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When Is Chemotherapy Used In Breast Cancer

Are There Ways To Prevent Hair Loss With Chemotherapy

Having chemotherapy for breast cancer – patient guide

Not everyone loses hair when receiving chemotherapy, but many people do. Some peoples hair only thins. Others lose the majority or all of their hair.

Using a cold cap can reduce hair loss. Cold caps cool your scalp before, during and after chemotherapy treatment. Cooling tightens the blood vessels in your scalp, potentially reducing how much chemotherapy goes to your hair follicles.

People may choose to wear a wig as a result of hair loss. Some private insurance companies may help cover wig costs if your doctor prescribes a cranial prosthesis or hair prosthesis. Medicare Parts A and B do not cover wigs, but the costs may be tax-deductible.

Where Is Chemotherapy Given

Unless youre having chemotherapy as tablets, youll normally be given your treatment at hospital as an outpatient or day case. This means youll be able to go home on the same day.

You may be at the hospital for a short time only. However, because of tests, waiting times and how long it takes to prepare and give the chemotherapy drugs, some people are there for most of the day. You may be asked to have blood tests a few days before you have your chemotherapy.

You might find it helpful to take things to help pass the time as well as snacks and drinks. You may be able to take someone to go with you to keep you company. Talk to your chemotherapy nurse to find out if this is possible.

In some areas chemotherapy may be given in a mobile treatment centre or in your home.

With some types of chemotherapy you may be given your first treatment as an inpatient and may need to stay in hospital overnight.

Where You Go For Chemotherapy

You may receive chemotherapy during a hospital stay, at home, or as an outpatient at a doctorâs office, clinic, or hospital. Outpatient means you do not stay overnight. No matter where you go for chemotherapy, your doctor and nurse will watch for side effects and help you manage them. For more information on side effects and how to manage them, see the section on side effects.

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The Types Of Radiotherapy

The type of radiotherapy you have will depend on the type of breast cancer and the type of surgery you have. Some women may not need to have radiotherapy at all.

Types of radiotherapy include:

  • breast radiotherapy after breast-conserving surgery, radiation is applied to the whole of the remaining breast tissue
  • chest-wall radiotherapy after a mastectomy, radiotherapy is applied to the chest wall
  • breast boost some women may be offered a boost of high-dose radiotherapy in the area where the cancer was removed however, this may affect the appearance of your breast, particularly if you have large breasts, and can sometimes have other side effects, including hardening of breast tissue
  • radiotherapy to the lymph nodes where radiotherapy is aimed at the armpit and the surrounding area to kill any cancer that may be in the lymph nodes

What To Expect When Undergoing This Treatment

More breast cancer patients can safely forego chemotherapy ...

    Chemotherapy involves the use of chemicals that target cancer cells, which is a standard treatment for some types of breast cancer. The goal of chemotherapy, or chemo, is to improve overall survival. In some cases, however, it may be prescribed to simply provide comfort carenot allowing the tumor to get too big, which can cause other discomforts in certain cases.

    Chemotherapy has been associated with potential side effects, some of which are severe. Healthcare providers are knowledgeable of such issues and can offer advice and provide tools and medications to help minimize the side effects.

    Whether your oncologist recommends chemotherapy for you depends on several factors, such as tumor type and location. Discuss your specific case and concerns with your healthcare provider.

    This article will give a broad overview of chemotherapy for breast cancer: how it works, how and when it’s given, types of drugs used in treatment, common infusion experiences, and potential side effects after receiving treatment.

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    Menstrual And Fertility Changes

    If you have a menstrual cycle, you may find that it changes under chemotherapy. Some people start menopause after completing chemotherapy. This becomes more common the closer you are to menopause, which typically starts around the age of 51.

    Periods can return after treatment is completed, but this often depends on your age and what kind of chemotherapy drugs were used. Typically, the younger you are, the greater the chance is that your period will return and youll produce fertile eggs.

    Talk with your doctor if you hope to get pregnant after chemotherapy. They can help design a treatment plan that least affects your fertility.

    Choosing A Chemo Combination

    Your doctor will probably talk to you about combining different chemo drugs. They may refer to them by abbreviations for their names. Some of the most common include:

    • AC: Adriamycin and Cytoxan
    • CMF: Cytoxan, methotrexate, and fluorouracil
    • FAC: Fluorouracil, Adriamycin, and Cytoxan
    • CAF: Cytoxan, Adriamycin, and fluorouracil

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    Expert Review And References

    • Bursein HJ, Harris JR, Morrow M. Malignant tumors of the breast. Devita, V. T., Jr., Lawrence, T. S., & Rosenberg, S. A. Cancer: Principles & Practice of Oncology. 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins 2008: 43.2: pp. 1606-54.
    • Foxson SB, Lattimer JG & Felder B. Breast cancer. Yarbro, CH, Wujcki D, & Holmes Gobel B. . Cancer Nursing: Principles and Practice. 7th ed. Sudbury, MA: Jones and Bartlett 2011: 48: pp. 1091-1145.
    • National Cancer Institute. Breast Cancer Treatment Health Professional Version. Bethesda, MD: National Cancer Institute 2010.
    • Breast cancer. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. National Comprehensive Cancer Network 2010.
    • Tripathy D, Eskenazi LB, Goodson, WH, et al. Breast. Ko, A. H., Dollinger, M., & Rosenbaum, E. Everyone’s Guide to Cancer Therapy: How Cancer is Diagnosed, Treated and Managed Day to Day. 5th ed. Kansas City: Andrews McMeel Publishing 2008: pp. 473-514.

    Immunotherapy For Breast Cancer

    What to Expect from Chemotherapy for Breast Cancer

    Immunotherapy is the use of medicines to boost a persons own immune system to recognize and destroy cancer cells more effectively. Immunotherapy typically works on specific proteins involved in the immune system to enhance the immune response. These drugs have side effects different from those of chemotherapy.

    Some immunotherapy drugs, for example, monoclonal antibodies, work in more than one way to control cancer cells and may also be considered targeted therapy because they block a specific protein on the cancer cell to keep it from growing.

    Immunotherapy is used to treat some types of breast cancer.

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    How You Have Chemotherapy

    You usually have treatment into your bloodstream .

    You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

    • central line
    • PICC line
    • portacath

    If you don’t have a central line you might have treatment through a thin short tube . The cannula goes into a vein in your arm each time you have treatment.

    Changes In Bowel Habit

    Chemotherapy drugs and the anti-nausea drugs used with them may cause diarrhoea or constipation. Constipation is an annoyance but can usually be easily managed with laxatives. Diarrhoea is sometimes an important warning sign that develops with particular chemotherapy drugs. If you get diarrhoea you should let your oncologist or nurse know. You will be given specific advice about how to manage it.

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    What To Expect During Treatment

    You usually get chemo in an outpatient center at a hospital or clinic. If you have early stage breast cancer, youâll probably get treatments for 3 to 6 months. It may last longer for advanced breast cancer. Youâll have treatment in cycles, which could be just once a week or as often as three times a week. If youâre getting radiation and chemo together, youâll get the radiation after the chemo treatment. You may want to have someone drive you home the first few times until you know how it affects you.

    On the day of treatment:

    • Technicians will take some of your blood for tests.
    • Your doctor will go over the blood test results and talk about your overall health.
    • The doctor orders the treatment.
    • Youâll meet with the person on your health care team whoâs going to give you the chemo.
    • Theyâll check your temperature, pulse, and blood pressure.
    • Theyâll put the IV into your vein.
    • Theyâll give you medications to prevent nausea, anxiety, and inflammation along with the chemotherapy.
    • When your treatment is done, theyâll remove your IV and check your vital signs again.
    • Youâll get prescriptions for dugs you can take at home to help with side effects.
    • Theyâll tell you what is OK to eat and drink once youâre home.

    Chemotherapy For Breast Cancer

    Complete Blood Count During Breast Cancer Treatment

    Chemotherapy uses anti-cancer drugs that may be given intravenously or by mouth. The drugs travel through the bloodstream to reach cancer cells in most parts of the body. Sometimes, if cancer spreads to the spinal fluid, which surrounds and cushions the brain and spinal cord, chemo may be given directly into in this area .

    On this page

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    Key Points To Remember

    • Chemotherapy is sometimes used after surgery for early-stage breast cancer to help lower the chances that your breast cancer will come back.
    • Some types of cancer have a very small chance of coming back. Women who have those types of cancer may not need chemo. There are gene tests that may show whether having chemo will help you reduce your chances that the cancer will return.
    • Your age, type of cancer, tumor size, and hormone receptor status have an effect on how well chemo will work to keep your cancer from coming back.
    • Different medicines used for chemo have different side effects. Your doctor can give you other medicines to help you deal with side effects like nausea and vomiting. Some women are bothered a lot by the side effects, but some arent.
    • The drugs used for chemo can be very expensive. Insurance policies dont always cover the whole cost. If you have no insurance, your doctor may be able to help you find drug companies or organizations that will help you pay for this treatment.

    Changes To Taste And Appetite

    Chemotherapy may cause changes in the taste of food, and even alterations to the taste of coffee and water.

    Often women describe food as having a metallic taste. These changes to taste are called dysgeusia. This problem may be difficult to counteract. Changes in taste, combined with nausea or uneasiness in the stomach, may cause cravings for unusual foods, rather like the symptoms of pregnancy. Care must be taken to avoid high calorie snacks as weight gain often occurs during chemotherapy.

    It is important to keep your strength up by eating frequent small meals and trying different foods. Talking to a dietician or an experienced chemotherapy or breast nurse can be very helpful.

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    Will The Nhs Fund An Unlicensed Medicine

    It’s possible for your doctor to prescribe a medicine outside the uses it’s licensed for if they’re willing to take personal responsibility for this ‘off-licence’ use of treatment.

    Your local clinical commissioning group may need to be involved, as it would have to decide whether to support your doctor’s decision and pay for the medicine from NHS budgets.

    Page last reviewed: 28 October 2019 Next review due: 28 October 2022

    Before You Start Chemotherapy

    Many breast cancer patients can skip chemo, study finds

    You need to have blood tests to make sure its safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

    The pharmacists make chemotherapy for each person individually. They do this once your blood test results have come through. Its worked out based on your weight, height and general health.

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    Breast Cancer: Test Reveals Who Can Skip Chemo After Surgery

    HealthDay Reporters

    FRIDAY, Dec. 3, 2021 — A genetic test can identify older breast cancer patients who can forgo chemotherapy after surgery, even if the cancer has spread to nearby lymph nodes, a large international clinical trial shows.

    “For decades, women with breast cancer that had spread to the axillary lymph nodes were treated with chemotherapy after surgery, to reduce the risk of recurrence,” explained Dr. Francisco Estreva, chief of breast medical oncology at Lenox Hill Hospital in New York City.

    However, the findings suggest that post-op chemo might not be needed for all patients, so the study “represents a paradigm shift in medical oncology,” said Estreva, who wasn’t involved in the new research.

    The study was led by Dr. Kevin Kalinsky, a SWOG investigator and a breast medical oncologist at the Winship Cancer Institute at Emory University in Atlanta. SWOG is a cancer clinical trials group funded by the U.S. National Cancer Institute. The findings were published Dec. 1 in the New England Journal of Medicine.

    The study was conducted at 632 sites in nine countries and included more than 5,000 women with HR+, HER2– breast cancer that had spread to as many as three lymph nodes.

    According to the study authors, in about one-third of HR+, HER2- breast cancer patients cancer has already spread to their lymph nodes at the time of diagnosis. These women have a higher risk of cancer recurrence after treatment.

    Estreva agreed.

    More information

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    Why Isnt A Cure The Goal

    It can be painful and shocking when you come to understand the differences between what chemotherapy may offer for early-stage breast cancer and what it may accomplish for metastatic breast cancer.

    It is not that healthcare providers dont want to attempt to cure advanced breast cancer with chemotherapy. They do. Its just that with the drugs we currently have, and the resistance which develops over time, the odds of chemotherapy curing an advanced cancer are very low. This is true even if you are treated with extremely high doses of several powerful drugs.

    According to studies, many people who have breast cancer are expecting that chemotherapy will cure their metastatic cancer. There are some cancers that respond and continue to respond to chemotherapy for a long time. Still, its important to understand what chemotherapy can and cant do with the drugs we currently have.

    If you are still hoping for a cure, talk to your healthcare provider. At this time there are not any approved medications that can cure metastatic breast cancer, though new medications are always being evaluated in clinical trials. For a few people, some of these newer medications, such as immunotherapy drugs, may offer a greater chance for long-term survivalbut we dont know for sure, and that is why they’re being studied.

    Breast Cancer Healthcare Provider Discussion Guide

    Get our printable guide for your next healthcare provider’s appointment to help you ask the right questions.

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    Treatment Recommendations For Her2/neu+ Locally Advanced Disease

    In patients with HER2/neu-positive disease, concurrent trastuzumab with chemotherapy improves the pCR rate. Regimens are listed below.

    AC-paclitaxel plus trastuzumab

    • Doxorubicin 60 mg/m2 IV plus cyclophosphamide 600 mg/ 2 IV on day 1 every 3 wk for 4 cycles, followed by
    • Paclitaxel 80 mg/m2 IV weekly for 12 weeks or paclitaxel 175mg/m2 every 3 wk for 4 cycles with:
    • Trastuzumab 4 mg/kg IV with first dose of paclitaxel, followed by
    • Trastuzumab 2 mg/kg IV weekly to complete 1-y total duration of trastuzumab therapy
    • As an alternative, trastuzumab 6 mg/kg IV every 3 wk following the completion of paclitaxel, to complete 1-y total duration of trastuzumab therapy

    Dose-dense ACpaclitaxel plus trastuzumab

    • Doxorubicin 60 mg/m2 IV plus cyclophosphamide 600 mg/m2 IV on day 1 every 2 wk for 4 cycles, followed by
    • Paclitaxel 175 mg/m2 IV every 2 wk for four cycles, with
    • Trastuzumab 4 mg/kg for the first dose and then 2 mg/kg weekly for 1-y total duration
    • As an alternative, trastuzumab 6 mg/kg every 3 wk following the completion of paclitaxel, and given to complete 1-y total duration of trastuzumab therapy

    AC-docetaxel plus trastuzumab

    • Doxorubicin 60 mg/m2 IV plus cyclophosphamide 600 mg/m2 IV on day 1 every 3 wk for four cycles, followed by
    • Docetaxel 100 mg/m2 every 3 wk for four cycles, with
    • Trastuzumab 4 mg/kg IV during week 1 and then 2 mg/kg IV weekly for 11 wk followed by trastuzumab 6 mg/kg every 3 wk to complete 1 y of trastuzumab

    AC-paclitaxel plus trastuzumab and pertuzumab

    How Chemotherapy Is Used With Other Cancer Treatments

    Cytoxan Chemotherapy for Breast Cancer Treatment

    When used with other treatments, chemotherapy can:

    • Make a tumor smaller before surgery or radiation therapy. This is called neoadjuvant chemotherapy.
    • Destroy cancer cells that may remain after treatment with surgery or radiation therapy. This is called adjuvant chemotherapy.
    • Help other treatments work better.
    • Kill cancer cells that have returned or spread to other parts of your body.

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    Which Chemo Is Best For You

    In cases of early stage cancer, an oncologist can make an informed decision about which drugs are best to use. Your age, the stage of the cancer, and any other health problems will all be taken into consideration before deciding on a chemo regimen.

    These drugs are usually injected into a vein, either at your doctors office or at a hospital. Locations that provide chemotherapy injections are often called infusion centers.

    You may need a port implanted if you have weak veins or are being given a certain type of drug. A port is a device thats surgically placed in your chest that allows for easy needle access. The port can be removed when therapy is finished.

    Typically, a person is given several drugs, often called a regimen. Regimens are designed to attack the cancer at different stages of growth and in different ways. Your chemo drugs will be given on a regular schedule in doses called rounds.

    According to the American Cancer Society, the most common drugs and regimens used for breast cancer today are:

    Regimen name

    While chemotherapy treatments have greatly improved over time, there are often still noticeable side effects of treatment.

    By C. Dixon

    Were here to help clear that up. Chemotherapy works by targeting cells at specific points in the cell cycle. Since cancer cells form more quickly than normal cells, the cancerous ones will be more readily destroyed by chemo than normal cells, though some normal cells will be affected .

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