Managing Side Effects
Many people are fearful about the types of side effects they may experience with certain types of cancer treatment. These fears grow from a belief that the side effects cannot be relieved. However, it is now possible to prevent or manage many common side effects of cancer treatment.
Preventing and managing side effects is extremely important for the success of your treatment because the better you feel, the more likely you’ll be able to complete your treatment as planned, which offers a greater chance for a successful outcome. Your doctor can help you anticipate the most common side effects, so that you are prepared if they occur.
Managing the Side Effects of Cancer Drugs
Although the side effects from systemic therapies, such as chemotherapy, immunotherapy and targeted therapy, have some differences, several of their most common side effects are the same. It is extremely important to talk openly with your doctor about any side effects you experience and to call your doctor’s office immediately if a side effect occurs suddenly.
It may be helpful to keep a diary of your symptoms so that your doctor can assist you in managing them. Write down when your symptom started and what you were doing at the time it started. Include where the symptom occurs, how long it lasts and how severe it is. Also include if any activities make the symptom better or worse.
Treatment-related fatigue occurs primarily because the body needs extra energy to repair the healthy tissue damaged by cancer treatment. Additionally, other side effects of treatment, such as pain, nausea and vomiting, can cause or worsen fatigue. Although most people think more rest will help relieve fatigue, increasing activity and performing regular exercise (such as walking or bike riding) are the best ways to combat it. If your fatigue is severe, your doctor may prescribe a drug to improve alertness.
Fever, which occurs when the body’s temperature is abnormally high, is the body’s response to infection. Fever can develop in a person who is receiving drug therapy. It can be particularly concerning if it occurs when a person’s white blood count is low. If you recently received chemotherapy and develop a fever, call your doctor immediately. If you know a medication you are taking has fever as a side effect or if you know your white blood count is low, check your temperature if you feel warm or unwell.
Your doctor may recommend trying over-the-counter medications, such as acetaminophen, to treat the fever related to flu-like syndrome. Avoid non-steroidal anti-inflammatory (NSAID) drugs, as well as aspirin, if you have a bleeding disorder. Discuss all of your options with your doctor before treatment begins to know the best way to manage a fever that develops after you begin treatment.
Coughing can be a symptom of follicular lymphoma or it can be caused by a treatment for follicular lymphoma. When coughing occurs due to follicular lymphoma, it’s typically caused when lymph vessels become blocked and fluid begins to accumulate around the lungs. Coughing is a side effect of some chemotherapy drugs. Your doctor may prescribe medications or recommend over-the-counter medications you can take to treat a cough, such as an antitussive, expectorant or decongestant.
Nausea and Vomiting
Nausea and vomiting occur as the result of a series of reactions between your stomach and your brain, which start when cancer drugs damage the cells lining the inside of the stomach. The cells send signals to an area in your brain that sends signals to trigger nausea and vomiting. It is much easier to prevent nausea and vomiting than to control them once they've started.
Recent advances have led to the development of prescription drugs called antiemetics, which can prevent and control nausea and vomiting. To further protect yourself, you may want to try some nondrug approaches, including progressive muscle relaxation, biofeedback, guided imagery, self-hypnosis and acupuncture. Eating several small meals rather than a few big meals a day, staying hydrated and avoiding unpleasant odors also can help.
Drink plenty of fluids in small amounts throughout the day. Try bland, easy-to-digest foods like crackers. Ginger and peppermint also can help with nausea, so you may try ginger ale or peppermint tea. Avoid eating your favorite foods after your chemotherapy is completed; they might not be your favorite foods anymore if you associate them with receiving this type of treatment.
Diarrhea is the passing of loose or watery stools three or more times a day, which may cause cramps in the abdomen and pain or discomfort in the rectum. When mild, diarrhea is an inconvenience. If left untreated, diarrhea can lead to serious problems, such as dehydration, loss of important nutrients, weight loss and fatigue. Your doctor may check you for a Clostridium difficile (C. diff) infection.
Once diarrhea occurs, consuming only clear liquids may help the lining of your intestines heal. Clear liquids include water, cranberry juice, ginger ale, clear broth, popsicles, decaffeinated tea and gelatin. As diarrhea improves, you can slowly add solid foods to your diet, starting with low-fiber foods like white rice or potatoes. Some foods can worsen diarrhea, including dairy products; spicy, greasy or fried foods; raw fruits or vegetables; or foods that are high in fiber.
Over-the-counter medicines and fiber supplements are available to control diarrhea, but ask your doctor before taking anything. If diarrhea is severe, your doctor may prescribe other medications or choose to stop your cancer treatment temporarily until your diarrhea is controlled.
You might even know when to anticipate bouts of diarrhea based on prior episodes you have experienced during your chemotherapy treatments. If so, mark your calendar so that you aren’t scheduling yourself to be out for a walk or having company when it is most likely to happen.
The abdomen is located between the chest and pelvis, and some treatments can cause pain in this area of the body. The pain can be the result of increased or decreased motility (movement) of the intestines, the destruction of beneficial (good) bacteria in the gut; ulcers; an intestinal perforation; or cramping of the bowel. Dull aches and cramping are common, but a sharp pain that does not go away in a few minutes may indicate a more serious problem. If that occurs, call your doctor immediately.
Mouth sores, also known as oral mucositis, are small cuts or ulcers that can affect the gums, tongue, roof of the mouth or lips. Mouth sores sometimes begin as mild pain or burning, followed by white patches that may become large red lesions. Pain may range from mild to severe, making it difficult to talk, eat or swallow. Taking good care of your teeth and gums is essential to managing mouth sores, and you should brush and floss several times a day. Your doctor may suggest rinsing your mouth with special solutions and may prescribe a medication that coats the lining of your mouth or pain medications that can be applied topically.
To manage mouth sores, keep your mouth and lips moist by using lip balm, sipping water, sucking on ice chips and drinking through a straw. Choose soft, moist foods that are easy to swallow, and consider letting your food cool to room temperature before you eat. It is also a good idea to avoid alcoholic beverages and tobacco products, as well as hot, spicy, citric, greasy, fried, coarse or rough-textured foods.
Skin reactions can include redness and irritation (similar to sunburn), skin rash or dry, flaky skin. These reactions often cause itchiness and discomfort. Although most reactions are mild to moderate, some can become severe if not treated early. If a rash develops and causes itchiness or pain, your doctor may prescribe a mild corticosteroid cream or an antibiotic gel. Severe rashes are usually treated with an oral antibiotic and perhaps an oral corticosteroid. When a rash is severe, the dose of the cancer drug(s) is often reduced or temporarily stopped until the rash improves.
Cognitive Dysfunction ("chemo brain")
People being treated for cancer often refer to “chemo brain” when they can’t think clearly or have trouble remembering details, such as names and dates. This cognitive dysfunction is associated with chemotherapy, but it can occur in people receiving all types of treatments. Even though it is treatment-related, some people don’t experience it until months or even years after treatment ends.
If you have this side effect, use a daily planner to keep track of things. Solve crossword puzzles or number games to help strengthen your mental ability. Record memory and attention problems to determine when you’re most affected. Don’t multitask; instead, focus on one thing at a time. Let friends and family know you’re having trouble, and ask them to help you remember and repeat information. Make a list each day of what needs to happen that day. As you complete each task, draw a line through it and then go on to the next task.
Untreated pain, even if it’s minor, can get out of hand quickly. In all cases, it is very important that your health care team know what is happening and reporting pain is the first step to feeling more comfortable and having a good quality of life.
Recovering from Radiation Therapy
Because radiation therapy is delivered from the outside of the body, the skin and underlying tissues in the area being treated may develop redness, dryness, peeling or itchiness. This sensitivity is short-term and usually resolves gradually within two months after treatment stops. Other side effects might include fatigue, anemia, hair loss in the area treated, nausea and vomiting. Management techniques for these side effects are very similar to those for managing the side effects from cancer drugs.
Side Effects of Cancer Drugs
Common to Most Drug Therapies
- Abdominal pain
- Increased risk of infection
- Mouth sores
- Nausea and vomiting
Additional Side Effects by Treatment Type:
- Cognitive dysfunction ("chemo brain")
- Hair loss
- Loss of appetite
- Nerve problems (including neuropathy)
- Immune-mediated adverse reactions
- Low blood counts
- Physical weakness
- Skin rash
- Abnormal glucose & lipid levels
- High blood pressure
- Skin and nail changes