Managing Breast Cancer Treatment During the COVID-19 Pandemic

In December 2018, Maria began feeling pain in her left breast. A mammogram later showed that she had a cancerous tumor and needed surgery. A small tumor of a different kind in her right breast convinced her to undergo a double mastectomy.

Shortly after her surgery, the COVID-19 crisis was declared a pandemic. Maria found herself recovering at home and undergoing radiation and chemotherapy, while working full-time and caring for her children. In this edited interview, Maria reflects on her cancer treatment and what she learned about prioritizing her health and family during the pandemic.

ACOG: Tell us about your breast cancer diagnosis.

Maria: Around the time of my son’s first birthday, I started having pain on the left side of my body, in my ribs and my shoulder. He was a very heavy toddler and I blamed the pain on the strain of carrying him. I ran into my gynecologist at an ice skating rink and I mentioned the pain. She recommended I come in to get checked out. I never did. I was busy with work and it was difficult for me to make time for myself with two kids. Our toddler kept getting ear infections, so I kept postponing my own care.

When my son was a year and a half, I started working out again, and one day after removing my sports bra, I realized my left breast was extremely swollen. I was in pain. I went to the doctor, who said it was probably a cyst. She recommended I make an appointment with a breast surgeon. Even if it wasn’t cancer, which she didn’t think it was, I would likely need surgery because the cyst was so big. I made appointments with the surgeon and for a mammogram. The minute I did the mammogram the technician knew I had cancer.

ACOG: When did it become clear that you would have a double mastectomy?

Maria: It became clear after a lot of testing. First, the mammography technician called the radiologist and said I needed a biopsy ASAP. My doctor urged me to go to the surgeon as quickly as possible. She knew I had cancer, and the only reason to do the biopsy was to know what type.

It turned out I had one big tumor in my left breast. It was triple-negative breast cancer, which can spread really quickly. I had to do a lot of tests to figure out if it had spread to other areas of my body.

They also found that I had a small tumor in my right breast that was a different type of cancer, but it was so small they couldn’t diagnose the cancer type. Even though I have no history of breast cancer in my family and I’m BRCA-negative, the two different types of cancer convinced me that I needed to have a double mastectomy. I didn’t want to risk having cancer again.

ACOG: What was your treatment plan?

Maria: They told me I needed to start 6 months of chemo right away, before surgery. I started chemo in August 2019 and finished at the end of January 2020. I had my double mastectomy at the end of February, just a couple of weeks before the COVID-19 crisis reached the United States.

ACOG: What was the surgery like?

Maria: Going into the surgery, I was most afraid of the unknown. I was afraid I wouldn’t wake up. I started feeling very scared and insecure, especially about how I would look. A couple of weeks before the surgery I started going to therapy. I also talked to the plastic surgeon and saw pictures of reconstructions, which was a suggestion from my therapist. Then I felt better about what I was doing.

The surgery itself was okay. The day of the surgery I was particularly quiet and calm. After the surgery, I woke up and two of my friends were there because my husband had to be with the kids. I was sleepy. I was surprised it was so quick. In the days after, I was good. They gave me medication to control the pain.

My doctor used temporary tissue expanders, empty breast implants that the doctor gradually fills with saline over several weeks. The implants expand the skin and tissue until they reach the breast size my doctor and I decided on for my reconstruction. I was happy with how the expanders looked. I didn’t think I looked sexy or would go to a nude beach, but it looks okay. When I have sex with my husband I like to wear a bralette or tank top because they don’t look great naked, but they did a great job in how they look with clothes. I can even show a little cleavage. I’m fine with that.

I thought it would be much more traumatic. I was so confident that it was the right decision that I have been able to forget about the scars and how I look. Technology and science have come so far. My scars are very similar to when a woman reduces her breasts.

ACOG: What happened next?

Maria: I was at home and still recovering from the mastectomy when the pandemic came. I had to do 25 sessions of radiation, then 4 more months of chemo at home with a pill. Then I had breast reconstruction—another surgery during the pandemic, this time without my parents traveling to help me. I was afraid they would catch the coronavirus during their trip.

ACOG: How was your care during the pandemic different from your care before the pandemic?

Maria: The hospital I’ve been going to has been absolutely great. They’ve taken all the standard COVID-19 precautions.

My chemo treatments started before COVID-19. At first I was going every other week, and then every week. Even with the trauma of feeling so awful and losing my hair, I became friendly with the nurses and the technicians helping me. It was a very nice relationship. On the last day of chemo I hugged everyone.

I started radiation during the pandemic, and that was very different. Wearing a mask, shield, and gloves means we have gotten to know each other less. You can’t hug them when you’re done. I’m very thankful for what they did for me, but it was a transactional process. Nobody, neither them nor me, wanted to talk or get close in order to limit exposure. The last day of radiation, I waved and said bye. I am not even sure I could recognize the technicians if I saw them again.

ACOG: Were you able to receive treatment on the same schedule despite the pandemic?

Maria: Yes. My appointments were never delayed because of COVID-19. However, some things have been more difficult. It’s difficult to have telemedicine appointments for such a serious disease. It’s harder for my doctors to see my body and help with the side effects of treatment.

For example, I developed hand-foot syndrome, where my hands and feet were radiating heat as if I had burns. This was a side effect of oral chemo, which I started at the end of June 2020. I told my oncologist about this during several telemedicine visits, but it was hard to show him how bad it was. Eventually I saw him in person, and he lowered my medication dose and gave me a special lotion to help with the burns.

ACOG: How did the treatment affect you physically and emotionally?

Maria: Chemo was the thing I was most scared about at the beginning. It ended up being fine. I didn’t get that sick. I felt normal. I wasn’t doing anything wild but I could work and take care of my kids, which was my priority.

Radiation was not as bad, but at the end I started getting very tired, and I had burns on my radiated breast. They hurt a lot. The weeks after I ended radiation, the pain on my radiated breast was awful.

Oral chemo was surprising. I felt very sick to my stomach. I had nausea and diarrhea. The pain from the burns caused by the hand and foot syndrome was terrible. I could not go out for walks, which is something I really enjoy. Other times I felt very tired, and all I wanted to do was sleep. But I needed to get out of bed, no matter how bad I felt.

The combination of treatments and the pandemic affected me much more than the surgery. My husband wasn’t able to take time off from work, my parents, in-laws, and friends were not able to help. I needed to help with the kids.

Between the treatments and how the breast area felt after surgery, it was definitely hard to take care of two young kids. I love my kids and husband, but I could not wait for them to go back to school and the office. It was a very difficult situation to recover from surgery and be in pain with your kids jumping all over you.

Now that the kids are back in school, both my husband and I feel more normal. We have our space to work at home and feel like we can enjoy coffee or lunch together once in a while.

ACOG: Have you found any support during this time?

Maria: I’m not from the DC area, so I don’t have family here. Before the pandemic, we had been planning to have my reconstruction over the summer and to send my daughter to stay with my parents. That didn’t happen because of COVID. I ended up having my reconstruction in November 2020, and I had to stay at the hospital by myself for a week. My husband had to stay home with the kids.

Once I started chemo, I didn’t want to see anybody for my own safety, so I was staying away from others since before the pandemic. But relatives would travel occasionally to check on us or watch the kids, and friends and coworkers tried to stop by and help.

Unfortunately that changed with COVID-19. We weren’t able to have people come and help. I had to do a lot of housework and childcare, and my husband did a lot too. He was amazing every single day. But I did see my neighbors and mom friends outside in our yards, which helped with my mental health. I also texted with friends, and the fact they checked on me helped a lot.

But basically, for about 14 months I’ve spent all my time with my kids. The only time I’m without kids is when I go to a doctor’s appointment. About a month ago I finally had a date with my husband. I can’t describe how good that felt.

ACOG: What do you wish you’d known at the beginning of your treatment journey?

Maria: It sounds naïve, but I didn’t know that the physical changes from chemo would be so intense. Sometimes doctors aren’t able to fully prepare you for all the things that are going to happen.

I was expecting to lose my hair on my head, but quite frankly I was not expecting to lose my hair everywhere else. I was very surprised by how hard it was. Losing my eyebrows and eyelashes was extremely traumatic. It took me by surprise. As a woman, you experience a kind of menopause with chemo for a year or two. It’s a physical process that affects the things that make you feel like a woman. I would recommend having someone help you be prepared for what you’re about to experience.

It also helps to have guidance on what to expect with all aspects of your treatment plan: the psychological effects of the physical changes, finances, childcare, and more.

ACOG: What else would you tell other women who are going through breast cancer treatment?

Maria: Going to therapy was very helpful. If someone is comfortable doing therapy by video conference, I would absolutely recommend it. My therapist helped me a lot with my decision process. It’s important to have a neutral person who can give advice.

If you have a partner, it's important to have conversations about housework and what treatment will entail. Your partner will have to be involved in more things. Are you able to hire someone to clean, or is your partner going to take over? Recognizing where you need help is crucial. I had always been in charge of laundry in my house, and I knew I would not be able to use my arms for a while. In a house with four family members, laundry was a big decision!

Another thing is to find ways to entertain yourself. Depending on what you like, it could be anything—meditation, yoga, reading. I love my job and working actually kept me sane.

Physical activity is also important. You lose muscle both from surgery and from radiation. You need to make your muscles strong again. Doing upper body workouts or stretches helps a lot to get your range of movement back. I spend an hour every day riding my exercise bike, lifting weights, or doing stretching exercises. It relaxes me and helps me keep my thoughts away from everything. It’s good for my mental health.

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This information is designed as an educational aid for the public. It offers current information and opinions related to women's health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.