Managing Side Effects of Treatment
It is by surmounting difficulties,
not by sinking under them,that we discover
— Hannah Webster
When undergoing treatment for
cancer, especially chemotherapy and radiation
therapy, there are a number of side effects
or symptoms you may experience. When your
doctor advises you of “possible” side
effects, this does not mean that you will
experience all of them. In fact, it is possible
for you to undergo treatment with little
to no side effects that disrupt your daily
Be sure to report any symptoms
or side effects to your doctor or nurse
immediately after you begin to experience
them. That way you will not have to continue
to be in pain, feel sick to your stomach
or tired for a long period of time. The sooner
you talk with your doctor or nurse, the sooner
they can begin to help you feel better.
this section we address some of the more
common side effects from cancer treatment.
We do not cover each and every possible
side effect or symptom. If you need information
on a side effect we have not covered,
try the Resources we have listed at the end
of this section. And, as always, talk
with your healthcare providers to get further
Your Healthcare Decisions Known
at some point you decide that you may
not be capable of making healthcare decisions
for yourself, you should consider executing
a Healthcare Power of Attorney and Living
Will. This will ensure that your healthcare
desires are known and will be followed.
(See also Hospice
Care and End of
What is fatigue?
Fatigue is a feeling
of extreme tiredness, exhaustion or lack
of energy. Fatigue can also make you feel
worn out, weak, heavy or slow. It is the
feeling that you don’t
have the energy to do the simple things
you usually do each day, like showering,
cooking, running errands, taking care
of others, working or doing light housework.
Fatigue in people with cancer often is
not improved by rest or sleep.
Why am I fatigued?
very common in people with cancer. There
are a number of possible reasons for
your reduced energy and
Cancer treatments such as chemotherapy,
radiation therapy, surgery and certain
drugs can contribute to draining your
energy. A tumor uses your energy for growth,
which reduces the energy available to the
rest of your body. Cancer cells destroyed
during treatment release chemicals that may
increase fatigue. Pain, infection and fever
also draw energy from your body.
of treatment, such as nausea and vomiting,
may worsen fatigue because you may not
be able to get good nutrition. Radiation
may contribute to fatigue because the body
uses energy to repair damaged skin tissue.
Also, a low red blood cell count (anemia)
may result from cancer treatment. Since red
blood cells are needed to carry oxygen throughout
your body, this reduction in oxygen-carrying
cells can contribute to your fatigue.
extreme stress that people with cancer
experience over a long period of time can
deplete energy levels. In addition, researchers
have found that about 40 to 60 percent of
the cases of fatigue among medical patients
are not caused by the disease or a physical
reason. Normal emotional responses to dealing
with cancer, such as sadness, depression,
anxiety and fear, can all cause or worsen
fatigue. All or any of these can decrease
your energy and add to your fatigue.
process also requires energy. This, too,
can contribute to fatigue.
What can I do
The good news is that
there are a number of things that you can
do to help manage your fatigue.
to balance your activity and rest each
day. Inadequate rest can be just as
energy depleting as not enough activity.
Napping can be helpful, but keep in mind
that napping during the day may interfere with your ability to
sleep through the night.
- Light to moderate exercise
may be helpful. Studies are showing that
light exercise on a regular basis may help people with cancer
have more physical energy,
improved appetite, better ability to function, improved outlook
and sense of well being,
and better ability to meet the challenges of cancer and cancer
treatment. Talk about exercise
with your health care provider.
- Practice energy conservation.
Any changes in daily routine require
the body to use more energy. Set priorities for activities in a
day, and keep a reasonable
schedule. Organize your work area to minimize trips. Avoid
unnecessary standing and other energy drains. Take advantage
of offers of help. Schedule
important daily activities during times of less fatigue,
and cancel unimportant activities that cause stress.
to do activities that you enjoy, if possible,
such as walking, gardening, birdwatching,
crafting or other hobbies.
- Practice healthy
eating habits. Good nutrition can provide
the fuel you need to promote and maintain
energy levels. You may want to avoid
fatty foods and large meals, as both can
leave you feeling sluggish. Discuss diet
and nutrition with your healthcare provider.
It may be necessary to
use medications to combat mouth sores, nausea and vomiting (possible
side effects of chemotherapy)
to ensure your ability to eat adequately.
- Let your doctor or nurse
know if (or when) you are having
difficulty with fatigue or other symptoms that are getting in the
way of your usual activities. They are there to
help you through the
Will I definitely lose all my
hair if I receive chemotherapy?
Understandably, this is a concern of
a patient undergoing chemotherapy.
Losing your hair is a visual cue
to yourself and to others that you are
sick. It can affect how you see
yourself and how you feel others view
Each woman is different in how
her body responds to different
chemotherapy drugs. Some women
may lose all their hair very quickly,
while for others the process takes
longer. Some women will experience
only a “thinning
out” of their hair
and will not lose it all.
Your doctor or nurse will
be able to give you an idea
of the likelihood of hair
loss based on your individual
does it take for the hair
to fall out?
each person is different. Depending on
your treatment, you might see some hair
loss anytime between 10
to 16 days after your first
It may fall out more quickly
or it may take a longer
period of time.
What can I do about hair
hair can be a stressful experience.
We all want to look our best and feel
good about our appearance. Losing your
hair can affect your level of confidence
and self-esteem. However, based on
your own comfort level, there are several
things you can do to cope with hair
- Cut your
hair short (or shorter) before you begin
treatment. This is one of the easiest
things you can do, especially if your
hair is long. A shorter style will make
your hair look thicker and fuller. If
your hair only thins out, you may not
need to do anything else. A shorter hairstyle can also help
reduce the anxiety and trauma from having large
amounts of hair fall out in a short amount of time.
you choose to wear wigs, try to find
your wigs before you begin treatment.
This will help you to match your current
hairstyle and color, if you wish. If you are able,
you may want to consider
buying more than one wig either the same color and style or two different
ones (for variety).
Having more than one wig will allow you to have one to wear while the
other is being
cleaned and restyled. It is best to try
on wigs after you have your hair cut
short for a more accurate fit.
- Find a hairstylist
who is skilled with wigs. This may be
your very own hairstylist, which will save you from searching for someone
to help you style
your wig. If you get your wig through a mail-order catalog, be prepared
for the wig to
need some shaping, styling and, perhaps,
even some cutting to suit your taste.
Your doctor or
nurse may have names of competent wig
stylists or you might try asking someone
in a support group
who they got to style their wigs. Also, check with your doctor to see if
center offers a “Look
Good . . . Feel Better” program,
sponsored by the
American Cancer Society.
- Wear scarves, hats,
turbans or other
with or without your wigs. Or, you may
decide that you don’t
want to wear a
wig or other headcoverings. It all depends
on your own comfort
- Consider shaving
your hair off. When your hair becomes
patchy all over your head, sometimes the best thing you can do is get
rid of it. Many
women report feeling better once they
take control and get rid of the hair
remnants. If you do this, be sure to
exercise great care if you are doing
it yourself. An electric razor is
probably the best method for shaving your head. Before you do, you may
want to consult
with your doctor or nurse. It’s possible they,
or a friend, may
be willing to do it for you.
can I find wigs and stylists, hats and
and how do I pay for
To find a
local, mail order, or Internet wig store,
wig stylist or stores that have scarves,
hats and turbans, check the Suppliers
of Breast Cancer Products and Services
on page 217, or ask your healthcare
provider for resources in your community.
Some wig stores or hairstylists offer
discounts to cancer patients needing
wigs or wig styling. Your local hospital
or cancer center or the local American
Cancer Society office may have a free
wig bank or loan closet, where you
can borrow a wig rather than buy one.
Also, some health insurance policies
cover the cost of a hairpiece needed
because of cancer treatment. It is
also a tax-deductible expense. Check
your policy, and ask your doctor
for a “prescription.”
long will it take for my hair to grow
your hair will begin to grow back once
you have completed treatment. Sometimes
it may start growing before you have
finished treatment. Sometimes hair may
grow back a different color or texture.
Since all women are different, there
is no way to tell how fast your hair
will grow back.
Some tips for taking
care of your head and hair during treatment:
a mild shampoo.
- Use a soft hair brush
or wide-tooth comb.
- If you use a hairdryer,
use low heat.
- Use sunscreen, a hat or scarf
to protect your
- Avoid brush rollers to set your hair.
- Avoid dying, perming or relaxing your
AND PROBLEMS WITH
You may not (and should not
expect to) have these symptoms; however,
you should be aware that they are possible.
Your doctor or nurse can help you to recognize
early signs or symptoms and can give you
medications to prevent or relieve them. New
drugs have made these side effects far less
common; and, when they do occur, they are
much less severe. Different drugs work for
different people, and you may need more than
one drug to get relief. Do not give up. Continue
to work with your doctor or nurse to find
the drug or drugs that work best for you.
Be sure to tell your healthcare
team if you are very nauseated or have vomited
for more than a day, or if your vomiting
is so bad that you cannot keep liquids down.
diet and nutrition are very important during
cancer treatment. Here are a few reasons
- A healthy diet helps
keep up your strength, fights fatigue and
promotes rebuilding of the healthy tissue
that cancer treatment has destroyed.
- A healthy
diet helps maintain your nutrient and
energy levels, protecting your natural
defenses for fighting infection. You need
this now because cancer patients are at
higher risk of getting infections due to
the effects of cancer treatment.
FOR MOUTH CARE DURING CHEMOTHERAPY
To keep your mouth, gums, throat and teeth healthy during chemotherapy,
consider the following:
If you have mouth sores, the following may help:
- Brush your teeth and gums after every meal. Use a soft
toothbrush and a gentle touch. If your gums are sensitive, ask your
doctor, nurse or dentist to recommend a special toothbrush or toothpaste.
Rinse with warm, salt water after meals and before bedtime.
- Avoid mouthwashes that contain any amount of alcohol.
Ask your doctor, nurse or dentist to suggest a mild or medicated mouthwash
or fluoride gel you might use. For example, mouthwash with baking soda
- Eat foods
cold or at room temperature.
- Try soft,
soothing foods, such
as ice cream, milkshakes,
baby food, soft fruits,
mashed potatoes, cooked
or scrambled eggs, yogurt,
cottage cheese, macaroni
and cheese, custards,
puddings and gelatin.
You can also puree cooked
foods in a blender.
irritating, acidic foods
and juices, such as tomato
or citrus; spicy or salty
foods; and rough or coarse
plenty of liquids. If
your mouth is dry, you
can also suck on ice
chips, popsicles, or
sugarless hard candy.
What can I do if I have nausea
Here are some tips to eating well
during your cancer treatment:
small meals throughout the day rather
than two or three regular meals. Your stomach
won’t feel as full, and smaller
meals are generally better tolerated.
and drink slowly, and chew your food
well for easier digestion.
- Pay attention
to your body signals. If one particular
food or flavor makes you sick to your
stomach, avoid it and eat more of the foods
that agree with you.
- If nausea is a problem
in the morning, try eating dry foods
like cereal, toast or crackers before getting
up. (Do not try this if you have mouth
or throat sores or if you are troubled
by a lack of saliva or dry mouth).
these foods–toast and crackers,
yogurt, sherbet, pretzels,
angel food cake, oatmeal, chicken (skinned, baked or broiled),
soft/bland fruits and vegetables,
clear liquids and ice chips. Carbohydrates or bland foods
can sometimes help reduce
- Avoid fatty, greasy or
fried foods. Sweets such as candy, cookies,
some cakes, spicy or hot or strong-smelling foods can make
your stomach more upset.
warm, stuffy rooms with strong odors.
deeply and slowly when you feel nauseated.
liquids at least an hour before or after
mealtime, instead of with your meals.
Drink frequently and drink small amounts.
Try cool, clear, unsweetened
fruit juices, such as apple or grape juice or light-colored sodas
such as ginger ale
that have lost their fizz and do not have
- Eat foods at room temperature
or cooler if hot foods or smells
add to your nausea.
- You may want to avoid your
favorite foods when you are
nauseated, or they may not be your favorite foods for long.
- Rest after meals,
but do not lie flat. Sitting for an hour
after meals allows your stomach time to empty.
- Wear loose, comfortable
clothing. Tight clothing can make
you feel more full and restricted.
- Keep track of when your
nausea occurs and what causes
or aggravates it. Try to make changes in your diet or schedule to allow for
- Avoid eating
one to two hours before treatment, especially
if your nausea occurs
- Suck on mints or tart candies.
(Do not use tart
candies if you have mouth or throat sores.)
- Distract yourself by chatting
with friends or
family members, listening to music, reading or watching a movie or television
Why is my mouth sore,
and what can I do about it?
Mouth soreness can result from chemotherapy
treatment. Chemotherapy drugs act
upon rapidly producing cells in your body.
The drugs affect more than just the
cancer cells. Your skin, hair, nails,
lining of the stomach, mucous membranes
(tongue, throat and inside your mouth)
are often damaged by chemotherapy drugs.
This can cause hair loss (discussed
earlier), skin changes, nausea, soreness in your
mouth, and other problems.
should be reported promptly to your healthcare
team. There are medications that can help.
Good oral care is very important
during cancer treatment. Not treating
mouth soreness right away can interfere
with your ability to eat and can
lead to an infection in your mouth.
You should not dismiss this as a
minor problem if it bothers you at
Will the treatments do anything
to my teeth?
Some people do have problems with
their teeth and gums during and after
radiation and chemotherapy. It is a good
idea to check with your dentist before
starting treatment. He or she might have
some suggestions about how to prevent
dental problems that may be caused by
treatments for cancer. Your dentist also
may suggest that you have any teeth cleaning,
dental work or cavity-filling done before
PAIN (from Cancer or
Pain is a personal and individual
experience. It is not defined or felt in
the same way by any two people. Your previous
life experience with pain may influence how
you deal with any pain you experience throughout
the diagnosis and treatment of your breast
Should I be experiencing pain
from the cancer or treatment?
Not all patients have to deal with pain,
but more often than not, it is a problem
that many patients do not discuss with
their doctors. For this reason, sometimes
pain symptoms go untreated. Regardless
of the degree of pain you experience, you
have the right to be comfortable at all
times and to have help to reduce or eliminate
Your first experience with discomfort may
follow your breast biopsy. You may experience
pain and discomfort again following surgery.
Pain that goes unrelieved can interfere
with your activity level and your ability
to sleep. It can put you under undue stress,
contribute to fatigue, and delay healing.
Your doctor or healthcare provider should
work with you to obtain an acceptable comfort
How can I manage my pain?
First, you should not have to suffer
through your pain. Misunderstandings about
pain often cause people to not get enough
relief from their pain. You can take
an active role in managing your pain
in a number of ways:
- Tell your
doctor or nurse when you have pain.
Pain often occurs in cycles. The earlier
you report it and seek treatment, the earlier
the cycle can be broken.
- Describe your
pain in specific terms–such
as throbbing, stabbing, aching, burning,
cramping, pinching, squeezing, tingling or twitching.
This will help your doctor help you
get relief from the pain.
- Learn to rate
your pain on a scale of 0 to 10, with
0 = no pain and 10 = the worst pain
you could imagine. This helps your healthcare
provider or caregiver understand
your level of pain, to determine what may
help achieve relief and to track when relief
is achieved and maintained. Keeping a pain
diary may also be helpful. This could include
when pain occurs, what kind of pain, rating
of pain and possible activities or events
which may relate to the pain.
- Describe anything
that helps relieve your pain. This will
provide a better understanding of your
pain. In addition to pain medication,
individuals have found certain body positions,
ice or warm compresses, massage, meditation
and acupuncture have helped them
achieve pain relief. You might even try some relaxation
techniques. Tell your doctor or
nurse what works for you.
- Do not hesitate
to discuss your past experiences, fears
or concerns about pain relief with your
doctor or healthcare provider.
- If you
are taking pain medications, and you
have persistent pain, take your pain medication
on a regular schedule. Do not skip doses
of your pain medication. If you wait
to take pain medication until you feel
pain, it is harder to control.
- If you are
in pain, and your doctor has no further
suggestions, ask to see a pain specialist
or have your doctor consult with a pain
specialist on your behalf.
Neuropathy (Nerve Pain or Weakness)
What is peripheral neuropathy?
Sometimes anti-cancer drugs can cause problems
with your body’s nerves. An example
of a condition affecting the nervous system
is peripheral neuropathy. It is caused
by injury to peripheral nerves (those outside
of the brain and spinal cord). They are
found throughout the body, but peripheral
neuropathy is most often limited to peripheral
nerves in the fingers, hands, arms, toes,
feet and legs.
The symptoms of peripheral
neuropathy may include tingling, “pins
and needles,” cold,
prickling, and burning sensations to numbness
and an unpleasant feeling when touching
or being touched. Or, it may feel like
muscle cramps, heaviness or weakness,
and can affect muscle strength coordination.
causes peripheral neuropathy?
The most commonly used chemotherapy
drugs that cause peripheral neuropathy
are cisplatin, Taxol, vincristine and
vinblastine. Peripheral neuropathy can
be caused by several conditions in addition
to chemotherapy. If you have peripheral
neuropathy before you start chemotherapy,
it may begin sooner or be more severe
What can I do if
I have peripheral neuropathy?
First, be sure to tell your doctor
or nurse if you are having symptoms.
They can suggest management strategies
and give you advice about the condition.
Some other coping strategies include:
your fingers are numb, be careful
about grasping objects that are sharp,
hot, or otherwise dangerous.
- If your sense
of balance or muscle strength is affected,
avoid falls by moving carefully, using
handrails on stairs, and using bath mats
in the tub or shower. A cane can also
- Wear shoes with rubber
or non-skid soles.
- Ask your doctor for pain
medication, if necessary.
If you already have
symptoms of peripheral neuropathy due to another condition, be sure to tell
your doctor or nurse before you start chemotherapy.
Many of the symptoms of nerve
effects can be treated. Medications, physical
therapy, exercise, massage, and a proper
diet all can be helpful. See our Resources
at the end of this section for organizations
and web sites that have more information
and tips about dealing with nerve side effects
and peripheral neuropathy.
The peripheral nervous system can
repair itself, particularly if the cause
of damage is removed. Recovery may be slow,
but after you stop chemotherapy, your condition
should get better.
Material for this section
was gathered from Chemotherapy and You
from the National Cancer Institute (800.4.CANCER
or www.cancer.gov) and other publications.
American Cancer Society (ACS)
800.ACS.2345 or 866.228.4327 (TTY)
Provides information and services for all
forms of cancer, diagnosis, treatment and
many other topics. Programs include: Look
Good . . . Feel Better (wig and cosmetic
help) at local hospitals.
American Institute for Cancer Research (AICR)
202.328.7744 or 800.843.8114
Provides a wide range of free educational
publications about nutrition, including tips
about nutrition and cancer and offers many
American Society of Clinical Oncology
A resource for oncologists and patients living
with cancer. The People Living With Cancer
web site (www.plwc.org) has a section about
Buddy Kemp Caring House (Charlotte, NC)
Provides a home-like environment for emotional
support away from the hospital setting. All
services are free and available to anyone.
212.221.3300 or 800.813.HOPE (4673)
Provides free emotional support, information
and practical help. Staffed by trained oncology
social workers. Publishes “A Helping
Hand,” a free resource guide for people
with cancer. Has much information and advice
about coping with cancer and chemotherapy
Cornucopia House Cancer Support Center (Chapel
Offers education, companionship and support
to help people cope with cancer. Services
free to people with cancer, family and friends
at any stage of their treatment, or survivorship.
Often has nutrition and food classes.
Look Good . . . Feel Better
A free, national public service program to
help female cancer patients with appearance
and self-image during cancer treatment. Call
American Cancer Society at 800.ACS.2345 to
find nearest program in your area, or call
the hotline above for information and referrals.
Spanish speakers available.
Cancer Information Service
800.4.CANCER or 800.332.8615 (TTY)
One of the best resources available for cancer
patients, this government organization provides
the toll-free hotline above in English and
Spanish for any questions about any type
of cancer. Offers much information and advice
about cancer treatments and side effects.
National Comprehensive Cancer Network
215.728.4788 or 888.909.6226
Publishes the following breast cancer treatment
guidelines with the American Cancer Society: “Cancer
Pain,” “Cancer-Related Fatigue,” “Fever
and Neutropenia” and “Nausea
The Neuropathy Association
A public nonprofit organization established
by people with neuropathy, their families
and friends to provide support and education.
Free registration required on the web site
to access information and support resources.
North Carolina Cancer Pain Initiative (Raleigh,
Clearinghouse for information about pain.
Organization tries to link patients and providers
with information about pain management. Call
to order free brochure, “Managing Pain
When You Have Cancer.”
Office of Dietary Supplements
at the National Institutes of Health
Has the latest scientific information about
supplements. Can search the web site for
The Wellness Community
202.659.9709 or toll free 888.793.WELL
Nonprofit organization provides online support
groups and education about cancer. Offers
the educational kit, “Frankly Speaking
About Cancer Treatment: Take Control of Side
Effects with Medicine, Mind and Body” (2002).
Books and More
Cancer Society’s Healthy Eating
Cookbook (2003). Includes hundreds of recipes,
healthy eating tips, cooking ideas, and healthy
food substitutions. Call 800.ACS.2345 or
Have to Hurt: How to Conquer the Pain Caused
by Cancer and Cancer Treatment, by Pamela
J. Haylock and Carol P. Curtiss (1997).
Explains cancer pain and how to manage
it, including medical options and alternative
Recovery Eating Plan: The Right Foods to
Help Fuel Your Recovery, by Daniel
W. Nixon, MD (1996). Useful guide for what
to eat after a cancer diagnosis, with a three-month
eating plan and recipes.
Survival Cookbook, by Donna L. Weihofen,
RD, MS, with Christina Marino, MD, MPH (2002).
Recipes and recommendations to help people
during and after cancer treatment, including
advice on overcoming specific problems such
as nausea and appetite loss.
Pain Control: Powerful Methods to Overcome
Cancer Pain, by the American
Cancer Society (2001). Comprehensive resource
on pain, treatment options and other issues.
Call 800.ACS.2345 or see www.cancer.org.
the Side Effects of Chemotherapy and Radiation
Therapy, by Marylin J. Dodd, RN, PhD, FAAN
(2001). Easy-to-read book describes possible
side effects and symptoms of chemotherapy
and radiation therapy, and offers suggestions
for managing each side effect.
Eat If You Have Cancer: A Guide to Adding
Nutritional Therapy to Your Treatment Plan, by Maureen Keane, MS, and Daniella
Chace, MS (1996). Explains how nutrition
affects physical function and gives suggestions
for nutritional supplements, food preparation,
and managing side effects of cancer treatment.
of Cancer Pain
A network of state-based Pain Initiative
organizations to remove barriers to pain
relief. Provides resources and guidance
and much more.
American Pain Foundation
An online resource for people with pain,
their families, friends, caregivers and the
general public. This site is devoted to patient
information and advocacy, and provides many
links to additional resources.
Cancer-Fatigue Discussion List
This public online support group provides
information and community to its members.
Cancer-Pain Discussion List
This public online support group provides
information and community to its members.
CancerSymptoms.org from the
Oncology Nursing Society
Devoted to the management of fatigue, eating
problems, pain, depression, peripheral neuropathy
and other side effects. Also in Spanish.
Use the “Fast Food Quest,” to
get the nutritional, fat and calorie content
of fast food chains.
The International Center for the Control
of Pain in Children and Adults
Has much information about pain of all kinds,
assessment, treatment and more. Includes
a section on home care and hospice, and a
Bill of Rights for Cancer Patients.
Coping with Cancer Pages
This site includes information about nutrition,
side effects, sexuality, and other topics
relating to cancer.
Pain-Caregivers Discussion List
A public online support group for caregivers
of patients suffering from cancer pain.
Recipes for Breast Cancer Survivors and
Contains many recipes, healthy and otherwise,
from those with breast cancer or whose lives
have been affected by breast cancer.