What to Expect: Tips for Managing Breast Cancer Treatment Side Effects

Laura Beth Ezell:

Can you walk us through some common treatments, side effects, and strategies for managing them?

Dr. Daniel Silbiger:

Sure. I’m starting with the one that I know women are very anxious about is hair loss. So, with any chemotherapy ones, you know, we do have certain regimens that we can use cold caps, so we do have safety with that, and many of our centers have cold capping available. So, working with provider, discussing that concern upfront, I think that is an important one. It’s not a 100 percent success with hair preservation, but certainly with certain regimens like our docetaxel-cyclophosphamide (Taxotere-Cytoxan) TC it’s called chemo regimen, there’s a strong likelihood, 60 plus percent for hair preservation.

You know, we mentioned fatigue, tiredness, that’s very common amongst all of our categories of treatments. For some of my patients it’s developing an exercise program, a better sleep regimen, a psychology care, you know, emotional well-being, psychological well-being, that can contribute to fatigue and burnout. I think some of my folks really how meditation has been effective for them, yoga, reiki, I’ve seen a lot of these integrative strategies be particularly helpful as well. And some of my folks have challenges with nausea, I think that one we have tremendous medications, ondansetron or Zofran, we have those. We have anti-psychological medicines like olanzapine (Zyprexa) have helped tremendously in that field too.

So, I think there are a number that those are a couple of things, for instance. I think we’ve talked about anxiety and depression, I think discussing with psychology is a great way, meeting with psychiatrists, optimizing antianxiety and antidepressant medicines can be very effective. I know people are worried sometimes about going on medication and that’s not always the right strategy either. Having psychology one on one discussions, we have group sessions that folks can engage in as well that can be effective. And as I mentioned, some of these other strategies with meditation and yoga as well. I have seen tremendous benefits of these support services too.

Laura Beth Ezzell:

Yeah. And you kind of answered some of the next question about just lifestyle approaches that can help, right?

Dr. Daniel Silbiger:

Absolutely. And there is some redundancy, but it really is incredible how much burden some of these issues we discussed can be on all facets of breast cancer care. And so, I think that mental health and well-being, I will tell you, it is a huge, huge barrier for some of my patients.

And that’s why I do spend so much time, including on this program mentioning that is because it really is a major factor. But I think getting a good sleep regimen. You know, balancing that work-life balance too, I think that’s important. If you’re requiring chemotherapy or more aggressive therapies, should you and can you reduce your workload? Can you take some time away during that? I think that’s a really important part. And being honest with family and maybe can the spouse or other family member or parents, can they help with a bit more of the childcare and some of the other activities? I think it’s that open honesty with support system that really goes a long way for success with the treatments.

Laura Beth Ezzell:

Yeah. And why is it so important for patients to mention those side effects or new systems to their care team?

Dr. Daniel Silbiger:

Oh, absolutely. Because as we mentioned with some of the underground ones, if it’s underground, your provider’s not going to know about it, right?

Laura Beth Ezzell:

Yeah.

Dr. Daniel Silbiger:

So, I know about blood counts; we take blood work. Right? We can learn some things from patients. How’s the kidneys doing and the liver doing and the blood counts? But if you’re nauseous, I won’t know unless you’re telling me right in front of me, that’s why I have to ask, obviously, we have to have good questions. If we’re developing numbness or neuropathy, that’s a quiet symptom oftentimes.

And so, I need to know about those things, and approaching that is really important. Anxiety … it’s really important because we can also make adjustments if there is tremendous amount of, going back to neuropathy, we can adjust the treatment dosing, we can space out some of the cycling. There’s a lot we can do, but if we don’t know about it, it will perhaps create more of a burden in the end because then nothing is being changed right away. So, open dialogue is really, really important.

Laura Beth Ezzell:

Yeah. Yeah. Great advice there. And let’s get to a few questions that were sent in prior to the program. This first one says, Marie asked, “Is chemo brain real and how can I manage it day to day? Is there any way to prevent it?”

Dr. Daniel Silbiger:

You know, I would say that there’s … it would be unfair to say that there is an absolute way to prevent. But what I’ve noticed is that for my patients, some of the things we’ve addressed, exercise is really helpful, meditation.

Laura Beth Ezzell:

Yeah.

Dr. Daniel Silbiger:

I think also having a little bit more structure. I think we often take for granted our memory and just the quick recall. I think writing things down, writing a schedule down. If you’re going to the grocery store, maybe it is a good idea, use those cellphones, document those things that you need to get. I think having some order to the day helps my patients. Structuring the day and writing things down has – I know it sounds like a simple thing, but it’s really an elegant, simple thing to help as well.

I have had some of my patients also – I think I mentioned meditation can be something I’ve seen beneficial too. But it is something that is overwhelmingly temporary for my patients who are in a curative setting on short courses of chemotherapy, for instance, but it takes time to recover, six to 12 months. It can take time –

Laura Beth Ezzell:

Yeah.

Dr. Daniel Silbiger:

– to recover that chemo processing or that brain fog or processing capabilities.

Laura Beth Ezzell:

Yeah. And then another question here says Amy wrote, “What should I do if my side effects are making it hard to stick to treatment?” And a great question there.

Dr. Daniel Silbiger:

This is very important because –

Laura Beth Ezzell:

Yeah.

Dr. Daniel Silbiger:

– we talk at our meetings a lot about do we really need that full dose? I’ll give one example. A medicine’s out there now called ribociclib (Kisqali), abemaciclib (Verzenio), some of these medicines we use for two to three years in curative breast setting or even in metastatic setting.

And we have data that shows, yes, we try to use the full dose, but maybe people are having too much fatigue. Maybe they’re having too much loose stools, or perhaps they’re just having too much muscle aches or pains. We have data that shows thoughtful reductions of the dosing seems to show equivalent outcomes. So, I always tell patients, don’t be afraid or alarmed to let us know those things because we have some data that shows dose reductions may not be a wrong strategy. Or sometimes taking a treatment break from some of these estrogen-blocking pills that folks are on, taking a month off, eight weeks off, it can recharge the body and allow one to tolerate those treatments better for five to 10 years that we need those treatments for ideally in many of our patients.

So, I think it’s really important and I think it is okay to be – not okay – it’s necessary to be honest, and that reductions or pauses on treatment are not always the wrong thing to do.

And, in fact, I mentioned neuropathy as another example. If we have to reduce chemotherapy, it’s essential because we don’t want to leave one with debilitating side effects in the long run.