Managing the Side Effects of Breast Cancer Treatment

Breast cancer treatment can bring side effects, and knowing what to expect makes them easier to manage. Here, I'll explain what helps with each type of treatment and when to contact us. Please save your 24-hour chemotherapy helpline number in your phone today. During chemotherapy and for six weeks afterwards; ring it day or night if your temperature reaches 37.5 degrees or drops below 36. This can be the first sign of a serious infection called sepsis, so please don't wait until the morning. Sepsis can also happen without a fever, so ring if you suddenly feel unwell; shivery or confused; or notice fast breathing or a racing heart. Whenever you call, or arrive at A&E; remember to say that you're having cancer treatment, because that changes how quickly you're seen. A few other symptoms need help quickly too; even without a temperature. If your arm, hand or the area around your breast turns red, hot and painful, you need to be seen the same day. For a painful swollen calf, ring your advice line straight away, and for chest pain or sudden breathlessness, call 9 9 9. After surgery some bruising; swelling; and discomfort are expected, and regular simple painkillers usually help. Numbness in the upper inner arm is common after armpit surgery, and often improves over months; although some may be permanent. Unlike numbness, new pain in your arm or around the operation site isn’t expected, so please report it. Swelling under the scar is common too, and it’s often a seroma, a collection of clear fluid. It’s part of healing and most are reabsorbed, but if one is uncomfortable it can be drained in clinic. Also, please tell us if it becomes red, hot or painful, or if you feel unwell. A seroma is a collection of clear fluid under the scar, which is part of healing and can be drained in clinic if needed, although please tell us if it becomes red, hot or painful. Your shoulder exercises usually start the day after surgery, because full movement is needed to plan radiotherapy. Armpit surgery can also affect how lymph fluid drains, which can lead to swelling called lymphoedema; most often in the arm. It affects fewer than one in ten women after a few lymph nodes are removed, and around one in five when they’re all removed. The risk keeps rising for about two years, so please report new tightness whenever it appears. National guidance says there's no sign that activity causes or worsens lymphoedema, so you don't need to restrict what you do. Infection is the real risk; so treat cuts, scratches and insect bites promptly, and tell your breast care nurse about any new swelling. During radiotherapy, the skin over the treated area often becomes pink, dry or itchy. It's usually at its worst towards the end of treatment, and for a week or two afterwards. If the skin breaks down, tell the radiographers at your next appointment rather than waiting to see if it settles. With chemotherapy, anti-sickness medicine is given beforehand, and it's best taken regularly rather than waiting until you feel sick. Scalp cooling, a very cold cap worn during treatment, can help many people keep more of their hair. Please also report numbness or tingling in your fingers or toes early, so the dose can be adjusted before damage becomes permanent. Hormone treatment tablets are usually taken for five years or longer, and they do more to lower the chance of the cancer returning than almost anything else. Joint pain is common, and moving regularly; exercise; and simple painkillers can all help; as can switching to a different tablet. If you take tamoxifen, the antidepressants fluoxetine and paroxetine must be avoided, so always check with us before starting a new medicine. Also, please report any vaginal bleeding promptly, particularly if you've been through the menopause. Vaginal dryness is also common, and moisturisers and lubricants are the first step. Aromatase inhibitors can thin the bones, so a bone density scan is usually recommended when you start, and weight-bearing exercise helps protect them. If you're struggling with any hormone tablet and thinking of stopping, please tell us first, because there's almost always something we can do. Across all these treatments, fatigue is common and should not be treated as ordinary tiredness. Building up activity gradually, helps more consistently than anything else tested. If something is worrying you, or a side effect is making treatment hard, please get in touch with me or my team.