Coping With Chemotherapy Side Effects for Breast Cancer
- Genetic testing can look for the BRCA gene, BRCA1 and BRCA2 which increases your risk for cancers including breast and ovarian. The National Cancer Institute estimates about 72% of women who inherit a BRCA1 mutation and about 69% of women who inherit a BRCA2 mutation will develop breast cancer by age 80.
- Some women at higher risk for breast cancer, such as carrying the BRCA1 or BRCA 2 gene should talk with their doctor about the risk and benefits of a prophylactic, or preventative, mastectomy. This procedure involves removing breast tissue to reduce the risk of developing breast cancer.
- Chemotherapy can cause several side effects including nausea, vomiting, and hair loss. Your doctor can help you manage some of these side effects. Fortunately for hair loss, while it usually begins about three to four weeks after beginning chemotherapy and continues throughout treatment, it usually regrows after treatment concludes.
- The Food and Drug Administration (FDA) approved cooling cap device that is placed on your head to minimize hair loss during cancer treatment. Medical oncologist Dr. Julie Nangia tells SurvivorNet “50% of women kept their hair after four cycles of chemo, and without the devices, 100% of patients lost their hair,” citing a research study.
Longtime “Today” show host Jill Martin Brooks, 47, is a year into her breast cancer journey, and despite the challenges chemotherapy brings, she’s refused to let it dampen her fighting spirit. “Red devil” chemo has been so tough on the brave journalist’s body that she sleeps for several days at a time and barely recognizes her body, going as far as to say she feels like a “shell of [herself].”
“I feel…I was given this to be able to help and save other people. I truly believe that deep down,” Brooks said on “Today” while recounting her journey.Read More
The brave and resilient journalist was diagnosed with stage 2 breast cancer last year. Her diagnosis came shortly after she underwent genetic testing and learned she carried the BRCA gene mutation, which increased her chance of developing cancer, including breast and ovarian.
“It was important for me to tell my story in real time because I knew if I told my story from the beginning, people would go and get tested,” Brooks said.
Genetic testing can look for the BRCA genes BRCA1 and BRCA2. The National Cancer Institute estimates about 72% of women who inherit a BRCA1 mutation and about 69% of women who inherit a BRCA2 mutation will develop breast cancer by age 80. Roughly 44% of women who inherit a harmful BRCA1 mutation and about 17% of women who inherit a harmful BRCA2 mutation will develop ovarian cancer by age 80.
WATCH: The BRCA mutation.
Since the discovery of the BRCA mutations in the 1990s, doctors have gone on to identify many other gene mutations that put people at a higher risk of developing breast cancer.
“There’s actually eight to 10 genes that also can put someone at a higher risk for breast cancer,” Dr. Elisa Port, a surgical oncologist at Mount Sinai, tells SurvivorNet. She adds that usually, that risk isn’t as high as the BRCA mutations. These additional gene mutations include PALB2, ATM, TP53, CHEK2, PTEN, CDH1 and STK11.
After Brooks learned she carried the BRCA gene, she planned to get a preventative mastectomy to minimize her cancer risk. The procedure Brooks attempted to pursue is a prophylactic or preventive mastectomy, which removes breast tissue to prevent cancer from developing. This procedure is an option for women at higher risk, such as Brooks, who carried the BRCA gene mutation.
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“Risk-reducing mastectomies are an operation where we take women at, usually, very high-risk for getting breast cancer … for genetic mutation carriers, who are the ones at the highest risk, there’s unfortunately only one way to actually prevent breast cancer,” Dr. Port explained.
“Early detection is a goal, it’s not a guarantee. For the woman who wants to be more proactive about actually preventing breast cancer, or as we say reducing her risk, unfortunately, the only way to do that is to remove the actual tissue at risk, and that is the breast tissue,” she adds.
WATCH: Understanding a preventative mastectomy.
“I look into the mirror, and my body is not my body anymore. I just had a mastectomy like six weeks ago. I just finished physical therapy from that so I could get my range of motion back,” Brooks said.
The benefits of a prophylactic or preventative surgery are:
- Significant reduction in cancer risk (from 80-90% to 1-2%)
- Nipples can often be spared
- Women can get reconstruction at the same time
“If I had known, this could have been prevented, and so I could have taken steps. That’s one main message I want to make sure I get out,” Brooks said.
Brooks’ treatment involved a double mastectomy (removal of both breasts), and she had 17 lymph nodes removed. She said she still has more treatment ahead of her with a hysterectomy to reduce her ovarian cancer risk further.
According to the National Cancer Institute, a hysterectomy removes part or all of the uterus (or womb), often along with the cervix. Women diagnosed with uterine, ovarian, and cervical cancer may have their cancer treated with a hysterectomy.
Currently, the stage of treatment impacting the popular journalist is an aggressive form of chemotherapy often dubbed “the red devil.” She has to complete eight chemo sessions in total. “Red devil” chemo involves anthracyclines, an adjuvant chemotherapy treatment given after surgery. Research published in JACC: CardioOncology says anthracyclines offer a “10% improvement in disease-free survival and a 7% improvement in overall survival, compared with the initial standard regimen of cyclophosphamide, methotrexate, and 5-fluorouracil.”
Anthracycline and taxane (a class of chemotherapy drugs) have become a mainstay for breast cancer treatment. However, despite the effectiveness of these chemotherapy drugs, they come with intense side effects such as nausea, vomiting, and alopecia (hair loss), which helped give it its “red devil” nickname.
“Chemotherapy that we give currently is not the chemotherapy from days gone by,” says Dr. Matthew Carlson, a gynecologic oncologist at UT Southwestern Medical Center. Patients are not vomiting and stuck in bed for weeks on end or coming into the hospital.”
“I feel like a shell of myself. It’s not like the movie that you picture of throwing up in the bathroom, at least for me. I sleep all day for five days,” Brooks said of her chemo.
Your doctor can offer you some remedies to help manage the side effects.
For nausea, doctors will usually prescribe effective medications, including Zofran, to help. “We have many, many, many medications that we give before, during, and after chemotherapy that should minimize the nausea that patients experience,” Dr. Carlson says, adding that there are also quite a few medications available for constipation and diarrhea. However, doctors may recommend dietary modifications first.
Brooks has turned to using steroids to help her with nausea.
“The steroids make you elevated and crazier, as my husband would jokingly say, but there are ways…to counteract the things that you typically stereotype chemo to be,” Brooks said.
To help chemo patients manage fatigue, while there aren’t quite medications the way there are for nausea, Dr. Carlson says that some patients may find it helpful to complement their treatment with alternative medicine supplements such as American Ginseng.
“Chemo is cumulative. It gets worse every time…Every time I sleep for one extra day, the week after chemo is like, there are no plans. I’ll be in bed, and I give myself the grace of that. Then, the week after that leading up to the next treatment, you feel OK,” Brooks said of her chemo experience.
Another notable side effect of chemotherapy involves hair loss. This is often an emotional stage of anyone’s cancer journey.
“For cancer patients, losing one’s hair can be unbelievably stressful. To start with, the dread of losing one’s hair can lead to some sleepless nights and feelings of anxiety,” Dr. Samantha Boardman, a New York-based psychiatrist and author, told SurvivorNet.
Chemotherapy can cause hair loss. It usually begins about three to four weeks after starting chemotherapy and continues throughout treatment.
It happens because this treatment targets quickly dividing cells throughout the body. That includes cancer cells but also hair cells.
Radiation is another treatment that can lead to hair loss if the hair is in the path of the tumor being treated. For example, radiation for a brain tumor may cause hair loss on the head.
WATCH: Coping with hair loss.
Most patients can expect regrowth four to six weeks after treatment. However, it is possible when your hair grows back, you may notice some changes in its color and texture.
Dr. Boardman suggests connecting with others experiencing cancer treatment like yours and asking them for first-hand advice.
“Talk to people who have been through it, get their advice, voice your concerns to your caregiver, and see what they can do,” Dr. Boardman added.
If losing your hair is a concern for you before cancer treatment, know you have options like wigs, hats, wraps, and more.
“At the beginning, I (was) like, I’ll just shave my head. And for some people, that is their journey, and that’s soothing for them. I’m not a big makeup person. (My hair) has always been something that makes me feel like myself,” Brooks explained.
To help her minimize losing her hair, Brooks has used cold caps. This involves using a Food and Drug Administration (FDA) approved device placed on your head to stave off hair loss.
WATCH: Understanding Scalp-Cooling Devices.
“With the scalp cooling devices, 50% of women kept their hair after four cycles of chemo, and without the devices, 100% of patients lost their hair,” medical oncologist Dr. Julie Nangia tells SurvivorNet.
“These devices can be anywhere from 20% to 100% effective in preventing hair loss, depending on the chemotherapy type. So, I think it really has made the journey cancer patients go through a little bit easier if they’re able to use these devices and successfully retain their hair,” Dr. Nangia adds.
While Brooks remains hopeful about her breast cancer journey, she’s grateful for her family and friends who have supported her along the way. Many experts tell SurvivorNet that having a support group helps you cope with the rigors of treatment and the string of emotions it brings.
WATCH: Seeking support after a diagnosis.
“But for people who feel like they need a little bit more, it is important to reach out to a mental health professional,” she added.
One benefit of having supporters is helping alleviate stress and anxiety following your diagnosis. Supporters can also help advocate for you during treatment.
At this journey stage, Brooks has started prioritizing getting enough rest. She also hopes by sharing her breast cancer journey, more women can learn from her experiences, particularly with genetic testing, to learn about their cancer risk early.
“I will take time off, and I will rest, and I will heal, and I will work out, and I will continue physical therapy, which has been a really big part of my journey, and I will continue to advocate for women and men to not be afraid of getting (genetic testing), not being afraid of getting treatment because of what it will bring and showcasing…what it is like to live through chemotherapy,” Brooks said.
What To Ask Your Doctor
If you have been diagnosed with breast cancer, you may have questions about keeping your strength through treatment. 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?
- Are there steps I can take daily to help minimize these side effects?
- What physical activity routine do you recommend for me during treatment?
- Do you have recommendations for someone who doesn’t particularly enjoy exercise?
- Can you recommend a dietician who can help me with healthy eating tips and weight maintenance?
- I’ve been having trouble sleeping. Do you have any treatment recommendations?