Managing symptoms and side effects of advanced breast cancer

Chemotherapy can reduce the number of white blood cells which help to fight infection. If your white blood cell count is low, you’ll be more susceptible to infections. A low white blood cell count is called neutropenia.

Always contact your specialist team/hospital IMMEDIATELY if:

• You develop a temperature of 38c or higher
• You feel shivery and shaky (chills)
• You feel very unwell (even with a normal/lower temperature)
• You have any other symptoms (signs of infection) such as a cold, sore throat, cough,
• passing urine frequently (urine infection) or diarrhoea.

The thought of being in pain can be a real worry. There are many different kinds of pain- relieving drugs (also known as analgesics) to help relieve different types and levels of pain.

Your specialist team (cancer and palliative teams) and/or specialist nurse will usually recommend a three-step approach to pain relief. This starts with mild pain relief taken regularly and moves on to moderate and then strong pain relief, often morphine-based, when necessary.

Morphine-based pain relief is effective for controlling many types of pain, and most people experience good pain relief, and a better quality of life. Morphine can be used at different stages of your advanced breast cancer disease, and doesn’t mean that the cancer is getting worse or that you’ll need to take morphine forever.

Because different types of pain respond to different kinds of pain-relieving medication, your doctor and/or nurse may use a combination of short and long acting pain relief. Whichever pain relief you’re given, it’s important to use it as prescribed.

Feeling sick (nausea) and vomiting can be caused by some cancer treatments, like chemotherapy, or by the disease itself. These symptoms can be really worrying, but there are a number of things we can do about it.

Your cancer specialist team will prescribe anti-sickness (anti-emetic) drugs to prevent this. Let your doctor or nurse know if these are not helping as there are several different types you can try.

Constipation can be caused by painkillers, some chemotherapy drugs, or some anti-sickness medicines. Your doctor and/or nurse can prescribe a medicine (laxative) to stimulate the bowel.

Diarrhoea can be caused by some chemotherapy drugs (capecitabine, 5FU), radiotherapy (to the pelvic and lumbar area) and some medications (e.g. laxatives, antibiotics, potassium supplements). Your oncologist can prescribe drugs to control this.

Follow the advice given and let your cancer specialist team know if the diarrhoea is severe or doesn’t improve.

Some people with ABC may experience shortness of breath. Shortness of breath (also known as dyspnoea) can be frustrating, especially when it limits your activity. For some people it can also be very frightening.

Treatment will depend on the cause of the shortness of breath. For example, a build-up of fluid in the lungs can be drained, and an infection treated with antibiotics.

If you have a sudden onset of shortness of breath that you cannot explain, seek IMMEDIATE medical advice from your specialist team to rule out the possibility of a blood clot that may require urgent medical treatment.

Numb or tingling hands and feet (also known as peripheral neuropathy) can be caused by some chemotherapy drugs (vinorelbine, gemcitabine, oxaliplatin, taxanes, and cisplatin).

It may affect your ability to do daily activities (e.g. buttoning a shirt, texting, picking up small items).

Always tell your cancer specialist team if you have these symptoms. They sometimes need to lower the dose of the chemotherapy drug. The symptoms usually improve slowly after treatment finishes, but in some people, their numb or tingling hands and/or feet may never go away. Talk to your doctor if you are worried about this.

Skin changes can be caused by some types of chemotherapy and targeted (biological) therapies. Skin changes can include soreness and redness of palms of hands and soles of feet (called palmar-plantar) and a rash (acneiform or maculopapular rash).

Your specialist cancer team will give you advice and prescribe medication to improve the symptoms.

Mouth problems can include soreness, ulcers and infection and are often caused by chemotherapy. Mouth washes, medicines and gels can help, your specialist doctor and/or nurse can prescribe these for you.

Cancer-related fatigue (extreme tiredness) is a common symptom experienced by people with ABC. Fatigue has many causes, from psychological factors such as the stress and worry of coping with the disease, to physical ones such as side effects of treatment, loss of appetite, and disturbed sleep.

Tell your doctor and/or specialist nurse how you’re feeling. They will carry out an assessment. In some instances, your fatigue may have a treatable cause, for example anaemia, which can be treated with iron supplements. They will also provide you with information and helpful tips for managing your fatigue.

Poor appetite can be due to the effects of the advanced breast cancer, treatment or anxiety. You might find it easier to eat little and often instead of having set meals.

If you have no interest in food or are losing weight, talk to your specialist team about dietary supplements or ask to speak to a dietician for specialist advice. In some circumstances you may be prescribed medication to help stimulate your appetite.

Our webinar, How to Eat, provides clear advice on eating well with breast cancer and how to manage side effects like nausea that come with treatment.

Sleeplessness/difficulty sleeping at night is commonly caused by physical and psychological factors. Physical symptoms such as pain or nausea can interfere with sleep, which can be treated. Having a lot on your mind can also keep you awake. There are many tips and strategies you can try to improve this, including reducing your caffeine intake during the day, having regular massages, avoiding technology before bed, taking a warm bath or shower, and practicing other relaxation techniques such as breathing exercises. If these don’t help, speak to your doctor about sleeping tablets.