What’s New in Supportive Oncology for Patients with Breast Cancer

October is Breast Cancer Awareness month, so this month’s newsletter will offer some insights, updates, and resources that I hope will be useful as you care for your patients with breast cancer.  If I have missed anything you use, please feel free to let me know.

Hot flashes
At ASCO 2025, results of the OASIS-4 trial were reported, showing that elinzanetant significantly decreased the frequency of moderate to severe hot flashes caused by endocrine therapy (i.e., aromatase inhibitors, SERMs, and estrogen receptor downregulators, or ovarian suppression) compared to placebo; common side effects of elinzanetant include headache, fatigue, somnolence and diarrhea. These are generally mild and disappear over time. Of note, however, is that 2.5% of patients discontinued elinzanetant due to these side effects or prolonged QT, bradycardia, or depression.  Use elinzanetant with caution, therefore, with other agents that prolong the QTc, such as ondansetron and olanzapine which are often prescribed to patients with breast cancer.

Fatigue
The 2024 ASCO-SIO guideline for fatigue in patients with breast cancer¹ give STRONG recommendations to Exercise: aerobic + resistance training for patients on active therapy and survivors; Cognitive Behavioral Therapy: coping strategies for patients on active therapy and survivors with moderate to severe fatigue; and Mind-body practices: Mindfulness meditation and stress reduction techniques. They also recommend Tai Chi, and Giqong during therapy, and for survivors: yoga, acupressure, acupuncture, moxibustion (the burning of mugwort leaves). The guidelines recommend AGAINST modafinil, psychostimulants, and L-carnitine.

Sexual Dysfunction
A systematic review of women with breast cancer published in 2025² found that sexual dysfunction is highly prevalent, rising in one study from 17.5% at baseline to 73-86% after 6 months of hormone therapy.  The main problems are with desire, arousal, lubrication, orgasm, satisfaction and, for women who engage in penetrative sexual activity, dyspareunia. Women and men whether on therapy or off suffer from changes in body image, including weight gain and feeling disconnected from their bodies.

My September newsletter, The Sexual Health Conversation Patients Wish You’d Start: Insights from Dr. Sharon Bober contains a detailed discussion of sexual dysfunction in patients with cancer. As Dr. Bober explains, we do not have to FIX these problems, but we do need to ask, listen, and then refer patients to sexual health clinics, or to the relevant practitioner, for example a gynecologist, urologist, pelvic floor physical therapist, or social worker

Patients with breast cancer who have a vagina and find themselves in an estrogen-depleted state need to maintain the health of the vaginal tissue to prevent urinary tract infections. Low dose topical estrogens (e.g. tablets) in the vagina twice a week can maintain the tissues, decrease dyspareunia and lower the incidence of urinary tract infections.  Additional therapy for dyspareunia includes lubricants and moisturizers.

How Integrative Therapy Can Help
Integrative therapies are also helpful for a variety of other symptoms experienced by patients with breast cancer.  For clarity, I’ve created a chart of the 2024 ASCO integrative therapy Guideline’s recommendations.³

References

1. Mustian K, Lacchetti C, Zick S, Bower JE. Management of Fatigue in Adult Survivors of Cancer: American Society of Clinical Oncology – Society for Integrative Oncology (ASCO-SIO) Guideline Update Clinical Insights. JCO Oncol Pract. 2024 Dec;20(12):1575-1579. doi: 10.1200/OP.24.00372. Epub 2024 Jul 2. PMID: 38954779.
2. Rodrigues-Machado N, Bonfill-Cosp X, Quntana M, et al. Sexual dysfunction in women with breast cancer: a systematic review. Support Care Cancer 2025;33:332
3. Gowin K, Muminovic M, Zick SM, Lee RT, Lacchetti C, Mehta A. Integrative Therapies in Cancer Care: An Update on the Guidelines. Am Soc Clin Oncol Educ Book. 2024 Jun;44(3):e431554. doi: 10.1200/EDBK_431554. PMID: 38820485.

Additional Resources

Organizations for Breast Cancer Patients and their Partners and Families

Several organizations exist to help patients with breast cancer and their partners and families. ASCO is partnering with the American Cancer Society to provide such support.   Here are ASCO’s website and the websites of a few others you can recommend (in alphabetical order): 

• American Cancer Society (www.cancer.org) for the American Society of Clinical Oncology (www.asco.org/practice-patients/patient-resources)
• Living Beyond Breast cancer (www.lbbc.org)
• National Breast Cancer Foundation (www.nationalbreastcancer.org)
• Susan G. Komen Foundation (www.komen.org)

Websites for Special populations

• For the Breast of Us: (www.breastofus.com) online community for women of color affected by breast cancer
• National Asian Breast Cancer Initiative (www.asianbreastcancer.org)

Other Resources On My Website

• The Special Pains Breast Cancer Can Cause, written by Dr. Janet Abrahm
• Breast Cancer Conversations, a podcast with Dr. Janet Abrahm