Management of chemotherapy-related arm symptoms in patients with breast cancer

Abstract

Anthracyclines are used widely as part of combination chemotherapy regimens to treat patients with early breast cancer. Epirubicin administered through a peripheral catheter may cause venous irritation resulting in symptoms of phlebitis. Management of phlebitis in oncology remains conflicted. In response to anecdotal patient reports of arm symptoms, a local audit was conducted to identify the incidence and type of arm symptoms during or after chemotherapy and their management. An audit questionnaire was designed by research and clinical staff and completed by 110 patients with breast cancer aged between 25 years and 76 years (± 52.7 years). FEC-80 was the most frequently administered (n=68) chemotherapy regimen. Out of 108 responses, 65 patients reported arm symptoms during chemotherapy, of which the most commonly reported were arm pain 43% (n=28), tightness 32% (n=21) and vein discolouration 22% (n=14). They were most commonly provided with a heat pad, ibuprofen gel or bandaging for symptom relief. Only 27 patients (25%) recalled being given aftercare advice on self-management of arm symptoms. While a number of interventions were used to manage symptoms, there was no standardised care. Uncertainty exists about appropriate intervention and advice on self-management of persisting arm symptoms. Future research and guideline development should focus on prevention and early detection, as well as assessing the effectiveness of interventions.