tumor stage 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 body.
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.
In 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 (September 2010).*
*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 Therefore, some information may be out of date at this time.
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.
Breast cancer 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.
Learn 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 the 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.
Learn more about insurance 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 used.
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 bloodstream.
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 port-a-cath.
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 programs.
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)
Hair 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.
Chemotherapy 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 numbness.
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 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).
Although studies of ways to ease fatigue are limited, some tips may help .
Tips to manage fatigue
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).
Chemotherapy 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 leukemia.
Some 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 menopause.
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 menopausal symptoms.
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.
If you 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.
At this time, there are no known treatments to protect the ovaries from the damaging effects of chemotherapy. However, some drugs are under study (learn more).
Learn more about fertility options for women undergoing chemotherapy.
Read our perspective on fertility options for women diagnosed with breast cancer (January 2012).*
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 .
Maintaining a 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 exercise.
Although mainly a short-term problem, fatigue can affect some people long-term . 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.
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 understood.
Cognitive problems may not be limited to women treated with chemotherapy. They have also been reported after other breast cancer treatments . More 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 problems .
Tips to improve cognitive function
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 damage . 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 heart conditions.
Leukemia has been linked to the use of certain chemotherapy drugs including cyclophosphamide, doxorubicin and epirubicin .
For most people with breast cancer, the benefits of chemotherapy outweigh these risks.
Learn more about talking to your health care provider.
Susan G. 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.
Komen supports 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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