Side Effect Management

In this section, you’ll read about common side effects of cancer and cancer treatment, along with ways to manage those side-effects.

Bone health
Bone health can be compromised by some chemotherapy drugs and by metastases. Endocrine therapies also have effects on bone health in different ways. Osteoporosis usually does not cause symptoms, but the following may be a sign of the condition: weight loss, stooped posture, curving of the upper back, bone tenderness, or loss of one or two inches in height. If a bone density scan shows signs of bone loss, your doctor may prescribe a bone-modifying agent. There is also evidence to suggest addition of a bone-modifying agent to adjuvant treatment may prevent breast cancer recurrence in bone for a population of women. Ask your oncologist if it is right for you. To promote good bone health, get enough calcium and vitamin D, and maintain a healthy weight. Perform weight-bearing exercises, such as walking, dancing and climbing stairs, which stimulate the production of bone-forming cells. Also, help prevent falls by wearing shoes that fit well and by avoiding clutter and small rugs in your home.

Cancer-related brain fog
This is a side effect of systemic cancer therapies. It means you may have trouble remembering details such as names, dates and telephone numbers; memory lapses in the middle of tasks or conversations; and difficulty paying attention. Strategies you can use to cope with brain fog include use a calendar to keep all your important information in one place; exercise your brain with crossword puzzles, games, and hobbies; get proper sleep, physical activity, and nutrition; and keep a record of your cognitive difficulties to share with your doctor, who may have other solutions. For more information, see our video on brain fog.

» Reading suggestion from our blog: Tips for managing cancer-related brain fog

Digestion: Constipation
Difficulty in emptying the bowels can result from chemotherapy, hormonal therapy or targeted therapies. To help manage your symptoms try to avoid foods that may lead to constipation such as bananas, cheese, meat, and eggs. Diarrhea (frequent and liquid discharge from the bowels) can result from chemotherapy or radiation, and can cause serious problems such as weight loss, fatigue, and dehydration.  Clear liquids such as broth, decaffeinated tea, water, ginger ale, and cranberry juice can help with dehydration.  Once symptoms improve, you can add low-fibre solid foods like white rice or potatoes.  Also, ask your doctor whether you can take an over-the-counter medication.

» Reading suggestions from our blog:

• Constipation: A hard truth
• Diarrhea – The opposite of constipation

Depression and anxiety
Affects roughly one-quarter of breast cancer patients. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), symptoms of clinical depression include at least two weeks of unusual sadness or decreased pleasure in daily activities, a decline in functioning, as well as five of the following:

• Depressed mood or irritable most of the day or nearly every day.  This could include feeling sad or empty.  It may be something you notice yourself or observed by your friends and family. 
• Decreased interest or pleasure in regular activities, most of the time
• A significant change in weight or appetite
• Change in sleep: this can include either lack of sleep (insomnia) or excessive sleepiness (hypersomnia)
• Change in activity: either an abnormal increase or reduction in activity levels
• Fatigue or loss of energy
• Guilt/worthlessness: Feelings of worthlessness or excessive or inappropriate guilt
• Concentration: diminished ability to think or concentrate, or more indecisive
• Suicidality: Thoughts of death or suicide, or developing a “suicide plan”

According to the DSM, symptoms of an anxiety disorder include the presence of excessive anxiety and worry for at least 6 months. At the same time, at least three of the following symptoms are present:

• Edginess or restlessness
• Tiring easily; more fatigued than usual
• Impaired concentration or feeling as though the mind goes blank
• Irritability (which may or may not be observable to others)
• Increased muscle aches or soreness
• Difficulty sleeping (due to trouble falling asleep or staying asleep, restlessness at night, or unsatisfying sleep)

While some sadness or anxiety is normal when you have breast cancer, mood disturbances require treatment if they are severe, persistent, or accompanied by thoughts of death and dying. If this is the case for you, ask your oncology team to refer you to the psychosocial oncology department or patient and family support service at your cancer centre. Here trained professionals are skilled at assisting people to receive the help they are seeking. Treatments include talk therapies, either individually or in a group, and anti-depressants or anti-anxiety agents designed to lift mood disturbances caused by chemical imbalances in the brain that can affect how we are feeling.

» Reading suggestions from our blog:

• Depression, anxiety and ways to cope
• Overcoming the lasting side effects of breast cancer
• How I regained control of my life when breast cancer made me feel like I had lost it

Fatigue
A potential side-effect of surgery, radiation therapy and chemotherapy, as well as the cancer itself.  Depression, stress, poor nutrition, changes in your sleep patterns along with other medical conditions may also cause or worsen fatigue. To manage fatigue, set priorities and try to only do the tasks that are most important. Participate in regular physical activity, such as walking or yoga. It may also be helpful to rest regularly and take frequent naps, while maintaining sleep quality at night. Eating a well-balanced diet may also help restore your energy. Also, try to find activities that will aid you in relaxing or distracting you from your fatigue. These activities can include reading, listening to music, or meditating.

» Reading suggestions from our blog:

• Tips for managing fatigue
• Cancer-related fatigue Q&A
• A running thread

Febrile neutropenia
Neutropenia (low white blood cells) results from chemotherapy and puts you at risk of an infection. The white blood cells are normally responsible to fighting bacterial infections. If you develop a fever, it is considered an emergency, since your body cannot fight an infection on its own. Symptoms of febrile neutropenia include fever, shaking chills, night sweats, nausea, vomiting, swelling, headache, and neck stiffness.  It is important to let your doctor know if you are experiencing any of these symptoms. You may need to postpone a chemotherapy treatment. There are drugs to help manage this side effect. Watch our video on how to manage the side effects of FN.

» Reading suggestion from our blog: Ask an expert: febrile neutropenia explained

Hand-foot syndrome is a side effect of a chemotherapy damaging the surrounding tissue in the hands or feet.  Symptoms range from redness, swelling, and a tingling or burning sensation to cracked, flaking, or peeling skin, blisters, and sometimes severe pain.  If you notice any of these symptoms, try the following techniques to manage it:

• Wrap an ice pack in a towel and apply it to the affected area for 15 to 20 minutes
• Avoid sources of heat such as hot showers, saunas, and hot weather
• Avoid using tools that put pressures on your hand, such as garden tools, knives, and screwdrivers
• Apply mild skin cream to the affected area and keep it well moisturized
• Take a pain medication such as ibuprofen

Hair loss due to chemotherapy or radiation may be very difficult for some people.  Wigs, hats and scarves may help you cope. If you are thinking about wearing a wig, you may want to pick one out before you start chemotherapy. This may help you find a good match for your natural color and cut. Many insurance plans cover all or part of the cost of a wig for people getting chemotherapy if the claim includes a health care provider's prescription or letter. To find a wig boutique in your area visit the Canadian Cancer Society’s Community Services Locator.

Lymphedema is a swelling of the arm or leg caused by a build-up of lymph, a fluid that transports white blood cells and cellular debris through the lymphatic system.  Lymphedema is usually the result of the removal of lymph nodes during breast cancer surgery, which causes a blockage and prevents the lymph from draining properly.  There is no cure for lymphedema, but it can be managed with special compression garments and other techniques.  For more information, visit the Canadian Lymphedema Framework at www.canadalymph.ca.

» Reading suggestions from our blog:

• Is your swollen arm a sign of lymphedema?
• Surviving breast cancer and living with lymphedema

Menopausal symptoms can result from endocrine therapy. Regular exercise, especially aerobic exercise (walking, running, swimming, bike riding), can help reduce hot flashes, mood swings, and sleep disturbances. Other strategies for managing hot flashes include wearing cotton, dressing in layers so you can remove clothes if needed, keeping ice water nearby to drink when a hot flash begins, taking a cool shower before going to bed, and opening the refrigerator door and putting your head in when a hot flash begins.  If they are not controlled with these conservative measures, ask your oncologist about prescription medications that may help lessen these side effects.

Mouth sores can be a side effect of radiation or chemotherapy. They can be painful and can cause difficulty with talking, eating, swallowing, and breathing. They can also become infected.  They can be prevented with mouth care, club soda rinses, or prophylactic mouthwashes for some drugs that have a high risk of causing mouth sores.  If you develop mouth sores, talk to your healthcare team about treatments.

Nausea/vomiting can be caused by chemotherapy, radiation, other anti-cancer drugs, and anxiety.  If vomiting becomes severe, it can lead to dehydration, which is a lack of essential fluids and minerals in your body. This may interrupt your cancer treatment plan. It is important to work with your health care team to try and manage these symptoms. There are medications called anti-emetics to prevent, and treat them. Speak to your healthcare team about options that might be right for you.

Nail changes can result from chemotherapy.  Your nails may have bruises or blemishes or they may become thin and brittle.  With these changes, there is a risk of infection and lymphedema may become worse.  Therefore, it is important to keep your nails trimmed and clean.  When doing housework or gardening, wear gloves to protect your nails. If you are concerned about any changes to your nails, tell your doctor.

Neuropathy is a side effect of chemotherapy and radiation that causes numbness and tingling in the hands and feet.  It can also cause a decreased feeling of hot and cold, discomfort when touched, muscle weakness and cramping, and balance problems. Treatments for neuropathy include medications, massage, acupuncture, and transcutaneous electrical nerve stimulation (TENS).  Strategies for managing neuropathy include avoiding tight fitting shoes or socks and extreme hot and cold temperatures.  Regular exercise can also be beneficial in managing neuropathy. It is important to also take safety precautions as the decreased feeling in your hands and feet may increase the risk for injury. Keep your house well-lit, try to keep your floor clear, and watch the floor in front of you as you walk. Ask your chemotherapy nurse if keeping your hands in an ice bath, or frozen gloves during the chemotherapy administration is right for you.  Be sure to notify your doctor if you have neuropathy symptoms, as they may consider changing the dose of treatment.

» Reading suggestions from our blog:

• Helping you live better with Chemo Induced Neuropathy
• Nerve damage is a little-known side effect of radiation

Pain can be caused by all treatments for breast cancer and by the cancer itself. Common sites for this pain include the back, bones, joints, abdomen, chest, muscles, and head. Chronic pain can also be caused by mastectomy amputation and radiation to tissues causing permanent tightness and shrinkage. There are many drugs as well as physical and psychological interventions available. Pain may be permanent, but can be relieved with massage and physiotherapy. Your doctor or pain specialist can help you manage your symptoms so you can continue your cancer treatments.

» Reading suggestion from our blog: 6 ways to manage joint pain

Skin changes caused by cancer treatment can include rashes, dry and itchy skin, hair loss, mouth sores, skin darkening, sensitivity to light, and skin growths. To manage skin changes, wash with mild soap and lukewarm water; moisturize your skin twice a day with a thick cream that contains no alcohol, perfume or dye; use an electric shaver if shaving is necessary; wear loose-fitting clothes; you can also use gentle laundry detergents that are free of perfumes or dyes; and protect your skin from the sun.

Side effects can be unpleasant and even life-threatening, and can interfere with your breast cancer treatment, so be sure to talk to your healthcare team about ways of managing them.  For more information on side effects, visit www.cancer.ca.

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