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“Breast cancer is the most common cancer and top three causes of death amongst women worldwide,” shares Dr Joline Lim, who is both a consultant at the National University Cancer Institute (NCIS) and assistant professor at the National University of Singapore’s Yong Loo Lin School of Medicine. “In Singapore, over 3,000 patients were diagnosed with breast cancer in 2018, accounting for more than a quarter of all cancers diagnosed amongst women that year.” Worse still: statistics show that breast cancer has been on the rise in Singapore over the past decade, and “spans young adults all the way to elderly women.”
According to Dr Lim, the good news is that, “While breast cancer may be common, treatment of breast cancer is fortunately very effective in its early stages, and the importance of breast cancer screening cannot be overemphasised. Early detection is the key to cure!”
Chemotherapy is a challenging time for patients and their families. Not only does it take a toll on patients’ mental health and resilience, changes in their physical appearance and self-image may prove another confronting challenge to overcome. “Chemotherapy is a challenging time for patients, and changes in the physical aspects can make the journey more arduous,” says Dr Joline Lim. “In general, chemotherapy affects the skin, hair, nails and body regardless of choice of chemotherapeutic agent, but the degree and extent of effect may be agent specific.”
“Patients may experience skin dryness, itch, photosensitivity, pigmentation changes and ulcers in the oral cavity. Nails may also become more brittle, appear darkened, and horizontal depressions or white discolouration along the nail bed may be observed,” says Dr Lim.
“The oncologist will recommend suitable skin moisturisers and oral care to try to mitigate these side effects. Certain chemotherapeutic agents are also known to cause more specific side effects, including palmar-plantar erythrodysesthesia (peeling of skin on palms and soles), or rash. We advise regular application of skin emollients if such side effects are anticipated, and in more severe cases, some may require short courses of topical antibiotics or topical steroids. If required, patients may also be referred to dermatologists for further advice on management and need for oral medications. In rare cases, patients may develop an allergic response or hypersensitivity to chemotherapy that may manifest as rash or hives that will require immediate medical attention for treatment.”
“Alopecia is a common temporary side effect of many chemotherapeutic agents, whereby patients experience hair loss during chemotherapy. Hair regrowth will almost certainly take place once chemotherapy is completed, and for some fortunate patients, even during later stages of chemotherapy! It is important to note that hair loss can happen anywhere on the body, including eyebrows and eyelashes. The degree of alopecia differs greatly depending on the choice of chemotherapy, with some causing complete alopecia, while others leading to minimal hair loss. In recent years, the U.S. Food and Drug Administration (FDA) has approved various scalp cooling systems that have been shown to decrease the degree of hair loss for women undergoing chemotherapy, with various degrees of success depending on the type of chemotherapy that is administered. Scalp cooling therapy is now available in various institutions including the National University Cancer Institute, Singapore.”
Dr Lim: “Taking good care of the skin is vital during chemotherapy as a breakdown in the skin barrier may cause pain and is a potential site for infection. Sun protection with sunscreen and UV protective clothing is encouraged as some chemotherapeutic agents can make the skin more sensitive to sunlight. For daily use, mild unscented and fragrance-free products may be more suitable. Regular use of moisturiser is highly recommended to alleviate skin dryness, irritation and decrease risk of cracking. They should contain products to help repair the skin and provide barrier protection, such as ceramide which is an important component of the skin barrier, petroleum jelly or lanolin for barrier protection. Use of mild topical retinoids is unlikely to have damaging effects, but excessive application can cause dryness or skin irritation. Regular use of lip balm is also encouraged to prevent chapped lips that may be further exacerbated by ulcers.”
Dr Lim also recommends that nails should be kept trimmed and clean, noting that if a manicure or pampering pedicure is on the cards, to “ensure that equipment used is clean so as to prevent introduction of any infection.” And whether you’re wanting to touch up your roots or give yourself a fresh new dye job, it’s best to do a patch test on a small area of the skin to ensure there’s minimal irritation to your scalp and skin. Dr Lim also notes that using natural hair dyes “may help minimise risk of sensitivity or rash.”
Dr Lim recommends avoiding alcohol-based products, as they may exacerbate skin dryness. And while you may be longing for a spa treatment or even and at-home scrub in the shower, “exfoliating agents or body scrubs that may put the skin under undue stress should also be avoided.” If in doubt, always check with your oncologist or dermatologist who can assess your skin’s condition.
Opt for short, cooler showers instead of “long warm baths may be more suitable as the latter may strip the skin of its protective layer. Products with fragrances or excessive content of minerals or vitamins are also generally not recommended as they may contain extra chemical or oils that increase the risk of contact dermatitis (skin allergy or irritation),” says Dr Lim.
“It is extremely vital to inform the doctor if you have known skin conditions like eczema or psoriasis, as these conditions may be exacerbated during chemotherapy. The doctor will be able to work with a dermatologist during the period of chemotherapy to minimise the risk of worsening the underlying skin condition, while maintaining optimal treatment for the cancer.”
“It is not uncommon for women to experience loss of appetite during the course of treatment partially due to change in taste, and also other chemotherapy side effects like nausea or bloatedness. Nonetheless, maintaining an healthy diet and stable weight is important, as food intake forms the building blocks for cell renewal and wound healing,” says Dr Lim. A balanced diet full of fruits, vegetables, and “plenty of liquids to maintain hydration,” is recommended. “During the course of treatment, the oncologist will do regular blood checks and may recommend stepping up on various food components that may be higher in certain electrolyte or mineral content based on the results of your blood investigations. Do check with the oncologist about what vitamin supplements may be required or are compatible with specific chemotherapies.”
According to Shiseido, many cancer patients experience skin dullness, pigmentation and loss of eyebrows. And, post-chemo, patients may find it particularly challenging to draw the eyebrows without any hair, due to lack of a guide and smoothness of the skin. Taking time to self-care after emotionally and physically draining chemotherapy sessions may help patients to regain their confidence, and encourage them to socially maintain ties with friends and family. Recognising the power of beauty and grooming, Shiseido opened the doors to its Shiseido Life Quality Centre in Singapore (SLQC) located at Cecil Street, Fraser Tower in 2019. The space partnered with medical institutions, non-profit organisations and other entities, and shares that about 15 per cent of SLQC visitors experience cancer related skin concerns.
With a rising number of people living longer despite their cancer diagnosis, SLQC has also seen an increase in inquiries about concealing the evidence of treatment. With more than 30 different types of skin conditions brought on as a side effect of cancer treatments, the SLQC’s aim is to help improve the quality of life for patients, helping them to regain their confidence. Their findings show that with beauty care, there is a significant improvement on the state of depression amongst patients. Caring for yourself transcends mere appearance, and is more about caring for one’s mind and self-image.
Pre-Covid, the SLQC played host to regular make-up seminars to medical specialists, as well as hairstylists, particularly those who work with cancer patients. Given the current Covid-19 situation, the space is temporarily closed however the SLQC offers digital support and complimentary one-to-one counselling sessions, offering tips on the best make-up methods and cosmetic products. Patients and their carers can also read the SLQC’s dedicated Beauty Book on make-up advice for cancer patients. The guide aims to help anyone with treatment related appearance concerns to feel like themselves with the power of make-up in four different areas: handcare, skincare, make-up and haircare. SLQC also offers online tutorials and personalised make-up consultations. Patients can also contact +65 6430 9969 and SLQC@shiseido.com.sg more information.
You are not alone. For more information about the cancer support systems and resources in Singapore, visit Health Hub or NCIS's Breast Cancer Support Groups. For cancer support in Malaysia, visit the National Cancer Society Malaysia.
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This article originally appeared in Vogue Singapore and has been adapted.
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