Head & Neck

Side Effects

It’s normal to be concerned about how cancer treatments will affect your health and daily life. Know that most side effects can be prevented, minimized or managed with preparation, frequent communication with your health care team and access to supportive care resources.

Supportive care, sometimes called palliative care, addresses the physical, emotional and practical needs of people diagnosed with cancer and their loved ones. Managing side effects is a primary focus. Resources may include pain management; counseling about nutrition, fitness, mental health or spirituality; physical/occupational therapy; speech therapy; complementary medicine and others.

Potentially Severe Side Effects

Severe side effects aren’t common with head and neck cancer treatments but can occur with some immunotherapy drugs. Reactions called immune-related adverse events (irAEs) are possible if the immune system becomes overstimulated by treatment and causes inflammation in one or more systems of the body. Severe irAEs can develop rapidly and may even become life-threatening without swift medical intervention.

Serious health problems that can potentially arise from these treatments include lung conditions, intestinal disorders, liver and kidney problems, diabetes, thyroid disorders, neurological problems, skin conditions and intravenous (IV) fusion-related reactions. Discuss your risks with your doctor, ask about early warning signs and learn when to seek emergency medical attention. Report symptoms immediately for two years following treatment.

Common Side Effects

The following side effects are common. It’s important to know they can be more intense with combination treatments.

Cognitive dysfunction, often called chemo brain by cancer survivors, involves problems with thinking, memory and concentration that can occur during and long after treatment. Although associated with chemotherapy, it can result from other treatments or from stress. Focus on one thing at a time, and be patient with yourself.

Constipation may occur, especially with strong pain medication. Talk with your health care team about preventive measures, such as making changes to your diet or lifestyle. If you are already constipated, ask how to manage it and whether over-the-counter remedies are recommended.

Decreased appetite and weight loss are common, as both treatments and cancer symptoms can make swallowing difficult and/or painful. Try high-calorie soft foods, such as pudding, milkshakes and cream soups, and add butter, oils or milk to recipes to increase calories. If you’re unable to get adequate nutrition from food and beverages, your doctor may recommend enteral (EN-teh-rul) nutrition (see Explaining Enternal Nutrition [Tube Feeding]). A palliative care specialist might even recommend a medication that stimulates the appetite.

Diarrhea can seriously affect your quality of life. When severe, it can lead to dehydration and loss of essential nutrients. Contact your doctor if you have more than six episodes in 24 hours. Ask about preventive medications, but check before taking over-the-counter remedies. Notice how soon after treatment diarrhea typically begins, and schedule your activities accordingly.

Fatigue is the most common symptom of cancer therapies. Treatment-related fatigue is more intense than general tiredness, lasts longer and may not be relieved by sleep. Discuss symptoms with your doctor to address or rule out any underlying causes, such as unrelieved pain or depression. Regular exercise is proven to fight fatigue. Even a 10-minute daily walk can make a difference.

Lymphedema is common after surgery or radiation therapy to the head or neck because lymph nodes may have been damaged, causing lymph fluid build-up. Swelling may appear under the chin, over an incision, in the neck or cheeks or along the jawline. Often, lymphedema also develops internally, causing symptoms such as voice changes or difficulty swallowing. Consider seeing a certified lymphedema specialist before treatment to find out how to reduce your risk and what to do if the condition occurs.

Nausea and vomiting are easier to prevent than control, so ask about antiemetics (anti-nausea medications) before treatment begins. Contact your doctor immediately about serious symptoms: more than three episodes an hour for at least three hours; blood in vomit; vomit resembling coffee grounds; weakness or dizziness; or if you cannot keep medication down, eat solid food for more than two days or drink more than 8 cups of fluid/ice chips in 24 hours.

Neutropenia is caused by a low white blood cell count. It increases your risk of infections and makes them harder to resolve. Contact your doctor immediately – don’t wait until the next day – about these symptoms: fever over 100.5°F; flu-like symptoms; sore throat or mouth sores; red, painful or swollen skin; pus drainage from a cut or sore; pain or burning during urination; pain or sores around the anus; or vaginal discharge or itching.

Pain in the muscles, joints, bones or elsewhere may result from surgery and other treatments or the cancer itself. Left untreated, even minor pain can get out of hand quickly. Unrelieved pain interferes with healing and can greatly affect your quality of life. Contact your doctor right away if you experience pain. Many pain management options are available, so expect your health care team to do everything possible to provide relief.

Skin and nail changes are common with most targeted therapy and chemotherapy drugs. Symptoms may include dry, flaky, itchy, blistered or peeling skin; a rash or dry, brittle, discolored or loose nails. Apply thick moisturizer throughout the day, wear gloves for cleaning and gardening and avoid professional manicures/pedicures during treatment.

Late Effects

Be alert for side effects that may develop long after treatment ends. These are known as “late effects.” For some survivors, completing active treatment may bring a particularly challenging time in their lives to a close. Side effects from therapies they received may disappear within weeks as their bodies slowly recover and heal. Other survivors, however, experience late side effects or medical conditions that can develop months or years after their treatment has ended.

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