Chemotherapy in patients with early breast cancer: clinical overview and management of long-term side effects

ABSTRACT

Introduction

Neo/adjuvant therapy for early-stage breast cancer has become increasingly common in the last few decades; as a consequence, the number of breast cancer survivors experiencing often debilitating long-term side effects has increased, and thus the need for a comprehensive approach to the variety of symptoms involved.

Areas covered and methods

We performed a literature search on the main public scientific databases (PubMed, Embase, Cochrane, and CrossRef) from 2000 to April 2022 to identify prevention and management strategies for the most common long-term side effects, including fatigue, insomnia, peripheral neuropathy, cognitive impairment, estrogen deprivation, cardiotoxicity, and second cancers.

Expert opinion

Long-term toxicities may affect a majority of breast cancer survivors, significantly interfering with their quality of life. Although there are guidelines for the management of isolated side effects, such as peripheral neuropathy, we aim to provide a more inclusive clinical-oriented approach, focusing on both prevention and therapeutic strategies

KEYWORDS:

• Chemotherapy
• cognitive impairment
• early breast cancer
• fatigue
• insomnia
• peripheral neuropathy
• toxicity

Article highlights

• Long-term side effects secondary to chemotherapy for breast cancer are an increasing health concern, affecting quality of life of a growing number of breast cancer survivors

• There is lack of standardization and a dearth of research about prevention strategies and optimal management

• For many side effects, the optimal management is represented by lifestyle changes, such as regular exercise, yoga, and mindfulness courses, rather than a pharmacological approach.

• Optimization of management could be implemented through dedicated supportive care clinics.

• Optimal management of certain side effects, such as cardiotoxicity, requires strict collaboration between different specialists.

Author contribution statement

Conceptualization: P Di Nardo and F Puglisi; investigation: P Di Nardo, C Lisanti, M Garutti, S Buriolla, M Alberti, and R Mazzeo; writing: P Di Nardo, C Lisanti, M Garutti, S Buriolla, M Alberti, and R Mazzeo; supervision: F Puglisi. All authors have read and agreed to the published version of the manuscript.

Declaration of interests

M Garutti reports advisory board from Novartis, Eli Lilly, PierreFabre, Roche and travel fees from Daichii Sankyo all outside the submitted work. F Puglisi received a honorarium for advisory boards, activities as a speaker, travel grants, research grants: Amgen, AstraZeneca, Daichii Sankyo, Celgene, Eisai, Eli Lilly, Gilead, Ipsen, MSD, Novartis, Pierre Fabre, Pfizer, Roche, Seagen, Takeda, Viatris. Research funding: AstraZeneca, Eisai, Roche. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was funded by the Italian Ministry of Health – Ricerca Corrente