Step 1: Make sure you have a medical team that supports you.
“Treatment for breast cancer is scary,” says Amy Tiersten, MD, oncologist and hematologist at Dubin Breast Center, Mount Sinai Hospital in New York City. “The role of the medical oncology team is really to demystify it, and carefully explain what will be happening and what can be done to ameliorate certain side effects.”
Open dialogue between the patient and the team is critical. In an ideal situation, patients should feel like they can reach out to their team whenever necessary to voice their concerns or ask questions.
Another benefit of open dialogue between the medical team and the patient is alerting the patient of all potential side effects during treatment. When the patient knows what possible side effects to expect, it can make the process less scary and can empower them to take steps to manage them.
For example, certain types of chemotherapy drugs can cause damage to small nerves in the fingers and toes (a condition known as peripheral neuropathy). This results in numbness and tingling. “Acupuncture has shown to be helpful for the treatment of neuropathy,” says Dr. Tiersten.
Women undergoing breast cancer treatment should also be aware of the potential for menopausal symptoms. Since anti-estrogen therapy is a common treatment for some types of breast cancer, that can affect hormone levels and put patients in a temporary state of early menopause. This can cause unpleasant symptoms—like hot flashes and vaginal dryness—as well as affect fertility, pregnancy, and even sex life. (Learn more about sex during breast cancer treatment here.)
“Thankfully, there [are] new drugs that have been studied that have been shown to be effective to minimize hot flashes or vaginal dryness,” says Dr. Tiersten.
Vaginal dryness is a side effect that Dr. Tiersten actively brings up with her patients. “It’s not something that someone might offer on their own,” she says. “To know that it’s a normal side effect of the drug they’re on, and [that] there are things that can be offered that might help, is really important.”
It’s not just medications that can help: Regular exercise has been shown to improve outlook of breast cancer treatment and reduce the risk of cancer recurrence. It can even relieve some of the side effects associated with chemotherapy.
“As much as people feel up to it, I recommend at least 30 minutes of walking, five days a week,” says Dr. Tiersten. “I find that that really helps with fatigue and other symptoms associated with treatment.”
One major part of dealing with breast cancer treatment that often gets overlooked is prioritizing your mental health. “It’s important to be in a place where psychological support can be offered, such as psychiatrists, psychologists, social workers who can help with plugging patients into support groups,” says Dr. Tiersten.
If you’re in a situation where your doctor is not being upfront and direct about side effects to expect, or how to manage them, that’s the time to advocate for yourself and ask those questions directly—or find a new medical oncology team.
Dr. Tiersten is a professor of medicine, hematology, and medical oncology at the Icahn School of Medicine at Mount Sinai. She sees patients at the Dubin Breast Center.
00:00:01,500 --> 00:00:03,840
Treatment for breast cancer is scary and
00:00:03,840 --> 00:00:07,850
I think that the role of the medical
oncology team is really to demystify it.
00:00:07,850 --> 00:00:10,559
And carefully explain what
will be happening and
00:00:10,559 --> 00:00:13,541
what can be done to ameliorate
certain side effects.
00:00:13,541 --> 00:00:19,157
00:00:19,157 --> 00:00:21,772
It's extremely important for
the patient and
00:00:21,772 --> 00:00:24,930
the medical oncology team to
have a very open dialogue.
00:00:24,930 --> 00:00:27,590
Where they feel that they can reach us
24/7 to address any kind of unexpected
00:00:27,590 --> 00:00:28,380
side effects or concerns.
00:00:31,810 --> 00:00:36,631
I also think it's important to be in
a place where psychological support
00:00:36,631 --> 00:00:41,621
can be offered such as psychiatrists,
psychologists, social workers.
00:00:41,621 --> 00:00:43,939
Who can help with plugging
patients into support groups and
00:00:43,939 --> 00:00:45,980
also just providing supportive therapy.
00:00:45,980 --> 00:00:50,107
And I think it's really important to
inform patients, for example, that some
00:00:50,107 --> 00:00:54,120
chemotherapy drugs can cause damage to
small nerves in the fingers and toes.
00:00:54,120 --> 00:00:58,625
Most commonly that's called peripheral
neuropathy and can result in numbness and
00:00:58,625 --> 00:01:00,930
tingling of the fingers and toes.
00:01:00,930 --> 00:01:05,340
Acupuncture has been shown to be helpful
for the treatment of neuropathy.
00:01:05,340 --> 00:01:10,950
In addition, a lot of our treatments for
breast cancer involve menopausal symptoms.
00:01:10,950 --> 00:01:14,940
Because we're frequently in a situation
where we're putting a young person
00:01:14,940 --> 00:01:19,700
into premature menopause and having to
manage the side effects of menopause.
00:01:19,700 --> 00:01:20,720
00:01:20,720 --> 00:01:25,710
many of the anti-estrogen medications
have menopausal symptoms as side effects.
00:01:25,710 --> 00:01:28,560
So thankfully there's new drugs that
have been studied that have been
00:01:28,560 --> 00:01:33,270
shown to be effective to minimize
hot flashes or vaginal dryness.
00:01:33,270 --> 00:01:37,630
I always specifically ask my patients
about a symptom such as vaginal dryness.
00:01:37,630 --> 00:01:40,740
It's not something that someone
might offer on their own and for
00:01:40,740 --> 00:01:43,760
them to know that it's a normal
side effect of the drug they're on.
00:01:43,760 --> 00:01:48,500
And there are things that can be offered
that might help is really important.
00:01:48,500 --> 00:01:52,960
We know that patients who exercise
regularly have a better prognosis in
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terms of reducing the risk of
the breast cancer coming back.
00:01:56,650 --> 00:02:01,039
As well as exercise really helps
ameliorate some of the side
00:02:01,039 --> 00:02:03,070
effects of chemotherapy.
00:02:03,070 --> 00:02:05,240
So as much as people feel up to it,
00:02:05,240 --> 00:02:09,910
I recommend at least 30 minutes of
walking five days a week as a good goal.
00:02:09,910 --> 00:02:12,460
And I find that that really
helps with the fatigue and
00:02:12,460 --> 00:02:15,310
other symptoms associated with treatment.
00:02:15,310 --> 00:02:19,000
The medical oncologist should be very
forthright about what the various
00:02:19,000 --> 00:02:20,980
treatment options are.
00:02:20,980 --> 00:02:24,046
Detailed information about
possible side effects and
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how to manage those side effects.
00:02:26,260 --> 00:02:30,680
And if the patient is not receiving that
sort of information then that would be
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a sign that advocating for oneself and
00:02:32,856 --> 00:02:36,814
finding a situation where those
things are being done is important.
00:02:36,814 --> 00:02:44,435
Side effects from breast cancer treatment. Baltimore, MD: Johns Hopkins Medicine. (Accessed on April 25, 2019 at https://www.hopkinsmedicine.org/kimmel_cancer_center/centers/breast_cancer_program/treatment_and_services/survivorship/side_effects.html.)
Treating breast cancer. Atlanta, GA: American Cancer Society. (Accessed on April 25, 2019 at https://www.cancer.org/cancer/breast-cancer/treatment.html.)