Late effects of chemotherapy for breast cancer treatment ...



0:14Hello, welcome to the Northamptonshire Wellbeing Programme.?My name is Harieta Garofide, I'm a Consultant Medical Oncologist at Northampton General Hospital, and we will be discussing the late side effects of chemotherapy treatments.0:29When we think of chemotherapy, we know the initial focus is on the immediate side effects, however. there are late side effects that may become a problem later on.0:43and the ones that we'll be covering today are the increased risk of a secondary cancer, early menopause, peripheral neuropathy, the risk of heart damage and the chemotherapy effect on concentration and memory.1:00When we talk about the increased risk of another cancer in the future, it was noticed that patients who had chemotherapy for breast cancer seem to be at high risk of developing leukaemia.1:14In the population of previous breast cancer patients, the risk of leukaemia was 30 in 100,000 patients compared to what we see in the general population, which is 8.7 cases in 100,000 patients.?So although that seems to be a significant difference,we know that these risks are actually smaller than the risks that patients are exposed to, from the breast cancer they were diagnosed with.?So this is the reason why chemotherapy is offered although we are aware of these particular long-term complications.1:59Another late side effect of chemotherapy treatment is early menopause which is explained by the chemotherapy's effect on the ovarian function.?The ovaries which produce oestrogens are at risk of being damaged by chemotherapy and sometimes after treatment we see that the ovarian function stops.?As a result,the menopausal symptoms can be more intense, and although there is no available treatments to reverse that,what we tend to do is try to prevent early menopause by using preparations like Zoladex, which are injections, that put the ovaries on hold,and with this, protect them by the damaging effects of chemotherapy, with these preparations that are higher chances of the ovaries recovering function.2:55and this is something we tend to use when patients are diagnosed with breast cancer at a very early age, and they want to maintain fertility.3:09and sometimes when we anticipate patients to complete hormone therapy when they are 40, 45 years old, when we would still like the ovarian function to resume because female hormones have a protective role when it comes to cardiovascular health.3:29So initially we may consider a good thing putting the ovaries on hold and lowering the oestrogen levels as part of hormone treatments.3:38However, when we look at the long term toxicity, protecting patients from cardiovascular risk is equally important.3:50Another problem with chemotherapy is the damage that it may cause to the nerve endings,and this is what we describe when we say peripheral neuropathy.4:04and this can be felt and described as a pain like burning or shooting pain; pins and needles; numbness; increased sensitivity, and sometimes finding changes in difficulties doing fiddly tasks like buttoning and unbuttoning clothing or turning pages.4:32Sometimes, this is a side effect that is reversible once treatment stops.?However, this can last longer, It may gradually improve over weeks, months, but on some occasions, this could be permanent nerve damage.4:50We know that docetaxel, the drug that we use commonly in treating breast cancer, comes with the risk of severe neuropathy in four in one hundred patients when it is used as standard doses.?And because there is no treatment available to improve the symptoms and treat this problem, the ideal strategy is preventing neuropathy by considering dose adjustments, and it was seen that with a 25% dose reduction of docetaxal the risk of severe nerve ending damage was lowered to 0.8%.5:31So, ideally, we would like to prevent this complication.?If it develops, it is important to avoid injury if the hands or feet are numb, and there is lack of sensation;and sometimes, there may be further support needed from occupational therapists.5:52Another side effect of chemotherapy that we use in the treatment of breast cancer is the risk of heart damage, which is associated with Epirubicin, the red drug in the chemotherapycombination.6:07and this increased risk can be seen 2 or 3 months from treatment and can be there years following treatment.6:16And, although the actual incidence caused by the heart damage are rare, we also know that these risks tend to be higher with cumulative doses that exceed the equivalent of 9, 10 cycles.?We usually offer 3 to 4 cycles as a standard treatment.6:44So, it is known that Epirubicin can cause heart failure.?This is why the cardiac function needs to be assessed prior to treatment.?We need to make sure that the heart is healthy,so we don't expose it to further risk by exposing it7:02to Epirubicin drug. Risk factors that may increase the chances of heart damage from Epirubicin are pre-existing heart condition,7:15previous radiotherapy that might have damaged the heart, or other medication that may have a damaging effect on the heart muscles. Effects on concentration and memory is what we describe when we use the word 'chemo brain'.?And this is when it is more difficult for patients to concentrate when they become more forgetful after they've had chemotherapy.?And although the actual cause to this process is unknown.?The explanation seems to be related to how chemotherapy may speed up the normal ageing process in the brain cells.?Obviously, this can also be combined with the effects of fatigue and menopausal symptoms that may be disrupting sleep.8:04In terms of how this is being managed, there is no specific treatment, and most times, we rely on practical measures, like using a diary or phone reminders, keeping the brain busy and Cognitive Behavioural Therapy.8:25So in conclusion, we would say that although a patient's diagnosis of breast cancer is part of the patients past, we know that this is a past that may affect the future.?And while8:40we know that the initial focus when someone is diagnosed with the breast cancer seems to be focused on the immediate side effects of chemotherapy and the immediate toxicity.?Following those initial six months, the focus becomes living beyond breast cancer.?And this is when these late side effects become more relevant.9:06Thank you for watching.RE-GENERATE TRANSCRIPTSAVE EDITS ................
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