Chemotherapy: Side Effects of Chemotherapy and How to Manage them
Trying out Hats to Wear after Chemotherapy
Feeling Tired and Exhausted due to Chemotherapy?
If you are undergoing chemotherapy and looking for ways to minimize your problems, you have come to the right place.
This article discusses the major side effects of chemotherapy and ways to manage them.
Fatigue Related to Chemotherapy
The effect of chemotherapy is different for different people. Some people feel tired, worn out and exhausted following chemotherapy while for some, it is not that difficult. Fatigue may be a side effect of some drugs, anaemia, breathing difficulty, anxiety and depression or due to lack of adequate sleep or all these factors together can also result in extreme fatigue.
- You may need help with your daily chores, or with looking after children if you feel exhausted.
- Activities should be planned by giving adequate rest periods in between.
- Some studies have shown that doing any kind of activities or exercises help in reducing fatigue than in taking complete bed rest. Activities like yoga, guided imagery, prayers etc. may help in reducing stress and fatigue.
- Having good food, enough to drink and adequate sleep and rest will also help in reducing fatigue.
Fatigue Is a Common Side Effect of Chemotherapy
- If you feel stressed out, during chemotherapy, try to relax by concentrating on your breaths.
- Try and breathe slowly and deeply.
- Keeping one hand on the abdomen will help you to concentrate on your breathing.
- You can also listen to light and pleasant music.
- Talk to someone else with whom you can confide your feelings. It can be a family member, a doctor, a nurse or another patient receiving chemotherapy.
Anxiety and Depression as Side Effect of Chemotherapy
At some point of treatment, you may feel sad, depressed, lonely, frustrated or angry. It is natural to have these feelings when one undergoes treatment for cancer. It is the stress of the disease and its treatment that brings in all these feelings. Some people get anxious with the development of side effects that chemotherapy is not working or some feel that if there are no side effects the chemotherapy is not working. Both are not correct. Side effects are not a measure of the effect of treatment. You have to take conscious effort to cheer up your mind and reassure your mind that these difficulties are temporary and you will soon overcome them. Practice letting go of negative feelings. Side effects of chemotherapy and depressive features should not prevent you from continuing with the treatment.
It is the reduction in number of red blood cells in the body. Red blood cells carry oxygen to the various tissues in our body. When there is less number of red blood cells, you may feel fatigued, dizzy or weak and tired. It can also lead to the over working of the heart thereby causing fast and pounding heart beats. Anaemia can be caused by some of the chemotherapeutic drugs because of their effects on the red blood cell producing bone marrows.
If you are anaemic, try to get plenty of rest and limit your activities. Try to take a high calorie, high protein and iron rich diet. Calorie will help to maintain your weight whereas protein will help in the repair of tissues. You may feel giddy if you stand up fast from a sitting position when you are anaemic. Likewise, if you try to stand up suddenly from a lying down position, you may feel the same. Change your positions slowly and step by step. For example if you want to stand up from a lying down position, first sit up for some time dangling your legs and slowly stand up with support if needed.
Use plastic instead of metal to regain appetite
- Eat small frequent portions of good food. Protein food will help in repairing the damage caused to the normal cells of the body by chemotherapeutic drugs and high calorie food will help in providing energy and reducing fatigue.
- Make a plan or schedule to eat. You need to eat forcefully when it is time even though you are not hungry.
- Milk shakes, soups and fruit juices will help in giving enough nutrients and in replacing the fluid if you have fluid loss through vomiting
- Increasing the activity like taking a walk just before the meals will improve the appetite.Take care not to drink too much of liquids just before the meals which may spoil the appetite.
- Using plastic spoons and forks while eating will help in reducing the metallic taste in the mouth. Avoid cooking in metallic utensils. Instead try cooking in glass pans.
- Try new food items and recipes for a change
- Your doctor may advice a high protein drink to compensate for the low intake.
- Avoid smoking and alcohol
Changes in Appetite Secondary to Chemotherapy
One of the major challenges faced by patients receiving chemotherapy is appetite changes. They may be fully aware of the importance of good nutrition to minimise the side effects, but may not like to put anything into their mouth because of the changes in appetite. Many patients complain of an overpowering metallic taste in the mouth. The familiar food items will taste differently to them.
It may be because of nausea, vomiting, sores in the mouth or because of the drugs that cause change in taste. It can also be a result of anxiety and depression
Chemotherapy targets the rapidly multiplying cancer cells. But they also target the rapidly multiplying normal cells; one of them being the bone marrow. Bone marrow produces the blood cells in the body and chemotherapy can lower the number of blood cells being produced by affecting the bone marrow’s ability to produce them. When it lowers the number of platelets, bleeding can occur. There can be bruises on your body, or bleeding from nose or into the mouth.
Constipation is a common side effect faced by patients receiving chemotherapy. It can be due to intake of food which is low in fibre, not drinking enough fluids, the effect of chemotherapeutic drugs or pain medications and inactivity of the person. The stools become hard and dry and difficult to pass and you may feel bloated or may have nausea.
Drink lot of fluids. People who live in the tropics should drink two and a half to three litres of fluids per day. Drinking warm fluids like tea or coffee in the morning is helpful to some.
Increase your activity. Moderate activities like walking or doing yoga will help in increasing the intestinal motility and help in constipation.
High fibre diet also helps in relieving constipation. Examples of high fibre food items include vegetables, fresh and dried fruits, nuts, legumes, beans and peas etc. When you take high fibre diet, drink enough water along with it.
If all these measures fail, you may need a stool softener or laxative prescribed by the doctor.
- Use soft toothbrush for brushing the teeth
- Avoid blowing nose; if needed, gently blow the nose
- If you want to shave, use electrical shaver instead of a razor. Some people experiencing hair fall related to chemotherapy prefer to shave their head. In that case it is better to go for electrical shaver to minimise cuts and bruises.
- Use scissors and knives carefully. If you cannot avoid getting into the kitchen, use padded gloves to protect your hands from cuts, bruises and scalds.
- Wear covered shoes all the time to avoid pricks and cuts on your foot.
- Avoid using tooth picks, tight clothing, enemas, suppositories, tampons or rectal thermometers.
- Straining at stools may initiate rectal bleeding if you have low platelet counts. Lot of fluids, high fibre diet and a stool softener will help in reducing constipation.
Contrary to constipation, diarrhoea is caused by an increase in the bowel movement which may be due to the effect of chemotherapeutic drugs, the effect of drugs to treat constipation, or may be due to some infections.
Take small frequent meals instead of three large meals.
Drink lot of water and include other fluids in your diet
Diarrhoea may cause loss in electrolytes like sodium and potassium from the body. Tender coconut water is very rich in these electrolytes. Other food items include bananas, oranges, lemon etc.
Soft and bland diet will aid absorption and minimise gastric irritation. Milk and milk products, spicy food and food rich in oil content may increase the bowel irritation and add to diarrhoea.
If there is lot of fluid loss due to diarrhoea you may require intravenous fluid and electrolyte supplementation.
Any medicine for diarrhoea should be taken in consultation with the treating doctor.
Hair loss (Alopecia)
Hair loss is caused by the action of drugs on the hair follicles. It often starts two to three weeks after chemotherapy begins. At this time, it is best to use a soft or satin cloth over the pillow cover as it becomes easy to clean. Satin also reduces friction and you feel more comfortable. Don’t get depressed by your looks in the mirror because you are going to get back your hair again.
Some people anticipate hair loss and prefer to shave their head. In that case use electrical shaver to avoid cuts and bruises. Using a scarf when you go out will protect you from cold and dust. You can use a scarf to cover your ears and head even when you are sleeping. Hair may grow back two to three months after chemotherapy is over. When the hair grows back treat it gently as the texture may be different from the previous texture. Use a wide combed tooth brush to comb your hair and a mild shampoo to clean it. Avoid blow drying your hair and procedures like straightening or curling the hair.
Chemotherapy Being Administered
Some of the chemotherapeutic drugs can cause a decrease in the number of white blood cells. White blood cells are essential part of our immune system and a reduction in the number of these cells will make the body prone to infection. Redness, rashes, fever and chills, headache, cough, painful urination or blood tinged urine are some of the signs of infection.
If you suspect any signs of infection inform your nurse and doctor immediately
Neutrophil count is checked regularly after the chemotherapeutic treatment and if the count is low, sometimes it is treated with medicine to raise the count.
You have to take special precautions to avoid getting infection. Of these the most important one is hand washing. Our hands harbour a lot of microorganisms and they may cause various diseases especially when your immunity is low. So you have to wash hands after using toilet, before and after cooking and eating, after blowing nose, cough and sneeze or touch any common items. Use hand sanitizer when you do not have accessibility to soap and water. You should avoid going near people with infection and overcrowding. Take good care of your body by cleaning your mouth often and keeping the skin clean. If you eat raw vegetables and fruits, soak them for some time and wash them thoroughly before eating. Fish, poultry and other meat should be thoroughly cooked.
Ulcers and pain in the mouth
Some types of chemotherapeutic drugs harm the rapidly multiplying normal cells of the body while they target the rapidly multiplying cancer cells. This can cause damage to the mucosal layer inside the mouth and other internal gastrointestinal organs. Your saliva may become very sticky and the amount of watery saliva will be very little. As a result, it may become difficult for you to clean your mouth and may lead to some infections. You may experience a change in taste and smell and increased sensitivity to hot and cold food items and even pain while taking food.
It is important to keep your mouth healthy before the chemotherapy starts. Your treating doctor may refer you to a dentist to assess the condition of your mouth and teeth before chemotherapy. While receiving chemotherapy, check your mouth every day for redness, spots or any other signs of inflammation. Try to keep your mouth moist by sucking on to ice chips or sugar free gums and candies. Some may like to chew on plain ice chips and ice chips with milk alternately.
Clean your mouth, teeth and gums after every meal and in the morning and at bedtime. Your doctor or nurse may ask you to rinse your mouth with a solution of 1/4 teaspoon baking soda and 1/8 teaspoon salt in 1 cup of warm water. Rinse your mouth with plain water after this. Use soft tooth brush to avoid bleeding from the gums. It is better to take soft diets which are easy to swallow till your mouth is healed. Avoid spicy foods, food and drinks that have lot of sugar and alcohol.
Nausea and Vomiting
Most of the chemotherapeutic drugs induce vomiting. On a routine basis, medicines are administered to patients before starting chemotherapy. Different types of drugs may be tried to arrest nausea and vomiting. Taking bland and dry food items may help in preventing nausea. Eat small frequent foods. You may feel less nauseated if you delay the food intake for at least one hour after treatment. The intensity of nausea and vomiting comes down as the treatment progress.
Cancer Treatment: Chemotherapy
Changes in the nervous system
Chemotherapy can cause tingling and numbness of hands and feet and burning sensation. Be careful while handling knives and scissors. Use thick padded gloves in the kitchen. You may feel week, tired and clumsy while walking. Make sure you don’t trip over anything and have a support to walk like holding on to the walls, staircase railings etc.
There is no harm in having sex during the therapy. But some patients do not feel like having sex or their sexual drive may be reduced. It could be due to the hormonal changes or dryness of vagina in women or impotence in males. Desire for having sex may improve once the therapy is over. Extreme anxiety and depression affect the sexual life in both men and women. Practice relaxation techniques to reduce stress and tension and plan activities to have closeness with the partner. For men it is very important that your partner do not get pregnant as some of the chemotherapeutic drugs can cause defects in the sperm and cause birth defects. For women if you have not achieved menopause it is important to avoid pregnancy as there can be defects to the foetus because of these drugs. Use a condom while having sex as the drugs can be excreted through secretions of the vagina and semen.
Skin and nail changes
Chemotherapy can cause dryness of the skin and brittleness of the nail. Your skin and the veins under the skin may look darker. You may get excessively tanned on exposure to sunlight. You need to take special care of your skin while receiving chemotherapy. Some chemotherapeutic drugs can cause skin in the area where you had radiation therapy to turn red. There can be skin reactions as a result of allergy to the drugs. If you have any of these problems, avoid excessively wetting your skin. Take quick showers and pat dry your skin. Use mild soap and shampoo. Put on a moisturising skin cream while your skin is still wet. Avoid scratching the skin. Avoid direct sunlight and use sunscreen lotion when you go out. The sun’s rays are strongest from 10 a.m. to 4 p.m.
Problems with urination
Some patients may get urinary problems such as burning micturition, urgency and increased frequency of urination, a change in the colour and smell of urine. Some of these problems may go away when you complete chemotherapy. Men in late adulthood can have prostatic enlargement and an obstruction to free flow of urine. There is a tendency to ask for catheterisation of the bladder when they get urgency of urination. But it is important to minimise introducing tubes into the body as it may cause infections secondary to low immunity during chemotherapy. Drinking plenty of water will help in flushing the drugs out of the bladder and kidneys.
Some chemotherapeutic drugs can cause fluid retention in the body. Your face, hands and feet or stomach may look swollen and puffy. Fluid may get collected around your lungs and heart and you may feel shortness of breath or get cough. If you have signs of fluid retention, the intake of fluid should be restricted. Avoid table salt and salty food as it may add to fluid retention.
Other side effects of chemotherapy
Chemotherapy can also cause problems with eyes like blurred vision and watery eyes, problems with memory and emotional changes. If you notice these changes, please let your treating doctor know about it.
The side effects which are described above are in general. You may not get all the side effects if you are undergoing chemotherapy. The side effects develop depending on the drugs used, your general health status and the stage of your disease. Most of these side effects go away when you stop chemotherapy. Eating good food, getting plenty of rest, having enough exercise and using some of the relaxation techniques will help you come out of it successfully. Please consult your doctor before taking vitamin supplements as some of these vitamins may interfere with the action of the drugs.