To effectively treat any cancer, doctors must be able to give patients their full dose of medications, on schedule. But side effects of chemotherapy and targeted treatments can interfere with treatment. That is why it is so important to prevent side effects, or to treat them promptly if they do develop. If you are experiencing any side effects, you can and should seek help. If your doctor doesn’t ask you about side effects, be sure to bring them up.
Here is a list of common side effects and ways they can be prevented and managed:
Nausea and vomiting are common concerns when it comes to chemotherapy. But the management of these symptoms has improved so much that most patients are able to avoid them. Doctors can prescribe a number of different drugs to prevent and reduce nausea and vomiting, including ondansetron (Zofran and others), granisetron and dolasetron (Anzemet). The steroid dexamethasone is also sometimes used, as is aprepitant (Emend).
Infections can result when the level of white blood cells drops due to chemotherapy. To raise the level of these blood cells, doctors sometimes prescribe medications such as filgrastim (Neupogen) or pegfilgrastim (Neulasta).
Anemia, caused by a lowered level of red blood cells, often occurs in patients with colorectal cancer who develop blood in the stool. Fatigue (an extreme tiredness that isn’t usually eased by sleep) is a main symptom of anemia. Depending on the cause, anemia treatment may include eating more iron-rich foods such as dark green, leafy vegetables; sweet potatoes; beans; meat and fish; or enriched bread, cereal or pasta. Ask your health care team which foods would be best for you. In some cases, doctors treat anemia with blood transfusions or drugs that help the body to make more red blood cells.
Blood clots may affect some cancer patients. This serious side effect occurs when a solid mass of blood forms and lodges in a blood vessel or in the heart, for example. Blood thinners such as warfarin (Coumadin and others) and drugs called LMWHs (low-molecular-weight heparins) effectively treat blood clots. For patients in the hospital who have had cancer surgery, doctors also use a mechanical cuff to prevent blood clots. The cuff is placed on the legs. It gently squeezes every few minutes to help keep blood flowing.
Mucositis (sores inside the mouth and on the lining of the throat and digestive tract) can result from radiation treatments and from some types of chemotherapy. Mucositis can be a serious problem because it can cause pain and infections, making it difficult to eat, drink and swallow. Once treatment ends, mouth sores do disappear. But before they fade, it’s important to work closely with your health care team to manage this side effect with good oral care and prescription products such as Gelclair or “miracle mouthwash” (sometimes called “magic mouthwash”).
Skin rash and other skin and nail conditions often result from the use of targeted treatments such as cetuximab and panitumumab. The symptoms are actually a sign that these drugs are working. If you are taking these medications or other EGFR inhibitors, talk with your health care team about the possible side effects and various ways to treat them.
Neuropathy (nerve damage) from chemotherapy such as oxaliplatin can lead to numbness or tingling in the hands and feet. Some people experience this symptom for months or even years. There is no sure way to prevent neuropathy, and doctors are still looking for treatments that work. Gabapentin (Neurontin and others) is often used to relieve the pain of neuropathy. A lot of research is being done in this area.
Talk with your doctor if you are interested in getting into a clinical trial studying neuropathy. In the meantime, avoid drinking alcohol, which can damage nerves. Wear sneakers or shoes with “rocker bottoms” that allow the feet to roll while walking and can relieve some of the pressure on the soles. And use hand tools, kitchen utensils and even toothbrushes and pens with wider grips that make them easier to hold. It’s very important to talk with your doctor about nerve symptoms you experience so that he or she can adjust the dose or stop oxaliplatin if needed.
Pain can greatly affect your quality of life––your daily activities, eating habits, ability to get a good night’s sleep and even your outlook and how you interact with others. Controlling different types of pain may require different approaches, which is why it is so important for members of your health care team to understand the cause of your pain and for you to have good communication with them.