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Adjuvant Therapy for Breast Cancer

This information will help you understand what adjuvant therapy is, how different kinds of adjuvant therapies work, what the possible side effects are and how to manage them. It also includes a list of resources you may find helpful during your treatment.  If you would like more information or have any questions, please speak with a member of your healthcare team. 

What Is Adjuvant Therapy?

Adjuvant therapy is treatment given in addition to your surgery, either before or after. It’s used to kill any cancer cells that may be left over in your breast or in the rest of your body, increasing the chance of a cure.  Large studies have shown that adjuvant therapy helps many women with breast cancer. Your doctor will decide which therapy you need and when the therapy will work best. Adjuvant therapy could be one or a combination of these:

  • Chemotherapy can kill cells by stopping the cells’ ability to multiply.  Your chemotherapy may last 3 to 6 months.
  • Hormonal therapy is used against cancers that are estrogen or progesterone positive.  It blocks natural hormones in the body that might help cancer cells grow. Hormonal therapy may be taken for years.
  • Antibody therapy attacks growth proteins on cancer cells. Antibody therapy may be taken for up to a year.
  • Radiation therapy targets cancer cells that doctors can’t see but remain in the breast or lymph nodes after surgery. Radiation therapy usually lasts 6 to 8 weeks.

Planning Your Adjuvant Therapy

Your treatment plan was created for you based on multiple factors.  Your doctor will take your full history, do a physical exam, review your test results, pathology results and x-rays, and then design your treatment plan.  Do not try to compare your treatment to someone else’s. Not everyone has the same plan.  Your doctor will discuss your plan with you in detail. If you need radiation, your doctor will tell you how it fits in with your treatment plan.  Always ask your doctor or nurse any questions you have. 

Side Effects and How To Manage Them

Chemotherapy works best against cells that divide quickly, such as cancer cells.  Some normal cells also divide quickly, however, including:

  • Blood cells
  • Hair roots
  • Nails
  • Cells that line your mouth, throat, stomach, and intestines

Because chemotherapy is killing these cells as well as the cancer cells, you may have a decrease in your blood counts, hair thinning or loss of your hair, changes in your nails, nausea, vomiting, or diarrhea while receiving chemotherapy. The side effects of chemotherapy depend on which medicaiton is given. For example, not all medications cause nausea and vomiting or hair loss. 

Hormonal therapies can cause changes in your hormone levels. This can change or stop your periods (menstrual cycle) and cause side effects related to menopause.  

Antibody therapies have fewer side effects, but can sometimes affect the way your organs work.  

More specific possible side effects of chemotherapy, hormonal therapy, and antibody therapy are described below. Each section gives you things to do to feel better. Your doctor and nurse will tell you which side effects to expect from your treatment. If you will receive radiation therapy to your breast as part of your adjuvant therapy, your nurse will give you additional written information. 

Nausea and Vomiting

Some, but not all, chemotherapy causes nausea and vomiting.  These side effects happen because the chemotherapy either irritates the areas of the brain that control nausea or the cells lining the mouth, throat, stomach, and intestines.  The medications we use now are very good at preventing or controlling nausea.  If the chemotherapy you will take can cause nausea and vomiting, you will receive anti-nausea medication before each treatment.  This is to reduce the chance that you will have nausea.  You will also be given a prescription to take home with you.  Your nurse will tell you how to take the medication.  Taking it the right way will give it the best chance to work. 

Nausea can make you want to stop eating.  Without eating and drinking your body will not have the energy it needs to repair itself from the effects of your treatment.  Below are some helpful hints to help you lessen your nausea.  Also, you may ask your nurse for the resource Eating Well During and After Cancer Treatment.

What you can do:

  • Take your anti-nausea medication as instructed by your doctor or nurse. Don't try to hold off taking the medication to see if the nausea will go away.
  • Eat dry, starchy foods (e.g., crackers, pretzels) or hard candy to help prevent nausea. 
  • Eat small, frequent meals.  Stop eating before you feel too full.
  • Drink 8 to 10 glasses of liquids every day.  This will avoid dehydration from vomiting. Sip little bits at a time to avoid more nausea.
  • Practice relaxing.  Listen to soft music, breath deeply, do yoga, or meditate.  You might also try to think of pleasant things to distract you. 
  • Ask your doctor or nurse to refer you to a dietitian for more suggestions. 

Things to avoid:

  • Fried, greasy, creamy, and spicy foods
  • Eating or cooking foods that have a strong odor

Contact your doctor or nurse if you:

  • Vomit for 24 hours
  • Have nausea that does not stop even if you take your anti-nausea medication
  • Are unable to drink or keep anything in your stomach
  • Feel light-headed or dizzy
  • Have heartburn or a “sour stomach,” or abdominal pain

Hair Loss or Thinning (Alopecia)

Some chemotherapy causes hair loss. Hair loss usually starts about 2 to 4 weeks after the first treatment.  If you do lose your hair, it will begin to grow back after your treatment is finished.  Some hormonal therapies can mildly affect your hair as well. Hair loss is affected by:

  • The type, dose, and length of time you take the medication(s)
  • The amount of hair you have before treatment
  • The amount of chemical processing (e.g., perm, dye) the hair had before treatment

What you can do:

  • Go to a Look Good Feel Better class to learn make-up and skin care techniques. Call (212) 639-5665 to sign up.
  • Use a mild shampoo.
  • Obtain a list of places to buy a wig. Talk to your doctor or nurse about getting a prescription for the wig. Check with your insurance provider about reimbursement.
  • Wear scarves and soft terry cloth turbans if they appeal to you; they are very comfortable and add variety.
  • When blow-drying your hair, use a low heat setting.

Things to avoid:

  • Bleaching or perming your hair, however you may use vegetable hair coloring
  • Hot curlers

Low White Blood Cell Count (Leukopenia)

A low white blood cell count raises your risk for getting an infection.  Low counts can occur 7 to 14 days after each treatment but may last longer in some cases.  A medication given by injection (shot) may be used to raise your white cell count.

What you can do:

  • Take your temperature by mouth every 4 hours if you think you have a fever or are having chills. Call your doctor or nurse if it is above 100.4° F (38° C). This is very important especially 7 to 14 days after each treatment.
  • Ask your nurse or doctor if you may take acetaminophen (Tylenol®).
  • Always wash your hands after using the toilet and before eating.
  • Protect your hands from cuts and burns:
    • Push back your cuticles instead of cutting them.
    • Wear gloves when you do the dishes, cook, or garden.
    • Keep your skin moisturized to avoid skin cracking.
  • If you have a cut, wash it with soap and water right away. Watch for signs of infection (redness, swelling, pus). If any develop, call your doctor.

Things to avoid:

  • People who are sick or have been exposed to anything that you can catch, such as chickenpox, strep, tuberculosis (TB), the flu or measles.
  • Dental work or surgery. Check with your doctor or nurse first.
  • Using tampons.
  • Using dental floss.
  • Using rectal thermometers or suppositories.
  • Live virus vaccines, such as the shingles vaccine, MMR, and the chickenpox vaccine.
  • Being around anyone who has received a live virus vaccine or nasal mist vaccine for 7 to 10 days after they received it.

Contact your doctor or nurse:

  • If you have redness, swelling, or pus leaking from a wound
  • If your temperature is 100.4° F (38° C) or higher when taken by mouth
  • If you have chills, with or without a fever
  • Before you receive any vaccines

Low Red Blood Cell Count (Anemia)

Anemia is caused when the body does not make enough red blood cells to carry oxygen. This can result in fatigue or shortness of breath. It can occur 7 to 14 days after each treatment, but is more likely to occur after months of treatment.

What you can do:

  • Eat foods that have iron, which may lessen your chance of becoming anemic. Iron-rich foods include lean meat, chicken, fish, dried apricots, raisins, beans, and lentils.
  • Choose activities that will help you save energy.
  • Take iron if your doctor prescribes it for you.

Things to avoid:

  • Anything that makes you feel tired
  • High altitudes, which may make you extremely dizzy

Contact your doctor or nurse if you have:

  • Dizziness
  • Severe fatigue
  • Shortness of breath
  • Chest pain

Low Platelet Count (Thrombocytopenia)

A low platelet count lowers the body's ability to form clots. This side effect is less common than low red or white blood cell counts. It may occur 10 to 14 days after a treatment, but is more likely after months of treatment.

What you can do:

  • Use a soft tooth brush for your teeth and gums.
  • If you currently floss you teeth you may continue to do so gently. If you do not floss regularly, don’t start now. Do not floss when your platelet counts are low.
  • Be careful not to cut or bump yourself.
  • Watch for any unexplained bruises or red spots on your skin.

Things to avoid:

  • Sharp objects (e.g., cuticle scissors, straight razors, sharp knives)
  • Rectal suppositories or thermometers
  • Dental work or surgery
  • Using tampons
  • Contact sports or anything that may result in bumping or banging
  • Alcoholic drinks. They can affect the body's ability to form clots by affecting how the liver works.
  • Ask your doctor or nurse if you can take aspirin, ibuprofen (Advil®), or other nonsteroidal anti-inflammatory drugs (NSAIDs). They will usually say yes, but if your treatment will cause a very low platelet count they might suggest that you avoid these medications.

Contact your doctor or nurse if you have:

  • Blood in your urine, stool, vomit, or when you cough
  • Unexplained bleeding, from your nose or gums
  • Any bruise that you do not remember getting
  • Changes in your vision
  • Headaches or any signs of a stroke, such as weakness on one side

Effects on the Nerves in the Hands or Feet (Neuropathy)

Some chemotherapy medications can affect the nerves in your hands or feet.  You could develop some numbness or tingling in your fingers, toes, or both.  This usually goes away after the treatment is completed; however you might feel some mild changes for a prolonged period of time or forever. If you have neuropathy you may have less ability to feel heat, so it’s important to take measures to prevent burning yourself, especially when using the stove, oven, or iron. You should also avoid using heating pads or hot packs.

Tell your doctor or nurse if you have:

  • Problems holding a pencil or pen, or closing buttons
  • Pain, burning, or tingling in your fingers or toes
  • Trouble walking or feeling the ground when you walk

Taste changes

A metallic taste in the mouth often occurs during treatment. Some foods may taste bland or unpleasant.

What you can do:

  • Chew flavored gum.
  • Suck hard candy to lessen the metallic taste. If it occurs while you are receiving chemotherapy, ask your nurse for a candy.
  • Do not eat foods that cause an unpleasant taste.
  • If food tastes bland, add more flavors.
  • Ask your doctor or nurse to refer you to a dietitian for more suggestions.

Diarrhea

Loose or liquid stools are caused by irritation of the lining of the stomach and intestines. This is often dependent on the chemotherapy medication you are taking. Your doctor or nurse will tell you whether or not to expect this.

What you can do:

  • Drink 8 to 10 glasses of liquids daily. Water, Gatorade®, Pedialyte® or liquids containing electrolytes such as Powerade® and other “sports” drinks are good choices.
  • Eat a diet of bananas, rice, applesauce, non-caffeinated tea, and white toast. This is sometimes called a BRAT diet.
  • Ask your doctor or nurse if you can take bismuth subsalicylate (Kaopectate®) or loperamide (Imodium A-D®).
  • Keep the rectal area clean and dry to help decrease skin irritation.
  • For rectal irritation try warm sitz baths. You can also apply a soothing cream such as A&D®, petroleum jelly (Vaseline®), or hemorrhoidal cream. Do not use suppositories without checking with your doctor.
  • Apply a warm cloth to the abdominal area, which may soothe cramping.
  • Ask your doctor or nurse to refer you to a dietitian for more suggestions.

Things to avoid:

  • Foods that contain high amounts of fiber (e.g., bran, fruits, nuts, and whole wheat products)
  • Foods and drinks that contain caffeine or artificial sweeteners (e.g., coffee, tea, colas, and other soft drinks) because they may stimulate your bowel
  • Dairy products or fresh fruits and vegetables
  • Foods that make you gassy, e.g. cabbage, beans
  • Stool softeners
  • Rectal suppositories

Contact your doctor or nurse if you have:

  • Three or more loose, watery stools in one day
  • Diarrhea, despite 2 days on the BRAT diet
  • Rectal irritation that is not relieved by the steps above
  • Blood in your stool

Constipation

Constipation is having less than your usual number of bowel movements or having hard stools. It is a common side effect of pain and anti-nausea medications. Some chemotherapy medications can also cause constipation.

What you can do:

  • Drink 8 to 10 glasses of decaffeinated liquids daily.
  • Increase your fiber intake slowly to prevent gas. Fiber is found in fruits, vegetables, cereals and grains (e.g., bran, oats, whole wheat bread, brown rice, beans).
  • Exercise if you can. Walking is excellent. Keep active; this helps your intestines move.
  • Ask your doctor or nurse if you can take medications such as docusate sodium (Colace®) or sennosides (Senokot®).
  • Ask your nurse for the resource Constipation.
  • Ask your doctor or nurse to refer you to a dietitian for more suggestions.

Things to avoid:

  • Suppository laxatives
  • Enemas

Contact your doctor or nurse if you:

  • Have not had a bowel movement or passed gas for more than 3 days
  • Have hard stools or difficulty moving your bowels for more than 3 days

Mouth Sores (Stomatitis)

Painful areas or sores in your mouth or throat are temporary.

What you can do:

  • Rinse your mouth 4 times a day using either a mixture of 1 to 2 teaspoons of baking soda or salt in 1 quart of water or an alcohol-free mouthwash. Do not swallow the solution.
  • Gargle with the solution in the morning, after each meal, and at bedtime.  If you vomit, clean your mouth well and gargle afterward.
  • Keep your lips moist with lip balm or ointments to prevent drying.
  • If you have dentures, remove them during mouth rinses and before bedtime.
  • Eat soft foods.
  • Ask your nurse or doctor to refer you to a dietitian if you are unable to eat.
  • Tell your doctor or nurse if you get cold sores frequently.

Things to avoid:

  • Commercial mouthwashes that may have alcohol or hydrogen peroxide. These can make the sores worse.
  • Acidic, salty, coarse, sharp or spicy foods
  • Foods that are hot to touch

Contact your doctor or nurse if you:

  • Get mouth sores
  • Have pain when eating or swallowing
  • Cannot get enough liquids down to keep yourself hydrated

Allergic Reaction

Rarely, chemotherapy can cause an allergic reaction while it’s being given.  You will be given medication to prevent this if needed for the specific chemotherapy or medication you’re receiving.  You will also be closely monitored by the nurse during your treatment.  Your doctor and nurse will tell you if any of the medications you’re getting can cause a reaction.

Pain

Getting chemotherapy is not painful.  However, some chemotherapy or the medications given to prevent low blood counts can cause aches between treatments.  Some hormonal therapies can cause achy joints. Tell your doctor or nurse if you have pain. Your doctor can adjust your medication or prescribe another medication to make you more comfortable.  Ask if it’s safe to use over-the-counter anti-inflammatory pain medications such as ibuprofen.

Eye Changes

Some chemotherapy medications may cause your eyes to be dry or teary. In these cases using lubricating wetting drops or allergy eyedrops may be helpful. Blurry vision may occur as a result of your eyes being dry or teary, but if you have blurry vision please see your eye doctor. Some treatments may also cause the eye lashes to fall out. This is temporary; they will grow back in when the treatment is finished.

Skin Changes

Sometimes chemotherapy can cause skin changes, such as darkening of the skin, nails, tongue, and the veins the chemotherapy was given in.  After treatment is finished these changes usually fade, but not always completely.  Rashes are uncommon, however common skin changes include:

  • Dryness
  • Itchiness
  • Cracking
  • Sensitivity to sunlight

What you can do:

  • Apply body lotion and hand creams, especially while your skin is still moist.
  • Use a sunscreen with an SPF of 30 or higher.
  • Wear broad-brimmed hats.
  • Wear long-sleeved clothes.
  • Wear light-colored clothes; these are more likely to reflect the sun.

Things to avoid:

  • Long, hot baths or showers
  • Being in direct sunlight

Contact your doctor or nurse if you:

  • Have skin that is peeling or blistering
  • Have a rash

Maintaining Your Weight

Some patients gain weight during treatment; others lose weight.  Weight gain can be due to fatigue, which decreases your activity level and causes you to burn fewer calories.  Some patients feel less nausea when they eat a lot of carbohydrates.  Others overeat because they are afraid that weight loss means they are sick. Many patients increase their caloric intake by drinking more juices and high-sugar drinks. For some women, their metabolism changes if they start menopause during or after treatment.

Certain medications and their side effects may result in weight loss.  Mouth sores may make it hard to maintain good eating habits.  Nausea may decrease appetite. 

What you can do:

  • Eat a well-balanced diet.
  • Drink water or unsweetened beverages.
  • Stay active and do gentle exercise.
  • Ask your doctor or nurse to refer you to a dietitian for more suggestions.

Cardiac Effects

Some chemotherapy medications or antibody therapies can affect the way your heart functions. Fast heart beats or fatigue can occur. Your doctor will let you know if the treatment you will receive requires any additional testing of your heart.

Contact your doctor or nurse if you have:

  • Fast or irregular heartbeats
  • Trouble breathing when you exert yourself
  • Chest pain or heaviness

Fatigue (Tiredness)

There are many possible causes of fatigue. Some medications cause fatigue directly, and others cause low blood counts which can cause fatigue.  If you feel fatigued in a way that prevents you from completing your normal daily activities, please tell your doctor or nurse.   For more information, ask your nurse for the resource called Handling Fatigue During and After Cancer Treatment

What you can do:

  • Eat a well-balanced diet.
  • Do activities and exercise when you have the energy.
  • Make time for yourself to rest.
  • Ask others to help you with your chores.

Cognitive Changes

Some patients tell us that they cannot think as clearly or quickly after treatment. You might:

  • Find it difficult to concentrate or focus
  • Find it difficult to do more than one thing at one time
  • Have trouble remembering things

We cannot predict who might have any of these problems, but many women report that they resolve over time. Fatigue, mood changes, stress, anxiety, normal aging, hormonal changes, and anesthesia can affect our thinking for some period of time. We are learning more about the impact adjuvant therapy can have on thinking. Studies are being done to understand why problems with thinking occur, how long they last, and to understand who develops them.

Sexual Intimacy

  • Chemotherapy and hormonal therapy can change:
    • How you feel about yourself
    • How your body looks to yourself and others
    • How comfortable you are being sexual and intimate
    • Your ability to get pregnant and have children
  • Surgery to treat breast cancer may require removing part or all of the breast. Reconstruction of the breast can be done to replace the breast shape. Although the surgical effects can be covered by clothing or a prosthesis, side effects of chemotherapy, such as hair loss, may change your looks in ways that cannot be covered as easily. All of these changes may affect how you feel about yourself and how you think others view you.
  • Your partner may withdraw from you because they worry about causing pain or discomfort during sex. You may think this withdrawal means that your partner does not find you desirable, but it may be that they are concerned about your comfort or may not know how to deal with your cancer.
  • Talking with your partner is the most important way to learn what you both are feeling. Sharing your thoughts may help you handle them better.
  • Ask your healthcare team for information and support so that you can continue to develop and share intimacy with those you love.

Menstrual Irregularities or Menopause

  • Your periods may change (to heavy or light), become irregular or stop. They may or may not return to your normal pattern or at all after the treatment is finished.
  • Even if your periods stop, you must still use a barrier method of birth control such as the condom or diaphragm. You could still be ovulating and get pregnant.
  • Ask your doctor when you can stop using birth control.
  • Chemotherapy can cause early menopause. Periods are more likely to stop if you are in your 40 or older.
  • Hormonal changes may cause mood swings.

Hot Flashes

You may have hot flashes or sweats that may interfere with your daily routine or your sleep.

What you can do:

  • Check with your doctor before taking any herbs. Do not use herbal remedies such as oil of evening primrose, cohosh or red clover. They can work like estrogen which might stimulate breast tumors.
  • Wear comfortable clothing.
  • Ask your doctor or nurse how to manage or treat menopausal symptoms.
  • Avoid hot foods and beverages, spicy food, caffeine, and alcohol.

Vaginal Dryness

Many women have vaginal dryness after menopause or from hormonal treatments.  This can make penetration painful or difficult.  It can also make it easier to get urinary tract infections (UTI). 

What you can do:

  • Use vaginal moisturizers regularly, such as Replens®, K-Y® Silk-E®, or Vitamin E gel caps.
  • Use lubricants during sexual activity to minimize discomfort. Examples include water-based lubricants, such as Astroglide®, K-Y® Jelly, or Liquid Silk®, or silicone lubricants, such as K-Y® Intrigue® or Pjur® Eros Bodyglide.
  • Make foreplay longer.  This may increase your arousal. 
  • Assure your partner that vaginal dryness is a side effect of the treatment, not your lack of desire.
  • Try different positions.  Some may be better than others.
  • See a specialist in our Female Sexual Medicine and Women's Health Program. For more information or to make an appointment, call (646) 888-5076.

Pregnancy

Do not get pregnant while you are receiving chemotherapy or hormonal therapy. These treatments can cause birth defects. You might still be at risk of getting pregnant for some time after your periods stop so continue to use birth control until your doctor tells you that you can stop.

  • Do not use oral birth control. They have estrogen and progesterone. These may stimulate tumor growth.
  • Use barrier methods of birth control (e.g., condom, diaphragm, or both).
  • Do not rely on the rhythm method. It is unreliable.

Chemotherapy or hormonal therapy can cause infertility. It is not always permanent, but often is. Discuss this with your doctor before you start treatment. You might also ask for additional resources, such as Cancer and Fertility: Information for Women.

Your Emotions During Treatment

You may feel emotional changes during treatment. How much you are affected is individual. Your roles at home or work may be affected.

  • It is common to feel sad, lonely, or angry.
  • You may feel tired a lot. Try to rest when you feel tired.
  • Your mood can go up and down.
  • Talk to those close to you about your feelings and the changes you are going through. Open communication will help you to understand each other better. Friends and family can support and comfort you.
  • Do not hesitate to ask for help. Accept when others offer you support.

Share your concerns with your doctors and nurses. They can tell you more about emotional changes you might have. They may also refer you to other resources, such as those listted in the next section.

Resources and Support Services at MSKCC

We have many ways to support and help our patients understand and cope with cancer. 

Art Therapy

(646) 888-5397

The art therapy group meets weekly in the group room, which is located within the library in the Evelyn H. Lauder Breast Center. It offers patients and families a chance to relax and be creative.

Counseling Center

(646) 888-0200

Many people find that counseling helps them deal with emotions during cancer treatment. We provide counseling for individuals, couples, families, and groups, as well as medications to help if you feel anxious or depressed.

Evelyn H. Lauder Breast Center Boutique

(646) 888-5330

Our boutique is located on the 2nd floor of the Evelyn H. Lauder Breast Center and is open Monday through Friday from 9:00 am to 5:00 pm. Come browse or talk with our experienced fitter for prostheses or breast forms. The boutique offers a large selection of headwear and head coverings, prosthetics, specialty bras, and bathing suits.

Genetic Counseling

(646) 888-4050

MSKCC's Clinical Genetics Service offers genetic testing and counseling about you and your family members' risk of getting certain cancers that are hereditary (passed through your genes).

Integrative Medicine Program

(646) 888-0800

Our Integrative Medicine Service offers patients many services to complement traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy.

Library

(646) 888-5993

The library located in the Evelyn H. Lauder Breast Center has books and videos on breast health topics.  Library materials are for use on-site, however staff can help you make copies if there is information you want to take home.  Many pamphlets are also available for you to keep. The library has computers with access to the Internet. 

Look Good Feel Better

(212) 639-5665

In the Look Good Feel Better class, makeup artists teach makeup techniques, skin and nail care, as well as hair styling and head-covering options that compensate for changes that can result from treatment.

Nutritional Counseling

(646) 888-4880

Our Nutrition Service offers nutrition counseling by one of our certified dietitians, who will review your current eating habits and advise you what to eat while you're going through treatment.

Patient-to-Patient Support Program

(212) 639-5007

You may find it comforting to speak with a cancer survivor or caregiver who has been through a similar treatment. Through our Patient-to-Patient Support Program, you can speak with former patients and caregivers.

Rehabilitation Services (Occupational and Physical Therapy) 

(646) 888-1900

At MSKCC, we offer a variety of outpatient rehabilitation services to help patients throughout all phases of treatment. These include occupational and physical therapy to help restore function in everyday activities, decrease pain, and enhance quality of life following certain cancer treatments.

Social Work

(646) 888-5271 or (646) 888-5203

Social workers help patients, family, and friends deal with issues that are common during cancer treatment. They provide counseling and can help you communicate with children and other family members. Our social workers can also help with referrals to community agencies and programs, including those that help with transportation and homecare.

Sexual Health Program

Cancer and its treatments can have an impact on your sexual health. MSK's Female Sexual Medicine and Women's Health Program helps female patients who are dealing with cancer-related sexual health challenges, including premature menopause and fertility issues. For more information, or to make an appointment, please call (646) 888-5076.

Tobacco Treatment Program

(212) 610-0507

Whether you've just been diagnosed with cancer, are undergoing treatment, or have overcome the disease, Memorial Sloan Kettering's Tobacco Treatment Program can help you stop smoking. Call for an appointment.

Frequently Asked Questions

Does someone need to come with me each time I have chemotherapy?

During your treatments you may receive medications that can make you very drowsy. If so, it would not be safe for you to drive a car or travel alone. It may be more convenient for a friend or family member to pick you up at the end of your treatment. After your first treatment, you will have a better idea of how you feel and what works best for you. You can also ask your doctor or nurse whether you are likely to feel drowsy.

What can I eat before and after chemotherapy? Are there any foods to avoid?

It is best to eat small regular meals before treatment to prevent a heavy and full feeling. Food safety is important during treatment. Avoid raw or undercooked meat, fish and poultry and unpasteurized products. Ask your nurse if you should review the Low Microbial Diet and Food Safety Guidelines booklet. Drink plenty of non-caffeinated liquids before and after the treatment to stay well hydrated.

Must I still take my anti-nausea medication even if I do not feel nauseated?

Nausea and vomiting can occur on the same day or even be as late as the second or third day afterward. If you are getting a medication that could cause nausea, your doctor will prescribe medication to lessen or prevent it. Always take your anti-nausea medication as your nurse tells you. Some medciation works best if you take it before you become nauseated. If you are still nauseated while taking the medication as prescribed, call your doctor or nurse.

I wasn't able to receive my chemotherapy when it was scheduled. Why did this happen?

Chemotherapy works on both cancer cells and normal cells. Your chemotherapy is scheduled so that your body has rest time between treatments. This allows normal cells to be replaced. Your body may need more time to reverse the effects of therapy, e.g., to allow mouth sores to heal or blood counts to rise to normal. Your doctor decides if your chemotherapy should be postponed.

My chemotherapy treatment was delayed because my ANC was low. What is an ANC?

An ANC is an absolute neutrophil count. A neutrophil is a white blood cell that helps fight bacteria. The count is expected to fall 7 to 14 days after chemotherapy. If your ANC is low, your doctor may delay your treatment until it is back to normal.

Can I do something to increase my blood counts?

Time will allow for your blood counts to recover. Sometimes your doctor may prescribe medication to maintain or raise your white blood cell count. These are usually shots given between treatments. Sometimes treatment will be delayed to allow time for your blood counts to recover. There is no evidence that vitamins or a special diet will speed the recovery of your blood counts. However, if you are iron deficient you may be more prone to anemia and might be advised to take iron supplements.

I have chills or a temperature above 100.4° F (38° C), but the doctor's office is closed. How can I reach a doctor?

You can always reach a doctor. During evenings, weekends, or holidays, call the hospital operator at (212) 639-2000. Ask for the doctor covering your doctor.

I have not lost my hair yet and my counts have not dropped. Does this mean that the chemotherapy is not working?

Not having side effects (such as hair loss, lowered blood counts, or nausea) does not mean that the chemotherapy is not working. Patients on different therapies have different side effects to varying degrees. Some medications do not cause these side effects. The degree of the side effects you have is not an index of the effectiveness of the treatment. Your doctor and nurse will monitor your progress and response to the chemotherapy.

What can I take for a headache?

You may take acetaminophen for a headache. If you feel that you have a fever or chills, check your temperature before you take the acetaminophen. Otherwise, the acetaminophen may lower your temperature and hide a fever, which is usually the first sign of infection. Call your doctor or nurse if you have chills or a temperature greater than 100.4° F (38° C). Ask your doctor or nurse if you may take products containing aspirin or ibuprofen (Advil®), since they may increase the chance for bleeding when some chemotherapy medications are given. Your nurse can give you a list of products to avoid.

I've been having problems urinating. Is this normal?

Some chemotherapy medications can irritate the bladder. Side effects can be urgency, burning, or blood in the urine. These may be signs of an infection or irritation. Call your doctor if you have any of these symptoms because your doctor may want a urine specimen. You may need to be treated for an infection. Make sure that you drink 8 to 10 glasses of liquids a day and empty your bladder frequently.

Can I still take my other prescribed medications?

In most cases, yes. Tell your doctor the names of all the medications, herbs, or supplements you take. These include the ones you need a prescription for and the ones you buy over-the-counter. Some medications, herbs, or supplements change the way the chemotherapy works. Do not start any new medications before checking with your doctor.

May I take vitamins or mineral supplements?

Avoid most vitamin, mineral, herbal or other dietary supplements. They might interfere with your treatment or affect your cancer. They might also increase the side effects of your treatment. Talk to your doctor or dietitian about any vitamin, mineral, herbal or other dietary supplements you are taking or may be interested in taking.

May I drink alcohol?

Many medications are processed by the liver. So is alcohol, which can:

  • Limit the liver's ability to process the chemotherapy, causing more side effects
  • Interact with some medications and lower their effectiveness
  • Cause the body to lose too much water
  • Interact with some anti-nausea medications
  • Cause too much drowsiness

For these reasons, we ask patients not to drink alcohol during chemotherapy. If you feel you must drink, please speak with your doctor or nurse.

Can I have dental work?

Do not have any procedure that can cause bleeding. If your blood counts are low, you are at a higher risk for a serious infection. Check with your doctor before you schedule any dental work, including cleanings or surgery.

Can I color or perm my hair?

We advise you not to color or perm your hair. Chemicals are abrasive to the hair follicles, speeding up the rate of hair loss during chemotherapy. If you must dye your hair, use a vegetable-based dye.

Is a wig covered by insurance?

Cancer patients who lose their hair may have insurance coverage for a wig. In this case, the wig is called a “total cranial prosthesis for chemotherapy-induced alopecia” and your doctor must write a prescription for it using the breast cancer diagnosis code (174.9). Check with your insurance company for details. 

Can I travel while I get chemotherapy?

Traveling is usually permitted, but it depends on your treatment and where you are going. Before you make any plans, discuss them with your doctor. Your doctor will advise you on precautions to take depending on where you are going. Seven to 14 days after receiving chemotherapy, your blood counts may drop. This puts you at risk for infection and your doctor may advise you not to travel during this time. Consider getting travel insurance in case you have to cancel your trip.

When will I be able to return to work?

Most patients can continue to work during chemotherapy. This, of course, varies according to the type of work and the level of fatigue you experience. Speak with your doctor or nurse.

Survivorship

About 2 to 5 years after treatment, your care may be transferred from your doctor to a survivorship nurse practitioner (NP). Your survivorship NP will be a member of MSK's breast cancer team. He or she will examine you and order tests, focusing on your long-term physical and psychological needs. Your survivorship NP will communicate with your local doctor about your breast cancer treatment and recovery so that in time, you can transfer your care to your local doctor.