Olympic figure skating star Dorothy Hamill was diagnosed with breast cancer nearly three years ago. However, despite being cancer free for two years, the 54-year-old told People magazine that she still suffers some side effects from the surgery, radiation, and chemotherapy treatments she underwent. “I don’t have a lot of energy,” she says. “I get really tired. Even when I’m not skating I get tired.”
Hamill is currently taking the estrogen antagonist tamoxifen. Studies show that tamoxifen helps prevent the original breast cancer from returning and also helps prevent the development of new cancers in the other breast. Hamill says that tamoxifen makes her “achy,” even if she is not skating.
The prognosis of breast cancer has been improving for several years. Early diagnosis is leading to an increasing number of long-term survivors. This leads to the conclusion that more women will survive long enough to experience long-term complications.
Richard Greil, in his 2009 article in Breast Care (Basel) called points out that several factors will contribute to this increase in long-term complications:
- Breast cancer is now understood as a primarily systemic disease from its early onset as evidenced by the observation of micrometastases in bone marrow and circulating cytokeratin-positive peripheral blood cells even in early stages of the disease.
- Breast cancer should be considered a chronic disease, as evidenced by a "lack of a plateau in relapse-free survival curves of breast cancer patients"
- More women are becoming candidates for adjuvant treatment
- More women will undergo rescue regimens in relapse
What are some of the long-term side effects of chemotherapy for breast cancer?
When patients ask, here's what you can tell them. Common long-term side effects of chemotherapy include:
- Early menopause
- Some chemotherapy can damage the ovaries and stop regular menstrual cycles. For some women, this is temporary, for others the change can be permanent. This is more common in women over 40. Symptoms include hot flashes and vaginal dryness. Because the onset of menopause is abrupt, these symptoms may be more intense than with natural menopause.
- Early menopause can affect fertility, although storing embryos before chemotherapy will allow some of these women to bear children.
- Weight gain
- Weight gain is common in women who are treated with chemotherapy, especially those who go into early menopause.
- Chemotherapy can change metabolism, and a less active lifestyle can contribute to weight gain.
- Fatigue
- Although mainly a short-term side effect, fatigue can affect some people for a long time.
- Rare side effects include heart problems and leukemia.
- Leukemia can be associated with the use of cyclophosphamide, doxorubicin, and epirubicin.
- Heart problelms, such as cardiomyopathy and congestive heart failure, have been linked to the use of doxorubicin and epirubicin.
- Cognitive function/ “Chemo-brain”
- Some people will have difficulty with their cognitive functioning such as mental “fogginess” and trouble with concentration and memory. This is often referred to as “chemo-brain”. For most people this is a short term problem, while others may have long-term mental changes.
The results showed that chemotherapy-related cognitive changes were significantly associated with older age and lower baseline cognitive reserve, thus spotlighting a subgroup at higher risk for cognitive changes after chemotherapy. Their studies also showed a significant impact of tamoxifen on processing speed and verbal memory.
As more women become long term survivors of breast cancer, the consequences of their treatment will become of increasing important as well as the subject of future research.