Breast cancer and its treatment can cause a number of symptoms and side effects. The greatest influence on the type of symptoms and side effects that you experience will be the sites your cancer has spread to and the type of treatment you are having. Other factors, such as your general health and wellbeing, will also play a part in how your symptoms may affect you.
The following section also provides information on managing a wide range of symptoms and side effects. Remember that everyone is different, and you are unlikely to experience all of these symptoms or side effects. Some people experience very few or have only mild side effects or symptoms.
I take my regular pain meds so that I can rest and sleep as much as I can. This means that I can do the things I want to do or need to do more often than not, which helps contribute to my wellbeing most of the time.
Many people believe that pain associated with metastatic breast cancer is inevitable. This is often one of people’s greatest fears. However, some people experience no pain at all and others very little.
It is important to know that pain can almost always be controlled. There are a number of treatments aimed at reducing or eliminating pain caused by metastases. There are also many different pain-relieving medications (analgesics) that can be used on their own or in combination to help people affected by metastatic breast cancer.
Over-the-counter medications and prescription drugs can be helpful to reduce or eliminate pain associated with metastatic breast cancer. Over-the-counter medications, including paracetamol (Panadol), can be effective in relieving mild pain and are most effective if taken regularly rather than waiting until the pain returns or worsens. Anti-inflammatory medications, such as aspirin and ibuprofen (Nurofen), can also be effective in relieving mild pain.
Codeine-containing medications, such as Panadeine and Panadeine Forte, can be effective in relieving moderate to strong pain associated with metastatic breast cancer, but you will need a prescription from your oncologist or GP to purchase them.
Opiate painkillers are prescription medications provide clinicians with options for helping manage moderate or more severe pain. There are many different versions of opiate painkillers, and new ones are introduced from time to time. The usual approach is the use of a slow-release form – these are either oral medications or patches that are placed on the skin and renewed every few days.
Examples of opiate painkillers are:
You may also be able to use fast-acting (as opposed to slow-release) pain medication for what is called “breakthrough pain”, which is pain that occurs despite the slow-release pain medication.
Examples of these fast-acting medications are:
The steroid medication dexamethasone can sometimes be very helpful for pain associated with metastases, such as bone or liver metastases.
Radiotherapy can be a very effective way of reducing bone pain in people who have bone metastases. Treatment may be given as a single dose or over several days. It can also help with bone healing. Treatment is generally well tolerated and has few side effects.
It should be possible to achieve good control of your pain. It is important for you to let your team know if you are having a lot of pain, as a change in dose or use of different drugs may be helpful.
Sometimes, your oncologist may suggest you see someone who specialises in cancer pain management, perhaps at a pain clinic or through a palliative care service. Palliative care physicians usually provide this advice in a cancer treatment team.
It is important to talk with your treating team about any pain you may be experiencing. The more accurately you can describe the pain, the easier it will be for your doctor to prescribe the most effective treatment.
Some people worry that if they take too much pain medication, they may become dependent on it. You may also find yourself worrying that increasing the amount of pain medication you are using means that your cancer is getting worse. There are many myths about pain-relieving agents and cancer, particularly morphine, which is why it is important to speak with your doctor about your pain and talk about what pain relief options may work best for you.
Complementary therapies may be helpful to reduce or control pain.
Peripheral neuropathy is the general term for pain or discomfort caused by damage to the nerves of the peripheral nervous system. Your peripheral nervous system is made up of the many nerves that bring signals from the brain and spinal cord to other (or peripheral) parts of the body, such as the hands and feet. Damage to those nerves can affect the way the body sends signals to muscles, joints, skin and internal organs. This can cause pain, numbness, loss of sensation and other symptoms.
Some of the intravenous chemotherapy drugs, including the family of drugs called taxanes and eribulin, can cause neuropathy that for some people can be significant. Some oral forms of chemotherapy, such as Xeloda (capecitabine) and Navelbine (vinorelbine), and some of the targeted therapies, including HER2 therapies, can also cause neuropathy.
Chemotherapy-associated neuropathy can start any time after treatment begins, and it may worsen as treatment continues. Usually it begins in the toes, but it can expand to include the legs, arms, hands and fingers.
The most common symptoms include:
Neuropathic pain can also occur from cancer causing damage to nerves.
It is important to tell your medical oncologist or nurse straight away if you experience symptoms of peripheral neuropathy so they can be managed before they get any worse. Your doctor may discuss changing your treatment plan to prevent any more nerve damage. These changes might include, for example, reducing the dose of chemotherapy or switching to another chemotherapy drug.
Medications that can help reduce the pain and discomfort associated with neuropathy include:
Talk to your treating team about strategies to help you effectively manage peripheral neuropathy.
Some hormone-blocking therapies may cause joint pain as a side effect. In particular, if you are taking an aromatase inhibitor (anastrazole, letrozole or exemestane) you may experience some joint stiffness or pain.
Joint stiffness most commonly occurs in the morning, and it tends to improve as you move around more. Some people find that gentle exercise and stretching helps, such as hydrotherapy (exercise in water), swimming, tai chi and yoga. If you want to try exercise, or if exercise is new to you, see Exercise and staying fit for suggestions on how to get started.
Acupuncture has also been shown to help joint pain for some people, and research trials are continuing in this area.
Over-the-counter drugs such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) such as Nurofen (ibuprofen) or Voltaren (diclofenac) may help relieve joint pain. Your doctor or pharmacist can give advice about what option may be best for you.
Treatment such as chemotherapy, particularly the anthracycline and taxane groups of drugs, can reduce the number of white blood cells your body produces and so increase your risk of infection. While you’re being treated, you’re likely to have regular blood tests to monitor your blood count. Your doctor may also order an injection of a growth factor (G-CSF) such as filgrastim to help the body produce more white blood cells and reduce the risk of infection.
If you have a fever of 38ºC or more you must immediately contact a member of your treatment team or attend a hospital emergency department, as this may be a sign of infection.
Fatigue is a common symptom of metastatic breast cancer, and it can also be a side effect of treatments, including chemotherapy and radiotherapy.
Poor nutrition, lack of sleep, pain and psychological issues such as stress, anxiety and depression can also contribute to fatigue, leaving you feeling exhausted and lacking in energy. This can then have a negative impact on your ability to cope, your quality of life and your independence.
Sometimes chemotherapy or the cancer itself causes anaemia, which can worsen fatigue. Regular blood tests will check your blood cell count while you are being treated.
Many of these factors relating to fatigue are treatable, so be sure to raise any issues with your doctor.
Nausea is occasionally caused by the cancer itself, especially if the liver or brain is affected or metastases in the bone are causing hypercalcaemia (high levels of calcium in the blood). Nausea may also be a side effect of chemotherapy, radiotherapy to the abdomen or brain, or strong pain killers. It can also be a symptom of constipation. Anxiety can worsen the feeling of nausea.
Medications used to control nausea are known as antiemetics. They work in different ways; if one isn’t effective, another one may be, so be sure to let your doctor know. If you feel too sick to swallow a tablet, many antiemetics are available as suppositories, injections, or under-the-tongue lozenges or wafers. Steroids can also help control nausea caused by chemotherapy and liver and brain metastases.
Modern anti-nausea drugs make it less likely that a person will experience excessive vomiting. However, talk to your doctor if you are experiencing vomiting. Complementary therapies such as relaxation therapy, hypnosis and acupuncture can help to manage nausea and vomiting.
Practical suggestions to help manage nausea and vomiting:
Constipation occurs when your bowel movements are infrequent (generally defined as less than three per week) and/or difficult to pass, and it can make you feel very uncomfortable and unwell. Unfortunately, constipation is very common in people with metastatic breast cancer because it can be caused by both the cancer and its treatment, especially chemotherapy and antiemetic and analgesic medications. Constipation may worsen if you stop exercising during treatment or change your eating and drinking habits, so it is best to work with your treating team to find the approaches that can help relieve your constipation.
Maintaining a healthy fluid intake is very important. You may find it easier if you take frequent sips throughout the day. Small, regular amounts of fluid and food are often more easily tolerated. Try to eat plenty of fresh fruit and vegetables and choose high-fibre foods such as wholemeal breads and cereals. Regular exercise such as a daily walk can also make a difference.
If these strategies don’t help, your doctor may recommend a laxative such as coloxyl or senna. Fibre supplements such as Fybogel or Metamucil are generally not recommended for constipation related to cancer or cancer treatments, as they may make your constipation worse.
Some chemotherapy and targeted drugs can damage the healthy cells that line the small and large bowel, causing diarrhoea, which is generally defined by having three or more loose, liquid bowel movements in a day. Diarrhoea can also be caused by an infection or drugs used to treat constipation.
Diarrhoea can be an unwanted minor side effect of treatment but can also sometimes be more serious. Uncontrolled diarrhoea may lead to dehydration, electrolyte imbalance and kidney problems, so if you are having frequent diarrhoea episodes, or if diarrhoea continues for more than 24 hours, it is important to let your oncologist, nurse or GP know immediately.
You should also seek medical advice if you have diarrhoea and experience any of the following symptoms:
As well as causing you to lose fluid from your bowel, diarrhoea can also cause you to lose salts such as sodium and potassium.
Rehydration fluids such as Gastrolyte can replace both the water and salts. You can purchase this over the counter at your pharmacy and some supermarkets. Your doctor may also recommend other medications such as Imodium or Gastro-Stop (loperamide) that can help you manage your symptoms and may be purchased over the counter.
Many aspects of cancer can cause you to lose your appetite, including your illness, treatment side effects such as a sore mouth or altered taste; fatigue; constipation; diarrhoea; and feeling anxious, sad or frustrated.
Many causes of a reduced appetite can be treated, so let your doctor know if you are struggling to eat well. You may wish to seek advice from a dietitian. The more you can let your treating team know about the changes in your appetite, the better your chances of them being able to help you manage the problem. You might like to keep a note of any weight you have lost or gained, when your appetite is better or worse, and whether it is associated with other symptoms such as nausea, constipation or stomach pain.
People who eat a quality, balanced diet don’t generally need supplements. However, when you have cancer, problems with appetite may mean your diet isn’t as balanced as it could be. Daily multivitamin and mineral supplements might help improve your appetite. Your doctor, pharmacist or dietitian will be able to help you find the most appropriate supplements for you.
Maintaining your normal weight can be challenging when you have metastatic breast cancer. Unintentional weight loss or weight gain are common impacts of metastatic breast cancer and its treatment. Gaining or losing weight can affect you physically and emotionally, so it’s important to discuss with a member of your treating team any concerns you have about your weight.
Metastatic breast cancer and common treatments can cause physical and emotional changes that interfere with your ability to maintain your normal weight. Some treatments may cause nausea, changes in the way food tastes or smells, or mouth tenderness that can make you feel like not eating. If you have metastases, especially in the abdominal area, you may have pain, discomfort or nausea that can affect your appetite. The medications you might be prescribed to help manage the side effects of treatment can also impact your appetite. If you are feeling anxious or stressed, you may lose interest in food. Many factors that can affect how much you feel like eating. Any reduction in appetite that extends longer than a few days may result in weight loss.
If you feel you are not able to eat enough to maintain your weight, your doctor may prescribe medication, such as steroids, to stimulate your appetite. Your doctor could also refer you to a dietitian who can discuss with you a meal plan and suggest supplements such as Sustagen.
Not all people with metastatic breast cancer lose weight. Some people gain weight, particularly during chemotherapy treatment.
Many chemotherapy regimens include a steroid (e.g.dexamethasone) that reduces nausea but can increase appetite and lead to weight gain. People who are taking a steroid also often notice that their face looks more rounded, or 'moon-faced'. This will subside when you no longer need to take the steroids for the chemotherapy treatment.
Some medications used to manage the side effects of chemotherapy can add to weight gain, and some people gain weight because of changes in their metabolism, sometimes due to menopause brought on by treatment. Others respond to anxiety by eating more. Sometimes, indulging in foods that satisfy a craving or offer a great source of pleasure can provide a psychological lift. Doing less exercise can also be a factor in weight gain.
Gaining weight can affect you both physically and emotionally. Discuss with your doctor any concerns that you have about your weight. It might be suggested that you see an exercise physiologist, who can design an exercise program that would help increase your metabolism. A referral to a dietitian may also be helpful if you are unsure how and what to eat to maintain a healthy diet.
Depression is more than just a low mood; it’s a serious condition that impacts both your physical and emotional wellbeing. Depression affects how you feel about yourself. You may lose interest in work, hobbies and doing things you normally enjoy. You may lack energy; have trouble sleeping or sleep more than usual; you might feel anxious or irritable or find it hard to concentrate.
Most people with metastatic breast cancer find that their mood can be affected by everything from symptoms and side effects of treatment to anxiety about what the future may hold to issues at home and with relationships. It is quite normal to feel great one day and ordinary the next. But if you find that you’re feeling low for more than a couple of weeks at a time, that you can’t enjoy the things you normally would, or you feel overwhelmed and unable to move forward, you may be depressed.
Depression is common in people with metastatic breast cancer. Many effective treatments for depression, including non-pharmaceutical strategies, are available, so talk to your medical oncologist or GP about what may help you.
Read about Depression and breast cancer.
One of the ironies of metastatic breast cancer is that you might feel exhausted through the day yet find it difficult to sleep at night. Many physical and psychological changes can cause difficulty sleeping when you have metastatic breast cancer. Physical symptoms like pain or nausea can interfere with sleep, and having a lot on your mind can also keep you awake.
Do what you can to sleep well. Strategies you can try for better sleep include:
Take a warm bath before bedtime.
Have a relaxing massage.
Drink warm drinks that you enjoy such as malted milk, milk with honey or chamomile tea.
Reduce caffeine intake during the day, and watch the timing of your caffeine intake (e.g. reduce the amount after lunch). Try to avoid ‘energy’ drinks.
Have a routine – aim to go to bed at the same time every night and get up at the same time every day.
Make your bedroom comfortable – ensure that your mattress and pillows support your neck and spine and your room is quiet and dark.
Avoid using technology (such as laptops or phones that emit blue light) immediately prior to sleep.
Deal with barriers to sleep – if you have pain, don’t try to be brave; time your recommended pain relief (e.g. before bedtime) so that pain doesn’t wake you.
Practise relaxation techniques – relaxation exercises such as yoga, mindfulness, meditation and tai chi may lessen worry and stress. Slow, deep breathing can help with relaxation.
Talk to your doctor about strategies and/or medications that may help you sleep better.
Hair is part of who you are, and losing your hair can make you feel like you’ve lost your sense of identity. It can also mean that you have less privacy around your diagnosis. It is perfectly normal to feel distressed at the thought that your hair might thin or fall out completely.
If avoiding hair loss is important to you, or you have a special event coming up, talk to your medical oncologist about treatment options that may result in less significant hair loss.
Several treatments for breast cancer including chemotherapy, hormone-blocking therapies and some targeted therapies can cause varying degrees of hair loss or thinning of hair. Some chemotherapy drugs are more likely to cause hair loss than others, particularly the anthracyclines and the taxanes, so it may be possible to have a chemotherapy that is less likely to make you lose your hair if that is important to you.
Radiotherapy to the brain can also cause hair loss. Usually, hair will grow back several months after completing radiotherapy. It may be thinner and have a different texture.
To help prevent or reduce hair loss from chemotherapy, some oncology day centres offer cold caps (scalp cooling) to people receiving certain types of chemotherapy. A cold cap is usually a strap-on cap through which cold liquid circulates while you are having chemotherapy.
The cooling effect of the cap is thought to prevent or reduce hair loss by putting the hair follicles into hibernation. If you would like to learn more about cold caps and whether they would be suitable for your situation, talk to your medical oncologist or oncology nurse.
Read more about Hair loss.
Over the last 17 years I have lost my hair three times. During the winter months I wore beanies around the house and to bed to keep warm. When I wanted to be ‘out there’, I would wear my football beanie. I found bandanas very comfortable and light, and they come in a great range of colours. I had a wig but found the bandanas and beanies a lot more comfortable.
Mouth ulcers can occur with chemotherapy and some targeted therapies, usually appearing five to 10 days after the start of each treatment cycle and clearing up within one to two weeks. Good oral hygiene helps prevent mouth ulcers, but if they occur they can be treated with analgesics such as paracetamol, by applying a local anaesthetic gel or by using sodium bicarbonate (baking soda) as a mouthwash.
There are mouth care products that are helpful for chemotherapy patients. Talk to your pharmacist for advice. Using a soft toothbrush and maintaining good dental hygiene, including regular appointments with your dentist, can help avoid complications from mouth ulcers associated with chemotherapy. It may be helpful to suck ice chips or an icy pole during your chemotherapy infusion and for a time afterwards.
Talk to your doctor or nurse about an effective mouthwash for your situation.
Fingernails and toenails may be affected by chemotherapy, becoming cracked and discoloured. Sometimes they also become tender.
You can help to prevent or manage nail changes by:
If these tips don’t help and you’re feeling distressed by these side effects, talk to your oncology nurse. It may be worth considering cooling gloves or socks (e.g. ice gloves and socks). Otherwise, skin and nail changes generally resolve themselves once you have finished treatment.
Many people report mental fogginess (i.e. “brain fog”), memory loss or feeling vague while being treated with chemotherapy and/or hormone-blocking therapy. It is important to tell your doctors if you are experiencing cognitive changes so they can identify potential causes and help you manage them.
Ongoing research is being conducted to better understand how best to manage the symptoms of cognitive impairment related to chemotherapy and/or hormone-blocking therapy.
Strategies that you may find helpful to manage cognitive impairment include:
The anthracycline group of drugs can affect your heart muscle, though this is a rare side effect of chemotherapy. The HER2 therapies can also affect your heart function. Your heart may be tested before and during treatment with these drugs. Your oncologist should talk to you more about this.
Some chemotherapy drugs, particularly docetaxel (Taxotere), can cause fluid retention. Swelling in the feet and ankles is more common than elsewhere in the body because of gravity. The steroid premedication taken with docetaxel helps to minimise fluid retention, so it’s important to take it as prescribed by your medical oncologist.
Some types of chemotherapy can cause dryness, itching, redness or peeling of the skin. Some drugs make your skin more sensitive to the sun, so it is important to cover up outdoors and use sunscreen. Non-perfumed moisturisers may help.
When you are having radiotherapy treatment the skin may become reddened, dry and itchy. Radiotherapy staff can recommend ways to help you manage this. The following suggestions may also help you:
If you have a sudden episode of unresolved breathlessness that you cannot explain, seek medical help immediately.
Headaches may be mild or severe, occasional or more frequent, and due to several causes such as muscular tension, exhaustion, dehydration, hypercalcaemia (high calcium), migraines or medication side effects. More rarely, headaches that continue and do not respond to medication may be a symptom of metastases in the brain, so seek medical advice if you are concerned.
Discuss your headache with your doctor so that they can investigate the cause and suggest treatment options. You might also consider increasing your water intake and using heat packs on your neck to relieve tension. A physiotherapist may be able to suggest exercises or strategies to help relieve your headache.
Menopause is the change that occurs in your body when your ovaries stop producing the hormone oestrogen. Treatments for metastatic breast cancer can trigger menopause, either temporarily (e.g. chemotherapy or hormone-blocking therapies) or permanently (e.g. surgery).
You may experience one or more side effects of menopause, such as hot flushes and sweats, tiredness, insomnia, vaginal dryness, decreased libido, aches and pains, and mood swings. Each person will experience the effects of menopause in different ways. If you are already going through menopause at the time of your diagnosis, your treatment may intensify the symptoms.
Your doctor can advise you about creams and treatments for vaginal dryness and medication for hot flushes. Regulating your body temperature by having tepid baths, wearing layered cotton clothes and limiting hot drinks and alcohol will also help. Many people find exercise, meditation and relaxation exercises helpful.
If you are experiencing severe menopausal side effects that are impacting your quality of life, talk with your oncologist about medications available to assist you.
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Contact BCNA’s Helpline on 1800 500 258 between 9.00 am and 5.00 pm AEST Monday to Friday, for information about the services and support that may be available for you and your family.
Let’s be Upfront about navigating a breast cancer diagnosis as an Aboriginal or Torres Strait Islander.
Let’s be upfront about pain, side effects and palliative care.
Let’s be Upfront about navigating relationships with your medical team.
Let’s be Upfront about living in a rural area following a breast cancer diagnosis.
Let’s be Upfront about living with metastatic breast cancer.
*This article does not provide medical advice and is intended for informational purposes only.
Please consult a medical professional or healthcare provider if you're seeking medical advice, diagnoses, or treatment.