Understanding Triple-Negative Breast Cancer - Episode 4

Managing Side Effects from Triple-Negative breast Cancer Treatment

Kristie L. Kahl: Can discuss some common side effects that we see with current standards of care for triple-negative breast cancer treatment?

Dr. Ogori Kalu: The current standard treatment includes chemotherapy, radiation, surgery and, of course, the side effects that everyone is most concerned about are the side effects of the chemotherapy. Three standard medications that are given for triple-negative breast cancer, one is called Adriamycin, the other one is called Cytoxan and the third one is called Taxol. These three medications have specific side effects, but in general, for the most part, these side effects are what we call reversible. Once the treatment is complete, then most women get back to normal.

So I'll start like with Adriamycin. Adriamycin is one of the chemotherapeutic drugs that has the nickname, the “Red Devil.” It's in a red bag, and it's the one that's sort of seen as very toxic, the most toxic to patients or the potential to be the most toxic for patients. One side effect or risk factor could be a decrease in your white blood cell count, what we call leukopenia or a decrease in a platelet count, which means patients have a high risk of bleeding. There could be damage to your cardiac cells, nausea, vomiting, diarrhea, headache, hair loss, general pain in the body like fatigue. So that a list of more common side effects from that particular medication.

The second medication I mentioned Cytoxan, that medication as well as the last one that I mentioned, those have a higher risk of neural toxicity or neuropathies. So patients can develop numbness and tingling in their fingers and toes, some can also develop some encephalopathies. Others can also have a risk of developing what we call myelodysplastic disorders, which are cancers that are coming from the bone marrow like lymphomas or leukemias. But again, for the most part, most of those side effects are reversible in the sense they can be treated, or over time it can improve. If there's some cardiac damage from chemotherapy, that unfortunately, is permanent. But as far as the neuropathies, those improve with time. The nausea, vomiting, diarrhea, malaise, bone pain, those sorts of things, those in time also go away after treatment is completed. And, you know, I will also say that during the course of treatment, if those symptoms are severe enough, particularly the ones with low blood count and excessive nausea, vomiting or diarrhea, there are medications that the oncologists have in their armamentarium to mitigate those symptoms, decrease them or eliminate them altogether. So, of course, during the course of treatment, these patients are always watched over very carefully. And all of these symptoms are addressed if they do arise.

Kristie L. Kahl: What should a patient do if they are experiencing one of these side effects?

Dr. Ogori Kalu: Well, of course, the first thing to do is bring it to the attention of their doctor, as far as the blood counts, and the issues with blood cells. That's something that more than likely the clinician will pick up because routine blood tests are done every time a patient receives their dose of chemotherapy. But as far as when they go home, the feelings of nausea, vomiting, diarrhea, fatigue, headaches or dizziness, definitely bring it to the attention of the clinician. Because not only could it be something that is related to the chemotherapy or could actually be related to their primary cancer, it's something that should be addressed immediately once it's encountered.

Kristie L. Kahl: How does palliative care play a role in triple-negative breast cancer treatment?

Dr. Ogori Kalu: So palliative care really is sort of the treatment plan to the whole patient. And palliative care is something that, at the moment of diagnosis all the way through treatment until the patient is cured or even if they have a chronic long-term disease process. So palliative care actually addresses not only the medical aspect of the patient's care, but also the psychosocial aspects of the patient's care, and also at times even spiritual aspects and can incorporate the support for their families as well. So during the process of having chemotherapeutic treatment or any kind of treatment, for the most part, palliative care is something that I recommend all patients investigate, because it's not just for patients who might be having a lot of pain or discomfort during the treatment. They can also help with some psychosocial aspects, if they need social support or family support or help getting to their treatments, that sort of thing that all falls under that umbrella. So yes, I believe it's very important when someone is diagnosed, to be connected to a palliative care team, so they can see what benefits they could get from that.

Kristie L. Kahl: Can you discuss the difference between palliative care and hospice?

Dr. Ogori Kalu: There's always that confusion between palliative care and hospice care. Palliative care, like I mentioned before, is from the moment you're diagnosed. You can be directed towards palliative care. And it's basically medical, psychosocial, all kinds of support for you and/or your family during your process during your treatment process. It could be while you have the disease, and it could be a curable disease as well. So it goes through your entire process. Hospice care is typically for patients who have six months or less left in their life. And it's a system put in place to maximize the quality of life during that time. So as for patients who we know will pass on within the next six months, and we're trying to maximize their time during that moment, and that's what hospice care is. So we want to make sure they're not in any pain or discomfort, we want to make sure things are in order for them. So that's the main difference. So hospice, if we know your terminal, versus palliative care is you don't have to be terminal, you can actually be cured from your disease process and survive. Hospice actually falls under the umbrella of palliative care, but palliative care is not hospice.

Kristie L. Kahl: What questions would you recommend patients be sure that they're asking their healthcare providers about the side effects they're experiencing?

Dr. Ogori Kalu: So from the very beginning, once a patient is diagnosed, the doctor tells them that they need to take x, y and z medication for x, y and z amount of time. The first things they should ask are, “What are the side effects? What do you anticipate I will experience during this process? And how long will that last? Is that something I would have to suffer through? Or can I stop the medication? If it gets too bad, what are the safeguards?” If it does get too bad, you know, so that the patient is not too scared and anxious. And some people might feel that they have to suffer through those symptoms, no matter how bad it gets, without bringing it to the doctor's attention, so they have to have that understanding from the very beginning that if they do have those symptoms, it may be expected, but it's definitely something that the clinician needs to know about when it occurs. So that's what they should make clear before they start. And as they go through the treatment, and if they're experiencing those symptoms, of course, talking to the doctor about them, letting them know if they're getting worse or getting better. Letting them know if they physically feel they can't tolerate any more treatment, because you know, the doctors or the clinicians will never know what you as an individual feel, physically, what you're able to stand versus not stand. So that open communication is key.

I think for a more effective treatment plan, because what patients also don't know is just because a doctor says that they might need 10 treatments over the course of four weeks, and they're suffering through symptoms over those four weeks, that the doctor can augment that treatment plan so that the patient can still get the most effective treatment and break up those treatment days so that the patient doesn't feel the effects of the medication, the side effects in medication as much. So if the patient is very open, as far as what kind of symptoms, how they’re feeling, their treatment plan, their doctor can augment it, so it's more tolerable. So it's very important for open dialogue to be part of the relationship between doctor and clinician.