Five Things to Reduce Side Effects from Most Common Breast Cancer Treatment

Researchers have identified several ways to manage the side effects of hormone therapy, which can help patients stick to this life-extending care.

More than 70 percent of breast cancers are hormone-receptor positive (HR+), which means that estrogen, progesterone, and other hormones fuel the tumors.

After surgery, the standard treatment for HR+ breast cancer is called endocrine therapy or hormone therapy. Patients take a daily pill that blocks or reduces the effects of the hormones to keep breast cancer from returning. Common hormone therapies are drugs such as tamoxifen or aromatase inhibitors. Doctors recommend that patients take them for 5-10 years, depending on the risk of cancer recurrence.

This type of treatment is remarkably effective—and can also be used to prevent cancer in women who are at high risk of invasive breast cancer, research shows.

The five-year survival rate for localized, early-stage breast cancer is now 99%. 

However, many women avoid taking hormone therapy for the prescribed length of time due to side effects, including:

• Hot flashes
• Bone, joint, or muscle stiffness and pain
• Vaginal dryness
• Brain fogginess
• Bone thinning in younger women.

It’s important to note that side effects are not the same for everyone. Some people rarely experience them while others say the side effects disturb quality of life.

Susan Dent, MD

Wilmot Cancer Institute physicians and scientists recently published an article that reviews the research and offers ways to manage side effects from hormone therapy. Led by Susan Dent, MD, professor of Medicine, Hematology/Oncology at the University of Rochester and director of Wilmot’s Judy DiMarzo Cancer Survivorship Program, the experts offer these recommendations:

Medications. If a patient already has bone loss, drugs like bisphosphonates can reduce the chances of osteoporosis or severe osteopenia. For hot flashes, drugs known as SSRIs that are normally used to treat anxiety or depression can also be used to manage flushing flare-ups—although there are risks as well as benefits to taking these medications. Discuss them with an oncologist.

Sexual side effects. Women can get relief with lubricants (only those types recommended by healthcare providers) and in some instances, topical estrogens. Recent data show no evidence that topical estrogens used by women with HR+ breast cancer increases the risk of breast cancer death, but it’s important to review the pros and cons of this approach with a doctor.

Lifestyle changes. These are things a person can do to improve health without medications. Research shows that exercise is a key component for extending cancer survivorship and managing side effects. It can range from vigorous or moderate aerobic activity such as running, to gentle yoga, tai-chi, strength-training, or walking. Doctors should supervise exercise plans, based on the degree of the cancer patient’s physical fitness at the start of treatment. The American Cancer Society published in 2022 a nutrition and physical activity guideline for cancer survivors.   

Mindfulness interventions. This includes group therapy, behavioral therapy (online or in person), and education about how to manage the psychological trauma associated with a cancer diagnosis and treatment. Practicing deep breathing, meditation, and yoga can alleviate anxiety, depression, fatigue, and other side effects. The Pluta Integrative Oncology and Wellness Center at Wilmot has many programs offered in-person and virtually—as well as a library of online information—that are free and available to all patients at the Wilmot Cancer Institute.

Acupuncture. Recent guidelines show it can help with pain, hot flashes, joint arthralgias, and neuropathy symptoms. (The needles are about the size of human hair, much smaller than those used commonly in health care.)  Cancer survivors can also consider acupressure, which does not involve needles and can be done independently using fingertips or a device on specific acupressure points.

** A final note: Patients interested in herbal supplements, vitamins, energy drinks, protein powders, or other non-regulated “health” products should speak with their doctors before using them. Some products can interact with cancer treatment or cause other health issues.

Additional University of Rochester and Wilmot physician-scientists who contributed to this research review: first author Timothy Winslow, MD, hematology/oncology fellowship chief; Allisa Huston, MD, professor of Medicine who specializes in treating breast cancer; and Ruth O’Regan, MD, also a breast cancer specialist and chair of the Department of Medicine.