Breast Cancer: Navigating Short-Term and Long-Term Side Effects
- For breast cancer survivors like Julia Louis-Dreyfus, 63, and million of others affected by the disease, there is evidence that treatment may have an even bigger impact on aging, according to a new study conducted by UCLA researchers.
- Researchers specifically looked into inflammation, DNA damage and cellular senescence — which is when a cell ages and stops dividing but does not die — and found that there was significant increase in these areas with breast cancer survivors no matter their treatment plans.
- Our team of SurvivorNet experts have weighed in on long-term side effects, and while it’s a concern that most patients have to navigate, it’s also important to know that most will continue to push forward and achieve positive physical and emotional outcomes, with a little work. For more on how to manage chemotherapy side effects, check out SurvivorNet’s digital guide.
Published on Tuesday in the Journal of the National Cancer Institute, researchers specifically looked into inflammation, DNA damage and cellular senescence — which is when a cell ages and stops dividing but does not die — and found that there was significant increase in these areas with breast cancer survivors no matter their treatment plans. These issues are linked to aging markers like frailty, cardiovascular issues and cognitive decline, which all can greatly affect a person’s quality of life.
Read MoreThe Veep star underwent six rounds of chemotherapy and a double mastectomy (the removal of breast tissue in both breasts) during her treatment.
She still looks as radiant and beautiful as ever, but many survivors will say that is often the problem, as when they seemingly get “back to health,” people may not understand the overall impact they have gone through from a treatment aspect and what issues they may be facing in the body.
“We’ve only just begun to understand the long-term consequences of cancer therapy and these findings are a critical step toward understanding the biological pathways that drive many post-treatment symptoms in breast cancer survivors,” Carroll added. “Our goal is to find ways to improve survivorship, not just in terms of years lived, but also in quality of life and overall health.”
Types of Breast Cancer Treatment
After a breast cancer diagnosis, your surgeon and/or oncologist will come up with a treatment plan dependant on what type of cancer, what stage, your age, and several other factors.
Your doctor has many ways to treat breast cancer, including:
- Surgery
- Chemotherapy
- Radiation
- Hormone therapy
- Targeted therapy
- Immunotherapy
Surgery
Most women with breast cancer will have surgery at some point in their treatment. Depending on how far your cancer has spread and your personal preferences, you and your doctor may decide to:
- Remove just the cancer and an area of healthy tissue around it (lumpectomy)
- Remove one breast (mastectomy)
- Remove both breasts (double mastectomy)
Removing your breasts can have a dramatic effect on your self-esteem, which is why some women who opt for a mastectomy then choose breast reconstruction surgery. This is a highly personal choice, and there is no “right” answer as to whether or not to reconstruct.
Chemotherapy
Chemotherapy uses strong drugs to kill cancer all over the body. You may get this treatment to shrink a tumor before surgery, afterward to get rid of any remaining cancer cells, or on its own if you can’t have surgery.
Whether or not to have chemotherapy can also be a choice, depending on a woman’s age, type of cancer, and stage.
Radiation Therapy
Radiation, the use of high-energy rays to destroy cancer cells, is also used after surgery to lower the chance that the cancer will come back after treatment. Many women undergo radiation as part of their treatment, especially if they opt for a lumpectomy instead of a mastectomy.
Hormone Therapy
The hormones estrogen and progesterone help some breast cancers grow. Doctors refer to these types of cancers as hormone-receptor-positive breast cancers. Receptors are proteins on the surface of breast cells that receive messages from estrogen, progesterone, or both, telling them to grow. Treatments that block these hormones may help stop the tumor.
Testing the tumor sample from a biopsy helps to determine whether hormone therapies such as tamoxifen (Nolvadex) or anastrozole (Arimidex) might work against the cancer. Women with breast cancer that is fueled by estrogen may take one of these drugs as part of their treatment.
Immunotherapy and Targeted Therapy
Immunotherapy and targeted therapies are newer forms of treatment. Immunotherapy boosts your body’s own immune response to help it stop the cancer.
As their name suggests, targeted therapies target certain substances that help the cancer grow. For example, drugs like trastuzumab (Herceptin) and pertuzumab (Perjeta) treat breast cancers that have too much of a protein called HER2 on their surface.
Treatment Effects on Aging
Chemotherapy, radiation and surgery can cause DNA damage. If a cell’s DNA is harmed, the DNA in your body will be triggered to work to repair it, but if there has been too much damage, this reparation can be interrupted or can fail, which then can lead to acceleration with aging.
Furthermore, a build-up of chemicals from these treatments can build up and damage other healthy cells, resulting in inflammation, a big contributor in aging, both in a physical sense and cognitive, meaning related to brain function.
Before beginning any treatment plan, it’s important to weigh the pros and cons with your doctor — and of course, always get multiple opinions. If chemotherapy is going to help keep someone alive, then obviously the benefits of treatment outweigh the side effects and risks of accelerated aging.
Staying Active Physically
Staying active physically and emotionally often go hand in hand. Staying active can boost your spirits and experts say good emotional health can also affect physical healing. Just because treatment may effect or diminish your overall health in time, as with the natural aging process, doesn’t mean you can’t still work on doing the things you love.
Lisa Csencsits, a resilient mother of two who went through breast cancer found hope and inner strength through the sport of cycling. While she had been cycling for years before cancer, the sport gained a greater sense of purpose throughout her journey. But after Csencsits’ surgeries, she found herself in intense pain. “I couldn’t raise my arms fully above my head, I couldn’t sleep, I couldn’t embrace my babies, I couldn’t do anything without experiencing pain,” she explained in a previous interview with SurvivorNet.
New York Mom Realizes She Can Cycle Like a Professional During Recovery From Breast Cancer
What she was experiencing was post-mastectomy pain syndrome (PMPS). This is a persistent pain a woman experiences following breast surgery. The pain tends to affect the chest and shoulder area for three months or longer after surgery.
“I loved challenging myself during my breast cancer journey and throughout all of my breast reconstruction surgeries, I felt like I hit rock bottom and I don’t think I would have ever felt so comfortable admitting that before I went through that process,” she said.
“I really hope other people who are going through this can just really bounce back and feel this amount of pride and know you can come out of the other side better than you ever could before,” Csencsits said.
‘Your Emotional Well-Being’ Can Impact Overall Survival
Dr. Dana Chase, a gynecologic oncologist at UCLA Health, says that maintaining good emotional health and quality of life is associated with better survival and better outcomes for patients. She encourages cancer patients to prioritize their emotional health for this reason.
“So definitely working on your emotional health, your physical well-being, your social environment, your emotional well-being, definitely working on those things and making them better are important and can impact your survival,” Dr. Chase told SurvivorNet.
WATCH: How emotional health plays a role in the cancer journey.
Dr. Chase suggests tapping into your support network, which includes loved ones like friends and family if you need help discovering what brings you positive emotions. You can also seek help from a patient advocate or a support group either in-person or virtually that shares your cancer or disease. These important people in your life can help you navigate your emotions and even join you for fun activities to boost your emotional health, which in turn, can help how you address any lasting physical ailments.
Managing Chemotherapy Side Effects
Chemotherapy is an effective tool for oncologists to help treat cancer by stopping cancerous cells from growing, dividing, and spreading to other organs. Chemo works by traveling through the bloodstream, killing cancerous cells. However, healthy cells are also impacted in the process, leading to side effects, with some lasting longer than people would like.
Patients almost universally experience fatigue, often alongside gastrointestinal side effects, such as nausea. Doctors have many effective medications to combat chemo-induced nausea. “But mitigating that fatigue often depends on the patient,” says Dr. Renata Urban, a gynecologic oncologist at the University of Washington in Seattle.
Managing chemo side effects
“Neuropathy is probably one of the most challenging side effects,” Dr. Urban previously told SurvivorNet. Neuropathy results from damage to the peripheral nerves. It usually resolves after chemotherapy treatment, but sometimes symptoms can persist. While it’s typically characterized by numbness or a pins-and-needles sensation in the hands and feet, neuropathy can have several different symptoms, including:
- Weakness in the hands or feet
- Stabbing or burning pain in the hands or feet
- Difficulty gripping, such as when holding a fork
- Difficulty with fine motor skills, such as writing or buttoning a shirt
- Nausea and vomiting are common side effects of chemotherapy. When chemotherapy affects the rapidly dividing cells in the lining of the stomach, the resulting cellular havoc in the gastrointestinal tract can lead to side effects such as nausea and vomiting. However, doctors can help patients mitigate the hit with various medications before, during, and after treatment.
Long-term Side Effects
Long-term side effects from chemotherapy, per the American Cancer Society, can include fatigue, bowel or bladder problems, sleep problems and/or mental distress.
Dr. Matthew Carlson, an oncologist at UT Southwestern Medical Center, previously told SurvivorNet that there are “side effects to chemotherapy that can be chronic, whether that’s fatigue, or what’s known as ‘chemo brain,’ foggy thinking and difficulty concentrating and forgetfulness, or muscle aches and pains, and of course, sleep.”
“Those things can last — and some of those are permanent, and for the most part, patients are back to normal within a year.”
Cancer-related fatigue
Cancer-related fatigue (CRF) can last weeks, months, or even years after treatment. Getting an adequate amount of sleep and listening to your body when it needs a rest, along with proper nutrition, water and exercise, can help.
Bowel or bladder problems
Cancer treatment can cause long-term or late side effects.
Common bowel and bladder problems include:
- Bowel obstruction or blockage
- Difficulty urinating or emptying your bladder
- Difficulty controlling your bowel movements
- Cystitis (bladder issues) or UTIs (urinary tract infections)
Sleep issues
Sleep-related problems usually involve a multitude of issues or conditions, along with pain, caffeine, medicine, work and coping methods — all of these things can cause or add to sleep problems after cancer treatment.
Mental distress
There is no doubt that cancer patients experience mental distress during the period of testing ahead of a diagnosis, after a diagnosis, through treatment, and recovery. But sometimes these emotional symptoms are long-lasting. Making sure you’re speaking to a trusted family member or friend or seeking professional help can ensure that you are navigating all of your mental and emotional challenges in a healthy manner.
Questions for Your Doctor
If you have been diagnosed with breast cancer, you may have questions about keeping your strength through treatment and for your recovery after. Here are a few questions to help you begin the conversation with your doctor:
- What treatment will I be receiving?
- What side effects are associated with this treatment?
- What long-term side effects can I expect?
- Are there steps I can take daily to help minimize these side effects?
- What physical activity routine do you recommend for me during and after treatment?
- Can you recommend a dietician who can help me combat short and long-term side effects?
Learn more about SurvivorNet's rigorous medical review process.
