A groundbreaking discussion at the 2024 San Antonio Breast Cancer Symposium is reshaping what it means to survive breast cancer, casting a long-overdue spotlight on taboo topics from sexual health to holistic supplements and daily habits. The latest research—summarized in a special session fantastically dubbed “Sex, Drugs, and Rock and Roll”—highlights not only new scientific findings, but emphasizes the urgent need for open, stigma-free conversations between breast cancer survivors, their families, and the medical community. For Thai survivors and their families who may face culture-specific taboos around sexuality and alternative medicine, these global insights are particularly relevant—and potentially life changing.
Survivorship issues extend far beyond the clinical goals of eradicating cancer cells. For the more than two million women worldwide—and nearly 50,000 Thai women annually—diagnosed with breast cancer, day-to-day quality of life is threatened by physical and psychological side effects that often go undiscussed. “This session is based on information [and] questions that are relevant to the daily lives of people with cancer,” said session moderator Dr. Christine Ambrosone of Roswell Park Comprehensive Cancer Center. She emphasized the need to address “the benefits [and] maybe the cons of a number of modifiable factors” that can impact life after cancer (“Sex, Drugs, and Rock and Roll for Breast Cancer Patients”, AACR, 2025).
Sexual health is a case in point. Few topics are so crucial yet so rarely broached in doctor-patient conversations, especially in conservative cultures like Thailand’s, where intimacy is often considered a private matter. “Sexual health is a complicated, multi-domain issue,” said Dr. Don S. Dizon of Brown University Health Cancer Institute. Many survivors face drastic changes in their sexual self-image and functioning—half of women undergoing mastectomy without reconstruction stop seeing their chest as a core part of their sexuality. Problems such as vaginal dryness and pain with intercourse are common with endocrine therapy, but Dr. Dizon notes, “After cancer, everyone deserves a sex life.” Interventions include moisturizers, topical therapies, and counseling to address intimacy challenges, which are not just physical, but also deeply emotional and relational.
In Thailand, sexual matters are rarely discussed openly, even among family members, let alone with healthcare providers. As a result, many survivors “jai-yai bpen klang” (ใจใหญ่เป็นกลาง) — keep their suffering hidden for fear of causing shame or distress. This new research insists that Thai medical teams and patients need to build a culture where sexual health is addressed without embarrassment, with clear communication about available treatments and support.
The session also tackled the controversial role of holistic medicine, a hot topic in Thailand where traditional remedies—ranging from herbal drinks to meditation—are widely popular. But many patients do not tell their doctors about supplement or cannabis use: only 22% of US breast cancer patients disclose cannabis use to physicians, and the figure plummets to 11% in places where medical marijuana remains illegal. Thai regulations are swiftly changing, with legalized medical marijuana and new integrative oncology clinics emerging, but stigma persists.
Dr. Heather Greenlee of Fred Hutch Cancer Center stated, “We really need to have an environment where patients can have safe discussions with [physicians] about what they’re doing.” She cited new guidelines from the American Society of Clinical Oncology (ASCO), which state that while cannabis may help nausea and vomiting when combined with other drugs, no evidence supports its use to improve cancer outcomes. As for dietary supplements, the short “approved” list includes ginger for nausea, ginseng for fatigue, and lavender aromatherapy for anxiety—but warns against potentially harmful substances like acetyl-l-carnitine, or ineffective supplements like aloe vera for skin irritation.
Debate is lively in Thai circles over the role of “ya-tam-rae” (ยาตำรายาแผนโบราณ—traditional medicine), but the message from international guidelines is clear: patients should talk openly with doctors about everything they use, and clinicians should be trained to listen without judgment. This is still a challenge in many Thai hospitals, where time-stretched doctors may lack training in alternative or complementary therapies.
If sex and supplements are sensitive, physical activity and healthy eating should be easier sells. Yet research shows that only 14% of female cancer survivors and just 13% of all survivors over 65 globally meet the US CDC’s exercise guidelines of just 150–300 minutes per week. Inactivity affects 40–60% of all survivors, and the trend is likely similar or worse in Thailand, where urban lifestyles and high heat make outdoor activity daunting. Dr. Rikki Cannioto’s meta-analysis offers game-changing data: moderate exercise cuts breast cancer mortality by almost half (48.5%) and decreases recurrence by 31%. Put simply, “Some physical activity is better than none, and adults who sit less gain some health benefits.”
The practical recommendation? Move more, sit less. For many Thai survivors coping with fatigue or post-operation discomfort, this can mean incremental changes—doing chores, gentle stretching, taking the stairs at BTS/MRT stations, or trying Thai “ram muay” (รำมวย—a traditional dance-martial art) for gentle physical engagement. There is no evidence that a “perfect” regime is required; even small increases in activity show major returns.
What about diet? Here, the story turns to the power of everyday choices. Dr. Lawrence H. Kushi’s studies found that greater adherence to Mediterranean, DASH, and similar high-quality diets is linked to lower all-cause and breast cancer-related mortality. Thai cuisine, rich in vegetables, freshwater fish, and herbs, can be adapted toward these diets, especially by limiting fried foods and sugary drinks. While alcohol—and even moderate consumption—is a known risk factor for developing several cancers, more research is needed on its influence after a cancer diagnosis. But given Thai women’s generally low rates of alcohol consumption compared to Western countries, as indicated by World Health Organization data, focusing on fruits, vegetables, and traditional “tam sang” (ตามสั่ง—fresh-cooked) meals over processed foods and sugary beverages is both a feasible and culturally sensitive shift.
These research findings arrive at a critical time: breast cancer rates in Thailand have steadily risen over the past two decades, with improved detection and survival shifting patient focus from “just surviving” to “living well.” Thai culture’s emphasis on community, family, and spiritual health (think วัด, making merit, and mutual caregiving) can be leveraged to build supportive networks for survivors as they confront physical, emotional, and practical challenges.
Looking to the future, the standard of breast cancer care in Thailand will likely continue to evolve in three key directions. First, the medical curriculum and hospital protocols must expand to address sexuality and intimacy openly, perhaps drawing on successful counseling models from Australia and Singapore where peer-led survivor groups break the silence. Second, ongoing government investment in integrative oncology and patient education will be needed, so patients can confidently discuss both modern treatments and traditional medicine. Third, public campaigns should encourage moderate movement and healthy eating as essential—not optional—parts of post-cancer health, with support from community centers and local leaders.
For Thai readers and their families, the takeaway is a call for honest, practical conversations: “ทำตัวเองให้ดีที่สุด” (“do your best for yourself”) now means not only following doctors’ orders but also honoring the physical, emotional, and cultural complexity of survivorship. Thai hospitals and clinics should create safer spaces for talking about sex, for sharing information about alternative remedies, and for supporting survivors’ efforts to exercise and eat well.
If you or a loved one is navigating life after breast cancer, consider these actionable steps: initiate open discussions with your healthcare team—even about sensitive subjects; keep a record of any supplements or herbal therapies you use and share it with your doctor; try to build up physical activity, even in small amounts, each week; and adjust meals to favor fruits, vegetables, and fish while easing back on fried and sugary foods. Coping with side effects or emotional struggles? Reach out to local support groups or online survivor networks, where sharing experiences can be both healing and empowering.
Above all, survivors should remember: your well-being does not end with the last round of chemotherapy. Life after breast cancer is a journey best lived “chai yai pen tam-mada”—with openness, compassion, and a steadfast belief that every woman, and every survivor, deserves not just quantity of life, but quality as well.
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