When Is Chemotherapy Used
Not all women with breast cancer will need chemo, but there are several situations in which chemo may be recommended:
- After surgery : Adjuvant chemo might be given to try to kill any cancer cells that might have been left behind or have spread but can’t be seen, even on imaging tests. If these cells were allowed to grow, they could form new tumors in other places in the body. Adjuvant chemo can lower the risk of breast cancer coming back.
- Before surgery : Neoadjuvant chemo might be given to try to shrink the tumor so it can be removed with less extensive surgery. Because of this, neoadjuvant chemo is often used to treat cancers that are too big to be removed by surgery when first diagnosed . Also, by giving chemo before the tumor is removed, doctors can see how the cancer responds to it. If the first set of chemo drugs doesnt shrink the tumor, your doctor will know that other drugs are needed. It should also kill any cancer cells that have spread but can’t be seen. Just like adjuvant chemo, neoadjuvant chemo can lower the risk of breast cancer coming back.
For certain types of breast cancer, if there are tumor cells still found at the time of surgery , you may be offered more chemotherapy after surgery to reduce the chances of the cancer coming back .
How Long Treatment Lasts
Youll usually have four to six cycles of AC chemotherapy, over three-four months. Both drugs are given on the same day, every three weeks.
The time between each cycle of treatment gives your body time to recover.
This may vary depending on whether the number of blood cells has returned to normal between each cycle.
Assessment For Quality Of Life Endpoints
Quality of life was assessed with the validated Amharic version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and the breastcancer-specific QLQ-BR23 .23 The QLQ-C30 includes nine multiple-item scales of symptoms , five to function , and one to overall healththe global health status and quality-of-life scale. It also includes six single-item scales. The QLQ-BR23 includes 23 questions regarding disease symptoms, treatment-related side effects, body image, sexuality, and future perspective.28 Patients were asked to complete both questionnaires at baseline and every two cycles of treatment.
For each of the multi-item scales, no item occurs in more than one scale. All of the scales and single-item measures range in score from 0 to 100. A high scale score represents a higher response level. Thus, a high score for a functional scale represents a high/healthy level of functioning, a high score for the global health status/QoL represents a high QoL, but a high score for a symptom scale/item represents a high level of symptomatology/problems. And the scoring was fixed according to the procedures stated on the scoring manual of EORTC QLQ-C30 and BR23.29 QoL deterioration was considered clinically meaningful using previously established thresholds for minimally important differences in QoL for EORTC QLQ-C30 and BR23, the threshold for MID was a change of 10 points from baseline.30
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Other Side Effects Of Act Chemo Treatment
You will be extremely tired and fatigued, not just physically but emotionally as well. To help counteract this, just limit yourself of your obligations. I sadly resigned as PTA Secretary and stopped my volunteer involvement with my kids running club and classroom work . It was very hard to quit before chemo when I was well, but I soon realized after chemo started that there was no way I could handle everything like I did before. As your chemo goes on, your periods of fatigue may last longer and longer. Just know your limits and try doing things to reduce your anxiety and stress levels as much as possible. If you have anemia then this may compound your fatigue.
Constipation and Diarrhea
Chemo can play havoc with your digestive system by having a negative effect on those healthy cells inside your bowels. These two things can pop up within days of each other, too. For constipation, docusate sodium is a mild over-the-counter remedy. Colace is another good medication. Eating foods high in fiber and drinking enough fluids will also help. For diarrhea, eating smaller meals for often, and making sure you drink enough fluids. Imodium AD is an over-the-counter remedy for this side effect.
Your skin will be itchy and dry, so a good moisturizer will be your good friend. You have cancer and are undergoing chemo. Indulge in something nice.
My 4 Chemo Nausea Medications
- A strong tablet taken once I arrive at the doctors office. It is so strong, in fact, that it is a controlled substance and lasts two weeks.
- A shot that is administered into my abdomen prior to treatment.
- Two other prescription medications that I take orally as needed once home. I always need them!
THEY WORK! I have not been physically ill.
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Menstrual Changes And Fertility Issues
For younger women, changes in menstrual periods are a common side effect of chemo. Premature menopause and infertility may occur and may be permanent. Some chemo drugs are more likely to cause this than others. The older a woman is when she gets chemotherapy, the more likely it is that she will go through menopause or become infertile as a result. When this happens, there is an increased risk of bone loss and osteoporosis. There are medicines that can treat or help prevent bone loss.
Even if your periods have stopped while you are on chemo, you may still be able to get pregnant. Getting pregnant while on chemo could lead to birth defects and interfere with treatment. If you are pre-menopausal before treatment and are sexually active, its important to discuss using birth control with your doctor. It is not a good idea for women with hormone receptor-positive breast cancer to take hormonal birth control , so its important to talk with both your oncologist and your gynecologist about what options would be best in your case. Women who have finished treatment can safely go on to have children, but it’s not safe to get pregnant while on treatment.
If you think you might want to have children after being treated for breast cancer, talk with your doctorbeforeyou start treatment. Learn more from our section on fertility concerns for women with cancer.
How Often Is Chemotherapy Given For Breast Cancer
Chemotherapy for breast cancer is given in cycles, usually 2 to 3 weeks long, with a short break in between. This gives the body time to recover after receiving chemotherapy. Some chemotherapy is only given on one day per cycle, while others are given on multiple days per cycle. For example, gemcitabine is often given on day 1, day 8, and day 15 of an overall 28-day treatment cycle .
A chemotherapy schedule depends on the type of chemotherapy medications given. Chemotherapy is usually given over 3 to 6 months, or longer in some cases, depending on the type and stage of breast cancer. If you experience bothersome side effects or the treatment is no longer working, you may need to switch treatment to a different chemotherapy or therapy option.
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How Is Chemotherapy Given
Chemo drugs for breast cancer are typically given into a vein , either as an injection over a few minutes or as an infusion over a longer period of time. This can be done in a doctors office, infusion center, or in a hospital setting.
Often, a slightly larger and sturdier IV is required in the vein system to administer chemo. These are known as central venous catheters , central venous access devices , or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take out blood for testing.
There are many different kinds of CVCs. The most common types are the port and the PICC line. For breast cancer patients, the central line is typically placed on the side opposite of the underarm that had lymph nodes removed for the breast cancer surgery.
Chemo is given in cycles, followed by a rest period to give you time to recover from the effects of the drugs. Cycles are most often 2 or 3 weeks long. The schedule varies depending on the drugs used. For example, with some drugs, the chemo is given only on the first day of the cycle. With others, it is given for a few days in a row, or once a week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.
Adjuvant and neoadjuvant chemo is often given for a total of 3 to 6 months, depending on the drugs used. The length of treatment for advanced breast cancer depends on how well it is working and what side effects you have.
Your Course Of Ac Chemotherapy
You will have chemotherapy as a course of several sessions of treatment over a few months. Each cycle of AC takes 21 days .
On the first day, you will have doxorubicin and cyclophosphamide. After this, you will have a rest period for 3 weeks.
After the rest period, you will start your second cycle of AC. This is exactly the same as the first cycle. Your doctor or nurse will tell you the number of cycles you are likely to have.
What Are The Side Effects Of Ac For Breast Cancer
Common side effects of combination Adriamycin and cyclophosphamide treatment include:
- Bladder irritation, pink or red urine
- Diarrhea or constipation
- Amenorrhea in women older than 40
- Gastrointestinal problems
- Adriamycin for injection. FDA
- Doxorubicin Medscape.com
- Rahman AM, Yusuf SW, Ewer MS. Anthracycline-induced cardiotoxicity and the cardiac-sparing effect of liposomal formulation. Int J Nanomedicine. 2007 2:567583.
- Rheingold SR, Neugut AI, Meadows AT. Therapy-Related Secondary Cancers. In: Kufe DW, Pollock RE, Weichselbaum RR, et al., editors. Holland-Frei Cancer Medicine. 6th edition. Hamilton : BC Decker 2003. Available from:
- Doxorubicin. Drugs.com Oct 7, 2019.
- Cyclophosphamide. Drugs.com Oct 20, 2019,
- Hortobagyi GN, Buzdar AU, Marcus CE, Smith TL. Immediate and long-term toxicity of adjuvant chemotherapy regimens containing doxorubicin in trials at M.D. Anderson Hospital and Tumor Institute. NCI Monogr. 1986 :105-9.
- Fujii T, Le Du F, Xiao L, et al. Effectiveness of an Adjuvant Chemotherapy Regimen for Early-Stage Breast Cancer: A Systematic Review and Network Meta-analysis. JAMA Oncol. 2015 1:13111318. doi:10.1001/jamaoncol.2015.3062
Less Common Side Effects Of Ec Chemotherapy
Epirubicin can affect the way your heart works and may not be suitable for people with existing heart conditions.
Heart problems as a result of epirubicin are not common. However, because they can happen, before you start chemotherapy your treatment team will arrange a heart function test to check your heart is working normally.
Epirubicin may cause your skin to become red and sore, especially if youve had radiotherapy recently. Let your treatment team know if this happens.
Your skin may darken due to extra pigment being produced. Any darkening usually returns to normal a few months after the treatment ends.
During EC chemotherapy treatment, and for several months afterwards, your skin will be more sensitive. Youll be more likely to get sunburnt so wear sunscreen with a high sun protection if youre out in the sun.
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What Are Some Common Side Effects Of Chemotherapy Used In Breast Cancer
Chemotherapy attacks cancer cells, but it can also attack healthy cells in your hair and gut. Chemotherapy side effects depend on the individual, the type of chemotherapy, the dosage and schedule, and the chemotherapy regimen being used.
In addition to some of the side effects mentioned above, chemotherapy used in breast cancer can cause the following more common side effects:
Easy bruising or bleeding
Chemotherapy effects can be bothersome, but sometimes necessary to receive effective treatment. Thankfully, however, there are other medications and strategies that can be used to help manage certain side effects. If youre receiving chemotherapy and you experience a bothersome side effect, make sure to mention it to your cancer specialist so they can help manage it.
If side effects are too bothersome or cannot be tolerated, your chemotherapy regimen may be altered, paused, or completely stopped.
Quality Of Life Pattern Among Breast Cancer Patients On Ac And Ac
The Pattern of Quality of Life Scores Among Breast Cancer Patients on Chemotherapy
The results from GLM repeated measures in Figure 1 and a linear mixed model in Table 2 depicted, global health status was declined by 15.78 points from baseline to the end of cycle 2. Likewise, cognitive functioning, emotional functioning, social functioning, role functioning, and physical functioning of the patients were significantly decreased by 9.02, 12.21, 16.67, 17.63, and 28.99 points from baseline/pretreatment score to the end of cycle 2 score respectively. After the end of cycle 2, GHS increased slowly to 6.85 above baseline score at the end of the chemotherapy course whereas emotional functioning was also increased to 4.44 points below the pretreatment score by the end of cycle 8. Moreover, role functioning and physical functioning subscales showed a kind stable pattern between cycle 2 and cycle 6, though they increased steeply towards 11.39 and 8.11 points below pretreatment level by the end of cycle 8, respectively. However, the cognitive functioning of the patients was showed a decreasing pattern from baseline to the end of cycle 8 though social functioning started to recover from its lowest score at the end of cycle 6 to 22.80 points below pretreatment score at the end of cycle 8 .
Table 2 EORTC QLQ-C30 Global Health Status and Functional Scales Score Over Time Among Breast Cancer Patients on AC and AC-T Chemotherapy, from January 1 to September 30, 2017 GC
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Purpose Of This Review
The purpose of this review is to critically evaluate the results of trials of neoadjuvant chemotherapy and neoadjuvant endocrine therapy for different breast cancer subtypes, discuss how neoadjuvant responses can inform adjuvant therapy, and highlight the importance of pathological complete response as a surrogate marker of distant disease-free survival , distant recurrence free survival , and event free survival which is interchangeable with disease-free survival , in the age of adaptive trial design. Notably, in contrast to overall survival , precise definitions of DFS and similar, related endpoints vary somewhat from trial to trial. pCR is generally a composite endpoint of primary tumor and lymph nodes. While pCR correlates with lower risk of recurrence, risk of recurrence still occurs and reduction of this risk remains an important goal. We also highlight functional and genomic predictive biomarkers in NET and their prediction of recurrence free survival , essentially equivalent to EFS.
Factors Affecting The Quality Of Life Of Study Participants
Socio-Demographic and Clinical-Pathological Factors
Literate patients had higher Global Health Status, physical, role, social functioning and sexual functioning scores than illiterate ones. Moreover, literate patients had lower fatigue, pain, dyspnea, appetite loss, diarrhea, and systemic therapy side effects scores than their counterparts. Tumor stage ¾ significantly impairs GHS, role, emotional, social functioning, sexual functioning, and future perspectives score of the patients than patients with tumor stage ½. Besides, it also causes deterioration of fatigue, constipation, and breast symptoms score.
Increasing age was also associated with increment in-body image, future perspectives, fatigue, insomnia, and constipation scores on contrary to its association with decrement in physical functioning, role functioning, and upset by hair loss score .
Table 6 Socio-Demographic and Clinical Factors Associated with Deterioration of Quality of Life on Stepwise Linear Regression, from January 1 to September 30, 2017 GC
Patients who received the AC-T regimen had lower nausea and vomiting, dyspnea, and appetite loss than those who received the AC regimen. Having children was among the contributing factor for having higher pain and financial problems score than those who had no children.
The Effect of AC and AC-T Chemotherapys Toxicities on Quality of Life Among Women with Breast Cancer in Ethiopia
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How Does Adriamycin And Cyclophosphamide Work
Adriamycin belongs to a class of cancer medicines called anthracycline antibiotics. It works by damaging the DNA inside cancer cells so they cannot replicate. It works at any point in the cell cycle.
Cyclophosphamide belongs to a class of cancer medicines called alkylating agents. Cyclophosphamide prevents cancer cells from dividing by cross-linking DNA strands and decreasing DNA synthesis. It works during the resting phase of the cancer cell cycle.
Immunohistochemistry And Molecular Classification
All pathologic specimens were reviewed by two experienced pathologists who determined the status of ER, PgR, and HER2 using immunohistochemical techniques. According to the Allred scoring system, ER and PgR negativity was defined as a total score from 0-2 by IHC using antibodies to the ER and PgR . According to National Comprehensive Cancer Network guidelines, HER2 was assessed using IHC techniques and/or fluorescence in situ hybridization . IHC grades 0 and 1 were defined as a negative result for HER2, and the lack of HER2 amplification was confirmed by FISH if HER2 was rated 2+ by IHC. “Triple negativity” was defined as a lack of expression of ER, PgR, and HER2. The HER2+ subtype was defined as HER2-positive with ER- and PR-negative, while hormone receptor-positive was defined as ER- and/or PR-positive, regardless of HER2-positivity subtypes. Ki-67 growth fractions and p53 status were assessed using antibodies: Ki-67 , and p53 . The percentage of positive nuclei stained for Ki-67 was calculated for each section based on approximately 1,000 carcinoma cell nuclei. High proliferative index was defined as 50% or more stained nuclei. Immunoreactivity of p53 was defined as greater than 5% of cells having distinct nuclear staining.
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