What a finish-line photo revealed about breast cancer care

Gail sent me a photo of herself crossing the finish line of her first Ironman triathlon. Her arms were raised overhead, a grin lighting up her sunburned face. Her left arm rose almost as high as her right. That small detail meant a great deal. Preserving the shoulder function she needed to swim had been an important consideration throughout her breast cancer care.

About a year earlier, we had bonded over her love of triathlons. Gail was 35, a competitive athlete and mother of two. When I asked what she enjoyed in life, she answered, “My kids and triathlons.” What still gives me pause is how close we came to planning her treatment without understanding how important racing was to her. And, Gail did not know she had treatment choices that could help preserve her ability to race. She had not realized that triathlons belonged in a conversation about cancer treatment.

Her answer changed our planning. We added physical therapy before surgery. A surgeon experienced in muscle-sparing breast reconstruction was consulted. The sequence of treatment with chemotherapy, radiation and surgery was adapted.

During Breast Cancer Awareness Month, much of the conversation focuses on screening and early detection. That attention matters. But diagnosis begins another series of consequential decisions that continue through treatment and survivorship.

For Gail, those decisions included protecting her ability to swim. For another patient, the same shoulder function might be essential to lifting at work or caring for a family member. Understanding those needs belongs in clinical care from the beginning.

The right decisions begin with the cancer and the patient

Breast cancer is not a  uniform disease. Even when the treatment options are similar, their consequences can differ enormously. A side effect one patient finds manageable may threaten another’s livelihood, independence or sense of self.

Clinical evidence defines the available options. The patient’s clinical situation determines their risks and benefits. Within those options, her priorities help us weigh the choices together. However, patients do not always volunteer their unique priorities. In the overwhelming weeks after diagnosis, concerns about work, exercise, family or sexual health may feel too small to mention alongside the goal of surviving cancer.

For my friend Melissa who was diagnosed with breast cancer a few years after the picture with this blog was taken, her answers meant reconstruction was not a good fit for her: “Every doctor assumed I wanted reconstruction. But I was a young mother who couldn't balance those frequent hour-long trips for fills, and I had my eye on getting back to triathlons. Going flat wasn't a compromise for me—it was the practical, active choice for my life,” she recently shared with me. 

We need to ask directly, explain the choices and make what we learn part of the plan. As Gail later shared with me, she learned that she could ask for both treatment aimed at curing her cancer and care that helped her thrive afterward.

The decisions continue between appointments

A treatment plan reflects what we know at one point in time. New results, treatment response, side effects and changes in a patient’s health or priorities can call for reassessment. Many of the details that should prompt that review emerge at home or at work during regular life activities.

 A patient notices pain when reaching overhead. She cannot sleep. She struggles to finish a shift or to answer emails. She wonders whether this is expected, something to mention next month or a reason to call today. Our questions need to surface these issues and make the connections. When did it start? What makes it worse? What does it stop you from doing?

The answers help us assess a symptom’s possible cause and severity and understand the consequences. Pain described as “mild” deserves another look if it prevents someone from doing an activity central to her life.

Structured processes for reporting symptoms and alerting the clinical team, such as we used at Color, may help improve quality of care. In the PRO-TECT randomized trial of 1,191 patients with metastatic cancers, electronic symptom monitoring linked to care-team alerts reduced the average number of ER visits from 1.30 to 1.02 per patient over 12 months. Importantly, deterioration in physical function and quality of life was delayed, slowing the trajectory of impact on the patients life.

For employers evaluating a cancer benefit, the practical question is what happens after a patient reports a concern. Who assesses it? Who communicates with the treating team? Who follows through on the next step?

Clinical management and oversight connect those steps: a clinician assesses what the symptom means for the patient, works with the treating team to address it and follows up to see whether the intervention made a difference. 

Looking well does not mean treatment is easy

For patients with hormone receptor–positive breast cancer, treatment may include years of endocrine therapy to reduce the risk of recurrence. Joint pain, hot flashes, sleep disruption and sexual side effects can become daily burdens. A patient may look well to everyone around her while struggling with a medication intended to protect her future.

A 2025 study of 13,675 women at Kaiser Permanente Northern California found that annual endocrine therapy adherence, measured through prescription fills, declined from 79% in the first year to 60% in the fifth. While the reasons a patient stops an oral therapy vary widely, early discontinuation often means the full benefit of treatment is not gained.

To achieve the best cancer outcomes, we need to ask how treatment affects daily life, assess symptoms and discuss alternatives. The goal is to help each patient sustain appropriate treatment while addressing its burdens. Melissa told me “I could live with the pain from the aromatase inhibitor (a type of endocrine therapy) in my hips and knees, but when the joint pain stopped me from knitting, that was the last straw. I went back to tamoxifen (a different type of endocrine therapy).”

At Color, our clinical team works closely with the patient and their local treating physicians to deliver proactive, continuous Expert Medical Opinion when concerns are identified: does the plan still fit what we know about the cancer and the patient? Employers evaluating a cancer benefit should look for this clinical continuity: support that remains available as treatment and patient needs evolve.

Life after treatment deserves continued clinical attention

The last chemotherapy infusion, radiation session or postoperative visit mark important milestones. Recovery has its own course. A side effect that felt tolerable for a few weeks may become life changing when it lasts months or years. A priority at work, home or in the community that was set aside during treatment may become central again.

In a French cohort of nearly 10,800 patients with early stage breast cancer, the quality of life trajectory of approximately one in six declined over the first year and never recovered by year six. 

For employers, this means looking beyond completion of treatment or a date of return to work. Patients may need continued symptom management and clinical care to return to their full potential. One  goal of survivorship care is to thrive in the new normal.

Gail’s finish-line photo reminds me how much came to pass from a simple question about what she enjoyed. Her answer changed our understanding of what a good outcome meant for her, and it changed the decisions we made together.

The question about priorities belongs at the beginning of cancer care. It deserves to be asked again throughout it by clinicians who can take action.