back and was everywhere and she's got young kids and she's about to die. She literally left those messages for me. And I still to this day don't really understand why all this happens. I know it's their discomfort that they're trying to deal with. But in any case, it's a minefield as you all know.

Now when you get diagnosed, you're wondering what the hell happened? How did this happen to me? And what did I do right or what did I do wrong and what can I change to reduce my risk of having another problem? I was going to ask Dr. Bao, what about the fear of cancer causing chemicals causing us distress after a diagnosis? And what about the patients that you see who are, let's say, extremely worried about every product they use, ingredients in all food, personal care products, clothing? They just want to do everything all at once to reduce their exposure. What goes in, on, and around them that could be unhealthy? How do you help people manage that sort of need and urge?

Dr. Ting Bao: Great question. So I will approach this with empathy and also provide a balanced perspective. So I would usually start with “I understand.” I acknowledge your worries are understandable, but then I'll move on to provide some context on this risk. So basically explain the relationship between exposure and risk is very complicated and depends on many factors. Dosage matters. Lots of things they say cause cancer, the dosage is just much higher than what you're exposed to. So in a way not necessarily need to be too worried about that. And duration matters and individual sensitivity matters. And also look at the scientific evidence. Those commonly feared chemicals that cause cancer, some data are not really strong. So don't think the moment you'll be exposed to a certain thing you will get cancer.

And then on the other hand I always discuss with my patient is in life there's so many things you cannot control and maybe focus on things you have more control over. For example, sleep well, that's really important. And then exercise more, all this, and eat well and reduce stress. All of this will do so much more benefit compared to those little potential risk of exposure.

And lastly, I would really try to explore is this really your deep fear or is it manifesting of your underlying anxiety? I remember I was doing a consultation and a patient came in with three pages of supplements she was going to take. And I was doing herb-drug interaction and finally I put my pen down. I was like, "Is this really you want to take it or it's your anxiety that wants to take it?" And she finally was like, "Okay, fine. It's my anxiety." And then she was like, "I'm so glad." I basically said, "Let's just forget about this. Let's just focus on you." So that approach, yeah.

Dr. Marisa Weiss: And as you say, you want to address the things that matter most. So for example, if you're someone who's having a lot of anxiety and your best friends are your cigarettes, it's the place you go to for comfort.

Dr. Ting Bao: Exactly.

Dr. Marisa Weiss: You do one-on-one time with this habit, this dependence you have on cigarettes, it's hard to give that up when it's your best friend. But that would be a most important thing to work on, not on your own, but with help because there are a lot of smoking cessation programs. Rather than do that than throwing out every plastic thing you have in your house. And when people ask you what they can do, you can give them things to do that would make a difference.

For example, when I went through breast cancer, I remember going through the drawers and going through and throwing everything out. My husband's like, "Whoa, whoa, whoa, whoa. I just bought that saran wrap. What are you doing?" And I'm like, "No, it's going, it's going, it's going." And then I know I replaced everything with jars and glasses and it was like no big deal. But you do have to get real with the things that people take for anxiety, like people who are smoking, it's your source of comfort, or alcohol or other drugs. Try to find healthier ways to manage, which has been a subject of this conversation all along. And I'm so grateful for all of our experts today.

And I was going to ask Susan just to talk about the relationships and how our relationships can be tested by a diagnosis. And one of our community members brought up ghosting and asked, "How do I deal with my disappointment due to a lack of support and empathy from my loved ones?"

Susan Glaser: I don't think I've talked to a single person who doesn't have a story about how someone disappointed them on some level from ghosting to just some minor sort of infraction. But I think it's really common and very important to be direct and honest and communicate to the people you love. Sometimes it's a way to weed out the good friends from the not good friends, but you'll see that certain really good friends just don't do illness well, or loved ones don't do illness well. Cousin Charlotte hasn't been to chemotherapy with you.

Be direct. You think she should know, she went through her own cancer or she's a psychologist, people need to know what you need. Everyone's needs are not the same. So that meant a lot to you that she missed your chemotherapy appointment? Then tell her. And it's okay, your needs change day by day. So one day you want her present, the next day you want to go to chemo alone because sometimes it's just easier to be alone. And talk to people, find people who get it. If that's a good friend, great, if it's your team, if it's the therapist that you're going to find.

And again, really try to accept offers of help when people want to help and set boundaries. You get to decide what works best for you. If you like to go to sleep at nine o'clock at night and your friend thinks, oh, it'll be fun, we'll have a girls' night watching old movies all night long, it's okay to say, "I really appreciate this time together, but I try to go to bed at nine o'clock. I need that eight hours, nine hours of sleep." So it's okay to set limits. So it's again, a practice.

Dr. Marisa Weiss: And a part of that practice is even figuring out what you need-

Susan Glaser: Exactly.

Dr. Marisa Weiss: ... what you want.

Susan Glaser: So hard.

Dr. Marisa Weiss: Right, and what you want to hold onto yourself and what you want let go for somebody else. I mean, for example, grocery shopping, I need a few things from the grocery store. Someone asks you, "What can I pick up for you?" That's a great thing to get help for. Pay them back from Venmo. You don't want someone to come in and read your kid a bedtime story if that's the source of pleasure and meaning that you get each day. But you do need to do work and figure out, okay, what do I need? What do I not need? What can go?

I always suggest to people, let the housekeeping go. Just take the vacuum cleaners out of your closet and put them outside and put the cleaning products on the back of the toilet. Everyone thinks that everything's clean just by seeing those things present. Don't even worry about doing the housework. Save your energy.

Susan Glaser: Great trick.

Dr. Marisa Weiss: It's a trick. It works. I've used it. But yeah, no, and knowing that your needs are going to change over time. I had a really close friend who disappeared when I was diagnosed. Her family all reached out to me, emailed, "I'm thinking about you. You okay? You got this." All this positive talk, right? And she did nothing. And then years later she crawled back and said, "Can I please, please be friends with you again? And is there anything you want to tell me?" And I'm like, "Yeah, well, guess what? I mean, if we're going to be friends, I do need to tell you that I was disappointed and hurt by you not coming forward."

And of course you know that you never know what's going on in someone's life. I have no idea what was going on in her life at the time, but let me tell you, I did let her crawl back in and we're friends again and I get pleasure from that. So there's a time and a season for all these different things and there's grief. When I lost her, I grieved that loss. 

And Susan, I was going to ask you about grief. Can you talk about anticipatory grief and other types of grief that a patient might feel at any time, including when treatment's over or when friends and family don't understand this kind of grief? And what advice do you have to explain it to people?

Susan Glaser: So anticipatory grief is a natural response to a loss that you anticipate, that you are imagining. You get the diagnosis, you imagine what life is like without breasts, on chemotherapy. What will it be like not to have hair? How long won't I be able to work for? Cancer is just a series of losses. We sadly call it the gift that keeps on giving loss, or taking for that matter.

Dr. Marisa Weiss: Stealing.

Susan Glaser: What? Yeah.

Dr. Marisa Weiss: Stealing. Stealing. Stealing your joy.

Susan Glaser: That's right, stealing. That's right. Well said. So recognize that your feelings are normal and try to talk about them. Give yourself grace to feel what you're feeling. Loss begins from like hello and continues even after treatment's over. How many people are finished with treatment, although they're on anti-estrogen therapy perhaps, or really finished, and people say, "You look great, your hair is back, it's over. Let's celebrate." And you don't feel like it. You're still mourning the breast loss, the crickety bones that you feel. You're still experiencing losses and people want to celebrate and you don't feel like celebrating. That's loss, that's usual, I hear that daily.

People with metastatic disease are experiencing just this ongoing waves of losses and good news, then bad news, treatment's working, treatment's not working, I feel crappy, now I feel okay. It's a series and it comes in waves. Seek support again through your team, through loved ones that get it. If not, then find people that get it.

Dr. Marisa Weiss: And you get so beat down and worn down thin and most people don't have a break. You just go from one treatment to the next, to the next, to the next. So taking a break from it, stepping outside of that, the relentless demands of treatment and just to get a break, get out of Dodge kind of thing. Go into nature now, shift it up. It makes a big difference I think.

Dr. Bao, I'm going to switch over to brain fog. Do you have any recommendations for managing this brain fog, like difficulty focusing and concentrating, and which all that can contribute to depression, feeling helpless?

Dr. Ting Bao: Definitely. It can be contributing to depression, also can be a symptom of depression. And also I think brain fog now, before we were looking at different symptoms separately, but now more and more so, we're looking at it as a symptom cluster. So rarely it's just one person only experiencing one symptom, like brain fog, sometimes people also have insomnia. So it seems to be closely related to sleep. And also sometimes people may have fatigue, pain, anxiety, depression.

So maybe change lifestyle to target all this area if possible, starting with sleep. So try to get seven to nine hours of quality sleep if possible. And yeah, that's important. And also exercise is really important. Try to exercise half an hour per day for six days per week. Make a big difference. That helps both with sleep and fatigue and also the mental acuity mainly because when you're exercising, aerobic exercise, you increase oxygen in your body and you can think better.

Nutrition support, so we usually recommend a Mediterranean diet, which is rich for omega-3, which potentially helps with the brain function. And then acupuncture, so at MSK when I was back there, Memorial Sloan Kettering Cancer Center, we did this sleep study and then basically we found people who sleep better, their cognitive function is better. Using that we applied for a grant, it's for the enhanced trial. It's acupuncture versus sham, fake acupuncture versus no acupuncture to help with brain fog. So the study results should be out pretty soon. Yeah, so try all this and-

Dr. Marisa Weiss: I was going to say sleep is queen and it's really important to look online at Breastcancer.org about sleep hygiene. It's a strange term, but you kind of think of yourself as a newborn baby and put yourself to bed at the same time, wake up at the same time, try to eat at the same time, exercise at the same time. You're trying to bring back the rhythms and rituals and routines that you have in your life so that you can move forward and feel like, okay, okay, we're moving forward. We're getting there. We're going to get back to a better place.

I was going to ask a question for both of you, Susan first or whoever first, what are the pros and cons of taking antidepressants for someone who has a history of breast cancer?

Susan Glaser: Well, I can't speak to the medical part, but the people I know that are taking antidepressants and a lot of patients are, they find it very, very helpful. Often there's resistance at first because I'm taking a lot of medication, I don't want to take medication. But when you think about it, you might be feeling anxiety, tremendous anxiety, physical anxiety. It's affecting your sleep, it's affecting your appetite. Maybe you're depressed, it's affecting your appetite, it's affecting your sleep. Think about what that's doing to your health.

Dr. Marisa Weiss: Absolutely. And it may be for right now, not forever. Dr. Bao, how do you counsel someone on this, the role of antidepressants?

Dr. Ting Bao: I think if you need it, you need it. It helps with mental health and potentially improve quality of life and reduce pain. Some antidepressants reduce hot flashes too and can help people sleep better. So I wouldn't resist that, but I would follow up with an expert and then get on the right dosage and all this. There are potentially some considerations as well. One is drug-drug interaction because for patients say on tamoxifen, if they're on certain antidepressants, they may reduce the effectiveness of tamoxifen. So just, you need to make sure you know that.

Dr. Marisa Weiss: Absolutely. Absolutely. And I know we're limited time left, but I was going to ask Dr. Bao, I know how important it is to the integrated medicine approach that you have, people love that, want that, need that. What's the most important aspect of integrated medicine that you think people need to know and how do they get access to it in other free or low-cost ways to try it?

Dr. Ting Bao: So I think for me the most important thing to get out is make it complementary and not alternative. So don't just stay with the conventional, with the standard anti-cancer treatment, and use all these integrated medicine approaches on the side to help support you. It works together, better. And then also evidence matters. There's so many different approaches that have good evidence, which is mentioned. So try to use those approaches.

In terms of the free low-cost resources, there's plenty of them, YouTube, you can just Google yoga, tai chi and other things and different apps, Insight Timer, Calm and other things. So there are plenty of resources and MSK has this About Herbs website. It's totally free and they give you all this information about dietary supplements. I think I use it often, recommend it all the time.

Dr. Marisa Weiss: Wow.

Dr. Ting Bao: Yeah.

Dr. Marisa Weiss: That's great. That's great. And Susan, we have one last question. I know we have very little time left, but an important question, which is, for someone who has trouble asking for help, how do you suggest that they get beyond that resistance and just ask, invite help?

Susan Glaser: Great question. Really tough when you are so self-sufficient and you feel that it shows a weakness. Work on that self-talk that asking for help is quite the opposite. If you're not doing this, you're not going to be able to do things if you're not asking for help. So it helps you to acknowledge that you have current limitations, either resources or physical abilities, and ask for help. People are more than happy. Find people that-

Dr. Marisa Weiss: Right. They could be waiting for an opportunity to help you.

Susan Glaser: Exactly.

Dr. Marisa Weiss: They just don't know how. Let them in. Well, I want to thank you both so much for sharing your insights, for all that you do every day to help people dealing with breast cancer. We are so, so grateful. Thank you.

Susan Glaser: Thank you.

Dr. Ting Bao: Thank you.

Susan Glaser: Thanks.

Dr. Marisa Weiss: Now it's my pleasure to welcome Bethany Adair. Bethany, as a mindset coach, you teach a mindfulness practice that also helps you as someone living with cancer yourself. Can you walk us through it and explain how someone would apply this technique if they're feeling anxious about whatever, their diagnosis, their scans, medical appointments, revealing their diagnosis, work-related stuff? Tell us how your work as a mindset coach addresses this.

Bethany Adair: Absolutely, and thank you so much for the invitation to be here. And gosh, everything shared so far, I'm taking notes. If I were on video, I was doing this the whole time because so many of these tools are actually things that I do integrate in my own healing journey as well. And I will say they work. Yeah, so a little bit of my background is I was diagnosed with stage two breast cancer in 2015, and then stage four in 2021. I am a mindset coach and also the author of this sweet book baby, My Guru Cancer. And ironically, I got certified in this practice two months before my first diagnosis. I was working in wellness as a yoga therapist and had all these plans on how I thought I'd share this work, but instead that diagnosis turned out to be the biggest invitation to practice what I preach.

And so I call it a mindfulness practice because we get to take a look at what our mind is full of in those moments of anxiety, fear, hopelessness, what are the stories, the thoughts running through our minds in those moments? And it's quite common that the beliefs that are running in our head, or I like to call them BS, belief systems, are actually not what's happening right here, right now in your real life. Very much your mind will jump to the past or the future.

And so this technique is a way to meet those thoughts with compassion, with kindness. And it's a really simple process. It's just four questions and some turnarounds. And so I'll actually share a little taste of the practice around scanxiety because my goodness, it got its own term. That's how popular and common and universal this experience is as any type of fear and anxiety. Not just around scan time, but also around any appointments or you see a message in your MyChart, you're on Instagram and you see a story of what happened with a friend or someone else traveling the cancer journey. So the mind is, there's no shortage of stressful thoughts and situations in this cancer journey.

I actually have my scans coming up. In two days on Thursday, I'll have my next round of scans. And so I'm always taking a look at my mind and emotions and what's happening. So a really common thought that obviously comes up during that time is the doctor will give me bad news. There's some kind of bad scenario coming up. Either cancer will come back or it will progress in some way or there'll be something questionable on the scan and that fear arises.

And so I'll just walk myself through those questions. And just please know, you don't have to write these questions down. There are going to be resources for you to practice this work on your own. But the first question is, is it true? I just ask myself, is it true, as a meditation, the doctor will give me bad news? And I just want to give myself an honest yes or a no. And when I'm freaking out, yeah, the answer is yes. It's like I know it's coming, it's happened before, it could happen again. I had that ache and pain or a headache this week. Oh my gosh, yes, it's true.

And then I move to the second question, well, can I absolutely know for sure that it's true? Can I know a hundred percent without a doubt that the doctor will give me bad news? It's just a yes or a no. And that question gives me pause. I really get to check in and look, God, can I know a hundred percent? Do I have evidence that would hold up in court for that? And I often find a no in this space. But no matter what your answer is, you can still move to the third question.

And the third question is all about honoring all the thoughts and emotions that do arise when we're believing these thoughts. So how do you react? What happens when you're believing the thought that the doctor will give me bad news? Well, immediately in my body it's like my breath goes away. I feel tension in my shoulders. I am panicking, anxious. I see images of the doctor giving me bad news, and then I have this whole future of what that will mean. Now I have a new treatment plan. What if I run out of treatment options? I'll have side effects. I won't be able to live a full life. There's a whole world happening when I believe that thought in my mind. And so I like to sit in that question for a bit just to empty, to get those emotions, get those scary thoughts out of my mind, out of my body.

And once I feel empty, I move to question four, which is who would I be without the thought? So I'm not changing my body, I'm not changing the fact that I'm having scans coming up, but who am I without the thought? And that can bring me back to the present moment. I look around and see my body's breathing. I can move. I feel really healthy and strong in this moment. I'm able to see how scans are really supportive. They let us know what's going on in our bodies, things that I can't see or touch, which can guide us to a better path of healing. So I feel more confident and encouraged I'm making the right choice going into scans. 

I see my doctors as support. I can reach out to people. I take care of myself in that space so I'm not so preoccupied with the what ifs and very much more dropped into what we talked about earlier, the present moment.

And then the last part of that process is called the turnaround. So you take the thought and flip it around to different opposites and see if that could also be true. So the doctor will give me bad news, the doctor will give me good news. I try that on. And I don't want to look at it as just a positive affirmation. I actually want to find examples or proof of how that could be true that the doctor will give me good news. Well, that's happened before. In fact, I've had scans with more good news than bad news. So I like to remember that about the past. The doctor could give me good news. I do have some guidance that my treatment right now seems to be doing really well. My tumor markers are dropping. So I use that as evidence.

Also, they could give me good news even if those scans do show some kind of growth progression. I can also see how that could be good news because I'm not interested in being on a treatment plan that isn't working on the cancer. So I want to hop on something as soon as possible that can meet the cancer where it is and address it. So it's always heartbreaking news to have that information of progression, but it also can lead to a better healing path for you.

And then I look at the turnaround, like I'll give myself bad news. 

And that's the funny part about this is I'm already doing that in my mind. I'm already seeing this worst-case scenario of the future, and that is complete imagination in this moment. So that's a little run-through of the process that supports me most. And it can be used in any challenge in cancer.

Dr. Marisa Weiss: Absolutely. And every time you keep circling around with it, you get haunted with these thoughts. It keeps festering and it's good to shift it, mix it up, and derail that because you'll keep thinking if you don't do that. And it's good to have a plan for getting results from your doctor because the uncertainty is what can often make things worse. So having a plan like I'm getting my tests on a Tuesday, can I get the results from you on Thursday as an example, and what time can I call you or will you be around? Can I email you, go through my portal, whatever it is? Make a plan for that.

Bethany Adair: Yeah.

Dr. Marisa Weiss: As you said, no matter what you find on these exams, the test results, usually there's something that you can do about it. And so it's just a question of what is it that you need to do about it. Now I was going to ask you what would you say to anyone feeling guilt or shame about having cancer or the emotions they're experiencing because of cancer? I mean, there are people from cultures where they're made to feel like getting cancer was their fault. How do you handle that?

Bethany Adair: It's so common of an experience and it's something I've dealt with myself. And I even had a really healthy background. I ate organic. I have no family history of breast cancer. I was doing lots of things to take care of myself and still got cancer, yet I still turned on myself. And so you caught that belief cancer is my fault. There's other beliefs like I could have done something to prevent this, or if only I were more evolved or spiritual, then I wouldn't have gotten cancer. Or if X, Y, Z happened, I wouldn't be in this scenario.

And first of all, I walked myself through that process that we just did. I questioned those thoughts. But there is one question that I ask myself that kind of stops me in my tracks and it's, can I prove it? Can I prove it without a doubt, a hundred percent, that if I could have done X, Y, Z, cancer wouldn't have happened? And I personally can't find that proof in my life. All I know is that it creates more pain, more suffering, and cancer is difficult enough. That shame game and self-blame makes it so much harder.

So if I could give people one piece of advice, and I tell myself this too, it is not your fault. And there are so many ways we're empowered in this journey. You've talked about loads of them in just this call and we get to face this journey any way we want. For me, I like to focus on a lot of gratitude, a lot of joy. I renamed my diagnosis as live the F out of life because that sounds a lot more fun than stage four cancer. It makes me laugh and smile, but you get to do it any way you want. And whatever emotion you're feeling, whatever belief is running through your mind, you're absolutely not alone in that.

Dr. Marisa Weiss: And it's also true that our diagnosis makes other people uncomfortable and they want to better understand how it happened to you. So they try figure out what to blame it on, like some kind of [inaudible 00:59:58]

Bethany Adair: I know.

Dr. Marisa Weiss: I remember my mother asked me when I was diagnosed, she goes, did you catch breast cancer from your patients? I was diagnosed 15 years ago and I've been in practice for 30 years. It was an innocent question, but she was just searching for something to blame it on. Well, Bethany, thank you so much for talking with us today and sharing your positive energy and perspective. And we are really looking forward to having Bethany lead a workshop for one of our metastatic breast cancer support groups. And we'll send the registration link to you all in an email for yourself or someone else that you care about.

Bethany Adair: Yeah, that'll be next month.

Dr. Marisa Weiss: Right. Right.

Bethany Adair: I'm very excited.

Dr. Marisa Weiss: Thank you.

Bethany Adair: Thank you for having me.

Dr. Marisa Weiss: Thank you so much. Now it's my pleasure to introduce Rhonda Schaller, who teaches with the integrative medicine and body program at Pratt Institute. Rhonda will lead us in a short meditation that addresses many of the feelings we've talked about today. Rhonda is also a beloved member of the Breastcancer.org community who's living with stage four breast cancer. 

Rhonda, I would like you to take it from here and lead us please. Thank you.

Rhonda Schaller: My pleasure. So let's take a moment. We've heard a lot of wonderful advice and some fabulous ways forward through our emotions, our thinking, our sensations. And so we're going to take 10 minutes and let it go, let the mind begin to settle, and I'm going to lead you. I'm going to guide you in a meditation so you can really begin to come into the present moment as best as you can. So here's our invitation. Eyes can be open or closed, your choice, feeling your feet firmly on the ground, wherever your hands are, they're resting in your lap or by your sides, and just checking in with the body. Perhaps you need to stand because you've been sitting and it's uncomfortable or you need to lay down or sit. Just take a few minutes and adjust your body. And then as you're ready, relaxing into the body. And so let's begin.

On purpose and with intention, let's let go of what we've been listening to, what we've been doing, and just bring your attention into the present moment as you breathe. And so to do this, it may help to bring the focus of your attention just to your breath, wherever the breath is in this moment. Just notice are you breathing short in the body? Is it at the chest? Is it deep in the body? Is it in the belly? Is it just at your nostrils? Wherever your breath is, just allow yourself to notice that you are breathing. And you're breathing in and you're breathing out, you're breathing naturally, just letting whatever rhythm for you is comfortable.

And if your mind should wander into yesterday or tomorrow, it is perfectly fine. Just notice a wandering mind. It's natural, but escort the mind back as soon as you notice you've wandered back to your breath. So we are breathing together, breathing in and breathing out. And you might notice as you breathe in and out, just very slowly, this feeling of relaxing a little bit more with each out breath, focusing on your breath a little bit more deeply, letting go, letting be.

So you're breathing in, you're breathing out. Each time you wander to thinking or listening to sounds or sensations, just with kindness, notice and then come back. Feet are on the ground, hands are in the lap. Perhaps you're just noticing how your body is as you release and relax into the breath. And perhaps the breath deepens and quiets all on its own as we're breathing. As my voice guides you, you're breathing in, feeling it deeply, completely.

That's our invitation, feeling the breath move through the body as we settle the mind into noticing this focusing, this natural feeling of breathing in and breathing out, just going with it, calm and relaxed as best as you can in this moment. Calm and relaxed, effortlessly breathing, one breath at a time, no two breaths the same, allowing your breath to take whatever rhythm feels comfortable for you in this moment as we relax and release and let go into the breath.

And the breath might become longer and finer. Perhaps you notice a pause in between the in breath and the out breath. So you are simply allowing your breath to come in as its own accord, effortlessly, and out on its own accord. And if the mind wanders away, with kindness, just notice and then come home to the body and the breath, noticing each breath in and each breath out, and just feeling the ease of it all, just allowing yourself this quiet, centered stillness, holding your attention lightly on the breath.

And you might notice sounds coming into your awareness, it's perfectly fine, the sound of my voice. It will come and go, sounds in the room, outside your window. Notice if sounds occur. And they will come and go as they're ready, like white clouds drifting across the blue sky of your mind. Just let them come and go. As you return to the breath, allowing your attention to rest lightly. On this stillness, the breath can unfold within you.

And you might notice sensations in your body as well. Just let them come and go, just the same as sound without judgment. As best as you can, we simply notice within our awareness and return for another minute on the breath, letting things come and go, breathing. The ease of it all as best as you can, breathing in and breathing out and just merging, dissolving, being in this moment.

And then if your eyes have been closed, opening the eyes, perhaps wiggling your fingers and your toes and just taking a moment, perhaps even putting your hand on your heart, a moment for gratitude that you allowed yourself these 10 minutes to breathe and to be inviting the calm abiding that is natural within you. So I thank you for your practice, and I'll turn it back to Dr. Weiss.

Dr. Marisa Weiss: Wow. Wow. Rhonda, thank you so much again for leading us in that powerful meditation. And thank you for all you do to help others in this community. You are a godsend. You're like manna from heaven, right? Truly. Thank you. 

Before we go, I want to summarize some of the important information that was shared today, some of these take-home pearls. We'll also email you with articles, videos, and podcast episodes. There is a lot of great information that can help you during this challenge. So from reframing your thinking to learning coping skills, repairing relationships, building mindfulness, exercising, improving your sleep, and overall quality of life, there are so many ways we can try to manage what we're feeling or give us a better quality of life in our everyday.

When it comes to mental health support, many people think of one-on-one therapy with a counselor, but that experience can vary as you've heard. Experts may follow a specific approach like behavioral therapy, cognitive therapy and more. And group therapy can provide clarity, ideas to help you, and introduce meaningful relationships as long as you know the groups are carefully designed and created. Our team at Breastcancer.org, because of what you've shared over the years, now we offer free virtual support groups, which take place every day of the week. You can sign up on Breastcancer.org. We will email all of you with a direct link and we hope you'll join us.

Other mental health support options could include antidepressant and anxiety, medications, cannabis for pain, anxiety or insomnia, sleep medicines, and we talked about sleep hygiene, and also possible other supplements that you may be hearing about depending on your situation. There are complementary medicines and therapies like acupuncture, meditation, yoga, and lifestyle changes that can help relieve your symptoms over time.

And again, these are practices. You can learn a little, try it out, learn a bit more, try it out, or just keep practicing what you learn. What you practice does grow stronger. You have to choose what you want to practice. If you want to practice feeling anxious, then you'll be anxious all the time. But if you practice some of the meditation tools that you've heard about today and other things, you'll get stronger at that. Okay?

You'll also find more information at Breastcancer.org/mental-health. And just remember, before you try something that could interfere with your breast cancer treatment, it's important to discuss that with your doctor. Like Dr. Bao said, there's some medicines that get in the way of tamoxifen doing its job, as an example.

If you've decided to work with a therapist, but you don't know where to start, you could ask your medical team or hospital, your social worker or your navigator. Go to people you trust for referrals. You can use your insurance company's database or search on the psychologytoday.com website. They have a database that will show you at least people who are in your network and who are near you and all that. It can take time and it will take time to find someone who's the right match for you. The person who's helpful to you now might be different from the person later on. Our needs change over time, right?

Okay, well, the cost of therapy can be intimidating on top of everything else, all the other expenses that you've had to shell out to be treated for breast cancer and all the things that happen with it, all the parking and all the babysitting and extra food and whatever it is. So the first step is to contact your insurance provider to find out what's exactly covered. Ask your doctors if there's a fund in the hospital. Sometimes a donor will say, "I want this money to go to people going through this to help them make their way through it and get to the other side of it."

Check the rules around healthcare providers who are in and out of your network and look into using a flexible spending account or health savings account to handle the fees. That way, you can do it with pre-tax dollars. Talk with your doctor or hospital about mental health services, as was I saying, that they offer. There may be a lot there that you just didn't know about. No one thought to offer it to you because you got so good at hiding the invisible scars. No one thought, oh, maybe you need a little help. You can also ask your therapist if they will charge on a sliding scale, meaning that the rate is adjusted based on your income.

Well, I hope to see all of you again on June 17th for an Ask Me Anything webinar to answer your questions about breast reconstruction. And then on July 22nd, we'll be talking more about mental health solutions and hearing from patients and advocates who understand exactly what you're going through. They'll share their personal stories and we'll learn from each other and from another leading mental health expert.

Finally, I would just want to thank you. Thank you for joining us. Thank you for taking this step forward to help yourself. 

I hope today's webinar has given you some new ideas and information and validated what you're feeling. Thank you again for being here and for being part of the Breastcancer.org community. Thank you to our amazing experts. We hope you all take care of yourself and reach out and ask for help and accept the help and do that homework of thinking about what would make me feel better. What do I need right now? What would make me feel joy, comfort, spontaneity, hopefulness, looking forward to the next day and feeling freer from the fears that can be so gripping? So thank you all for being here and take care.

Q: I'm coming towards the end of my 5 years as I had HER2+ with lymph node involvement. I can't get the thought of a recurrence out of my mind. It's like I am waiting for something to happen. Is this normal and how can I change my train of thought? TIA. 

A from Jen Uscher: It’s certainly normal to worry about recurrence. You might want to consider talking with a therapist who specializes in working with people who’ve been diagnosed with cancer.

Q: I think many of us would feel better if there was a post-treatment test to monitor recurrence in the whole body, not just a mammogram. Is there any such test in development? 

A from Dr. Ting Bao: There is some progress in developing whole-body monitoring tests for cancer recurrence beyond traditional imaging like mammograms. Liquid biopsies combined with strategic imaging represent the most promising approach for comprehensive post-treatment monitoring. While some tests are FDA-approved for specific purposes, many of the most comprehensive whole-body monitoring approaches are still in development and clinical testing.

Q: I had a lumpectomy. I have a lot of scar tissue which really hurts during mammograms and exams. Is scar tissue normal? 

A from Jen Uscher: It’s normal to have some scar tissue after a lumpectomy. Since you're experiencing pain, you might want to consider treatments that can help such as physical therapy. This article covers some treatments for managing scar tissue after breast cancer surgery. 

Q: My breast cancer treatment is over and the controls [screening] are every six months now. When I was in the hospital and everything is okay, I am overwhelmingly happy. But afterwards I feel as if I am living from control to control. I feel as I was playing over time, not knowing how it will end. How can I get out of this survival feeling? Thank you. 

A from Dr. Ting Bao: It's completely normal to feel like you're living "from control to control"  [“screening” to “screening”] after cancer treatment. This is so common it has a name — "scanxiety." Some ways to ease this feeling:

• Gradually plan activities beyond your next medical appointment

• Connect with other survivors who understand what you're experiencing

• Try mindfulness practices to bring you back to the present moment

• Consider talking with a professional who specializes in cancer survivorship

• Create meaningful ways to mark time passing successfully

• Focus on health factors you can control

Q: I got very depressed and doctors tried me on various anti depression meds all with side effects. It’s 7 years and I’m still stressed and feel terrible. 

A from Jen Uscher: It might be worth considering trying some other therapies in addition to medication (if you haven’t done so already)…such as talk therapy and complementary therapies: (meditation, yoga, massage, tai chi, acupuncture). Increasing the amount of physical exercise you’re getting can also help in some cases.

Q: Will the worry stress me out and bring it back? 

A from Dr. Marisa Weiss: Great question. Stressing yourself out reduces your quality of life — but it's not associated with a higher risk of recurrence. Time to get practicing on managing your emotions and mind. Meditation is one great approach. Wishing you the best.

Q: I have neuropathy in my feet from chemo. Acupuncture did not help. Anything new on the horizon to ease symptoms? 

A from Jen Uscher: This article covers some ways of treating and managing neuropathy.  

Q: What is the best diet for post chemo/radiation/surgery/reconstruction? How do we make sure that we are tracked and offered scans to make sure it doesn't come back? Thanks so much. 

A From Jen Uscher: The American Cancer Society has recommendations on diet and nutrition for people who’ve had cancer. Re: making sure you are tracked after active treatment ends, you might want to read this article about how to get good follow-up care.

Q: I have been cancer-free for 12 years and still have thoughts and fears of recurrence. Is this normal?

A from Bethany Adair: This is absolutely a normal experience! You are not alone. 

Q: Please speak to mental health during survivorship — after active treatment and waiting for the 5 year mark. 

A from Dr. Marisa Weiss: The fear of recurrence never goes away. It’s like a whale in your living room. Try to shrink it down to the size of a magazine rack. But know, with hearing about a new diagnosis or with having a new pain, the fear can shoot huge, taking over your living room. It's normal. Up to and beyond 5 years. Just do the best you can each day to be as healthy as possible.

Q: My daughter is a social worker for stage 4 kidney disease centers. We really need social workers in oncology centers. I could really have used a social worker when I was diagnosed. I just walked out of the oncologist upon diagnosis of stage 4 TNBC without a clue as to resources or mental help after receiving shocking news. How do we get social workers in this capacity? 

A from Jen Uscher: There are some nonprofit organizations that offer free patient navigation (often provided by social workers) for people diagnosed with breast cancer nationwide. A few examples are Cancer Care, Cancer Support Community, SHARE Cancer Support, the American Cancer Society.  Also, Triage Cancer offers free navigation for legal, financial, and other practical issues after a cancer diagnosis.

Q: As a mental health clinician, I was surprised that I was never once offered any type of mental health support. When I asked a social worker during radiation, I was told to find a therapist virtually because I live too far away. Rural care is sadly lacking any coordination. No cancer-specific post op instructions either. 

A from Jen Uscher: Sadly, we often hear that people are not offered resources for mental health support after a breast cancer diagnosis. Breastcancer.org offers some resources to help people find therapy/support. 

Q: How and what does acupuncture help? 

A from Jen Uscher: This article gives an overview of how acupuncture works and what it’s helpful for. This podcast covers how acupuncture can ease breast cancer treatment side effects. Acupuncture can be effective, for example, for joint pain caused by aromatase inhibitors, and side effects after a mastectomy.   

Q: What study was that for yoga and sleep? 

A from Dr. Ting Bao: https://pubmed.ncbi.nlm.nih.gov/23940231/ 

Q: I had surgery in October and radiotherapy in December. I really struggled post radiotherapy with soreness and felt totally overwhelmed to be done with treatment. I'm extremely worried about the first mammogram in September and not totally confident in the system, paranoid it will come back. Is this a normal feeling? 

A from Susan Glaser: Completely normal. You're just finished with treatment and of course you'll be worried. Try to allow yourself to be worried a few days/1 week before the mammogram, not months before. Try to find a support avenue as well. But this is very normal.

Q: Any tips on doing yoga when the AIs are causing dizziness? 

A from Bethany Adair: Yes! Move slowly during transitions and keep your head above your heart.

Q: I had DCIS hormone pos HER2-negative stage 0. I had a lumpectomy and 1 node removed which was clear. 20 radiation treatments in 10 days because there was a microscopic break in my wall. Finished radiation in April 2024. I have osteoporosis in my spine. Four weeks ago I had 2 compression fractures in my thoracic. Can radiation increase fracture risk?  Also my breast feels hard now is that normal? 

A From Dr. Marisa Weiss: Radiation to the breast doesn't affect your spine or risk of osteoporosis in general. But make sure to get help with your bone health. It's so important.

Q: Why are there SO MANY NIH and peer reviewed studies showing the benefits of alternative treatments and natural treatments that even work synergistically along with traditional cancer treatment, but they're not approved? How are we still here in 2025 with the same treatments from decades ago? I know the recent progress in targeted immunotherapy, but why do we have so many successful peer reviewed studies that remain unapproved? And would you encourage a naturopath. Thank you for all you do. 

A from Dr. Ting Bao: While many studies show promising results for integrative therapies, they often face methodological challenges that make them less convincing to regulatory bodies:

• Small sample sizes

• Lack of proper control groups

• Inconsistent preparations or dosages

• Difficulty standardizing natural products

• Challenges isolating active ingredients

• Limited funding for large-scale clinical trials

Q: I was diagnosed with breast cancer in September 2023. I had a double mastectomy, and recently had my implants. My body hurts, my scars but mostly I feel fear and very fatigued. Can’t sleep well. Will I ever feel better? 

A from Susan Glaser: Absolutely, it takes time. Make sure you introduce some light exercise/movement, even massage therapy to help loosen your muscles. Over time, you will definitely feel better.

Q: How do I participate in the mindfulness course that Dr. Ting Bao is describing? 

A from Dr. Ting Bao: To participate in Mindfulness-Based Stress Reduction (MBSR) or Mindfulness-Based Cognitive Therapy (MBCT) courses, here are the steps you can take:

Find local programs: Check nearby hospitals, wellness centers, community centers, and universities. Many cancer centers now offer these programs specifically for cancer survivors. Mental health clinics or psychology departments often run MBCT courses

Look for online options: Several established organizations offer live online courses with certified instructors. For example, the Center for Mindfulness (University of Massachusetts Medical School) offers the original MBSR program online and Oxford Mindfulness Centre provides MBCT courses online.

Q: What do you mean by hot flashes? Sweating during the night? 

A from Dr. Ting Bao: Yes, hot flashes are sudden feelings of intense warmth that spread over your body, particularly the face, neck, and chest. They're often accompanied by sweating (which can be especially noticeable at night, often called "night sweats").

A from Jen Uscher: Here’s more info on hot flashes. 

Q: I am concerned about developing lymphedema from lymph node removal. Can I still do acupuncture? 

A from Dr. Ting Bao: The evidence increasingly suggests that properly administered acupuncture is safe for patients with lymphedema risk, and multiple clinical trials have been conducted without significant adverse events. Some practitioners still take the most conservative approach of avoiding the affected arm, while others consider work on the affected arm safe when performed by properly trained practitioners. The best approach is to have a conversation with both your medical team and a qualified acupuncturist (ideally one with oncology experience) to determine the safest protocol for your specific situation.

Q: I just had a bilateral mastectomy about 3 weeks ago. What type of yoga can I do to facilitate my healing process? 

A from Dr. Ting Bao: Before starting any yoga, even the gentlest forms, please confirm with your surgeon that you're cleared for these movements. Everyone's recovery is different, and your surgical team knows your specific situation best.

A from Jen Uscher: Here’s an article and a podcast on trying yoga after a breast cancer diagnosis.

Q: I’m curious how common a really severe depression is during treatment — I mean something that is much worse than the anxiety, grief, and unhappiness caused by the general suckiness that is cancer. 

A from Susan Glaser: It happens. That is the reason to seek professional help — it can help.

Q: Does radiotherapy after a lumpectomy leave residual pain in the area? I’m 6 months after my treatment and the breast area is very tender and almost bruised feeling. 

A From Dr. Marisa Weiss: Yes, that's very common. You can also have breast pain after surgery too, with and without radiation. It's not usually a sign of anything like recurrence.

Q: How can I tell whether my symptoms are caused by cancer, chemo, or the menopause I've entered due to the treatment? Brain fog, aching joints, depression, paranoia — my doctor seems to dismiss all of them as menopause but doesn't really offer any treatments. 

A from Jennifer Uscher: The symptoms you’re describing could have more than one cause (they could be due, for example, to both treatments and to menopause). I’m sorry to hear your doctor isn’t offering help with side effects. This article covers some ways of getting help with chemo side effects and this article covers ways of managing menopause side effects. You might want to consider making an appointment at a clinic/program that focuses on side effect management, such as a cancer survivorship clinic or cancer rehabilitation therapy program.

Q: Are some of these therapies offered specifically for cancer warriors and virtually? If not virtually, do cancer institutes/centers offer these therapies? 

A from Bethany Adair: My offerings (coaching, classes, workshops) are all virtual so you can join from anywhere in your PJ’s :) www.mygurucancer.com and I’ll be offering a free virtual workshop on Mindset with Breastcancer.org in June, too!

A from Jen Uscher: Many cancer centers and cancer nonprofits offer ways to access complementary therapies and mental health support (virtually and in person). 

Q: Where can I find a therapist that specializes in breast cancer? 

A from Jen Uscher: It’s not always easy to find a therapist who specializes in breast cancer. You could try seeing if a social worker or patient navigator at your cancer treatment center can refer you to one. You could also search for one on PsychologyToday.com. There are also a number of nonprofit organizations that have cancer support groups (some of which are free) and that are facilitated by mental health professionals who specialize in breast cancer. This article has some tips on finding mental health support after a breast cancer diagnosis. 

Q: What is the best way to get checked for breast cancer without getting lots of radiation?

A from Jen Uscher: The amount of radiation exposure from a mammogram is very small and the benefits of the test generally outweigh the risks. Some other breast imaging tests, such as a breast ultrasound and a breast MRI, don’t involve any radiation.

Q: Are there support groups out there geared towards people who are dealing with preexisting mood disorders and the effect breast cancer treatment has on them? I’m on aromatase inhibitors and the hormonal changes make managing bipolar disorder challenging. My psychiatrist (I’m seeing at cancer center) and therapist are both recommending I attend a support group but neither know of any for this type of scenario. 

A from Susan Glaser: Try contacting the American Cancer Society to see if they are aware of any such groups. There are groups that deal with aromatase inhibitors (SHARE). Perhaps the organization will know of other groups. How challenging for you.

Q: I am a woman married to a woman... there is an astounding lack of information and support for the LGBTQ+ community cancer survivors, thrivers, and especially caregivers. Do you have any resources you recommend? (The mental health side is different...worries from both me and my wife about how we feel about each other's bodies, fear and anxiety about the possibility of my wife having to go through this...) 

A from Jen Uscher: Breastcancer.org’s virtual support groups are a welcoming, inclusive community of people going through treatment and survivorship. Also, this article and this podcast have some tips on finding LGBTQ-friendly cancer care providers.

Q: What are the thoughts about EMDR therapy? I feel like I have PTSD. I started seeing a therapist recently but she’s new to the oncology therapy field. 

A from Jen Uscher: This article discusses EMDR therapy for PTSD. 

Q: Are there “stages” of post-treatment mental health, like there is for death? I was hopeful, almost euphoric, after treatment and then I crashed. 

A from Susan Glaser: That's a great question. I would think so. Like grief, other emotions come in waves. Find yourself support and learn ways to cope with the phases because they will come and go, and diminish in time.

Q: How do you cope with cancer ghosting? 

A from Lisa Kline: Breastcancer.org has some information on this exact topic. 

Q: I am in remission, but every mole is a melanoma. I don’t know. My doctors were very clinical.

A from Dr. Marisa Weiss: Your medical doctors and surgeons are very clinical. That's why it's so important to seek emotional support from a mental health professional.

Q: Just something to share — I had a double mastectomy and didn't realize what was involved in recovery and how it would affect me. I was also on Letrozole but had horrible side effects. Just was on treatment break for 6 weeks, and started Tamoxifen, which is way better for symptom management. Although not as effective, it's much better for me. Symptoms such as brain fog, pain, depression, fatigue, etc... are way less with this new med. 

A from Susan Glaser: I'm glad you changed medications. Sometimes the change alleviates the side effects just enough so as to be tolerable.

Q: Can you please point me to clinical trials or studies that have evaluated the effectiveness of acupuncture, yoga, or mindfulness for cancer patients — particularly in terms of symptom relief, quality of life, or treatment side effects? I'm hoping to explore evidence-based integrative options and share with my medical team. 

A from Dr. Ting Bao: https://integrativeonc.org/practice-guidelines/ 

Q: What is “cancer ghosting”? 

A from Lisa Kline: Cancer ghosting refers to when friends and loved ones cut off contact with you after a diagnosis. Here’s more information.  

Q: These scars are invisible. Are there any resources that help with "proving" mental health and cognitive issues to your insurance company? 

A from Susan Glaser: Good documentation from specialists, mental health clinicians, neuropsychologists — if they are available to you in your area.

A from Jen Uscher: Has your health care provider or mental health provider communicated with your insurance company about your diagnoses/situation? Have they used diagnostic codes?

Q: How about using RoundUp chemical? Is that something we shouldn't use? 

A from Jen Uscher: Some research has linked RoundUp weed killer (glyphosate) with breast cancer risk. It may be better to avoid it if that’s an option for you.

Q: I am 8 months post lumpectomy, chemo, and radiation. I still have terrible fatigue (I also have low risk MDS). What can be helpful with fatigue please? 

A from Jen Uscher: This article and this podcast cover some ways to manage cancer-related fatigue. 

Q: I turn to food to take away my anxiety. I gained 38 pounds. 

A from Dr. Marisa Weiss: Food is a source of comfort. But food can also be medicine and we have so many more tools now than before. Weight management steps that address anxiety as a major reason why so many of us go to the kitchen and eat and eat, also, drink and drink.

Q: Despite some very difficult emotions, I have been reluctant to seek counseling since talking about things always seems to make me feel worse. How would therapy still be a good option for me? 

A from Susan Glaser: I think it would be helpful to get to the understanding of why you feel worse talking about your emotions and getting support for them. Perhaps adding some activities that provide some joy to you along with the therapy will be helpful.

A from Jen Uscher: You might want to listen to this podcast about how therapy can help people affected by breast cancer.

Q: I was exercising and it was helping a lot. Now I have neuropathy and it has made me very depressed and isolated — my family also does not understand the pain.

A from Bethany Adair: A physical therapist may be able to support you with exercises for neuropathy and is often covered by insurance. I’ve used PT to deal with so many side effects.

Q: Fortunately I’ve not been let down by my friends. They’ve all been incredible. I’ve been mostly disappointed by my doctors. Not listening to me, not addressing my concerns, needing years to get help for one of many side effects. Not a question, but felt it may resonate with the group. 

A from Susan Glaser: Great point. How fortunate you are to have such a good group of friends. Would you consider changing medical teams if you feel that your care has been compromised by being misunderstood? That's important for your care.

Q: How to change your quality of sleep? I do sleep around 7-8 hours, but most of it is light sleep or REM. My deep sleep is hardly 30-40 minutes in a night. 

A from Jen Uscher: This article has some tips for improving the quality of your sleep. 

Q: Is brain fog related to chemo? 

A from Lisa Kline: Yes, it can be. Here’s some more information. 

Q: What types of financial support are there for nontraditional treatments (for acupuncture, etc)? 

A from Jen Uscher: A number of national and local nonprofits offer financial support to help people with breast cancer get access to complementary therapies.  (A couple examples of the national ones are Unite for HER and the United Breast Cancer Foundation. Many also offer free online classes (some are live and some are recorded) in yoga, meditation, tai chi, etc.

Q: What about body image, sensuality? My partner seems to look at me with disgust...or at least that's how it seems. On the other hand, I don't recognize myself anymore, either. We've talked about it but it seems so long as I'm in treatment, it's unlikely to change. It's just so sad. 

A from Jen Uscher: You might find it helpful to read this article, which discusses some ways of getting help with body image issues.

Q: Are SSRIs recommended for depression and do they help with sleep issues? Hot flashes? 

A from Jen Uscher: Yes, SSRIs can be helpful for depression and for hot flashes.  Whether they can be helpful for sleep can vary (some may cause insomnia in some individuals).

Q: What will you recommend to help chest tightness after mastectomy surgery?

A from Bethany Adair: Physical therapy and gentle yoga really helped me!

Q: What types of vitamins and supplements are recommended?

A from Jen Uscher: Here’s some information on supplements from Breastcancer.org. Memorial Sloan Kettering’s website has a lot of helpful info as well.

Q: Rather than scanxiety, I have anxiety from not having any annual imaging scan post-surgery! I opted for aesthetic flat closure after bilateral mastectomy but only have a physical exam at follow-up appointments. My chest area feels very lumpy and bumpy to me and I think I’d feel more reassured if I had an ultrasound scan. What’s normal for flat patients’ follow up and how can I convince myself that the consultant is right when he says all is fine? 

A from Bethany Adair: I have needed to advocate for extra scans with my medical team — if that’s what will bring you more peace of mind, go for it!

A from Jen Uscher: This article has some tips on navigating your follow-up care (including follow-up scans) after active treatment.

Q: My wife was diagnosed with HER2-positive breast cancer. She has finished chemo and is currently undergoing radiation. I do all I can for her. I want her to express her feelings and she does. Problem is, I feel like I can only say so much and that she should seek some help from a professional mental health advocate. How can I convince her to do this rather than try to deal with it on her own? 

A from Lisa Kline: Our support groups may be a good starting point for your wife. These are facilitated group discussions hosted by Breastcancer.org’s professional community team.

Q: Incredible Rhonda. What an inspiration you are. I need your voice in my head :) 

A from Rhonda Schaller: My pleasure — I post often in the discussion threads on Breastcancer.org. Join me there!

Q: Fabulous meditation..love Rhonda's voice....she should make recordings!  fabulous webinar, thx so much 

A from Rhonda Schaller: I run a meditation program. Here are my recordings. 

Q: I've had difficulty finding an MBC specific support group online. 

A from Lisa Kline: We have one for you. Here’s the sign up page.