A new wave of research is shining light on the crucial, yet often overlooked, aspects of survivorship for breast cancer patients—including sexual health, holistic symptom management, and lifestyle choices like exercise and diet. The 2024 San Antonio Breast Cancer Symposium recently devoted a special session to these quality-of-life issues, signaling an important shift in how doctors, researchers, and advocates are addressing the daily realities faced by breast cancer survivors worldwide—including here in Thailand.
This story matters deeply for Thai readers, where breast cancer remains among the most common cancers in women, and survivorship is steadily improving thanks to earlier detection and better treatments (WHO). With more Thai women living years beyond their diagnosis, attention is shifting from mere survival to ensuring the best possible quality of life. The Symposium’s focus on topics such as sexual wellbeing, supplements, and exercise offers promising guidance, but also highlights challenges in how these topics are discussed in medical and social settings—especially in cultures where sexual health remains sensitive.
The session, titled “Sex, Drugs, Rock and Roll,” covered a broad spectrum of daily-life issues long neglected in mainstream cancer care. According to a senior moderator from Roswell Park Comprehensive Cancer Center, the goal was to present “the benefits and maybe the cons of a number of modifiable factors.” As survivors cope with symptoms such as pain, fatigue, or nausea, or experience deep changes in their sexual self-image, the need for open dialogue—across genders, ages, and cultures—is increasingly clear.
Research indicates that sexual health is a multi-faceted issue for breast cancer survivors, encompassing not only physical symptoms—such as vaginal dryness and pain linked to endocrine therapy—but also profound emotional and mental impacts. A leading oncologist from Brown University Health Cancer Institute shared, “If I ask an audience, ‘How many of you are having issues with intercourse,’ I get one answer. If I ask about problems with intimacy, I get a very different one.” A striking study highlighted at the event found that the percentage of women who viewed their chest as part of their sexuality plunged from 95% to 47% after mastectomy without reconstruction. Interventions like vaginal moisturizers, topical numbing agents, and relationship counseling were cited as important aids, but the speaker emphasized, “After cancer, everyone deserves a sex life.”
The Symposium also investigated the growing trend among breast cancer survivors to seek out holistic therapies, such as supplements and cannabis, to manage symptoms. An expert from Fred Hutch Cancer Center stressed both the promise and peril: while some supplements (ginger for nausea, ginseng for fatigue, lavender aromatherapy for anxiety) offer evidence-backed benefits, others can be risky—or outright harmful. Fish oil, for example, may increase bleeding risk, and antioxidants might counteract therapies that rely on oxidative stress. Notably, while 42% of breast cancer patients in one U.S. study reported using cannabis, only 22% disclosed this to their doctors—underscoring a serious communication gap, especially in regions where taboos or legal restrictions persist. Thai physicians and survivors face parallel challenges in broaching these topics, as legal and cultural sensitivities remain pronounced.
Recent American Society of Clinical Oncology (ASCO) guidelines recommend cannabis as an add-on for controlling nausea and vomiting in specific situations, but not for pain, fatigue, or overall cancer outcomes (ASCO Guidelines). For many supplements—such as aloe vera for radiation skin reactions or acetyl-l-carnitine for nerve pain—the evidence remains unconvincing or shows harm. The takeaway for both Thai and international patients: consult with your oncologist before trying any holistic or herbal remedy, and do not withhold information about supplement or cannabis use out of shame or fear.
Physical activity, once viewed merely as a supportive therapy, is now recognized for its potential life-saving impact during breast cancer treatment. Research spearheaded by Roswell Park Comprehensive Cancer Center pooled data from multiple studies and found that meeting CDC guidelines for exercise (at least 150 minutes of moderate or 75 minutes of vigorous activity per week) reduced mortality by nearly half and recurrence by 31%. Even modest increases in activity provided significant gains—“there is no minimum threshold,” the researcher stated. This has critical implications for Thailand, where rapid urbanization and changing lifestyles have driven many residents—especially in Bangkok and other cities—towards more sedentary routines.
Another expert, from Kaiser Permanente Northern California, addressed the “rolls” side of “sex, drugs, and rock and roll”: dietary patterns. Data show that adherence to high-quality diets like the Mediterranean or DASH diet is associated with sharply lower breast cancer-specific and all-cause mortality. While alcohol increases the risk of developing breast cancer, researchers are still combing through evidence on its effects after diagnosis.
For Thai survivors, these findings surface at a time of rising interest in integrative medicine, traditional herbs, and a growing gym and wellness sector. Yet challenges remain. Many survivors struggle to access reliable information or feel uncomfortable discussing sexual health and holistic therapies with doctors—mirroring trends worldwide. In addition, cultural reluctance to discuss intimacy is deeply rooted in Thai society, even within close families.
Looking ahead, these new findings are likely to influence Thailand’s medical community, patient support networks, and possibly even national guidelines for survivorship care. Thai hospitals, particularly in Bangkok and major provinces, are increasingly adding survivorship clinics and multidisciplinary teams—including physical therapists, nutritionists, and psychologists—to help address the “whole patient.” Meanwhile, non-profit organizations and survivor groups are beginning to offer peer counseling on sexuality and body image, signaling a gradual but significant cultural shift.
What does this mean for Thai patients and families today? Start by asking your medical team about issues of sexuality, diet, exercise, and alternative therapies—no topic should be off-limits. Track your physical activity and consider small, consistent goals. When considering supplements or herbal products—from widely marketed vitamins to traditional Thai remedies—always review them with your doctor. For those experiencing intimacy challenges, both medical and counseling options are available, and no one should feel they must suffer in silence.
Finally, for Thai policymakers and community leaders, the emerging evidence reinforces the need for more open, culturally sensitive conversations about sexual health, safe use of supplements, and healthy lifestyles for cancer survivors. National cancer strategies should prioritize not only early detection and treatment, but also holistic, patient-centered survivorship care.
For readers seeking more information, detailed practice guidelines can be reviewed on the American Society of Clinical Oncology’s website (ASCO Lifestyle and Survivorship Guidelines), while in Thailand, resources are available through major hospitals’ breast cancer clinics and organizations like the National Cancer Institute (nci.go.th).
By engaging in honest discussions, staying active, eating well, and seeking help without shame, Thai breast cancer survivors can embrace a future with not only longer life—but better life.