Breast Cancer

Managing Side Effects

A cancer diagnosis can affect every part of your life. Supportive care services are available to address challenges you and your loved ones may face physically, emotionally, psychologically, socially, financially and spiritually. A major focus is to help you minimize and manage side effects.

Severe side effects are not common but can occur with some cancer treatments, such as immunotherapy. Immune-related adverse events (irAEs) can develop rapidly and become serious – even potentially life-threatening – without swift medical attention. Ask about irAEs to watch for, and report symptoms to your doctor immediately during treatment and for up to two years afterward.

Anemia (too few red blood cells) can result in fatigue, weakness, shortness of breath, dizziness and other symptoms. Get enough sleep consistently, exercise regularly when possible and pace yourself, balancing activity with rest.

Chemo brain (cognitive dysfunction) refers to trouble remembering details, not being able to think clearly or having difficulty processing information. This can occur during treatment and sometimes long afterward. Although associated with chemotherapy, it has been linked to other treatments, stress and hormone depletion. Use a daily planner, make to-do lists and focus on one thing at a time.

Diarrhea can significantly affect your quality of life. If severe, it can lead to dehydration, loss of essential nutrients and delayed treatment. Avoid accidents by knowing where to find clean restrooms at places you frequent and along routes you travel. Check with your doctor before taking over-the-counter remedies or fiber supplements. If you are just starting a treatment that has a relatively high risk of causing diarrhea, ask the doctor or nurses how soon this side effect will likely start and how long it usually lasts. Find out how to proactively address it. If you have an important event, such as a daughter’s wedding or son’s graduation, discuss with your doctor if this drug can be started around that timeframe. You need to preserve these happy memories.

Emotional distress is common. Anger, anxiety, depression, fear, grief and guilt may arise. Don’t hesitate to ask for a referral to a patient counselor or mental health professional. Check out cancer support groups locally or online, or reach out to close friends or a spiritual advisor. Contact your doctor about excessive crying or continued feelings of hopelessness or despair. Get immediate medical attention if you have thoughts of suicide or death. Being diagnosed and going through treatment is like being on a rollercoaster. There are ups and downs, and they are unpredictable.

Fatigue is the most commonly reported side effect of cancer therapy. Compared with general tiredness, treatment-related fatigue lasts longer, is more severe and may not be relieved by sleep. Regular exercise is proven to fight fatigue. Even a daily 10-minute walk can make a difference. Get eight hours of sleep every night and take naps as needed, limiting them to 20 or 30 minutes each. Save your energy for what is most important.

Hair loss (alopecia) and thinning, including loss of your eyebrows and eyelashes, can result from many drug therapies. Radiation therapy to a particular area of your body causes hair loss there. Hair usually regrows gradually once treatment ends (see Look and Feel Your Best). Ask what to expect with your treatment.

Infertility can result from some cancer treatments for both men and women. It can affect the ability to become pregnant or maintain a pregnancy. If your plans include having a biological child, learn about fertility preservation with a reproductive specialist before treatment. Some preservation procedures may delay your cancer treatment, so discuss timing with your oncologist as soon as possible.

Joint pain (arthralgia) may range from mild to severe and typically ends when you finish treatment. You may receive treatment for years, so it is important to discuss pain management. Help your doctor by noting when and where pain occurs, its severity, how long it lasts and possible triggers.

Lymphedema occurs when lymph nodes are removed or damaged during treatment, causing swelling in that part of the body as lymph fluid builds up in tissues. Those at higher risk are patients who have had radiation therapy to an area where lymph nodes were surgically removed. A certified lymphedema specialist can help you learn how to reduce your risk of developing it. Contact the specialist at the first sign of swelling. Elevating the swollen limb may also help.

Mouth sores and/or dry mouth are uncomfortable and may increase your risk of cavities and oral infections. Pain from sores on the gums, tongue, roof of mouth or lips can make it difficult to talk, eat or swallow. Avoid spicy and rough-textured foods, fruit juice, soda, alcohol and tobacco. Drink plenty of clear, caffeine-free liquids to keep your mouth moist, suck on ice chips and carry a water bottle to keep a drink handy. Use a soft-bristled toothbrush. Ask your doctor about available medications.

Nausea and vomiting are much easier to prevent than to control, so ask your doctor about antiemetics (anti-nausea drugs) before treatment begins. Severe cases can lead to dehydration and delay treatment. Eat smaller, more frequent meals, drink plenty of water and avoid unpleasant odors. Try peppermints or ginger-flavored lozenges.

Neuropathy can occur from damage to the nerves that control movement and feeling in your limbs. Symptoms include numbness, pain, burning sensation, tingling and loss of feeling that usually begins in the hands or feet. Avoid standing for a long time. Wear loose-fitting clothing and comfortable shoes.

Neutropenia (low white blood cell count) increases your risk of infection, especially for pneumonia, bronchitis and sinusitis. It also makes infections harder to resolve. Report signs of infection to your doctor right away, and ask how high your fever must be to seek medical care. Wash your hands often with soap, practice good hygiene and wear gloves when cleaning or gardening. Avoid crowds, sick people and close contact with small children. Children can harbor germs that could be harmful to you.

Pneumonitis (inflammation of the lungs) can cause chest pain, shortness of breath, wheezing or an unexplained cough. These symptoms can signal a serious condition, so contact your doctor immediately if they arise or worsen.

Sexuality issues, such as reduced sexual desire, are common, particularly 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 finding new ways to be intimate. Personal lubricant may relieve vaginal dryness for women during intercourse.

Skin reactions may include rash; redness and irritation similar to sunburn; or dry, flaky or peeling skin that becomes itchy. Moisturize your skin twice a day with a thick cream. Avoid lotions, soaps, deodorants or detergents containing alcohols, perfumes or dyes.

Thrombocytopenia (too few platelets in the blood) can lead to easy bruising, trouble stopping a nosebleed, excessive bleeding from a cut or wound and other clotting-related issues. Avoid taking Omega 3 supplements, aspirin and other blood thinners while undergoing treatment, and tell your doctor about all supplements you are taking.

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