Getting appropriate care for breast cancer is critical to treating the disease. Some treatments can cause emotional, physical and sexual side effects. Being aware of possible side effects — and knowing how to ask for help — can boost quality of life during treatment and beyond.
Here is what you need to know about breast cancer treatment side effects:
What are the possible side effects of breast cancer surgery?
Many patients with breast cancer start their treatment with breast surgery that includes the removal of lymph nodes. Potential side effects from surgery depend on the type of cancer and surgery. Learn more about the types of breast surgery.
Lymphedema is a possible side effect, which happens when lymph fluid builds up in the fatty tissues under the skin. It can occur after cancer surgery when lymph nodes are removed, or after radiation therapy that damages lymph nodes or blood vessels.
“When performing a lumpectomy, breast surgeons aim to limit the number of lymph nodes we remove to reduce the risk of lymphedema in the arm. We do this by precisely targeting the lymph nodes that drain the breast and preserving as many lymph nodes as possible,” said Dr. Jeanne Capasse, a breast surgeon at Norwalk Hospital.
Dr. Jeanne Capasse, Breast Surgery, Nuvance Health
Physical therapy and occupational therapy can help manage lymphedema symptoms, including pain and swelling. Compression sleeves can help keep fluid out of the arm. Maintaining a healthy weight can also reduce the risk of lymphedema symptoms and may lower the risk of breast cancer recurring, too.
Breast swelling may occur after surgery or radiation therapy. You may be referred to our lymphedema therapists to discuss massage or compression devices to help get the fluid out of the breast and decrease pain.
Women who have mastectomies with breast reconstruction often have implants, which may need to be replaced throughout their life. Your surgeon will provide information about how often the implants should be evaluated to see if they need to be replaced.
What are possible side effects of chemotherapy and hormone therapy?
Everyone reacts to medications differently and side effects vary depending on the person. The good news is there have been improvements in chemotherapy and hormone therapy treatments resulting in fewer side effects.
“If side effects do occur, we have better ways to manage them. For example, there are medications to manage nausea from chemotherapy, and cold cap therapy can help patients keep their hair during chemotherapy,” said Dr. Lisa Phuong, breast medical oncologist at Norwalk Hospital.
Dr. Lisa Phuong, Breast Medical Oncology, Nuvance Health
During chemotherapy, some patients may experience “chemo brain” or brain fog and may not be able to think as clearly. Keep your brain active with puzzles or reading. If you need additional help, a neuropsychiatrist can suggest mindfulness exercises. Staying active can also help people maintain their cognition or overcome brain fog because it increases blood flow and oxygen to the brain.
Some people may experience neuropathy, which is numbness or weakness in the fingers and toes that can continue after chemotherapy ends. While this can be frustrating, in some cases, it may go away after the body heals.
Joint pain is a known side effect of hormone-therapy. Staying active and exercising can reduce joint pain. Also, research shows that exercise can reduce the risk of breast cancer recurring, which is a win-win. Medicine-related joint pain usually goes away after stopping the medication.
Some women may go through menopause if they have chemotherapy or hormone-driven medications that suppress the ovaries. There are ways to manage symptoms of menopause, which include hot flashes. Talk with your doctor — antidepressants, certain supplements and integrative medicine options such as acupuncture may help.
“We encourage our patients to try a medication if their care team recommends it before they decide not to because of potential side effects,” said Dr. Phuong. “The benefits of preventing the cancer likely outweigh the negatives of side effects. It is also important to remember that all side effects may not be permanent.”
Talk with your medical oncologist if the side effects from a medication are debilitating. There may be other medication options.
What are the side effects of radiation oncology?
“Today’s radiation treatments are more targeted, with the aim to preserve healthy tissue while still achieving the goal of eliminating the cancer,” said Dr. Philip Gilbo, chief of radiation oncology at Norwalk Hospital.
Dr. Philip Gilbo, Chief of Radiation Oncology, Norwalk Hospital
The short term side effects of radiation therapy are often fatigue and skin changes which resolve several weeks after completion. However, there can be long-term effects that can sometimes cause tenderness of the breast tissue as well as swelling and arm lymphedema if radiation is targeted at the lymph nodes under the arm.
Some people may have chronic breast or chest tenderness after radiation therapy. Talk with your doctor about whether arm or shoulder exercises could help to minimize discomfort or stiffness.
“Radiation could make future surgery to the same area more difficult. It is important to talk with your doctor before having surgery on the area that previously received radiation treatment,” said Dr. Capasse.
What are the emotional side effects of breast cancer?
There can be many emotional ups and downs from a breast cancer diagnosis through survivorship.
Many patients’ main concern is that the breast cancer will come back. They may worry every time they feel pain in their breast, even though breast cancer usually does not hurt. Knowing this can sometimes help alleviate fear. However, it is important to see your doctor if anything feels unusual.
“I have noticed that patients usually gear up for treatment and focus on getting through it. Then, when treatment is complete, they crash and feel depressed. The weight of their diagnosis hits them at a time when they do not have as many medical appointments and their care team is not around them as much as they were during active treatment,” said Dr. Capasse.
“In addition, side effects from treatments, such as hormone therapy, may alter mood,” said Dr. Phuong.
“Patients tell me they are surprised to feel like this because they think they should be feeling happy they completed treatment,” said Dr. Capasse. “It may be helpful to know that many people experience these feelings and they usually go away with time.”
“At Nuvance Health, we connect patients with support services when they complete active treatment to help them navigate these feelings. For example, support groups, combined with making healthy lifestyle choices such as eating well and exercising, may also help boost mood,” said Dr. Capasse.
Talk with your doctor if you feel depressed post-breast cancer treatment. They may suggest you see a therapist or psychiatrist. Talk therapy or medication, if you are clinically depressed, may be helpful. Most of the time, talking about how you are feeling and letting yourself grieve for what you lost because of breast cancer can help.
What are sexual side effects of breast cancer?
“It is common to feel emotional about how the breast looks after surgery. Some people may have self-esteem issues after having surgery on their breast. They may feel less attractive, which can alter their sexual desire and libido,” said Dr. Capasse.
“Some medications can affect sex drive and also cause vaginal dryness for women, making sex more difficult. Some treatments can also cause early menopause, which can affect confidence and sex drive,” said Dr. Phuong.
It is common for patients to feel uncomfortable talking about these sexual concerns with their doctor and partner. But, they can help. Your doctor may recommend seeing a therapist or psychiatrist for emotional issues and may recommend a medication to manage physical side effects like vaginal dryness.
It is also important to talk with your partner about how you are feeling. If your partner is unaware of your feelings, they may think something else is wrong and it could cause friction in your relationship. Your partner can also be a source of support during a challenging time.
If you are not comfortable talking about sexual side effects with your doctor, online resources from trusted sources are available, such as the National Cancer Institute.
The bottom line: Your quality of life is important, and your care team can help you manage most side effects from breast cancer treatment so they are tolerable. Talk with your doctor if you have side effects from treatments.