By Kim Thiboldeaux
Everyone knows that cancer treatment can cause side effects. The potential side effects vary by type of treatment, and the experience varies from person to person. Some of the better known side effects include hair loss, nausea, vomiting, fatigue, and infection. Newer drugs can cause skin rash or flu-like symptoms.
The good news is that doctors have come a long way in managing side effects and taking steps to prevent or lessen their severity. It is important to talk with your medical team about side effects. Ask about the possible side effects of every treatment you consider. Find out if there are ways to plan for and preempt them and what you can do if these side effects arise. For example:
- At what point do you call or email the doctor or nurse?
- Are there over-the-counter medications that can help?
- When do you go to the emergency room?
Since some side effects can be severe and even life-threatening, please do not suffer in silence. There are ways to manage side effects and perhaps even options you haven’t considered. Your doctor may be able to give you a temporary “holiday” from treatment or reduce the dose of the drugs you are taking so you can better tolerate the treatment. Good preparation and a contingency plan can help ease your mind and let your caregivers know what to look for and how to help.
Here are some of the most common side effects of cancer treatment, what to look for, and how they are managed.
Anemia, infection, and bleeding: Cancer treatments can affect your red blood cell, white blood cell, and platelet counts. Low levels of red blood cells can cause anemia and fatigue. Low levels of white blood cells can increase your risk of infection. Treatment can also affect your body’s level of platelets—the cells that allow your body to form blood clots when needed. Low levels of platelets can lead to easy bruising or bleeding. Your healthcare team will monitor your blood counts and tell you what signs to look for. Your team can help you manage symptoms of anemia and give you tips to prevent infection and bleeding. For example, it may be helpful to eat foods rich in iron and get rest. Wash your hands and avoid being around people who are sick to prevent infection. Try to avoid injury, and take care when brushing your teeth to prevent bleeding. In some situations, blood transfusions are used to increase blood cells counts.
Since some side effects can be severe and even life-threatening, please do not suffer in silence.
Cognitive changes (“chemo brain“): Chemotherapy can cause changes to your thinking. You may feel forgetful, become confused, or have trouble recalling words. It can help to make lists and write things down. Let the people around you know what you are experiencing. They can be more helpful and patient.
Constipation: Chemotherapy and drugs used to treat pain can interfere with regular bowel movements. You also may be prone to this if you are less active. If this is a possible side effect of treatment, start drinking more fluids and changing your diet in advance to prevent it. There are also medicines that can help.
Diarrhea: Certain drugs may cause very loose or watery stools. There are changes you can make to your diet to help prevent and manage diarrhea. For example, you can avoid caffeine and spicy foods, and eat smaller meals. If you have more than three incidents of diarrhea in a day, call your healthcare team.
Fatigue: Fatigue is one of the most common side effects of cancer treatment. It is a feeling of tiredness that you just can’t shake. Keep track of when you feel the most tired and how long it lasts. Notice when you have energy and use that time. Take good care of your body—try to sleep, exercise, drink water, and eat healthy foods.
Hair loss: Some chemo drugs can cause hair loss in some people. You may lose hair on any or all parts of your body. Hair may start to fall out ten to twenty-one days after you start treatment. There are many ways to prepare for and deal with hair loss, including the use of a cooling cap to help prevent it. Be sure to find out what your insurance will cover.
Hot flashes: Hormone treatments can cause hot flashes, as well as vaginal dryness and other symptoms of menopause. It can help to exercise, wear lighter clothing and layers, and avoid hot showers, spicy foods, alcohol, and smoking. Acupuncture is sometimes used to relieve symptoms.
Infertility: Some cancers and their treatments may cause infertility in men and women. The impact of treatment on fertility depends on many factors, such as age, the type of treatment, and how long the treatment lasts. For example, some drugs can cause women to experience early menopause. Other treatments may affect a man’s ability to produce healthy sperm. It is very important to talk to your doctor as soon as possible, before treatment starts, if you plan to have children.
Lymphedema: Treatment can damage the lymph nodes, causing swelling and pain in the extremities. It often occurs in the arms and hands. There are many steps you can take to manage it and reduce pain, including exercising, wearing a compression sleeve, and avoiding lifting heavy objects. You might want to ask your care team for a referral to a clinic that treats lymphedema.
Mouth and throat problems: Certain drugs and radiation can affect your mouth and interfere with eating. You may develop mouth sores, dry mouth, or changes to your sense of taste or smell. Depending on the problem, there are treatments and strategies to help, like avoiding hot foods or using plastic utensils. You may find relief in ice chips or chewing gum.
The good news is that doctors have come a long way in managing side effects and taking steps to prevent or lessen their severity.
Nausea and vomiting: Nausea is a common side effect of cancer treatment. There are many drugs you can take to prevent and treat nausea. People also find relaxation exercises such as meditation and deep breathing to be helpful.
Nerve problems (neuropathy): You may notice pain, tingling, swelling, or muscle weakness. It often begins in the hands or feet. Let your healthcare team know if you have new pain, if you are not able to feel the ground when you walk, or if you have trouble lifting small objects or buttoning a shirt.
Pain: Pain has many possible causes. If you have pain, keep track of where it is, what it feels like, when you notice it, and how long it lasts. Also note the severity of pain on a scale of one to ten with ten being the worst. Talk with your healthcare team and keep track of anything you take to treat pain. There are many ways to manage pain, and pain can get worse if it is not managed. Tell your team about any pain you have.
Sexual side effects: Issues with sex can be physical or psychological, or both. Some cancer treatments can reduce your sex drive or interfere with sexual function. Cancer can also cause physical changes that affect body image and lessen your interest in sex. Fatigue and depression can affect sex and intimacy as well. Depression can lessen your desire for sex, but some of the drugs used to treat it can decrease your libido. If you experience sexual side effects, the first step is to talk about it.
Skin and nail changes and rashes: Certain drugs and radiation can cause changes that affect the skin. Changes vary by treatment but can include redness, dryness, itching, burning, pain, or rashes. There may be ways to prevent this. Ask your doctor in advance. It is also helpful to report any changes you notice right away and ask about treatment. This is especially true if you are taking targeted therapy. If left untreated, skin and nail problems can become severe. Likewise, changes to the hands and feet caused by chemotherapy may be a sign of hand-foot syndrome and should be treated right away.
Sleep changes: Your body needs rest to fight cancer. If you find that you are unable to fall asleep or you wake in the middle of the night, focus on improving your sleep habits. For example, avoid caffeine and stick to a regular bedtime routine. If worry keeps you awake, try relaxing with meditation or seek support from a therapist. If the problem becomes severe, your doctor may prescribe medicine to help.
Urinary and bladder problems: These can include inability to urinate, blood in the urine, painful urination, leaking, cloudy or red urine, and infection. They may be accompanied by back pain or fever. Be sure to report these symptoms early on to prevent or treat infection.
Weight changes: Cancer can affect your weight in different ways. Treatment can make it harder to eat or hold down food, leading to weight loss. Or you may find that discomfort or fatigue interferes with your activity level, causing weight gain. Changes in weight can affect how we feel about ourselves and our overall health. Talk with your doctor about your concerns and how to address them.
Kim Thiboldeaux is the former CEO and Executive Chair of the Cancer Support Community. This article is adapted from her book, Your Cancer Road Map: Navigating Life with Resilience, BenBella Books, Inc. She also co-authored Reclaiming Your Life After Diagnosis and The Total Cancer Wellness Guide. Kim hosts the award-winning Frankly Speaking About Cancer radio show. She also serves on multiple advisory boards, speaks at leading conferences, and frequently appears in national media outlets.