Identifying, Managing Adverse Effects of Treatment for Advanced Breast Cancer

A recent review detailed the types of side effects patients with advanced breast cancer may experience with various systemic anticancer therapies and provides direction for management of these adverse effects. This review was published in Seminars in Oncology Nursing.

The review was authored by Celia Diez de los Rios de la Serna of the University of Glasgow in Glasgow, UK, University of Barcelona in Barcelona, Spain, and the Education Working Group EONS, and colleagues. 

In developing this review, Diez de los Rios de la Serna and colleagues used peer-reviewed articles and national and international practice guidelines, including guidelines published by the European Society for Medical Oncology (ESMO), American Society of Clinical Oncology (ASCO), and the Multinational Association of Supportive Care in Cancer (MASCC).

“Nurses have a crucial role in monitoring, assessing, escalating, and supporting in the coordination of treatment of the side effects,” Deiz de los Rios de la Serna and colleagues wrote in their report.

The authors emphasized the importance of early assessment of side effects for optimal management of toxicities. They also described tools available for grading toxicities, such as the Common Terminology Criteria for Adverse Events (CTCAE) or the United Kingdom Oncology Nursing Society (UKONS) Triage Tool, the latter of which provides information directed toward nursing practice. 

As de los Rios de la Serna and colleagues noted in their review, patients with advanced breast cancer may be treated with and experience adverse effects from endocrine therapies, targeted therapies, immunotherapy, or chemotherapy. 

The review includes descriptions of the most common side effects associated with each class of treatment and possible interventions in the management of these, with attention to frequency and the seriousness or severity of side effects. 

Interventions presented ranged from pharmacologic and nonpharmacologic strategies for managing hot flashes associated with endocrine therapy, to the management of diarrhea associated with targeted therapies, to the use of immune-modulating drugs or steroids for some immunotherapy adverse effects. 

Complementary/alternative therapy interventions such as cognitive behavioral therapy (CBT), yoga and mindfulness, acupuncture, and various types of physical exercise are commonly used strategies with proven effectiveness for many adverse effects.

Diarrhea, and other gastrointestinal effects, is a common adverse effect of targeted therapies and chemotherapy. These effects can be managed with dietary changes (eg, 8 to 10 oz of clear liquids, frequent small meals). Other strategies are to hold or reduce medication doses and/or administer loperamide, octreotide, IV fluids, or prophylactic antibiotics.

The authors emphasize maintaining advanced breast cancer disease control and optimal treatment dosing among key aspects of nursing practice. “Management and decision-making related to treatment side effects requires holistic assessment skills, a good understanding of toxicity grading, and up-to-date knowledge of interventions to alleviate side effects,” Deiz de los Rios de la Serna and colleagues wrote in their report, highlighting the important role nurses play in treatment of patients with advanced breast cancer.