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Treatment for Advanced Breast Cancer

Learning you have advanced breast cancer can lead to feelings of uncertainty. We believe that with time, information, and the support of your healthcare team, you can become more empowered and better prepared to face this diagnosis. This guide will help you understand your diagnosis by explaining advanced breast cancer, the treatments that are used to manage it, and how to cope with the symptoms you may experience during treatment. It also includes information about supportive resources that you may find helpful during treatment. If you have any questions or would like more information, talk with a member of your healthcare team.

Understanding Advanced Breast Cancer

Advanced breast cancer (also called metastatic or stage 4 breast cancer) is the spread of cancer from the breast to the skin, lymph nodes, or another part of the body such as the liver, lungs, or bones. Some people have advanced breast cancer when they are first diagnosed, but it is more common to develop advanced breast cancer when cancer comes back somewhere else in the body, after seemingly successful initial diagnosis and treatment. Advanced breast cancer is a chronic condition that requires lifelong care. The goal of treatment is to control it for as long as possible so that you can carry on most of your usual activities.

Planning Your Care

There are many treatments available for advanced breast cancer and the choice of treatments is based on many factors. To create the care plan that’s right for you, your doctor will review your medical history, examine you, and review your test results. If necessary, he or she will refer you to specialists for certain treatments, such as radiation therapy or surgery. Your doctor will discuss your care plan with you in detail. Do not compare your care plan to someone else’s; the same plan may not be right for everyone. 

Occasionally you will have tests to monitor how the disease is responding to treatment. Sometimes the cancer grows despite certain treatments. If this happens, your doctor will talk with you about changing your care plan. New treatments are being developed all the time, increasing your options for therapy.

Do not get pregnant while you are receiving therapy.  These treatments can cause birth defects and the hormones of pregnancy can affect how your disease behaves. 

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

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.  

Chemotherapy

Most people with advanced breast cancer will receive chemotherapy at some point during their treatment. Chemotherapy can kill cells in many ways, including by stopping their ability to multiply. Some chemotherapy is available as a pill, though many must be given through an intravenous (IV) catheter. 

Chemotherapy kills cells that divide quickly, including some cancer cells.  However, some normal cells also divide quickly. These include:

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

Because chemotherapy is affecting these cells as well as the cancer cells, you may have a decrease in your blood counts, thinning or loss of your hair, changes in your nails, nausea, vomiting, or diarrhea. How many of these side effects you can get will depend on the type of chemotherapy, the dose, and how often it is given. Not all chemotherapy causes nausea, vomiting, or hair loss. Your doctors and nurses should discuss the specific toxicities of each treatment with you.

Hormone therapy

Estrogen and progesterone are hormones. If the cancer has hormone receptors in it, then antihormonal medications may be used to treat it. We often refer to this as “hormone therapy.” Hormone therapy blocks natural hormones in the body that might help cancer cells grow. Some hormone therapies are taken orally and some given by injection. Hormone therapy can cause changes in your hormone levels. This can change or stop your monthly periods, make you unable to get pregnant (infertile), or lead to symptoms of menopause.

Targeted therapy

Targeted therapy attacks some growth and other proteins in cancer cells. Antibody therapy is an example of targeted therapy. Whether your doctor suggests targeted therapy depends on the type of breast cancer you have. Some targeted therapies have fewer side effects than chemotherapy, but there can still be some. Your doctor and nurse will tell you what to expect.

Implanted ports

Almost all patients will need an implanted port at some time during their treatment for advanced breast cancer. A port may be referred to by a brand name, such as BardPort®, Mediport®, PowerPort®, or Port-A-Cath®. A port is a small device, like an artificial vein, that is placed under the skin and is connected to a catheter (thin tube) that goes into the large veins, usually in the chest. You may have a port inserted at the start of your treatment if you don’t have many veins that can be safely used, or it may happen later in your care after your veins have been used a lot. 

A port is used to administer your treatments and can also be used for drawing blood. There are many benefits to having a port, including fewer delays and needle sticks when trying to find a good vein for treatment and less risk of chemotherapy leaking out of the veins and causing damage to the surrounding tissue.

A port is inserted during a short procedure, usually in the Radiology department, and can be used that same day if needed. Once your incision from the procedure is healed, you can swim, bathe, and resume all of your normal activities even with a port.

If you would like to learn more about ports you can ask your nurse for the resource Your Implanted Port. Talk with your doctor or nurse about when a port may be appropriate for you.

Clinical trials (research studies)

There is often a role for a clinical trial as part of the care plan for advanced breast cancer. A clinical trial is a research study that tests a new treatment. This may include studying a new drug or combination of drugs to treat breast cancer, a new dose or schedule of a drug, new tests to measure your response to a treatment, or new types of supportive care. Clinical trials may also include surveys to help us better understand our patients, and they may include studies conducted on your tumor or normal tissues and cells. The information we learn from clinical trials helps us learn how to provide better care for people with cancer.

Below are some commonly asked questions about clinical trials. For more information, or to learn if there are any clinical trials that are right for you, talk with your doctor. You may also visit our website at www.mskcc.org/cancer-care/clinical-trials.

How much does it cost to be on a clinical trial?

The parts of your care that are not standard are paid for by the clinical trial. Routine tests, treatments, or procedures that you would normally have as part of your treatment will be billed to you or your insurance company. However, some health plans do not pay for these costs once you join a clinical trial. If you have any questions regarding what your plan covers, call your insurance company. MSK also has financial counselors available to help you. You can reach a financial counselor by calling (646) 227-9978.

What are the risks and benefits of going on a clinical trial?

Clinical trials may offer you access to a treatment before it is available to most patients. However, not all new treatments are better. For example, you are not guaranteed that the trial drug is more effective or safer than other options. Clinical trials are designed to get answers to research questions in the safest way possible. You may change your mind about being on a clinical trial at any time.

What do the different phases of clinical trials mean?

  • Phase I: These trials are testing new medication in people for the first time. The goals of these studies are to find the safest doses, the best ways to give the drugs, and how often to give them. These patients are closely monitored for side effects. Phase I clinical trials enroll only a small number of patients.
  • Phase II: These trials examine how safe new drugs are and how well they work. These studies often focus on one type of cancer.
  • Phase III: These trials compare how a new drug or treatment works compared to the current standard of care or another experimental treatment. People who take part in the trial are randomly assigned to receive either the new or the standard treatment. Phase III trials take place after successful phase I and II studies. These trials often include large numbers of people possibly from other centers or across the country.
  • Phase IV: These trials are not common and they take place after the drug has been on the market.  They help us learn more about how safe the treatments are and how well they work over time.

Advance care planning

Advance care planning involves making decisions about your healthcare. By thinking about your healthcare now, you can make sure your wishes are carried out the way you would want them to be if ever you’re unable to speak for yourself. Planning in advance can also help put your loved ones at ease because they don’t have to guess what you would want or worry whether they’ve made the right decision.

We recommend you talk with a member of your healthcare team about your wishes early in your treatment and anytime you feel like things have changed. He or she can help you make sure your choices are documented in a way that is recognized by the law. Written instructions on how you want medical decisions to be made if you are unable to communicate or make the decisions yourself are called “advance directives.” The 2 most common types of advance directives are a Health Care Proxy and a living will.

  • A Health Care Proxy is a legal document that identifies the person you want to make medical decisions on your behalf if you are unable to make them for yourself.
  • A living will is a document that states your wishes about your medical care. It goes into effect if you develop an irreversible condition that prevents you from making your own medical decisions, such as if you become terminally ill or permanently unconscious. In the document, you specify which treatments you do or don’t want to receive if you are in this situation.

Possible Symptoms and How to Manage Them

Advanced breast cancer affects the way you feel, physically and emotionally. Some symptoms may be from the cancer itself, while others may be from the treatment(s). You may have many of these symptoms, some, or none at all. Your doctor and nurse will tell you which symptoms you are most likely to experience.

This section describes symptoms you may experience. If you have any questions or if you need more information, talk with your doctor or nurse. Do not wait for your next appointment; he or she may be able to give you advice or a prescription to help you feel better.

Allergic reactions

Some medications can cause an allergic reaction while the medication is being given, but this is rare. You will be given medications to prevent this, if needed. You will also be closely monitored by your nurse during your treatment.  Your doctor and nurse will tell you if any of the medications you are getting are likely to cause an allergic reaction. If you have a rash, shortness of breath, or swelling while you’re at home, call your doctor or nurse.

Constipation

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

What you can do:

  • Drink 8 to 10 glasses of decaffeinated liquids daily.
  • Slowly increase the amount of fiber you eat to help prevent gas. Fiber is found in fruits, vegetables, cereals, and grains (e.g., bran, oats, whole wheat or whole grain breads and cereal, brown rice, beans).
  • Exercise if you can. Walking is an excellent way to keep active, and it helps decrease constipation. 
  • Ask your doctor or nurse if you can take medications such as docusate sodium (Colace®), senna (Senokot®), or polyethylene glycol (MiraLAX®).
  • Ask your doctor or nurse to refer you to a dietitian for more suggestions. 

Things to avoid:

  • Suppositories
  • 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.

Diarrhea

Loose or liquid stools (diarrhea) are caused by irritation of the lining of the stomach and intestines.

What you can do:

  • Drink 8 to 10 glasses of liquids daily so that you don’t get dehydrated.  Water, juices diluted with water, or liquids containing electrolytes, such as Pedialyte®, Gatorade®, Powerade®, and other sports drinks are good choices.
  • Eat a diet of bananas, white rice, applesauce, non-caffeinated tea, and white toast. This is sometimes called a BRAT diet. 
  • Eat canned fruit and smooth peanut butter. These may help bind your stools.
  • Ask your doctor or nurse if you can take bismuth subsalicylate (Kaopectate®) or loperamide (Imodium A-D®).  
  • Keep your rectal area clean and dry to help decrease skin irritation.
  • Try warm sitz baths to help with rectal irritation. You can also apply a soothing cream such as A&D®, Vaseline®, or hemorrhoidal cream.
  • Drink beverages at room temperature. Hot beverages may stimulate your bowels and ice cold beverages may cause cramping.
  • Do not use suppositories.
  • Apply a warm cloth to your abdominal area. This 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, oats, whole wheat or whole grain breads and cereal, brown rice, beans)
  • Foods and drinks that contain caffeine or high amounts of artificial sweeteners or sugar (e.g., coffee, tea, colas, and other soft drinks). They may stimulate your bowel.
  • Dairy products
  • Raw fruits and vegetables.  Have canned fruits and cooked non-gassy vegetables like green beans or carrots instead.
  • Foods that make you bloated or gassy (e.g., cabbage, beans)
  • Stool softeners
  • Rectal suppositories

Contact your doctor or nurse if you have:

  • Three or more loose, watery stools in 1 day.
  • Diarrhea despite 2 days on the BRAT diet.
  • Rectal irritation that is not relieved by the steps above.
  • Blood in your stool.

Emotional changes

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

Possible emotional changes:

  • Your mood can vary at times.
  • It is common to feel anxious about the diagnosis and treatment. Some people feel sad, alone, or angry.
  • You may feel tired a lot. Try to rest when you feel tired.

What you can do:

  • Talk to those close to you about your feelings and the changes you are going through.  Friends and family can support and comfort you. Open communication will help you to understand each other better. 
  • Do not hesitate to ask for help.  Accept when others offer you support.

A member of the Department of Psychiatry and Behavioral Sciences can help you with:

  • Difficulty relating to others.
  • Depression, irritability or difficulty sleeping.
  • Anxiety and panic attacks.
  • Learning relaxation techniques.

A social worker can assist you with:

  • Referrals to community services and resources.
  • Emotional concerns such as depression and anxiety.
  • Finding support groups or family counseling. Many patients find support groups helpful. You can get more information on these groups by speaking with one of our social workers.

Some patients find soft music or relaxation recordings helpful.  CDs are available in the boutique and in most bookstores. 

Eye and vision changes

Some chemotherapy medications may cause dry eyes or increased tearing. If this happens, you can use wetting drops or allergy eyedrops. If you have blurry vision during your treatment, see your eye doctor. It may be because your eyes are dry or tearing. 

Some chemotherapy medications may cause your eyelashes and eyebrows to fall out. If this happens, it is temporary. They will grow back in after you have stopped taking that chemotherapy medication.

Fatigue

Many people describe fatigue as feeling weak or having no energy. Fatigue from treatment can range from a mild to an extreme feeling of being tired.

What you can do:

  • Eat a well-balanced diet including protein sources like chicken, fish, eggs, lentils or peanut butter, grains such as pasta, rice, breads and cereals, and fruits and vegetables.
  • Do activities and exercise when you have the energy.
  • Make time to rest.
  • Ask others to help you with your chores.
  • Check with your doctor or nurse before starting any vitamins or supplements.
  • Talk with your doctor or nurse.  Your nurse can give you the resource Handling Fatigue During and After Cancer Treatment, which includes a lot of helpful information. 

Hair loss (alopecia)

Some chemotherapy medications cause hair loss.  Hair loss usually starts about 2 to 4 weeks after the first chemotherapy treatment. If you do lose your hair, it will begin to grow back once you’re no longer taking that chemotherapy medication.  Some hormonal therapies can mildly affect your hair as well. Generally, 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:

  • Talk with your doctor or nurse about getting a prescription for a wig before you start treatment.  Check with your insurance provider about reimbursement.
  • Go to a Look Good Feel Better class to learn makeup and head-covering techniques. Call (212) 639-5665 to sign up. Information is also available on the internet at /cancer-care/counseling-support/look-good-feel-better
  • Use a mild shampoo.
  • When blow-drying your hair, use a low heat setting. 
  • Wear scarves and soft terry cloth turbans if they appeal to you; they are very comfortable and add variety.

Things to avoid:

  • Bleaching or perming your hair.  You may use vegetable-based hair coloring.
  • Hot curlers

Heart problems

Some chemotherapy and some targeted therapy can affect the way your heart functions. You may have a fast heart beat, feel tired (fatigue), or short of breath. Your doctor will tell you if the treatment you are receiving requires any heart tests.

Tell your doctor or nurse if you have:

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

Hot flashes

You may have hot flashes or sweats that 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, loose-fitting cotton clothing.
  • Ask your doctor or nurse how to manage or treat menopausal symptoms.
  • Avoid hot foods and beverages, spicy food, caffeine, and alcohol.
  • Drink enough liquids to avoid dehydration

Low platelet count (thrombocytopenia)

A low platelet count lowers the body’s ability to stop bleeding or bruising. This side effect is less common than having low red or white blood cell counts. You may have a low platelet count 10 to 14 days after chemotherapy, but this is more common after months of chemotherapy. 

What you can do:

  • Use a soft tooth brush for your teeth and gums.
  • If you currently floss your teeth, you may continue to do so gently. If you do not floss regularly, don’t start now.
  • 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)
  • Using rectal thermometers or suppositories
  • Dental work or surgery
  • Contact sports or anything that may result in bumping or banging
  • Having more than 3 alcoholic drinks per week. Alcohol can affect the body’s ability to form clots by affecting how the liver works. 
  • Ask your doctor if you can take anti-inflammatory medication such as ibuprofen (Advil®, Motrin®) or naproxen (Aleve®, Naprosyn®).
  • Notify your doctor if you take aspirin or blood thinners for other health conditions.

Contact your doctor or nurse if you have:

  • Blood in your urine, stool, vomit, or when you cough
  • Unexplained bruising or bleeding from your nose or gums
  • Changes in your vision
  • Headaches or any signs of a stroke, such as weakness on one side

Low red blood cell count (anemia)

Anemia is when your body does not make enough red blood cells. Red blood cells carry oxygen through your body. When you don’t have enough red blood cells, you may feel tired (fatigue) or short of breath.  Anemia can occur 7 to 14 days after each chemotherapy treatment but is more likely to occur after months of chemotherapy treatment. 

What you can do:

  • Eating foods that have iron may lessen your chance of developing anemia.  These include lean red meat, spinach, chicken liver, shellfish, dried fruits, legumes (beans), and fortified cereals. For more information ask your nurse for the resource Iron in Your Diet, or find it online on www.mskcc.org/pe.
  • Choose activities that will help you save energy.  
  • Take iron if your doctor prescribes it for you.

Things to avoid:

  • Anything that makes you tired
  • High altitudes, which can make you very dizzy 

Contact your doctor or nurse if you have:

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

Low white blood cell count (leukopenia)

Low counts tend to occur 7 to 14 days after each chemotherapy treatment, but may sometimes last longer. When your white blood cell count is low, you are more likely to get an infection. Your doctor may prescribe a medication given by injection (shot) to raise your white blood 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:
    • Do not cut your cuticles; push them back instead.
    • Wear gloves when you do the dishes, cook, or garden.
  • Keep your skin moisturized so it won’t crack.
  • 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.
  • Sometimes your doctor will prescribe a growth factor injection called filgrastim (Neupogen®) or pegfilgrastim (Neulasta®) to keep your white blood cell count up. This might prevent infections or allow your treatments take place on time.

Things to avoid:

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

Contact your doctor or nurse:

  • If you have redness, swelling, or pus leaking from a wound.
  • If you have an oral temperature of 100.4° F (38° C) or higher. 
  • If you have chills or body aches, with or without fever.
  • Before you receive any vaccines.

Memory issues

Some people find they cannot think as clearly or as quickly as they did before treatment. You may find that you:

  • Have difficulty concentrating or focusing.
  • Have difficulty doing more than one thing at a time.
  • Have trouble remembering things.

These symptoms can be caused by various factors. Fatigue, mood changes, stress, anxiety, normal aging, hormonal changes, the disease and anesthesia can affect your thinking for some period of time.

We are studying the impact that the medications we use for treating breast cancer can have on thinking. We hope to learn why problems with thinking occur, how long they last, and who develops them. We also hope to find out how to manage these problems until they get better.

Many people do not experience any of these problems. We cannot predict who might have them, but they often go away over time. If this is something you’re worried about, talk with your doctor. He or she can also tell you about any studies that you might be eligible to participate in, if you’re interested. 

If you do experience any of these symptoms, an occupational therapist can help you maintain participation in everyday activities and can provide helpful strategies for improving attention, concentration, and memory.

What you can do:

  • Make sure you get enough sleep.
  • Eat a well balanced diet.  
  • Read and socialize to keep yourself stimulated.
  • Seek counseling if you have anxiety or depression because they can add to memory problems.

Things to avoid:

  • Unnecessary medication that can make you sleepy.
  • Stress, as much as possible. It can be distracting.

Contact your doctor or nurse if:

  • The changes in memory are preventing you from doing your normal daily activities
  • You also have headaches
  • You also have trouble with your vision or balance

Menstrual cycle (period) changes

Some treatments may cause your periods to change (to heavy or light), become irregular, or stop.  Also, your treatment plan may include medication or surgery to stop your periods.

  • If you still have ovaries and a uterus, you can still be ovulating and can get pregnant, even if your periods stop. If you have ovaries and a uterus, you must use a non-hormonal form of birth control such as a condom, diaphragm, or non-hormonal IUD.
  • Ask your doctor when you can stop using these methods of birth control.
  • Hormonal changes may cause mood swings.

Mouth sores (mucositis)

Some treatments can cause painful areas or sores in the mouth or throat. These are often temporary.

What you can do:

  • Rinse your mouth 4 times a day using a mixture of 1 to 2 teaspoons of baking soda or salt in 1 quart of water, or using an alcohol-free mouthwash. Do not swallow the solution.
  • You can also 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.
  • If you have dentures, remove them while you rinse your mouth and before you go to bed.
  • 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, and spicy foods
  • Foods that are hot to touch

Contact your doctor or nurse if:

  • You have mouth sores that are painful or prevent you from eating or drinking.
  • You have pain in your mouth or throat when eating or swallowing, even if you don’t see sores.
  • You cannot get enough liquids down to keep yourself hydrated.

Muscle, bone, and joint problems

Some treatments can affect your muscles, bones, or joints. You might develop

  • Bony discomfort from growth factors
  • Joint stiffness or pain
  • Decreased bone density

What you can do:

  • Gentle exercise
  • Ask your doctor if you can take anti-inflammatory medication such as ibuprofen (Advil®, Motrin®) or naproxen (Aleve®, Naprosyn®).
  • Ask your doctor if you should take vitamin D

Contact your doctor or nurse if:

  • You are very uncomfortable or stiff or have pain
  • You have leg weakness or difficulty walking
  • Your hands or fingers feel stiff

Nausea and vomiting

Some chemotherapy causes nausea and vomiting.  Nausea and vomiting happen because chemotherapy irritates either the areas of the brain that control nausea or the cells lining the mouth, throat, stomach, and intestines.

There are medications that are very good at preventing or controlling nausea. If the chemotherapy you will receive can cause nausea and vomiting, you will get antinausea medication before and/or after each chemotherapy treatment. This will 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.  Not eating and drinking will deprive your body of the energy it needs to repair itself from the effects of your chemotherapy.  Below are some 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 (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 prevent dehydration from vomiting. Sip a little bit at a time to avoid more nausea.
  • Practice relaxing. Listen to soft music, breathe deeply, do yoga, or meditate. You might also try to think of pleasant things to distract yourself. 
  • Ask your doctor or nurse to refer you to a dietitian for more suggestions. 

Things to avoid:

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

Call your doctor or nurse if you:

  • Are vomiting 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, a “sour stomach,” or pain in your stomach area.

Neuropathy

Some chemotherapy can affect the nerves in your hands or feet.  You could develop some numbness or tingling in your fingers, toes, or both.  This may be temporary or permanent depending on how long you are on the chemotherapy. Your doctor may be able to make the neuropathy less bothersome by using medications or changing the dose of your chemotherapy.

What you can do:

  • Be extra careful to avoid burning yourself when using the stove, oven, or iron. You may not be able to feel heat as much as you used to.

What to avoid:

  • Using heating pads or hot packs

Tell your doctor or nurse if you have:

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

Pain

Pain is common for people with cancer.  It can come from the tumor or as a result of cancer treatment. You should never feel you have to suffer from pain. If you’re having pain, talk with your doctor.  He or she will suggest ways to treat it based on the type of pain and how bad it is.

  • Mild pain that comes and goes may be controlled with over-the-counter medications.       
  • More severe or chronic pain may be managed with prescription medications, acupuncture, acupressure, massage therapy, and, in some cases, radiation therapy.

You and your doctor can discuss what will work best for you. If you choose to take medications to treat your pain, talk with your doctor or nurse about the side effects. Constipation, nausea, and sleepiness are common side effects from pain medications. 

MSK also has a Palliative Medicine Service. These doctors and nurses can help you manage pain, and they can also help with other symptoms, such as shortness of breath, nausea, as well as with emotional issues such as sadness, depression, and anxiety. These specialists are available for appointments at the main hospital Monday through Friday, and some appointments are available at the Evelyn H. Lauder Breast Center.  For more information about the Palliative Medicine Service go to www.mskcc.org/cancer-care/palliative-care, or speak with your doctor about making an appointment.

Sexual intimacy 

Breast cancer often changes how breasts look. This may be because of a tumor, radiation, or surgery. Although these changes can be covered by clothing, side effects such as hair loss may change your looks in ways that cannot be hidden as easily.  Changes in your body from chemotherapy and hormone therapy may affect:

  • How you feel about yourself
  • Your comfort with exposing your body to another person
  • Your desire for sex
  • How your body responds sexually
  • Your ability to get pregnant and have children

What you can do:

  • Talk with your partner. It is the most important way to learn what you both are feeling. You may find that he or she is worried about causing you pain or discomfort during sex. 
  • Talk with a member of your healthcare team.
  • 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.
  • Read additional resources, such as Sexuality & Cancer: For the Woman Who Has Cancer and Her Partner, available from the American Cancer Society by calling (800) ACS-2345.

Skin changes

Chemotherapy can cause changes to your skin. You may have darkening of your skin, nails, tongue, and the veins in which you have received the chemotherapy. You may also have general skin changes, including:

  • Dryness
  • Itchiness
  • Cracking
  • Sensitivity to sunlight

What you can do:

  • Apply body lotion and hand creams while your skin is still moist.
  • Use a sunscreen with an SPF of 30 or higher every day.
  • Wear broad-brimmed hats.
  • Wear long-sleeved clothes.
  • Wear light-colored clothes.

Things to avoid:

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

Contact your doctor or nurse if:

  • Your skin is peeling or blistering.
  • You have a rash.
  • You have any new bumps or nodules on your skin.

Taste changes

Having a metallic taste in your mouth is common 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. 
  • Ask your doctor or nurse to refer you to a dietitian for more suggestions.

Things to avoid:

  • Eating foods that cause an unpleasant taste.

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®, KY Silk-E®, and 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 KY Intrigue® or Pjur Eros Body Glide®.
  • 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.

Weight changes

Some people gain weight during treatment, while others lose weight.  

  • Weight gain can be due to:
    • Fatigue, which decreases your activity level and causes you to burn fewer calories.
    • Eating a lot of carbohydrates. Eating carbohydrates may help relieve nausea in some people.
    • Overeating because some people are afraid that weight loss means they are sick.
    • Drinking more juices and drinks high in sugar.
    • Starting menopause during or after treatment which can cause some women’s metabolisms to change.

What you can do

  • Eat a well-balanced diet and avoid extra calories
  • Exercise regularly
  • Ask your doctor or nurse to refer you to a dietitian for more suggestions. 

Weight loss can be due to

  • Nausea from medications
  • Mouth sores which make it hard to eat
  • Lack of appetite
  • The effects of cancer       
  • Loss of appetite from medication, constipation or depression

What you can do:

  • Eat a well-balanced diet.
  • Eat small frequent meals if you can’t finish a large meal.
  • Add extra calories to your meals and by snacking in between.
  • Ask your doctor if there are medications that can improve your appetite.
  • Ask your doctor or nurse to refer you to a dietitian for more suggestions. 

Resources and Support Services at Memorial Sloan Kettering

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

MSK'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.

Palliative Care Medicine

(646) 888-2726

The expertise of MSK's Pain and Palliative Care Service is available to patients throughout their cancer treatment. These doctors and nurses specialize in helping patients manage physical symptoms such as pain, shortness of breath, and nausea, as well as emotional issues, such as sadness, depression, and anxiety. They work with a patient's primary team, providing an extra layer of support. If you feel that you or your loved one might benefit from the care provided by the Pain and Palliative Care Service, talk with your doctor.

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 MSK, 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 Worker

(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 Sexual Health Program can help you take action and address sexual health issues before, during, or after your treatment.

  • Our 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.
  • Our Male Sexual and Reproductive Medicine Program helps male patients who are dealing with cancer-related sexual health challenges, including erectile dysfunction. For more information, or to make an appointment, please call (646) 422-4359.
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 treatment?

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 chemotherapy 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 resource. Drink plenty of non-caffeinated liquids before and after your chemotherapy appointment to stay well hydrated.

Do I still need to take my antinausea medication if I’m not nauseous?  

Nausea and vomiting can occur on the same day or as late as the second or third day after chemotherapy. If the chemotherapy you’re receiving can cause nausea, your doctor will prescribe medication to lessen or prevent it. Always take your anti-nausea medication as instructed.  Some medication works best if you take it before you become nauseated. If you are still nauseated while taking your medication as instructed, call your doctor or nurse. 

Why wasn’t I able to receive my chemotherapy when it was scheduled?

Chemotherapy works on both cancer cells and normal cells. Your chemotherapy is scheduled so that your body has time to recover 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 will decide 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 to14 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?

Your blood counts will recover over time.  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 your iron levels are low, you may be more likely to have anemia (a low red blood cell count) and may 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 isn’t working.  Different therapies cause different side effects, to varying degrees. Also, different people can react differently to the same treatment. Your doctor and nurse will monitor your progress and response to treatment. 

What can I take for a headache?

You may take acetaminophen (Tylenol® or Extra Strength Tylenol®) for a headache.  If you feel that you have a fever or chills, check your temperature before you take 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, since they may increase the chance for bleeding with some chemotherapy.  Your nurse can give you a list of products to avoid.

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

Some chemotherapy 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; he or she 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 each day and empty your bladder frequently.

Can I still take my other prescription medications?

In most cases, you can continue to take your prescription medications.  Tell your doctor the names of all the medications, herbs, and 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. 

Can I drink alcohol?

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

  • Limit your 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.
  • Cause too much drowsiness.

For these reasons, we recommend you limit 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 as this may allow bacteria to enter your bloodstream.  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 or discuss this further with your doctor. 

Is a wig covered by insurance?

People who lose their hair from cancer treatment may have insurance coverage for a wig.  In this case, the doctor should write a prescription for a “total cranial prosthesis for chemotherapy-induced alopecia” and include the breast cancer diagnosis code (174.9) on the prescription.  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.  It may also be necessary for you and your doctor to plan a treatment holiday or break week from your treatment so you can take extended trips. Consider getting travel insurance in case you have to cancel your trip for any reason. 

Will I be able to continue working?

Many people with advanced breast cancer continue to work. Whether you can work depends on the type of work, side effects of treatment, and symptoms of your breast cancer.  Speak with your doctor or nurse if you are struggling to continue working or would like to take a leave of absence from work.