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Breast Cancer Survivors: Managing Treatment Side Effects

Sometimes the cure feels worse than the disease. But new drugs and therapies help reduce the ill effects of chemotherapy and radiation.

By Gina Shaw
WebMD Feature

Reviewed By Charlotte Grayson

For many women diagnosed with breast cancer, the disease doesn't make them feel ill. It's the treatment -- surgery, radiation, and, most of all, chemotherapy. Coping with side effects that range from nausea and fatigue to mouth sores and premature menopause can make four, six, or eight months of treatment seem like a lifetime.

And for many women, side effects can linger long after breast cancer treatment is over. What's more, some, such as low blood counts or nausea and vomiting so extreme they can't be controlled, can delay the next treatment, possibly making it less effective.

As scientists research new treatments for breast cancer, they're also studying new "treatments for the treatments," new ways to prevent or reduce some of the most debilitating side effects of cancer therapies.

New Drug Controls Nausea

One of the most common (and awful) side effects of many types of chemotherapy is nausea and vomiting. It leaves many women exhausted, dehydrated, and sometimes so distressed that they want to stop chemotherapy altogether. Some women are so affected by chemotherapy nausea that, even years later, they find themselves searching for a bathroom or a bucket at the mere sight of their oncologist.

Now, a new drug is helping many more women get through chemotherapy nausea-free. Emend, approved by the FDA in 2003, works differently than many of the other standard anti-nausea medications used with chemotherapy. It blocks "substance P," a chemical substance that transmits nausea and vomiting signals to the brain. It's effective at staving off "delayed-onset" nausea, which hits 24 to 48 hours after a chemotherapy dose and can last as long as five days. In studies, Emend kept about 20% more patients nausea-free for up to five days following chemotherapy.

In late 2004, Memorial Sloan-Kettering Cancer Center in New York made Emend part of its standard regimen of drugs for women undergoing breast cancer chemotherapy. "It's very well tolerated and very effective," says Andrew Seidman, associate attending physician in the Breast Cancer Medicine Service at Sloan-Kettering.

"It doesn't replace other anti-nausea drugs, but rather works well in combination with them. With these other medications alone, patients still had the potential for breakthrough nausea two or three days after treatment. Since we've made the change, I think we're doing an even better job at managing nausea."

Sick and Tired: Tackling Fatigue

Almost everyone undergoing breast cancer treatment feels some fatigue. It often builds up over the course of treatment, so while you start out thinking "This isn't so bad; I still have plenty of energy," by the end of chemotherapy and radiation you may feel lucky if you can get out of bed.

Some treatment-related fatigue, doctors say, is almost inevitable. "Chemotherapy does cause collateral damage to normal tissues, and the broad tissue damage is one source of this fatigue," says Mark Pegram, MD, director of the Women's Cancer Program at the Jonsson Comprehensive Cancer Center at UCLA. "Until we have more targeted therapies that don't damage normal tissues as much as chemotherapy does, we will have to try to manage fatigue as best we can."

Longer-lasting drugs to treat chemotherapy-induced anemia, which can leave patients drained and dragging, are now available, says Pegram. These red blood cell boosters were once only available as weekly injections, but a newer drug in this category, Aranesp, requires fewer injections and office visits.

According to a study presented at the San Antonio Breast Cancer Symposium in 2004, 94% of patients treated with Aranesp reported a significant improvement in their quality of life. "I don't think that anybody has a magic bullet for fatigue, but maintaining an adequate hemoglobin level is definitely an important goal," says Pegram.

Aiming to Protect Bones, Prevent Osteoporosis

Women diagnosed with breast cancer before going through menopause often endure "chemopause." This short-term or permanent menopause is a result of chemotherapy, which interferes with the production of ovarian cells. Research shows this early and harder-hitting form of menopause (which happens all at once, instead of the slower slide of natural menopause) can lead to an increased risk of osteoporosis.



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