Management of side effects during and post-treatment in breast cancer survivors

Authors: Palesh, O. et. al.
Source: Breast J. 2018;24:167-175 doi: 10.1111/tbj.12862
www.ncbi.nlm.nih.gov/pubmed/28845551

This study reviewed the complications of fatigue, insomnia and cognitive impairment among breast cancer patients. The researchers evaluated current literature about the origins of these complications and the most effective treatments of each.

The investigators first pointed out that while surgery, chemotherapy, endocrine therapy and radiation can cause difficult side effects, breast cancer itself, and a woman’s physical predispositions, can play important roles in the experiences of breast cancer treatment complications. This understanding helps to explain the importance of non-pharmaceutical interventions in combatting side effects.

Breast cancer-related fatigue is the most common treatment experience among patients. It can be caused by or enhance anxiety, depression, pain and insomnia. It may also influence a woman’s ability to comply with cancer treatment. The researchers found that medical intervention (stimulants) had a small effect on treating fatigue. On the other hand, gentle exercise (such as yoga) and psychological interventions were much more effective. Interestingly, it appears that both interventions together are less effective. This may be because of the difficulty to commit to the time demands of both treatments at once.

Insomnia (the inability to fall asleep or stay asleep, occurring at least 3 days per week over at least 3 months) is the second most frequent treatment side effect. Very often, insomnia is treated with medications (non-benzodiazepines, benzodiazepines, antidepressants). Unfortunately, these treatments can have untoward side effects of their own such as residual sedation, rebound insomnia and possible addiction. They appear to be more effective for acute, rather than chronic, insomnia. The team noted that cognitive based therapy (i.e., teaching patients to avoid naps and to use the bed only for sleep and sex) is as effective as medications for insomnia, and that its effects endure after treatment has ended.

Cognitive impairment can be caused by breast cancer treatment. The researchers estimate that, for up to 40% of patients, such impairment may be caused by the breast cancer itself. About three-fourths of breast cancer patients experience some cognitive dysfunction during treatment. Pharmaceutical interventions for cognitive impairment have been tried with mixed effects.  As more is learned about how treatments such as chemotherapy affect brain function, targeted medications may improve side effects. Current information shows that cognitive therapies are successful in improving deficits. Exercises to enhance memory, attention, mental processing and visual-spatial skills can be taught by a professional and then carried out by individuals with self-training. Cognitive function is also improved with gentle exercise.

The most commonly experienced breast cancer side effects can have different and multiple causes. Currently, pharmaceutical interventions have limited success and may create more side effects. Exercise and cognitive based therapies continue to demonstrate effectiveness. It is important that patients speak to professionals to determine what interventions are safest and most appropriate for them.