Advanced Breast Cancer

Managing Side Effects

Almost every cancer treatment can cause side effects because when cancer cells are destroyed, healthy cells often get destroyed, too. Not everyone has the same side effects, even if they have the same type of treatment for the same type of cancer. Many side effects can be managed by you and your medical team. Following are treatment types and some side effects that may occur specifically from them.

Chemotherapy

Chemotherapy acts to damage cells that divide quickly because cancer cells divide quickly. Unfortunately, it also affects normal cells that divide quickly, such as hair and nail cells and the cells lining the inside of the gastrointestinal tract. Side effects can include hair loss, nail changes, mouth sores, diarrhea, constipation, nausea and vomiting, changes in appetite and low blood cell counts.

Hormone Therapy

Hormone therapy may cause fatigue, muscle and joint pains, vaginal dryness or discharge, hot flashes and mood swings. Blood clots are a less common but more serious side effect of some hormone therapy drugs. If a blood clot develops, it is usually in a leg, but a clot there can sometimes break off and travel to the lungs, where it can pose more harm. If pain, redness or swelling develops in your calf or if you have shortness of breath or chest pain, call your doctor right away. These symptoms could be signs of a clot.

Targeted Therapy

Targeted therapies tend to damage only the cells they target, which may result in fewer side effects. Although most effects of targeted therapy are mild, some carry a risk of congestive heart failure, which usually goes away after the drug is no longer taken.

Radiation Therapy

Radiation usually damages the areas that are being targeted. Side effects may include fatigue, loss of appetite, skin changes and low blood cell counts. Whole-brain radiation therapy is associated with potential side effects such as memory loss, extreme fatigue, temporary baldness, skin rash and hearing loss.

Steroid Therapy

Corticosteroids, drugs given to help decrease swelling around the brain when there is brain metastasis, may be associated with a range of side effects. Some common side effects include weight gain, acid indigestion, muscle weakness, difficulty sleeping, mood swings, elevated blood sugar, acne and swelling of the face.

Medical Supportive Therapies

Bone-modifying drugs, which help prevent bone problems, are associated with fatigue and nausea. These drugs may also cause damage to the jawbone. Take special care of your mouth, gums and teeth; visit your dentist regularly; and avoid invasive dental work.

Be sure to tell your medical team when symptoms persist despite treatment or if you experience any new ones. They will work with you to manage your symptoms, provide you with greater control over your daily activities and improve your quality of life.

 

Common Side Effects

Alopecia

Alopecia (hair loss) is often caused by chemotherapy and radiation therapy. Hair loss associated with chemotherapy can occur all over the body, affecting not only the head but also the eyebrows, face, chest, pubic area, etc. Hair loss associated with radiation therapy occurs only in the area receiving radiation.

Management Strategies

  • Use a soft-bristled hairbrush or wide-toothed comb.
  • Ask your doctor about a cooling cap.
  • Sleep on a satin or silk pillowcase.
  • Avoid using hair dye and heating devices (dryers, curling irons, etc.).
  • Ask your doctor for a prescription for a wig which may make it eligible for insurance coverage.
  • Use a gentle, pH-balanced shampoo.

Cognitive Dysfunction

Cognitive dysfunction (“Chemo brain”) is the feeling of not being able to think clearly or having trouble remembering details, but it doesn’t just happen with chemotherapy. It can occur in people receiving many types of treatments during or after treatment.

Management Strategies

  • Use a daily planner or calendar to keep track of “to-do” lists and events.
  • Solve crossword puzzles or number games to strengthen your mental ability.
  • Focus on one thing at a time. It’s okay not to multitask.
  • Organize your home and work spaces, and keep important items, such as keys, in a specific place.

Diarrhea

Diarrhea can be caused by many types of treatment, and it can feel like a life-interrupting event. Eliminating it or learning how to manage it can greatly improve your quality of life. Left untreated, it can lead to serious problems, such as dehydration, loss of important nutrients, weight loss and fatigue.

Management Strategies

  • Drink plenty of fluids (water and other clear liquids, such as broth).
  • Eat several small meals throughout the day rather than three big meals.
  • Ask your doctor about anti-diarrhea medications.
  • Avoid alcohol, caffeine and fatty foods.
  • Eat bland foods.

If you experience any of the following serious effects, contact your doctor immediately:

  • Six or more loose bowel movements per day for more than two days in a row
  • Blood in the stool, around the anal area, on the toilet paper or in the toilet bowl
  • Inability to urinate for at least 12 hours
  • Fever
  • Loss of five pounds or more after the diarrhea starts
  • Swollen or painful abdomen
  • Dizziness or light headedness upon standing up

Fatigue

Fatigue related to cancer and its treatments is different from the fatigue that healthy people feel. It usually lasts longer, is more severe and is unrelieved by sleep.

Management Strategies

  • Take frequent naps that are not more than 45 minutes each. Get eight hours of sleep each night.
  • Do some form of regular physical activity, such as walking, yoga or bike riding.
  • Set a routine for sleeping and waking.
  • Prioritize. Rest up for what you really want to do.

Lymphedema

Lymphedema is an excess of fluid in body tissues that causes abnormal swelling of a limb. It is most likely to occur in people who have surgery that involves removal of lymph nodes from the underarm, groin, pelvis or neck. The more lymph nodes removed, the greater the risk for lymphedema.

Management Strategies

  • Use a compression garment or tight bandages to apply pressure to the area.
  • Elevate the swollen limb to encourage drainage of the lymphatic system.
  • Talk to your doctor about manual lymphatic drainage and complete decongestive therapy.

Nausea and Vomiting

Nausea and vomiting can cause severe dehydration and interrupt your treatment plan. Nausea is feeling sick to your stomach and may be accompanied by vomiting (throwing up). Severe cases of vomiting can lead to dehydration. You can also develop environmental nausea, which means that being in a specific physical environment, such as the chemotherapy infusion room, can trigger these side effects. Certain smells, such as the smell of rubbing alcohol used to clean your skin before an injection, can also bring on nausea and vomiting. Talk to your doctor about lowering your medication doses or adding antiemetics (anti-nausea drugs).

Management Strategies

  • Eat five to six small meals a day instead of three large meals, and eat a light meal a few hours before certain treatments.
  • Drink plenty of fluids throughout the day.
  • Avoid foods or smells that trigger nausea.
  • Sip ginger ale or chamomile tea, or suck on peppermint candies.
  • Avoid alcohol, spicy foods and caffeine.

If you experience any of the following serious effects, contact your doctor immediately:

  • More than three episodes of vomiting per hour for at least three hours
  • Blood in vomit
  • Vomit resembling coffee grounds
  • Inability to drink more than eight cups of fluid or ice chips in 24 hours or eat solid food for more than two days
  • Weakness or dizziness
  • Cannot keep your medications down

Neuropathy

Neuropathy is pain or discomfort caused by damage to the peripheral nervous system, which includes the nerves that control movement and feeling in the arms and legs. Symptoms are numbness, pain, burning, tingling or loss of feeling in the hands or feet. For patients who are already diabetic, this side effect can become worse.

Management Strategies

  • Avoid tight clothes.
  • Keep your hands and feet warm.
  • Avoid standing or walking for long amounts of time.
  • Wear comfortable shoes.
  • Talk with your oncologist about prescription medicines designed specifically to relieve neuropathic pain.

Neutropenia

Neutropenia (low white blood cell count) is a low number of neutrophils, a type of white blood cell. Neutrophils play an important role in preventing infection throughout the body, so having an abnormally low number of neutrophils increases the risk of infection. Neutropenia also makes it more difficult for an infection to resolve if bacteria do enter the body. The lower the neutrophil count, the greater the risk for infection.

Management Strategies

  • Talk to your doctor about drugs that may help you produce more white blood cells.
  • Wash your hands often, and use hand sanitizer regularly.
  • Wear gloves when doing chores.
  • Avoid sick people and crowded places.

If you experience any of the following serious effects, contact your doctor immediately:

  • Fever (oral temperature over 100.5°F), OR chills OR sweating
  • Flu-like symptoms (body aches, chills, general fatigue) with or without fever
  • Coughing, shortness of breath or painful breathing
  • Abdominal pain
  • Sore throat or mouth sores
  • Redness, pain or swelling on skin
  • Pus or drainage from any open cut or sore
  • Pain or burning with urination
  • Pain or sores around the anus
  • Vaginal discharge/itching

 

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