Breast Cancer Symptom Management

Management of Breast Cancer Side Effects

Managing Symptoms and Side Effects of Breast Cancer

Welcome to the Side Effects Management section, a tool designed to help patients understand and manage the side effects of cancer treatment. Our goal is to provide clear information, practical strategies, and self-management tools to improve quality of life during cancer treatment.


In this section you will find

  • Detailed information on the most common side effects.
  • Proven strategies to manage symptoms like nausea, fatigue, pain, and more.
  • Guides on when and how to apply these strategies.
  • Resources to track and monitor your symptoms.
  • Tips for effectively communicating with your medical team.

Every cancer experience is unique. Use this information as a foundation for discussions with your medical team to tailor these strategies to your situation. We are here to support you throughout your treatment, providing tools to actively engage in your care and improve your well-being.

Pain

  • Types: Nociceptive (somatic and visceral), neuropathic
  • Evaluation: Numeric pain scale (0-10), location, characteristics.

Management strategies

  • Pharmacological (WHO Analgesic Ladder)
    • Level 1: Non-opioids (acetaminophen, NSAIDs).
    • Level 2: Weak opioids (codeine, tramadol).
    • Level 3: Strong opioids (morphine, fentanyl).
    • Adjuvants: Antidepressants, anticonvulsants for neuropathic pain.
  • Non-pharmacological
    • Physical therapy.
    • Acupuncture.
    • Relaxation and mindfulness techniques.
    • Transcutaneous electrical nerve stimulation (TENS).

When to apply

  • Pharmacological: As prescribed or when pain occurs (scale >4/10).
  • Non-pharmacological: As part of a comprehensive pain management plan.

Monitoring

  • Pain diary, medication side effects.

Fatigue

Persistent feeling of tiredness not relieved by rest. Caused by cancer treatment, anemia, dehydration, depression, pain


Management

  • Exercise
    • Type: Aerobic (walking, swimming) and resistance
    • Intensity: Moderate, 150 minutes/week or 75 minutes of vigorous intensity.
  • Energy conservation
    • Prioritize activities
    • Scheduled rest periods
  • Psychosocial interventions
    • Cognitive-behavioral therapy
    • Mindfulness
  • Sleep management
    • Sleep hygiene
    • Sleep restriction therapy
  • Nutrition
    • Balanced diet
    • Supplementation (if needed) of iron, vitamin B12

When to apply

  • Exercise: Daily, adapted to patient capacity.
  • Psychological interventions: Weekly or as needed.
  • Sleep management: Continuous implementation.

Monitoring

  • Use of fatigue scales (e.g., Brief Fatigue Inventory) weekly.

Nausea and Vomiting

Caused by: Chemotherapy, radiation therapy, surgery, anxiety.


Pharmacological strategies

  • 5-HT3 antagonists: Ondansetron, granisetron, palonosetron.
  • NK1 antagonists: Aprepitant, fosaprepitant.
  • Corticosteroids: Dexamethasone
  • Others: Metoclopramide, olanzapine

Non-pharmacological strategies

  • Relaxation techniques: Meditation, deep breathing.
  • Acupressure: Use of wristbands
  • Diet: Small, frequent meals, avoid strong odors, prefer cold foods

When to apply

  • Prophylaxis: 30-60 minutes before chemotherapy.
  • Treatment: At the first sign of nausea, following the prescribed regimen.

Monitoring

  • Keep a diary of nausea/vomiting episodes and treatment efficacy.

Mucositis

Inflammation and ulceration of the oral mucosa, caused by chemotherapy and radiotherapy in the head and neck.


Prevention and management strategies

  • Basic oral care
    • Gentle brushing with a soft-bristle toothbrush.
    • Rinsing with saline or baking soda solution 4-6 times a day.
  • Pain management
    • Rinses with viscous lidocaine.
    • Systemic analgesics if necessary.
  • Prevention
    • Oral cryotherapy during the infusion of certain chemotherapeutic agents.
    • Low-level laser therapy.
  • Treatment
    • Mucosal coating agents.
    • Growth factors (e.g., palifermin) in selected cases.
  • Nutrition
    • Balanced diet
    • Supplementation (if needed) of iron, vitamin B12

When to apply

  • Oral care: At least 4 times a day.
  • Cryotherapy: During chemotherapy infusion (e.g., bolus 5-fluorouracil).
  • Laser: Daily during active treatment and recovery.

Monitoring

  • Daily evaluation of the oral cavity.
  • Use of mucositis evaluation scales (e.g., WHO Oral Toxicity Scale).

Neutropenia and Infection Risk

  • Definition: Absolute neutrophil count <1500 cells/μL.
  • Causes: Chemotherapy, radiotherapy, bone marrow infiltration by cancer.

Prevention and management strategies

  • Pharmacological (WHO Analgesic Ladder)
    • Granulocyte colony-stimulating factors (G-CSF): Filgrastim, pegfilgrastim.
    • Prophylactic antibiotics in selected cases.
  • Non-pharmacological
    • Rigorous hygiene: Frequent hand washing.
    • Avoid crowds and sick people.
    • Proper food cooking.
    • Oral care.

When to apply

  • G-CSF: When chemotherapy regimens have a >20% risk of febrile neutropenia.
  • Antibiotics: In cases of febrile neutropenia or prolonged neutropenia.

Monitoring

  • Complete blood count regularly.
  • Monitoring for signs of infection (fever, chills, cough).

Alopecia

Hair loss is a common side effect of chemotherapy.


Management

  • Short haircut before treatment
  • Use of wigs, scarves, hats
  • Scalp cooling during chemotherapy (controversial)
  • Psychological support

American Cancer Society - Hair Loss

Skin Problems

Includes dryness, rashes, color changes.


Management

  • Intense skin hydration
  • Sun protection (SPF 30 or higher)
  • Avoid irritating products
  • Specific topical treatments depending on the problem (corticosteroids, antibiotics)

Peripheral Neuropathy

Common with certain chemotherapeutic agents like taxanes and platinums.


Management

  • Dose adjustment or change of chemotherapeutic regimen
  • Medications: gabapentin, pregabalin, duloxetine
  • Physical therapy and occupational therapy
  • Acupuncture

Lymphedema

Swelling of the arm due to lymph node removal.


Management

  • Complex Decongestive Therapy:
    • Manual lymphatic drainage
    • Compression bandaging
    • Specific mobilization exercises
  • Compression garments
  • Meticulous skin care
  • In severe cases, consider surgery

National Lymphedema Network - Position Paper: The Diagnosis and Treatment of Lymphedema

Fertility Issues

Chemotherapy and hormonal therapy may affect fertility.


Preservation Options:

  • Cryopreservation of oocytes or embryos
  • Ovarian suppression with GnRH analogs during chemotherapy
  • Ovarian transposition before radiotherapy
  • Early discussion with fertility specialists

American Society of Clinical Oncology (ASCO) Guideline on Fertility Preservation in Patients With Cancer

Cognitive Problems ('Chemo Brain')

Affects memory, concentration, and executive functions.


Management

  • Cognitive training
  • Regular physical exercise
  • Mindfulness techniques
  • In severe cases, consider medications like methylphenidate