October is Breast Cancer Awareness Month: a time to remember to get your mammogram and look for changes in your breasts. It’s also a time for healthcare providers to recognize the intricacies of caring for breast cancer patients, even outside oncology settings.

Of course, many clinicians treat breast cancer patients and survivors with specialties besides oncology. Gynecologists, surgeons, radiologists, and even primary care physicians all play a crucial role in treating cancer patients. Since so many providers are involved in the care and treatment of patients battling this horrible diagnosis, communication is essential not only between providers but between providers and the patients themselves. A reported symptom that seems benign could mean there are complications brewing.

I should know. During my breast cancer treatment, which included a double mastectomy and chemotherapy, a fever of 103°F was not a simple fever at all. Instead, it was neutropenia and kidney complications that had been misdiagnosed. Initially, my PCP believed my fever was secondary to the fly. However, the next day my plastic surgeon examined me and felt I needed to be seen in the ER. I was diagnosed with a yeast infection from my breast tissue expanders, ultimately leading to surgery and a week-long hospital admission.

Many seemingly minor symptoms, like fevers, in breast cancer patients should warrant further examination or, at minimum, questions by providers who encounter them despite their specialties. For example, Kathleen Sacharian, MSN, CRNP, AOCNP, an oncology educator and medical science liaison, says the following symptoms should be looked at more closely if reported by patients.

Fatigue

When undergoing chemotherapy, fatigue is especially common. But when a patient who finished months ago asks about the persistent fatigue, even with plenty of sleep and daily exercise, don’t simply chalk it up to past treatment. “Patients are often surprised to learn that they can feel fatigue six months after their last treatment,” Sacharian explains. “The big challenge for doctors is that side effects can be immediate and long-term, or they may present themselves years later. While chemotherapies probably play a role, fatigue is the most common symptom breast cancer patients experience. Therefore, it’s worthwhile for providers to look into the patient’s current medication regimen.

“We often recommend increasing physical activity to help improve fatigue, as well as identifying other causes that may be contributing, such as insomnia or anemia,” Sacharian adds. Serotonin-norepinephrine reuptake Inhibitors (SNRIs), among other drugs, might be exacerbating the symptom. Many patients on aromatase inhibitors such as tamoxifen report joint pain, hot flashes, and other menopausal symptoms, which can be especially worrisome for young people. “These symptoms may be related to hormonal medications that patients with hormone receptor-positive breast cancer may receive, but with a breast cancer patient, there’s always the concern that cancer has metastasized, Sacharian advises.

Even without metastases, joint pain is a quality-of-life issue and increases the risk of osteoporosis. Rather than eliminating the medication causing the symptom, which could facilitate cancer’s return, Sacharian recommends prescribing exercise, NSAIDs, and “whatever it takes to keep them on their medication.” You may also want to ask the patient’s oncologist about switching aromatase inhibitors if this is a suspected cause.

Neuropathic Itching

My mastectomies caused my own breast cancer pet peeve. When lymph nodes are removed, and nerves are cut during the excision of breast tissue, the region can lose feeling. This can present as an itch on your skin, but no way to relieve it. This symptom is called neuropathic itching and occurs in up to 50% of mastectomy patients. Unfortunately, antihistamines, lidocaine patches, ice packs, and other treatments do not bring relief, and the sensations can appear anytime, without warning. “Patients may experience discomfort, numbness, or reduced mobility following mastectomy but often will see slow, gradual improvement,” says Sacharian. “The key is determining if it’s a short-term symptom that will fade or if the pain or swelling is a symptom of another condition that needs to be treated, such as lymphedema.”

Weight Gain, Bloating, and Lymphedema  

Having cancer doesn’t mean you will appear frail and ill. On the contrary, many patients gain weight during and after treatment. The causes can be stress, depression, reduced energy, or treatment-related. If this symptom arises, Sacharian advises that providers make appropriate lifestyle recommendations and consider other medical conditions that may be involved.

Similarly, bloating and swelling are also concerns for breast cancer patients. While treatment may induce swelling, lymphedema among patients with lymph nodes removed is serious. Most lymphedema cases occur within the first two years after surgery. Swelling in the legs and feet is common after chemotherapy, but it could also indicate “a blood clot or a heart problem,” Sacharian says.

Patients should feel free to openly communicate with their healthcare providers, clinicians, and other care team members so everyone can work together to find the causes of concerning symptoms. In addition, providers may recommend that their patients carry a wallet card listing medications, surgeries, treatments, and any other pertinent information, in case they find themselves in the ER.

The takeaway point of my article is simple. When working with breast cancer patients, remember to consider the less common causes of a symptom to catch more serious ailments early. It may just save someone’s life.