Over the last couple of decades, there have been huge advances in breast cancer treatments. What hasn’t changed, however, are the side effects. They’re a common, unpleasant part of many breast cancer treatments, says Kathleen Fenn, MD, a breast cancer oncologist at Yale Medicine in New Haven, Connecticut.
Most of the time, they can be managed through lifestyle and certain medications. But very rarely, they can get so bad that you may reconsider treatment.
For example, many people taking hormone therapy skip doses or stop taking it early because of side effects. You may be able to lessen your side effects before you reach the point of dropping your current treatment. Even if you do decide to switch treatments, your doctor may not advise it. But switching breast cancer treatment isn’t exactly uncommon. It just depends on your situation and your treatment goals.
Most Common Breast Cancer Treatment Side Effects
Most women with early or locally advanced breast cancer are treated with either chemotherapy, endocrine therapy, or targeted therapies like PARP inhibitors, says Fenn. While side effects vary depending on which treatment you get, the main ones include:
- Tiredness
- Low white blood cell count
- Early menopause, if you’re not already menopausal
- Hair loss
- Joint and bone pain
- Hot flashes
- Weakness
- Nausea
- Diarrhea
Certain forms of treatment tend to have fewer side effects than others. For example, many people tolerate endocrine therapy very well. But chemotherapy can often cause more significant side effects, like nausea, throwing up, and hair loss. Immunotherapy can cause inflammation or swelling in the body that can lead to colitis (bowel inflammation), diabetes, and thyroid problems.
The side effects you get from a treatment may differ from those of someone else, even if you both receive the same treatment.
How to Manage Breast Cancer Treatment Side Effects
There are many ways doctors can help you manage breast cancer treatment side effects so that you can continue with treatment. Here are some things they often recommend.
Hot flashes
Since women with breast cancer can’t safely take estrogen — a common treatment for hot flashes — doctors generally start with nonhormonal supplements, Fenn says. One common one is a pollen extract supplement that may ease symptoms, but more research is needed.
Another option is the prescription medication fezolinetant (Veozah), which works on your hypothalamus, the part of your brain that controls body temperature. “It has been a real game changer for many of my patients,” says Fenn.
Acupuncture may also help treat hot flashes in women with breast cancer.
Muscle aches
Physical activity is one of the best ways to ease muscle aches and stiffness from breast cancer treatment. Flexibility and strength exercises in particular can ease joint and muscle pain. Staying active has also been shown to help lessen fatigue in patients with cancer.
Other things — such as over-the-counter pain medication and heat/ice packs — can help ease muscle soreness and aching. But always talk to your doctor before starting anything new during breast cancer treatment.
Vaginal dryness
Your doctor may recommend over-the-counter lubrication products. Vaginal moisturizers might also help. But if those don’t work, you can talk to your doctor about a vaginal estrogen cream.
“We used to consider it too risky for patients diagnosed with hormone receptor-positive breast cancer, but studies suggest they can be safely used for short periods of time,” Fenn says.
Feeling sick and throwing up
Immunotherapy and targeted therapy can cause you to feel sick or throw up. These are also common side effects of chemotherapy.
“Many of my patients are fearful of them, but we’re able to minimize and even eliminate these symptoms entirely with medications like long-acting IV drugs given on the day of chemotherapy,” Fenn says.
Taking anti-nausea medication before treatment, even if you feel like you might not need it, can help. Other things that may help you avoid nausea include:
- Eating cold foods instead of hot foods
- Eating small meals more often throughout the day
- Staying hydrated
- Drinking ginger-based drinks
Peripheral neuropathy
Chemotherapy can affect the fine nerves in your hands and feet. This can cause numbness, tingling, and pain. Your doctor may recommend cryotherapy, where you wear cold socks and gloves during your infusion. This helps reduce circulation in your hands and feet while chemo is given, which may lower the amount of medication that reaches these areas. Regular exercise to improve overall circulation may also help.
Hair loss
Hair loss is also common, especially scalp hair loss. But cooling caps may help. These are closely fitted caps that are cooled by chilled liquid. You wear them on your head during chemotherapy treatment. The cold helps slow blood flow to your scalp, so chemotherapy is less likely to affect your hair.
Keep in mind, if you have hair loss from immunotherapy or targeted drug therapy, scalp cooling doesn’t prevent thinning or hair loss.
When Is It Time to Rethink Breast Cancer Treatment Options?
There’s no magic formula to let you know when it’s time to rethink treatment options.
“It’s very individual to each patient,” says Fenn.
If your symptoms are mild to moderate, it’s best to first try if anything can help ease them. But if side effects don’t get better or become severe enough to seriously affect your quality of life, talk to your oncologist about whether this is the right treatment for you, Fenn says.
What does switching breast cancer treatment look like?
If you do decide to change your breast cancer treatment, your doctor may suggest that you switch to another drug in the same medication class. If you’re on an aromatase inhibitor, for example, and have serious joint pain, you may find symptoms get better if you switch to a different one. Joint pain may even get better after switching to the medication tamoxifen, says Fenn.
Switching breast cancer treatment can also look like less time on that treatment. For example, you may decide with your doctor that you’ll only stay on endocrine therapy for three years instead of five.
If you’re on chemotherapy, it may mean that you simply lower your current chemotherapy dose, says Bora Lim, MD, a breast cancer oncologist at the MD Anderson Cancer Center in Houston. “There’s always room to decrease if someone is having significant side effects,” she says. “Sometimes we just need to lower the dose a little to see a big improvement.”
If you’re on two forms of treatment at the same time — such as immunotherapy and chemotherapy — your doctor may also recommend you stop one. “We often use both together, as they work in different ways to kill cancer cells,” Lim says. “But as recently as five years ago, we put breast cancer patients on chemotherapy alone. Was it perfect? No, but it was still very effective.”
Can anyone switch breast cancer treatment?
In certain situations, your doctor may advise you not to switch breast cancer treatment.
“If it’s chemotherapy for three to six months, we tend to encourage patients to try to stick with the regimen, since we know it’s the best option,” Lim says.
In these cases, a more aggressive treatment — such as taking nausea meds around the clock — may help push you through to the finish line. “I tell my patients it’s like a 100-meter race: We torture you, but the goal is to finish the cycle,” she says.
Pros and Cons of Switching Breast Cancer Treatment
Like any medical decision, there are clear pros and cons of switching breast cancer treatment. Here are some things to keep in mind.
Pros of switching breast cancer treatment
It may be necessary to protect you against life-threatening side effects.
“Immunotherapy has been a game changer for breast cancer treatment, but the medications can sometimes cause your immune cells to attack your own body,” Lim says.
Your immune system may begin to attack your thyroid, bowels, or, more seriously, your brain. When this happens, you and your doctor may decide it’s better for you overall if you switch breast cancer treatment.
But the advantages of switching breast cancer treatment depend on your specific case.
Cons of switching breast cancer treatment
There are a few reasons why you may want to think carefully about switching breast cancer treatment.
The risk of cancer growing or getting worse. Your doctor recommended your current treatment based on your overall disease profile: the information they have about you, your body, and your cancer. “There’s always the chance that the new treatment won’t be as effective,” Fenn says.
More side effects. You may still have side effects from the new treatment, some of which may be even worse than those from the old drugs. It depends on the treatment and how you may react to it.
Anxiety. You may feel anxious or nervous while you switch over to the new treatment. Always tell your doctor about any worries you have. They can give you more information and answer any questions.
How to Talk to Your Doctor About Switching Breast Cancer Treatment
It’s important to be able to feel that you can talk openly to your doctor. You and your health care provider should make treatment decisions together. This is called shared decision-making. Here are a few things to keep in mind:
Keep a side effects diary. Write down when side effects occur, how long they last, and what effect they have on your daily activities. Also note how strong the side effect is. For example, rate pain on a scale of 1 to 10. This is important information that will help your doctor make new treatment recommendations.
Bring someone with you to appointments. They can serve as a second set of ears and take notes. They can also give your doctor more information about how side effects affect your quality of life.
Ask about other options. It may be possible to ease side effects if you just lower a medication dose, for example. There may be other, similar drugs you can switch to.
Consider a second opinion. It’s a good idea to always get a second opinion if you’re considering changing your treatment plan, advises Fenn. Another doctor can offer advice on pros and cons, and may even have suggestions on how to tweak your current treatment to make side effects more bearable.
If you have any concerns about breast cancer treatment side effects, it’s always important to speak to your doctor.
“We want our patients to feel empowered and confident in their treatment plans,” Fenn says. “Most of the time, we can come up with a supportive care plan that keeps people in their current treatment. But we never want to push patients past what they can reasonably tolerate.”
