Once the surgery, radiation and chemotherapy are over, women need to establish a new sense of normalcy. It's easier for some patients than others.

When a woman hears the words "It's cancer," she may feel like the walls of her world are tumbling down around her. After the initial shock, she establishes a new definition of normal, as her ordinary daily tasks are replaced by doctor's appointments, treatment sessions, therapy and learning everything she can about the disease.

As treatment draws to a close--anywhere from a few months to several years later--she will have to establish another view of normal. Most cancer patients will get to that point. According to the Centers for Disease Control and Prevention, in 2007 (the most recent year for which statistics are available), more than 200,000 women were diagnosed with breast cancer--the most common form of cancer in women next to non-melanoma skin cancer. Of those women, 40,000 lost the battle. The other 160,000 fought to come out on the other side and establish new lives as cancer survivors.

Medical professionals say there are a number of factors survivors must adjust to, and changes they will need to accept, in their new idea of normalcy. That includes both physical and mental factors.

Dr. Steven Cox, chief medical officer of Fairfield Medical Center, says physical changes can vary widely. "In the first weeks and months after surgery, if the patient has had a mastectomy or lymph node sampling beneath the arm, she may have problems moving her arms," he says. Arm and shoulder exercises will restore range of motion, and most can be done at home with only minimal instruction.

"Occasionally, if the patient has had extensive surgery, she may need physical therapy," Cox says. With breast reconstruction, recovery is sometimes more complex, involving extra time, tissue expanders and multiple procedures.

Many cancer patients undergo a course of hormone therapy to help prevent recurrence, Cox says. A number of different medications may be used, including estrogen blockers (which, as the name suggests, block the effects of estrogen on breast tissue) and aromatase inhibitors that prevent the formation of estrogen. Some of the medications may cause hot flashes, Cox says, but those symptoms can be alleviated with the use of certain anti-depressant medications.

Dr. Jeanna Knoble of the Mark H. Zangmeister Center says the prescribed therapy depends upon the individual patient. "Women whose breast tumors express estrogen/progesterone receptors generally continue on what we call hormonal therapy for five years, and the specific drug used is often based on whether she is pre- or postmenopausal. We also take into account the side effects of these drugs in the context of a specific patient."

Knoble says that immediately following surgery, chemotherapy or radiation treatments, patients should expect to see their medical team at least every four to six months. Intervals grow longer the further a patient gets from her diagnosis.

Cox says patients will continue to see their medical team at least once per year for life. They will have an annual mammogram and a manual exam of the breasts and lymph nodes in the arm and neck, along with an occasional ultrasound in the office if anything looks suspicious.

Recurrence Prevention

Aside from hormone therapy, medical experts are still seeking preventive measures. Some are as simple as a vitamin supplement or even a walk in the sun. Studies have demonstrated that maintaining adequate vitamin D levels can inhibit recurrence of the disease, Knoble says.

"There has been some data to suggest women with low vitamin D levels have increased breast cancer recurrence risk," she says. "Given this, along with other benefits from vitamin D, including osteoporosis prevention, I check vitamin D levels in all my breast cancer patients and put those with low levels on supplement. It is also quite difficult to get too high a vitamin D level, so this is a safe, low-cost measure without significant risk or side effects."

Joyce Cox, a certified oncology nurse at Fairfield Medical Center (and wife of Dr. Steven Cox), recommends that women recovering from cancer take good care of their bodies using common sense guidelines.

"Make healthy dietary choices such as eating at least five servings of vegetables and fruits every day, choosing whole grains, and cutting down on saturated and trans fats," she says. "Take a daily multivitamin with folic acid, vitamin D and calcium. Limit red meat intake and if you drink alcohol, limit it to less than one drink a day."

Many medical professionals guard against estrogen replacement and estrogen from food sources. Hormone replacement therapies and estrogen supplements can be of concern to breast cancer patients, as can soy-based foods, which can contain high levels of plant estrogens.

Mental Health

Maintaining a positive outlook after a life-threatening illness can be difficult, but it can make all the difference.

Laura Beemiller, an oncology social worker with the Zangmeister Center, says many women feel a loss of purpose as their treatment draws to a close. "There may be a sense of loss after working with the health-care team so intensely for a period of time," she says. "Suddenly, you're only seeing these people every month, or three months or six months."

Some patients form a close bond with their medical professionals and some don't, depending upon the personalities involved. But the sense of lacking direction is more universal.

"At least when they were in treatment, they were doing something to tackle the issue," Beemiller says. "After treatment ends, they may feel like they aren't doing enough to make sure it doesn't come back. It's a control thing."

Alongside the potential stumbling block of where to go next, patients may also find themselves embracing life, and embracing their victory over disease and the fear that went along with it. "It's a mixed bag," Beemiller says. "There may be some anxiety and loss, but there can also be celebration and hope."

Many cancer patients experience situational depression upon their initial diagnosis, which may abate or continue after treatment concludes. "How you deal with the diagnosis from the beginning determines how you will deal with it at the end," Beemiller says. "Afterward, life is different. It may never be the same as before, so there is a process of rediscovering who you are now."

Knoble says an anti-depressant or anti-anxiety medication can help reset a patient's perspective while she is healing emotionally. "I encourage a trial of anti-depressant therapy to help take the magnifying glass a bit farther away from every detail and concern," she says. "This has been helpful to many patients."

Physical Changes

Joyce Cox says women may have a difficult time adjusting to a new body image. "Typically, a woman's breasts are symbols of positive self-image such as femininity, sexuality and motherhood," she says. "For women who lose a breast, this loss can deeply affect them, and joining a support group is sometimes helpful. Expressing your emotions is extremely important, and many women find journaling, exercise, meditation and guided imagery ways to release their feelings."

After treatment wraps up, patients begin the process of focusing less on the body and more on the spiritual aspects. "You've done the physical stuff, and now you need to do the rest of the ‘taking care of me,' " Beemiller says.

Physicians and nurses can provide information about support groups, nutritional counselors, exercise classes and education resources to help patients get through treatment and the months and years following.

Emotions may come in waves that strike unexpectedly. Beemiller says it's common for a patient who thought she was doing well to suddenly find herself needing a little extra support. Guided imagery classes, instruction in stress relief techniques and the like can help restore emotional balance.

Knoble recommends regular exercise to keep both the body and the mind in top shape. A consciously positive attitude is also helpful. Remembering that life is a journey, not a race, can help women see the beauty and meaning in what is happening right now, rather than looking ahead to another challenge or problem, she says.

"I think it is important for women to try to take things one day at a time," Knoble says. "It's helpful to remember that, years from now, most women with localized or early stage disease are cured and treatment is behind them."

‘I've Been Given a Chance'

Tina Strauss just passed the five-year mark of being deemed cancer-free. She didn't feel a sense of loss at the end of her treatment, but rather a call to action. "I was happy it was over," she says. "I'm a busy person. I didn't have time for radiation treatments every day. I had things to do."

Strauss underwent nine months of chemotherapy, radiation and surgical procedures under the supervision of Dr. William Farrar, a surgical oncologist and director of the JamesCare Comprehensive Breast Center at the Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. Afterward, Strauss wanted to do something positive with the experience, so she joined two programs that help women work through breast cancer.

Look Good...Feel Better, offered through the American Cancer Society, pairs patients with licensed cosmetologists who teach them tricks and tips to look their best--even when they're losing their hair and feeling sick from chemotherapy drugs. Women learn about wigs and scarves to hide hair loss, as well as how to use powders, shadows and other cosmetics to camouflage the signs of the illness they're fighting.

Reach to Recovery is a cancer society program that pairs breast cancer survivors with newly diagnosed patients. "As a survivor, they set you up with someone who is having a very similar treatment as you, and sometimes who is close to your age so they can relate to you," Strauss says. "You contact them after their diagnosis and before their surgery to try to help them through the process."

Strauss didn't obsess over the "why me" question many cancer patients ask themselves or their spiritual advisors. Instead, she says she feels like she was meant to be in this place in her life at this time. About six months before her diagnosis, after watching her sister-in-law lose a battle with breast and ovarian cancer, Strauss says she asked God how she could help women who were fighting the disease. After her diagnosis, she was frightened but knew she would pull through.

"I believe I survived so that I could share this experience with other women," Strauss says. "I've been given a chance to help people see what's on the other side of cancer."

Finding Support

Several Central Ohio organizations serve as educational and support clearinghouses for cancer patients and survivors. The Zangmeister Center shares space with Haven of Hope Cancer Foundation, a nonprofit that offers pet therapy, Pilates, yoga, a walking club, therapeutic touch lessons and other educational opportunities. The center also provides access to a chaplain and dietician, art lessons and sexuality support groups.

The JamesCare Comprehensive Breast Center, located on Olentangy River Road, offers a similar one-stop shop for services and support. Farrar says patients receive a high quality of care in a timely fashion because everything is located in one place. The center also hosts Hope's Boutique, a shop where women can obtain wigs, bras and other items related to their treatment and recovery.

OSU bills the JamesCare center as the first facility of its kind in the Midwest. "It gives us the ability to treat breast cancer and promote breast health in one building," Farrar says. "We have everything--prevention, medical oncology, plastic surgery, breast implants, physical therapy, psychologists, survivorship groups, genetic counseling and MRIs."

During treatment, patients can have "curbside consultations," in which they meet with a surgical oncologist, medical oncologist, plastic surgeon and more, all in a single day.

The center also offers instruction in qigong and yoga; music therapy in the form of drumming, guitar and a victory choir; and survivorship classes not only for former patients, but for their children and families as well.

Kristin Campbell is a freelance writer.

Reprinted from the July 2011 issue of Columbus C.E.O. Copyright © Columbus C.E.O.