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Managing symptoms and side effects

 

Managing the symptoms and side effects of secondary breast cancer can be a struggle. If you’re worried about how the physical and emotional side effects of secondary breast cancer will affect your quality of life, this information may be of some assistance.

Pain

Many women believe that pain is inevitable as secondary breast cancer progresses. However, some women experience no pain at all and others very little. Those who do experience pain usually find that their pain can be very well controlled.

Different types of pain need to be treated in different ways. Some of the treatments you may be offered are as follows:

Analgesics

Analgesics (pain killers) are best given before the pain starts. They can be taken as tablets, liquids, suppositories, skin patches, injections or even a ‘lollypop’ that can be sucked. Sometimes low-strength drugs are given with stronger drugs as they complement each other, working in different ways.

Morphine is given at any stage when mild pain killers are not working. It doesn’t necessarily mean that your cancer is getting worse. Some people resist taking morphine because they fear they will become addicted. There is no risk of addiction if morphine is used to control pain.

Other medications

  • Anti-inflammatories can be very effective in controlling bone pain.  
  • Bisphosphonates and Xgeva can also treat bone pain and strengthen bones. 
  • Steroids can help reduce pain related to nerve compression, and bone, brain and liver secondaries.
  • Muscle relaxants relieve muscle spasm and pain. They can also reduce anxiety and sleeplessness which often increase pain.

Non-medical pain relief

Some women find acupuncture, relaxation techniques and yoga reduce their pain. The article on complementary therapies in Issue 17 of The Inside Story provides more information on this topic.

  • Massage can reduce pain and provide comfort, but avoid inflamed or swollen areas. You may want to seek out a massage therapist who is trained in oncology massage. You can call the Cancer Council Information and Support Service on 13 11 20 to find about an oncology massage therapist in your local area.
  • Cold packs can reduce inflammation, muscle aches and spasms or joint pain, but should be avoided if circulation is poor. Warm packs help pain caused by stiffness or muscle tightness. Avoid using packs on areas that are being treated with radiotherapy.

If your pain is not well controlled, you can ask your doctor to refer you to a palliative care physician or a pain clinic as they specialise in pain management. Physiotherapists and occupational therapists can also assist with exercises and aids that help reduce pain. BCNA's your treatment and care page has more information.

The Australian Pain Management Association website has useful information on pain management options, including how to seek help for persistent (chronic) pain and how to choose a pain management team. There is also advice on things you can try yourself to help manage your pain.

Pain issues from a woman’s perspective

In her speech to the National Pain Summit in Canberra in March 2010, BCNA member Helen Owens told the story of her personal experience of managing pain associated with secondary breast cancer. Her speech included recommendations for improvements to the Australian health system for better access to adequate pain management.

Hair loss

Because it’s visible to others, hair loss can be one of the more distressing side effects of chemotherapy. BCNA's hair loss page contains information and tips for dealing with hair loss.

Nausea and vomiting

Nausea is sometimes caused by the secondary breast cancer itself, especially if it is in the liver or brain, or if bone cancer is causing high levels of calcium in the blood. It could also be a symptom of constipation, a side effect of radiotherapy, chemotherapy or strong pain killers.

  • Anti-nausea drugs work in different ways and can be taken as tablets, suppositories or injections.
  • Some women find that complementary therapies such as relaxation therapy, hypnosis and acupuncture helps their nausea. 
  • Eating small, frequent meals, resting before and after eating, and drinking plenty of fluids can help prevent nausea.

Constipation

This very common symptom of secondary breast cancer can make you feel miserable. It may be due to the cancer, or a side effect of pain killers, reduced mobility and changes in eating and drinking habits. It can also get worse and you stop exercising during treatment.

  • Maintaining a healthy fluid intake is important – you may find it easier if you take frequent sips throughout the day.
  • Small regular meals are more easily tolerated than three large meals. Try to eat plenty of fresh fruit, vegetables and high-fibre cereals and breads.
  • Regular exercise such as a daily walk can help.
  • If these strategies don’t work, your doctor may recommend a laxative. Fibre supplements are recommended for constipation related to medicines or cancer as they often make it worse.

Diarrhoea

Chemotherapy can cause diarrhoea. It can also be caused by an infection or drugs used to treat constipation. Things you can do to help manage diarrhoea include:

  • eating five to six small meals per day instead of three large ones
  • eating low fibre foods
  • drinking eight to 12 cups of clear liquid per day.

Sore mouth

A sore mouth and ulcers can occur with chemotherapy, and can be helped by:

  • mild pain killers
  • local anaesthetic gel 
  • rinsing with bicarbonate of soda in water 
  • cleaning teeth with a soft toothbrush improves oral hygiene and can reduce the risk of getting ulcers.

Poor appetite

Poor appetite can result from secondary breast cancer, its treatment or a side effect such as a sore mouth, constipation, diarrhoea or feeling sad, anxious or frustrated. Talk to your doctor if you’re struggling to eat well as many of these causes can be treated. You may also consider:

  • Seeing a dietitian
  • Choosing foods you enjoy or eat soft foods if your mouth is sore
  • Eating small meals frequently, rather than three large meals per day
  • If you are losing weight, your doctor may prescribe medication to stimulate your appetite.

Early menopause

Chemotherapy and ovarian suppression can cause early menopause, when periods stop. This can cause hot flushes, dry vagina and night sweats. Your doctor will be able to help you manage these symptoms. BCNA's chemotherapy page provides more information.

Fatigue and tiredness

Fatigue is a common symptom of secondary breast cancer and can also be a side effect of chemotherapy and radiotherapy. It is often described as relentless tiredness, with a feeling that everything seems much more of an effort. Activities such as yoga or swimming can revitalise your mind and spirit and help reduce fatigue.

BCNA's fatigue page and the section on physical wellbeing contain more information, in particular about how exercise can boost your energy levels.

Issue 17 of The Inside Story includes an article on managing sleep and fatigue.

Difficulty sleeping

You may feel exhausted, yet still have trouble sleeping. Try warm baths, massages, warm drinks (malted milk, milk with honey, chamomile tea) and if nothing is working, you may want to consider sleeping tablets.

Breathing problems

Shortness of breath can be both frustrating and frightening. It doesn’t mean the cancer is getting worse, it may simply be a build up of fluid on the lungs or an infection, both of which are easily treated. Ask your doctor whether a physiotherapist could help if the feeling persists.

‘Chemo brain’

A less common side effect of chemotherapy is a condition known as ‘chemo brain’ or ‘chemo fog’. It is described as feeling vague. Some women say they have trouble remembering things and find they aren’t as organised as they used to be. BCNA's Chemo brain page has some suggestions on how to manage the effects.

I really began to worry when I noticed I was forgetting things. I started doing crosswords, which helped me to focus and reassured me that I was okay. I also found that my diary became my best friend. – Anna

Depression

Depression is common for women with secondary breast cancer, and can be related to pain, medications, lack of support or a history of the illness. There are many effective treatments available. The BCNA Anxiety, depression and breast cancer fact sheet offers more information.

More information

For more information on managing the symptoms and side effects of secondary breast cancer, please consider the following resources: