Side Effects

Side Effects

• Overview
• Anemia
• Bone Loss
• Cognitive Dysfunction
• Decreased Appetite
• Depression
• Diarrhea
• Early Menopause
• Fatigue
• Fertility Issues
• Hair Loss
• High Calcium Levels
• Lymphedema
• Mouth Sores
• Nausea & Vomiting
• Neutropenia
• Nutrition Challenges
• Pain
• Peripheral Neuropathy
• Sexuality Issues
• Shortness of Breath
• Skin Reactions
• Sleep Problems

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Understanding the Side Effects of Cancer Treatment

Most cancer treatments have side effects, but you likely won’t experience all of them. People respond differently, even to the same diagnosis and type of treatment. Though you may feel anxious about how you will react, it may help to know your multidisciplinary health care team will help you manage the side effects of cancer and its treatments by drawing on a broad range of services known as supportive care. The goal is for you to maintain a good quality of life from the time you are diagnosed through survivorship.

Supportive care addresses the physical, emotional, practical, spiritual, financial and family-related challenges of people diagnosed with cancer and their loved ones. This includes assisting your children, family members, caregivers and others close to you. Resources your team may offer include pain management; counseling about nutrition, fitness, mental health or spirituality; physical/occupational therapy; speech therapy; complementary medicine and others.

Also called palliative care, these services are designed to benefit anyone with a serious or life-threatening illness from diagnosis through survivorship. Palliative care is often confused with hospice care, which is reserved for end-of-life care. Think of the purpose of palliative care as “quality-of- life preservation” or “quality-of-life restoration.”

You are an important part of side effect management, too. Keeping the lines of communication open with your health care team and letting them know as soon as a symptom or side effect occurs enables them to address it early, hopefully before it gets worse. Be honest with your family and caregiver about the side effects you have and their level of severity.

These services are often covered by individual insurance plans, Medicare and Medicaid. To learn more, you can talk with the hospital’s social worker or financial counselor or your health insurance representative.

Potentially Severe Side Effects

Though serious side effects are rare, they can occur with certain treatments. Ask your doctor whether you are at risk from the therapies in your treatment plan, how to identify the symptoms and when to seek emergency care. Report symptoms immediately so they can be treated rapidly. Following are some potentially severe side effects:

• Infection can occur as a result of a low white blood cell count (neutropenia) or other factors. Contact your doctor immediately – do not wait until the next day – if you have any of these symptoms: oral temperature over 100.4° F, chills or sweating; body aches, chills and fatigue with or without fever; coughing, shortness of breath or painful breathing; abdominal pain; sore throat; mouth sores; painful, swollen or reddened skin; pus or drainage from an open cut or sore; pain or burning during urination; pain or sores around the anus; or vaginal discharge or itching. If you cannot reach your doctor, go to the emergency room.
• Immune-related adverse events (irAEs) may occur with certain immunotherapy drugs if the immune system becomes overstimulated by treatment and causes inflammation in one or more organ or system in the body. Some irAEs can develop rapidly, becoming severe and even life-threatening without immediate medical attention.
• Cytokine release syndrome can occur if immune cells affected by treatment rapidly release large amounts of cytokines into the bloodstream. Symptoms may include headache, fever, nausea, rash, low blood pressure, rapid heartbeat and difficulty breathing.
• Infusion-related reactions most frequently occur with treatment given intravenously (IV) through a vein in your arm, usually soon after exposure to the drug. Reactions are generally mild, such as itching, rash or fever. More serious symptoms, such as shaking, chills, low blood pressure, dizziness, breathing difficulties or irregular heartbeat, can be serious or even fatal without medical intervention.
• Tumor lysis syndrome (TLS) may occur after the treatment of a fast-growing cancer, especially certain blood cancers. Symptoms may include vomiting, diarrhea, muscle cramps or twitches, neuropathy and decreased urination. TLS can potentially cause damage to the kidneys, heart, liver or other organs.

Some Common Physical Side Effects

Knowing the symptoms will help you recognize physical side effects more easily (see Table 1, page 6). Additionally, be alert for late effects. They are side effects that can occur long after treatment begins.

More Areas of Support

Having cancer can affect many parts of your life, and other types of support are available to ensure your whole person is being cared for. If you are having challenges in an area not listed here, talk with your health care team. You do not have to go through this alone.

Social support is available in many forms, both in person and online. Family and friends are wonderful resources, but they can only understand so much. Find a support group for cancer survivors online or in your area. Many organizations offer one-on-one buddy programs that pair you with another person who has the same type of cancer as you. Opening up to people who have had a similar experience can offer comfort and support that is invaluable. Consider contacting a counselor and therapist with expertise in working with people living with cancer.

Dietary support may be needed if you have challenges eating or with your appetite. Ask your health care team for a referral to a dietitian who can help you understand how to get the nutrients your body needs.

Spiritual or religious guidance may be available from a chaplain or spiritual care advisor at the hospital or in your religious community. Spiritual support is available to you even if you do not consider yourself a religious person.

Financial counseling is accessible from a social worker, nurse navigator or financial counselor. The stress and anxiety of paying for treatment and other related expenses can negatively affect your well-being. Understanding the costs ahead can help you feel more in control.

Focus on Maintaining a Healthy State of Mind

Emotional side effects, such as anger, fear, anxiety, depression and loneliness, are normal, but it is crucial that you acknowledge and address them. Having a positive sense of well-being can help you cope and even manage physical side effects better.

The following are some common emotions you may have. Share how you feel with your health care team so they can help. Contact them about excessive crying or continued feelings of hopelessness or despair. Get immediate medical attention for thoughts of suicide or death. Remember, you’ll have ups and downs that may be unpredictable, but you don’t have to go through them alone.

Anxiety can begin as soon as you receive your diagnosis. Moderate to severe anxiety is often treated with medication, therapy or a combination of both. Explore relaxation techniques, such as meditation, muscle relaxation, yoga or guided imagery. Peer-to-peer cancer support volunteers can offer insight into what to expect, and they’re often available by phone or online.

You may also have scanxiety, a mixture of anxiety and stress that can happen when you are awaiting results from imaging scans, laboratory tests or exams you have as part of your treatment plan. That is a lot of stress to put on your mind and your body, and it may help to find ways to manage it. In addition to the previous suggestions for relieving anxiety, set expectations with your doctor or nurse about when and how you will receive the results so you are not left waiting and wondering. Remind yourself that it is normal to feel this way. Consider discussing your fears with your friends, a support group or a therapist. Keep your mind occupied with things you enjoy, such as reading, playing games or gardening. Staying busy gives you less time to worry.

Depression is a psychological reaction to your situation as a whole. Certain ongoing treatments, such as chemotherapy or hormone therapy, can also cause or contribute to depression. Don’t avoid talking to your doctor about it because you think depression is just part of having cancer. It should be treated. It is extremely important to talk with your doctor about feeling hopeless, helpless or numb. If these feelings last more than a few days or if you have thoughts of death or of attempting suicide, seek medical attention immediately.

Doubt can lead to confusion and questions about the meaning of life and its purpose. Some people find strength in support from family, friends, the community or spirituality. It may also help to open up to a counselor, support group or spiritual advisor.

Embarrassment about physical changes can affect your self-esteem and body image. Though physical health is the priority realistically, your emotional well-being may suffer when you don’t feel good about yourself. Treatments may leave scars, discoloration of the skin, hair loss and lymphedema, which can affect mood and self-image.

Fear is common. Every ache and pain may trigger a concern. Do your best to focus on the present.

Guilt may occur if you feel you’ve been a burden to loved ones or if you wonder why you survived when others with similar conditions didn’t. Talk with a therapist about these feelings. You might find that you can lessen your guilt by giving back to the cancer community. It can provide a sense of purpose and well-being that can help take away blame you may be placing on yourself.