Managing Side Effects
Cancer treatment may cause certain physical or emotional side effects. Some people have symptoms from the cancer itself, and others experience side effects from treatment. Although less common, still others may experience no symptoms or side effects at all.
Managing side effects is important because the better you feel, the more likely you’ll be able to complete your treatment as planned. Ask your doctor about side effects when discussing treatment options. Familiarizing yourself with these potential side effects will help you anticipate and manage the most common problems if they develop.
Certain side effects and their severity can also depend on your age or overall health. While some might cause a lot of discomfort, pain and emotional distress, others might be only a minor inconvenience. If side effects occur, tell your medical team so they can recommend a remedy as quickly as possible.
Fatigue associated with cancer and cancer treatment is stronger and lasts longer than normal exhaustion. It can be caused by medications, chemotherapy or radiation therapy, all of which may damage healthy cells. This damage forces the body to spend extra energy to rebuild the damaged cells, which can make you feel more tired. Fatigue may also be caused by the cancer itself and occurs in almost everyone at some point during cancer treatment.
What to try:
- Accept help from others who offer to assist with meals, chores and other duties.
- Remain active. This has been shown to reduce fatigue and prepare you for a good night’s sleep.
- Set a routine for sleeping and waking. Try to get eight hours of sleep per night.
- Relax. Breathe deeply, try yoga, read a book, pray or meditate.
- Ask your doctor about lab tests to see if you have anemia (low red blood cell count) or another condition that may cause fatigue.
- Talk to your doctor about other symptoms you have that may contribute to fatigue, such as nausea and vomiting, pain and depression.
- Conserve energy. Set priorities and do only what’s most important when you have the most energy.
- Balance activity and rest, and try to follow a structured daily routine.
- When you nap, try to limit it to 45 minutes or less.
- Review your medications with your doctor to see if another type or lower dose can help you function better.
Nausea and vomiting
Nausea is feeling sick to your stomach and may be accompanied by vomiting (throwing up). Severe cases of vomiting can lead to dehydration and interrupt treatment. Chemotherapy drugs commonly cause nausea and vomiting, but other cancer treatment and certain pain medications may also trigger them. Nausea and vomiting are much easier to prevent than to control once they’ve started. Drugs known as antiemetics may be prescribed to help prevent and control nausea and vomiting.
What to try:
- Rather than three large meals a day, eat what you can when you can in smaller portions.
- Try eating a light meal a few hours before your scheduled (nonsurgical) treatment.
- Drink plenty of fluids throughout the day.
- Try your best to recognize and avoid smells that can trigger nausea.
- Rest after eating, but don’t lie flat.
- Smell or eat peppermints, or try lavender essential oil.
- Sip chamomile tea.
Diarrhea occurs in many people with cancer, especially as a result of treatment. Diarrhea may become severe and even life-threatening so, if you have it, talk to your doctor. Don’t be embarrassed to bring it up. It’s a common problem, and your doctor has heard it before.
What to try:
- Drink six to eight glasses of fluids per day, including water, sports drinks and broth.
- Eat foods that are easy to digest, such as applesauce, bananas, boiled white rice, mashed potatoes, plain toast and crackers.
- Avoid caffeine, alcohol, high-fiber foods, fried or greasy foods, creamy sauces, spicy foods, dairy and chocolate.
Alopecia (hair loss)
Hair loss is common, especially with chemotherapy and radiation therapy. Hair loss can occur all over the body, affecting not only the head but also the eyebrows, pubic area, etc. If your treatment may cause alopecia, think about how you want to handle hair loss before it happens. You may choose to cut your hair or shave your head. You may be more comfortable wearing a scarf, head wrap or hat. This is a personal decision, and the right choice is the one that makes you feel the best.
Many chemotherapy drugs trigger the hair to begin falling out seven to ten days after the first cycle of treatment begins, and it might not grow back until three to six months after treatment ends. Hair loss is usually a temporary side effect, but your hair may grow back in a different color or texture.
Scalp cooling has been effective in preventing hair loss for some people receiving chemotherapy. With scalp cooling, also called cold cap therapy, a person wears a helmet-shaped cap filled with soft gel packs cooled to between -15 to -40 degrees Fahrenheit. The cap is worn before, during and after chemotherapy. The cold temperature reduces blood flow to the head, which makes chemotherapy drugs less likely to reach and destroy the hair follicles.
What to try:
- Use a soft brush or wide-toothed comb, and be gentle with your hair.
- Don’t use hair dye or heating devices such as dryers, rollers or curling irons.
- Try sleeping on a satin or silk pillowcase to reduce friction.
- Avoid braids, ponytails and elastic bands, which can cause breakage.
- Use a gentle, pH-balanced shampoo.
Cognitive dysfunction (“chemo brain”)
Many people undergoing chemotherapy say they have trouble remembering names, dates and other details. This lapse in memory can happen in the middle of tasks or conversations and can leave you feeling like you’re in a mental fog.
What to try:
- Use a daily planner or calendar to keep track of “to do” lists, phone numbers and events.
- Do crossword puzzles or number games to keep your brain sharp and to strengthen your mental ability.
- Be physically active. Exercise can help you stay more mentally alert.
- Focus on one event at a time, and try not to multi-task.
- Tell friends and family that you’re having trouble so they can help you remember important information.
Neutropenia (low white blood cell count)
Neutropenia occurs when your body doesn’t produce enough neutrophils, a type of white blood cell. Neutropenia puts your body at a higher risk for infection. Nearly half of all people receiving chemotherapy for cancer have neutropenia, so your doctor will schedule regular blood tests to check for it. Depending on your test results, treatment could be postponed or stopped to let your body catch up on producing healthy neutrophils.
What to try:
- Although there is no known way to prevent neutropenia, frequent hand washing and good hygiene practices can help prevent infections.
- Treatment with a growth factor may help if you have an extremely low neutrophil count. Growth factors are special proteins that stimulate the bone marrow to produce more white blood cells and are usually given as an injection under the skin.
Lymphedema (abnormal swelling)
Your lymphatic system carries white blood cells throughout the body to fight infections. When lymph nodes are removed, lymph can build up, which can cause swelling in the area where the lymph nodes were removed. Many women with breast or gynecologic cancers have lymphedema after surgery or radiation therapy. Talk to your doctor about a referral to a physical therapist or other professional who can help alleviate the discomfort that comes with this side effect.
What to try:
- Apply pressure to the area with a compression sleeve. Some sleeves include a pump that inflates the sleeve intermittently to apply the correct amount of pressure. (Tight bandage wraps might help as well.)
- Elevate the swollen limbs to encourage drainage.
- Low-level laser therapy may help women who experience swelling in their arms, which often occurs after a mastectomy.
- Wear loose-fitting clothing, and limit your time in the extreme heat or cold.
Motherhood is a part of life that many women, including those with cancer, envision for themselves. Unfortunately, cancer treatments can cause temporary or permanent infertility (the inability to start or maintain a pregnancy). Talk to your doctor before treatment, if possible, to understand your risk of fertility issues and ways you can safeguard your fertility.
What to try:
- If you think you may want to bear children at some point and your doctor does not raise the issue of fertility, ask about options for preserving fertility or about a referral to a fertility specialist.
- For more ways to start a family after cancer treatment, see Fertility.
Cancer and its treatment often affect how women feel about themselves, their bodies and their intimate relationships. A lack of sexual desire occurs for many reasons and is the most common sexual issue for women with cancer. Before you begin treatment, ask your doctor if it can affect sexuality.
Cancer-related sexuality issues are most likely to occur in women who have had treatment directed at their reproductive organs and have untreated side effects, such as fatigue, nausea, vomiting, mouth sores, pain and diarrhea, all of which can reduce overall interest in sex and feelings of desirability. Women often experience menopausal symptoms such as hot flashes and vaginal dryness, which may result in painful intercourse.
What to try:
- Counseling and/or sex therapy (individual or couples) can help you process the emotions surrounding sexuality issues.
- Exercise can reduce menopausal symptoms and enhance interest in sex and feelings of desirability.
- Communicate openly with your partner, and talk about ways to be intimate other than sexual intercourse.
- Try using vaginal moisturizer daily and personal lubricant during sex to help relieve vaginal dryness.
Cancer is commonly accompanied by depression, which is also a side effect of several cancer-fighting medications. Many people experience a depressed mood and lose interest in activities that used to bring them pleasure. Depression is more complex than just feeling sad or hopeless and can be a result of low hormones or a chemical imbalance in the brain.
Having uncontrolled pain and other unrelieved symptoms can contribute to depression. Many antidepressants are available, but each comes with its own side effects. Talk to your doctor about whether the benefits outweigh the risks.
What to try:
- Engage in regular physical activity and deep-breathing exercises.
- Use meditation and imagery techniques to calm your mind.
- Talk to a professional about your problems, and get advice about available medications that may help.
- Join a cancer support group to get help while helping others.
Osteoporosis (bone loss)
Loss of bone mass can be caused by cancer and its treatment. The loss of bone density is known as osteoporosis, which occurs when the cells that rebuild bone are not replaced as fast as they get destroyed. As a result, bones become thin, porous and brittle.
Many treatments and medications can cause bone loss, including radiation therapy, chemotherapy and hormone therapy. Bone mass can be measured with a bone density scan before treatment so that your doctor can compare the results to ones taken during and after treatment.
Once bone is lost, it cannot be replaced. Ask your doctor if bone-modifying agents are an option for you. If you have bone metastases (cancer that has spread to your bones), your doctor may prescribe medication. External-beam radiation therapy is used to relieve symptoms of bone loss. Low-level radiation can be injected into your veins when multiple sites of painful metastases exist.
What to try:
- Get enough calcium by eating dairy products, leafy greens and beans, and get enough vitamin D by eating salmon or fortified breakfast cereal. Or, with your doctor’s approval, take supplements to ensure you get plenty of both.
- If possible, exercise daily to help stimulate bone-forming cells.
- Maintain a healthy weight to prevent bone loss and fractures (breaks).
- Wear shoes that fit well, and eliminate clutter in your home to avoid falls.
Metastatic Bone Disease
Bone loss also occurs if you have bone metastasis. This is when a primary cancer spreads to your bone. The pain from metastatic bone disease can range from nonexistent to severe. Ask your doctor about medications to manage metastatic bone disease. External-beam radiation therapy may be suggested by your doctor to relieve symptoms of bone loss, and low-level radiation can be injected into your veins when multiple sites of painful metastases exist. The radiation beams are aimed at the area of the metastasis, and relief is often immediate.
What else to try:
- Take vitamins and supplements and increase your calcium and vitamin D.
- Minimize fall risks.
- Drink little to no alcohol.
- Avoid smoking and secondhand smoke.
Questions to ask your doctor when discussing treatment options
- What are the possible side effects of each of my treatment options?
- How common are these side effects?
- Is there a way to decrease the possibility that these side effects will occur?
- When are these side effects most likely to occur?
- How long will the side effects probably last?
- Are there medications or other remedies available to relieve these side effects?
- Is there anything else I can do to help prevent or relieve side effects?
- How severe can these side effects be?
- When should I contact a member of my treatment team about a side effect? Whom should I call?
- Could the severity of side effects impact my treatment schedule?