Treatment Side Effects Can Impact Each Other
A little-noticed but intriguing article appeared a while ago in the Journal of Symptom Management. It addressed the interrelationship between various side effects from cancer treatment, and how a single, untreated symptom can actually worsen other treatment side effects.
Dr. Paul Jacobsen of the Moffitt Cancer Center in Tampa, Florida understood what most breast cancer patients undergoing chemotherapy already know—that they get tired as a result of their treatment! However, Jacobsen took this one step further. He wanted to see if there was a direct, measurable relationship between fatigue and the nausea and vomiting experienced by many women undergoing chemotherapy.
Jacobsen studied a group of 54 women who were just beginning adjuvant chemotherapy and assessed their level of fatigue before and throughout the course of their three-week treatment cycles. He found that patients experienced worse fatigue levels both before and during chemotherapy. However, their fatigue was the most debilitating during the week immediately following chemotherapy treatment, when nausea and vomiting were the most prevalent.
Not all women experienced nausea and vomiting, and their energy levels were substantially higher during the first week following treatment. Jacobsen was thus able to directly quantify a relationship between fatigue and nausea and vomiting. He suggested that aggressive symptom management—not only for these symptoms, but for any treatment-related side effects—would make chemotherapy more tolerable and enhance the overall well-being of the cancer patient throughout treatment and recovery.
Side effects from cancer treatment are common, but they don’t affect everyone. You may have few or possibly no reactions, depending on the type of treatment you are receiving and your unique response to it. When side effects do occur, however, there are medications and treatments that can usually help to alleviate their symptoms, and there are also a number of things you can do to help yourself.
While certainly not all-inclusive, the following are some of the most common side effects from cancer treatment, including some of the ways in which they can be overcome.
Nausea and vomiting are two of the most common side effects of cancer treatment. They are actually two different physical actions. Nausea is the unpleasant wavelike feeling in the back of the throat or stomach that may or may not result in vomiting. Vomiting is the forceful elimination of the contents of the stomach. Both of these actions are controlled by the central nervous system.
Chemotherapy is the most common treatment-related cause of nausea and vomiting. The drug, dose, schedule and method of administration all determine how often nausea occurs and how severe it will be. Usually, these symptoms can be prevented or controlled.
Radiation therapy to certain parts of the body can also cause nausea and vomiting. Patients who are receiving radiation to the gastrointestinal (GI) tract or brain are more likely to experience nausea and vomiting than are patients who are receiving radiation therapy for cancer in other sites. Because cells of the GI tract are dividing quickly, they are very sensitive to radiation therapy. In general, the higher the daily dose of radiation and the greater the amount of tissue that is exposed, the more nausea and vomiting are likely to occur.
Since 1991, a new class of drugs has remarkably reduced the impact of nausea and vomiting as treatment side effects. Ondansetron HCL (Zofran) and granisetron HCL (Kytril) work better than older medications to minimize nausea. They also don't cause drowsiness. Occasionally, relaxation techniques such as guided imagery, meditation or deep breathing may also help to control nausea and vomiting.
Fatigue affects more than three-quarters of patients undergoing cancer treatment. It can include feeling tired, weak, exhausted, slow, or simply lethargic. Fatigue may be acute or chronic. Acute fatigue is normal tiredness with occasional symptoms that begin quickly and last for a short time. Simple rest and "taking it easy" may be all that is necessary to overcome it. Chronic fatigue is longer lasting. It can result from the cancer treatment, or from the spread of the cancer itself. It can become physically—and even emotionally—debilitating.
Fatigue can occur for many reasons. It can be caused by anemia, nausea and vomiting, loss of appetite, decreased levels of hormones, medications, emotional distress, difficulty sleeping, pain and other factors. In the case of radiation, it may also be caused by the increased energy needed to repair damaged skin tissue.
Treatments for fatigue can include certain medications to stimulate blood cell production, or psychostimulant drugs to improve emotional well being. Treatment for chronic fatigue that is related to anemia may include red blood cell transfusions. Beyond these, moderate exercise, sufficient rest, and simply setting priorities have been shown to result in significant improvements.
Chemotherapy impairs your bone marrow’s ability to make white blood cells. A decreased white blood cell count makes you less able to fight infections. There are medicines called colony stimulating factors that can help speed the recovery of white blood cells, shortening the time when the white blood cell count is very low (and the risk of infection is high). But you can also minimize your infection risk when your counts are low by washing your hands throughout the day, staying away from people with illnesses, avoiding crowds, and maintaining good mouth care.
Some anticancer drugs can cause sores in the mouth and throat, a condition called stomatitis or mucositis. Other drugs can make these tissues dry and irritated or cause them to bleed. Patients who have not been eating well since beginning chemotherapy are more likely to get mouth sores. But there are medicines available to treat these symptoms. It may be helpful to eat soothing foods such as ice cream, milkshakes, soft fruits and easy-to-chew items. Also, drink plenty of liquids, but not acidic juices such as tomato and citrus drinks. And avoid spicy or salty foods.
During radiation therapy, it is common for the skin in the treated area to become red, dry, tender, and itchy. There may also be localized darkening of the skin. This area should be exposed to the air as much as possible, but protected from sunlight. You should avoid wearing clothes that rub the treated area and not use any lotion or cream on your skin without checking with your doctor or nurse.
Constipation is a common problem for cancer patients and can be caused by the growth and spread of the cancer or by certain treatments for the disease. Other causes for the condition include poor diet, changes in bowel habits, and lack of exercise. To help offset constipation, your doctor may tell you to increase the amount of fluid you drink each day, exercise as appropriate for your condition, and eat plenty of dietary fiber. If these don’t help, there are medicines, enemas and natural stool softeners that may be recommended.
Other side effects of cancer treatments can include loss of appetite, hair loss, numbness and tingling in hands or feet, headaches, darkening of the skin and fingernails, and vaginal dryness. These are usually temporary and subside soon after treatment ends. Certain drugs used in the treatment of some cancers can cause some hearing loss or kidney damage. (To help protect the kidney while taking these drugs, patients may receive extra fluid intravenously.)
Each patient's body will respond to cancer treatment in its own way. The National Cancer Institute offers the following suggestions for taking care of yourself during the course of treatment and recovery:
SOURCES:
Journal of Pain and Symptom Management, October 1999; 18:233-242
The National Cancer Institute (http://www.nci.nih.gov)
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