The kinds of side effects you have during breast cancer treatment depend on your subtype of breast cancer and the treatment it requires. Some side effects impact your quality of life more than others. But there are ways to help lessen them.
During a WebMD Reddit AMA about early-stage breast cancer, dealing with treatment side effects was a recurring topic. Jane Meisel, MD, a professor at Emory School of Medicine at Emory University, specializes in women’s health with a focus in breast cancer. She offered her insights on healthy habits, supplements, and medications that may help.
Medication for Hot Flashes
Most breast cancers are hormone receptor-positive, meaning the hormones estrogen and/or progesterone fuel their growth. Treatment involves endocrine or anti-estrogen therapy.
“People tend to be on these therapies for much longer than chemotherapy, which, although intense, goes on for a shorter period of time,” says Meisel. “You might be on endocrine therapy for 5 to 10 years, depending on the type of breast cancer you have and its risk. So we talk a lot about side effects, and we really think about ways to manage them.”
One of the most common side effects of endocrine therapy is hot flashes. That’s the sudden feeling of being hot and sweaty. Sometimes, hot flashes happen at night and cause night sweats. Chemotherapy may also cause hot flashes, if it brings on early menopause.
When you have a history of hormone-sensitive breast cancer, hormone replacement therapy (which adds estrogen back to your system) isn’t an option for treating hot flashes, so alternatives are important. Meisel often recommends non-medication approaches such as acupuncture, yoga, and exercise as a first step. But if your hot flashes are severe, your doctor may also prescribe medications.
“The three most common medications I mention are gabapentin, oxybutynin, and sometimes venlafaxine,” says Meisel.
Doctors often prescribe gabapentin to treat nerve pain after breast surgery. It can work on hot flashes because it also impacts some of the same nerve pathways that control hot flashes, she says. Gabapentin often makes you sleepy when you take it, which Meisel says can be helpful for nighttime hot flashes.
“You also don’t have to take it every day for it to be effective,” says Meisel. “You can take it for a few days, then stop. Or bring it on a trip if you want to make sure you don't have hot flashes while you're on vacation, for example.”
Venlafaxine is an antidepressant at high doses, so in addition to reducing hot flashes it may also ease mood changes. For breast cancer treatment-related joint pain, Meisel says she typically starts with a low dose, working up to a higher dose if you need more coverage.
“The nice thing about venlafaxine, especially for patients on endocrine therapy and experiencing low moods or anxiety related to having an estrogen taken away or just having survived breast cancer, is it can sometimes take the edge off those new related symptoms as well,” Meisel says.
Oxybutynin, another option, can be effective not just for hot flashes, but also bladder instability. Meisel says it may cause dry mouth, so if you’re in a profession that involves public speaking, that can be a challenge to consider.
Supplements for Joint Pain
Joint pain, also called arthralgia, can be an issue when you take aromatase inhibitors. While it’s not technically arthritis, it can feel similar and interfere with your daily life.
Meisel recommends a few natural supplements that may help:
Tart cherry. This isa supplement often used to treat gout. In studies, researchers found that people drinking 8 ounces of diluted tart cherry juice concentrate every day for four weeks had a nearly 20% decrease in certain proteins that measure body inflammation. But you can get these benefits without chugging juice, says Meisel. “It’s a lot of sugar and calories that some women don't want, so I usually recommend the concentrate,” she says. “I recommend 30 milliliters — about a teaspoon — twice a day. Or you can also find it in gummy form, which is typically a dose of two gummies a day.”
Collagen peptides. This often comes in powder form you can mix into your coffee or any beverage. Collagen supports your joints. It can be helpful for hair and nail growth as well.
“If your hair is thinning or your nails aren’t growing as quickly, collagen can also be great for all three of those things: joints, hair, and skin,” says Meisel. She recommends 12 grams of collagen peptides daily.
Coenzyme Q10 (CoQ10). Your body makes this antioxidant that naturally protects your cells from damage. As a supplement, you can take it as a capsule, chewable tablet, or liquid syrup. Meisel recommends 100 to 200 milligrams daily.
Regular exercise is another important tool for managing your joint pain. Try low-impact activities like walking, yoga, and swimming. They can help your joints stay flexible and reduce your discomfort.
Stress Management for the Emotional Toll of Treatment
Stress, anxiety, and depression are common side effects of breast cancer treatment. They may result from the treatment itself, or the reality of breast cancer diagnosis. Actively managing your stress is crucial.
“Having breast cancer, treating breast cancer, surviving breast cancer — all of these are stressful things,” says Meisel.
For acute stress, such as anxiety or panic attacks that require medical treatment, Meisel recommends having a short course of a medication such as lorazepam on hand. For keeping life on a more even keel from day to day, other strategies are helpful.
“Therapy [with a licensed mental health professional] can be very, very helpful,” says Meisel. “Even a few sessions can provide tools for managing fear of recurrence, spiraling thoughts, or the stress of daily demands.”
She also encourages prioritizing time for the things you enjoy.
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
Jane Meisel, MD, oncologist, professor, Emory School of Medicine.
Oncology Reviews: “Treating ER-positive breast cancer: a review of the current FDA-approved SERMs and SERDs and their mechanisms of action.”
Mayo Clinic Comprehensive Cancer Center Blog: “Study backs oxybutynin for Hot Flashes in Breast Cancer Survivors.”
Arthritis Foundation: “Are Cherries a Cure for Gout?”
Mayo Clinic: “Exercise helps ease arthritis pain and stiffness.”
