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). It’s sometimes known as palliative care.
Symptom management is part of supportive care. Symptom management aims to prevent or relieve the side effects of breast cancer and breast cancer 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 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.
Susan G. Komen®‘s Metastatic Breast Cancer (MBC) Impact Series
Susan G. Komen’s free MBC Impact Series provides people living with metastatic breast cancer and their loved ones a safe, 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 www.komen.org/mbcseries.
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 your appetite.
Light exercise (if you’re able) may help increase your 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
For more tips on improving nutrition and loss of appetite (including recipes), visit the National Cancer Institute website.
Fred Hutchinson Cancer Center’s Cook for Your Life website offers recipes, cooking videos and nutrition and health information in English and Spanish.
Nausea is a common side effect of some breast cancer treatments.
Your health care provider will prescribe medications to ease nausea caused by chemotherapy.
The National Comprehensive Cancer Network (NCCN) has a booklet with information on preventing and coping with nausea and vomiting.
Tips to manage nausea
Medical marijuana is not legal in every state. If you’re considering using medical marijuana, check the laws in your state.
The National Cancer Institute has more information on marijuana and nausea related to chemotherapy.
Some medications used in metastatic breast cancer care, such as those used to ease nausea or pain, may cause constipation.
If you become constipated, you may need to change 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 of taking the recommended laxatives, tell your health care provider.
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 .
Ways to manage diarrhea
|Adapted from select sources [57-58].|
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 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
For some people, fatigue is caused by anemia (a drop in red blood cell count).
Learn about ways to manage anemia.
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 be there for 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 [61-62].
Tips to manage fatigue
Adapted from selected sources [61-62].
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 information on these studies, visit the FDA website.
Growth factor drugs increase the risk of blood clots and stroke [63-67]. They may also shorten survival [63-67]. So, they aren’t recommended for the treatment of anemia after chemotherapy ends [59-62].
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 the standard of care for everyone with breast cancer. It’s especially important for those with metastatic breast cancer though.
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.
- Cognitive function problems (cancer brain, chemo-brain)
- Fingernail and toenail weakness
- Hair loss
- Hot flashes and night sweats
- Irregular periods or spotting (uterine bleeding)
- Joint pain
- Loss of bone mineral density (may lead to osteoporosis or bone fractures)
- Loss of sex drive
- Mouth and throat sores
- Muscle pain
- Vaginal symptoms
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:
Managing practical needs
Throughout your care, you may face many practical challenges. You must deal with financial issues as well as everyday needs.
After a metastatic breast cancer diagnosis, dealing with insurance and financial issues can be 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:
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 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. Some offer help with the cost of child or elder care. Others offer lodging if you need a place to stay overnight during treatment.
Learn more about:
Komen Financial Assistance Program
Susan G. Komen® created the Komen Financial Assistance Program to help those struggling with the costs of breast cancer treatment by providing financial assistance to eligible individuals.
Funding is available for eligible individuals undergoing breast cancer treatment at any stage or living with metastatic breast cancer (stage IV).
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After treatment for breast cancer ends
At some point, you may decide to stop active treatment 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.
The National Institutes of Health (NIH) website has information on end-of-life planning and care, including questions you may want 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.
Read our perspective on palliative care, hospice and metastatic breast cancer.*
SUSAN G. KOMEN® SUPPORT RESOURCES
Read our perspective on 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.