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Do What You Can to Ease Side Effects of Treatment and Symptoms for Breast Cancer

Middle-aged woman gazing into the distance

You may be worried about what it will be like to get treatment for breast cancer. You will likely have physical concerns since your cancer may cause symptoms, and you may have side effects from your treatment, too. In this section, you'll learn more about how to respond to some of the most common ones. They are listed in alphabetical order.

Talk to your doctor about the side effects that are most common with the treatment you are getting and what you can do about them.

Anxiety and depression

Many people feel blue, anxious, or distressed after being told they have cancer. It is normal to feel this way. These feelings may become stronger if you get hormone therapy. Sometimes these feelings may continue or come back throughout treatment, but they usually lessen as a person adjusts to the diagnosis. Talk to your doctor if these feelings become intense and long-lasting. If they interfere with your ability to do things, you may need professional help.

Taking these actions may ease your mental stress:

  • Talk with your family or friends.

  • Consider joining a cancer support group or finding a cancer "buddy" who can help you cope.

  • Consider learning relaxation techniques, meditation, or yoga to help control and ease mood swings.

  • Exercise to help boost your mood and ease anxiety.

  • Talk to your doctor about how you are feeling; you may benefit from medications for depression and anxiety.

  • Consider getting a referral to talk with a social worker, psychologist, or psychiatrist. These specially trained health care professionals can help you sort through your feelings and figure out healthy ways to deal with them.

Appetite changes

People who eat well during cancer treatment maintain their strength better, are more active, and are better able to lower their chance of infection. It's important to remember that your body needs energy to heal itself. Maintaining your weight is a good way to know if you are giving your body the energy it needs. When you're being treated for cancer, a healthy diet that is high in protein is usually best. The problem is that side effects of treatment, especially chemotherapy, can make you not want to eat. Some chemotherapy treatments can change the way food tastes to you. Radiation to the head, neck, or chest area can reduce your appetite or make it hard for you to swallow. Some people can gain weight as a side effect from steroids or hormone therapy. If this is the case for you, focus on getting a balanced diet and increasing your activity level. Ask your doctor for a referral to a registered dietitian if you are having trouble maintaining your appetite or your weight.

Also, try these tips to stimulate your desire to eat:

  • If you can, eat foods high in protein several times a day. These foods include milk, cheese, cottage cheese, yogurt, meat, fish, eggs, beans, peanut butter, and nuts. Protein helps build and repair tissue, and cancer treatments cause you to use more protein than usual.

  • To maintain your weight, eat high-calorie foods such as margarine or butter, sugar, honey, jams, jellies, cream cheese, dried fruit, gravies or sauces, mayonnaise, and salad dressing.

  • Get plenty of fluids to help control your body temperature and keep your bowels moving. In addition to water, fruit juices, and other liquids, try gelatin, pudding, soups, fruit bars, and ice cream.

  • Eat small meals throughout the day instead of 3 large ones.

  • Keep healthy snacks handy to eat when you are hungry.

  • Eat with friends or play your favorite music at mealtime to boost your appetite.

  • Eat your biggest meal in the morning. Many people getting treatment for cancer find that this is when their appetite is greatest.

  • If you can, increase your activity level. Doing so may boost your appetite.

  • On days when you don't feel like eating at all, don't worry about it. Try again the next day. If you find your appetite doesn't improve in several days, talk with your doctor or nurse.

Bleeding problems

Certain kinds of chemotherapy may reduce your blood platelet count and lead to a problem called thrombocytopenia. Without enough platelets, your blood may not clot the way it should, and you may bleed and bruise easily. If your doctor tells you that your platelet count is low, take these actions to avoid injuries that could lead to bleeding problems:

  • Protect your skin from cuts and scrapes, and be very careful if you must use sharp objects.

  • Shave with an electric razor.

  • Use a soft toothbrush to prevent bleeding gums, and talk to your doctor about whether it is OK to floss.

  • Take steps to prevent constipation, which can lead to hemorrhoids.

  • Call your doctor if you develop a rash, bleeding, or bruising.

Bloating

Some chemotherapy drugs cause your body to retain water. This water retention will go away when your treatment ends.

Here's what you can do for relief:

  • If your bloating is severe, your doctor may prescribe a diuretic or water pill.

  • Take short walks.

  • Elevate your legs as often as you can.

Constipation

Constipation, which includes difficult or infrequent bowel movements, can range from mildly uncomfortable to painful. Taking certain pain medications can lead to constipation so it's wise to take these preventive actions. It's also a less common side effect of hormone therapy. These same steps will give you relief if you are already constipated:

  • Drink plenty of fluids, 6 to 8 glasses a day, especially water and prune juice.

  • Eat foods high in fiber, such as cereals, whole grains, and fruits and vegetables that are approved by your doctor.

  • Exercise.

  • Take stool softeners or a laxative only as prescribed by your doctor.

Cough

Certain hormone therapies, such as the aromatase inhibitor Arimidex (anastrozole), can increase coughing symptoms. Try these tips to soothe your cough:

  • Drink at least 8 glasses of fluid a day to keep the lining of the breathing tube moist.

  • Use a humidifier to increase the moisture in the air.

  • Ask your doctor about medicines to stop or help control coughing.

Diarrhea

Diarrhea, which includes loose or frequent bowel movements, or both, may lead to dehydration if you don't take these precautions. Many drugs can cause bowel changes. Try these steps:

  • Avoid milk and milk products.

  • Avoid gas-producing vegetables, dried fruit, fiber cereals, seeds, popcorn, nuts, corn, and dried beans.

  • Eat low-residue, low-fiber foods such as those found in the BRAT diet (bananas, rice, applesauce, and toast).

  • Increase your intake of fluids, such as water and broth, to prevent dehydration.

  • Ask your doctor about medications that may help.

Hair loss (alopecia)

Losing your hair can be upsetting because thinning or baldness is a visible reminder that you are being treated for cancer. Keep in mind that your hair will grow back after treatment.

Try these coping tips:

  • Consider cutting your hair short before treatment starts.

  • Think about getting a wig, hat, or scarf before your hair loss starts. That way, you can get a wig that matches your hair, and you'll be ready with head coverings, if you choose to use them.

  • Because your scalp may be more sensitive to temperature and sun, protect it with sunscreen and hats or scarves.

Hot flashes

A hot flash is also called a hot flush. It is a sudden rush of warmth to the face, neck, upper chest, and back--with or without sweating. It can last for a few seconds to an hour or more. Hot flashes can occur with chemotherapy or hormone therapy. Some women have mild symptoms, while others have more severe ones. In many cases, hot flashes stop when treatment stops. Some women report that hot flashes last for years after hormone treatment is done. To ease them, try these tips:

  • Limit your intake of hot drinks, caffeine, alcohol, and spicy foods.

  • Avoid strenuous exercise.

  • Layer your clothing so that you can add or remove as needed.

  • Stay out of environments with very warm temperatures.

  • Use sprays or moist wipes to help lower skin temperature

  • Ask your doctor about relaxation training or acupuncture.

  • Ask your doctor about medications or supplements you can take to ease symptoms.

Infection

Without enough white blood cells, your body may not be able to fight infection. Many types of chemotherapy can cause low white blood cell counts, which is called neutropenia.

If your doctor tells you that your white blood cell count is low, take these actions to stay healthy:

  • Avoid crowds or people with colds.

  • Wash your hands often throughout the day to kill germs. Bathe daily to keep the number of bacteria down

  • Call your doctor right away if you have any of these signs of infection: a temperature of 100.5°F (38°C) or higher, severe chills, a cough, pain, a burning sensation during urination, or any sores or redness.

Insomnia (trouble sleeping)

Insomnia can be caused by anxiety, depression, or your cancer treatment. Use these tips to improve your rest:

  • Keep a regular bedtime schedule.

  • Use your bed only for sleeping, not watching TV.

  • If you don't fall asleep within 15 minutes, get up, do something else, and try again later.

  • Avoid stimulants such as caffeine and tobacco, especially close to bedtime.

  • Don't eat, drink fluids, or exercise close to your bedtime.

  • Avoid long naps during the day.

Lymphedema (swelling in your hand or arm)

If your lymph nodes are removed from your armpit, you may have swelling in your hand or arm, called lymphedema, on the side where you had surgery. This is more likely if you also have radiation therapy to your armpit. Lymphedema may occur right after surgery, or it may happen many years later. It is caused when excess lymph fluid collects in tissue.

To reduce your risk or improve symptoms of lymphedema, take these actions:

  • Clean the skin of your arm daily and use moisturizing lotion.

  • Wear loose jewelry and clothes without tight bands.

  • Carry your handbag on your other arm.

  • Have your blood pressure taken on your other arm.

  • Do not use elastic bandages with tight bands.

  • Do not sit in 1 position for more than 30 minutes.

  • Watch for signs of infection, such as redness, pain, heat, swelling, and fever. Call the doctor immediately if any of these signs or symptoms appear.

  • Do your prescribed exercises regularly. If you have swelling, keep your affected arm raised above the level of your heart, when possible.

  • Keep regular follow-up appointments with your doctor.

To avoid injury and infection in your arm, take these precautions:

  • Use an electric razor for shaving.

  • Wear gardening and cooking gloves.

  • Use thimbles when sewing.

  • Take care of your fingernails. Don't cut or bite your cuticles.

  • Use sunscreen.

  • Clean cuts with soap and water, and then use antibacterial ointment.

  • Use gauze wrapping instead of tape; do not wrap so tightly that circulation is cut off.

  • Talk with your doctor or nurse about any rashes.

  • Avoid needles, like shots or blood draws, in the affected arm.

  • Do not have your blood pressure taken in the affected arm.

  • Avoid extreme hot or cold such as ice packs or heating pads.

  • Do not overwork the affected arm.

Menopausal symptoms

Some types of chemotherapy and hormone therapy can damage the ovaries or cause menopausal symptoms in women who've not yet reached menopause. They include symptoms such as hot flashes, vaginal dryness, mood swings, and weight changes. Periods may become irregular or may stop, and you may not be able to get pregnant. However, some women may still be able to get pregnant during treatment:

  • If needed, talk with your doctor about birth control before treatment begins. It is not safe to get pregnant during cancer treatment. 

  • Talk with your doctor about ways to manage menopausal symptoms, such as using lubricants for vaginal dryness, doing mild exercise, and talking with a therapist about mood swings or signs of depression.

  • Report any unusual bleeding to your doctor.

  • Continue with regular pelvic exams.

Also see Vaginal dryness and other vaginal problems below.

Mouth sores (mucositis) and dryness

Some types of treatment may cause mouth sores and dryness. Mouth sores may hurt and make eating unpleasant. Chronic dryness can impair your ability to taste, chew, and even speak.

To prevent sores or to treat dryness in your mouth, take these actions:

  • Brush your teeth after meals and before bedtime; floss every day (check with your doctor about flossing).

  • Keep your mouth and lips clean and moist; try lip salves to keep your lips moist.

  • Suck on sugar-free candies or frozen fruit bars or chew sugar-free gum to increase moisture in your mouth.

  • Sip water frequently.

  • Eat soft and pureed foods that are easier to swallow if you have dry mouth.

To ease the pain if you get sores in your mouth, take these actions:

  • Avoid alcohol and mouthwashes containing alcohol because they may irritate the sores.

  • Avoid hot, rough, or spicy foods because they may irritate the sores.

  • Avoid tobacco because it may irritate sores.

  • Ask your doctor about topical mouth medications.

  • Take over-the-counter pain medication, such as Tylenol (acetaminophen), if necessary.

  • Call your doctor or nurse if your temperature reaches 100.5°F (38°C) or higher.

Nausea or vomiting

Nausea or vomiting as a result of chemotherapy, radiation treatment, and sometimes hormone therapy for cancer may range from barely noticeable to severe. It may help you to understand the different types of nausea:

  • Acute-onset nausea and vomiting occurs within a few minutes to several hours after chemotherapy. The worst episodes tend to be 5 to 6 hours after treatment, and the symptoms end within the first 24 hours.

  • Delayed-onset vomiting develops more than 24 hours after treatment.

  • Anticipatory nausea and vomiting are learned from previous experiences with vomiting. As you prepare for the next dose of chemotherapy, you may anticipate that nausea and vomiting will occur as it did previously, which triggers the actual reflex.

  • Breakthrough vomiting means vomiting occurs despite treatment to prevent it. It requires other types of treatment.

  • Refractory vomiting occurs after one or more chemotherapy treatments -- essentially, you're no longer responding to the antinausea treatments you have been getting and will need to try new ones.

To prevent nausea, take these actions:

  • Ask your doctor about getting a prescription medicine to control nausea and vomiting. Then, make sure you take it as directed. If you are vomiting and cannot take the medicine, call your doctor or nurse.

  • If you have bothersome nausea and vomiting even though you are taking your medicine, call your doctor or nurse. Your medicine may be changed or other medicines may be added to it.

To help ease nausea or vomiting, try these tips:

  • Try eating foods and drinking beverages that were easy to take or made you feel better when you had the flu or were nauseated in the past. These might be bland foods, sour candy, pickles, dry crackers, ginger ale, flat soda, or others.

  • Drink lots of fluids -- 6 to 8 glasses of liquids -- such as water, broth, or Gatorade, a day to avoid dehydration.

  • Do not eat fatty or fried foods, very spicy foods, or very sweet foods.

  • Eat foods that are at room temperature or cold. The smells from hot foods may make your nausea worse.

  • Ask your doctor or nurse if he or she can help you learn a relaxation exercise. This may make you feel less anxious and more in control, and decrease your nausea.

  • Ask your doctor or nurse about using acupressure bands on your wrists, which may help decrease your nausea.

Nerve damage (peripheral neuropathy)

If you have numbness, tingling, or weakness in your hands and feet, you may have nerve damage called peripheral neuropathy. Some types of chemotherapy are known to cause this. Other signs of this problem are ringing in your ears or feeling too hot or too cold.

If you have symptoms such as these, let your doctor know and take precautions to protect yourself:

  • Take extra care walking and moving so that you don't fall.

  • Use warm, not hot, water for bathing to prevent burns. Consider using a shower chair or railing.

  • If your daily activities become too difficult, ask your doctor for a referral to an occupational therapist or a physical therapist. They can help teach you new ways of doing things so that you can stay as active as possible.

  • Take extra care when driving (you may have trouble feeling the gas and brake pedals). Ask friends and family to drive you places.

Pain (including pain in joints, back, and bones)

Try these tips to ease pain:

  • For mild to moderate pain, over-the-counter pain medication can help with pain in many parts of your body, such as your joints or back.

  • You can treat pain at an injection site with warm or cold compresses.

  • Take your pain medications regularly; don't wait for your pain to become severe. (Take steps to avoid constipation, a common side effect of pain medications.)

  • Change your activity level. See if you feel better if you rest more or move around more -- either may help.

  • Distract yourself with music, funny videos, or computer games.

  • Use heat, cold, or relaxation techniques such as yoga, meditation, or guided visualization. Ask your doctor or nurse where you can learn more about these.

Pain in your neck, chest, or back

The removal of a breast can make your weight shift, causing you to feel off-balance, especially if you have large breasts. This can lead to discomfort in your neck and back. A bra with a fake breast, called a prosthesis, not only allows you to look like you did before your surgery, it also helps balance the weight in your chest. If you get a prosthesis, be sure to do the following:

  • Make sure the prosthesis fits properly.

  • Check that the weight of the prosthesis is similar to that of your remaining breast.

  • Consider getting a bra that has pockets inside to hold the prosthesis. This keeps the prosthesis from rubbing against your skin and causing irritation.

Sexual problems

Hormone therapy may decrease your desire to have sex. Feelings of depression from having cancer, losing a breast, or fatigue from other treatments can also have a negative impact on your sexual desires.

Here are some ways you may cope better:

  • Talk with your partner about changes in your desire to have sex.

  • Explore new ways to share affection and intimacy.

  • Discuss sexual problems with your doctor or with other members of your health care team. They may be able to refer you to a counselor who specializes in sexual problems or to a sexual rehabilitation program.

Skin changes

Radiation treatment can cause dry or red skin in the area being treated. After breast surgery, the skin in the breast area may also be tight, or you may feel numbness or tingling over the chest area. With some types of chemotherapy, you may also have nail changes, such as splitting, or slower growth.

Try these tips:

  • Protect your skin from sun exposure, especially between 10 a.m. and 4 p.m., by wearing sunscreen with an SPF of at least 15.

  • Ask your doctor or nurse what kind of lotion you can use to moisturize and soothe your skin. Don't use any lotion, soap, deodorant, sun block, cologne, cosmetics, or powder on your skin within 2 hours after radiation treatment because they may cause irritation.

  • Wear loose, soft clothing over the treated area. Cotton underwear can help prevent further irritation.

  • Ask your nurse or doctor about special exercises and other ways to cope with changes in sensation, such as tightness or numbness in the chest area.

  • Don't scratch, rub, or scrub treated skin. After washing, gently blot-dry.

  • Don't bandage skin with tape. If you must bandage it, use paper tape and ask your nurse to help you place the dressings so that you can avoid irritation.

  • Don't apply heat or cold to the treated area. Bathe only with lukewarm water.

  • If you must shave the treated area, use only an electric shaver. Don't use lotion before shaving. And don't use hair-removal products.

  • Keep your nails well trimmed and clean.

Thinking problems (chemo brain)

You may have mild problems with concentration and memory during and after chemotherapy. Fatigue can make the problem worse.

Taking these actions may help.

  • Make lists and write down important information.

  • Use other tools to help organize your life, such as calendars, pill dispensers, or alarm clocks.

  • Ask your doctor about medications or nutritional supplements that may help.

Tiredness

Tiredness is a very common symptom and side effect. The tiredness that comes with cancer treatment is often called fatigue. It often doesn't get better with rest and can make it hard for you to do the things you need to do. Many things can cause fatigue, such as depression, pain, poor nutrition, certain medications, and inadequate sleep. It can also be a result of anemia caused by low levels of red blood cells, which carry oxygen throughout the body. If your body does not have this oxygen, you may feel tired. Decreased red blood cell counts can be caused by blood loss, chemotherapy or radiation, or the cancer itself. Other changes in blood counts can also cause fatigue. Tiredness can last months after treatment ends. You may feel only slightly tired, or you may suffer from extreme fatigue.

Taking these actions may help increase your energy levels:

  • Take short rests when you feel tired. Avoid long naps during the day so that you can sleep well at night.

  • Add regular exercise, such as walking, to your daily routine, under your doctor's supervision. It may also help you sleep better.

  • Balance activity with rest. Save your energy for important tasks.

  • Drink plenty of fluids to prevent dehydration, which can lead to tiredness.

  • Take action to treat a poor appetite because eating improperly can make you tired. As long as diarrhea isn't a problem for you, it may also help to eat plenty of fruits, vegetables, and complex carbohydrates, such as whole wheat bread.

  • If your fatigue is severe or chronic, ask for help with routine tasks that can drain your energy, such as grocery shopping or housework. Some people reduce their hours at work.

  • Talk with your doctor about medications or treatments that may help you manage your anemia.

Vaginal dryness and other vaginal problems

Vaginal dryness and discharge can be bothersome side effect of hormone therapy. In addition to vaginal dryness, lowered estrogen levels may cause women to have vaginal thinning and difficult or painful intercourse. Lubricants can help with some of these problems. Vaginal infections may also occur more often. When you talk with your doctor about these problems, make sure he or she knows you've had cancer. Try these methods to ease symptoms:

  • Use over-the-counter vaginal moisturizers and lubricants Replens, Gyne-Moistrin, and Lubrin.

  • Before sexual activity use water-soluble lubricants, such as KY Jelly and Astroglide or other mild vaginal moisturizers.

  • Apply vitamin E oil to the area to ease irritation and burning.

  • Ask your doctor about products that may help replace estrogen vaginally.

  • Talk to your doctor right away if you think you may have a yeast infection or other unusual vaginal discharge.

  • Wear cotton underwear and pantyhose with a ventilated cotton lining, and don't wear tight slacks or shorts.

Weight gain

This can result from hormone therapy and the steroids that are often used during cancer treatment. To help lose weight, take these actions:

  • Exercise each day for about 20 to 30 minutes, under your doctor's supervision.

  • Eat foods low in fat, such as fruits and vegetables.

  • Ask your doctor to recommend a weight-management program.

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