Managing Cancer Treatment Side Effects
Starting your personalized cancer treatment plan usually brings a sense of relief because you're taking steps toward the hope for a cancer-free future. But along with that relief can come some concerns about the treatment's side effects.
Because cancer treatments seek to disrupt or destroy cancer cells, they can affect healthy cells while on their mission. When healthy cells are affected there can be side effects. They vary based on the treatment being used and your body's reaction to them.
That’s why it’s important to discuss expected cancer treatment side effects with your care team early on. Our patients experience a thorough treatment education session with an RMCC team member prior to starting the particular treatment that's being used. Feel free to take notes so you can recall information later. It is also helpful to keep a journal so that you can remember questions or concerns you may have along the way to discuss at office visits. Your cancer specialists can help you understand what to expect and how to cope.
While undergoing cancer treatment, you may have trouble falling or staying asleep. That, in turn, can make other side effects, like fatigue, even worse. You may need to have a sleep study to pinpoint the type of sleep problem you’re having. To help you sleep, try out some of the strategies listed below.
- Ensure your bedroom is dark, cool, and quiet.
- Develop a calming nighttime ritual.
- Create an energizing ritual in the morning with light exposure and exercise.
- Go to bed and wake up at consistent times.
- Keep electronic devices out of your bedroom, and don’t use them for at least two hours before bedtime.
- Avoid or reduce caffeine, alcohol, and sugary foods.
- Utilize blue light reduction to watch TV or use computers in the evening.
- Consider melatonin replacement therapy after discussing with your provider.
- Use aromatherapy such as lavender for relaxation.
Fatigue is more than being tired. It's a kind of tired that a good night's rest doesn't fix. Nearly constant fatigue is the most common chemotherapy side effect, according to the American Society of Clinical Oncology. Fatigue can also occur due to immunotherapy, hormone therapy, and radiation therapy. Cancer-related fatigue can go beyond physical exhaustion – it can also leave you feeling mentally and emotionally spent.
A key way to counter fatigue is to exercise regularly. Physical activity can boost your energy and mood. Ask your cancer care team what types of exercise would be safe and beneficial for you. They will take any recent surgeries or other aspects of your treatment into consideration when making recommendations. Movement early in the day can help with generalized joint aches related to some treatment regimens as well as awaken your body early to help aid in sleep at the end of day.
Addressing the mental aspects of fatigue is as important as managing its physical effects. Practicing yoga may help reduce fatigue by helping you focus on being present in the moment. Breathing exercises and progressive muscle relaxation can help manage stress which tends to be at higher levels for you and your family during cancer treatment. A counselor can help you better understand how fatigue is affecting your mental health if some common tactics aren't working to give you relief.
We also have social workers on our team that can provide many effective coping strategies. You can ask to be connected with them in person, via email or by phone. Reach out when you are struggling so we can help you get the support you need.
Perhaps no side effect is more closely associated with cancer treatment than hair loss. The good news: it's not something every cancer patient will experience. Some chemotherapy can cause widespread hair loss, and radiation therapy can cause hair to fall out in the area receiving treatment. Hair loss usually begins one to three weeks after treatment starts, according to the American Cancer Society. Fortunately, hair is resilient and sometimes regrows with more volume or curl than it had before – it usually starts returning before treatment concludes. Using a cooling cap – a device that keeps the scalp cold before, during, and after chemotherapy – may reduce your risk of hair loss. Steps you can take to manage hair loss include:
- As hair begins to fall out, choose a look you’re comfortable with, whether it’s cutting or shaving off your hair, or wearing a wig or scarf
- Handle your hair with care by combing it gently, washing it less often – use a mild shampoo – and patting it dry
- Talk with family, friends, or other individuals undergoing cancer treatment about your emotions surrounding hair loss
- Use lotion to moisturize your scalp
- Wear a hat or sunscreen to protect your scalp
Loss of Appetite
Maintaining nutrition is an important part of staying healthy during cancer treatment, but treatment may not make it easy. That’s because chemotherapy and other types of treatment can sap your appetite. In addition, other side effects, such as difficulty swallowing, dry mouth, and nausea, can make food less appealing. Finding recipes that are nutrient-dense and appetizing is critical to helping you want to consume the foods your body needs.
If you have a poor appetite, try eating small, frequent snacks – high-protein foods can boost energy and help reduce fatigue – instead of large meals. Drink plenty of liquids to avoid dehydration. Stay as active as possible, which may improve your appetite.
Be sure to take any anti-nausea medications your oncologist sends home with you. Not feeling nauseous will go a long way in making it easier to eat several small meals every day.
Talk to your provider if it's not working as expected to trial alternative medications or use a combination of them appropriately. You can also document onset of the first nausea symptom and with additional treatments you take before that time to hopefully avoid nausea entirely. Anti-nausea medications can come with their own side effects such as constipation, headaches, or drowsiness, so be sure to write comments and questions in a journal to bring to office visits so your providers may adjust side effect management as needed.
Surgery to remove lymph nodes as well as radiation therapy in a lymph node area can cause lymph (lymphatic system fluid) to accumulate, often in an arm or leg. This is a condition called lymphedema, which can cause swelling and skin changes.
To treat lymphedema, your cancer specialist may recommend wearing a compression stocking or sleeve to help reduce swelling. You may also see a certified lymphedema therapist, who can perform a special type of massage to help lymph drain away from your arm or leg.
It is important to stretch and massage areas daily as early intervention can be preventative. There are many therapy resources for education including oncology rehabilitation and other therapists specializing in this field. Your providers can help connect you.
You can help manage and prevent lymphedema using additional tactics such as:
- Exercise and stretch regularly to help keep lymph from accumulating.
- Protect your skin. Moisturize with lotion and use sunscreen so you avoid burns. Skin in the area where lymphedema is occurring can get drier and crack easier than other areas of the body which can then get infected easier.
- Try to keep the area elevated to allow the fluid to drain if you start to notice swelling.
- Avoid tight fitting or restrictive clothing in the area of your body where you've received treatment. This can cause lymph fluid to collect and swelling to begin.
Nausea and Vomiting
Chemotherapy, immunotherapy, targeted therapy, and radiation therapy can lead to nausea and vomiting. Generally, your cancer care team can help minimize this effect with medications given prior to your treatment or as part of your infusion. You may also be prescribed some to take home to use as needed. Other things that help include:
- Avoid strong-smelling foods or other strong scents such as cologne
- Eat small, frequent meals
- Keep track of foods that make you feel sick so you can avoid them
- Stay hydrated. If you vomit you should consider drinking something with electrolytes to help rebalance your salt and water levels.
Chemotherapy and radiation therapy can cause pain in many parts of the body. For example, chemotherapy can lead to headaches and muscle pain, and both chemotherapy and radiation therapy can cause painful nerve damage. Treating pain is key because it can hinder your immune system and delay healing, according to the National Cancer Institute.
Your cancer specialist may prescribe pain medication, and it’s important to take it as directed. In addition, he or she may refer you to a pain specialist to treat specific types of discomfort, such as nerve pain. Applying heat or ice to painful areas, and avoiding activities that make pain worse, may also help.
Chemotherapy, immunotherapy, and targeted therapy – treatments that circulate throughout the body to attack cancer cells – can cause wide-ranging skin changes. These include dryness, rashes, greater sensitivity to sunlight, and mouth sores other than blisters. Radiation therapy can also cause skin problems, such as dryness, itchiness, and a rash that looks like a sunburn. However, these side effects are usually confined to the area where you received treatment.
To care for your skin during treatment, you can:
- Avoid shaving if your skin is tender
- Keep areas of skin that received radiation therapy clean and dry
- Use moisturizers to prevent dryness and itchiness. While Aquaphor can be greasy, it can also be very effective and safe to use. If over the counter creams are not effective, your care team can suggest prescription strength creams to help with issues.
- Wash with mild soap; avoid fragranced lotions or cleansers
- Wear loose-fitting clothes and broad brimmed hats, and use sunscreen on exposed skin
When to Call the Oncologist
There are some side effects that your oncology team should review and address right away rather than during your next scheduled appointment. If you notice any of these, contact your oncologist, even if it's a weekend or after hours. Someone will be able to assist you with assessing the best next steps.
- Fever greater than 100.4°F
- Uncontrolled nausea and vomiting
- Pain at your IV site
- Any concern or questions related to your medical care