Managing side effects

Risk of infection

Some side-effects of treatment can be life-threatening.

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.

Other signs of infection can include warmth, redness, swelling around any surgical wound or discharge coming from it, or feeling unwell without a fever.

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.

For more information on fatigue here.

Managing hormone changes

Treatments can cause a range of side effects that alter the quality of your life. These include menopausal symptoms, hot flushes, and weight gain. Women may have changes to their menstrual cycle resulting in early menopause. This may be temporary or permanent.

Keeping active, eating well and following the advice of your cancer treatment team will help in managing these side effects.

Managing hot flushes

You may find that hot flushes reduce as your body becomes used to the treatment, but others may have ongoing problems. You can help manage these by:

• maintaining a healthy weight

• stopping smoking if you smoke

• drinking plenty of fluids and limiting alcohol and caffeine

• reducing the amount of spicy food you eat

• keeping your room at a cool temperature and using a fan

• using cotton fabrics rather than synthetics. If you sweat a lot at night, try using a cotton towel on top of your sheet when you sleep

• having lukewarm baths or showers

• talking to your GP or treatment team about any medications that might relieve symptoms

• trying acupuncture or hypnotherapy – some people have found that this helps.

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.

information yellow5 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

Some people may have problems with the effects of surgery for some time afterwards. These include:

• cording

• pain in your arm and changes to sensation

• changes to your arm or shoulder movement

• seroma (fluid collecting around the wound).

Cording

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

Arm and shoulder movement and strength usually improve after a few months. Doing exercises helps reduce the risk of long-term problems. Ask your GP to refer you to a physiotherapist if it doesn’t improve. Cancer Council Australia has a useful guide for arm and shoulder exercises after breast surgery.

Fluid collecting around the wound (seroma)

Seroma is a build-up of fluid around, or very close to, your wound. It usually goes away within a few weeks. Talk to your treatment team if your swelling does not seem to be going away. They may need to drain the fluid.

Lymphoedema

Lymphoedema is a long-term side-effect after some treatments for breast cancer. This is swelling in an area of the body due to the lymph vessels being removed or blocked. In people with breast cancer, there is a small risk that the arm and chest wall on the side where you have had radiation treatment or surgery may be affected.

The best treatment for lymphoedema is a programme of exercise, massage and skincare, and a properly fitted compression sleeve or bandaging. Damage to the lymph nodes means it is not usually possible to reverse the swelling, so the aim of treatment is to control the swelling on a long-term basis.

Contact your local Cancer Society for details of lymphoedema therapists available in your area.

See these Cancer Society information sheets Understanding lymphoedema and Living with lymphoedema

Losing your hair

Not everyone loses their hair during chemotherapy treatment for cancer. Some people find that their hair becomes thin and dry, while others lose all the hair from their heads and their bodies. Whether this happens to you depends on what treatment you are given. If you are having chemotherapy treatment for breast cancer you are likely to lose your hair.

Your cancer treatment team will advise you if this is a likely side effect of your treatment. Your hair may start to fall out two or three weeks after your first treatment, or it may take a while. Your scalp may feel hot, tender or itchy just before your hair starts to fall out. It takes between 4 and 12 months for your hair to regrow after chemotherapy. Your head may be quite itchy as your hair begins to grow back and it is not unusual for your new hair to have a different texture or colour.

Managing hair loss

Many people find losing their hair very upsetting. For most people, hair will grow back. Until it does you might want to wear a wig, a scarf or a hat. If you choose a wig it is a good idea to look at wigs before you start losing your hair so you can make sure it matches your style and colour.

The Government offers a subsidy that helps to pay for the cost of a wig or alternative head covering. You must get a certificate from your cancer treatment team that states you are entitled to a wig.

“ 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

More information on managing hair loss is available on our website.

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.

Bowel changes

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.