Breast Cancer Survivorship

When finishing treatment for breast cancer, most people feel different than they did before diagnosis. Oftentimes, it is difficult to adjust to the “new normal.” Fred Hutch's Breast Cancer Program created this educational resource guide to help you through this transition. This guide covers a variety of topics and includes outside resources. We invite you to explore the resources at your own pace, in a place that works for you.

woman in a garden with a child

Healthy Living

Certain choices can have an impact on your health post-treatment. The following resources can help guide you to hopefully reducing your risk of getting cancer again. Nutrition and physical activity are strategies that should be relatively easy to adopt but other things you can pursue may be beneficial. You may have had genetic testing in the past but as our knowledge and technology improve you may find further testing provides helpful new information. Integrative medicine can help you cope with treatment side effects and enhance your wellness and quality of life.


Nutritional overview provided by Raymond Palko, MS, RD, CSO, CD.

Evidence-based studies have shown that by increasing physical activity, choosing healthy foods, and maintaining a healthy weight, you can reduce your or risk of getting cancer again. While there is no one-size-fits-all strategy, following these general guidelines will help:

  • Choose whole, plant-based foods.
  • Eat less processed foods and moderate amounts of animal-based foods
  • Limit alcohol intake.
  • Stay active on a regular basis by doing something you enjoy, such as walking, riding a bicycle, practicing yoga, or something else.

Nutrition Videos

Physical Activity

Physical activity overview provided by Lexi Harlow PT, DPT, CLT.

  • Prioritizing physical activity is essential to thriving as a cancer survivor. By participating in regular exercise, you improve your quality of life and ensure you have energy to participate in the activities you enjoy doing.  
  • Regular physical activity can help you manage fatigue, reduce anxiety and depression, improve your sleep, maintain a healthy weight, and improve muscle strength and bone health. Exercise programs can be beneficial for addressing treatment side effects such as neuropathy, lymphedema, muscle weakness, and/or pain. 
  • To optimize the benefits of exercise, it is important to include cardiovascular conditioning, resistance training, and stretching routines.  Many survivors can safely begin or maintain their own exercise program, but consultation with an exercise specialist or physical therapist can be helpful when addressing specific side effects or activity limitations.  
  • In order to stay active, it is important to choose exercise or physical activity that is simple and enjoyable. Cancer survivors should avoid inactivity and return to normal activities as soon as safely possible after diagnosis and treatment.  It is important to start slowly and build up the amount of activity as you get stronger. 


Genetics overview provided by Cynthia Handford, MSc, CGC, CCGC

  • Some people have breast cancer because it is inherited in their family. Genetic testing uses a blood or saliva sample to look for inherited changes in breast cancer genes. Knowing if you have an inherited genetic change can:
    • find an explanation for why your cancer happened
    • give information about your chance of developing another cancer
    • help with decisions about treatment, screening, and prevention
    • find out if your family members are at increased risk for cancer
  • Health insurance usually covers genetic testing and low-cost options are also available. Results take 2-3 weeks to complete.
  • If you had genetic testing in the past that only looked at a few genes, you may need updated testing. It is important to repeat genetic testing over time as our knowledge and technology improve.
  • If you are interested in learning more about genetic testing options, ask your medical team to refer you to the Clinical Genetics team or call .206.606.6990.

Integrative Medicine

Integrative medicine overview provided by Lexi Harlow PT, DPT, CLT.

  • Integrative Medicine is a patient-centered, evidence informed field of cancer care that uses mind and body practices, acupuncture, natural products, and lifestyle modifications, together with conventional cancer treatments. 
  • While medical treatments focus on fighting the disease, Integrative Medicine, in collaboration with our other supportive care services, can help you cope with treatment side effects and enhance your wellness and quality of life. Integrative Medicine providers at Fred Hutch will work closely with your care team.
woman experiencing a headache

Late and Long-Term Side Effects

This section covers late and long-term side effects like lymphedema, cognitive changes, fatigue, and neuropathy and provides resources to help understand how you might approach managing these difficulties.


Lymphedema overview provided by Lexi Harlow PT, DPT, CLT.

  • Lymphedema is the buildup of fluid and swelling that happens when your lymphatic system is affected by treatment. Signs of lymphedema include mild to severe swelling, feelings of fullness or tightness, or burning or tingling in the treated area.  Lymphedema typically occurs in the area of your body that was treated with radiation or surgery, such as lymph node removal. Not everyone who has radiation or surgery lymphedema.
  • The most important step you can take to help reduce your risk is to live a healthy lifestyle. This includes eating nutritious foods, staying well-hydrated, exercising on a regular basis, getting good sleep and rest when you need it, and taking care of your skin in the at-risk area.
  • You can also make regular appointments with a certified lymphedema therapist (CLT). They will monitor the treated area, work with you to create a treatment plan, and discuss questions and concerns with you as needed. 
  • If you think you may have lymphedema, please contact your medical team and call the Fred Hutchinson Cancer Center Physical Therapy Department at 206.606.6373.

Cognitive Changes

Cognitive changes overview provided by Myron Goldberg, MD.

  • Cognitive difficulties are common in patients undergoing treatment of breast cancer and  most frequently involve declines in sustained attention, short-term memory, processing speed, word finding, and organization and planning.  While often labeled as “chemobrain” or “chemofog,” the cognitive difficulties may not always be related to chemotherapy, as other potential causes can be present, including the cancer condition itself, concomitant medical conditions (e.g., anemia), sleep disturbance, fatigue, pain, and emotional factors (e.g., stress, depression).  While often mild in severity, the difficulties can have significant effects on the individual’s ability to function well in their daily life, especially in busy, demanding settings.  
  • The first step in addressing cognitive difficulties should be to inform your medical care providers, who can help determine if there are causes that can be improved with treatment.  Many self-initiated strategies can also be very helpful in enhancing cognitive functioning and include, for example, pacing activities in the day to help with fatigue and increase alertness, good sleep habits, regular exercise, healthy diet, engagement in cognitively stimulating activities (e.g., frequent social interactions, crossword puzzles, taking an academic course, learning a new hobby), and stress management (e.g., yoga, meditation, relaxation strategies). 
  • Additionally, use of compensatory systems can improve cognitive functioning in daily life and involve, for example, consistent use of a daily planner or smart phone to help with recall of important appointments or daily tasks to be completed and a memory book to write down important information from conversations or medical appointments. 

Cognitive Changes Video


Fatigue overview provided by Jenica Holt-Melnick, PT, DPT, CLT.

  • Fatigue is one of the most common symptoms experienced by people with cancer. Cancer related fatigue is described as a lasting tiredness that gets in the way of normal  life activities. 
  • Fatigue may continue long after cancer treatment is completed. Energy conservation strategies can be helpful to manage your symptoms. Some strategies can include keeping a diary to allow you to track time when you may have more energy to complete daily tasks, creating regular rest/sleep routines and delegating as much as possible to friends or family. 
  • Light physical activity and exercise can also help improve energy levels. If you are experiencing fatigue, it is important to talk to your team so they can help you cope with it. 

Fatigue Video


Neuropathy overview provided by Tresa M. McGranahan, MD, PhD.

  • Peripheral neuropathy is a common side effect of certain chemotherapies that treat breast  cancer. It is a nerve problem that impacts your sensory and motor nerves.
  • If your sensory nerves are affected, you may have numbness, tingling, or burning sensations in your arms or legs. 
  • If your motor nerves are affected, you may have muscle weakness, cramping, or twitching. 
  • Peripheral neuropathy usually begins in the hands or feet and gets worse over time. When you have peripheral neuropathy, you have a greater chance of injuring yourself. 

Neuropathy Video