Alleviating Side Effects
After 22 years working at Fox Chase Cancer Center, clinical nurse specialist Carolyn Weaver is struck by all the progress that has been made in managing the side effects of cancer treatment.
“There have been so many advances in medication for nausea, for example,” says Weaver. “Ten years ago there was one drug. Now there is a whole menu of drugs, and vomiting can pretty much be eliminated.
“Some patients may still have some nausea and decreased appetite. The image of an individual wasting away from breast cancer treatment, however, is not accurate. In fact, our patients may need to manage weight gain instead.
Among the most common side effects are sleep disturbances such as insomnia and fatigue, as well as the risk of infection. This is because, while chemotherapy is killing fast-growing cancer cells, it is killing fast-growing red and white blood cells as well. With fewer red blood cells, patients may become anemic. With fewer white blood cells, their vulnerability to infections from viruses and bacteria may increase. For this reason, Weaver urges women to call their doctor if they have even a trace of an infection such as a sore throat or burning upon urination.
Consequences of chemotherapy include constipation or diarrhea, and as few as two loose stools a day could be of concern because they can lead to dehydration, so this should be reported too, Weaver says. Other side effects include mouth sores, shortness of breath, or hand and foot syndrome, where the palm and soles of the feet get red and peel.
While not typically a problem with the drugs used in halting breast cancer, ototoxicity (ear poisoning) may cause dizziness or hearing loss for a genetically susceptible individual and should also be reported immediately.
Skin burns could be a potential side effect of prolonged radiation, but much can be done to protect sensitive skin with special ointments.
While most patients will have discomfort and some numbness from a mastectomy, Weaver says they typically do very well with ordinary pain medication. A few women, however, may suffer from mastectomy pain syndrome and these individuals should be referred to a pain center.
“People should be aware of all these side effects, but know they don’t have to suffer and live with them,” says Weaver, adding that there are so many ways to treat all of these side effects today.
A different kind of consequence of cancer treatment is the emotional distress and anxiety that some women experience because of a changed body image. Weaver encourages women to participate in support and survivor groups, or one-on-one counseling sessions, which are very helpful. Reconstructive surgery may help, too.
Weaver points out that at Fox Chase, a comprehensive cancer center with teams of plastic surgeons in addition to oncologists, more than 75 percent of women routinely schedule reconstructive surgery with the mastectomy, regardless of their age.
“It’s not just for younger women. Even if patients have a lumpectomy and might not be symmetrical, lingerie shops can give them insets for their bras. There are a lot of places that cater to women who have had surgery.”
Fatigue commonly lingers after treatment ends. By talking with your health care team, you may be able to pinpoint the cause, treat it, and speed up the time it takes to feel good again.
Weight gain may be associated with the hormonal/endocrine therapy that follows breast cancer treatment and needs to be monitored along with one’s risk for osteoporosis. Hot flashes are common, but Weaver says women don’t have to put up with these things. If one remedy doesn’t work, they can try another one.
Another concern is the worry of recurrence and the anxiety and depression it can cause. For some, the fear of recurrence may lessen over time, but it never goes away entirely. While some anxiety and depression are not unusual, if it persists of interferes with a woman’s quality of life or her ability to resume activities of daily living, she should seek help from a mental health professional who may prescribe medications or psychotherapy to manage symptoms.
“We want to know anything that may be troubling you,” Weaver says. “Don’t ever think you are bothering us. You may have an appointment next week, but if you are having a problem now, you can’t afford to wait.”
This article was originally printed in Lifeline.