Advanced Breast Cancer

Supportive Care

National breast cancer support groups and oncology organizations strongly recommend including palliative care in your treatment plan. Also called supportive care, these services are frequently declined because many people confuse them with hospice care. Palliative care, however, is designed to help you live your best life by managing advanced breast cancer as a chronic illness, and you’re encouraged to begin as soon as possible after diagnosis.

A primary focus is effective side effect and symptom control. You may experience different side effects if your doctor changes therapies to slow disease progression. Be clear with your doctor and palliative care expert about the quality of life you want, and ask about expected side effects of each therapy. Following are some of the most common possible side effects.

Anemia (low red blood cell count) can result in fatigue, weakness, shortness of breath, dizziness and other symptoms. Your doctor may adjust your treatment if your levels drop too low. Get enough sleep, exercise regularly when possible and pace yourself by balancing activity with rest.

Chemo brain (cognitive dysfunction) refers to difficulties with memory, processing information and mental focus. Although associated with chemotherapy, it is also linked to other treatments, hormone depletion and stress. Use a planner or calendar and carry it with you. Make to-do lists, and focus on one thing at a time instead of multitasking.

Constipation can be very uncomfortable and may lead to serious medical issues. Talk to your doctor about preventive medications or dietary and lifestyle changes you can make. If constipation becomes painful, ask your doctor for help.

Diarrhea affects your quality of life. Severe cases can lead to dehydration and loss of essential nutrients, interrupting treatment. Ask your doctor before taking over-the-counter remedies or fiber supplements. Over time, you may be able to anticipate bouts of diarrhea and plan accordingly. Avoid accidents by learning locations of clean restrooms at places you frequent.

Be sure to share dates of upcoming milestones such as family weddings, graduations and anniversary celebrations, as your doctor may be able to adjust your treatment schedule so you can enjoy these occasions.

Emotional distress may include feeling angry, depressed, scared, anxious or overwhelmed. Talk with a patient counselor or mental health professional. Find a local or online metastatic cancer support group. Explore your feelings with a trusted friend, fellow metastatic cancer patient or spiritual advisor. Seek immediate help for thoughts of suicide.

Fatigue caused by cancer treatment lasts longer and is more intense than general tiredness and may be unrelieved by sleep. Regular exercise is a proven fatigue-fighter, and even a 10-minute daily walk can energize you. Sleep eight hours each night, and take 20- to 30-minute naps as needed. Conserve your energy for people and activities that mean the most to you.

Hair loss (alopecia) related to cancer treatment can affect your whole body. If it’s likely you will lose your hair, you can choose from caps, hats, turbans and scarves available at cancer-related boutiques or online. For a wig, ask your doctor to prescribe a “cranial prosthesis due to hair loss from cancer treatment.” Such wording may qualify the wig for full or partial health insurance coverage. Also ask your doctor about scalp-cooling technology to avoid chemotherapy-induced alopecia.

Lymphedema occurs when lymph nodes are removed or damaged, causing swelling as lymph fluid builds up in nearby tissues. Consider meeting with a certified lymphedema specialist to learn how to reduce your risk. At the first sign of swelling, get fitted for a compression garment, and ask about massage treatments for lymphatic drainage.

Nausea and vomiting are easier to prevent than control, so ask your doctor about antiemetics (anti-nausea drugs) before beginning treatment. Severe cases can cause dehydration. Eat smaller, more frequent meals and stay well-hydrated. Try peppermints or ginger-flavored lozenges. Nondrug approaches include progressive muscle relaxation, guided imagery, acupuncture, self-hypnosis and biofeedback.

Neuropathy can occur from damage to nerves controlling movement and feeling in the limbs. Symptoms include numbness, pain, burning sensations and tingling, usually in the hands or feet at first. If you are diabetic, neuropathy can worsen existing symptoms. Avoid standing longer than necessary, wear comfortable shoes and keep hands and feet warm. Ask your doctor about prescription medications for neuropathic pain.

Neutropenia (low white blood cell count) commonly occurs in people treated with chemotherapy and increases the risk of infection, especially pneumonia, bronchitis and sinusitis. It also makes infections harder to resolve. Report signs of infection right away. Call your doctor immediately if your fever is 100.5 °F or higher. Wash your hands often with soap. Wear gloves for cleaning and gardening. Avoid crowds and sick people.

Pain may occur in joints or muscles and can be severe if cancer has spread to the bones. Unresolved pain can escalate quickly, so contact your health care team right away if you’re in pain. To help them find the best solution, keep a journal of pain-related symptoms, noting when and where pain occurs, how severe it is, length and possible triggers.

Sexuality issues, such as reduced desire or feeling less desirable, may occur if treatment alters your appearance or energy level. Your doctor may not discuss sexuality issues, so it’s important that you do. If you have a partner, communicate your feelings, and be open to discovering new ways to share intimacy.

Skin reactions may include rash, redness and irritation or dry, flaky or peeling skin that may itch. Moisturize skin twice a day with a thick cream. Avoid products containing alcohols, perfumes or dyes. Some treatments also increase sun sensitivity, so apply high-SPF sunscreen and limit sun exposure.

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