Side Effects of Breast Cancer Treatment and How to Manage Them
Breast cancer treatment, which varies based on the type and stage of cancer, is designed to target and eliminate cancer cells. While treatment of breast cancer is required and helpful in most cases, each type of treatment can cause both temporary and long-term side effects. If you or a loved one is undergoing treatment for breast cancer, it helps to be prepared for potential side effects so that they can be better understood, mitigated, and managed.
The most common treatment options for breast cancer today are chemotherapy radiation, hormone therapy, targeted therapy, and surgery. Most treatment plans include a combination of these options. Depending on the specific treatment and your individual health history, side effects may vary. You should always talk with your doctor about your risk factors for side effects, any side effects you experience, and options for mitigating, or relieving, those side effects.
Remember that everyone experiences a cancer diagnosis, treatment, and treatment side effects differently—what may greatly affect one patient may not affect another. It is important to keep in constant contact with your care team to discuss any treatment side effects that may come up for you.
Table of Contents
Click on the following links to jump to side effects and management tips for each treatment type.
Chemotherapy Side Effects
Radiation Side Effects
Hormone Therapy Side Effects
Targeted Therapy Side Effects
Surgery Side Effects
Late-Term Side Effects
Tips on Talking with Your Care Provider
Where to Find Help and Support
Chemotherapy Side Effects
One of the most common treatments for breast cancer, chemotherapy uses one or more anti-cancer drugs to kill cancer cells in the body. Some chemotherapy side effects are well-known whereas others are less common and harder to recognize.
Based on type, dosage, and length of treatment, the most frequent chemo-related side effects include:
- Hair loss
- Mouth sores
- Fatigue
- Loss of appetite
- Nausea and vomiting
- Diarrhea
- Nail changes
- Easy bruising
- Pain and numbness (neuropathy) in the fingers and feet
- “Chemo brain” or difficulty with memory and concentration
- Increased risk of infection due to lower white blood cell counts
- Hormonal side effects, such as:
- Vaginal dryness
- Hot flashes
- Potential or premature menopause
- Fertility issues
- Low white blood count
- Low red blood count
Managing Chemotherapy Side Effects
While chemotherapy side effects can be very unpleasant, the good news is that many chemo-related side effects stop when treatment ends. In the meantime, there are ways you and your care team can help mitigate some of the side effects of chemotherapy. Always check with your medical professional before beginning a new regimen. In addition to the tips below, read What Helps During Chemo: Patients and Survivors Share Tips & Advice.
Try to eat a chemo-friendly diet
Chemotherapy often causes patients to feel nauseous, making it difficult to identify foods that sound appealing and sit well in the stomach. To combat treatment-related nausea, focus on eating smaller meals throughout the day and opt for bland foods such as crackers, toast, yogurt, oatmeal, and pasta. Eating peppermints or smelling peppermint can sometimes help. Need chemo-friendly recipe ideas? Download NBCF’s free cookbook, Healthy Recipes for Cancer Patients.
Chemotherapy can also cause painful sores in the mouth as well as changes in the taste buds, making certain foods taste bitter or metallic. Rinsing your mouth before and after eating can remove unpleasant tastes, and sucking on sour or citrus-flavored candies can help mask the metallic aftertaste left by chemo meds. Your doctor may prescribe a special solution for you to swish in your mouth to help heal these types of sores.
Staying hydrated by drinking plenty of water, decaffeinated teas, and juices is also important to help combat the chemo side effects of vomiting and diarrhea. But ultimately, eat what you can, when you can. Read more about how good nutrition can help minimize side effects and help the body heal with NBCF’s free eBook, Nutrition Care for Breast Cancer Patients.
Talk to your doctor about anti-nausea medications
There are several different over-the-counter and prescription medications that can be used to treat chemo-induced nausea. Most doctors will anticipate nausea as a chemotherapy side effect and write prescriptions before your first chemo treatment. But if your doctor doesn’t offer a prescription before treatment, it can be useful to ask for one.
Be sure to fill all prescriptions your doctor gives you and keep them on hand to take as prescribed. If a prescribed anti-nausea medication doesn’t work for you, contact your physician’s office and ask for an alternative to try.
Balance rest with movement or exercise
Fatigue is a very common side effect of chemotherapy, and it is important to give your body the rest it needs when you experience chemo-related fatigue. But on days when you feel up to it, try to get in some movement or exercise. This can look like walking to the mailbox or further, stretching to relieve sore muscles, or even doing something practical like organizing your closet. Research has shown that physical activity can help relieve pain, reduce fatigue, and stimulate appetite.
Practice yoga, meditation, or mindfulness
Along the same lines as movement and exercise, yoga and meditation provide gentle movement and stretching for the body, focus the mind to decrease anxiety, and provide a refuge during stressful times. Meditation can help anchor your mind to the present, particularly when it wants to race off in another direction. To learn how to strengthen your mind-body connection, download NBCF’s free guide, 10 Prompts to Mindfulness, and practice them when you feel stressed or overwhelmed during treatment.
Prepare for hair loss
For many patients, hair loss is inevitable with chemotherapy treatment. However, the severity of hair loss can differ depending on the type and dosage of chemo. While the loss of your hair can be traumatic, you can help alleviate the shock by being prepared in advance. You may choose to cut or shave your hair before it begins falling out, or you may wish to invest in a cooling cap to try to minimize the amount of hair lost during chemo. Remember, your hair will grow back after chemotherapy is complete, though it may be a different texture or even a different color than before.
Radiation Side Effects
Radiation is a cancer treatment that uses high-energy photon beams to target cancer cells; it can be used to shrink tumors prior to surgery or chemotherapy, or as a standalone treatment.
The most common side effects of radiation for breast cancer include:
- Fatigue
- Breast soreness
- Swelling of the area being radiated
- Skin irritation of the area being radiated
The severity of these side effects may increase as treatment progresses. Skin on and around the area being radiated can feel irritated and look red, with occasional peeling, similar to a sunburn. The area may continue to appear tan or discolored even after radiation.
Some people also experience changes in skin sensation and discomfort in the armpit area. More serious risks include lymphedema, or swelling of the arm/upper body when lymphatic fluid fails to drain properly.
Managing Radiation Side Effects
It can take a couple of weeks for the side effects of radiation, such as skin irritation, to appear. It’s important to let your care team know how you are doing throughout your radiation treatments so that they can recommend specific ways to lessen the severity of side effects.
Use lotions and creams
The main side effects of radiation affect the surface of the skin. Therefore, it is important to keep the area(s) being radiated moisturized and hydrated. Try using unscented and/or medical-grade lotions or creams on the irritated area, or ask your care team for prescription-strength creams to reduce radiation side effects.
Try to stay well-rested and mindful
Like chemotherapy, radiation treatment can cause physical and mental fatigue. Be sure to rest your body when you feel tired, and consider practicing mindfulness or meditation to strengthen the mind-body connection as you undergo radiation.
Exercise in the form of walking
Walking for 30 minutes, five times a week during and several weeks after completion of radiation can help to diminish the side effect of fatigue by more than 70%.
Hormone Therapy Side Effects
Hormone therapy can be used to treat breast cancer that is sensitive to hormones, such as estrogen or progesterone, by either preventing hormones from attaching to cancer cell receptors or decreasing the production of hormones altogether. Hormone therapy is typically recommended for patients with tumors that are hormone receptor-positive. Hormone therapy is usually taken for five years or longer.
While they vary based on the specific drug or type of hormone therapy used, common side effects of hormone therapy include:
- Hot flashes
- Vaginal dryness
- Night sweats
- Muscle and joint pain
- Osteoporosis
- Weight gain
- Headaches
- Nausea
- Fatigue
- Mood swings
- Low libido
Hormone therapy can also affect women’s menstrual cycles, sometimes causing irregular periods or the cessation of periods (menopause) in premenopausal women.
Managing Hormone Therapy Side Effects
While some of the side effects of hormone therapy are short term, many side effects may last much longer, possibly throughout the rest of a woman’s life. It is important to try to manage any short- or long-term side effects you may experience by working with your doctor. Other ways to manage side effects may include the following.
Eat a healthy, well-balanced diet
Good nutrition provides the fuel you need to heal and stay healthy. It can also help minimize the side effects of cancer treatment. To learn more about healthy and balanced eating for cancer patients and survivors, download the free NBCF eBook, Nutrition Care for Breast Cancer Patients.
Stay active through movement or exercise
Weight gain, muscle and joint pain, and osteoporosis are common long-term side effects of hormone therapy. To combat these, try to incorporate movement or exercise into your daily routine. Studies show that 150 minutes of exercise a week, or approximately 20 minutes per day, can help reduce the severity of these common side effects.
Use vaginal lubricants or moisturizers
If vaginal dryness becomes bothersome, or if you experience pain or discomfort during intercourse due to vaginal dryness, try using water-soluble vaginal lubricants prior to sex. If dryness or discomfort continues to be an issue, contact your gynecologist. Vaginal moisturizers may be used to routinely to maintain a healthy vaginal wall. Some doctors may even prescribe a very low dose of estrogen, known as Estrodiol, in a vaginal tablet form to be used twice a week. It has very low blood absorption and can restore vaginal wall health.
Stop smoking and reduce alcohol intake
Both smoking and drinking alcohol have negative effects on health, especially for a breast cancer patient or survivor. Stopping smoking and reducing alcohol intake can reduce the severity of treatment side effects by improving your overall health and wellness. It also reduces the risk of breast cancer recurrence.
Talk to your doctor about natural supplements
Many natural supplements, such as Vitamin D, calcium, magnesium, and even probiotics can help reduce the side effects of hormone therapy. Talk to your doctor about any potential drug interactions before adding new vitamins or supplements to your treatment plan.
Targeted Therapy Side Effects
A newer breast cancer treatment option, targeted therapy uses drugs that can block the growth of breast cancer cells by targeting specific proteins on breast cancer cells without harming other cells. It is often used in combination with chemotherapy—some of the side effects overlap and some are different. They include:
- Nausea and vomiting
- Fatigue
- Diarrhea
- Mouth sores
- Rashes and/or dry skin
- Pain and numbness (neuropathy) in the fingers and feet
- Cardiac changes
Your doctor will also monitor for signs of heart, lung, liver, and clotting issues during treatment.
Managing Targeted Therapy Side Effects
As with chemotherapy, the severity and duration of targeted therapy side effects vary depending on the type of therapy and the individual receiving it. It’s important to speak with your doctor or care team about side effects you should expect with targeted therapy, and ways to manage them as they come up throughout your treatment.
For women on biologic targeted therapies for HER2+ breast cancer, heart tests are periodically done to help ensure there are no cardiac side effects happening. Cardiac side effects from this classification of drugs can happen up to 10 years after taking the last treatment.
Surgery Side Effects
Surgery remains the most common treatment for breast cancer, and can consist of lumpectomy, mastectomy, breast reconstruction, and lymph node removal. As with any surgery, side effects can include pain and discomfort, stiffness, and swelling.
Other potential side effects from breast cancer surgery are:
- Nerve pain
- Fatigue
- Change in sensation to the area around the surgical site
- Skin changes and bruising
- Nausea
- Scar tissue at the surgical site
- Lymphedema
Soon after surgery, if you experience fluid discharge from the surgical site, an elevated temperature, or a wound that is warm to the touch, these can be signs of infection and you should contact your doctor immediately.
For more information on different types of breast cancer surgery, including potential side effects, download NBCF’s free eBook, Breast Cancer Surgery: What You Need to Know.
Managing Surgery Side Effects
It is important that you follow all instructions from your surgeon and care team in the post-op period. This will include taking all prescribed medication as directed, caring for the wound site, and attending surgical follow-up appointments.
Stretching and physical therapy
Once you have been given the all-clear and are released from your surgeon’s care, follow up with your physician or care team for any stretches or exercises you need to do to keep the surgical site from stiffening up (or “cording”) and to increase your range of motion. Your doctor may suggest you add a physical therapist to your care team to accomplish this. Physical therapy can help relieve pain, decrease fatigue, and stimulate appetite. Massage and acupuncture may also be part of your post-surgical wellness toolkit.
A physical therapist or your care team can also help you manage lymphedema symptoms through wearing a professionally fitted compression sleeve on the affected area or through professional massage.
Women who undergo mastectomy without reconstruction may experience phantom limb sensation or pain. The brain treats the breast as if it were a limb, like an arm or leg. When someone has a limb amputated, they may comment that they can “still feel” the limb, or that the missing limb feels hot or sore. The same symptoms can happen following mastectomy. For women who have had a mastectomy but experience phantom limb sensation in the form of nipple itching, scratching in the underarm area has proven to help diminish this symptom. Wearing a breast prosthesis can also help mitigate, or lessen, phantom breast pain or sensation. For more information on how to prepare for a mastectomy or other breast surgery, read Checklist for Recovery After Mastectomy.
Late-Term Side Effects
Many side effects abate at the conclusion of breast cancer treatment, but there are potential “late” side effects that can appear several months or even years down the road. These can include bone health issues and osteoporosis, lymphedema, phantom breast pain, decreased strength, heart issues, weight fluctuations, nerve damage, decreased range of motion, and longer-term fatigue.
While not every breast cancer treatment side effect can be reversed, they can be addressed and treated. Talk with your healthcare team about the possibility of late-term side effects and how to prepare for and manage them.
Tips on Talking with Your Care Provider
When discussing the side effects of breast cancer treatment with your care team, it helps to be organized.
Consider keeping a journal that notes what side effects you have, how long they typically last, and how much they disrupt your daily life. The more information you gather, the easier it will be for your healthcare provider to offer support and symptom management.
Don’t be afraid to be honest: Your team has to know about your side effects to help you treat them. If you feel uncomfortable speaking to a male doctor about hormone therapy side effects, ask to speak to a female doctor or nurse on staff instead.
Where to Find Help and Support
When you or a loved one is going through breast cancer treatment, the treatments themselves and any related side effects can sometimes feel overwhelming. No matter what your symptoms or side effects, having someone to talk to can make a tremendous difference. NBCF support groups create a safe space for patients and survivors to give and receive help.
Sources
American Cancer Society
Breastcancer.org
Mayo Clinic
National Cancer Institute