Triple Negative Breast Cancer
Supportive Care
Knowing the side effects to expect and what to do if they occur will make you more confident and better prepared to move forward with treatment. Your health care team will work with you to identify, prevent and manage any physical and mental side effects that may occur. The goal is to help you maintain a good quality of life from the time you’re diagnosed through treatment and survivorship.
Be proactive by asking your health care provider what side effects you might experience before starting treatment. And ask if there is anything you can do to minimize them. Take the approach of “see something, say something.” Report symptoms promptly. Even if they seem trivial, your health care team needs to know so they can monitor you and keep you as comfortable as possible. Make it easier by downloading a Side Effect Tracker at PatientResource.com/Tracker
The following common side effects may result from various cancer treatments.
ANOREXIA (LOSS OF APPETITE)
Losing your appetite can occur with some treatments such as chemotherapy and immunotherapy.
BONE LOSS AND BONE PAIN
The loss of bone density occurs when the cells that rebuild bone are not replaced as fast as they get destroyed. As a result, bones become thin, porous and brittle. Bone loss also occurs if cancer spreads to the bone. This can also cause bone pain. Bone modifying agents, lifestyle and exercise can help build bone density.
COGNITIVE DYSFUNCTION (“CHEMO BRAIN”)
Many women who receive chemotherapy for triple negative breast cancer (TNBC) have trouble remembering words or directions, or concentrating, and may experience memory lapses in the middle of tasks. These memory and thinking problems are collectively referred to as chemo brain and can leave you feeling like you are in a mental fog. Keep a record of the problems you have and when they happen, and share this information with your health care provider.
CONSTIPATION
This side effect is characterized by difficulty passing stools or a decrease in bowel movement frequency as compared to your normal bowel schedule. It can occur at any time during treatment. The best way to manage constipation is to prevent it. Talk to your health care provider about preventive medications or dietary and lifestyle changes you can make.
DEEP VEIN THROMBOSIS (DVT)
Deep vein thrombosis is a formation of a blood clot in a vein, usually in the leg. This condition may be a side effect caused by surgery as well as lack of physical activity.
DIARRHEA
Some treatments can cause diarrhea that becomes severe. Left untreated, it can even become life threatening. Contact your health care provider if it is severe. However, any type of diarrhea can affect your quality of life. Let your health care provider know if you have an important event coming up. They may be able to adjust the timing of the treatment to enable you to enjoy your event without worrying about this side effect.
FATIGUE
Fatigue caused by cancer and its treatment is different than just feeling tired. It’s stronger and often lasts longer, even with enough sleep. Fatigue often occurs with chemotherapy, immunotherapy and radiation therapy. Many non-treatment-related contributors, such as stress, other medical conditions, altered sleep/wake cycles and reduced activity, may cause fatigue.
HAIR LOSS (ALOPECIA)
Alopecia is the medical term for abnormal loss of hair on the head or elsewhere on the body, such as eyelashes, eyebrows, in the armpits and pubic area, and on arms and legs. Hair on the head often falls out in clumps during shampooing or brushing, or even during sleep. Hair loss can be one of the most emotionally difficult side effects of treatment for TNBC.
Radiation therapy may cause hair loss in the treated area. Chemotherapy drugs, as well as some immunotherapy and targeted therapy drugs, may cause hair loss. Not every person will lose their hair, even when taking the same drug or having the same treatment that causes hair loss in someone else. Treatment drugs work by killing rapidly dividing cells. Because cells in the hair follicles also divide rapidly, they may be damaged by these treatments. Hair loss from drugs usually begins within 10 to 14 days after the start of treatment and gets worse within one to two months. In some instances, depending on the drugs, hair loss may begin with a sensation of the scalp itching, and within a few hours, hair begins to fall out.
INFERTILITY
Certain treatments can affect the ability to start or maintain a pregnancy. If maintaining your fertility is important to you, talk to your health care provider and a licensed counselor about safeguards as early as possible in treatment planning. Fertility can be affected by a single treatment, and preservation options become more limited after treatment begins. Also contact your insurance provider to find out whether fertility preservation is covered.
LYMPHEDEMA
Lymphedema is an excess amount of fluid in body tissues that can cause abnormal swelling of an arm or leg. This condition occurs when lymph fluid builds up in the tissues and causes swelling, usually in an arm or a leg. It can occur when lymph nodes have been damaged or removed during surgery or by radiation therapy. Some patients who have breast cancer experience lymphedema immediately after surgery or radiation therapy. However, it can occur months or even years after treatment ends. See a certified lymphedema specialist to be properly fitted for compression garments.
MOUTH SORES
These tiny sores begin in the lining of the mouth and can affect the gums, tongue, roof of mouth and/or lips. Pain may range from mild to severe, making it difficult to talk, eat or swallow. Mouth sores are much easier to treat early, so contact your health care team as soon as you notice symptoms.
NAIL AND SKIN CHANGES
Radiation therapy, chemotherapy and targeted therapy can cause brittle nails, nail blemishes and skin changes. Immunotherapy has also been associated with rash, itching and peeling or blistering skin. Avoid cutting your nails, and use mild, unscented soap.
Skin reactions may occur from many types of treatment and may include redness and irritation (similar to sunburn), an acne-like rash and itchy or dry, flaky or peeling skin.
NAUSEA AND VOMITING
Nausea is feeling sick to your stomach and may come with an urge to vomit. Nausea and vomiting are most often caused by chemotherapy but can be caused by other treatments, too. Your health care provider may be able to prescribe medicines to prevent or reduce nausea before or during your treatment.
Nausea and vomiting may occur after a surgical procedure and is commonly referred to as post-operative nausea and vomiting (PONV). It may occur in the first 24 to 48 hours after a surgery. PONV may also occur as a result of the surgical procedure (depending on the location of the surgery) or, more likely, a reaction to the anesthesia or post-operative medication.
NEUROPATHY
Neuropathy is pain or discomfort caused by damage to the nerves that control movement and feeling in the arms and legs. Symptoms include numbness, pain, burning, tingling or loss of feeling in the hands or feet. If you have these symptoms, keep a journal of when they happen, what they are, how long they last and how intense they are, and share this information with your health care provider. Chemotherapy can cause neuropathy, but not everyone who receives chemotherapy will experience neuropathy.
NEUTROPENIA (LOW WHITE BLOOD CELL COUNT)
This may occur when your body doesn’t produce enough neutrophils, a type of white blood cell. It puts your body at a higher risk for infection. Contact your medical team if you have a fever. Ask your health care provider in advance how high your fever needs to be for you to call.
PAIN
Pain can occur in muscles, bones or joints, or in the abdomen. Left untreated, even minor pain can get out of hand quickly and affect your body’s ability to heal. Contact your health care provider if the pain does not go away or worsens. Other types of pain you may experience include:
- Phantom limb pain, is a condition where patients have a sensation of residual breast tissue that can include both non-painful sensations as well as pain where the breast was removed. Phantom breast pain can happen after mastectomy. The brain treats the breast as if it were a limb.
- Post-mastectomy pain syndrome (PMPS) is chronic nerve pain that lasts three months or more after breast surgery. You may experience PMPS in the chest, armpit and/or arm. You may feel tightness, burning, tingling or itching in these areas, in addition to numbness or extra sensitivity around the surgical site. PMPS will not go away without treatment. Tell your health care provider about your pain or disability so you can begin to receive treatment.
SEROMA
A seroma is a fluid-filled bulge that can form under the skin at the surgery site. After breast surgery, it is possible for fluid to fill in at the surgical area under the skin. Treatment of a seroma will vary depending on its size and if it is causing pain. Draining the fluid from the breast is the most common treatment.
SHORTNESS OF BREATH (DYSPNEA)
Contact your health care provider immediately if you are short of breath or have difficulty breathing with or without coughing. In rare cases, some therapies can cause inflammation of the lung, known as interstitial lung disease (ILD). Your health care provider will monitor you for the condition. ILD damages the tissues between the small air sacs in your lungs (alveoli) and the blood vessels around them. This makes it harder to breathe.
THROMBOCYTOPENIA (CAUSING BLEEDING/BRUISING/CLOTTING ISSUES)
This side effect can occur from some chemotherapies because they may interfere with the body’s ability to make platelets, a type of blood cell. Thrombocytopenia can lead to bleeding and clotting problems, as well as easy bruising.
Potentially Severe Side Effects
Drug therapies used to treat TNBC are powerful. Some can cause side effects that are serious and may even be life threatening. If any of your therapies have the potential to cause a severe side effect, it is critical that you understand what to watch for before treatment begins.
Be aware that not all potentially severe side effects are ones you can recognize. Some are only identifiable on lab work and imaging results. Therefore, it is crucial to stay on schedule with your follow-up appointments for monitoring. Some of these severe side effects include the following.
Immune-related adverse events (irAEs) are associated with certain immunotherapy drugs. Some irAEs can develop rapidly, becoming severe and even life threatening without swift medical attention. They can occur if the immune system becomes overstimulated by treatment and causes inflammation in one or more organs or systems in the body.
Contact your medical team if symptoms arise between appointments. Remain alert to the possibility of irAEs for up to two years after completing immunotherapy.
Infection can occur as a result of a low white blood cell count (neutropenia/leukopenia) or other factors. Contact your health care provider immediately – do not wait until the next day – if you have any of these symptoms: oral temperature over 100.4°F, chills or sweating; body aches, chills and fatigue with or without fever; coughing, shortness of breath or painful breathing; abdominal pain; sore throat; mouth sores; painful, swollen or reddened skin; pus or drainage from an open cut or sore; pain or burning during urination; pain or sores around the anus; or vaginal discharge or itching.
Infusion-related reactions occur with drug therapies that are given intravenously (IV) through a vein in your arm or through a port, usually soon after exposure to the drug. Reactions are generally mild, such as itching, rash or fever. Other symptoms, such as shaking, chills, low blood pressure, dizziness, throat tightness, skin rash or flushing, breathing difficulties and irregular heartbeat, can be serious or even fatal without medical intervention.
Managing Mental Health Concerns
Breast cancer may challenge you emotionally as much as it does physically. Don’t pressure yourself to feel a certain way. How you react to your diagnosis and treatment will be unique. Allow yourself to nurture your well-being and express your feelings freely. Being emotionally healthy will help you better cope with cancer-related issues, including managing side effects.
Many women struggle with anger, anxiety, depression, embarrassment, fear, grief and more. The physical changes from treatment can impact your self-esteem, body image and desirability. All of these feelings are completely normal, and you must address them for the sake of your mental health. Contact your doctor about excessive crying or continued feelings of hopelessness or despair. Get immediate medical attention for thoughts of suicide or death.
Male Breast Cancer: Find Your Strength & Support
Feeling overwhelmed after receiving a cancer diagnosis is normal, especially when it is a cancer you may not have realized you could even have. TNBC and other types of breast cancer can be diagnosed in men as well as women.
When you learned about your diagnosis, your shock may have been compounded by embarrassment at having what is traditionally known as a “woman’s disease.” Realize that your feelings are valid. Discussing them and comparing notes with other men who have breast cancer, also known as chest cancer, can be immensely helpful.
TNBC occurs when malignant cells invade the breast tissue. It can develop in men at any age, with the average age at diagnosis between 65 and 70 years.
The breasts are made up of connective, fatty and fibrous tissues (see Figure 1). Though a lump may seem easier for men to feel because they typically have less breast tissue than women, they may ignore it or not report breast changes or bloody nipple discharge to their doctor because they may not realize they are at risk. They also do not obtain screening mammograms. As a result, male breast cancer may be diagnosed at a later stage.
For more information about Male Breast Cancer, go to PatientResource.com/Breast_Cancer_Male
Common Treatment-related Side Efects
| Side Effects | Ways to Manage |
| Anemia (low red blood cell count) | Get plenty of rest; participate in regular physical activity |
| Chemo brain (cognitive dysfunction) | Take notes; keep lists; use a daily planner, don't multitask |
| Constipation | Drink more liquids; increase physical activity; contact your doctor before trying over-the-counter medications or adjusting your diet |
| Diarrhea | Drink plenty of fluids; eat several small meals; avoid greasy foods, know where clean restrooms are to prevent accidents |
| Emotional distress | Speak to a counselor or mental health professional; join a local or online cancer support group; seek help immediately for thoughts of suicide |
| Fatigue | Balance activity and rest; take short naps; sleep regularly, participate in regular activity; ask for help |
| Hair loss (alopecia) | Wear a wig, scarf or hat; use a wide-toothed comb; sleep on a satin pillowcase; ask your doctor for a prescription for a wig or a cooling cap |
| Lymphedema | Wear a compression garment; elevate the swollen limb |
| Mouth Sores | Brush teeth often with a toothbrush with soft bristles; eat soft foods; drink plenty of fluids |
| Nausea, vomiting | Take antiemetics as prescribed; eat several small meals; drink plenty of fluids; avoid unpleasant odors |
| Neuropathy | Avoid tight clothes or shoes; keep hands and feet warm; avoid standing for long periods of time |
| Neutropenia (low white blood cell count) | Wash hands frequently; avoid crowds and children; wash fruits and vegetables carefully; contact your doctor for a fever higher than 100.5°F |
| Skin reactions | Use mild soap; use thick cream (with no alcohol, perfume or dye) to moisturize skin |
