Breast Cancer Treatment Side Effects Come Center Stage

By Christine Haran
While there?s never a good time to get breast cancer, women diagnosed today tend to have less debilitating treatment experiences than women who were diagnosed 10 years ago. While one might assume the change is due to gentler therapies, chemotherapy for breast cancer, for example, has actually gotten more aggressive.

"The improvements in quality of life are due to two things." says John Glaspy, MD, medical director of the Oncology Center at the University of California, Los Angeles Jonsson Cancer Center. "Number one, there?s a greater focus on quality of life, and number two, the advent of several breakthrough drugs that have helped us to better manage patients experiencing side effects."

Chemotherapy
Chemotherapy, of all cancer treatment, is most feared for its toxicity, and the most disabling side effect has traditionally been nausea and vomiting. The experience is so ingrained that some women who have undergone chemotherapy recall anticipating nausea or gagging at the sight of the hospital where they received their chemo, or even at the sight of their oncology nurse.


Today, however, new medications have made such difficult experiences increasingly usual. "New serotonin-based anti-nausea drugs have revolutionized oncology." Dr. Glaspy says, "making vomiting rare and nausea less common among women being treated for breast cancer."

Chemo-related fatigue is also often better managed today, though women are still likely to be more tired than usual. Women with very low red blood counts may be prescribed a drug that stimulates red blood cell production and thus helps with anemia-related fatigue. Many women will not have such low blood counts, however. And not all chemo-related fatigue is related to anemia. These women are often advised to cope with their fatigue by doing moderate exercise, even just walking around the block, and cutting down on some of their activities.

"Women need to pace themselves and prioritize their time." says Jean M. Lynn, MPH, an oncology-certified nurse and director of the Breast Care Center at George Washington University in Washington, DC. "I always look at breast cancer as a part-time job for six months. You can?t continue doing everything else you were doing. If you try to do everything, you?ll just crash."

Other side effects for which treatments are available are infections, such as yeast infections, and local therapies for mouth sores and mucositis, which is an inflammation of the mucous lining in the mouth. There are also effective medications for digestive problems, such as diarrhea and constipation, which may result from chemotherapy and the anti-nausea drugs taken during treatment.

There is not yet a solution for hair loss, which continues to be devastating for many women on chemotherapy. Chemo-related cognitive problems, such as memory loss and difficulty concentrating, also continue to frustrate women. While a drug for "chemo brain" is now in clinical trials, for now oncology nurses recommend that women simply take the time to write down those details they?re likely to forget.
Some premenopausal women, particularly those in their late 30s and 40s, may stop having their periods because of chemotherapy. This chemically-induced premature menopause can lead to menopausal symptoms such hot flashes, night sweats and vaginal dryness.

Hormonal therapy
These menopausal symptoms also appear in women being treated for breast cancer with hormonal therapies such as tamoxifen or aromatase inhibitors. And women taking aromatase inhibitors may also experience aching joints and bone loss and are more prone to osteoporosis and bone fractures.

While menopausal hormone therapy is sometimes recommended to treat menopausal symptoms, it is not offered to women with breast cancer because the hormones may increase risk of breast cancer recurrence. Instead, for hot flashes, Lynn suggests women use non-drug strategies such as avoiding caffeine, alcohol and spicy foods, and dressing in layers so that they can remove clothing during a hot flash. Some studies have found that certain antidepressants and vitamin E supplements are helpful. And to treat vaginal dryness, women with breast cancer may use local estrogen treatments, such as Estring, which is a ring that is placed in the vagina, or Vagifem tablets. The small amounts of estrogen in these products do not appear to increase risk.


Lynn adds that menopausal side effects of hormonal therapy do tend to wear off over time. So the hot flashes a woman experienced in her first year of tamoxifen, for example, are likely to be much stronger than those she has in year five.

Radiation Therapy
Radiation therapy to the breast, a treatment that follows lumpectomy and sometimes mastectomy, can cause fatigue, but the major side effect is skin irritation. Fair-skinned women tend to have more reddening or darkening of the skin and soreness than darker-skinned women, though any woman can have a reaction. Lynn says that because women are closely monitored, severe reactions such as peeling or blistering are rare.

To soothe their skin, women are usually given creams such as Aquaphor, biafine or pure aloe vera gel. Oncology nurses also advise women to wear soft sports bras or camisoles, as bras with underwire can be irritating to the skin.

Improving Quality of Life
Just as every woman?s breast cancer is different, women?s treatment experiences will vary. As Dr. Glapsy explains, "Some women have no side effects, some have one or two, and other women have all of them. And some women have them bad and some women have them mild, and you don?t know until you?ve started."

While some women will be more affected by treatment than others, it?s safe to say that many will be able to continue leading an active life during treatment. "I think that breast cancer treatment has evolved tremendously." Lynn says. "And we continue to find new ways to manage the side effects with new strategies and interventions to help women have the best quality of life they can possibly have."

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