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

Before you cancel any vacation plans, or decide not to make new ones, talk to your doctor. In many cases, you can adjust your treatment schedule so you still have the freedom to enjoy summer fun.

Scheduling your vacation: Before, after, or during treatment

You may be able to postpone the start of your treatment until your vacation is over. Or you might decide now to plan a relaxing getaway after your treatment ends.

If you're planning a post-treatment getaway, remember not to book it too tightly. Occasionally the end of treatment may be delayed. For example, a dose of chemotherapy might be delayed by low blood counts. Or radiation may be delayed because of problems with the radiation machine.

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

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

Scheduling local treatment: Surgery and radiation

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

"How soon you can go on vacation depends on whether or not you are having a full lymph node dissection or reconstruction," Dr. Domchek says. She explains that it's difficult, but not impossible, to travel and stay elsewhere while surgical drains are in place.TRAM flap reconstruction—in which tissue is taken from the abdomen and used to make a breast—has a longer recovery time, so it's less practical to book a vacation right after that.

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

Remember also that it takes about a week after surgery for the pathology report to be ready. So that week can be a nice time to take a mental break as well as a physical break—if you can manage to get your mind off the wait and onto recovery and relaxation.

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

Radiation: For the greatest effectiveness from radiation therapy, once you start your treatment, it's essential to keep to a continuous schedule and complete a full course. This means receiving treatment once a day, five days a week, for five to seven weeks. Rather than interrupting your treatment, it's better to postpone the start of your treatment to allow for your vacation plans.

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

Another way to free you up on a Friday—if your radiation oncologist is willing—is to get two treatments in one day (Monday, Tuesday, Wednesday, or Thursday) that same week, separated by 4 to 6 hours. The second treatment on another day will take the place of the Friday treatment.

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

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

Treatments you get after surgery to lower your risk of the breast cancer coming back should go forward as soon as possible after surgery. Still, if therapy hasn't begun yet, you might want to adjust your start date to suit your vacation plans. Find out how frequently you will receive chemotherapy, hormonal therapy, or immune therapy and set the date to start when you get back from vacation. A week or two delay is usually acceptable.

It's important to remember that your treatment schedule can be flexible, especially during the summer when you may want to focus on enjoying time away with loved ones, or relaxation time alone.

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

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

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

Remember also that if chemotherapy, immune therapy, or both are working for you, going on vacation is not a reason to stop treatment indefinitely. If you decided to take a short break from treatment, expect to restart it as soon as you return.

Chemotherapy tips: Xeloda (chemical name: capecitabine) is a chemotherapy that you take by pill. If your doctor starts you on this medication and you are tolerating it well, you might be able to continue the medication while on vacation.

If you're undergoing treatment, pay attention to the pattern of how it affects you. For example, you may feel well enough during week three after chemotherapy to take a long weekend getaway.

Immune therapy tips: Herceptin is an immune system treatment given intravenously (through a needle in a vein) in your doctor's office. Women may receive Herceptin if they have HER2-positive breast cancer that's metastatic, or if they have earlier-stage cancer and are part of a clinical trial.

Side effects of Herceptin are usually mild, so you'll probably feel well enough to leave within a few days of your treatment.

If you have HER2-positive metastatic disease, you may be receiving Herceptin every week for as long as it's working. You can also receive it every three weeks.

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

But even if you go away and skip a weekly treatment, you don't have to lose touch with your medical team. If the once-a-week connection with your nurse and your doctor offers much-needed reassurance, you don't have to give that up. While you're away, tap into that good energy with a phone call at your regular treatment time.

Other summertime treatment concerns:

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

But what about the tickets you paid for months ago or the beach house lease you signed? Are you stuck with it? Did you get travel insurance just in case?

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

Plan a summer that's right for YOU

The most important thing to remember is that you need to do what feels right for you this summer. If you feel that you just need to get away from it all for a while, see if you can start chemotherapy or radiation a week or two later than planned. If you don't feel up to that two-week whitewater rafting adventure holiday, let your family know that you'd prefer something a little less rigorous this year, and that you're looking forward to taking the vacation next summer, or in a different season. Vacation spots can be less crowded in the fall or winter. And you can take a winter vacation in a part of the world that's having summer!

If you focus on YOUR needs, and let your loved ones and doctors know your desires and limits, they will be able to help you make this a relaxing and enjoyable summer season.