Helping you manage symptoms and side effects associated with metastatic breast cancer treatment

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1 Helping you manage symptoms and side effects associated with metastatic breast cancer treatment 2015 AstraZeneca. All rights reserved Last Updated 9/15

2 with metastatic breast cancer treatment 2 Whether you ve just been diagnosed with metastatic breast cancer or have been living with the disease, knowing what to expect, and what you may be able to do to relieve your discomfort right from the start, can help you cope with the changes your body goes through. In the pages that follow, we ll discuss common side effects a woman undergoing metastatic breast cancer treatment may experience. The side effects may be a result of surgery, chemotherapy, or hormonal treatment. They may also be brought on by natural postmenopausal changes. Most women go through menopause at around 50 years of age. That s the stage in life when menstruation stops and the ovaries stop producing eggs and estrogen. It could start as early as 40 for some women or as late as the late 50s. In most cases, this is a normal, expected part of aging. But for some women who undergo certain medical treatments, the onset of menopause may be brought on early. Different women will have different symptoms of menopause. Some women have few, if any, symptoms. But for others, the symptoms can be extensive and severe. Lifestyle, diet, and activity may play a role in which symptoms a woman experiences, and the severity of these symptoms. These symptoms may last for a few months or they could continue for years. They can include hot flashes, vaginal dryness, bone density loss, depression, and more. This brochure will let you know how some of these side effects may affect your body. And we ll give you some tips on how you may be able to manage them. Keep in mind, you may experience some, none, or all of these side effects. But it s important to know as much as possible to better manage these side effects so you can stay on your breast cancer treatment as prescribed by your doctor. You should know that this list of side effects is not complete. Please talk to your doctor for more information. Hot flashes Hot flashes are one of the most common side effects of hormonal treatment. Hot flashes have a lot to do with the hormonal changes within your body. These changes can be caused by menopause and medication, and may be influenced by lifestyle. You may be able to alleviate hot flashes by avoiding certain triggers of them. Avoiding triggers If you can identify the things that trigger your hot flashes, you ve made the first step in getting the upper hand. Try to keep a record of when your hot flashes occur, what you were eating or doing, or how you were feeling at the time. Here are some hot flash triggers you should try to avoid: Alcohol Hot food Spicy food Caffeine Diet pills Hot rooms Hot tubs Saunas Hot showers Smoking Ways to cope There are certain medicines you can take to treat hot flashes that reduce hot flash triggers inside the brain. Be sure to talk to your doctor about which medical option is best for you. Reducing stress Many women find that stress tops the charts as a trigger for hot flashes. To ease stress, try the following tips: Give yourself more time to plan work, shopping, or outings If you have a busy schedule, give yourself a chance to relax and cool off Plan your schedule to avoid stressful situations when you re most likely to be in a sweat 1 For more information about dealing with hot flashes, you can visit the All About Hot Flashes page at 1

3 with metastatic breast cancer treatment 3 Joint Symptoms Some women who are on hormonal therapy may experience some form of joint and muscle pain. Pain in the joints may come from your treatment as well as from other medical conditions or medications you re taking. To help manage joint and muscle pain, talk to your doctor. There are over-the-counter medications available or prescribed by your doctor that may help manage this side effect. You may also want to consider strength-building exercises. Time can sometimes be a good healer; some joint and muscle pain may go away by itself in a few weeks or months. Joint pain may also respond to massage, heat, and swimming. Yoga also helps to strengthen and stretch your muscles, which may reduce pain in the supporting muscles and soft tissues. Talk with your doctor before starting any exercise program to find one that will work best for you. Nausea and vomiting Nausea and vomiting are sometimes experienced during the course of metastatic breast cancer treatment. Nausea and vomiting can be side effects of specific cancer treatments, such as chemotherapy They may also accompany pain medications that are sometimes used during treatment Anxiety can either cause or contribute to the experience of nausea during breast cancer treatment Should you ever experience nausea or vomiting at any time during your treatment, you should discuss this with your doctor Very mild nausea may just be a nuisance to you. But more bothersome, treatment-related nausea and vomiting can often be controlled or minimized by specific medications. Talk to your doctor to see if there are any treatment approaches that may be right for you. Bone health Factors that affect bone health Maintaining good bone health is an important long-term concern for all women especially if you have been affected by breast cancer. Osteoporosis, a weakening of the bones, is a common problem for postmenopausal women. The risk of osteoporosis may be increased by some breast cancer treatments. The impact metastatic breast cancer treatment can have on your bones depends on several factors, including: How strong your bones were before you were diagnosed with breast cancer Which type of metastatic breast cancer treatments you receive Your menopausal status Hormonal treatment and bone health Certain hormonal treatments for breast cancer can affect the health of your bones and may cause or put you at risk for bone loss. Bone mineral density (BMD) is a common measure of bone loss and refers to the amount of calcium you have in your bones. Because calcium makes your bones strong, doctors can use BMD measurement to determine how likely it will be that your bones will weaken.

4 with metastatic breast cancer treatment 4 Helping to keep your bones strong Women can lose up to 20% of their bone mass in the 5 to 7 years following menopause. Women with osteoporosis are much more likely to suffer a fracture. Regardless of age, all women can reduce their risk of osteoporosis by: Eating a balanced diet rich in calcium and vitamin D Engaging in weight-bearing exercise, such as walking Avoiding smoking and excessive alcohol consumption Having a BMD test to help your doctor determine if you are at risk for osteoporosis There is no cure for osteoporosis; however, your doctor may recommend medicines that have been successful in preventing and/or treating osteoporosis in postmenopausal women. Hair Loss You may already be concerned that your metastatic breast cancer treatment may cause you to lose your hair. Even if you and your doctor have discussed this possibility, the thought of it can still make you feel uneasy. Here are some things you can do to help prepare: Ask your doctor or nurse if your cancer therapy will make your hair fall out. If so, find out how soon it may start to fall out and how much hair loss you should expect Cut your hair short before you start treatment. Short hair is easier to style and can help you adjust to losing your hair Use mild shampoos and soft hairbrushes to protect your hair as it starts to thin If you plan to wear a wig and want it to match your natural hair color, shop for it before your hair falls out Invest in comfortable cotton or terry cloth turbans, scarves, or caps Visit for more tips on hair loss help Weight Gain or Weight Loss Sometimes, metastatic breast cancer treatment can cause weight gain or weight loss. If you experience weight gain, you may want to consider starting an exercise program. If you experience significant weight loss, you may begin to feel weak and tired. Here are some tips you might consider as you start to address weight-related concerns: To regain your energy, you may need to supplement your diet with extra protein and calories It can be helpful to monitor your weight and eating patterns in a journal so that you can discuss any concerns with your treatment team. If you are losing weight, the dietitian or nutritionist on your team can offer specific recommendations for increasing your intake of high-calorie foods and sources of protein If you are gaining weight, consult your doctor. You may be advised to lower the fat and reduce the calories in your diet Your doctor may also encourage you to start exercising. A regular program of moderate exercise, such as walking or swimming a few times a week, may be beneficial, both during and after cancer treatment Fatigue Fatigue brought on by cancer treatments can be physically, emotionally, and mentally draining. Treatment-related fatigue can have a major impact on many areas of your life. It can affect your daily routine, your relationships, and your general sense of well-being You may experience fatigue in the following ways: Unlike normal tiredness relieved by rest, exercise, or a good night s sleep, treatment-related fatigue can leave you feeling wiped out, even after getting plenty of rest Treatment-related fatigue may make it hard to concentrate or think clearly. As a result, it can dampen your interest in activities that might usually give you pleasure

5 with metastatic breast cancer treatment 5 Treatment-related fatigue may not be relieved by rest or moderate activity. If you experience this, ask your treatment team to evaluate your condition Treatment-related fatigue may be related to anemia, a manageable condition that occurs when your red blood cell count is low The key to managing fatigue is to be aware of your energy levels and to pace yourself accordingly. By listening to your body, you may be able to carve out windows of opportunity for activities that are important to you. Vaginal Dryness Vaginal dryness caused by cancer therapy can be uncomfortable. If you are sexually active, this condition may make it more difficult to relax, and as a result, intercourse may not be as enjoyable. You may find the following tips to be helpful: Use a water-based vaginal lubricant or moisturizer. These products are available without a prescription in many drugstores. Avoid using petroleum jelly, which may increase the risk of vaginal yeast infections Ask your oncology nurse if there are samples for you to try Lymphedema Lymphedema is a complication that may develop following mastectomy, surgery to remove lymph nodes from the armpit, or radiation therapy to the underarm area. Because lymphedema can develop immediately after metastatic breast cancer treatments or many years later, you are always at risk. If fluid from the lymph nodes under your arm does not drain properly: It can cause swelling in your arm and hand Your arm may feel heavy or tight It can be difficult to perform everyday tasks if the swelling is severe The affected arm has a higher risk of infection Managing lymphedema Lymphedema can be managed in the following ways: Elevating the affected arm Giving massage therapy to the affected arm Receiving physical therapy on the affected arm Performing mild exercises to maintain flexibility and range of motion Wearing a compression sleeve. A compression sleeve is an elastic bandage that helps the fluid drain from the affected arm Precautionary steps Researchers are looking at ways to prevent and treat lymphedema. Until more is known about this disorder, it may be wise to take these precautions: Avoid using your affected arm to lift or carry grocery bags, large purses, or other heavy objects Wear gloves when gardening or washing dishes to guard against developing an infection in the affected arm Apply moisturizing cream daily to the affected arm, especially after bathing Avoid wearing tight clothing, watchbands, or bracelets on the affected arm Use your unaffected arm for blood tests, injections, vaccinations, or blood pressure checks whenever possible Try keeping your affected arm elevated when resting Call your doctor if your arm or hand becomes red, warm, or swollen. You may have an infection that requires immediate treatment

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