Chemotherapy for breast cancer

Overview

Chemotherapy is a frequently employed treatment method for breast cancer. Its primary goal is to eliminate cancer cells within the breast or those that have spread from the breast to other areas of the body. Oncologists commonly administer chemotherapy either before or after breast cancer surgery, and they may use a single chemotherapy drug, a combination of drugs, or combine chemotherapy with other therapeutic approaches.

Chemotherapy for breast cancer can lead to a range of side effects, some of which may manifest long after the completion of treatment. Oncologists are equipped with strategies and recommendations to help patients manage immediate and short-term side effects. Additionally, they provide information regarding potential long-term side effects to ensure comprehensive care and support throughout the treatment process.

Types of chemotherapy for breast cancer

Chemotherapy medications come in various forms, and your oncologist may prescribe one or more drugs based on your specific situation. Here are some chemotherapy options for different breast cancer treatments:

Adjuvant and neoadjuvant breast cancer treatment:

• 5-fluorouracil or capecitabine
• Cyclophosphamide
• Carboplatin
• Anthracyclines (e.g., doxorubicin and epirubicin)
• Taxanes (e.g., paclitaxel and docetaxel)

Metastatic breast cancer treatment:

• Eribulin
• Platinum agents
• Ixabepilone
• Vinorelbine
• Capecitabine
• Gemcitabine
• Taxanes (e.g., paclitaxel, docetaxel, and albumin-bound paclitaxel)
• Anthracyclines (e.g., doxorubicin, liposomal doxorubicin, and epirubicin)
• Antibody drug conjugates (e.g., ado-trastuzumab emtansine, fam-trastuzumab deruxtecan, and sacituzumab govitecan)

Chemotherapy can be administered through various methods, including intravenous (IV) infusion, injections, or oral tablets. Typically, patients receive chemotherapy in a hospital or an infusion center. Intravenously delivered chemotherapy often involves the use of Central Venous Catheters (CVCs), and there are several types available:

Types of central venous catheters (CVCs):

• Central line: A long plastic tube inserted into veins in your arms, neck, or heart.
• Peripherally inserted central catheter (PICC): Inserted by providers into an arm vein.
• Chemo port: A tiny implanted device that allows doctors to administer chemotherapy intravenously without the need for repeated needle injections.

Reasons for undergoing the procedure

Chemotherapy can be administered in various ways for the treatment of breast cancer:

• Neoadjuvant chemotherapy (before surgery): Neoadjuvant chemotherapy is given before surgery. Its purpose is to shrink breast cancer tumors, making it easier for the surgeon to remove the tumor without taking healthy breast tissue. Additionally, it provides early feedback on the effectiveness of specific chemotherapy drugs.
• Adjuvant chemotherapy (after surgery): Adjuvant chemotherapy is administered after surgery. Even after surgery, some microscopic cancer cells may remain undetected. Adjuvant chemotherapy helps eliminate these remaining cancer cells and reduces the risk of breast cancer recurrence.
• Metastatic breast cancer treatment: When breast cancer has spread from the breast to other parts of the body, chemotherapy may be the primary treatment approach to target and control the cancer in these distant areas.
• Inflammatory breast cancer (IBC) treatment: IBC doesn’t form tumors that can be surgically removed. Therefore, chemotherapy is often used as the initial treatment for IBC, aiming to shrink the cancer and control its growth.
• Triple-negative breast cancer (TNBC) treatment: TNBC is typically treated with a combination of chemotherapy and immunotherapy to effectively target this specific subtype of breast cancer.
• HER2+ breast cancer prevention: In cases where HER2+ breast cancer is likely to return, a combination of chemotherapy and targeted therapy may be used as a proactive measure to prevent recurrence.

These different approaches to chemotherapy are tailored to the specific characteristics of the breast cancer and its stage, ensuring the most effective treatment for each patient.

Risks

Some chemotherapy drugs used to treat breast cancer may lead to the development of second or new cancers such as acute myeloid leukemia and myelodysplastic syndromes. Unlike metastatic breast cancer, which involves the spread of the original cancer, these second cancers can emerge years after individuals have completed their breast cancer chemotherapy treatment.

Before chemotherapy

Tailoring chemotherapy for breast cancer involves a careful consideration of various factors by oncologists and pharmacists. These factors include the type and stage of breast cancer, test results, and your body mass index (BMI), all of which help determine the appropriate dosage. During this process, your healthcare team will thoroughly explain the chosen chemotherapy regimen, its rationale, and potential side effects. It is an ideal time to discuss preparations for your treatment, as chemotherapy may extend over several months. People’s experiences with chemotherapy vary, with some managing their daily activities relatively well, while others struggle with significant side effects. Therefore, understanding what to anticipate can aid in effective planning.

Here are some practical tips for managing chemotherapy treatment:

• Arrange for support: Consider arranging for additional assistance at home for a day or two after each treatment session. It’s also helpful to have someone accompany you to treatment, provide company during the session, and take you back home.
• Comfort matters: Select comfortable clothing to wear during treatment to ensure relaxation. Bringing along a pillow or blanket can enhance your comfort.
• Entertainment: To pass the time during chemotherapy sessions, bring something to read or games to play. If you prefer digital entertainment, remember to bring headphones for your tablet to watch shows, listen to podcasts, or enjoy music without disturbing others receiving treatment.
• Stay hydrated: Chemotherapy can be dehydrating, so plan to increase your water intake the day before your treatment.
• Explore palliative care: Speak with your oncologist about palliative care, which not only helps manage cancer symptoms and treatment side effects but also provides invaluable support and programs throughout your breast cancer chemotherapy journey and beyond.

By following these recommendations and actively involving your healthcare team, you can better prepare for and navigate the challenges of breast cancer chemotherapy treatment.

During the procedure

Upon your arrival at the healthcare facility for chemotherapy, a healthcare provider will guide you to the designated area where you will receive your treatment.

Here’s what the healthcare provider will do:

• Accessing your CVC or starting an IV: The healthcare provider will either access your central venous catheter (CVC) or initiate an intravenous (IV) line to administer the chemotherapy drugs into your bloodstream.
• Monitoring during treatment: Throughout the treatment, your healthcare provider will keep a close eye on you. In rare instances, there might be an issue such as chemotherapy drugs leaking from the IV (known as extravasation). Healthcare providers are trained to handle such situations promptly.
• Post-treatment care: After the chemotherapy session is completed, the healthcare provider will flush the IV line or CVC with a saline solution. Subsequently, they will remove the IV from your arm or the CVC.
• Monitoring period: You will be required to remain in your treatment area for approximately 30 minutes following the procedure. This period allows your healthcare provider to confirm that you are not experiencing any unusual reactions to the chemotherapy treatment.

This process ensures that you receive safe and effective chemotherapy while being closely monitored for any potential complications.

After the procedure

After completing chemotherapy, your oncologist will order imaging tests, such as computed tomography (CT) scans or magnetic resonance imaging (MRI) scans, to assess the tumor’s status and determine the subsequent course of action.

For instance, if you underwent neoadjuvant chemotherapy, the next steps may entail surgical removal of the tumor followed by chemotherapy to eradicate any remaining cancer cells. If surgery and post-surgery chemotherapy effectively eliminated cancer symptoms and signs, your oncologist may establish a schedule for regular follow-up examinations and screening tests.

Outcome

Managing side effects and well-being during chemotherapy:

• Structured treatment: Healthcare providers carefully schedule chemotherapy to allow your body to recover between sessions. It’s common for individuals to experience varying recovery times. If you encounter unexpected recovery issues, consult your oncologist, who may suggest alternative chemotherapy drugs.
• Balanced nutrition: Chemotherapy can affect your appetite, but maintaining a well-rounded diet is essential in combating cancer-related fatigue. Aim to consume protein and other vital nutrients. Consider switching to several small meals throughout the day instead of three large ones. Seek advice from a nutritionist for meal planning.
• Stay active: Dealing with cancer and its treatments can be stressful. Engaging in regular light exercises such as walking or practicing yoga can help alleviate stress and reduce chemotherapy-induced fatigue.
• Emotional support: Coping with chemotherapy may trigger a range of emotions, from anxiety about side effects to frustration due to treatment disruptions. Finding a trusted individual to talk to or joining a support group can provide an outlet for expressing your feelings.
• Regular check-ins: Throughout your treatment, you will have scheduled appointments with your oncologist. It’s crucial to maintain these regular check-ins. Additionally, if you experience any of the following symptoms, contact your healthcare provider or seek immediate medical attention:
  • Fever exceeding 100.4 degrees Fahrenheit (38 degrees Celsius).
  • Chest pain or difficulty breathing.
  • Chills.
  • Sudden confusion or delirium.
  • Severe headache accompanied by neck stiffness.

Prioritizing your physical and emotional well-being during chemotherapy is vital. Discuss any concerns with your healthcare team, as they are there to support you throughout your journey.