When cancer treatment becomes a family journey

After learning she had breast cancer, Tan Chiew Mei cried through the night. Pregnant with her second child and with a young daughter at home, she could not stop wondering who would look after her daughter if she were no longer there.

Then she focused on two things: “I want to get treated. And I want to keep my baby.”

Tan, then 37, had found a hard lump in her breast. An initial ultrasound left her feeling reassured, but another assessment two weeks later found that it had grown, leading to a biopsy. The diagnosis was triple-negative breast cancer.

Chemotherapy began within days. With appointments and decisions coming quickly, she concentrated on getting through treatment. But knowing what to ask was another matter.

Tan was not too shy to speak, but often she simply could not think of a question during consultations. She would listen, say “OK”, and then draw a blank when invited to ask more.

She trusted her doctors with major treatment decisions, but that did not mean she understood every change she experienced along the way. Looking back, she encourages patients to prepare for appointments and raise even the questions that might seem unimportant.

No question too small

For women diagnosed with breast cancer during pregnancy, treatment decisions can feel especially difficult because the patient would be worrying about both her own health and her baby’s wellbeing, says consultant clinical oncologist Dr John Low.

The treatment plan has to consider both mother and baby, he explained, with close coordination between the oncology team, obstetrician and breast surgeon.

As not all cancer medicines are suitable during pregnancy, timing, monitoring and each woman’s circumstances all matter. Low encourages patients to understand what treatment is intended to achieve, why it has been recommended, how long it may take, possible side effects, and what to watch for at home.

Patients can also ask what the cancer type and stage mean specifically for them. Those conversations need not happen only at the first appointment; different concerns often emerge as treatment progresses.

Support beyond medication matters, too. Low encourages patients to ask about counselling, psychological support and patient groups that may help them through the experience.

“There are no questions that you cannot ask your treatment team,” he stressed.

For Tan, one of the hardest moments came after childbirth – she endured an induced delivery followed by surgery the next morning.

Waking weak and in pain, she cried again. “I felt very emotional, when I realised how difficult it had been to get to this point, and the journey was not over yet.”

There was now a newborn to care for alongside her older daughter, and more chemotherapy ahead. She also had to come to terms with being unable to breastfeed her son during treatment.

Some aspects of chemotherapy were easier than she had feared: she could eat and did not vomit. But other symptoms were difficult: she lost her hair, and experienced leg pain and tingling that made walking hard, as well as sore gums and itchy skin.

These were not minor inconveniences: they shaped daily life and deserved attention alongside the bigger medical decisions.

Who can help between appointments?

Oncology nurse educator Norhaniza Rashid hears many everyday concerns from patients, often only after a consultation, when they begin thinking about what treatment will mean once they are back home.

Before the first chemotherapy cycle, she tries to include a caregiver when explaining what to expect. Patients receive a great deal of information and may not remember all of it, so she checks in during later cycles and encourages them to contact the team during office hours.

Some ask whether they can still hug their children or share a bed with a spouse. Norhaniza reassures them that chemotherapy does not mean they must stop being close to their families, while explaining any precautions they should take at home.

It is just as important, she said, to know who to contact between appointments, which symptoms need urgent attention, and what to do outside office hours.

Fortunately, Tan had help outside the clinic. Her husband accompanied her to appointments, her mother cooked during chemotherapy, and her siblings helped care for the children. Her employer also checked the company’s prolonged-illness leave policy, allowing her time away from work.

“Whenever there was a doctor’s appointment, the whole village would come to my house,” she recalled.

Tan found distraction in K-dramas and, when she felt able, did light chores around the house to keep herself occupied. She also remembers patients swapping experiences in the waiting area, where conversation helped her feel part of a community.

Coping, however, did not mean she never felt overwhelmed.

Norhaniza encourages patients to do something they enjoy, such as gardening or catching up with friends. When someone cannot face even those suggestions, she asks what is worrying them most and listens patiently to offer the best advice.

So, what comes next?

Now a mother of three, Tan continues to attend follow-up appointments and says her checks have remained clear so far. Her approach to the possibility of recurrence is simply to “deal with it as it comes”.

The end of treatment brings its own set of questions: what follow-up is needed, which changes should be reported, and where to turn if concerns arise between visits.

Tan also wishes she had sought advice sooner when she first noticed the lump, rather than waiting for her next pregnancy appointment. She urges women not to take their health for granted, to be disciplined about breast self-awareness, and not to put off screening or having an unfamiliar change checked.

Her advice is simple: “Just ask whatever. Don’t feel shy to ask.”

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