I help care for many patients with breast cancer and there is something quite odd I have been recently witnessing in this population. While it is not highly frequent, it is frequent enough that I can no longer ignore the situation.
Over the past year, some women have experienced bone pain after receiving granulocyte colony stimulating factor (G-CSF) injections, which is to be expected. But the phenomenon they have experienced is this pain in their mastectomy scar area. Also accompanying the pain, which many of my patients have described as a "heavy, painful" feeling, is itching and some darkening of the scar area. No rash is present, and mastitis and other possible explanations are often ruled out.
The first couple of times I saw this, I thought it was a coincidence. But now, a year later, I have seen it more than half a dozen times in different office locations in our city.
I researched and could not find any specific explanation for this localized pain, itching, and discoloration of the mastectomy scar area for these women after receiving G-CSF injections. Our recommendations thus far have been OTC pain relievers, prescription pain relievers, and/or an antihistamine. All suggestions help to lessen the symptoms. If the symptoms are severe, we consider not using the injections again.
As we know, G-CSFs are indicated for use with any chemotherapy regimen that has a reported incidence for neutropenic fever of equal to or greater than 20 percent. Also, it is appropriate in dose-dense regimens as well. Its use is to help minimize the extent and duration of neutropenic fever with treatment, avoiding complications, hospitalization, and delays in treatments. One of the many newer tools we have in oncology within the past decade or so.
In some situations, G-CSFs are not recommended, as in the use for myeloid malignancy (due to its effects on the bone marrow) or in concurrent therapy with radiation (due to the negative effect it may have on the lungs due to the leukocytosis).
Clinical decision making comes into play when suggesting it for those regimens and patients that may benefit from its use when the patient's history and present health is considered. Such as those patients who are older (such as those older than 65 years of age), have a poor performance status, had prior episodes of neutropenic fever, have poor nutritional status, or other serious comorbidities.
Some of the common side effects listed for these types of injections did not mention these specific side effects directly. But what I did find was close: bone pain (31 percent to 57 percent), myalgia (21 percent), and arthralgia (16 percent). Less than 1 percent in reported side effects included cutaneous vasculitis, erythema, flushing, hyperleukocytosis, hypoxia, leukocytosis, rash, and urticaria.
My own personal conclusion is that the immune system still "sees" the mastectomy area as a place in need of healing, and therefore after a patient receives a G-CSF injection, the newly generated white blood cells flock to that particular area. This of course is just a hypothesis and I have yet to prove this theory.
Has anyone else witnessed this with their breast cancer population?