9.2 Long-Term Side Effects

9.2.1 Pain

You might continue to have pain even after your breast cancer treatments have ended (Canadian Cancer Society, 2018b). Sometimes, pain fades with time; however, for others, the pain lasts for a long time (chronic).

Even though you may have chronic pain, you can find ways to manage it (Canadian Cancer Society, 2018b). Make sure to talk to your healthcare team about potential treatment methods to reduce your pain.

You can complete the OPQRSTUV form to understand your pain (Northern Health, 2019). OPQRSTUV stands for:

• onset,
• provoking/palliating,
• quality,
• region/radiation,
• severity,
• treatment,
• understanding,
• and values (Northern Health, 2019).

For more information on the OPQRSTUV form, see below for Northern Health’s PDF version.

To learn more about pain relief, check out Video 24 (Canadian Cancer Society, 2021d).

9.2.2 Nausea & Vomiting

Nausea and vomiting are common long-term side effects of breast cancer treatment; luckily, there are lots of ways to mitigate them (BC Cancer, 2020b).

One treatment method is to take anti-nausea medications prescribed to you by your healthcare team (BC Cancer, 2020b). Make sure to take this medication exactly as directed to ensure its effectiveness.

Another method is monitoring and changing your diet (BC Cancer, 2020b). By monitoring your eating and drinking, you can identify foods that may cause you to feel ill. You might notice that the smell of cooking or hot food makes you nauseous. If this scenario applies to you, then you can ask someone to help you cook so that you limit your exposure to this nausea trigger. Sticking to foods that are cold or room temperature, low in fat, or not fried can be helpful.

As mentioned previously, specific complementary and alternative therapies, like acupuncture, can help reduce nausea (BC Cancer, 2020b).

Lastly, keep your mouth clean to avoid nausea caused by bacteria in your mouth (BC Cancer, 2020b). Brushing a minimum of twice a day is recommended.

9.2.3 Bladder & Bowel Incontinence

Incontinence means that you do not have control over your bladder and or bowel functions (Canadian Cancer Society, 2018b). For some, bladder and bowel incontinence only lasts a short time post-treatment; meanwhile, for others, it can be permanent.

There are various ways to improve your symptoms, including:

• doing physiotherapy,
• utilizing incontinence pads,
• creating a schedule of when to empty your bladder or bowels,
• and changing your diet (e.g., how much you drink) (Canadian Cancer Society, 2018b).

No matter how long it lasts, bladder and bowel incontinence can disrupt your daily life (Canadian Cancer Society, 2018b). When you’re away from home, you might be constantly worried about whether there is a bathroom close by. Speak to your healthcare team about this anxiety for treatment recommendations.

9.2.4 Weight Changes

After breast cancer treatment, you might experience either weight gain or loss (Canadian Cancer Society, 2018b). These weight changes can happen for many reasons, including being too tired to be physically active or having difficulty chewing and swallowing.

Weight changes can be distressing and affect self-esteem (Canadian Cancer Society, 2018b). Someone specializing in nutrition, such as a dietician, can recommend strategies to get back to a healthy weight.

9.2.5 Fatigue

Fatigue is a common long-term side effect of breast cancer treatment (Canadian Breast Cancer Society, 2018b). Although you might have experienced tiredness before, fatigue is quite different. Sleeping, resting, or other energizing activities do not improve fatigue.

Being fatigued can lead to moodiness, hopelessness, and weakness (Canadian Cancer Society, 2018b). Other aspects of your life, such as appetite problems and worry, can heighten your feelings and emotions.

Inform your healthcare team if fatigue interferes with daily life (Canadian Cancer Society, 2018b). Some strategies you can do to manage your fatigue include:

• Staying active — exercise a little each day by going for walks or doing other physical activities you enjoy.
• Asking for help if needed — get help from others with preparing meals, buying groceries, or helping with your children.
• Returning gradually to your normal activities — slowly return to work, activities, and exercise so you do not tire yourself out. (Canadian Cancer Society, 2018b)

9.2.6 Cognitive Impairment (Chemo Brain)

Cognitive impairment means that you are having problems with your memory, concentration, and ability to think (Canadian Cancer Society, 2018b). This long-term effect is also known as chemo brain because it often occurs during or after certain treatment methods, like chemotherapy.

Symptoms of chemo brain can include:

• confusion,
• memory problems,
• concentration difficulties,
• and brain fog (Mayo Clinic, 2023b).

Chemo brain may get better with time, but if it does not, there are ways to manage your symptoms (Mayo Clinic, 2023a). Strategies to manage symptoms include:

• Writing everything down — Record significant dates, times, phone numbers, questions you might have, or anything else you might need to remember.
• Getting enough sleep and rest — Aim for around 7 to 8 hours of sleep each night.
• Doing activities that engage your brain — Try reading, doing crossword puzzles, sudoku, and other mentally stimulating games.
• Managing anxiety and stress — Do stress-relief techniques, like meditation, to lower your stress levels. (Mayo Clinic, 2023a)

9.2.7 Menopause

You can go into early menopause after breast cancer treatment if your ovaries were removed or unintentionally damaged (e.g., chemotherapy) (Canadian Cancer Society, 2018b).

Signs of early menopause can include:

• sweating,
• hot flashes,
• weight gain,
• mood changes,
• vaginal changes (e.g., tightness and dryness),
• and loss of sex drive (Canadian Cancer Society, 2018b).

If you experience these symptoms, talk to your healthcare team about strategies to help with them.

9.2.8 Nerve Damage (Neuropathy)

Nerve damage, also known as neuropathy, can be caused by many different cancer treatments (Canadian Cancer Society, 2018b). Some initial symptoms you might notice are numbness, tingling, or burning in your hands and or feet. Severe versions of these symptoms can cause difficulties with walking, balancing, driving, eating, and completing other tasks.

Neuropathy may never go away (Canadian Cancer Society, 2018b). Treatment methods can include medications, physiotherapy, exercise, and acupuncture.

Here are some helpful tips for dealing with neuropathy:

• remove any rugs or clutter on your floors to decrease your risk of tripping,
• use non-slip mats in your home (e.g., bathroom),
• wear shoes that have a good grip on them,
• get up slowly when going from sitting to standing,
• be careful when handling sharp objects (e.g., knives),
• continue to exercise safely (e.g., use a stationary bike),
• and use safety equipment (e.g., a walker) (Canadian Cancer Society, 2018b).

9.2.9 Osteoporosis

Osteoporosis weakens your bones due to a loss of bone mass, which means your bones can break more easily (Canadian Cancer Society, 2018b). Specific breast cancer treatments increase your chances of developing osteoporosis. Talk to your healthcare team about whether your treatment method can cause osteoporosis and what you can do to prevent it or minimize its effects.

9.2.10 Second (New) Cancer

Second, or new, cancer is when you develop a type of cancer other than breast cancer (Canadian Cancer Society, 2018b). For example, you might have had breast cancer, but then you develop ovarian cancer later on.

Talk to your healthcare team about your risk factors for other cancers and see if there are ways you can lower your risk of developing a second cancer (Canadian Cancer Society, 2018b).