Journeying with breast cancer (BC) survivors through holistic multidisciplinary care enables them to cope better with physical and emotional stress, improves survivorship and adherence to endocrine therapy, and reduces recurrence risk, emphasized BC coach, Ms Isabel Galiano, and a multidisciplinary oncology care panel at the 14th Asia-Pacific Breast Cancer Summit (APBCS 2026).
“Many women describe life immediately after the end of active treatment as exiting an ‘auto-pilot’ mode where emotions surge as reality settles. It is a phase when we are often very sensitive and become very vulnerable as the reality of what happened really hits us,” said Galiano, who just celebrated her 20th anniversary as a two-time BC survivor. “Survivors feel ‘less safe’ as the safety net of active treatment fades while some side effects linger and new side effects emerge. They often feel lonely and ‘not understood’ as others expect them to just get back to ‘normal life’. At the same time, they also feel overwhelmed with information overload from well-meaning family and friends and online reading.”
Sleep disturbance/insomnia is also common in BC survivors. Exhaustion from sleep disturbance compounds stress and side effects of endocrine therapy (eg, joint pain, sexual dysfunction), leading to adherence issues and increased recurrence risk. [Neuropsychiatr Dis Treat 2014;10:1113-1124; Am Soc Clin Oncol Educ Book 2023;43:e390442; SAGE Open Med 2022;10:20503121221078722; Breast Cancer Res Treat 2022;196:535-547; Gebursthilfe Frauenheilkd 2026;86:75-83]
“Education alone is insufficient. Effective communication of evidence-based interventions [eg, exercise/physical activity] and, more importantly, ongoing support and behavioural change strategies are required for implementation of measures that will help survivors navigate and overcome challenges at different stages of the journey,” said Galiano. “In practice, such strategies include personalizing roadmap, individualizing the approach, prioritizing goals, engaging through collaborative goal-setting, building accountability structures, using nonjudgmental and validating language, and celebrating small wins.”
Galiano cited The Pink Ribbon Initiative, a nurse- and community navigator–led navigation programme in breast clinics of four public hospitals in Malaysia providing emotional support, care coordination and barrier resolution, as a real-world example demonstrating the effectiveness of patient navigation. Treatment adherence improved from 87 to 98 percent after programme initiation and, notably, treatment default rate decreased from 14 to 4 percent. [JCO Global Oncol 2024;10:e2300297]
The CHALLENGE trial in post–adjuvant chemotherapy stage II/III colon cancer survivors (n=889; median follow-up, 7.9 years) demonstrated the benefit of a structured exercise programme in cancer survivors. Exercise adherence rate was 70 percent in the group that received supervised physical activity coaching for 3 years vs 28 percent in the group that received only printed lifestyle advice. Recurrence and mortality rates in the coached group were 28 and 37 lower, respectively, further highlighting the importance of support. [N Engl J Med 2025;392:1976-1989]
Growing evidence of benefit has compelled the use of supportive care as part of the continuum of cancer survivor care in integrative oncology – a patient-centred, evidence-informed field of cancer care that utilizes mind and body practices, natural products, and/or lifestyle modifications from different traditions alongside conventional cancer treatments. Evidence-based guidelines for incorporating complementary and integrative therapies into conventional oncology clinical practice have been published by the ASCO–Society of Integrative Oncology. [J Natl Cancer Inst Monogr 2017;2017(52); https://integrativeonc.org/practice-guidelines/]
“For us cancer survivors, treatment is a chapter in our lives. Survivorship is the rest of our lives,” noted Galiano.