Managing side effects of advanced breast cancer

Advanced breast cancer and its treatment can cause a number of symptoms and side effects. Factors such as the patient’s health and comorbidities will affect the severity of symptoms or side effects. Guides to managing cancer-related symptoms can be found under palliative care at the appropriate regional HealthPathways.

Constipation

Constipation can be caused by painkillers, some chemotherapy drugs and anti-emetic medication.

Depression and anxiety

Patients presenting with anxiety, depression or other mood disorders can be referred for specialist support through counselling or psychological support. Many districts have cancer-specific psychology services. 

Diarrhoea

This can be caused by chemotherapy drugs (e.g. capecitabine, 5FU), radiation therapy to the pelvic and lumbar area, and some medications (e.g. laxatives, antibiotics, potassium supplements).

Dyspnoea (shortness of breath)

Treatment will depend on the cause (e.g. drainage for a build-up of fluid in the lungs or antibiotics for an infection). If the patient presents with sudden onset dyspnoea, with no explanation, immediate medical attention is required to exclude the possibility of a pulmonary embolism.

Fatigue

Cancer-related fatigue is a common symptom for those with MBC. Causes can be psychological or physical. Patients experiencing fatigue should be assessed for a treatable cause (e.g. anaemia), and provided with information to managing fatigue.

Hot flushes

Hot flushes are a common side effect of endocrine therapy and can vary in intensity and frequency. They are manageable in most patients and medications may help relieve symptoms.

Insomnia

The cause of insomnia can be physical and/or psychological. Underlying causes (e.g. pain, nausea) should be treated to improve the patient’s sleep, and sleeping tablets can be prescribed.

Mouth problems

Mouth problems are a common side effect of chemotherapy. Problems can include mouth pain, ulcers and infection. Patients can be prescribed mouth washes, medicines and gels to alleviate symptoms.

Nausea and vomiting

Anti-emetic drugs can be used to control nausea and vomiting caused by chemotherapy.

Pain

Analgesics can help to reduce pain and a three-step approach to pain relief is usually recommended. Patients will start with mild pain relief, taken regularly, before moving on to moderate and then strong pain relief, often morphine-based, when necessary. Morphine-based pain relief is effective for controlling many types of pain, and most people will experience good pain relief and a better quality of life. Clinicians may choose to prescribe a combination of short- and long-acting pain relief, depending on the different types of pain experienced by the patient.

Poor appetite

Lack of appetite may be caused by ABC, treatment or psychological factors (e.g. anxiety). Treatment can include dietary supplements, a consultation with a dietitian or, in some circumstances, patients can be prescribed appetite stimulants.

Skin changes

These can be a side effect of some chemotherapy regimens and targeted therapies. Symptoms can include palmar-plantar (soreness and redness of the palms and soles) and acneiform or maculopapular rash.

Neutropenia

Chemotherapy can result in low white blood cell count, where patients will be immuno-compromised. Patients should contact their specialist team and/or hospital immediately if:

•  temperature > 38°C or higher
• experiencing chills
• Suddenly unwell regardless of temperature. 

Any other symptoms (signs of infection) such as a cold, sore throat, cough, urinary tract infection or diarrhoea.

Peripheral neuropathy (numb or tingling hands and feet)

This can be caused by chemotherapy drugs (e.g. vinorelbine, gemcitabine, oxaliplatin, taxanes, and cisplatin), and can affect patients’ ability to carry out day-to-day activities. This can be treated by lowering the dosage of chemotherapy, and symptoms usually improve after treatment finishes. In some patients, however, peripheral neuropathy may become permanent.

Integrative therapies

Integrative therapies are used alongside conventional treatment, and can benefit patients’ quality of life and wellbeing. Discuss the use of complementary therapies with your patient to ensure there are no contraindications with their treatment.