This transcript is extracted from the ‘Breast Cancer Treatment – What to Expect‘ video.

And so now we’re actually moving on to Ashlene Alexander, who’s our oncology nurse practitioner, and she’ll be doing a talk on treatment and what to expect. Over to you. Thank you.

Hi, everyone. It’s lovely to see you all here today. Very scary looking at all these faces. But I do see some familiar faces, so it’s lovely. It’s very reassuring. And thank you all for coming today. It really is encouraging to us whenever we put on these events. So we hope you all benefit from something that you’ve heard here today.

So as Amy said, I’m Ashlene and I’m the oncology nurse practitioner. I work in Laurel House. You may have seen me floating about on the Wednesday. I help prescribe some of the chemo treatments with the team Doctor Mooney and Doctor Douglas, then I also do, the review clinic, so I follow patients up after treatment. So that may be face to face or on the telephone.

So you’ve maybe seen me. Heard of me or spoke to me. So I have quite a bit to cover today treatment and what to expect. And I’m really going to cover the long term complications. So I appreciate some of you may still be going through treatment. And those side effects are very short term while you’re going through treatment.

And we try to manage them at each assessment as you’re experiencing them. So I’m going to park that and I’m going to talk more about the long term complications and things that you can maybe do to try and help yourself and things that are out there that you could try. If you’re struggling with the side effects that can go on for some people for quite a long time, I will try to keep to time.

If you see me speeding up, it’s because Bernie’s told me I’m going too slow and we need to keep going. So I’ll blame Bernie if I get really quick. If I go past something that you need to talk to me about, please do feel free later on. Or my contact details are about please do feel me and we can talk 1 to 1 about whatever the issue is about.

I’ll try to do my best to get everything covered so Bernie had touched earlier on treatments for breast cancer. So years ago it used to be just to be one thing for everybody in surgery and one form of treatment. And that was it. And thankfully we have very much moved on from that. And there are so many more new treatment options, different ways of giving treatment.

So we’ve all these things, that we can do to help with, the treatment for it, I’m going to talk a little bit a few things on chemotherapy, but I’m mostly going to talk about endocrine treatment or hormone therapy. And I appreciate not everyone in the room will be on these drugs. But, I would imagine the majority of you are.

And that’s just what we’re going to talk about today and just things that you can help with yourself. So peripheral neuropathy if you’re going through, chemotherapy, it’s it’s nerve damage. Bernie touched on it regarding surgery, but nerves can also become damage because of chemotherapy. Symptoms are pins and needles, numbness and pain in the hands and feet.

And it’s very much different for every person. Some people have very minimal of these symptoms, and others will have extreme, difficulty with these. It is caused by the chemotherapy. We usually would say that they do improve as the nerves start to repair over time, but it is a long process. The further you move away from treatment, it should improve.

But some people will always have a bit of nerve pain. And, that’s hard for a lot of people to, to manage. Managing symptoms for that there is medication. So if you’re not aware of that and you’re struggling with it, you can speak to your GP about it. Lots of people will be on that medication to help.

Again, some people it will help them. Others they don’t like the side effects from those drugs as well. So I would say if you are struggling with it, it is something to consider. And you can speak to your GP or myself or one of our team about that. Your complementary therapies that Bernie spoke about earlier as well.

Acupuncture is very good for peripheral neuropathy. So acupuncture, reflexology, massage, all those things can can try and alleviate the symptoms a little bit for you. People would say it gets worse when the hands and feet are colder. So just try and keep them warm. Please, please please wear oven gloves and make sure they are okay. Because if you have numbness or, tingling pins and needles in the hands, if you reach for something in the oven, then you won’t realize that you could potentially be giving yourself a severe burn and not even realizing it because you have the numbness feeling there.

Avoid going barefoot around the house. I know I certainly, in this nice weather. Run around with bare feet, but be careful with that, because if you stub your toe where you stand on something again, because of the numbness, you may not even be aware that you’re doing that. And you could get an infection there very easily. Menthol creams are very good.

So things that contain menthol, the sort of the Vics Vapor rub, some people have had benefit from that. I would say that to buy that sort of cream over the counter, it can be quite expensive. So if you have a good GP that would prescribe it for you to try it, or if you can get a sample or a smaller tube to try it.

First of all, some people have tried it and said it doesn’t help, and others say that it does ease the symptoms a little bit. So it is worth trying again. Again, just back to the the heat issue, but more of the feet if you’re just, in the shower or in the bath, just be very careful of the water before you put your hands or feet and wear good fitting shoes because if you’re normally wear that.

That could be rubbing you if that’s if the feet are numb. And if you are having and severe issues with balance or walking, Physio and OT are there to help with those, issues. So a lot of people will talk about chemo brain. I forget this. I don’t remember that. I can’t remember where I left this. It is, a complication for a lot of people and it does go on a long time after treatment as well.

It’s difficulty in absorbing the information. You can forget things. Some people would say they struggle to find the appropriate words, that they need to use. So it is multifactorial. There’s lots of things can, can develop or can lead to that being a problem. With all of our treatment regimes. They all bring symptoms, side effects. With early menopause as well, brought on by cancer treatments, fatigue.

If we’re tired, we can’t concentrate the same and that’s just for everybody, a given. And then also things anxiety, stress, worry about, you know, worry about the cancer, worrying about the treatments, worrying about everything else that comes with that. And, and if the mood is low, they all impact on the memory. Then if you are having other symptoms of pain, nausea or other physical symptoms, these are just some things, some hints and tips that we can maybe try or think about.

Using planners, calendars, lists. They will say to me, but I didn’t have to do that before work. But you didn’t go through all your cancer treatments before and it does impact on your life. It does take time to recover from all of that. There’s lots of apps on phones now. You can make good use of those.

Try to establish a daily routine, and get back to, Bernie sort of said about a new normal. It’s going to be different for everybody, so life won’t be the same straight after treatment as it was before treatment. Life also will not be the same. Five years from now. Things will gradually improve, but it’s just about trying to use what you can when you need to.

That’s not to say you won’t always have to keep using these things, but they’ve just helped you through those early days. The brain exercises, Sudoku, word searches, crosswords. Keeping the brain active is key. The brain will play tricks on you. And it is. Those are good things to be doing and to keep busy. Physical activity, rest.

Exercise, healthy balanced diet. You’ll hear me talking about that right throughout this talk. These are all key things that are for everybody, for a baseline, for general health. But when you’ve gone through treatments for breast cancer, they are of vital importance to help you recover from this. On your road back to your new normal.

Chemotherapy can have effects on fertility, as I’m sure a lot of you are aware, it can cause infertility. If you are thinking about becoming pregnant after cancer treatment, we would say please wait for two years before getting pregnant. If you’re on tamoxifen, I’ll talk about that a little bit later on. It is advisable you do not get pregnant while on tamoxifen, and if you’re wanting to start a family and you’re on tamoxifen, you do need to speak to one of their oncology team about that.

Even though periods can become altered or stopped because of treatment, that doesn’t always necessarily mean you cannot become pregnant. So if you’re in that age bracket, it is still possible to get pregnant. So please do be very careful with that.

So endocrine treatment or hormone therapy. So some breast cancers are hormone positive. That just means oestrogen or er positive. You might have heard that talked about when you’ve been discussing your results. And this just means that the oestrogen is helping the cancer to grow. So you will be prescribed, endocrine treatment if your cancer has been hormone positive.

It’s given to stop the effect of the oestrogen on the breast cancer cells. And, it’s really given to help reduce the chance of the breast cancer coming back. And also to reduce the risk of a new breast cancer forming. Can be given at different times. During Covid, we would have started it may be before surgery if surgery was going to be delayed because of Covid restrictions.

It won’t be given at the same time as chemotherapy. So if you’re getting, chemotherapy, it will start after chemotherapy, but it can be given at the same time as targeted therapy. So like Herceptin or Phesgo. And it will be given during or after radiotherapy usually. But we’ll say to you, if you’re starting radiotherapy, wait until your radiotherapy is over and then you can start your hormone treatment.

And that’s just to allow you time to get over one treatment before we start into another. Then it can be given at other times as well. These are some of the names of, treatments that we would use. So the tamoxifen and then the other group of three drugs, Anastrozole, Exemestane and Letrozole. So they’re known as aromatase inhibitors.

So it’s just to show you because you might be aware of some of those names. So it’s usually taken for around five years, but some of you will be advised to take it up to ten years. And it really is based on your pathology. Individual to you. And we will advise you about that. Some women, depending on their family history, may be offered hormone therapy to help prevent breast cancer occurring.

So on the previous slide, when I said about when it’s given, it can be given at other times, recent research has showed that these treatments, have been beneficial for some people who are at high risk or have a significant family history and or a higher risk of developing a breast cancer. We now know that these treatments can maybe be given prophylactically to try and help reduce that.

So what I want you to take away from today is that it is individualized and it is evidence based. So while you may be sitting at the table, somebody that is on that treatment, you may not necessarily be on it for the same length of time.

These are some of the side effects from the treatments. So as you can see it is lengthy. And I’ve already been speaking to a couple of people and they’ve been saying about hot flushes and night sweats. So we’re going to talk just about a few of these, I suppose a few of the more common ones, and the ones that would really impact maybe in your daily life.

So hot flushes. This is different for everybody. Some people will tell me I’ve minimal hot flushes, but I can manage it. Others tell me they have severe drenching, hot flushes, night sweats. If you’re out working in a, public environment, this is problem for you where you are drenching and having to take a change of clothes. That’s debilitating.

We are wanting you on this treatment for five, possibly ten years. So it has to be manageable. It’s very hard to treat it because it’s still unclear, but it is thought it’s due to a change in the temperature. I would say try taking it first of all at an alternative time. So if you take your treatment first thing in the morning, you could try taking it at night.

Now, not one day in the morning and one day at night, but a few weeks at the same time to see if that makes a difference, for some people would prefer to have the hot flushes during the day. Others will say, well, I’d prefer to have it overnight and be out and about during the day and not as not as big an issue. That simple switch for some people have been enough.

I would also say be very careful about the brand of your hormone treatment. It still will be tamoxifen or anastrozole, but the coating can be different. With the coating comes different ingredients. That that alone can, change your symptoms entirely. So some people have said to me they’re fine on any brand. Others tell me there’s only one particular brand they can take.

So if you have noticed that you’re symptoms have changed one month to the next, do take a note of what brand you have had and see if that makes a difference for you.

Just some tips for managing hot flushes. I’m sure you know of a lot of them. Okay, I’m speaking to somebody in the bathroom earlier and she said with the layered clothing, wear layers that you can remove. Just not one big bulky jumper that you can’t take off, layers that you can remove in public if you need to.

Sharing a bed with a partner or two single duvets instead of a double. It might be enough to stop any rows happening, that somebody’s cold and somebodys hot. There are things out there on the on the market, chillo pillows and cooling scarves that you just bring out. And the scarves are instantly cook that you can wrap around your neck.

Just if you’re right, in a public environment, hand held fans, complementary therapies, they really are key. They work wonders for us. I say lots of, symptoms and side effects. So do you avail of a complementary therapies. It’s not a quick fix. These things do take time to work. Then about a healthy body weight your exercise again all playing a part there.

We do have medication that we can use if we, if you’re having severe difficulties and you want to go down that route and try something else, we don’t usually recommend HRT after you’ve had a breast cancer diagnosis. So for the for people that are on these hormone treatments, their breast cancer has been hormone positive. We are trying to block the oestrogen in the body.

So we don’t want to be adding on any more oestrogen to the body that we have to work with. Some prescription medication can help, but they do have side effects as well. So it’s really about weighing everything up and seeing, which is going to work for you. These are a list of some drugs that we would use for hot flushes.

Some of them in their original form are anti-depressants. So as long as you’re not on something already for your mood, we can look at adding in one of these. They are not given in the same dose as they would be if you were needing it for the mood, they’re given in a much lower dose. And some of them are nerve pain medication as well.

So they do have side effects. Some ladies will say no, I would prefer to manage the hot flushes and deal with the side effects of these drugs. Others, the hot flushes are so severe they will try and manage the side effects of the drugs. So very individualized. I would say if you’re struggling with hot flushes again, we want you on this tablet for five, possibly ten years.

So if you are struggling, I think it is worth trying one of these drugs to to see if it helps with those with those symptoms, so do speak, to your GP. They can prescribe these or speak to me and I can send a letter to the GP and we can try it.

And sometimes it’s just about finding your own way of managing the hot flushes, getting your bum stuck in the fridge. We need to buy one of those big American style fridges so it has to be a perk somwhere. Joint pain, very very common on these tablets. So ladies will tell me they feel like they’ve aged and 20 years from starting this tablet.

But once love oestrogen they thrive on oestrogen. We’re blocking the oestrogen in the body. And that’s why you have the joint pain. You usually would tend to be the smaller joints, the wrists, the knuckles, the knees, ankles, toes. Ladies say getting up in the morning really stiff, really sore. It does tend to ease as the day goes on.

So we would say try over-the-counter analgesia table,t gels, things like that that you can rub on regular exercise to strengthen the bones is what is key, strengthen the joints. The muscles. Some people say to me, I don’t like taking tablets. And I completely understand that after the array of drugs that you’ve maybe received over the last few months, you just don’t want any other medication in your body.

But if you can take something simple like paracetamol, half an hour before you do a little bit of exercise, if that helps you get out and do the exercise then that is key, for a few weeks. You may not have to continue on that, but it is an endless circle. If we don’t break that circle somewhere. The exercise will help. If you craft,

I know in the nicer evenings if you’re out and about maybe doing things, but even if you craft keeping the joints moving, if you’re knit, even you’re knit nothing. You just knit an endless scarf keeping the joints going, knit, knit, knit or craft anything to keep the joints moving is what is key. Swimming, yoga, pilates are excellent.

Stretching out, exercises to stretch out the joints. We can discuss switching to an alternative hormone medication, and I’m sure I’ve done that with some of you here. It does work for some people. Others they may be develop different side effects and say they want to go back on the previous one. They all list the same side effects.

They all do the same thing. They’re all blocking oestrogen in the body. But it’s like two people taking paracetamol. It will react differently for every person. So if you are struggling, please do speak to us and we can try a different one and see if that works. In severe cases, then you can be referred to a pain management clinic as well, and this is very different for everybody.

Some will have minimal joint pain and say they can manage it, others will have severe debilitating joint pain. They can’t open jars and it really affects their daily struggles. The aromatase inhibitors, the group of three drugs Anastrzole, Letrozole and Exemestane in the literature and have the potential of carrying an increased risk of causing osteoporosis. Ladies, as we get older, we’re all at higher risk of developing osteoporosis anyway.

So when we add in these drugs, that increases the risk further. So we will do a Dexa scan or a bone density scan it’s called, at the baseline. And then if we need to repeat that we’ll do that every 2 to 3 years. We’ll add in, calcium and vitamin D supplements to help the bones. And if there is signs of osteoporosis, we will add on a weekly bone tablet, and then we’ll keep a check on that so that the drugs aren’t making things any worse for the bones for you.

Okay. Lifestyle factors, diet, a good healthy diet. You know, your calcium, vitamin D in your diet and stopping smoking, limiting alcohol and your weight bearing exercises all help with bone health. So because we’re blocking that oestrogen, a very common side effect of vaginal dryness, this in turn can lead to increased risk of urine infections. And again, I spoke to some ladies severe debilitating urine infection time after time.

So do you speak to your GP if you need antibiotics, if there is anything with, any issues with incontinence, do seek medical advice. I hope you’re all doing your pelvic floor exercises as we sit here right now. Cus nobody’ll know you’re even doing them. And then it can lead to problems with sexual intercourse, which for a lot of people, is very important.

It’s very important part of a relationship. So if you are having issues with this, I would recommend vaginal moisturizer. Non-hormonal. It is, for long term use. So is used daily and then short acting just before or during intercourse to use lubricants again, non-hormonal. Please do be very careful if you are using these not to use condoms because they can break the condom down.

These can bought over the counter. You can get your GP to prescribe them. Please don’t use things like KY jelly, Vaseline or body, or just normal body lotion as you get a cream for your hands and cream for your face and cream for your body. There is a cream for specifically for a vagina, so please do avail of those.

And try those. And exercise, relaxation if you are anxious about this, low mood, fatigue, all of those impact on your sexual relationships, please do communicate with your partner and let them know. They won’t, they won’t understand what’s going on. Maybe some of you don’t even know that this could be an issue. You know, with vaginal dryness.

So do communicate. Speak with them. There are other forms of intimacy, you know, do hand-holding, cuddling, talking to your partner and just building up to that gradually, work in partnership together. It is a very common problem. It’s a very important part of any relationship. So, if you need to speak to me afterwards, please stay.

We get lots of questions about herbal remedies and herbal supplements. Do they work. Not sure, there’s not enough evidence. People will tell me they’re taking it and they feel better. That’s good. But the evidence doesn’t say if there of any particular benefit. Are they safe? Not sure. There’s not enough evidence. Cost implications? Usually herbal supplements can be very expensive, so please do be careful with that.

What are the side effects? Not sure. There’s not enough evidence and interactions. We don’t know. They haven’t been tested against the drugs that you’re on. So as a general rule of thumb, we do not recommend these. I would say if you are taking any herbal supplements please, please be extremely careful. Lots of herbal supplements contain oestrogen. We’re trying to block the oestrogen, and lots of herbal supplements mimic the effects of oestrogen.

That being said, there are probably very low dose of oestrogen, but we are trying to block whatever oestrogen is already there. We don’t want to be adding extra and we have to work with. Back to our lifestyle factors. They keep coming up again and again. Broccoli versus Chocoloate. I know which one I’ll been picking, so it’s not about one or the other.

It’s about everything in moderation. Alcohol, small glass of wine if you really want that. And it’s not like the wee guy on the treadmill going 90 to a dozen once a month. It’s about regular exercise, daily. There was, a research, evidence from a research done in Europe a few years ago, and it was specifically in ladies with breast cancer, and checking daily exercise 30 minutes a day for five days out of the seven where you were just getting heart rate going a little bit, where you were just feeling a little bit out of breath.

Reduced the chance of recurrence by something like 40 odd percent. Now, if we could put that on a tablet, everyone be wanting it. I get it, lives are busy. You don’t feel like it. You know it is hard to get up and get going sometimes, but it’s just to let you know it is important overall. Tamoxifen a couple of things to be careful about.

If you are on Tamoxifen. It carries a risk of carrying, causing a blood clot that is a very low risk. Those are the signs and symptoms, the blood clot in the leg or the lung. And that’s what it might look like in the leg. If you are on tamoxifen and you develop any of these symptoms, please do speak to your GP or get yourself to A&E and get yourself checked out.

Let them know you’re on tamoxifen. They’ll know what carries that little bit of a risk and they will, they’ll get it sorted for you. Please do let us know if you’re on tamoxifen and you’ve developed a blood clot. We would not want you on tamoxifen. If you have had a blood clot, that would only increase the risk further.

So your treatment needs to be looked at. If that’s the case. And it can have the risk of causing changes to the lining of the womb. So again, if you’ve ever experienced any unexplained vaginal bleeding, please do report that to your GP or again to ourselves and we’ll get you referred to Gynae and get everything checked out for you.

These are low risk of happening, but the risk is there. The benefit of the drug for breast cancer far outweighs the chance that this will happen. But you need to be mindful of it and if those things happen, please get in touch with us and we’ll get everything checked out for you. If you are still experiencing regular periods while on tamoxifen, they can become a bit irregular.

It’s very hard to monitor for unexplained vaginal bleeding, so I would say if the bleeding is not in keeping with a period bleed or it’s extremely heavy, or you’re just worried about it and think, that’s not my normal, just give us a call and we’ll get everything checked out for you. When you’re due to stop your endocrine therapy, you’ll be advised by one of us.

When that, when that needs to stop. Some people do worry about this, and others are overjoyed. And again, it comes back to your symptoms and how you’ve tolerated. If you’ve really struggled for five years, you will be more than happy to come off this treatment. I would say it’s like your chemo, it’s evidence based. It’s, you don’t take chemo forever.

Radiotherapy is evidence based for a set amount of time you will not get radiotherapy continuously and your endocrine treatment is exactly the same. It is evidence based for a set amount of time as to what is needed. So what happens next? Keep in touch with us when you finish treatment. You will put onto a review clinic that maybe with one of the doctors or at my review clinic.

We will follow you up for five years after treatment. We don’t always see you throughout those five years. You have our contact details and you contact us if you have any concerns. We tend to see you at the start of treatment and then sometimes midway, and then at the end of the five years you will have our contact details and you phone us if there’s any issues.

And between those times and we’re happy to see you if you have anything physical with the breast, it’s Bernie and the breast care team in the surgical department. You will get your mammogram as Bernie said every year for five years. And with the oncology team, we review those time points. But you have our details if you need to speak to us, and we’re happy to see you in between those times.

Things to be mindful of as Bernie said, persistent bone pain, persistent headaches that aren’t settling with painkillers. You don’t know what’s causing them, and they’re not getting better. Respiratory problems, cough, shortness of breath, dirty spit. You’ve been running to the GP and you’ve had antibiotics after antibiotics, and things just aren’t getting better, well why? Why are things not improving.

Or if you have any dramatic weight loss for no reason. Those are the main things we say. Just be mindful of and get checked out. But folks, if youse are running to your GP week on week, month on month, you know you’re not well, the GP doesn’t know what’s wrong with you. Please do get in touch with us.

It’s self-directed aftercare. It’s what is followed up for yourselves. So you just make contact with us and we’ll book a scan. We’ll bring you up or down appointment and check you out and see if there’s anything else we need to look into. Thank you for listening. I’m sorry if I rushed that, I will be about, You can speak to me at any point.

Thanks.