A cancer diagnosis can be one of the most life-changing events you can experience. Fortunately, there are excellent treatment options available, and many cancers have high cure and survival rates. Many people know someone who has gone through cancer treatment, including chemotherapy and radiation, and have witnessed some of the unpleasant side effects these can cause firsthand.
The Importance of Managing Side Effects
Advances in pharmacological research have brought us more targeted therapies that minimize the impact of chemotherapy and radiation on unaffected areas of the body. In addition, great improvements have been made in medications for the management of nausea and vomiting, two of the most common side effects seen with chemotherapy and immunotherapy agents.
Creating a customized plan of care that focuses on the entire patient is crucial to ensuring proper side effect prevention and management. Utilizing the tools we have to mitigate any undesirable effects of treatment can help improve the patient’s mood, compliance with therapy, and overall quality of life.
Reducing Distress During Cancer Treatment
Frequently assessing the patient for any undesired effects of chemotherapy, radiation, and other cancer treatments allows for early intervention and mitigation should any issues arise. It is important to understand the psychological impact of a cancer diagnosis and how it can have a profound impact on patients’ lives.
Coping mechanisms, support resources, and relaxation techniques should be at the top of your list when providing patient education. Many cancer centers offer in-person support groups for people with different types of cancers so that they can socialize with those who are having similar experiences with their cancer treatment. In addition, there are many online groups dedicated to providing support for people with cancer, their loved ones, and support systems.
Yoga is commonly used as a relaxation technique and can be beneficial for people with cancer. Additional relaxation methods to consider are controlled breathing exercises, music, art, and meditation.
Maintaining Quality of Life During Cancer Treatment
Cancer, along with many other medical diagnoses, is said to be more responsive to treatment when the patient has a positive outlook. Depression is common among people with cancer, and it is important to complete screenings during each visit. Antidepressants should be considered when the patient exhibits signs of depression. Anxiety may also be present and interfere with the ability to rest. Using anti-anxiety medications can help alleviate this symptom, allowing the patient to achieve quality rest.
Staying active is another key element to improving overall well-being. It is important for people with cancer to follow some form of physical activity routine. Consultation with their cancer care team allows for the development of a comprehensive activity plan that takes the individual’s diagnoses and specific needs into consideration.
Supporting emotional well-being can take a strategic approach that may include counseling, therapy, and participation in support groups.
Cancer Treatment Side Effects
Caring for people with cancer requires clinicians to have a large body of knowledge. Understanding the mechanism of action for chemotherapy, radiation, and other cancer treatments allows the clinician to anticipate the patient’s needs throughout their cancer care.
For instance, consider the degree of nausea and vomiting that can result from different types of chemotherapy. Having this knowledge provides the clinician with the ability to anticipate the patient’s needs and mitigate potential nausea and vomiting.
Being familiar with different types of cancer and cancer treatments allows clinicians to develop a plan of care optimized for the person with cancer to minimize the impact of treatment on their overall well-being and quality of life.
Different Types of Cancer Treatments
In today’s healthcare system, there are many treatment options for cancer. These range from traditional chemotherapy, radiation, and surgical treatment to newer, more advanced immunotherapy. One of the benefits of immunotherapy is that it tends to be more targeted and, therefore, has fewer systemic side effects.
Radiation and surgical treatment have their own unique side effects. Radiation burns, excess esophageal swelling, and difficulty swallowing can occur even with today’s targeted radiation beam therapies. When surgical interventions are performed, people with cancer may experience complications like infection, respiratory failure, organ dysfunction, or possible death. While these can occur with any surgical procedure, people with cancer may be at a higher risk due to their already compromised immune system and the overall decline in health from the cancer itself.
Managing Physical Side Effects
As mentioned earlier, each patient should be assessed for potential side effects at each visit. Patients should also be encouraged to contact their provider should they experience any difficulty between visits. Many cancer centers have nurse navigators who specialize in various types of cancer. These individuals are the primary contact person for the patient and a liaison to the rest of the cancer treatment team. Unfortunately, side effects are a part of cancer treatment, with common experiences including digestive problems and hair loss.
Nausea and Vomiting
Nausea and vomiting are two of the most common side effects of cancer treatments like chemotherapy and radiation. Chemotherapy results in nausea and vomiting due to its systemic effects, while radiation causes nausea and vomiting and is related to the area being targeted. The brain, gastrointestinal tract, and liver are some of the target areas for radiation that can lead to nausea and vomiting.
Uncontrolled nausea and vomiting can cause serious complications, such as:
Serious metabolic derangements.
Nutritional depletion and anorexia.
Deterioration of the patient’s physical and mental status.
Esophageal tears.
Fractures.
Wound dehiscence.
Withdrawal from potentially useful and curative antineoplastic treatment.
Degeneration of self-care and functional ability.
While antiemetics are the first line of defense for the prevention and treatment of nausea and vomiting, research has shown other viable options, including:
Progressive muscle relaxation with guided imagery.
Hypnosis.
Systematic desensitization.
Electromyography and thermal biofeedback.
Distraction via the use of video games.
It is also important to recognize that nausea and vomiting can be acute, delayed, anticipatory, breakthrough, refractory, or chronic.
Digestive Problems and Changes in Appetite
Gastrointestinal problems can be common in people being treated for cancer. Issues may include diarrhea, constipation, fecal impaction, and even bowel obstructions. Radiation enteritis can also occur when the targeted area includes the gastrointestinal tract.
Planning for the prevention of these complications should be included in the overall plan of care. Addressing any changes in appetite can be accomplished through dietary changes. It may become more important to ensure calorie intake and not necessarily focus on total nutritional value. If a patient is unable to eat anything except ice cream or other cold foods due to pain, they should be encouraged to do so. Supplements can be added if needed for nutritional value, and the insertion of a feeding tube may become necessary. Even with the feeding tube in place, oral intake should be encouraged to ensure continued motility of the entire gastrointestinal tract.
Staying hydrated is crucial in cancer treatment. Many chemotherapy agents can cause damage to the kidneys, and it is important to hydrate before and after receiving these medications to ensure they are processed and eliminated from the body in a timely manner.
Digestive enzymes can also help prevent gastrointestinal complications. Common over-the-counter enzyme supplements may contain amylase, lipase, or protease. In patients with pancreatic cancer, prescription enzymes may be used to help with food processing and nutrient absorption. Pancreatic enzyme replacement therapy (PERT) is commonly used in these cases. PERT includes amylase, lipase, and protease and aids in the breakdown of carbohydrates, fats, and proteins.
Diarrhea and Constipation
Diarrhea and constipation should be taken seriously when they occur during cancer treatment. There are 5 recognized grades of diarrhea and constipation, with the 4th grade having life-threatening consequences leading to death at grade 5 if they are not treated. Diarrhea can lead to severe dehydration and electrolyte imbalances, while constipation can result in an obstruction or toxic megacolon.
Over-the-counter antidiarrheals are useful in initial treatment; however, additional therapy may be required if the symptoms persist. Stool softeners, laxatives, dietary modifications, including increasing fiber, and enemas can help with managing constipation at home.
Diarrhea that consists of an increase of 4-6 stools per day over the patient’s baseline should be reported to the cancer care team. Seven or more stools, with or without incontinence, usually lead to hospitalization. For those with constipation, symptoms that persist with regular use of laxatives or enemas should be brought to the attention of the care team for further evaluation and treatment.
Mouth Sores and Dental Problems
Chemotherapy agents and radiation have a negative impact on the oral cavity and can result in several mouth and dental problems, such as:
Changes in taste (dysgeusia) or smell.
Dry mouth (xerostomia).
Infections and mouth sores.
Pain or swelling in your mouth (oral mucositis).
Sensitivity to hot or cold foods.
Swallowing problems (dysphagia).
Tooth decay (cavities).
It is recommended that patients receive a thorough dental exam before beginning cancer treatment and that any issues are addressed prior to initiating therapy when possible. In addition, patients should check their mouths for any signs of sores or white spots and tell their provider as soon as possible if these are found. Good oral hygiene is crucial and should include brushing teeth and gums after each meal and before going to bed using a very soft-bristled toothbrush. Rinsing the mouth with a solution of warm water, baking soda, and salt is also recommended throughout the day to maintain adequate moisture.
Fatigue and Weakness
Cancer fatigue is common during treatment and can occur at any time. Many patients find it difficult to complete their daily activities as a result. Energy conservation is important for these patients so that they can maintain some normalcy in their family and social lives.
Having no energy; feeling extremely tired, drained, or lethargic.
Having difficulty moving; feeling heavy or slow.
Having difficulty thinking, remembering, or paying attention.
Having a sense of physical, emotional, and/or mental exhaustion.
Not feeling rested, even after sleeping.
Addressing cancer fatigue requires a multifaceted approach. Maintaining a healthy balance of nutrition and hydration can help improve energy levels. Good sleep habits, including short naps when necessary, also help decrease fatigue. Physical activity is encouraged. The patient should participate in an activity they enjoy so they are more likely to continue throughout their treatment. Simply walking has been shown to positively impact energy levels. Part of the treatment plan should also address any supplement use that will help balance energy and rest.
Weakened Immune System
Cancer and chemotherapy negatively impact the white blood cells that help the body fight infection. This decrease in white blood cells is called neutropenia. In people with severe neutropenia, an infection can lead to the development of sepsis, which is a life-threatening emergency.
Monitoring for a temperature above 100.4 °F (38 °C). Fever is considered a medical emergency for those undergoing cancer treatment.
Washing their hands often. This is important for the patient and any caregivers, family members, or medical personnel with whom they interact.
Recognizing the signs of infection: fever, sore throat, cough, congestion, redness or swelling of the skin, diarrhea, or vomiting. The patient should contact their provider as soon as any of these are recognized.
Wearing a mask is also recommended when interacting with others. This has become more commonplace since the COVID-19 pandemic; however, some people have lessened their awareness of the importance of wearing face masks when they are sick or around others who may be sick. This is particularly important for people undergoing cancer treatment due to their weakened immune systems.
Increased Risk of Bleeding
In addition to white blood cells, chemotherapy and radiation also impact platelets.This decrease in platelets is called thrombocytopenia. Obtaining a complete blood count (CBC) during cancer treatment can help providers recognize any abnormalities in platelet levels early so proper interventions can be taken.
Bleeding precautions should be followed when thrombocytopenia is suspected or confirmed. Patients are advised to brush their teeth gently with a soft-bristled toothbrush, wear shoes at all times to prevent injury, exercise extra caution when using sharp objects, and shave with an electric razor instead of a blade. Keeping a thorough medication history is also important so that any over-the-counter medication use that can increase the risk of bleeding, such as aspirin and ibuprofen, is addressed.
Neuropathy (Numbness or Tingling in Hands and Feet)
Nerve damage can also be a complication of cancer treatment, affecting both sensory and motor nerves. Symptoms include tingling, numbness, problems sensing temperature, weak muscles, swallowing, and breathing difficulties. Certain medications, like gabapentin, acupuncture, massage, or physical therapy, can address the symptoms of neuropathy.
Hair Loss and Skin Problems
Hair loss (alopecia) can result from chemotherapy and radiation treatments. In most cases, the hair will grow back in 2 to 3 months after chemotherapy and 4 to 6 months after radiation. It is important to use sunscreen or wear a hat when outdoors to minimize sun damage. Keeping the skin well hydrated with lotion can help decrease the negative effects of radiation on the skin. A more recent innovation for the prevention of hair loss is the use of an FDA-cleared cooling cap. Studies showed that scalp cooling resulted in 62 of 101 patients experiencing less than 50% hair loss, while the entire group of participants without scalp cooling had more than 50% hair loss.
Emotional support is also key for patients experiencing hair loss, as this can negatively impact their body image.
Cold Sensitivity
Chemotherapy agents, especially oxaliplatin, can also cause sensitivity to cold. This symptom can occur during or shortly after the chemotherapy infusion finishes. Addressing the cold sensitivity may include drinking room temperature or warm drinks, dressing in layers, or using hand warmers. Some studies have shown that chewing ice during the infusion may help prevent cold sensitivity.
Managing Emotional and Psychological Side Effects
A cancer diagnosis causes a plethora of emotions for the patient and their loved ones. Acknowledging the emotional and psychological impacts of cancer and its treatment should be a priority in the patient’s plan of care.
Anxiety and Depression
Fear of the unknown can lead to anxiety and depression in people with cancer. This is why it is important to provide resources such as support groups, counseling, and therapy as part of the overall plan of care. The American Cancer Society (ACS) provides several tools to help patients and families cope with anxiety, depression, and emotional distress that can occur during the cancer treatment journey. Recognizing the signs and intervening early can help improve the quality of life for the patient.
Body Image and Self-Esteem Issues
Hair loss and skin changes that can occur during cancer treatment can negatively impact patients’ body image and self-esteem. Support for these individuals includes counseling and access to support groups with people undergoing treatment for similar cancers. Many cancer centers offer assistance with wigs and head coverings for patients to use while they are experiencing hair loss.
Sleep Disturbances and Changes in Mood
Sleep can be impacted by stress, anxiety, and depression. All of these emotions can be present at any point during cancer treatment. Practicing relaxation techniques like progressive stretching can help facilitate the onset of sleep. Good sleep hygiene is also important to ensure adequate rest. Some recommendations for sleep include going to bed and getting up at the same time each day and avoiding caffeine, nicotine, and other stimulants in the hours before bedtime. Naps may be necessary to help offset cancer fatigue; however, they should be limited to less than an hour at a time to minimize their impact on nighttime sleep.
Communication Tips: Talk With Your Cancer Care Team
Talking about cancer can sometimes feel like a taboo topic. It is important for patients to be comfortable with their healthcare team so they can be open and honest about how they are feeling throughout the treatment journey. The rapport between the patient and the care team should be focused on during each visit. Collaboration throughout the team will positively impact the patient experience and treatment outcomes.
Encourage Patients to Discuss Their Concerns
Advocating for yourself can often feel like a daunting task. Many people are grateful for the care they are receiving and feel that it would be an inconvenience to acknowledge something that is not working for them in their treatment. Patients should be encouraged to discuss any and all of their concerns at each visit. The healthcare team should employ good listening skills to emphasize that the patient is being heard. Journaling throughout the cancer treatment can be an effective tool for communicating with the care team and prevents the need for the patient to remember everything they want to address during the visit. The journal can also help the patient track any side effects and impact of the treatment on their mood and energy levels.
Patients’ Treatment Preferences
Today’s patients have access to a never-ending supply of information and misinformation via the Internet. It is important to listen to the patient should they have any recommendations or preferences for their treatment plan. Should any of these methods be inappropriate to pursue, the provider should discuss the reasoning behind not following the patient’s request. In addition, should a patient decide to pursue a different treatment option, like holistic care, the team should be supportive and provide any assistance the patient may need in transitioning their care.
Building Trust and Open Lines of Communication
Approaching patients with an open mind and being nonjudgemental will go a long way in developing a positive collaborative relationship. Reassure the patient that there are ways to have their concerns addressed in a timely manner. Many cancer centers offer a triage or nurse-first telephone line where patients can express their concerns. The nurse can then relay this information to the care team and return to the patient with a proposed solution all within a single phone call.
Lifestyle Adjustments to Cope With Side Effects
Cancer treatment impacts all aspects of the patients’ life. There can be significant changes to their current lifestyle based on the care they are receiving and its potential side effects. Focusing on diet, exercise, and sleep can minimize the treatment impact on the patients’ lifestyle.
Adjusting Diet
Dietary considerations for chemotherapy and radiation treatment can help prevent or alleviate gastrointestinal side effects. Providing consultation with a dietician or other nutritional expert as part of the care team will help the patient navigate these challenges. Some suggestions may include eating smaller portions more frequently to prevent feeling bloated, which can lead to nausea and vomiting. Focus on food choices that are high in nutrients and suggest supplements when appropriate to help the patient maintain optimal nutrition. Hydration is also key in preventing constipation and helps prevent the fatigue that can result from dehydration.
Regular Exercise
Physical activity has been shown to have multiple benefits for people with cancer. Evidence supports that moderate-intensity aerobic or resistance exercises can help with anxiety, depression, and fatigue. Patients also reported improved health-related quality of life when following a regular exercise routine. Other evidence suggests that exercise can benefit bone health and sleep. In patients with breast cancer, exercise may help alleviate the lymphedema that can occur in these individuals.
Adequate Rest and Sleep
Insomnia and other sleep problems are commonly observed in cancer patients. Stress, treatment, medication side effects, and hospital stays can all negatively impact sleep. Be sure to discuss the patient’s sleep patterns and difficulties during each visit. Encourage the patient to practice good sleep hygiene. Cognitive behavioral therapy (CBT) or relaxation techniques, including guided imagery and self-hypnosis, may be beneficial. Consider the use of sleep medications when necessary.
Complementary Therapies to Manage Side Effects
Side effects from cancer treatment may be mitigated using complementary therapies. Holistic approaches like acupuncture, massage therapy, yoga, and meditation can help people with cancer improve their quality of life during their treatment journey.
Acupuncture
Acupuncture is a part of traditional Chinese medicine and has been practiced for thousands of years. While it has been practiced in the United States for about 200 years, the U.S. Food and Drug Administration did not approve the acupuncture needle as a medical device until 1996.
Acupuncture is used to help with symptom management for patients experiencing side effects from chemotherapy and radiation treatments. Studies have shown the effectiveness of acupuncture in the treatment of chemotherapy-induced nausea and vomiting. As with any treatment modality, patients should be encouraged to find qualified practitioners to avoid any adverse effects from the acupuncture procedure.
Many cancer centers offer massage therapy as part of their treatment plan. If there isn’t an in-house option, it is important to provide the patient with information about local certified massage therapists who have experience working with cancer patients.
Yoga
Yoga combines meditation, breathing, postures, and poses to help connect the mind and body. It has been said to result in a state of relaxation and peace. Evidence also suggests that it can lower stress, improve strength, and reduce back pain. For people with cancer, yoga may help alleviate cancer symptoms or side effects resulting from treatment.
Yoga can be practiced in group classes, with one-on-one instructors, or even by following a video presentation. On the Internet, yoga videos can be found on popular websites like YouTube and YogaAnytime.
Meditation
Studies have shown that practicing meditation can help alleviate the symptoms of various health conditions, help with sleep, and improve mood. In fact, the National Institutes of Health (NIH) shared that studies have shown meditation can help alleviate anxiety, stress, and fatigue and improve sleep for patients with cancer.
Tips From Other Cancer Patients Who Have Been Through Chemotherapy
1. Rest
2. Hydrate
3. Eat
4. Prepare yourself for potential hair loss
5. Create a sense of normalcy
6. Turn to your support and care teams
7. Keep comfort items close to you
8. Stay ahead of your side effects
9. Stay positive
10. Oral care is serious
11. Be aware of signs of neuropathy
12. Remember—everyone’s experience with chemotherapy is different
Additional Information
What are the five most common coping strategies that have been identified for cancer patients?
Emotion-focused coping strategies include self-blame, distraction, religion, acceptance, and emotional support.
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