What to Expect – Chemotherapy - Black TNBC Sanctuary

What is chemotherapy?

Chemotherapy—chemo for short—is often the main whole-body treatment for triple negative breast cancer (TNBC). Instead of picking one area of the body, chemotherapy will kill cancer cells throughout your entire body. Chemotherapy is very good at killing rapidly dividing cancer cells, which are common in TNBC.

There are many types of chemotherapy drugs, and you and your doctor will choose the best combination for you. A 2024 study found that the chemo drug docetaxel causes less nerve damage than the chemo drug paclitaxel for Black women with breast cancer.

Who gets chemotherapy?

Most individuals diagnosed with TNBC have chemotherapy in their treatment plan.

In rare cases, you might not receive chemotherapy. For example, if you have a very low-grade tumor (the cancer cells are not dividing quickly), if the tumor is very small, or if the risks of chemotherapy outweigh the benefits. Because chemotherapy is a common treatment for triple-negative breast cancer, always ask your doctor to explain the reasons why you would not receive it.

When is chemo given?

Chemo may be given before breast surgery (called neoadjuvant therapy), after breast surgery (called adjuvant therapy), or both before and after surgery.

For those with stage 1-3 TNBC, chemo may be given by itself or with the immunotherapy pembrolizumab (Keytruda) to shrink the size of a tumor before surgery. If cancer cells are still present, chemo following surgery may also be recommended. TNBC typically responds well to chemo, but it is more likely to recur after treatment compared with other breast cancer subtypes. Post-surgery chemotherapy can help to reduce the chances of disease recurrence.

How is chemo given?

Chemo is given intravenously (IV), orally, as an injection, or as an infusion over a longer period to stop or slow cancer cell growth. Chemo is typically given in cycles of two to three weeks with a rest period in between to give patients time to recover. In total, treatment with chemo is given over a period of around three to six months.

Are there other medications that I will receive along with or right after my chemotherapy?

Some drugs—like immunotherapies and targeted therapies—can be given with chemotherapy. Ask your doctor if you are getting either type of medicine at the same time as your chemo.

Chemotherapy can wipe out your immune system. In fact, you will have blood tests before every chemo infusion to make sure that your white blood cell count (the most important immune system cells) is high enough to have chemo. To help with this, your doctor will likely prescribe a medicine called pegfilgrastim (Neulasta or Neulasta Onpro) that works to increase your white blood cells and lower your risk of infection.

Your doctor may prescribe a steroid for nausea in the days leading up to a chemotherapy transfusion.

Talk to your doctor about other medications that you could receive during your chemotherapy treatment.

Questions to ask your oncologist about chemotherapy:

Am I a candidate for any clinical trials?
What type of chemotherapy do you recommend and why?
How many rounds will I need to complete and why?
How long will each treatment take?
Are there any integrative therapies that may help with the side effects?
Will I be able to work immediately after treatment?
Will I be able to drive myself home after treatment?
Is there childcare available for me during my treatment?
Are there options for alternative doses if I don’t tolerate this treatment well?

Sanctuary Tips

If you start to experience neuropathy, tell your doctor right away. Neuropathy (nerve damage) can occur in the hands, arms, feet, and legs where an individual may feel numbness, pain, burning or tingling sensations, sensitivity to cold or heat, or weakness in one or more of those areas. Black patients have been found to be 2.9 times more likely to experience taxane-induced peripheral neuropathy than white patients.
Don’t be afraid to talk to your doctor about side effects you’re experiencing. They can offer you IV fluids, constipation medicines, and other support that you need to get through treatment.
While the idea of a port can seem scary, many people find having a port more convenient because you don’t have to be stuck with a needle every time.
Chemo makes a lot of people feel nauseous. Your doctor should give you anti-nausea medication—if they don’t offer, ask for it. Take the nausea medication before each chemo treatment. In general, take the nausea medication before you need it!
In terms of nausea, people find that ginger and smaller, more frequent meals can help. Some people also swear by non-metal utensils (plastic, compostable, etc.) because the metallic taste makes the nausea worse.
Whatever you can stomach, eat it! Popular chemo foods include ice cream, smoothies, mashed potatoes, applesauce, and saltine crackers.
Stay hydrated! Adding electrolytes to your water helps.
Get rest. Nearly everyone feels fatigue during chemo. You will need more rest than you’re used to. Be kind to yourself and listen to your body.
Prioritize gentle movements and exercise like walking and yoga.
Tell people how they can help you and don’t feel bad for being direct—people will want to help you, but don’t know how. Some ideas: laundry, cleaning, cooking and grocery shopping, and child care.
Chemo treatment centers tend to be cold—bring a blanket and some warm layers with you.
Chemo treatment centers can also be pretty loud—noise-canceling headphones are great.
To avoid mouth sores, use the special mouthwash that your doctor prescribes. If they haven’t prescribed it, ask for it.
If your doctor prescribes Neulasta during chemo, they may also recommend that you take Claritin for the days leading up to and after the injection to decrease any bone pain.
If you are taking taxol, many people choose to ice their hands & feet during each infusion to try to prevent neuropathy.
Most people who go through chemo experience hair loss. Cold capping is an option that may help keep more of your hair. Learn more about cold caps in our resources section under Hair & Beauty.
The effects of chemo are cumulative. You might not feel the full impact of side effects until you’ve had multiple treatments. If you need to make important plans, schedule those for earlier in the chemo cycle.
Find something that gives you pleasure (painting, knitting, light exercise, playing music, etc.).

What are the potential side effects of chemotherapy?

Treating triple negative breast cancer is incredibly important. It also comes with some side effects. We know that reading a list of potential side effects can be scary and stressful—just because something is on this list doesn’t mean you will definitely experience it. But if we’re being honest, you will likely face something on this list. We’ve faced them ourselves. And we want you to be prepared to tackle it equipped with resources and support. We’re here for you.

You can learn more about recognizing, managing, and minimizing these side effects in our resources section.

Hair loss
Nail changes
Mouth sores
Loss of appetite or weight change
Nausea and vomiting
Diarrhea
Fatigue
Menstrual changes and fertility issues may occur in young women, including premature menopause and infertility. These symptoms may also lead to increased risk of other conditions, including heart disease, bone loss, and osteoporosis. Getting pregnant while on chemo is also not recommended as it can lead to birth defects.
Hand-foot syndrome—in which numbness, tingling, and redness occurs in the palms of the hands and the soles of the feet—may be caused by certain chemo drugs, such as capecitabine and liposomal doxorubicin.
Chemo brain, or a slight decline in mental function, may include problems with concentration and memory and can last for a few years.
An increased risk of diseases such as myelodysplastic syndromes or acute myeloid leukemia is rare but has occurred when taking certain chemo drugs, such as doxorubicin.

Additionally, a few side effects impact Black patients disproportionately:

Neuropathy, or nerve damage, can occur in the hands, arms, feet, and legs where an individual may feel numbness, pain, burning or tingling sensations, sensitivity to cold or heat, or weakness in one or more of those areas. In a study published in JCO Precision Oncology, Black patients were found to be 2.9 times more likely to experience taxane-induced peripheral neuropathy than white patients.
While not common, permanent heart damage—also called cardiomyopathy–may occur when taking doxorubicin, epirubicin, and some other chemo drugs. In the same recent JCO Precision Oncology study, Black patients were 1.8 times more likely to suffer from anthracycline-induced congestive heart failure.

Video:

The Doctor Is In: Neuropathy