Managing side effects
Risk of infection
Chemotherapy can lower your ability to fight infection. If you feel unwell, even if you have a normal temperature, if you are feverish, have chills and shivers, or your temperature is 38˚C or more, take action immediately.He kaioraora ētahi o ngā pānga ki te taha. Ka whakaiti te mahi hahau i tō āheinga ki te patu mate urutā. Mehemea e māuiui ana koe, ahakoa te pai tonu o tō pāmahana, kei te kirikā rānei koe, kei te makariri me te tāwiriwiri, mēnā kua eke tō pāmahana ki te 38˚C, neke atu rānei, kia kakama tonu tō whai āwhina.
You must contact your treatment team, or go to your nearest hospital emergency department immediately and tell them you are receiving breast cancer treatment if you develop any signs of infection. It is important that you do not wait until the next morning or after the weekend to seek assistance.
Coping with fatigue
Fatigue is often confused with tiredness. Usually you know why you are tired and a good night’s sleep solves the problem. Fatigue is overwhelming tiredness (physical and emotional) and is not relieved by rest or sleep. Cancer-related fatigue is one of the most common side effects of cancer and its treatment. It can happen to anyone with any type of cancer and at any time, during and after treatment. Gentle exercise can help to relieve fatigue.
• If you need time to rest during the day don’t be afraid to say no to visitors.
• Other things that may help include: planning ahead and pacing yourself, increasing fluid intake, having plenty of nutritious snacks on hand.
Managing hormone changes
Managing hot flushes
Mood changes, anxiety and depression
Having breast cancer can cause worry, stress and sadness, making it seem an effort to keep active and connect with family/whānau and friends. This can lead to isolation and may make it harder to manage the effects of treatment. Some treatments for breast cancer, such as hormone treatments, can put you at a greater risk of experiencing mood changes, anxiety, and depression.
Two key signs of depression are constantly feeling down or hopeless, and having little pleasure in doing the things you used to enjoy. Remember that your mental health is as important as your physical health. If you are concerned, talk to your GP or treatment team. There’s a lot that can be done that can make a difference.
Mindfulness programmes, relaxation, meditation and exercise are all helpful things to try when you are feeling low. Talk to a trained counsellor about how you are feeling.
Contact the Depression Helpline on 0800 111 757. This website has a range of tools to help you manage these emotions www.depression.org.nz.
Your oncology service, local Cancer Society, or the Breast Cancer Foundation may be able to offer counselling or a referral to a counselling service.
Coping with a changed appearance
Any treatment you have may change your appearance. Surgery may leave you without a breast and with scarring, while chemotherapy may cause a temporary loss of body hair. After radiation, your skin in the treated area may be slightly darker than the surrounding skin. You may gain weight from medications used during your treatment.
Any changes to your appearance may make you feel self-conscious. Some people may react differently towards you and this can be upsetting. If you are finding it difficult to deal with these changes there are people who can help you. Tell your family/whānau and friends how you are feeling so they can support you.
Focusing on yourself as a whole person, not just the part of you that has been scarred or altered, can help. Find a breast prosthesis (if you have had a mastectomy or your breast has reduced) that suits you and think about ways you can nurture and love yourself and your body. The next section on living well has some suggestions.
Changes in bone strength
Some hormone treatments can reduce the strength of your bones, making them weak (osteoporosis). You can help to keep your bones strong with regular weight-bearing exercises such as walking and eating food rich in calcium and vitamin D. Your doctor may prescribe medication to protect your bones if you are at higher risk of osteoporosis.
Side effects of surgery
This may feel like a tight cord is running from your armpit to your hand – this is caused by hardened lymph vessels. You may have limited movement for some months after surgery. A physiotherapist can provide you with localised massage and gentle stretching exercises. Ask your treatment team to refer you to a physiotherapist. Massage can help too.
Pain and changes in sensation
You might continue to have numbness, tingling or pain in your upper arm because of swelling or injury to the nerves during surgery. Your treatment team can prescribe pain medication if this does not improve within a few weeks.
Changes to your arm or shoulder movement
Fluid collecting around the wound (seroma)
Losing your hair
Managing hair loss
“ When in turmoil or doubt, choose change. I chose change to ‘control a controllable’ – cutting my long hair short then shorter still and dyed in two bright colours. On the first day of my chemotherapy I shaved it. I’m enjoying the opportunity to reinvent, create and embrace the ‘new me’.” Rachel
Look Good Feel Better helps people affected by cancer to manage the appearance-related side effects of cancer treatment. It provides free, practical classes with skincare, make-up and headwear demonstrations, with the goal that participants leave feeling empowered and ready to face their cancer diagnoses with confidence. You can find out more about these workshops from the Cancer Society or on the Look Good Feel Better website www.lgfb.co.nz.
Numbness and tingling (peripheral neuropathy)
Some medications cause pins and needles, tingling, a loss of feeling in fingers or toes or both, muscle weakness (particularly in the legs), a change in hearing, or ringing in the ears. This is called peripheral neuropathy.
Chemotherapy treatments are most likely to cause this side effect. If you start to have difficulty with simple tasks such as doing up buttons or tying shoe laces, let your cancer treatment team know. A slight change in your treatment may be needed. Peripheral neuropathy usually gets better when treatment is over, but sometimes it is permanent.
Feeling sick (nausea)
There are many reasons why people with breast cancer may feel sick and there are ways to manage this. The following suggestions maybe helpful:
• eat small meals at frequent intervals
• avoid fatty or fried foods
• rest before and after eating
• do not lie flat during or after eating
• drink plenty of fluids
• see a dietitian or nutritionist for dietary advice
• try relaxation exercises
• do something enjoyable as a distraction from feeling sick.
There are many different anti-sickness medicines that work in different ways. Let your doctor know if you are feeling sick or any prescribed medication is not effective. Most anti-sickness medicines take 20 to 30 minutes to work.
Forgetfulness and concentration problems (chemo brain)
Many people say they find it hard to concentrate, focus and remember during and after treatment with chemotherapy. This is often called chemo-brain. It can be very frustrating and it may help to know it can happen to anyone who has treatment and it usually gets better with time. There are useful ways of managing this:
• eating well, exercising regularly and getting enough rest
• creating lists and reminders
• doing memory exercises.
Chemotherapy can cause constipation and/or diarrhoea. Constipation can usually be helped by drinking plenty of fluids, eating more fibre in your diet, and doing some gentle exercise. If needed, your GP can prescribe medications (laxatives) to help relieve constipation.
Let your treatment team or GP know if you have diarrhoea as it may need further treatment. It is important to keep up your fluid intake if you have diarrhoea, to replace the fluid you are losing.