How to manage late effects of breast cancer treatment

When cancer treatment is over, many people feel relief. They no longer experience the side effects that come along with treatment.

But it’s also a time to keep asking questions. That’s because no matter the treatment plan, there’s a possibility that some new symptoms — called late effects of cancer treatment — could still occur.

Being prepared and asking questions — especially when still close to the treatment process — can help those affected by late effects manage their health in the months and years after cancer treatment.

Here’s a list of questions, recommended by Mayo Clinic experts, to ask about late effects of cancer treatment.

Q: What late effects are common given my specific treatment program?

A: Late effects vary depending on the type of cancer and treatment you had. They can be caused by any of the main types of cancer treatment, including chemotherapy, radiation, surgery or hormone therapy.

As newer treatments like targeted therapy and immunotherapy are developed, researchers may find that they, too, cause late effects.

Don’t be afraid to dig a little and find out if there are elements to your treatment program that are more likely to cause late effects. Your doctor can help you understand what to expect — and the best ways to manage or minimize potential symptoms.

After hormone therapy, common types of late effects may include:

• Blood clots
• Menopausal symptoms
• Increased risk of other cancers
• Bone loss (osteoporosis)
• Sexual side effects

After radiation, common types of late effects may include:

• Dental issues, like cavities
• Early menopause
• Heart or lung problems
• Thyroid issues
• Lymphedema (swelling that generally occurs in your arms or legs)
• Increased risk of other cancers or stroke
• Fertility issues
• Intestinal problems
• Memory issues

After chemotherapy, common types of late effects may include:

• Dental issues, like cavities
• Early menopause
• Hearing loss
• Heart or lung problems
• Increased risk of other cancers
• Infertility
• Loss of taste
• Bone loss (osteoporosis)
• Nerve damage

After surgery, a common late effect may include:

• Lymphedema

Q: What signs or symptoms should I watch for?

A: Late effects of cancer treatment vary from person to person. Your experience may be different from someone else’s, even if you had the same kind of cancer and treatment.

Late effects can cause changes in your weight, breathing, energy level or even mood. Ask your doctor about the signs and symptoms that are most common for your particular situation. Pay attention to your body and report any health changes to your care team.

Q: When do late effects of cancer treatment typically occur?

A: Again, this depends on the specific treatment or treatments you received. But late effects can occur months or even years after you’ve finished treatment.

Some late effects, like lymphedema, can occur in the days and weeks after surgery or radiation. Other late effects, like menopausal symptoms following breast cancer treatment, may not occur until 1 to 2 years after treatment.

Q: How should I anticipate managing these late effects?

A: You can help counteract many of the late effects of cancer treatment.

For instance, if your treatment increases your risk of osteoporosis, there are medications you can take to help minimize bone loss. Or if you’re experiencing joint pain, treatments like acupuncture have been shown to help.

Keep your doctor updated on any changes to your health. He or she will evaluate your symptoms, decide if you need additional testing and help you manage any side effects that come your way.

Q: Is there anything I can do to prevent late effects?

A: Many of the late effects of cancer treatment can be minimized by taking action before, during or after treatment.

Ask your doctor for measures you can take to reduce your risk of late effects depending on your specific situation. Some examples:

• Risk of osteoporosis. Do regular weight-bearing exercises like walking, don’t smoke and limit your alcohol intake.
• Risk of heart problems. Eat a heart-healthy diet, maintain a healthy weight, exercise regularly, quit smoking and get enough sleep.
• Risk of eye problems. Schedule appointments with an ophthalmologist, who can assess your eye health and risk of developing cataracts.
• Risk of hearing problems. Schedule appointments with an audiologist, who can assess your hearing and determine your risk of hearing loss.
• Risk of dental problems. Make regular appointments with your dentist. Take care of your teeth with regular brushing and flossing. Gargle with a mouthwash every day. (But avoid washes that contain alcohol.)

Q: How should I manage lymphedema?

Lymphedema starts when part of the lymph system is damaged or blocked, something that can happen during breast cancer surgery or radiation treatment. Lymph fluid builds up in part of your body, causing swelling, inflammation and sometimes other symptoms.

• Get diagnosed early. If you notice swelling, achiness or heaviness in an arm or your chest area, talk to your healthcare team. You might be able to avoid severe lymphedema with early treatment.
• Get fitted compression garments. Wearing a garment that’s too tight or loose could actually make your symptoms worse. A lymphedema therapist can help.
• Protect your skin. To prevent infection, make keep you’re the area clean and moisturized. Pay attention to cracked, dry skin. Protect against cuts, scrapes and burns and avoid tight jewelry.
• Find exercise that’s safe for you. Exercise after cancer keeps your mobility up and could help relieve symptoms of lymphedema. But gradually get into it. Too much can lead to flare ups.
• Track changes. Take note of anything that is new or changing, like rashes, achiness, swelling. Let your healthcare team know if these symptoms start spreading to other parts of the body.
• Find support. Lymphedema can take it out of you, emotionally and physically. So remember to be patient with yourself and lean on the people around you.

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