HER2+ Breast Cancer
Supportive Care
Facing a breast cancer diagnosis can feel like being on a roller coaster in more ways than one. Managing the physical challenges of treatment may cause a range of emotions including fear, sadness, anxiety, anger and loneliness. It is okay to feel what you feel. Lean on your health care team to help you navigate your journey. You are not alone.
Start with learning about the possible physical side effects that may accompany your diagnosis. Advances have been made to prevent and relieve many of them.
Your health care team members will use supportive care services to help address the physical, emotional, practical, spiritual, financial and family-related challenges you may experience. Ask your nurse navigator about the supportive care services offered at your cancer facility and in your area. If you need assistance and cannot find it, talk with a member of your health care team who can refer you to resources that will help.
Before treatment begins, let your team know about any important life events you have in the next 6 to 9 months. Many times they will adjust your treatment schedule so side effects do not prevent you from living your life. The most important thing is to communicate honestly with your health care team about how you feel.
Physical Side Effects
Table 1 lists many of the common physical side effects that may occur, but you will likely not experience them all. There are also differences in the degree with which a side effect may trouble you. Keep in mind that everyone’s reaction to treatment is unique. If your side effects become too difficult, tell your doctor. Sometimes your medication can be adjusted, which may make them more tolerable.
Do not be afraid to report side effects. Some people worry they will be taken off their drug, and others hesitate to “bother” their medical team. You don’t have to live without relief.
Long-term Effects
Side effects that develop weeks, months or years after treatment ends are known as late effects. They can vary widely from person to person based on many factors.
Some late effects disappear over time while others may be permanent. Because they can be so hard to predict, knowing what to do if they occur is a good course of action.
If possible, talk with your doctor before you start a treatment about the symptoms to be the most concerned about, including potential late effects.
Table 1 - Some Common Side Effects
| Side Effects | Symptoms |
| Anemia | Low energy, weakness, dizziness, light-headedness, shortness of breath, rapid heartbeat |
| Blood clots | Leg discomfort |
| Bone loss and pain | Weakened bone caused by the cancer or treatment |
| Cardiotoxicity | Shortness of breath, chest pain, heart palpitations, fluid retention in legs |
| Chemo brain (cognitive dysfunction) | Brain fog, confusion and/or memory problems |
| Constipation | Difficulty passing stools or less frequent bowel movements |
| Decreased appetite | Eating less than usual, feeling full after minimal eating, not feeling hungry |
| Diarrhea | Frequent loose or watery bowel movements |
| Fatigue | Tiredness that is increased and harder to relieve than typical fatigue |
| Fever | Raised body temperature that could signal an infection |
| Hair loss (alopecia) | Hair loss on the head, face and body (also see Emotional Well-Being, below) |
| Hand-foot syndrome | Pain, swelling, tightness and redness on the palms of the hands or the soles of the feet |
| Headache | Pain or discomfort in the head |
| Hepatotoxicity | Jaundice (yellowing of skin and whites of eyes), itching, abdominal pain in upper right abdomen |
| Hot flashes | Sudden, temporary onset of body warmth, flushing and sweating |
| Lymphedema | Swelling where lymph nodes have been removed or damaged |
| Mouth sores | Small cuts or ulcers that can affect the gums, tongue, roof of the mouth or lips |
| Nausea and vomiting | The feeling of needing to throw up and/or throwing up |
| Neuropathy | Numbness, pain, burning sensations and tingling, usually in the hands or feet |
| Neutropenia | Low white blood cell count that increases the risk of infection |
| Pain | Pain and aches in the muscles, bones, tendons, ligaments or nerves |
| Phantom pain | Nipple or breast pain following a mastectomy; over time, the brain adjusts to the absence of the breast |
| PMPS* (post-mastectomy pain syndrome) | Chronic nerve pain that includes tightness, burning, tingling, numbness or itching in the surgical site, chest, armpit and/or arm |
| Respiratory problems | Shortness of breath (dyspnea) with or without cough, upper respiratory infections |
| Skin reactions | Rash, redness and irritation, or dry, flaky or peeling skin that may itch |
| Sleep problems | Insomnia (the inability to fall asleep or stay asleep), disruption of the wake-sleep cycle and excessive sleepiness |
| Thrombocytopenia | Low number of platelets in the blood, which can lead to bruising and bleeding |
| Weight changes | Gaining or losing weight unintentionally |
Emotional Well-being
Because having breast cancer can cause you to feel a range of emotions, such as anxiety, fear and guilt, do not hesitate to ask for a referral to a patient counselor or mental health professional to help you work through your feelings. Check out cancer support groups locally or online, or reach out to close friends or a spiritual advisor. Get immediate medical attention if you have thoughts of suicide or death.
Be mindful that some physical side effects can also affect you emotionally, particularly with hair loss, sexual health and infertility.
Managing hair loss (alopecia). Not everyone being treated for breast cancer will lose their hair. But for many who do, it can cause you to feel self-conscious, vulnerable, exposed, embarrassed, angry or depressed. It’s important to be aware that losing your hair may affect you more deeply than you expect. Sharing your feelings with a friend, loved one or support group may benefit your emotional well-being.
Hair loss and thinning, including loss of your eyebrows and eyelashes, can result from many drug therapies. Hair loss can begin two to three weeks after the first chemotherapy treatment. Eyebrows and eyelashes can begin to fall out about two to three months after chemotherapy. Hair usually regrows gradually once treatment ends.
An option that may help reduce hair loss during treatment is to use a cooling cap, which is worn from a half hour before treatment to an hour and a half after treatment. The cold seeps into the scalp and shrinks the blood vessels, reducing the metabolism of the follicle cells, which slows or reduces hair loss.
If you choose to wear a wig, contact your oncologist’s office for a prescription for a “cranial prosthesis due to alopecia caused by cancer treatment.” Such phrasing may qualify the wig to be covered partially or in full as a medical expense, but contact your health insurance provider first to find out. Some online sources offer free wigs to cancer patients.
Impacts to sexual health. Treatment may cause reduced sexual desire and make you feel less desirable, particularly if treatment alters your appearance or energy level. If you have a partner, communicate your feelings and be open to finding new ways to be intimate. Physical changes, such as vaginal dryness, can occur. Personal lubricant may help during intercourse. Sexual health is an important part of life. Your doctor may not discuss this, so it is essential that you do. Some breast centers have sexologists for exactly this purpose.
Explore fertility preservation options. Infertility can result from some cancer treatments. If your plans include having a biological child, learn about fertility preservation with a reproductive specialist before treatment. Be sure to ask about insurance coverage and the financial obligations that accompany preservation. Some preservation procedures may delay your cancer treatment, so discuss timing with your oncologist as soon as possible.
