Chemotherapy and Cancer Treatment, Coping with Side Effects
What Causes Side Effects?
There are many different types of chemotherapy drugs. Because cancer cells may grow and divide more rapidly than normal cells, many anticancer drugs are made to kill growing cells. But certain normal, healthy cells also multiply quickly, and certain types of chemotherapy can affect these cells, too. This damage to normal cells can cause some side effects. The fast-growing, normal cells most likely to be affected are blood cells forming in the bone marrow and cells in the digestive tract (mouth, stomach, intestines, esophagus), reproductive system (sexual organs), and hair follicles. Some anticancer drugs may affect cells of vital organs, such as the heart, kidney, bladder, lungs, and nervous system.
It is not necessary for a patient to get any side effects to have the chemotherapy drugs be of benefit in fighting their cancer.
You may have none of these side effects or just a few. The kinds of side effects you have and how severe they are, depend on the type and dose of chemotherapy you get and how your body reacts. Before starting chemotherapy, your doctor will discuss the side effects that you are most likely to get with the drugs you will be receiving. Before starting the treatment, you may be asked to sign a consent form. If so, then you should be given all the facts about treatment including the drugs you will be given and their side effects before you sign the consent form. Patients participating in clinical trials as treatment for their type of cancer are always given a consent form to sign.
How Long Do Side Effects Last?
Normal cells usually recover when chemotherapy is over, so most side effects gradually go away after treatment ends, and the healthy cells have a chance to grow normally. The time it takes to get over side effects depends on many things, including both the intensity of the dose of chemotherapy drug that you are given, your present overall health, and the kind of chemotherapy you have been taking.
Most people have no serious long-term problems from chemotherapy. However, on some occasions, chemotherapy can cause permanent changes or damage to the heart, lungs, nerves, kidneys, reproductive or other organs. And certain types of chemotherapy may have delayed effects, such as a second cancer, that show up many years later. Ask your doctor about the chances of any serious, long-term effects that can result from the treatment you are receiving (but remember to balance your concerns with the immediate threat of your cancer).
The side effects of chemotherapy can be unpleasant, but they must be measured against the treatment's ability to destroy cancer. Medicines can help prevent some side effects such as nausea. Sometimes people receiving chemotherapy become discouraged about the length of time their treatment is taking or the side effects they are having. If that happens to you, talk to your doctor or nurse. They may be able to suggest ways to make side effects easier to deal with or reduce them. Doses of chemotherapy have to be scheduled in such a way as to allow the body to recover from the effects of the drug or drugs on the normal tissues of the body.
Below you will find suggestions for dealing with some of the more common side effects of chemotherapy.
- Fatigue - Getting extra rest and not engaging in physically strenuous activities can lessen your feeling of tiredness/fatigue.
- Nausea & Vomiting - In addition to being sure that you understand how to use the anti-nausea medicines that you are given, some find that avoiding fatty and greasy foods help lessen nausea. Ginger supplements can also be helpful. Drinking liquids in sufficient amounts to avoid dehydration during periods of nausea and vomiting is important. If you cannot keep down fluids, then you doctors office must be notified, as you may need supplemental IV fluids.
- Pain - Be sure not to minimize your reports of your pain. Cancer does not have to hurt and neither does chemotherapy. Treatments can often lessen your pain. Getting pain with a treatment does NOT necessarily mean that the cancer is being attacked by the chemotherapy.
- Hair Loss - Some chemotherapy causes hair loss while others do not. Ice caps worn during the chemotherapy infusion can lessen the extent of hair loss for SOME patients. If you lose hair it may be all over your body and not just on your head. There are excellent head wraps, hats and wigs available. Do not let hair loss cause you to become isolated from your normal life and friends.
- Anemia - When chemotherapy drugs affect the red blood cell making areas of the body/ the bone marrow- anemia can occur. Symptoms can include increased fatigue or shortness of breath or getting pale. Tell your doctor about such symptoms. Foods high in iron may not help with this type of anemia. Eat as balanced a diet as possible. Take supplemental iron or vitamins if prescribed by your doctor. There are shots of growth factors available today which your doctor may order that can help you be less anemic during chemotherapy treatments.
- Infection - Chemotherapy treatments can lower your resistance to infection especially by lowering the numbers of infection fighting white blood cells. You doctor may prescribe shots to boost or speed the recovery of your white blood cell levels. You should avoid people already ill with a fev er over 100 degrees. You should practice good handwashing and bathroom hygienic practices.
- Blood Clotting Problems - If your chemotherapy or your cancer interfere with either the numbers of blood clotting cells (platelets) being produced or with production of blood clotting factors by your liver then you may bruise or bleed more easily. Do not use classic blood thinning medicines such Coumadin or heparin or other medicines which can thin the blood as a side effect without your doctor's permission. Those medicines include aspirin or ibuprofen or naproxen and others. Drinking no alcoholic beverages or no more than one alcoholic beverage in a 24 period can also lessen these problems.
- Mouth, Gum and Throat Problems - If you mouth gums or throat become sore during treatment it is still important that you eat and drink. Avoid food that is too hot or too cold or too spicy. Ask your doctor for medicines which can numb your mouth but if you use them you could swallow something “down the wrong tube” so eat carefully. Use soft bristle tooth brushes when your mouth is sore. Non alcoholic mouthwashes such as a teaspoonful of salt and a teaspoonful of baking soda in 6 ounces of warm water can be helpful to keep your mouth clean.
- Diarrhea and Constipation - Staying well hydrated will help with both problems. Use of over the counter medications such as Imodium for diarrhea may be recommended. Use of enemas or suppositories for constipation must be avoided when your white blood count or blood clotting cell levels are low. Laxatives by mouth are often safe and effective.
- Nerve and Muscle Effects - Some chemotherapy can cause temporary muscle aches due toi their effects on nerves. Tell your doctor if this happens as doses may be able to be adjusted or alternative forms of chemotherapy may be tried. Also tell the doctor about numbness developing in fingers and toes. Failure to mention that can lead to permanent damage to those areas' nerves which can occur unless doses are adjusted or a drug is stopped.
- Effects on Skin and Nails - Some chemotherapy will cause lines to form on nails which will disappear with time. Other forms of chemotherapy can cause weakening or ridging or pitting of the nails. Do not clip those nails too closely during chemotherapy as they can become more damaged or the feet or hands infected. Gelatin can be helpful as an oral supplement.
- Radiation Recall - In some cases where an area was previously treated with radiation therapy the later treatment with certain drugs such as adriamycin/doxorubicin can cause previous skin reddening from radiation treatments to reappear – or to be “recalled.” Keep those areas out of the sun until the effect is lessened which will usually occur with time.
- Kidney and Bladder Effects - Stay well hydrated during chemotherapy treatments to flush the drugs through the system. Certain chemotherapy can actually directly damage the bladder lining and can cause painful bleeding unless one drinks enough and forces themselves to urinate every 4 hours for about 36 hours after the chemotherapy (cytoxan and related drugs). Some chemotherapy will painlessly discolor the urine. If it is not painful to be passing pink urine then it is probably just a temporary discoloration.
- Flu-Like Symptoms - Fatigue and muscle aching can caus e you to feel like you are getting the flu during chemotherapy. If you develop a flu like fever over 100 degrees during those times then that can be an emergency and you should call the doctor's office at any hour to report that fever as the fever could be due to an infection that you cannot fight off when your white blood cell level is low. Without fever- just rest and drink plenty of fluids for the flu like symptoms without fever. Tylenol may help with the pain of the aching muscles. If it is not strong enough to control the pain, then call your doctor and they may prescribe something stronger.
- Fluid Retention - Some drugs can cause mild fluid retention in the hands and feet or more severe fluid retention internally. Avoiding salty food can help lessen fluid retention. Unexplained increases in weight, suddenly tight rings, or new shortness of breath should all be reported. Water pills can be used to lessen these problems- but should only be of the type provided by prescription during chemotherapy. Sometimes fluid retention can result in a need to change chemotherapy drugs.
- Effects on Sexual Organs and Sexuality - Sexual activity can continue during chemotherapy though lubricants should be used to lessen irritation of the skin or mucous membranes. Some will find that their interest in sex has lessened following their diagnosis or during chemotherapy. This can be due to depression brought on by real or perceived changes in your body. Some spouses are very supportive during chemotherapy. Others pull away and can even become unfaithful or intolerant of the changes in their partners to fulfill their needs. It is imperative to be honest and explicit with your doctor and his staff about these issues as medications and counseling can be arranged.
IMAGES PROVIDED BY:
Medically reviewed by Jay Zatzkin, MD; Board Certification in Internal Medicine and Oncology July 13, 2017
Portions of the above information has been provided with the kind permission of the National Cancer Institute, National Institutes of Health (www.nci.nih.gov/).