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Preparing for Side Effects

Posted Aug 24 2008 1:49pm
ANNOUNCER: After a woman with breast cancer undergoes surgery, she's often prescribed what's called "adjuvant" therapy, which targets cancer cells that may remain in her body.

AMAN BUZDAR, MD: The goal of adjuvant therapy in breast cancer is to cut down the risk of recurrence of cancer and keep the woman free of cancer as long as we can.

ANNOUNCER: Adjuvant therapy kills diseased cells. But it often interferes with normal biological processes. Side effects are often the result.

The most common adjuvant therapy for breast cancer is chemotherapy.

GENEROSA GRANA, MD: The main toxicity with chemotherapy revolves around hair loss for many of the regimens, which is complete and usually occurs within two weeks of the administration of chemotherapy; nausea and vomiting, low blood counts, low white count, low platelet count, low hemoglobin that may put a woman at risk of infection or bleeding; fatigue.

ANNOUNCER: More serious -- but very rare -- side effects from chemotherapy can include nerve damage, heart damage and leukemia.

Some drugs can damage the ovaries, reducing the production of estrogen. Pre-mature menopause can result.

GENEROSA GRANA, MD: One of the problems for young women is menopause. Many of these chemotherapy regimens will stop menstrual function, and depending on the age of the woman, she may go into permanent menopause. So for the woman who has not completed her family, that can often be a really upsetting situation.

ANNOUNCER: But most of the other side effects associated with chemotherapy can be effectively managed. Especially side effects that used to cause big problems just a few years ago.

WILLIAM GRADISHAR, MD: Nausea and vomiting, generally what we tell our patients today is those things are more of the past than the present. It doesn't mean that a woman won't experience some queasiness, maybe not feel quite right, but the newer antiemetic or antinausea drugs that we use -- both before chemotherapy and for patients to take home with them, have largely eliminated the nausea and vomiting.

ANNOUNCER: Another type of adjuvant therapy for breast cancer is radiation. GENEROSA GRANA, MD: The main serious side effects of radiation are darkening of the skin, ulceration of the skin. These are self-limited. For some small number of women you can get a swollen, thickened breast long term, a darkened breast long term with some local discomfort, but by and large, most women tolerate radiation therapy quite well.

ANNOUNCER: In very rare instances, radiation itself can cause cancer.

But in most cases, side effects from radiation can be managed. Often with creams and sometimes by interrupting the treatment for short periods, to allow breast tissue to heal.

Breast cancer cells often contain receptors for estrogen or progesterone. In these cases, hormonal agents can also be used in adjuvant therapy.

Women who are pre-menopausal are treated with tamoxifen, which blocks the effect of estrogen on cancer cells.

WILLIAM GRADISHAR, MD: With tamoxifen, hot flashes are relatively common. Women can develop a vaginal discharge, vaginal bleeding and very infrequently, endometrial cancer or uterine cancer related to the drug's use. Extremely rarely, women can get cataracts or some visual disturbances. But again, these are side effects that are relatively uncommon.

ANNOUNCER: Women who are past menopause can be treated with tamoxifen or another class of hormonal agents called aromatase inhibitors, which reduce already-low levels of estrogen in the body.

Preliminary data from a clinical trail called ATAC shows one of these drugs, Arimidex, is effective, and produces fewer of the side effects associated with tamoxifen.

GENEROSA GRANA, MD: Arimidex appears to be superior to tamoxifen when it comes to a decrease in hot flashes and night sweats; a decrease in weight gain, although slight; a decrease in uterine cancer risk; vaginal bleeding and vaginal discharge; a decrease in clotting risk and that means both lower extremity clots, pulmonary emboli and stroke; and probably a decrease in cardiovascular events in general.

ANNOUNCER: But some side effects are more prevalent with aromatase inhibitors.

WILLIAM GRADISHAR, MD: The aromatase inhibitors are associated with musculoskeletal complaints. In all of the clinical trials, there seemed to be a slightly higher chance that women would complain of sort of aches and pains in their bones. That does not mean it's universal; in fact, it was infrequent, but nevertheless, more than what we saw with tamoxifen.

ANNOUNCER: Another side effect of aromatase inhibitors stems from the loss of the protection that estrogen normally provides against bone loss in older women.

AMAN BUDZDER, MD: You're taking a postmenopausal women and you're lowering the estrogen further. So there is an increased likelihood of developing osteoporosis or loss of calcium from the bones, and the woman may be a the increased risk of developing fracture.

ANNOUNCER: New scanning technology makes it possible for doctors to measure easily the strength of a woman's bone at the start of adjuvant therapy, and to monitor possible changes during treatment with hormonal agents.

GENEROSA GRANA, MD: In practice, what I tend to do is obtain bone mineral density assessment. If the woman has good bone mineral density, I feel comfortable. I will monitor that every two years.

On the other hand, if a woman is already beginning with less than ideal bone mineral density -- osteopenia -- again, there are medications that we can use, bisphosphonates, such as Actonel or Fosamax that can be added to the cocktail to protect bone.

ANNOUNCER: Cancer therapy often calls to mind images of discomfort and suffering.

But many women now undergo treatment with fewer and milder side effects, compared to just a few years ago.

And that means women have more choice among therapies, because so many are well tolerated, as well as effective.

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