Tips Doctors don’t Tell Breast Cancer Patients

Breast cancer patients don’t have identical experiences due to a variety of factors including patient age, overall health, type, dose or sequence of treatment.

Depending on cancer stage and biologic markers, a patient may undergo surgery first followed by chemotherapy to control any distant spread (metastasis) and radiation (to maximize local treatment).

Others may receive chemotherapy first (neoadjuvant treatment) to reduce tumor size before surgery and radiation.

Depending on presence or absence of cell-surface receptors (biologic markers) such estrogen, progesterone, or HER2, a patient could become a candidate for hormonal treatment (e.g. Tamoxifen) and/or Herceptin (antibody against HER2).

Chemotherapy regimes vary, but a common one involves 4 cycles (1 cycle/month) of doxorubicin and cyclophosphamide, followed by 4 cycles of Docetaxel and dexamethasone (related to prednisone, a type of steroid). Doxorubicin in high doses can affect cardiac function, so the oncologist will give lowest effective dose or may consider an alternative regime if the patient has pre-existing cardiac dysfunction. A nuclear test called MUGA scan is routinely performed to assess cardiac function prior to initiating chemotherapy. Other common side effects include but are not limited to: Hair loss, nausea, nail discoloration, dry skin, appetite change, neuropathic leg pain.

Here are a few tips and information my oncologist didn’t adequately provide prior to treatment:

During chemotherapy:

Once hair loss becomes noticeable – after cycle 4 in my case, consider shaving your hair instead of waiting to lose it bit by bit, which can be irritating as it can block the drain after showering and a lot of vacuuming/floor cleaning will be required!

Eat a balanced healthy diet. Consider beets and other vegetables for their known benefits as anti-oxidants and a natural source for vitamins and iron. That will help maintain red cell count as close to normal as possible.

Nausea: Dexamethasone and other modern anti-nausea therapy such as ondansteron are very helpful in almost eliminating the nausea sensation. I experienced only slight nausea the first few days post every cycle – but results may vary.

Docetaxel-specific issues:

I experienced excruciating sharp/burning leg pain to the point I had to take Gabapentin and Tylenol with codeine (T3). My advice is to ask for T3 and Gabapentin before leaving the hospital after starting taxol. The pain started a few days after my first cycle of taxol and stayed for a week or so. The soles of my feet were painful to touch. Legs felt really weak afterwards and improved over several months. Given the neuropathic mechanism of the pain some people believe Gabapentin helps more than codeine. I tend to agree but it doesn’t hurt to take both if pain is intense. A dose reduction to taxol was required.

Docetaxel also causes nail discoloration. I was given ice-filled gloves to wear on my hands during taxol infusion to prevent discoloration. The cancer hospital where I received treatment did not offer protection for my feet, but that is an option. I did not elect to protect my feet so nails turned dusky grey but normalized completely with time.

Dexamethasone:

It will increase your appetite but not to worry because you will be taking it temporarily. Once you are off Dex try cutting your food portions and stick to a healthy diet to loose the extra kilos.

Notice that the effects of first regime and second regime occur together – that can be overwhelming. Afterwards, everything gets better.

During radiation:

The process is painless and very straightforward, but daily treatments are required so ensure you have ready access to transportation.

You will experience darkening of your skin. Later this dark skin will peel off while showering and drying with towel and you will get your most of your normal skin back.

Post surgery:

Discomfort was minimal in my case. I had two drains, one under my axilla (as lymph node dissection was performed) and one at the mastectomy site. The drains were removed once the drainage was minimal, and again I didn’t feel much. Buy a wedge pillow to sleep comfortably.

After completing treatment:

Overall fatigue and low energy. This can last for months to years, and no one can predict definitively how long the symptoms will last

Leg weakness

Struggle losing weight

Push yourself to establish an active daily routine. Start by walking 10 minutes a day at a minimum. Increase according to your ability. Stay positive, don’t lose hope or be lazy

Thyroid Cancer:

Thyroid Cancer patients usually receive Radio Active iodine treatment in addition to surgery. The Iodine is a clear tasteless liquid. Total isolation is necessary for up to 3 days (in-hospital). Take your laptop and download a couple of movies. Very important is to wrap your gadgets with a clear plastic wrap (laptop, cell phone) and anything you will come in contact with and want to use later, otherwise you will be required to dump you precious iPhone!

After hospital discharge, direct physical contact with young children is prohibited. However, you don’t have to book a hotel room! You can stay in the house with your kids but be particularly cognizant about not sharing utensils, hugging your kids etc. (as if you have a bad flu) for up to 1 week post RAI. Official recommendations vary, and some society guidelines suggest total isolation up to 2 weeks – which is both not practical and unnecessary even when the highest dose is given. The guidelines are not based on robust trial data, but feel free to consult with the radiation oncologist regarding this issue. However, also consult the nuclear medicine doctor as they have more experience, and rad-onc can be more conservative.

If additional RAI treatments are required, significant but transient (8 weeks) loss of taste can occur.

The above article is my personal view.

Always seek the advice of a physician or other licensed health care professional regarding any questions you have about your medical condition(s) and treatment(s)

Author:

Dania Shaikh, Bachelors in CS & Stat

Breast Cancer Survivor, Vancouver, BC Canada

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