Re: Advances in the care of breast cancer survivors

Agreement: 
I Agree
Body: 

Dear Editor

I appreciated this excellent summary of advances in the care of breast cancer survivors.

One obvious omission was the lack of description of the effects of steroids during chemotherapy.

Dexamethasone is routinely used to prevent side effects – allergy and oedema – for docetaxel regimens, frequently used.

The cumulative dose of 54 mg, of this steroid, which has a long half life, may result in proximal myopathy post chemotherapy, with a recovery time from this side effect of perhaps 6 months or more to recover muscle strength.

Further, for susceptible people, it increases the likelihood of developing diabetes. Nican published a study in 2019, which delineated an increase in diabetes of 3-7% in women treated for breast cancer (from the studied year pre and post treatment 2016), probably a result of such dexamethasone use. As diabetes is a known risk factor for primary breast cancer and recurrence risk, this is relevant.

Blood glucose levels are routinely monitored as part of the panel of blood tests during chemotherapy, but in non diabetics raised levels are not routinely treated or commented upon.

New UK guidelines have been produced regarding management of hyperglycaemia during chemotherapy, but how these have been actioned is not clear, particularly for those who were not diabetic prior to treatment.

Regarding CIPN, current consent forms for patients do not clearly state that peripheral neuropathy may begin long after treatment has been completed – due to ‘coasting’ – that is die back of nerves over time, so symptoms may peak at 3 months or more after chemotherapy has been completed. This may occur at a time when patients have been discharged from immediate oncology treatment, so they may be left without access to useful care. Duloxetine is the only proven drug therapy re amelioration of symptoms for CIPN, but other physical/psychological measures which may help are not mentioned. (Advice that altered sensation does not necessarily mean altered physical ability (so it is safe to remain active), advice that sensory distraction is useful – wearing gloves or socks to create real sensation to negate the discomfort of overactive nerves.)

In the print version of this review there was no mention of Lymphoedema. During breast cancer treatment, this is highlighted as something to be feared, and leaflets are given out regarding how to do manual lymphatic drainage. If these leaflets were accompanied by advice that personal massage (despite pain) was useful in prevention of future problems, more people would do it. Having experienced excellent care from a Lymphoedema specialist, who, in my view ‘kneaded my chest like a bit of pastry’, I was so grateful to her for giving me permission to treat myself with vigour, having been frightened to touch the cancer area, in case I injured it, or spread the cancer.

During, and after my own treatment for breast cancer, I read many research studies, and relevant advice, and noticed the deficits mentioned above.

I would be grateful if my comments/observations would be added to what you have written.

No competing Interests: 
Yes
The following competing Interests: 
Electronic Publication Date: 
Wednesday, November 15, 2023 – 00:24
Workflow State: 
Released
Full Title: 

Re: Advances in the care of breast cancer survivors

Highwire Comment Response to: 
Check this box if you would like your letter to appear anonymously:: 
Last Name: 
Watters
First name and middle initial: 
Janet P
Address: 
Occupation: 
retired GP
Affiliation: 
BHSCT
BMJ: Additional Article Info: 
Rapid response

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