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Managing Side Effects 

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Cancer treatments are made to destroy cancer cells. Most common side effects involve part of the body where the normal, healthy cells divide as rapidly as cancer cells. The most rapidly dividing human cells include:

Blood cells 
 Cells that line the mouth, throat and stomach (gastrointestinal system) 
 Hair follicles

Different treatments cause different side effects, and side effects vary from patient to patient. To help your treatment care team make you as comfortable as possible, they need to know about any side effects or changes you are experiencing.

Although your cancer care team will do all they can to make you comfortable, you will need to take extra care of yourself during this time. It is very important for you to understand what is happening to you and to know some ways to minimize your symptoms.

The most common side effects of treatment include:

Low Blood Counts 
Radiation therapy and chemotherapy drugs may affect bone marrow. Bone marrow is where blood cells are produced. The three major types of blood cells are: red blood cells, white blood cells and platelets.

Preventing Infection

The following suggestions can help lower the possibility of an infection:

Hand washing. The most important way to prevent infection is through hand washing. This means that not only do you need to wash your own hands, but everyone who comes in contact with you should wash their hands as well.

 Avoid persons with colds or infections. Explain to them that you are more susceptible to infection and they should understand.

 Avoid fresh flowers, plants or fruits while your WBC is low. These carry bacteria and fungi that can be transmitted to you. Alternative options are silk flowers or balloons.

 Any cut, scratch or non-healed area should be inspected, cleaned and have a new dressing at least once a day. Show any of these areas to the physician or nurse on your next visit.

 Clean your mouth several times a day. Report any white patches, ulcers or sore areas to a member of your treatment care team. Use petroleum jelly, lip balm or moisturizer to prevent dry, cracking lips.

 Keep fingernails short and neatly trimmed. This can prevent infections which can easily be caused by scratching. 

 Visits by children are discouraged while your blood count is low. Children are exposed to many infectious diseases at school and day care.

 Red Cells
Red cells carry oxygen. When the red cell level drops below normal, patients are considered anemic. If the red cell level drops significantly, patients may feel fatigued, short of breath or weak. Patients with extremely low red cell level may require a blood transfusion.

 White Cells
Neutrophils are special white blood cells (WBC) that provide protection against infection. Neutropenia occurs when the neutrophil count drops significantly. When this happens, the body cannot fight infection. 

Often the first sign of an infection is a fever, chills or feeling ill. It is especially important for patients with cancer to prevent infection because white cells cannot be transfused from one patient to another.

Most chemotherapy drugs cause blood counts to drop to their lowest point 7-10 days after treatment is started. This time is called the nadir. If you are receiving chemotherapy, it is very important that you contact your physician if you have symptoms during this time.

It is particularly important to contact your physician if you have a fever. A fever is any temperature above 100.5 degrees. Often, temperatures will rise and then fall. Call your physician immediately even if your temperature returns to normal.

Platelets
Platelets are required for normal blood clotting. Patients with very low platelet counts may bruise easily or may develop small blood clots under the skin, bleeding of the gums or other bleeding. If platelet levels drop extremely low, the patient may require a blood transfusion.

Thrombocytopenia occurs when the platelet count drops significantly, making it much easier for the patient to bleed. Treatment includes prevention of bleeding and transfusion of platelets. Transfused platelets act as mature stand-ins for your developing cells until your body is able to produce enough platelets on its own.


Anemia

Anemia occurs when the red blood cell count drops significantly, making it difficult for your body to get enough oxygen to its tissues, organs and muscles. Signs that you may be anemic include: frequently feeling very tired, becoming short of breath when getting out of bed or exercising, and becoming dizzy or lightheaded when going from lying down to sitting or standing up.

When anemia occurs, it is generally treated with transfusions of packed red blood cells (RBCs). Transfusions give your body the extra RBCs it needs to carry oxygen until your own RBCs are high enough to do the job on their own. You may also need extra oxygen during this time. The final decision of when your RBC count is low enough to require a transfusion will be made by your physician based on your individual circumstances.


Mouth/Throat

Mouth Sores

Mouth sores can develop for a variety of reasons. If you develop mouth sores, it is important to let your physician know, especially if the sores are causing you pain and preventing you from eating or drinking.

Cold Sores
Cold sores are caused by a type of herpes virus. This type of infection is very common and usually goes away on its own. Once you've had a cold sore, stress or illness can cause it to redevelop.

Mucositis
Mucositis is an inflammation of the lining of the mouth and throat. It may appear as redness or sores and can be painful. It is important to contact your physician if you have mouth sores that cause you to have pain or difficulty swallowing. There are a number of medications that can help alleviate this pain.

Thrush
Patients with cancer may develop a fungal infection called thrush which appears as a white coating on the mouth or throat. Thrush may or may not be painful and is easily treated with an anti-fungal medication.

Dry Mouth
There are several ways to ease the pain of dry mouth which can occur after radiation therapy or chemotherapy: 
–  Rinse with warm salt water every 2 hours. 
–  Carry a bottle of water with you at all times. 
–  Moisten lips every 2-4 hours with lanolin-based cream. 
–  Avoid licking your lips. 
–  Moisten food with sauces or gravies. 
– If dryness is severe, consult your physician.

Good mouth care begins with routine dental check-ups. It is important for you to let your dentist know that you have cancer. If you are receiving chemotherapy or radiation therapy, do not have any dental work done until you have talked with your medical or radiation oncologist.


Constipation
Certain types of cancer, pain medications, chemotherapy and decreased activity can all make having a normal bowel movement difficult. Severe constipation can lead to painful abdominal cramps, nausea, bloating and decreased appetite. It is extremely important for you to have regular bowel movements so that you remain as healthy and comfortable as possible while undergoing treatment.

To prevent constipation: 
–  Drink 8 large glasses of non-alcoholic beverages daily. 
–  Maintain the activity level recommended by your physician. 
–  Eat five servings of fruit/vegetables each day. 
–  If these preventive steps do not help, ask your physician or nurse about prescribing a laxative.


Diarrhea

Chemotherapy and radiation therapy affect the cells lining the stomach and can sometimes cause diarrhea. Diarrhea is best treated when detected early, so contact your physician or nurse if you are experience cramping, gas or loose stools for more than 24 hours. A change in diet may be necessary.

To prevent diarrhea: 
–   Drink 8-12 glasses of water a day to make up for the loss of water in your body. 
–  The best liquids to drink are clear in color: apple juice, ginger ale, weak tea, broth and Jell-O are good choices. 
–  Let carbonated drinks lose their fizz before you drink them. 
–  Eat frequent, small meals. 
–  Avoid high-fiber foods which can lead to diarrhea and cramping. These include: whole grain breads, cereals, raw vegetables, beans, nuts, seeds, popcorn and fresh and dried fruits. 
–  Eat low fiber foods such as: white bread, white rice or noodles, creamed cereals, ripe bananas, canned fruit without the skin, pureed vegetables, fish, chicken or turkey without the skin. 
–  Avoid milk products, fried or greasy foods and foods that are difficult to digest such as cabbage, broccoli, cauliflower, corn and spicy foods.


Loss of Appetite

A common side effect of treatment is loss of appetite. However, a good diet is one of the best ways to help damaged cells rebuild. Even if you are not hungry, try to eat small meals often and eat a variety of foods. Physicians have found that patients who eat well can better handle the side effects of treatment.

Tips for Handling Loss of Appetite 
–  If you have pain while chewing or swallowing, ask your physician about recommending a powdered liquid diet supplement. 
–  Milkshakes and pureed fruits often taste good when solid food does not. There are nutritional supplements that can be added to milkshakes to give you the vitamins and protein you need. 
–  Keep healthy snacks nearby for nibbling. 
– If you can only eat small amounts, increase calories by adding butter, cream sauces or melted cheese to your recipes. You may also want to substitute milk or half-and-half when water is called for in recipes. 
– Ask the Sentara nutritionist about special recipe booklets and diet guides. 
– Use soft lighting, quiet music and colorful table settings to make eating a special event. 
– If friends and family offer to cook for you, let them ― and do not be afraid to tell them what you like to eat.


Nausea and Vomiting

Many cancer patients experience nausea and vomiting at some time during their treatment. If you develop nausea or vomiting, it is important to tell your physician or nurse. It is also important to drink plenty of fluids during your treatment to help your body stay hydrated. If you are unable to drink for a prolonged period of time, you may become dehydrated.

How to Treat Nausea
If you do experience nausea, the following diet changes may ease your symptoms and help you recover more quickly: 
–  Start with clear liquids before you move on to solid foods. 
– Eat bland foods, such as crackers and plain baked potatoes (avoid foods with a strong smell, color or taste). 
– Eat several small meals throughout the day instead of three larger meals. 
– Avoid foods high in fat, such as French fries or hamburgers. 
– Avoid spicy foods such as peppers and hot sauces. Try unseasoned or lightly seasoned baked, broiled or steamed foods instead. 
– Avoid foods high in acid, such as orange juice or tomato-based foods. 
– Avoid foods that cause gas, such as cabbage and beans. 
– Ask your physician or nurse for any reading materials that have good food ideas.

 


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