Lymphoedema after axillary dissection and/or
radiotherapy. It can arise at any time, even many
years after treatment.
● Cardiovascular toxicity after radiotherapy, and
increased cardiovascular risk after premature
menopause. Treat with appropriate medical and
risk-reduction strategies.
● Congestive heart failure associated with anthracyclines
and trastuzumab. Monitor (mandatory with
trastuzumab) and manage medically if present.
● DVT, stroke (tamoxifen). Treat as usual if present.
● Hot flushes after premature menopause, tamoxifen
or aromatase inhibitors (less so). SSRIs, SNRIs and
gabapentin may be useful. Alternatives such as
black cohosh have also been suggested.
● Vaginal dryness and dyspareunia. Non-hormonal
moisturisers and lubricants; use local oestrogen
with caution as there may be systemic absorption.
● Loss of libido resulting from altered body image,
radiotherapy, chemotherapy, depression or
dyspareunia. Counselling may be helpful, as well as
appropriate medical treatment.
● Arthralgia and musculoskeletal symptoms, from
aromatase inhibitors and sometimes tamoxifen.
Conservative treatment such as paracetamol or
NSAIDs if needed.
● Depression and anxiety following the diagnosis,
loss of body image, concern about morbidity and
mortality, and the direct effects of some
treatment. Treat as usual, including supportive
counselling and antidepressants if needed.
● Fatigue, associated with the diagnosis and
treatment. Provide support, encourage activity,
and rule out psychiatric or biological causes
(depression, anaemia, hypothyroidism).
● Weight gain, which can occur with chemotherapy
and possibly with tamoxifen and aromatase
inhibitors. Manage as usual with diet and
exercise.
● Osteopenia or osteoporosis, associated with
treatment-induced menopause and aromatase
inhibitors. Monitor bone mineral density and treat
as usual, including bisphosphonates if needed.
NEJM 2007; 356:2505-13.
Drug class
Anthracycline
Alkylating agent
Anti-metabolite - Folic acid analogue
- Uracil analogue
- Taxane
Selective oestrogen receptor modulator
Nonsteroidal aromatase inhibitors
Steroidal aromatase inactivator
Luteinising hormone releasing hormone agonist
Monoclonal antibody
