Managing Side Effects and Supportive Care – Metastatic Breast Cancer

Supportive care is all the care given to improve the quality of life for people with breast cancer (or any serious health condition).

Symptom management (also called palliative care) is part of supportive care. Symptom management aims to prevent or relieve the side effects of breast cancer and its treatment (such as pain or nausea). It’s an extra layer of care given along with treatment for the cancer.

Supportive care also includes taking care of emotional, social, spiritual and practical needs (such as child care and elder care).

All metastatic breast cancer treatments have some side effects. Many can be managed, and some can be prevented. Before any treatment begins, talk with your health care provider about possible side effects and ways to deal with them.

Bone-strengthening therapy for people with bone metastases

The bones are one of the most common sites of breast cancer metastases. People with bone metastases are at risk of serious bone complications, including bone fractures (breaks), spinal cord compression and bone pain.

Bone-strengthening therapy lowers the risk of bone complications related to bone metastases and helps reduce bone pain.

Learn more about bone strengthening therapy and bone metastases.

Nutrition and help with loss of appetite

Loss of appetite

Loss of appetite is a common problem for people with metastatic breast cancer. It can be caused by breast cancer treatment or by the cancer itself.

Stress, depression, nausea, constipation and changes in your sense of taste or smell can also affect appetite.

Light exercise (if you’re able) may help increase appetite.

Nutrition and unwanted weight loss

Although a loss of appetite can make it hard to eat, it’s important to get enough calories, protein and nutrients. Eating helps strengthen your body.

Your health care provider can help you decide how many calories you need each day.

For most people with metastatic breast cancer, major weight loss isn’t a problem until the cancer is very advanced.

Tips to prevent unwanted weight loss

Eat small meals and snacks every few hours throughout the day. Try not to snack too close to mealtimes to avoid feeling too full before meals. Limit fluids at meals to avoid feeling too full, but drink plenty of fluids at other times during the day. Take high-calorie snacks with you when you’re on the go. Eat your favorite foods more often. Increase the calorie content of meals and snacks with healthy choices by adding oils, avocado, nuts, pesto and natural peanut or almond butter. Sip on homemade smoothies, milk shakes or prepared liquid supplement drinks (such as Ensure and Boost).

For more tips on improving nutrition and loss of appetite (including recipes), visit the National Cancer Institute website.

Nausea

Nausea is a common side effect of some breast cancer treatments.

Your health care provider will prescribe medications to ease nausea caused by chemotherapy.

Watch our video on diet and nutrition tips to manage side effects during treatment for metastatic breast cancer.

The National Comprehensive Cancer Network (NCCN) has a booklet with information on preventing and coping with nausea and vomiting.

Tips to manage nausea

Eat 4-6 small meals (instead of larger meals) each day. Try ginger tea, ginger ale or crystallized ginger, or add fresh ginger when you’re cooking. Drink lemonade or lemon water. Eat bland, easy-to-digest foods that don’t have an odor. Eat cool or frozen foods. These may have fewer odors than warmer foods. Avoid foods that are spicy, fried, very greasy or very sweet. Cook and freeze meals to reheat during times when you feel nauseous. Reheating causes fewer odors than cooking. Open the windows when possible to keep fresh air flowing. Use an overhead fan to decrease cooking odors. Take walks (when you can) to get fresh air. Talk with your health care provider about complementary and integrative therapies (such as acupressure, acupuncture, relaxation techniques, hypnosis, guided imagery and music therapy) that may help.

Medical marijuana

Some people report marijuana may be helpful for nausea and vomiting [57]. However, there are no studies proving marijuana is useful for cancer-related health conditions.

Medical marijuana is not legal in every state.

The National Cancer Institute has more information on marijuana and nausea related to chemotherapy.

Constipation

Some medications used in metastatic breast cancer care, such as those used to ease nausea, may cause constipation.

If you become constipated, you may need to make some changes in your diet or take medications to promote regularity. To manage constipation, your health care provider may recommend you:

• Eat high-fiber foods (such as fruits and vegetables)
• Drink plenty of liquids (warm or hot liquids may be helpful)
• Take a soluble fiber supplement (for example, Benefiber rather than Metamucil)
• Use a mild laxative (such as Senna) or a stronger laxative (such as polyethylene glycol (Miralax))

If you don’t have a bowel movement within 4 days, despite taking the recommended laxatives, tell your health care provider.

Diarrhea

Some chemotherapy drugs and some HER2-targeted therapy drugs can cause diarrhea. Bowel movements may become more frequent and/or looser. You may also have cramping and gas.

Some ways to manage diarrhea are listed below. Talk with your health care provider about which over-the-counter diarrhea medication to use and take it as prescribed. If it doesn’t work, you may need prescription medicine.

Keep track of the number of bowel movements you have. If you’re having more than 4 loose bowel movements a day or the diarrhea doesn’t improve after 2 days, or if you become dehydrated or light-headed, let your health care provider know. These are signs the diarrhea is serious and you need medical care.

If the diarrhea improves after 1-2 days, you can eat small, regular meals again [58].

Ways to manage diarrhea

Eat small, bland meals such as bananas, rice, toast, applesauce or plain pasta. Include foods and drinks that have potassium such as bananas, potatoes, apricots and some sports drinks in your diet. (You may lose potassium when you have diarrhea.) Drink 8-10 large glasses of clear liquids a day. Broth and sports drinks with electrolytes are good choices. Avoid milk and other dairy products. Avoid acidic drinks such as orange juice and tomato juice. Let carbonated soft drinks go flat before drinking them (pour the drink into a glass and let it sit for at least 10 minutes). Avoid alcohol and caffeine. Avoid foods that are spicy, fried, very greasy or very sweet. Sit in a tub of warm water or a sitz bath to ease discomfort in the anal area. Keep the anal area clean and apply a water-repellent ointment or petroleum jelly to the area.

Adapted from select sources [58-59].

Fatigue

Fatigue is common with metastatic breast cancer and can greatly impact quality of life.

You may feel like you don’t have any energy and may be tired all of the time. Resting may not help.

Your health care provider should check for signs of fatigue at each visit and can help you find ways to manage it.

Causes of fatigue

Many breast cancer treatments cause fatigue. Pain, depression and trouble sleeping are other common causes of fatigue [60].

For some people, fatigue is caused by anemia (a drop in red blood cells). 

Learn about ways to manage anemia.

Managing fatigue

It’s hard to be active when you feel tired, but getting some physical activity may help reduce fatigue [60-61]. Even doing exercises while seated may help [61].

You may want to ask someone to be your walking partner. Family and friends often want to help, but don’t know how. This may be a way friends and family can help you.

If you feel overly tired or have trouble sleeping talk with your health care provider. Together, you can find the best ways to manage fatigue.

Although studies of ways to ease fatigue are limited, the tips below may help [62-63].

Tips to manage fatigue

Sleep at least 8 hours each night. If you nap, sleep for less than an hour. Alternate tasks that take more energy with those that take less energy. Plan your daily tasks to prevent from doing too much in a day. Let others help (for example, prepare meals and help with chores). Take breaks, even when you’re having a good day. Sit down to do daily tasks, such as bathing or folding laundry.

Adapted from selected sources [62-63].

Learn more about fatigue and insomnia. 

Anemia (low red blood cell count)

Chemotherapy can cause a drop in your red blood cell count. This is called anemia.

Anemia can cause fatigue and shortness of breath. It can also make you look pale.

Sometimes, anemia can be treated by increasing iron or folate in the diet. Severe anemia can be treated with a blood transfusion.

Growth factors, such as erythropoietin (Procrit, Epogen and Aranesp) and similar drugs can increase red blood cell count and reduce the need for blood transfusions. However, safety studies have raised questions about whether people with breast cancer should take these drugs (for more on these studies, visit the FDA website).

Growth factor drugs increase the risk of blood clots and stroke [64-67]. They may also shorten survival [64-67]. So, they aren’t recommended for the treatment of anemia after chemotherapy ends [60-63].

Palliative care and pain control

The side effects from treatments and the cancer itself can affect quality of life.

Controlling pain and other symptoms (called palliative care) should be part of standard care for everyone with breast cancer. It’s especially important for those with metastatic breast cancer.

Treatment may include pain medications and may target specific parts of the body.

Learn more about managing pain related to metastatic breast cancer.

Other side effects

There are many possible side effects of metastatic breast cancer treatment.

Before any treatment begins, talk with your health care provider about possible side effects and ways to deal with them.

Learn about:

• Cognitive function problems (cancer brain, chemo-brain)
• Fingernail and toenail weakness
• Hair loss
• Hot flashes and night sweats
• Insomnia
• Irregular periods or spotting (uterine bleeding)
• Joint pain
• Loss of bone mineral density (may lead to osteoporosis or bone fractures)
• Loss of sex drive
• Lymphedema
• Mouth and throat sores
• Muscle pain
• Vaginal symptoms
• Vomiting

Emotional well-being

Taking care of your emotional well-being is as important as tending to the physical side effects of treatment.

Talk with your health care provider or a patient navigator about how you’re coping. They can help you find ways to improve your emotional well-being and can help you find a counselor or support group.

Learn more about:

• Coping with stress
• Counseling and support groups
• Depression  

Find information for family and friends and a brochure for helpful tips for family and friends.

Managing practical needs

Throughout your care, you may face many practical challenges. You must deal with financial issues as well as everyday needs.

Financial issues

After a metastatic breast cancer diagnosis, dealing with insurance and financial issues can feel overwhelming.

Whether you need help going through your insurance plan or financial assistance for medical and daily life expenses, there are resources to help you and your family.

Learn more about:

• Insurance
• Financial resources
• Prescription drug assistance

Travel, lodging child care and elder care

Getting to your breast cancer treatments can be hard, especially if you don’t live near the hospital or medical center.

If you need a ride to and from treatment or help with child care or elder care, there may be resources available.

Family and friends often want to help, but don’t know how. These may be great ways for them to get involved. It’s OK to ask for help.

Some organizations offer programs to help with transportation or costs related to transportation, child care and elder care. Others offer lodging if you need a place to stay overnight during treatment.

Learn more about:

• Transportation assistance
• Lodging assistance
• Child care and elder care assistance

After treatment for breast cancer ends

At some point, you may decide to stop active treatments for the cancer. This can happen when treatment stops showing a benefit or when it greatly affects your quality of life.

Once treatment is stopped, palliative care becomes the main focus of care, rather than just a part of treatment.

This can be a very difficult time. Your health care provider or hospital can arrange for counseling or a support group.

Hospice can make this later stage of care as comfortable as possible.

Learn more about support groups, hospice care and other types of support.

Resources

The National Institutes of Health (NIH) website has information on end-of-life planning and care, including questions to ask your health care provider.

The American Society for Clinical Oncology (ASCO) has a guide for patients and their families to help make decisions on end-of-life care.

SUSAN G. KOMEN® SUPPORT RESOURCES

If you or a loved one needs more information about breast health or breast cancer, call the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877-465-6636). All calls are answered by a trained specialist or oncology social worker in English and Spanish, Monday through Friday from 9:00 a.m. to 10:00 p.m. ET. You can also email the helpline at helpline@komen.org. We offer an online support community through our closed Komen Metastatic Breast Cancer group. The Facebook group provides a place where those living with metastatic breast cancer, and those who love them, can find support, friendship and information. Visit Facebook, search for Komen Metastatic Breast Cancer (Stage IV) Group and request to join the closed group. Our free monthly MBC Impact Series provides people living with metastatic breast cancer and their loved ones a safe, collaborative space to gather information related to MBC and discover practical resources to help make decisions for improved physical and emotional health. To learn more and register visit https://komen.org/mbcseries. Our podcast series Real Pink covers many relevant topics for people living with metastatic breast cancer and caregivers. Our Family and Friends section has detailed information and resources for loved ones. Our fact sheets, booklets and other education materials offer additional information.

Learn more about what Komen is doing for people with metastatic breast cancer.

*Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date.

Updated 03/07/22