Metastatic Breast Cancer Symptom Management: 5 Things to Know

Kate M. O'Rourke

Disclosures

June 18, 2020

2. Fatigue is a common and disabling symptom in patients with breast cancer that can significantly decrease quality of life.

Though difficult to treat, there is evidence that exercise can reduce cancer-related fatigue in patients with MBC. Winder commented, "You can manage fatigue by adjusting doses or adjusting schedules, but there are not any treatments for fatigue, particularly," Breast cancer treatments that can cause fatigue include chemotherapy agents; radiation therapy; surgery; hormonal therapies; CDK4/6 inhibitors; HER2-targeted therapies, including ado-trastuzumab emtansine (T-DM1; Kadcyla), lapatinib (Tykerb), neratinib, pertuzumab (Perjeta), and trastuzumab (Herceptin); the PIK3CA inhibitor alpelisib (Piqray); and the immunotherapy atezolizumab (Tecentriq).

"Treating fatigue in patients with cancer is a tough one," said Tolaney. "Some of the strategies that we do try for fatigue are giving people treatment breaks, to help them recover from their treatment, and reducing the dose of the drugs that are causing the fatigue can also help."

3. Treatment-related nausea and vomiting can have a significant impact on quality of life.

Opioids prescribed to manage pain in patients with MBC can sometimes cause nausea. Radiation can also cause nausea.

Numerous cancer treatments can cause nausea in patients with MBC, including anthracycline plus cyclophosphamide; cisplatin; doxorubicin; carboplatin; PARP inhibitors, such as olaparib (Lynparza) or talazopariib (Talzenna); and CDK4/6 inhibitors. Nausea severity can influence cancer-related fatigue.

"Treating nausea depends on the drug that we are giving," Tolaney remarked. "For some drugs that are known to cause significant nausea, we give antinausea prophylaxis, which works very well. For other drugs that cause more intermittent nausea, we will use as-needed antiemetic drugs, and we usually do quite well in this area."

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