I Have A Student With Breast Cancer - What Do I Do?!
I think most yoga teachers, myself included, have had an experience of someone coming to us with a health issue we have not dealt with before and get that slightly panicky feeling when it’s a bit beyond our training or we lack experience. As a teacher trainer, I’m hearing this more and more from yoga teachers who contact me about someone with breast cancer in their class.
It’s worth knowing that breast cancer is the most common cancer of all and the one most you’re likely to encounter as a yoga teacher.
You may have an existing student who develops breast cancer, or you may have a new student enquire who has been told yoga would be helpful and is looking for a class. Perhaps it is someone who has finished treatment and is looking to get more active again and recover. How women dealing with breast cancer arrive in your class can be very varied.
Even for experienced teachers who feel comfortable adapting for injury, a situation like this can raise all kinds of questions and uncertainties which can undermine confidence. Nobody wants to be standing in front of a class feeling unsure about what or how to teach.
You might be wondering what kinds of postures are safe and suitable. Can they bear weight on their arms or take them overhead? Are inversions okay? What about downward dog or chest openers? What breathwork is appropriate?
If the student is in more active treatment, you may have even more questions. What if she has had a mastectomy or had lymph nodes removed? Is there a risk of lymphoedema? What practices are appropriate if she’s having radiotherapy or chemotherapy? What do I need to be aware of if she’s taking hormone therapy?
You can see how easy it is for our minds to race, looking for a list of things we should or shouldn’t teach.
I feel though that this is not a particularly helpful starting point, and can take us down the wrong path altogether. For me, rather than asking “What yoga poses are safe for someone with breast cancer?”, the more useful question is “What does this particular person need from me today?”. It leads us to a completely different place, which in turn can address many of those initial questions anyway.
The approach I have developed over the years is a much more therapeutic one, where we start with the student rather than looking at our lesson plan and trying to work out how we can fit this person with breast cancer into it. We can easily find ourselves spending a lot of time trying to work out what modifications or alternatives we need to offer, which can tie us in knots and doesn’t necessarily best serve the student.
Instead of starting with adaptations and what to avoid, we start with the student. Asking why are they coming to yoga, what do they need, what are their most problematic side effects, what are their priorities and what is happening for them right now, gives us information that can help us create a lesson plan that suits them, rather than trying to get them to fit into what we want to teach.
This flexible, responsive approach allows us to work with the huge range of experiences women can have with breast cancer. It’s one of the reasons I don’t hand out prescriptive sequences or lesson plans. Each person with cancer is unique, and there simply isn’t a one-size-fits-all lesson plan.
Even breast cancer itself is not one disease. There are different types, grades and stages, with different treatment pathways and combinations of treatments. All of this is important information for us to understand, but we also need to remember that someone’s own life circumstances, personality, medical history and experience of treatment will influence how cancer affects them.
Their diagnosis of breast cancer therefore gives us some useful information, but it doesn’t tell us everything we need to know.
It doesn’t tell us how someone is feeling today. It doesn’t tell us what treatment they’ve had, what side effects they’re experiencing, how their movement has changed, what they’re worried about, what they’re hoping to get from yoga, or what their relationship with their body is like now. It certainly doesn’t tell us what they can and can’t do.
That’s why I don’t believe that learning a list of “safe” and “unsafe” yoga poses is enough to make us confident Yoga for Cancer teachers.
So what do we actually need to know?
I tend to think about this in five stages. They aren’t a rigid checklist, but they give us a framework for thinking about the individual in front of us.
1. What treatment has happened so far?
The first thing we need to do is gather some information to build a picture of where she is physically right now. We won’t know what yoga is appropriate if we don’t know what we are dealing with. Going through your intake process or health questionnaire sensitively will be helpful to find out what surgery and other treatment she has had so far, what side effects she is experiencing and what further procedures and treatment are upcoming. All of these things give us useful information to appreciate what her body has been through, what her capabilities and limitations are, and what might be relevant to her overall yoga practice.
2. What is the wider impact?
The next important thing to consider is the wider impact beyond the immediate physical side effects. We need to think holistically about the mental and emotional side-effects she may be experiencing. Many women develop body image issues which in turn can affect confidence, joy, intimacy and sense of femininity. There can be a loss of personal identity and confidence along with increased fear and anxiety. All of this can influence the way someone approaches their yoga practise. They may have lost trust in their body and be nervous about movement through fear of making things worse.
3. Are they experiencing medical menopause?
This is an important question to ask women with breast cancer as the treatment can induce a sudden medical or ‘crash’ menopause. This is a huge subject in itself which you might like read more about in another blog here, but in brief - many women say that it is a much bigger and life changing issue to deal with than the cancer itself.
For younger women it can mean the loss of fertility and having menopause out of sync with their peers, for older women it can bring back symptoms that were long past or create new ones that they never had before. Medical menopause symptoms are typically more severe than naturally occurring ones. There is such a wide range of potential symptoms that it’s useful to ask your student which they have so you can take those into consideration when teaching.
4. What does she want from yoga?
In some ways for me this is the most crucial question as is speaks to her underlying goals, needs and desires. When we ask a woman with breast cancer what it is that that she wants to get from her practice, not only do we receive useful information, it also gives her back a bit of agency over her body and her life. For cancer patients the process of receiving medical treatment is by its nature a passive one; there is a sense of being ‘done to’. Yoga provides an opportunity to have a space where she can control what happens to her body.
What someone wants from their yoga will vary from women to woman. Not all breast cancer patients want the same thing! It maybe about regaining mobility or strength, or perhaps she is longing for some sleep and mental calm. It may be simply that yoga has been where she feels at home. All of these are valid goals and can help us offer the best support.
5. What do I need to adapt — and what don’t I need to adapt?
The first thing to say here is that there is no one size fits all list of adaptations as each student is unique. We don’t adapt a yoga practice simply because someone has breast cancer; we need to refer back to our assessment of their current abilities, needs and goals to see what is appropriate and useful.
From this we can start to choose practices that are beneficial for that student, rather than starting with what we want to teach and then trying to adapt the student to fit. This will help to naturally avoid unsuitable practises. For example, to recover from breast surgery I wouldn’t think of handstands as a helpful practise, so they wouldn’t be in my lesson plan. Equally, something that is useful might not need much adaptation at all.
The next important principle of how I teach is that we encourage the student to choose the adaptations. This comes from teaching each practise very slowly, step-by-step and offering lots of different options (such as hands on hips, hands on shoulders, cactus arms, arms overhead). If we use interoceptive language we can lead the student to choose what feels right rather than push themselves to do what looks right. Not only is this safer it again, puts the student in control of their body and yoga practice.
Knowing when you need more information
Being a confident yoga teacher doesn’t mean you need to know everything! An important aspect of developing our confidence is becoming comfortable with recognising when something is outside our knowledge or scope of practice.
Sometimes we just need to ask the student for more information or suggest they check something with their medical team. Sometimes we need to do a bit of our own research and other times we may need to refer to a more experienced or specialist teacher.
For me, confidence isn’t about having an answer to every question. It’s about knowing what questions to ask, understanding what information matters and having a process for making sensible decisions. That is very different from standing in front of a student with a list of rules and hoping we don’t get anything wrong.
Perhaps the biggest shift we can make when teaching yoga to someone with breast cancer is moving away from asking “What can’t she do?” and towards asking “What does she need from me today?”
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If you’d like to explore this topic further I have a pre-recorded Masterclass on Supporting Women With Breast Cancer that you find here.
If you are interested in becoming an accredited yoga for cancer teacher – you can find out more about my 12 week Holistic Teacher Training Course here.