For Any Cancer Diagnosis
Q. I'm worried that a few side effects from my cancer treatment won't go away. Do you know how long they might last?
Experiencing lingering side effects after cancer treatment is over is common. These side effects can be especially frustrating when you expect to feel better as soon as treatment is over. Most side effects gradually lessen with time as your body recovers from treatment. Share your concerns and questions about continuing side effects with your medical team and what can be done to address them. I’d recommend keeping a detailed daily log of the side effects you are experiencing—this makes it easier to report details to your doctor. Our Connect® Education Workshop, Communicating with Your Health Care Team After Treatment: Making the Most of Your Visit can help you prepare for your appointments.
Connecting with others in a support group for people who are post-treatment can be helpful. A support group is a place to share tips and ways of coping with other survivors who might be experiencing similar lingering side effects. We offer support groups over the telephone, online and in person (New York City area). You can also speak with a social worker who will locate groups in your area.
Finally, read our publications to learn ways to cope with side effects.
Q. I have been receiving chemotherapy treatments for the past six months and my memory is not as good as it used to be. Is this because of the chemo? What should I do?
During chemotherapy treatments, you may notice memory or thinking changes, sometimes referred to as chemobrain. Chemobrain affects your cognitive or thinking abilities including: memory, attention, concentration, word finding or retrieval, multi-tasking, learning, and sense of direction. Researchers are not certain of the exact causes of these difficulties, but they are currently studying this problem in order to find ways to both treat and prevent it.
There are a number of treatable conditions that can affect memory, such as low blood counts, hormonal changes, stress, fatigue, sleep disturbances, depression, and anxiety. Some of your medications could also be affecting your ability to think clearly.
It is important for you to talk with your doctor if you are having trouble with your memory. Your health care team can be very helpful to you in figuring out ways to manage your memory and thinking changes related to chemotherapy. Bring a list of your questions to your doctor, take notes, and ask permission to record your visit. If possible, bring someone with you. Get a second opinion if your doctor doesn’t take your concerns seriously.
Memory tools can help to boost your memory. Write things down in a planner, pick one spot to keep your keys and wallet, place reminders around your home and work space of tasks you need to do, and recognize the importance of nutrition, exercise and sleep.
CancerCare offers the following fact sheets addressing chemobrain:
- Cognitive Problems After Chemotherapy
- Doctor, Can We Talk About Chemobrain?
- Combating Chemobrain: Keeping Your Memory Sharp
- Improving Your Concentration: Three Key Steps
Remember that you are not alone. Work with your health care team to address your memory changes, join a support group, learn more about chemobrain through our educational workshop, Chemotherapy Related Memory and Thinking Changes, and most importantly be kind to yourself.
Q. My dad is elderly and is scheduled to start treatment for cancer. We are concerned about his ability to tolerate treatment side effects given his age.
The single greatest risk factor for cancer is aging. Our population is living longer and cancer is a disease that occurs in older adults. There is no clear data, however, showing that certain cancer treatments, when appropriate, should not be offered on the basis of age. The only exception is when there are pre-existing health problems.
Chronic health problems unrelated to cancer — such as hypertension, diabetes, heart disease or arthritis — do need to be considered with regard to cancer treatment and its side effects. For an older adult, it is important that the choice of treatment plan takes into account his or her overall health status, including:
- any medications being taken and their possible interaction with cancer treatments
- the person’s mobility, balance, and memory
- any nutritional needs or restrictions
- social supports, including who will be there to help with daily concerns like grocery shopping, cooking, and providing transportation to medical appointments.
It is appropriate for you and your dad to expect to control treatment side effects. Before your father starts treatment, make sure his doctor knows about any medications he is currently taking for other health problems, and ask about what treatment side effects he should expect. In many cancer centers, there are health care specialists that will work with your doctor to help manage treatment side effects. Talk with your dad’s doctor about symptoms you and he are worried about. Don’t be afraid, embarrassed, or hesitate to ask questions, voice your opinion, and seek the care your dad needs and deserves.
For more information, read these CancerCare publications:
- Caregiving for Your Loved One with Cancer
- Understanding and Managing Chemotherapy Side Effects
- Controlling Cancer Pain: What You Need to Know to Get Relief
- Your Health Care Team: Your Doctor is Only The Beginning
Our professional oncology social workers can also help people with cancer and their loved ones with the practical and emotional concerns arising from a cancer diagnosis. Contact us 1-800-813-HOPE (4673).
Q. I have a full-time job. How will side effects from my chemotherapy affect my ability to work?
Many people are able to continue working during their treatments and being proactive can make all the difference. The keys are good communication with your health care team, knowing up front what the expected side effects will be, and developing a plan with your doctor.
Schedule an appointment with your doctor to talk about your job and its activities. Make sure that your doctor understands the importance of your job as a source of health insurance, income and purpose, and that your employment be considered in any medical decisions. Get details about your treatment side effects and develop a plan that addresses each one. Explore with your doctor options that will make it easier to continue working, such as scheduling treatments on Friday afternoons to minimize their impact on work.
Once you have spoken with your doctor and know better what to expect, you may want to talk to your supervisor or human resource department about your need for flex time or time off. If you work full time, learn about workplace legal protections and accommodations. Know the provisions of the Americans with Disabilities Act and Family and Medical Leave Act. You may also contact the Equal Employment Opportunity Commission. All are helpful resources for understanding your legal rights in the workplace when you have cancer.
CancerCare offers these additional resources:
Q. I'm worried about how the side effects from my treatment will interfere with the holidays. Any suggestions?
People view the holidays as a time to celebrate and connect with family and friends. However, the season can be stressful if you are living with cancer and trying to manage treatment side effects such as fatigue, weight loss or gain, nausea or pain.
Fortunately, doctors have many ways to reduce and even prevent side effects. At CancerCare, we often use the word “coping” to describe how people deal with cancer. People sometimes mistakenly think that coping means just living with a problem, whether you like it or not. But coping actually means managing a problem and finding a new way to take control of it.
You can maximize your enjoyment of the holidays by letting your health care team know now about your holiday plans and ask for their help in taking control of treatment side effects. Make an appointment with your doctor to discuss your concerns and ask for guidance regarding holiday meals, travel, and conserving your energy, as well as rescheduling your treatments, if possible, so that any resulting side effects will not occur on during the holidays.
CancerCare offers publications offering additional information so that you can better manage your treatment side effects and enjoy the holiday season:
- Coping with Cancer During the Holidays
- Understanding and Managing Chemotherapy Side Effects
- Coping with Cancer: Tools to Help You Live
You can find additional information about managing treatment side effects through the National Cancer Institute.
CancerCare’s social workers are here to help you with emotional support and practical help. Call 1-800-813-HOPE (4673) or email firstname.lastname@example.org.
Q. I am the caregiver for my elderly father who has cancer. My father’s cancer has spread to his bones and he's having pain. What can I do to help relieve his pain?
Your father is fortunate to have a caring family caregiver who wants to help him get relief from his pain. Unrelieved pain may cause sadness, decreased mobility, and irritability. Treating cancer pain is essential to your father’s well being and I offer these suggestions:
- Ask your father if he is willing to discuss his discomfort and pain with his health care team and if he wishes you to accompany him on his next appointment.
- With your father’s approval, schedule an appointment as soon as possible.
- Patients are often asked to describe their pain using a Pain Scale of 1-10 with 10 being the greatest amount of pain. His health care team will ask a number of questions to help identify the type of pain, examine the area where the pain is most bothersome, and order imaging tests to further determine the source of the pain.
- Pain is effectively treated by over the counter as well as prescription medications. Most cancer hospitals have multi-disciplinary Pain Teams to recommend the best approaches to manage pain.
- There are a number of prescription medications; some are delivered intravenously, to treat bone metastases. These treatments can also reduce pain.
CancerCare Connect booklets and fact sheets are also very informative:
- Caring for Your Bones When You Have Cancer
- Controlling Cancer Pain: What You Need to Know to Get Relief
The National Cancer Institute’s Cancer Information Service is a resource for additional information. Call 1-800-4-CANCER or visit www.cancer.gov.
Q. I've heard recently about this condition - what is neuropathy?
Neuropathy, also called peripheral neuropathy, is a term that describes the special kind of pain and discomfort caused by nerve damage. It is typically characterized by a feeling of weakness, numbness, tingling, or burning in the hands and feet. It can result from a number of different medical issues including infection, diabetes, kidney disease, and traumatic injury. Peripheral neuropathy can also be a common side effect of certain chemotherapy treatments, and can develop after surgery (especially for breast or lung cancer).
If you have concerns that you or a loved may be experiencing symptoms of neuropathy, be sure to discuss the issue with your health care team as there are treatments available to help control the symptoms. A typical treatment regimen may include over-the-counter or prescription medications. Your doctors can work with you to find the best treatment or combination of treatments to manage your discomfort.
For additional information, CancerCare offers many resources about neuropathy.
You can also find information through The Neuropathy Association.
Q. I stopped cancer treatment some time ago and am still struggling with neuropathy. How long does neuropathy usually last? What treatments might I pursue?
Many cancer survivors experience post-treatment neuropathy. For some, the symptoms may lessen gradually over a period of weeks or months. For others, the symptoms may persist or even become chronic. It is difficult to provide a typical timeline of symptoms, because there is so much variation from case to case. Many factors impact the degree to which someone experiences neuropathy including:
- the type of chemotherapy drug or combination of drugs used
- the chemotherapy dosage
- the overall length of the treatment regimen.
In addition, each person responds differently to chemotherapy.
It’s important to seek out a consultation with an experienced neurologist if you are experiencing neuropathy. Fortunately, there are a number of treatments available to help manage the chronic pain and discomfort caused by neuropathy. For mild symptoms, over-the-counter pain relievers like Tylenol or Motrin may be adequate. For more severe symptoms, your doctor may prescribe stronger pain medication; anti-convulsant medication to help calm the nerves and central nervous system; or antidepressants to decrease the chemicals in the brain that transmit pain signals. Physical therapy may improve balance and strength while occupational therapy may improve the fine motor skills used in tasks like writing or buttoning a shirt. Alternative treatments such as biofeedback, acupuncture, or transcutaneous nerve stimulation (TENS) are also available. Your health care team can work with you to determine the best treatment or combination of treatments to address your situation.
Since other health issues may cause or further aggravate nerve damage, it is important to consult regularly with your medical team. Other underlying medical conditions can contribute to your symptoms. Diabetes, autoimmune disorders, kidney disease, or physical trauma are just a few of the other common causes of neuropathy. Your health care team should conduct a thorough assessment of your risk to determine whether other kinds of interventions would be helpful for you.
It’s also a good idea to keep track of your neuropathy symptoms, so that you can provide detailed reports about your symptoms to your health care team.
For more information about neuropathy, please visit CancerCare’s neuropathy resources or The Neuropathy Association’s website. The Neuropathy Association also offers a list of U.S. neuropathy medical centers.
Q. Any tips for dealing with neuropathy in cold weather?
Cold weather poses special challenges for people affected by neuropathy. Prolonged exposure to the cold causes the body to slow blood circulation to the hands and feet in an effort to preserve the body’s core temperature. The reduced blood flow can intensify neuropathy symptoms and potentially cause further damage to already affected peripheral nerves. This is of special concern to those who experience their neuropathy pain as a numbness or tingling sensation. Their ability to measure the effects of the cold is compromised since they already experience those physical warning signals that would otherwise indicate a need to get to warmer conditions.
Tips to lessen the pain and lower your risk of further nerve damage:
- Wear warm, dry clothing in cold weather.
- Protect your hands and feet by wearing thick socks, thick mittens or gloves.
- Take intermittent breaks from the cold to reduce your exposure to extreme temperatures.
- Limit or avoid caffeine before an outing as it can temporarily cause blood vessels to narrow.
- Do not smoke as cigarette smoke can slow circulation.
- Limit alcohol use since excessive consumption can lead to vitamin deficiency which can, in turn, damage peripheral nerves.
- Incorporate exercise into your routine to improve overall circulation.
- Explore comfort measures like massage or use of flexible splints for support.
The information I’ve shared above is meant to be helpful and educational, but is not a substitute for medical advice. Please be sure to consult with your health care team for personalized advice and guidance.
For more information about neuropathy, please view all CancerCare’s neuropathy resources.
For Breast Cancer
Q. I'm 43 years old, married and going to have a mastectomy. I'm insecure about how my body is going to look and being intimate with my husband. How can I maintain my femininity and a positive body image?
When it comes to changes in our bodies, no matter what a woman’s age, those changes will challenge how we see ourselves and our perception of how others see us. This can be especially true for women who have had a mastectomy or bilateral surgery since images in the media so often place a heavy emphasis on how women look. Breast reconstruction has helped many women redefine their feelings about the loss of a breast. You might want to consult with a plastic surgeon about what options are available to you. For women who do not choose reconstruction, the use of a breast prosthesis can be a good alternative. A prosthesis can give a look of symmetry; many of the newer prostheses are made of a lighter weight material and come in special forms that can be used in swimwear and night gowns. It’s important to recognize that this is a loss, and with loss comes grief. Remember that it will take time to adjust and it’s a good idea to reach out for support and guidance during this time.
Treatment for breast cancer such as chemotherapy or hormonal blockers may also have side effects that can produce early menopause, vaginal dryness and a diminished desire for intimacy. Talking with your doctor about products that can reduce symptoms of dryness or discomfort can help. Opening a conversation about your concerns with your partner is an important first step. Many people don’t understand the actual physical basis for diminished desire and feel they are being rejected.
How to Help Your Wife (and Yourself) Through Diagnosis, Treatment and Beyond (Rodale Inc.) by Mark Silver, is one book you and your partner might find helpful. In addition, you may try contacting Living Beyond Breast Cancer.
You can also find additional information and advice in a previous Ask CancerCare that addressed body image and intimacy issues.
Q. Since being diagnosed with breast cancer, I can't seem to keep on top of things like I used to and it seems like I'm in a fog. I've mentioned this to my doctor but I think his focus is more on my treatment and less on my concerns. Anything I can say to make him listen?
After being diagnosed with cancer, many women report having trouble finding words and remembering things. Be persistent in communicating with your doctor about what you are experiencing. Here are some tips that may help you:
- Request a time to speak with your doctor to focus on your specific concerns
- Express how these concerns are affecting you and your quality of life
- Be specific and give examples
- Use statements such as, “I need your help understanding this” and “Do you have any suggestions on what I can do?”
It’s also possible that you may be experiencing side effects from chemotherapy. This is sometimes referred to as “chemobrain,” a condition that affects your short-term memory. You may consider getting evaluated by a neuropsychologist (an expert trained in how the nervous system, especially the brain, controls mental functions such as language, memory, and perception) who can assess any cognitive changes and suggest mental exercises to improve memory and thinking. Chemobrain usually lessens over time once treatment has ended.
A few steps you can take now to improve your memory:
- Keep a notebook or day planner where you can write down things you need to remember
- Keep the notebook in a specific place so you can find it when you need to
- Use Post-it notes to place reminders in your home, office or other spaces
To learn more about chemobrain, read CancerCare’s fact sheets:
Q. I was diagnosed with breast cancer in late 2010. I received 6 rounds of chemotherapy, and I still experience severe knee pain. Is this pain related to the chemotherapy and when will it end?
It is not uncommon for people who have undergone chemotherapy and other cancer treatments to experience long-term side effects. For example, certain breast cancer treatments such as chemotherapy and hormonal treatments may contribute to bone loss, which could cause knee pain (view our bone health resources). Your body’s reaction to cancer treatment depends on factors such as treatment length, dosage prescribed, and your personal health history. Most side effects are temporary, but some can last for some time after treatment is over.
It is important to discuss your symptoms with your medical team so you can find some relief. Are they aware of your knee pain? I would strongly encourage you to tell your doctor about your concerns if you haven’t already. He or she is in the best position to investigate whether your pain is chemo-related. In the event that your doctor is not accessible, your nurses and oncology social workers are great resources. Nurses have a wide range of skills and are usually in charge of implementing the plan of care your doctor has set up for you. They are trained to administer medication, monitor side effects, and educate you on the medications you are receiving. Oncology social workers are professionally trained to counsel people affected by cancer and help them access practical assistance. They can also act as a liaison between you and members of your medical team. CancerCare offers a free podcast with tips to help you plan for your post-treatment medical appointments, Communicating With Your Health Care Team After Treatment: Making the Most of Your Visit.
Finally, many people find it helpful to keep a record of side effects to bring to your next appointment. You can create a daily journal that details information such as when the pain occurred and for how long, how strong was the discomfort/pain using a scale of 1-10, and how the side effect impacts your daily activities. Learn more about our resources on coping with pain.
For Cervical Cancer
Q. I am looking to connect with survivors of cervical and/or vaginal cancers who have found success in managing long-term side effects of pelvic radiation. I have been offered little in terms of treatment of after-effects and am wondering if anyone has found relief.
There many ways to connect with others who are experiencing long-term side effects as a result of their cancer treatment. For many women who undergo treatment for gynecological cancers, there can be varying side effects that are short term or longer term. Having the opportunity to talk with others and share your experience may help you better cope with your side effects and learn new ways to manage them.
CancerCare offers many valuable resources to help survivors cope with post-treatment concerns. Learn about our post-treatment survivorship resources which include support groups, educational workshops, and publications. Joining a support group is a great way to share personal experiences, ease the feeling of isolation, explore new ideas, and receive helpful feedback from others.
The National Cervical Cancer Coalition has an online support community which is peer-led. Additionally, EyesonthePrize.org provides support and information for women coping with gynecological cancers.
As always, you can speak with a CancerCare oncology social worker about your concerns.
For Colorectal Cancer
Q. After two surgical operations on my rectum and colon and receiving chemotherapy, I have numbness and reduced sensitivity in my fingers and feet. My doctors suggested Gabapentin, but it gave me problems with my sense of balance. Is there anything else I can do to lessen these symptoms?
The numbness and reduced sensitivity in your fingers and feet is called peripheral neuropathy, which is nerve damage that often results from certain chemotherapy treatments (e.g., oxaliplatin). It is sometimes referred to as the “glove and stocking sensation,” as it feels similar to wearing gloves or thick stockings on your hands or feet.
Certain medications can reduce the pain and annoying physical sensations that accompany neuropathy while the nerves repair themselves. Gabapentin relieves the pain of neuropathy by changing the way your body senses pain. It is meant to control your condition but will not cure it. Fortunately, there are several other types of medications for neuropathy, including anticonvulsants, antidepressants, local anesthetics, and opioids, that can be taken individually or in combination. Work with your doctor to find the right approach for you. Keep in mind that it can take one to two years or more for symptoms to go away completely.
Here are some tips that may help you manage and cope with the symptoms of peripheral neuropathy:
- Avoid drinking alcohol, which can damage nerves.
- Wear sneakers or shoes with “rocker bottoms” that allow the feet to roll while walking, provide better traction and can relieve some of the pressure on the soles.
- Remove throw rugs from your home to reduce the chance of slipping and falling.
- Rather than stand, sit down while doing activities such as drying your hair, applying makeup or preparing food.
- Use hand tools, kitchen utensils, and even toothbrushes and pens with wider grips, to make them easier to hold.
- If you have diabetes, manage your blood sugar level very carefully, as high levels can have a negative impact on nerves.
- Join a support group to learn how others lived with, and overcome, the challenges of neuropathy.
- Consult a psychiatrist, physical therapist, or occupational therapist who can provide guidance tailored to your specific circumstances.
- CancerCare has several resources to help you learn more about living with neuropathy. Listen to our Connect Education Workshop podcast, Understanding Peripheral Neuropathy.
For additional help and support, visit the The Neuropathy Association’s website.
For Head and Neck Cancer
Q. What are the long term permanent side effects in my throat from radiation?
Depending on exactly where you receive radiation, a number of side effects can occur either on a temporary, long-term, or delayed basis. They include changes in sensation (the ability to feel), secretions (dry mouth), taste, and range of motion (when tissue hardening restricts movement and posture). These side effects can then affect key physical functions associated with the mouth and throat, such as speech and, especially after radiation, swallowing.
Whether these side effects turn into a chronic condition (or lead to other problems) often depends on how soon they are recognized and treated. Certain precautions such as addressing dental issues, can be taken before treatment begins to reduce—if not outright prevent—long-term side effects. A publication from the National Cancer Institute, Oral Complications of Chemotherapy and Head/Neck Radiation, provides an overview of possible treatment side effects and how to manage them.
Other helpful resources include these CancerCare podcasts:
Q. I underwent a modified radical neck dissection. I lost feeling on the left side of my neck, head, tongue and shoulder. I have no sense of taste and have difficulty swallowing. Will the feeling and sense of taste return?
There are a number of changes after treatment similar to what you’ve described, some of which can be permanent. Rehabilitation, however, can ease the side effects of treatment, and there are ways to cope with these effects over the long term.
Given the complexities of treating head and neck cancer, a team approach which utilizes a variety of different specialists is essential to minimizing the complications and maximizing the chances for recovery. In addition to the treating physicians—an oral or ear, nose and throat surgeon, a medical and/or radiation oncologist, a plastic surgeon, prosthodontist, and a dentist among them—a number of other health care professionals can assist with your recovery. These other team members include dietitians, social workers, nurses, physical therapists, and speech-language therapists.
Check with your surgeon regarding the loss of feeling on the side of neck. While nerves may have been cut in the area during the node dissection, you should not rule out at least some sensation returning over time. Have your taste and swallowing problems evaluated using tests such as the modified barium swallow (a kind of x-ray) or fiberoptic endoscopy. A speech-language pathologist can provide advice and guide you with therapeutic exercises to improve swallowing ability. There are also medications (both prescription and over the counter) that can help with saliva problems and dietary changes (such as avoiding foods that are made up of small particles) to ensure you continue to obtain sufficient nutrition.
Consider joining a peer support group at your local medical center or through organizations such as Support for People with Oral and Head and Neck Cancer (SPOHNC) or CancerCare.
Q. I'm worried my husband has some ongoing side effects from his treatment for acute lymphoblastic leukemia (ALL). Do you know if there are specialists who treat side effects from treatments?
Blood cancers are called hematopoietic cancers and treated by hematologists (doctors who specialize in blood disorders). Blood cancers consist of three types: leukemia, disease of the blood; lymphoma, disease of the lymphatic system; and multiple myeloma, disease of the bone marrow. There are numerous subtypes of all three blood cancers, especially among lymphomas and leukemias. The diagnosis is very important because it will directly impact the treatment options, and different treatments may result in different side effects.
ALL is a cancer of the white blood cells, the cells in the body that normally fight infection. Most cases of leukemia are associated with changes in genes and chromosomes in the cancerous white cells, which is the case for ALL.
Because many standard cancer treatments are very powerful, they also carry a risk of side effects; loss of hair, fatigue and nausea are the most common. Most side effects go away after treatment. However, some treatments can have ongoing and on occasion permanent side effects, which can include neuropathy, “chemobrain” and anemia, among others.
The professionals who make up his treatment team are the best people to address his side effects. His doctor might adjust treatment when side effects are dangerous or harmful. If side effects continue post-treatment, again his treatment team is the best source for help. Your husband may be prescribed medications to help manage side effects, or referred to a specialist who can monitor and treat side effects. Specialists include physical therapists, neurologists, psychiatrists, nutritionists or other specialized health care professionals.
Please take a look at our Connect Education Workshop podcasts that address the side effects of treatment. In addition, CancerCare also offers a number of publications that might be helpful in managing side effects.
Additional resources addressing ALL treatment and side effects include: – Leukemia and Lymphoma Society – National Cancer Institute’s Adult ALL Treatment Summary
For Lung Cancer
Q. My 68-year-old husband was diagnosed with lung cancer in 2004, had radiation and chemo, and is currently in remission. Since ending his treatment, his personality has changed drastically and he directs his anger towards me. Can chemo affect a person mentally?
Chemotherapy can affect a person’s mood, as can other medications such as steroids. It is important that you and your husband inform his doctor of changes in his mood to rule out any medical causes. The change in his personality may also be a sign that he is still struggling emotionally with his diagnosis and treatment. Cancer can be overwhelming and bring up many feelings from anxiety to anger to sadness. As your husband’s primary caregiver, those feelings may be directed towards you since you are the one he is closest to and trusts. If you haven’t done so already, letting your husband know how his feelings and behavior affect you is important. Seeking couple’s counseling is also a good idea if you are having difficulties communicating with each other.
The end of treatment often can lead to many strong and conflicting feelings. When a person is first diagnosed with cancer, he/she is often focused on learning about the diagnosis and getting through treatment. This can delay the emotional impact of cancer and feelings may come up once treatment ends, as there is more time to think about what has happened. For more information on coping post-treatment read, After Treatment Ends: Tools for the Adult Cancer Survivor.
Q. I was diagnosed with non-small cell lung cancer and am receiving chemotherapy. I've had two colds within a three-week period and also a low level of hemoglobin in my blood (the doctor has recommended erythropoietin treatments). Could these issues be diet related?
Chemotherapy for either small cell or non-small cell lung cancer tends to be fairly aggressive and can produce some difficult side effects. While chemotherapy is focused on destroying lung cancer cells it can also interferes with the production of the three types of blood cells: red blood cells, white blood cells, and platelets. Normally, just before you start a chemotherapy session, your doctor arranges for you to have blood tests to determine the effect the chemotherapy is having on your blood cells. Low counts of any of these cells may prompt either a change in dosage or frequency of treatment, or a need to take medication that can stimulate bone marrow production of the blood cells.
Your colds may be due to the chemotherapy’s suppression of the bone marrow’s production of white blood cells, which are the body’s infection fighters. If your doctor feels that your white cell count has significantly decreased, he or she may consider putting you on a medication for this condition. Ask your doctor whether this might be a possibility.
Similarly, the low levels of hemoglobin you mention may be due to low red blood cell counts caused by chemotherapy. Red blood cells carry oxygen and iron to provide the body with components necessary for energy. Red blood cells are an important factor in maintaining energy levels in our bodies and too few of them can result in fatigue and anemia. It sounds like your doctor believes an erythropoietin-type drug might be helpful in boosting your red blood cell count. While extreme low red blood cell counts are not normally related to diet, you might also want to ask your doctor for a referral to a dietitian who works with cancer patients to develop a meal plan that would increase your dietary intake of iron and help you maintain a healthy weight.
CancerCare offers publications that provide more detailed information on managing chemotherapy side effects.
Q. I was diagnosed with stage IB non-small cell lung cancer. I had surgery (lobe resection) and my doctor gave me a referral to an oncologist for "adjuvant treatment," meaning chemotherapy. Why do I need to do this?
For a long time, it was believed that only surgery was necessary to achieve a successful outcome for lung cancer patients diagnosed with stage IB to IIIA non-small cell lung cancer. However, a number of recent investigational research studies provided evidence that patients who received both surgery as their primary treatment and chemotherapy as an “adjuvant,” or secondary treatment, reduced their risk of the cancer recurring. Unlike chemotherapy used as a primary therapy, adjuvant chemotherapy is usually shorter-term and has a fixed duration.
You should discuss any of your concerns about the side effects of chemotherapy with your oncologist before treatment starts. I do want to say that there are significantly fewer, less severe side effects in current-day chemotherapy treatments and much more can be done to address them.
For more information on lung cancer staging and treatment, read our booklets:
- Your Guide to the Latest Cancer Research and Treatments – Highlights from ASCO 2012
- Progress in the Treatment of Lung Cancer
View all of CancerCare’s publications about managing side effects.
Q. I'm in remission after having chemotherapy and radiation for small cell lung cancer. I've recently started having a shortness of breath when I'm at rest (doesn't seem to happen at work). Is there anything I can do?
The shortness of breath, or dyspnea, you are experiencing can be uncomfortable and frightening. The more you struggle for air, the harder your lungs work to get oxygen, and the more distressed you feel. It is extremely important to consult a medical professional to find out what might be setting this cycle in motion. Possible causes could be:
- a side effect of chemotherapy or radiation (which may reduce lung capacity)
- anemia, meaning your lungs don’t have enough red blood cells to deliver oxygen throughout your body
- a non-cancer lung condition, like asthma, COPD, or an allergy
- anxiety caused by fears of recurrence, the lasting emotional effects of having had cancer, or other types of stress
Contact the American Lung Association (1-800-LUNGUSA) for information on other possible causes of dyspnea. Depending on its source, a doctor may prescribe a steroidal or anti-anxiety medication, supplements, oxygen, or special exercises. The Lung Cancer Alliance has a very helpful video demonstration of breathing techniques to relieve dyspnea. Progressive relaxation, meditation, and guided imagery can all help reduce stress and anxiety. CancerCare has several Connect Education Workshops that address stress management in cancer survivors including Fear of Recurrence and Late Effects: Living with Uncertainty and Managing the Stress of Survivorship.
To prepare for your doctor’s appointment, keep a record of your breathing problems, with these questions in mind:
- When do you experience shortness of breath?
- When does it feel worst?
- How long does each episode last?
- What is going on around you before, during, and after each episode?
- Does anything make it feel better?
Take your record with you to your appointment. It is very important that a medical professional review your symptoms, especially if you’re also feeling faint and dizzy, if your heart is pounding, or if it’s difficult to breathe even at rest.
CancerCare has information on creating a survivorship care plan that can be used to personalize your post-treatment needs and communicate them to your health care provider.
Don’t be afraid to advocate for yourself so that your medical, emotional, and practical needs are addressed, and your quality of life is maximized.
Q. I finished my chemotherapy for anaplastic stage IV lymphoma over a year ago, but I still must nap every day. Will there come a day when I will not be so exhausted?
Fatigue is one of the most common side effects of cancer treatment and ranks at the top of symptoms reported along side of pain. More often medical experts focus on treating pain rather than fatigue because of the degree of discomfort for the patient. However, over the long term, fatigue can have an equally profound effect on quality of life for many patients. Simple activities of daily living can take longer, require more energy, and be debilitating. The end result is that people may retreat from many of the activities that brought them happiness prior to cancer treatment.
Fatigue is an expected side effect of chemotherapy and radiation and usually dissipates over time after treatment has ended. But in some cases, it can go on for years or become a chronic condition. There are three factors one needs to look at when addressing fatigue: physical, psychological, and emotional. Sometimes only one factor may be the cause of fatigue; other times it might be a combination. Interventions to combat fatigue can be pharmacological, behavioral or psychological. Integrative medicine practices (e.g., acupuncture, meditation and vitamin supplements) can also be utilized. Fatigue during treatment, or lingering well past, should be discussed with your oncology team and be explored with other medical specialists as needed. In some instances, the underlying cause of chronic fatigue might not be identified, but with help, people can find ways to adapt and still enjoy a full life.
To learn more about coping with fatigue, please watch Memorial Sloan Kettering’s informative webcast, Coping With Fatigue After Cancer Treatment.