Beyond the Cancer Diagnosis: Interview with Muna Al-Khaifi, by Adrian Pogacian

In the most recent episode of ‘Beyond the Cancer Diagnosis’, Adrian Pogacian aims to answer to a delicate question: What comes next for Breast Cancer Survivorship Care when treatment is over, together with Dr. Muna Al-Khaifi, lead of the Breast Cancer Survivorship Program at Odette Cancer Centre.

Dr. Muna Alkhaifi is a general practitioner (GP) oncologist with a specialization in Women’s Health. She completed her Family Medicine residency at the University of Toronto, followed by a Women’s Health Fellowship at Women’s College Hospital. Additionally, Dr. Alkhaifi holds a Masters of Public Health degree from the University of Toronto. She is currently an Assistant Professor in the Department of Family and Community Medicine at the University of Toronto and an Associate Scientist at Sunnybrook Research Institute.

Dr. Alkhaifi founded and currently leads the Breast Cancer Survivorship Program at Sunnybrook Health Sciences Centre. She also operates a women’s health clinic focused on menopause and sexual health in the community. Dr. Alkhaifi is dedicated to providing high-quality, patient-centered care, with an emphasis on compassionate and holistic treatment.

Dr. Alkhaifi’s research focuses on the needs, quality of life, side effects, and challenges faced by breast cancer survivors, including sexual health and psychological issues. She is dedicated to advancing education in survivorship care by designing and integrating innovative curricula for medical residents and undergraduate medical students, with a focus on humanism and cultural sensitiv

Adrian Pogacian, licensed clinical psychologist, with executive education in Psycho-oncology, holding a degree in Global Health Diplomacy from Geneva Graduate Institute and a certificate in Medical Intel Course from NATO School, Oberammergau.  Currently, invited speaker and associate lecturer with focus on Impact of Cancer Diagnosis on Couples and Families, Communication in Cancer Care and managing Fear of Recurrence. His expertise is on Coping with Cancer and Posttraumatic Growth.

Additionally, Founder of INCKA Psycho-oncology Center incka.org, Host of Beyond the Cancer Diagnosis Interview Series at OncoDaily.com, Journalist at CancerWorld.net, co-author of the first Romanian Multimodal Care Guideline in Pediatric Onco-hematology, active contributor to the International Psycho-oncology Society, presently IPOS Fear of Cancer Recurrence (FORwards) Special Interest Group Board Member (2025-2027), IPOS Early Career Professionals in Psycho-Oncology Committee Founding Member (2023-2026) and Multinational Association of Supportive Care in Cancer (MASCC) member.

Breast Cancer Survivorship Care
Now that treatment is over…what next?

Adrian Pogacian: Dear Muna, you are currently working as the lead of the Breast Cancer Survivorship Program at Odette Cancer Centre. To begin our interview, I would like to ask you to share with our audience its history, mission and values.

Muna Al-Khaifi: I developed the Breast Cancer Survivorship Program at the Odette Cancer Centre in response to the growing understanding that breast cancer care doesn’t end when active treatment does. My goal was to improve the lives of breast cancer survivors, which led me to propose and establish the Sunnybrook Breast Cancer Survivorship Care Clinic. I am currently the physician lead of the survivorship program at the Louise Temerty Breast Centre.

While advances in surgery, chemotherapy, radiation, and targeted therapies have greatly improved outcomes for women with early-stage breast cancer, many continue to face physical, emotional, and psychological challenges after treatment ends. These can include side effects from anti-hormone therapy, lingering effects from chemotherapy, and the broader life changes that come with a cancer diagnosis.

This program was designed to support women in navigating the post-treatment phase in a structured, compassionate, and evidence-informed way. We help patients manage ongoing concerns and guide them in building a healthy, balanced lifestyle as they move forward in survivorship.

Our mission is to support women in navigating life after active breast cancer treatment by addressing the unique medical, emotional, and lifestyle challenges they may face. We aim to empower patients through individualized care, education, and resources that promote long-term health, cancer surveillance, and overall well-being. Ultimately, we strive to help women reclaim their sense of self and quality of life post-treatment.

Our program is grounded in the values of compassion, empowerment, collaboration, and continuity of care. We practice compassion by creating a safe, supportive space for patients to express their concerns, value empowerment by providing the tools and knowledge needed for recovery, and believe in collaboration through close coordination with oncologists, primary care providers, and allied health professionals. Finally, we emphasize continuity, helping patients transition from oncology-led treatment back to their family doctor with a clear plan and confidence in their future health management.

Adrian Pogacian: In addition, this year is the inaugural International Breast Cancer Survivorship Conference. What does it mean for both, patients and health care provider communities? And, what are your personal expectations?

Muna Al-Khaifi: This year marks the inaugural International Breast Cancer Survivorship and Supportive Care Conference, and I believe it represents a major milestone for both patients and healthcare provider communities. For patients, it signals a growing global recognition that survivorship is not the end of cancer care, but a critical phase that deserves the same level of attention, innovation, and compassion as active treatment. Survivors face a wide range of ongoing challenges, physical, emotional, and psychological, and this conference is a step toward addressing those needs more comprehensively and equitably.

For healthcare providers, this conference provides a much-needed opportunity to come together across disciplines to learn, collaborate, and share the latest advancements in survivorship care. From managing post-surgical impairments to understanding hormonal side effects and leveraging technologies like AI and digital health, we’re covering the full spectrum of survivorship. We’re also focusing on building sustainable models of care that can be implemented globally, improving outcomes while maintaining accessibility.

My expectations for this conference are that it will be a meaningful step forward in improving survivorship care. First, I hope it empowers health professionals with the tools and knowledge they need to deliver evidence-based, patient-centered survivorship care. Secondly, I hope it initiates a global discussion that will inspire systemic change, and bring survivorship into the spotlight not just as an afterthought, but as an important component of cancer care. It is my hope that this conference becomes an annual platform for continued innovation, education, and collaboration in breast cancer survivorship.

Adrian Pogacian: You are focused on Breast Cancer Care once the treatment is over. In this regard, what are the main psycho-emotional differences of breast cancer patients when talking about the period after treatment and during treatment?

Muna Al-Khaifi: There are important psycho-emotional differences between the treatment phase and the period after treatment in the breast cancer journey, and understanding these differences is crucial for person centered care.

During the diagnostic phase, patients frequently experience increased levels of anxiety, and emotional distress as they move through the process of diagnosis and preparing for treatment. The uncertainty surrounding the extent of the disease, available treatment options, and prognosis can contribute to a significant emotional burden. This phase also involves coping with physical side effects, managing treatment-related disruptions to daily life, and adjusting to changes in body image and self-perception. Certain groups, such as younger women, those with limited social support, or individuals with pre-existing psychological conditions, may be at increased risk of distress.

After treatment, breast cancer survivors face a wide range of challenges, many of which are long-term and not immediately visible. These can include difficulties returning to work, ongoing physical effects from treatment such as persistent fatigue, problems with memory or concentration, and nerve-related issues like numbness or tingling in the hands and feet. Emotionally, survivors often carry a heavy burden that includes fear of the cancer returning, worry about how their illness has affected their loved ones, and ongoing symptoms of depression or anxiety. Many also report experiencing intrusive thoughts and may begin to avoid certain situations or conversations as they struggle with uncertainty about their future and concerns about disease progression.

Overall, comprehensive psychological support remains important throughout the entirety of the breast cancer journey. While psychological distress is common both during and after treatment, the nature of the distress shifts: from immediate uncertainty and physical challenges during treatment, to long-term fears, role transitions, and emotional recovery in survivorship. Addressing these issues through distress screening and tailored interventions is essential for improving survivors’ quality of life.

Adrian Pogacian: You’ve approached the subject of Efficacy of Multimodal Psychological Interventions on Pain After Surgery in Breast Cancer Survivors. Could you share more with regard to the outcome of this interesting review?

Muna Al-Khaifi: This systematic review explored the effectiveness of various psychological interventions in managing postoperative pain among breast cancer survivors. A total of eight studies reported improvements in pain outcomes with interventions such as mindfulness-based cognitive therapy (MBCT), progressive muscle relaxation (PMR) combined with visualization or diaphragmatic breathing, Qigong mind-body exercises, pranic meditation, supportive-expressive group therapy, and integrated yoga.

One of the strongest findings came from a randomized controlled trial (RCT) evaluating MBCT, which demonstrated a clinically significant reduction in pain intensity. Similarly, interventions involving PMR, whether paired with visualization or breathing exercises, showed significant decreases in postoperative pain levels. Qigong, a traditional mind-body practice that integrates physical movement with focused attention and controlled breathing, also showed both statistically significant and self-reported clinical improvements in pain severity and interference with daily functioning.

Based on these findings, the review offers several key recommendations: the need for larger and more rigorously designed RCTs, the standardization of pain measurement tools across studies, clearer operational definitions of psychological interventions, and the evaluation of these techniques as adjuncts to pharmacological or physical pain treatments. There is also a strong case for further exploration of MBCT, PMR, and cognitive behavioral therapy (CBT), given their established efficacy in other clinical contexts involving chronic or treatment-resistant pain.

Thus, while preliminary evidence is promising, especially for MBCT and PMR, future research should focus on improving methodological quality and integrating psychological interventions into multimodal pain management strategies for breast cancer survivors. These approaches hold potential not only for improving pain outcomes but also for enhancing overall quality of life during recovery and survivorship.

Based on these findings, key recommendations include conducting larger, rigorously designed RCTs, standardizing pain measurement across studies, clearly defining psychological interventions, and testing their efficacy alongside pharmacologic or physical treatments. Additionally, the evidence supports further exploration of interventions like MBCT, PMR, and CBT, given their promise in managing pain in other clinical populations.

Adrian Pogacian: As an expert on breast cancer care and women’s health, what is most challenging: to educate, to promote, to connect or to advocate?

Muna Al-Khaifi: Educate: One of the ongoing challenges in breast cancer care is ensuring that patients and the public receive accurate, timely, and understandable information. Education must also be culturally sensitive and health-literacy appropriate to effectively reach diverse populations. Moreover, discussing complex topics like genetic risk, fertility preservation, sexual health or other long-term side effects requires not just content expertise but empathy and communication skills.

Equally important is educating healthcare providers to better understand the components of survivorship care. For example, in our mixed-methods study on The Implementation of a Novel Adult Cancer Survivorship Curriculum at Sunnybrook Health Sciences Centre, we developed a two-part curriculum for family medicine residents. The curriculum included a virtual didactic session focused on key survivorship care principles and an in-person discussion led by patient-teachers, aiming to integrate humanistic and experiential learning. We evaluated the curriculum using pre- and post-session surveys to assess changes in residents’ confidence, attitudes, and knowledge. At baseline, residents reported low confidence in their understanding of cancer prevention, follow-up care, and the management of long-term side effects of cancer treatment. Qualitative analysis revealed that the curriculum was positively received, with patient involvement as educators being a particularly impactful component. Further, residents appreciated the opportunity to learn directly from patients, and suggestions for future iterations included expanding the program to be longer, more comprehensive, and to include a broader and more diverse range of patient voices.

Promote: Promoting breast cancer awareness and early detection remains challenging, especially in underserved and marginalized communities. Social stigma, fear of diagnosis, and historical mistrust in medical systems often result in delayed screening and poorer outcomes

Connect: Facilitating meaningful connections, between patients and providers, or among patients themselves, can be deeply impactful but may be overlooked. Emotional support, peer mentorship, and community-building are essential, especially during survivorship, yet many patients report feeling isolated or “cut off” once treatment ends

Advocate: Advocacy involves influencing not just individual behaviour, but systems, policies, and cultural attitudes. Advocating for equitable access to care, coverage for survivorship services, and investment in women’s health research requires sustained effort, collaboration, and political will. Disparities persist in outcomes based on race, income, geography, and other social determinants, highlighting the urgent need for continued advocacy.

Adrian Pogacian: Another field of your expertise is sexual health, an underestimated subject nowadays. Besides psychoeducation, what are the key aspects of sexual health, as well as the factors that influence it?

Muna Al-Khaifi: Sexual health is a fundamental yet often overlooked component of quality of life, particularly in breast cancer survivorship. Key aspects of sexual health include physical well-being, emotional and psychological resilience, relationship dynamics, and informed access to effective interventions.

Physically, survivors may experience symptoms like vaginal dryness, pain during intercourse, and genitourinary syndrome of menopause. These symptoms are frequently linked to treatments such as chemotherapy, radiation, surgery, and hormone therapy, which can induce early menopause and lead to a range of sexual dysfunctions, including decreased desire, difficulty with arousal, and discomfort during intimacy.

In addition to physical symptoms, psychological and emotional factors are major influences on sexual health. Many survivors struggle with depression, anxiety, and changes in body image following surgery or other physical changes, which can lower self-esteem and reduce both sexual interest and satisfaction. These mental health challenges often have a reciprocal relationship with sexual functioning. When individuals feel disconnected from their bodies or their partners, their overall sexual well-being can decline significantly.

Also, relationship dynamics significantly influence sexual health. When there is open and honest communication between partners, individuals may feel more supported and understood, which can improve comfort with intimacy. On the other hand, limited communication or challenges within the relationship can contribute to feelings of frustration or emotional distance. It’s also important to recognize how difficult it can be for individuals to bring up these concerns. Many breast cancer survivors are interested in discussing sexual health but may hesitate to do so, especially if healthcare providers do not address the topic first.

Finally, sexual health is shaped by broader social and systemic factors. These include access to information, cultural beliefs, age, gender identity, and socioeconomic background.

Overall, sexual health is influenced by physical, emotional, relational, and systemic factors. Addressing it effectively requires more than psychoeducation, it demands a proactive, compassionate, and inclusive approach that places the individual’s overall well-being and lived experience at the center of care. In addition to education, treatment options may include vaginal moisturizers and lubricants, pelvic floor physiotherapy, hormonal or non-hormonal therapies, counseling, cognitive-behavioral interventions, and couple-based therapy. These options should be tailored to each patient’s needs, preferences, and treatment history.

Read Other Episodes of Beyond the Cancer Diagnosis on OncoDaily.