Balancing Act: Treating Breast Cancer and Other Conditions at the Same Time
Kimberly Dafforn, of Fort Wayne, Indiana, is 48 years old and has been living with hormone receptor-positive metastatic breast cancer since 2007, for which she takes different medicines including palbociclib (Ibrance). She also takes methotrexate to treat rheumatoid arthritis, a disease that can cause painful swelling in the joints. Because both medicines can affect her blood cell counts, her doctors continually check her counts and share the results with her. If they get too low, Kimberly knows to speak with her different specialists about what treatments will change, and how.
Taking care of my health is becoming a full-time job.
Dealing with side effects of multiple medicines is just one of the issues people face when they need treatment for more than one condition, a situation that is very common.
Kimberly also has diabetes, so she must deal with arthritis pain, making sure she takes all her treatments on time, and many extra doctors’ appointments. She meets regularly with an oncologist for breast cancer, a rheumatologist for arthritis and an endocrinologist for diabetes.
“Taking care of my health is becoming a full-time job,” Kimberly says.
Many factors go into deciding how to treat breast cancer. A comorbidity, a condition you have in addition to breast cancer, can make that decision even more complex. Comorbidities are common and becoming more so. As people are living longer, they are more likely to develop multiple conditions associated with getting older, says Gretchen G. Kimmick, MD, MS, a medical oncologist with the Duke University Health System, in Durham, North Carolina.
The same health conditions that are common in the general public are common in people with breast cancer and cancer in general, says Dr. Kimmick. These include heart disease, high blood pressure, diabetes, obesity and other cancers. When you have more than one condition, your doctors must consider possible medicines for each one and how they might interact with each other or affect the other conditions.
Navigating Your Healthcare Team
Monique Lloyd, 51, of Newcastle, Delaware, learned early that finding doctors you trust and making sure they speak to each other and to you is key to dealing with multiple conditions.
Monique has two forms of the autoimmune disease lupus. With an autoimmune disease, your immune system, the organs and cells that protect your body from infections, attacks healthy cells by mistake. Lupus symptoms come in episodes, or flares. These flares can be triggered by taking certain medicines, having surgery, getting an infection, or mental or physical stress, all of which are common experiences during cancer treatment.
In 2010 Monique was diagnosed with stage III triple-negative breast cancer. She was concerned about how her body would react to breast cancer treatments. She realized she would have
to take an active role and find a healthcare team she was confident would work together to address those concerns.
Cancer specialists may not know a lot about your other conditions. Advocating for yourself and asking questions can help ensure you’re getting good care for all your health concerns.
“[With lupus] one misstep and you can wind up in a flare. You can wind up with organ damage. It literally can kill you,” Monique says.
When her first surgeon suggested a lumpectomy and radiation, Monique worried the radiation could cause a lupus flare in the same way ultraviolet light is known to. She asked if the radiation could set off the lupus, but her surgeon’s “I don’t think so” answer failed to give her confidence. She spoke to friends and family and went for a second opinion at a hospital where a panel of doctors from different specialties recommended against
Monique decided, with her doctors, to get a double mastectomy. Throughout her treatment the different members of her medical team worked together and shared information.
The rheumatologist recommended Monique get steroids before surgery to help prevent a lupus flare. Results of all blood tests were shared with all doctors.
“Everybody was on the same page. They knew what [medicines] I was taking and if [I had] any questions or concerns [they would] be [answered] by them all,” Monique says.
Carla Page, 54, of Ormond Beach, Florida, was diagnosed with stage II, hormone receptor-positive, HER2-positive breast cancer in 2008. It recurred to her lungs and liver in 2012. She noticed in 2016 that she was more tired than usual. Any physical activity left her winded and needing a break. She thought it was a side effect of her medicine and didn’t tell her doctor until she was struggling with even simple activities.
“I’m talking [the kind of] tired where I had to stop six times as I’m trying to walk around a small block. And [my doctor said] ‘Oh, no, that’s a problem,’” Carla says.
She was diagnosed with pulmonary arterial hypertension, high blood pressure in the arteries that carry blood from the heart to the lungs. In people with this condition, the heart has to work harder to get blood through, causing it to weaken. Pulmonary hypertension has been linked to some breast cancer medicines, but it is also very common in the general population. Carla’s doctors told her that cancer treatments could have caused the high blood pressure, but there’s no way to know for sure.
Once she knew the cause of her fatigue, Carla started treatment, which helped her get up, walk and generally get back to her life. But it also complicated her cancer treatment.
At the time, she was taking trastuzumab (Herceptin), a targeted therapy known to impact heart health. In order to treat the high blood pressure, her doctors asked her to stop taking trastuzumab for a while so her heart could recover. Pulmonary hypertension doesn’t go away completely, but after treating it for some time, her oncologist felt her heart was healthy enough to start trastuzumab again.
“We did one cycle of the Herceptin again and the effects were to the point where [my doctor] knew [through test results] if [I] continued the Herceptin that … my heart would not handle it well,” Carla says.
Treating multiple conditions is not as simple as making a list of medicines you cannot take. Finding the right treatment involves combining the right medicines, doses and schedules to best treat the conditions while trying to save you from dangerous or uncomfortable side effects.
“When considering treatment options, you’ve got a certain percentage chance of side effects, and you have to weigh the pros and cons of both,” Dr. Kimmick says. “There’s a lot of different factors that go in. The more illnesses you have, the greater chance of complications.”
Medicines don’t work the same for every person. One medicine may work very well in some people but it may not work as well in others. One person may experience serious side effects and another person may not feel affected much at all. With each added medicine you take, you are more likely to feel side effects from at least one medicine, and it’s possible to feel side effects from some or all of them.
Doctors try to choose medicines that give you the best chance of successful treatment with the fewest side effects. But you may face choices if you take medicines for multiple conditions. The pain Kimberly feels from rheumatoid arthritis would normally be treated with a higher dose of medicine, but her rheumatologist doesn’t want to add to the high level of medicines she is taking for different diseases. So to avoid the risk of more side effects or her cancer treatment working less well, Kimberly puts up with more pain.
When considering treatment options, you’ve got a certain percentage chance of side effects, and you have to weigh the pros and cons of both. There’s a lot of different factors that go in. The more illnesses you have, the greater chance of complications.
Take Charge of Your Health
For Monique, being informed and active in her care means listening to her doctors and learning about her conditions, but also finding doctors who are willing to listen to her. When one doctor wasn’t responsive, she found a new one, and you can too. If something doesn’t feel right, you should feel confident your doctors will take your concern seriously.
“Anything that looks odd to me, I question,” Monique says. “I know that it’s to my benefit to know as much or more than [other people] because those questions that don’t get asked are usually the things that get you into trouble.”
Dr. Kimmick says it’s important to visit your primary care physician and continue care for ongoing medical problems as you go through breast cancer treatment. Your primary care provider is better prepared to take care of your non-cancer medical problems than are your cancer doctors.
“A lot of people want to concentrate on the cancer treatment and not pay attention to other [health problems] because they are so busy with cancer treatment, but it’s really important to pay attention to [your overall health] too” Dr. Kimmick says.