Ten tips to manage chemotherapy for breast cancer

THE lived experience of people with cancer provides important insights for improving care. As a doctor who underwent 16 cycles of chemotherapy for breast cancerI was inspired to compile and share the following top tips to help manage the physical and mental challenges of chemotherapy. The following recommendations are practical ways for health professionals to guide patients who are also undergoing chemotherapy and, where appropriate, may be provided directly to patients.

1. Exercise

Exercise has extensive benefits for cancer survival and tolerating chemotherapy side effects (here and here). Walking around the block or in the garden is better than nothing. Ideally, work up to vigorous exercise or incorporate more intense exercise sessions when tolerated. One-hundred and fifty minutes of moderate intensity or 75 minutes of vigorous intensity exercise a week is recommended, along with resistance training. Inactivity leads to physical deconditioning, causing loss of muscle mass and strength. Please see your GP or treating team for individual advice, seeing an exercise physiologist or physiotherapist with an interest in cancer treatment exercise programs is useful. GPs can arrange care plans that assist patients in covering the cost of these visits through Medicare.

2. Social connection

Aim to contact someone every day. The restrictions of being immunocompromised and the fatigue from chemotherapy makes contact with others challenging. Combined with mouth dryness and ulcers making talking difficult, and skin sensitivity making physical contact painful, it is easy to isolate and feel alone. Text messages can work well and online networks can provide understanding from those going through similar journeys.

3. Conserve energy for the things that matter most

Write a list of daily priorities and keep this in a prominent place. Discover what provides joy and aim for a moment of this each day. It can be something as simple as asking a friend or family member to send a daily photo of something that brings joy.

4. Mindfulness

The benefits of mindfulness are well documented. Making time to learn and practice during and after treatments is invaluable. Online applications and recordings are available. Consider using noise cancelling headphones during chemotherapy to enable meditation or listening to music in which to become absorbed. Finding a way to internally settle yourself when distressed is a resource that is so valuable when going through a journey as unpredictable as cancer treatment.

5. Laugh and have fun

See the funny side of life where you can. This can feel impossible on many days of chemotherapy, and it is okay to feel a full range of emotions; however, having a funny podcast, television show or video to bring a moment of relief can be immensely helpful. Have a list or ask others for suggestions. This certainly does not mean that you must be positive and upbeat all the time. It is about having a moment of fun despite the challenges.

6. Educate and empower yourself

Read widely and ask lots of questions of your treating team. Know what can be done to manage side effects and find out which websites provide evidenced-based information. Moisturising mouthwash, toothpaste and spray are useful for mouth care. Moisturise your skin and use lip balm several times a day for relief and prevention of dryness. Manage bladder and bowel issues as soon as they arise. Saline nasal spray and nose oil spray are useful for nasal dryness. A bag with these things inside is useful around the home and when going out.

7. Sleep and rest

Sleep as well as you can. Develop sleep rituals and try to get up each morning at a regular time, even if you need a nap after an hour. Learn to rest. Know rest is obtained from relaxation, so explore relaxation options to use when unable to sleep. Have relaxing music, podcasts or other options to pass the time for those nights when sleep is elusive. The endlessness of managing issues such as hot flushes, an irritable bladder, and trying to find a comfortable position when your whole body aches and your skin is so sensitive is unrelenting. The light of dawn after a long night brings an appreciation of sleep that may have been previously taken for granted.

8. Eat well

Make good nutrition and hydration a priority. Although some people lose weight, most actually gain weight and weight can increase up to 10 kg during chemotherapy. Corticosteroids used with chemotherapy, comfort eating and a decrease in exercise are all factors that can contribute to weight gain, so when people ask if they can do anything, be specific about a particular recipe they could cook. Cancer cookbooks are helpful on providing food that is nutritious, easily digested, and manageable when nauseated. Body weight is measured at every intravenous chemotherapy visit to calculate precise dosing, so this is an effective way to monitor weight loss or gain. A cancer-specific dietician can be valuable.

 9. Have something to look forward to

Mark small wins and plan some outings. If possible, a day trip or even a night away somewhere relaxing can be rejuvenating. Yoga can be both an enjoyable and effective way to manage chemotherapy effects such as muscular pain, sleep disturbance, fatigue and distress.

10. Do something new

Learn a skill or do something new. Chemotherapy often causes brain fog and fatigue, but discovering something new that inspires you can provide something to look forward to.

“Adopt the pace of nature: her secret is patience.” These words by American philosopher, Ralph Emerson emulate the mindset necessary to survive multiple cycles of chemotherapy. These tips aim to provide hope to patients as they manage the challenges of undergoing chemotherapy.

Dr Emma Warnecke is an Associate Professor in the Tasmanian School of Medicine at the University of Tasmania. She has recorded relaxation and mindfulness podcasts for university students which can be used for anyone.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.