and certain tumor characteristics (such as hormone receptor
status), as well as your age, overall health and personal preferences.
For those with early breast cancer, chemotherapy
is usually given after breast surgery (called adjuvant chemotherapy), but before
radiation therapy. Adjuvant chemotherapy helps lower the risk of breast cancer
recurrence by getting rid of cancer cells that might still be present in the
Chemotherapy is sometimes
used before surgery (called neoadjuvant or preoperative chemotherapy). In women
with large tumors who need a mastectomy, neoadjuvant chemotherapy may shrink the tumor enough
that a lumpectomy becomes an option.
women with locally advanced breast cancer, neoadjuvant chemotherapy can reduce
the size of the tumor in the breast and/or in the lymph nodes, and make it
easier to surgically remove the cancer.
Learn more about neoadjuvant chemotherapy.
Read our perspective on neoadjuvant chemotherapy
the information provided within Komen Perspectives articles is only current as
of the date of posting. Therefore, some information may be out of date at this
For those with metastatic breast
cancer, chemotherapy is used to kill cancer cells that have spread from the
breast to other parts of the body. Chemotherapy can reduce cancer-related
symptoms and prolong survival.
Learn more about treatment for
metastatic breast cancer.
Although exact chemotherapy plans vary from person to person, treatment
guidelines help ensure quality care. These guidelines are based on the latest
research and the consensus of experts. The National Comprehensive Care
Network (NCCN) and American
Society of Clinical Oncology (ASCO) are two respected organizations
that regularly update and post their guidelines online. The National Cancer Institute (NCI) also has overviews
of treatment options.
treatment is most effective when all parts of the treatment plan are followed.
So, it is important to follow your treatment plan (for medications and other
therapies) prescribed by your health care provider in terms of:
Side effects are one reason people have
trouble completing oral chemotherapy . Although most side effects go away
shortly after chemotherapy ends, preventing or treating symptoms can help you
complete your course of chemotherapy. You should never feel you have to endure
side effects, such as nausea. Talk to your health care provider about any side
effects you are having. He/she may be able to prescribe medications to treat
your side effects or change your treatment plan to reduce them.
more about the
side effects of chemotherapy.
If you have trouble remembering to
take oral chemotherapy or medications to treat side effects, a daily pillbox or
setting an alarm on your watch or mobile device (you may be able to download a
mobile app) may help .
Learn more about
importance of following your breast cancer treatment plan.
If you have transportation, child care or elder care issues that
make getting to IV chemotherapy treatments difficult, there may be resources
that can help. Getting to and from the treatment can be hard, especially if you
live far away. If you need a ride to and from treatment or have child care or
elder care needs, there are resources to help. Family and friends often want to
help, but do not know how. These are ways they may be helpful to you. And, some
organizations offer programs to assist with transportation, child care and elder
care costs. Others offer lodging if you need a place to stay overnight so that
you can get treatment.
Don’t hesitate to ask for help from your
co-survivors or contact organizations that offer help with
transportation, lodging, child care or elder care.
Chemotherapy drug costs can quickly become a
financial burden for you and your family. Medicare and many insurance providers
offer prescription drug plans. One may already be included in your policy or you
may be able to buy an extra plan for prescriptions.
Some drugs are off-patent and a generic
form may be available. Generic drugs are cheaper than the name brands, but are
just as effective. You may also qualify for assistance from programs that help
with drug costs or offer low-cost or free prescriptions.
plans and prescription
drug assistance programs.
A chemotherapy schedule depends on the drugs and
combinations of drugs used in your treatment plan. Chemotherapy is often given
in cycles, with days or weeks off between treatments. This cycling gives your
body a chance to recover between treatments. A full course of chemotherapy
usually lasts three to six months.
Chemotherapy drugs can be taken in pill form or injected intravenously (into
a vein with an IV). Often, a combination of two or three chemotherapy drugs is
Most modern chemotherapy regimens for breast cancer involve IV
drugs, given in an outpatient setting at a hospital or clinic. At each visit, an
IV is inserted into the arm, allowing the drugs to drip into the
Some people have a surgical procedure to insert a small
device called a port-a-cath under the skin of the chest. Chemotherapy drugs can
be given through the port-a-cath, which remains in place for the three to six
months of treatment. A port-a-cath is helpful if it is difficult to put in an IV
at each visit. The picture below shows a person getting chemotherapy through a
Source: National Cancer Institute (www.cancer.gov)
Each chemotherapy visit lasts from one to six hours,
including time with your medical and nursing teams.
At each visit, your
blood counts will be checked and you may be given anti-nausea medications and
other treatments to make the chemotherapy easier to tolerate. You can bring a
friend or family member with you during the visit. You may also choose to read,
listen to music or watch television.
Before you begin chemotherapy, talk
to your health care provider about possible side effects and whether you need to
have someone drive you home after each visit.
If you do not live near the treatment
center, it can be hard to get to and from chemotherapy sessions. Sometimes,
there are programs that offer help with local or long-distance transportation
and lodging. Learn more about these
Chemotherapy has many common side
effects. Most occur during treatment and begin to go away shortly after
treatment ends. Others can last for months or even years. How common and how the
severe side effects are depends on the type of chemotherapy.
Let your oncologist or nurse know how the sessions are making you
feel. They may be able to treat or prevent many side effects.
You may be worried about chemotherapy and its possible side effects. This is
normal. Talk openly with your health care provider and express your concerns.
He/she may be able to suggest a hospital social worker, patient navigator,
psychologist or support group that can help ease anxiety related to chemotherapy
or to having breast cancer.
Learn more about support groups.
Some of the most common short-term side effects of chemotherapy are
hair loss (alopecia), nausea and vomiting. The side effects you are likely to
have depend on the chemotherapy drugs you are given.
Facts For Life: Chemotherapy and Side Effects (PDF)
loss (also called alopecia (A-loh-PEE-shuh)) is a well-known side effect of
chemotherapy. Though it's most visible on your head, hair loss may occur all
over your body (including eyebrows and pubic hair).
Over the years,
people have tried many things to prevent hair loss with chemotherapy. Using a
gentle shampoo and washing your hair less often may reduce hair loss. A
technique called scalp cooling is currently under study as a way to reduce hair
loss . A
special cap is filled with a very cold substance and worn during each
chemotherapy session. At this time, it is not known whether scalp cooling
reduces hair loss.
With some chemotherapy drugs (including
anthracyclines such as doxorubicin, and taxanes such as paclitaxel or
docetaxel), however, you almost always lose your hair.
During treatment, you will deal with many
emotional aspects of breast cancer. Losing your hair can be especially hard. As
with breast surgery, losing your hair affects a part of your body that is tied
to your identity.
Wigs, hats and scarves may help you cope with hair
loss. If you are thinking about wearing a wig, you may want to pick one out
before you start chemotherapy. This may help you find a good match for your
natural color and cut. Many insurance plans cover all or part of the cost of a
wig for people getting chemotherapy if the claim includes a health care
provider's prescription or letter.
Some people cut their hair short
once they start chemotherapy to prepare for the loss of their hair. This may
help you feel in control.
Hair will begin to grow back two to three months
after treatment ends, though it may be a different color and texture than it was
before . It
often comes in curlier and grayer. Hair texture will return to normal over many
months. You may dye, color or treat your hair whenever you like.
A note if you are traveling by air
Susan G. Komen® wants to ensure
breast cancer survivors are treated with respect and dignity. If you have lost
your hair due to chemotherapy and wear a scarf or other head covering, below are
some steps you can take that may help you as you plan your air travel. You do
not need to do so, but if you wish, tell the Transportation Security
Administration (TSA) agent you are undergoing breast cancer treatment. If you
prefer to give this information more discreetly, the TSA now offers a
notification card you can give to the agent (find this card on the TSA website).
If you have concerns about airline security screening, visit the TSA website for the latest information and a list of other
tips to make the process as comfortable as possible.
Some (but not all) chemotherapy drugs cause nausea
and vomiting. To help prevent and control nausea and vomiting, your health care
provider will prescribe anti-nausea medications and give you instructions on how
to use them. The anti-nausea medications you are prescribed will depend on the
chemotherapy drugs you are given.
Tips to manage nausea
Some chemotherapy drugs (such as paclitaxel
and docetaxel) can damage your fingernails and toenails. The nails may:
Like hair loss, nail
problems are temporary. Keeping your nails short during treatment may make nail
care easier. Your nails will return to normal once chemotherapy ends. You may
use nail polish whenever you wish.
Chemotherapy drugs (including
vinorelbine, cisplatin and taxanes such as paclitaxel and docetaxel) can cause
nerve damage. If this happens, you may feel a burning or shooting pain
(neuropathy) or numbness, usually in your fingers or toes. These side effects
almost always go away after chemotherapy ends, though it may take weeks or
months. In rare cases, the numbness or pain can persist.
can also cause muscle pain (myalgia) or numbness. If you have these side
effects, tell your health care provider right away. He/she may want to adjust
your chemotherapy plan to ease these symptoms. Your provider may also prescribe
mild pain relievers or suggest other treatments to ease the pain or
Learn more about managing pain related to treatment.
Some chemotherapy drugs
(including doxorubicin and docetaxel) can harm the tissues lining your mouth and
throat, causing sores (called mucositis or stomatitis). These sores can make it
painful to eat and drink. Mouth sores go away once chemotherapy ends. However if
you have any pain or see any problems in your mouth or throat, contact your
health care provider. He/she can prescribe a special mouthwash or other
medication to relieve pain and treat the sores.
Chemotherapy can cause fatigue. You may feel like you don’t have any energy
and may be tired all of the time. Sometimes, getting enough rest doesn’t
Regular exercise, even just walking for 10 to 20 minutes every
day, can help reduce fatigue [28-30].
Getting a good night’s sleep is also important. Talk to your health care
provider if you have fatigue or problems sleeping (insomnia).
studies of ways to ease fatigue are limited, some tips may help .
Tips to manage
Chemotherapy drugs can cause other short-term side effects, including:
Some of these side effects, such as loss
of menstrual periods, may last after treatment ends.
Chemotherapy can cause a drop in the red blood cell count (called anemia).
Anemia can cause fatigue and shortness of breath. It can also make you look
pale. Sometimes, anemia can be treated by increasing iron or folate in the diet. Severe anemia can be
treated with a blood transfusion.
Growth factors, such as erythropoietin
(Procrit, Epogen and Aranesp) and similar drugs can increase red blood cell
count. However, safety analyses have raised questions about whether people with
breast cancer should get erythropoietin (for more on these safety analyses,
visit the FDA website).
can also cause a drop in the white blood cell count (called leukopenia or
neutropenia). Some chemotherapy plans include white blood cell growth factors
such as filgrastim (Neupogen) and pegfilgrastim (Neulasta). These growth factors
help maintain white blood cell counts and reduce the risk of infection while you
are undergoing chemotherapy. Growth factors are given by injection. A nurse can
inject these medications, or you can learn to do it yourself.
Common long-term side effects of chemotherapy include early
menopause and weight gain. Rare side effects include heart problems and
chemotherapy drugs can damage the ovaries and stop regular menstrual cycles
(amenorrhea). In women under 40, this condition is often temporary (periods
usually start again). In women over 40, it is more often permanent, meaning
menopause begins earlier than expected .
Some women may begin having periods again months or years after chemotherapy
ends. However, even for women whose periods return, menopause may still begin at
an earlier age than for other women .
Going through early menopause can be very upsetting. As with natural
menopause, you may have symptoms such as hot flashes (including night sweats)
and vaginal dryness (also called vaginal atrophy). And, because the onset of
menopause is abrupt, these symptoms may be more severe than with natural
Early menopause can also affect bone health. Menopause can
cause a loss of bone density (osteopenia or osteoporosis). And, some women who
go through menopause have muscle or joint aches.
Learn about ways to ease
Read our perspective on managing menopausal
symptoms (April 2012).*
*Please note, the information provided within
Komen Perspectives articles is only current as of the date of posting.
Therefore, some information may be out of date at this time.
were hoping to have a child after breast cancer treatment, early menopause can
be especially difficult. However, there are procedures that may allow you to
have children after treatment. Speak to a fertility specialist before starting
treatment to understand your options.
The most common procedure for
preserving fertility involves storing embryos before chemotherapy begins. In
this procedure, some of your eggs are collected and fertilized by sperm from a
spouse, partner or donor.
Insurance coverage for fertility services
varies widely from state to state, so it is important to check with your
insurance provider to find out which procedures are covered.
time, there are no known treatments to protect the ovaries from the damaging
effects of chemotherapy. However, some drugs are under study (learn
Learn more about fertility options for women
Read our perspective on fertility options for
women diagnosed with breast cancer (January 2012).*
*Please note, the
information provided within Komen Perspectives articles is only current as of
the date of posting. Therefore, some information may be out of date at this
Weight gain is a common side effect of chemotherapy, especially in women who
go into early menopause .
Changes in metabolism caused by chemotherapy and a less active lifestyle add to
weight gain during treatment. One study found that breast cancer survivors who
got chemotherapy were 65 percent more likely to gain weight compared to those
who did not get chemotherapy .
Women who gain weight usually put on about five to ten pounds . The more weight a woman
gains, the less likely she is to return to her pre-diagnosis weight .
healthy weight after a breast cancer diagnosis is important and may improve
survival [33-35]. Learn more about body
weight and survival after breast cancer.
Eating tips to
manage your weight
Making healthy food choices
and getting regular exercise during treatment (if possible) may help prevent
weight gain. Seeing a dietician may also help. Learn more about a healthy diet and
Although mainly a short-term problem, fatigue can affect some people
You may feel like you don’t have any energy and may feel tired all of the time.
Sometimes, getting enough rest doesn’t help.
Regular exercise, even
just walking for 10 to 20 minutes every day, can help reduce fatigue [28-30]. Getting a good
night’s sleep is also important. Talk to your health care provider if you have
fatigue or problems sleeping (insomnia).
Learn more about fatigue and insomnia.
Some people have cognitive problems after chemotherapy, including mental
“fogginess” and trouble with concentration, memory and multi-tasking [37-38]. This condition is
often called “cancer brain” or “chemo-brain.”
Most people have mild
symptoms, though some have more troubling cognitive problems that can impact
daily life. Symptoms may last for one to two years after treatment or longer.
Most people report that they go away over time.
The link between
cognitive problems and breast cancer diagnosis and treatment remains unclear.
Medications used to treat the side effects of chemotherapy, such as sleeping
aids and anti-nausea medications, can also cause these symptoms. And, stress,
anxiety and depression can affect cognitive function. Symptoms may first appear
with the stress related to diagnosis and treatment and then become worse after
chemotherapy. Age may also play a role. Some studies show older women tend to
have more cognitive problems after chemotherapy than younger women . At this time,
the true extent of the cognitive effects of chemotherapy is not well
Cognitive problems may not be limited to women treated with
chemotherapy. They have also been reported after other breast cancer treatments
research is needed in this area.
Although there are no data to show the
tips below improve cognitive function, they may help some people with memory
Tips to improve
Heart problems and leukemia are rare but severe side
effects of certain types of chemotherapy. These risks are related to the dose
and type of chemotherapy drug. With the doses given today, the risk of having
either heart problems or leukemia is low [40-41].
Heart problems, like cardiomyopathy (enlarged, weakened heart) and congestive
heart failure, have been linked to the use of certain chemotherapy drugs (such
as doxorubicin and epirubicin) and to the use of trastuzumab [40-41]. (Learn more about trastuzumab.) These conditions
can sometimes be reversed if the drugs are stopped at the first sign of heart
With drugs that may cause heart problems, extra care is taken to avoid heart
problems. For example, before you begin chemotherapy with the drug doxorubicin,
your heart function will be measured to make sure there are no pre-existing
Leukemia has been linked to the use of certain
chemotherapy drugs including cyclophosphamide, doxorubicin and epirubicin .
most people with breast cancer, the benefits of chemotherapy outweigh these
more about talking to your health care provider.
Komen® position on fairness in oral chemotherapy drug coverage
While intravenously (IV)
chemotherapy is a well-known part of cancer treatment, an increasing number of
chemotherapy drugs today can be taken by mouth (oral). Insurance policies have
not kept pace with these advances in chemotherapy. As a result, people often
find themselves facing high out-of-pocket costs when filling their prescriptions
for oral chemotherapy (sometimes costing thousands of dollars per month). This
disparity exists because IV chemotherapy is usually covered under a health
insurance plan’s medical benefit, whereas oral chemotherapy is usually covered
under a plan’s prescription drug benefit.
High prescription drug costs
are a barrier to care. High costs can prevent people from getting the
medications prescribed by their health care providers. No one should be forced
to get less appropriate treatment simply because an insurer provides more
coverage for IV chemotherapy than oral chemotherapy.
efforts at the state and federal level to require insurers to provide equal (or
better) coverage for oral chemotherapy as they provide for IV chemotherapy to
ensure people have access to affordable, appropriate treatment for their cancer.
Komen Support Resources
Learn about the chemotherapy drugs used to treat breast cancer.
Read about emerging areas of research in the treatment of early breast cancer.
Interactive Treatment Navigation Tool
Facts for Life: Chemotherapy and Side Effects
Breast Cancer 101 - Side Effects of Chemotherapy
Questions to Ask Y our Doctor About Chemotherapy
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