Living with Breast Cancer
Smoking. If you smoke, it is very important that you quit as it aggravates the side effects associated with the treatments, such as loss of appetite and decreased lung capacity.
Alcohol. As with smoking, you should not consume large amounts of alcohol, although drinking is not prohibited.
Diet. There is no scientific evidence to suggest you should avoid eating proteins or sugars if you have cancer. No particular food is contraindicated, except on rare occasions due to interactions with certain drugs. Eat whatever you want but in small amounts and several times a day. It is important to maintain your muscular body mass and avoid losing too much weight.
Complementary therapies. They are not contraindicated. However, you should always discuss them with your doctor beforehand.
Physical activity. Unless your doctor tells you otherwise, you should try to follow your normal routine and practice physical exercise if possible. It will help minimise treatment-related side effects and accelerate recovery. Practising physical activities tends to produce a greater feeling of well-being. Ask your doctor about the most appropriate level of activity for you. Similarly, physiotherapy is very important after surgery and whenever patients suffer a loss of muscular mass in their legs.
Sexual intercourse. As long as you generally feel well enough, then you can still practice sex. It is important for women of childbearing age to take contraceptive measures, as you should not get pregnant during treatment.
Pregnancy. It is not a rare situation and nowadays pregnant women can still receive breast cancer treatment. Surgery is one of the main treatments and anaesthesia does not imply any risk for the foetus. The most used procedure is a radical mastectomy because conservative surgery would require a course of radiotherapy which could affect the foetus. If conservative surgery is selected, then the treatment must be postponed until after delivery. In cases where the patient must receive chemotherapy, it can be administered during the second and third trimesters without increasing the risk of foetal malformations. Whenever post-surgery chemotherapy is necessary it must always be delayed until the second trimester. If the patient is already in the third trimester, then labour is induced a few weeks before the due date to avoid delaying the start of chemotherapy.
Emotional support. There are different patient and family support groups that provide advice and support from people who have endured a similar situation. Ask staff at your health centre about this type of organisation.
It is important to know that breast cancer is not contagious and its treatments do not pose any danger.
What to do if symptoms appear
The following symptoms could appear throughout treatment with chemotherapy:
Nausea and vomiting. Nausea and vomiting are the most common side effects and can appear despite taking drugs to prevent it. It should be taken into account that each chemotherapy is specific for each patient. In this respect, before you start it, the oncologist will inform you on the possibility of the appearance of these side effects, and the most suitable drugs to prevent them. Besides drugs that prevent vomiting and nausea (antiemetics), it might be worthwhile to use anxiolytics and relaxation techniques that may help reduce the general level of anxiety.
Mucositis. Mucositis consists of an inflammation of the mucosa that may cause sores or painful ulcers. The common location is in the mouth mucosa, particularly on the lips, tongue, palate, and throat. Although it can also affect other mucosa, such as anal, vulvar, or vaginal. If there is pain, or changes are observed in the mouth during cancer treatment, it is important to mention it to your doctor. The alleviation of the side effects is an important aspect in the care and treatment of cancer.
Constipation. Constipation is defined as less than two bowel movements in a week, with changes in the consistency. They are hard and may cause pain on expulsing them. It is the most common intestinal problem in patients with cancer, and affects up to 40% when the disease is advanced, and up to 90% when morphine, codeine and thebaine (opiates) are taken to calm pain or cough. It is recommended to increase the intake of fibre and to reduce the consumption of astringents, such as rice, as well as to drink fluids, to perform exercise and take laxatives. Occasionally, the constipation may indicate a more serious problem that may require more tests; therefore it is advised to mention any constipation symptom or changes you might experience to the medical care team.
Diarrhoea. When the chemotherapy affects the cells that cover the bowel, its functioning may be altered. As a result, the bowel loses the capacity to absorb water and certain nutrients, leading to diarrhoea. The healthcare team prescribes drugs that prevent the diarrhoea occurring or that stop it as soon as possible. Following an astringent diet based on foods low in fibre, like rice or boiled fish, baked apple, etc.), drinking fluids slower, avoiding dairy products and derivatives, eliminating irritant drinks such as coffee or alcohol, can help to control this symptom. Occasionally, the diarrhoea may be significant, both in its duration and in the number of bowel movements per day. In these cases, in order to prevent dehydration, it is essential to contact the healthcare team so that the most suitable treatment is prescribed.
Fever. Fever can appear as a side effect to the drugs administered. It generally appears in the first hours after their administration and disappears rapidly. It can also be associated to an infection caught due to the lowering of defences (immunosuppression) that is caused by the treatment itself and requires an antibiotic treatment. If a temperature of above 38 °C appears during treatment, particularly if it is accompanied by purulent sputum, fatigue, pain, or bleeding on passing urine, reddening around the catheter area, or any other associated symptom, the healthcare team should be contacted urgently.
Skin, nails, and hair follicles. The chemotherapy may affect the skin, nails, and hair follicles. Although this toxicity does not normally imply severity and is reversible, its management is very important since it may affect the quality of life of patients due to its influence on their body image.
- Hair loss (alopecia). It is produced by the action of different drugs on the hair follicle that triggers its destruction and, thus, the loss of hair. It is a side effect that does not always appear, since it depends on the type of drug employed. Furthermore, the hair loss may be generalised, that is to say, besides affecting the scalp, it may affect other parts of the body, axillae, arms, legs, eyebrows, eyelashes, etc. It is a reversible effect, although sometimes the hair may grow with characteristics different to the original (colour, texture, etc.).
- Itching (pruritus), reddening (erythema), dryness and flaky skin. They are generally symptoms of little importance, but they must be monitored. If there is sudden or intense itching on the skin, bumps, or shortness of breath, it could mean an allergic reaction that requires immediate attention.
- The nails may turn a darker colour, be more fragile and break easily, and vertical stripes may appear on them.
Incompatibility with drugs. Chemotherapy can interact with other treatments; therefore the health team must be informed. Special attention must be taken in those patients that take digoxin (a drug for the treatment of heart diseases), since it can interfere with the absorption of other drugs. Oral anticoagulants (drugs for the treatment of heart diseases) can increase the toxicity or decrease the effectiveness of the drugs that are eliminated. The antivirals (drugs for the treatment of HIV infection) can interact with some of the chemotherapy drugs. Interactions have also been observed with anti-epileptic drugs.
Peripherally inserted central catheters (PICC line) and Port-a-Cath®. Chemotherapy is usually administered intravenously. Different devices are available for patients whose veins are difficult to access so that the nursing team can avoid repeatedly puncturing and damaging peripheral veins. A Port-a-Cath® and a peripherally inserted central catheter (PICC line) are the most used devices in cases of lung cancer.
A PICC line is a catheter introduced through a vein in the upper arm. The end of the catheter finishes in a large vein close to the heart. It is inserted by making a small incision in the skin under the effect of a local anaesthetic. Once in place, the catheter is fixed to the arm to keep it in place. The healthcare team will then take an X-ray to ensure it is in the correct position. Once the PICC has been placed, the patient can go home without any complications. The catheter is protected with a waterproof dressing but it is still a good idea to avoid wetting it directly as it could become detached. Your healthcare centre will replace the dressing once a week.
- The Port-a-Cath® is in the shape of a plastic disc and is inserted beneath the skin on the chest or on the arm, and connects with the blood stream via a catheter. The insertion of a Port-a-Cath® involves a short surgical procedure with local anaesthesia. Once the Port-a-Cath® and the catheter are inserted correctly and the incision has healed, only a small bump beneath the skin is noticed. It should not cause any discomfort, but is recommended to consult the health team before carrying out any activity that may involve excessive or repetitive physical movement. When no treatment is received, on not having a needle inserted, it does not require any special maintenance and the patient may wash and bathe normally. When treatment is received, the needle is covered with a dressing to fix it and keep the puncture area clean. The dressing must be kept clean and dry. The injection area must be examined regularly. If it moves, swells or reddening or a haematoma appears, it must be mentioned to the health team.
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