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Managing the Side Effects of Triple-Negative Breast Cancer

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Published on October 8, 2020

How Can I Manage the Side Effects of Triple-Negative Breast Cancer Treatment?

There are many treatment options for triple-negative breast cancer (TNBC), which can bring an array of related side effects. What are the common side effects of chemotherapy? What does immunotherapy entail? Can introducing exercise and diet mitigate the effects? After treatment is finished, what lifestyle changes should you make to prevent recurrence? 

TNBC survivors Ricki Fairley and Moira Quinn, along with cancer expert Dr. Tolaney of the Dana-Farber Cancer Institute, will answer all of these questions and more regarding side effect management and long-term health. 

This is Part 4 of a four-part series. Watch Part 1 (Treatments for Early-Stage Triple-Negative Breast Cancer (TNBC)), Part 2 (Triple-Negative Breast Cancer Treatment Options By Subtype ), and Part 3 (Clinical Trials for Triple-Negative Breast Cancer) for more information.

This program is supported by an educational grant from Daiichi Sankyo. This organization has no editorial control. It is produced by Patient Power and Patient Power is solely responsible for program content. 


Transcript | Managing the Side Effects of Triple-Negative Breast Cancer

What are the side effects of new TNBC treatments?

Dr. Tolaney:
Some of these newer drugs do have new and different side effects. I think most people are very aware of some of the standard side effects from standard chemotherapy. Like several of our drugs, unfortunately, can cause hair loss. Although I will say now with scalp cooling sometimes people can keep their hair and with certain drugs and so that's something definitely to talk to your oncologist about and before starting treatment is if scalp cooling would be an option and if it could be beneficial for you.

Chemotherapy generally can also lower your blood count and so it could put you at risk for infections and so something that has to be monitored and sometimes we do give growth factor drugs to help stimulate your white blood cell counts. It can also cause some fatigue and some drugs can cause neuropathy and some drugs can even cause heart toxicity that needs to be monitored. I think, again, many people are familiar with some of these side effects like nausea, diarrhea, but I think what's very different for example, are the side effects from immunotherapy because this isn't chemotherapy.

What are the effects of immunotherapy?

What the immunotherapy is doing is it's stimulating your immune system so that your immune system attacks and kills the cancer, but what if you're... normally people tolerate these drugs fine. They're IV drugs that are given every two or three weeks, sometimes every four weeks and generally, they go home and they don't notice too much difference. Sometimes people get a low-grade temperature or feel a little achy and then they feel fine.

But there are rare serious toxicities that can occur from immunotherapy because what if your immune system gets a little too revved up and what if it starts seeing normal cells as things that don't belong as foreign things, and it starts attacking your normal healthy lung, for example, then your lungs are going to get all inflamed from being attacked by your immune system and you could get a cough or feel short-winded and that's a serious side effect and one that we need to hold immunotherapy for. Quiet down the inflammation with some steroids and that's very different than standard toxicity.

Some people get diarrhea, but it's not because the way they think of diarrhea from chemotherapy, but instead it's because their colon got inflamed, and so the treatment for that is very different when it's from immunotherapy. You have to give steroids to quiet it down. It's very important if someone's on immunotherapy that they realize they're on it because if they ever go to see a doctor that's not their regular oncologist, they need to know that they're on immunotherapy because the workup and treatment for immune-related toxicities is very different.

How can you prevent recurrence and maintain health after treatment?

Ricki Fairley:
So you've gone through your treatment and now you're on the other side of it. You're NED, no evidence of disease. What lifestyle changes should you make to keep yourself healthy and to kind of prevent recurrence? I know for African American women, their occurrence rate is like 39%, it's pretty high. What should we be doing when we sort of get healthy again?

Dr. Tolaney:
I think we're learning more and more about this, and there is some data to suggest that perhaps rigorous aerobic level exercise can potentially help reduce risks of recurrence. This is based off some retrospective data and some small prospective trials. There is an ongoing trial currently called the BWEL study. It's run by a large cooperative group in the U.S., the Alliance group, where they are randomizing women after all their treatment to get enrolled into a diet and exercise intervention versus not, and really looking to prove that this will help improve outcomes and so there's this suggestion.

I think given that I always do have a discussion with my patients about the importance of keeping very active and exercising regularly. Because again, there is a suggestion that it could help prevent recurrence and obviously I think it's very good for you in general, in terms of your general health anyway so there's no downside to that. In terms of the diet, which is a very frequent question we get, I think it's challenging because the data isn't so clear. There isn't an ideal diet that I can recommend and say that this diet is the one that's going to help prevent recurrence.

We get lots of questions about, can I drink alcohol? Can I eat red meat? What can I do to help prevent this cancer from coming back? There is some data that heavy alcohol consumption is not good and may be associated with higher rates of recurrence, but what does heavy mean? There are different studies that actually quote different numbers of glasses per week that we need to stay below. My general rule of thumb is things in moderation are probably okay.

I think one doesn't have to be so strict that you can never have a glass of wine. We do not know that. I think there's some people who think they should not eat any sugar, which is really, really hard to do and not proven. There isn't yet good enough data to provide the perfect dietary recommendation.

Does mental health play a role in long-term well-being?

Moira Quinn:
Do you have any kind of feedback about the health of your mind or mind exercises? We talked about body, we talked about exercise. How about mind?

Dr. Tolaney:
That's an excellent point. There's a lot of very interesting data to suggest that there's a very strong mind-body interaction and that there is some work that has been done. There is actually a very interesting trial that one of my colleagues had run where she randomized women prior to surgery to go into an exercise intervention. Really intensive exercise, or to have a mind-body intervention, and then looked at the tumor in the breast at the time of surgery and compared the tumors between the heavy exercisers versus those patients who had a mind-body intervention.

It was really interesting that there were multiple immune signaling pathways that were impacted in the heavy exercisers, suggesting that maybe there is something to this intensive exercise in terms of augmenting your immune system. Whereas they actually truthfully didn't see that in the mind-body intervention, but it was a very small number of patients and I think we need more work here to better understand exactly what the true impact is biologically in the cancer, but there is some suggestion that there can be some pathways that can be altered by this.

Ricki Fairley:
Moira, I did a lot of crazy things when I was sick. When I was on chemo, I divorced my husband at 30 years.

Moira Quinn:
Oh, dear.

Ricki Fairley:
I quit my business partners and started my own company and I sold my big house in the suburbs. I moved to the beach. Are you crazy? Have you lost your mind? Chemo brain... but I had to make decision to choose life and I knew that I had to find peace so I could heal my body and so I did a lot of crazy things to choose life and find peace. I think it helped me heal but I had to learn that I had to get rid of all the cancers in my life, not just the one in my breasts. What did you do Moira? Did you do anything different or crazy like me?

Moira Quinn:
What I did learn, what I did find is that I found out what was important in my life and I discovered that with... I have children and grandchildren. I discovered, why did I ever say no to my children or grandchildren when I wanted them to come over? When I wanted to do things for them. Why did I ever say no to them? Why did I ever do that?

I learned to say yes to the things in my life that were important and no to that things in my life that were not. It did a really good job of helping me prioritize what was important in my life and what mattered to me and to say yes to those things, and then just say no to the things that I didn't really care about anymore. It's a great prioritizer in your life and I feel like in a lot of ways, it was one of the worst things that happened and the best things that ever happen to me, to be honest because it allowed me to make some really good decisions in my life.

And my brother told me in the beginning, my brother is a psychologist. He said in the beginning make a decision matrix as I was completely panicked and freaked out. He said, make a decision matrix. Don't make every decision right now because you can't. Make the best decision in front of you now then make the next good decision, then make the next good decision and do it all through a decision matrix and decide what's important, and the one thing that was important to me was to survive. I would do anything to survive.

Ricki Fairley:
Anything to just survive. Yeah.

Moira Quinn:
I chose life. So, every decision I made was is this going to help me survive? Then I will do it. Is this going to help me survive? Yes. Then I will do it. That was my decision matrix. I will live.

Ricki Fairley:
We thank you so much for today. Thank you so much. My message of hope is, your peace is non-negotiable. Find your peace. Your peace is non-negotiable. 

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