Managing Treatment Side Effects

Palliative care for managing side effects

To help reduce the severity and duration of most side effects and improve your overall quality of life, you may want to request palliative care.

Because palliative care has been used by hospice programs for decades, many people confuse palliative care with “end-of-life” care. However, palliative care (also called “supportive care” or “symptom management”) is about improving the quality of life of people with long-term illnesses. As scientific evidence is starting to emerge that shows palliative care may actually help patients live longer, many people are becoming aware of its benefits in improving their quality of life during and after cancer treatment.

Common side effects of chemotherapy, targeted therapy, and radiation therapy

Common chemotherapy side effects include:

• Nausea and vomiting
• Diarrhea
• Constipation
• Tiredness
• Pain
• Loss of appetite
• Hair loss
• Skin and nail changes
• Numbness and tingling
• Swelling

Targeted therapies are designed to be more precise and cause fewer and less severe side effects than chemotherapy and radiation treatments. Depending on the specific drug, side effects may include:

• Nausea and vomiting
• Diarrhea
• Constipation
• Swelling of hands and feet
• Rash and other skin changes
• Vision problems

Common radiation side effects include:

• Nausea and vomiting
• Diarrhea
• Tiredness
• Hair loss
• Skin changes

Nausea and vomiting

Nausea (feeling like you are going to throw up) or vomiting (actually throwing up) are typically less severe on days when you do not have treatment. However, regularly taking a prescribed anti-nausea medicine can help reduce symptoms.

Other ways to reduce symptoms:

• Avoid specific types of trigger foods (greasy, salty, sweet, spicy) that make you feel sick.
• If the smells of meals sicken you, try having cold meals, which naturally have fewer aromas.
• Make sure you are eating enough by having smaller meals throughout the day.
• On days when you have treatment, wait at least an hour before eating or drinking.

Diarrhea

Frequent bowel movements that are loose, soft, or watery can be very disruptive to quality of life and can also cause dehydration. For most people it is important to rehydrate the body by drinking 8 to 12 cups of liquid each day to replenish fluids.

There are also several steps you can take to reduce symptoms of diarrhea:

• Talk to your doctor to find out the safest medicines for you to take.
• Consider your diet. Some foods can promote diarrhea, while others (such as bananas, rice, applesauce, and dry toast) can help to reduce symptoms.
• Try eating five or six smaller meals throughout the day instead of three big meals.

Constipation

Infrequent bowel movements that are painful or difficult to pass can increase the risk of hemorrhoids and other problems if they are not managed properly. It is important to talk to your doctor about constipation symptoms, particularly if you have not had a bowel movement in 2 or more days.

There are several steps you can take to reduce constipation:

• Try to be more active. Lying down or sitting for too long can increase symptoms of constipation.
• Make sure you are drinking enough. Eight cups of fluid daily is enough for most people. In addition to water, also consider having prune juice or other fruit and vegetable juices.
• Eat more high-fiber foods such as whole-grain bread, nuts, fruits, and vegetables.
• If lifestyle changes are not helping, talk to your doctor about medications that can improve the regularity of your bowel movements.

Tiredness

Lung cancer medications, sleeplessness, depression, and pain can make you feel weak and tired. To combat this, you should plan to get plenty of rest, prioritize important tasks, and ask others to help you.

There are ways to get some of your energy back: 

• Make sure that you are eating and drinking enough. When your energy is high, consider cooking and freezing foods for those low-energy days.
• Be as active as you can. Though it seems counterintuitive, light exercises such as yoga, stretching, and walking can give you an energy boost.
• Try taking short naps to rejuvenate yourself during the day.
• A relaxing bedtime routine may help you get the 8 hours of sleep you need. Consider taking a bath, listening to music, or reading a book to help you unwind before bed.

Pain

If you find that you are in pain, please do not just tolerate it. Talk to your doctor about medicines that can be used to treat the pain. By reducing your pain, you will feel stronger and healthier.

There are ways to help your doctor help you:

• Keep a journal that tracks your pain. Include time, activity, severity, and description of pain.
• Work with your doctor to adjust medications and fine-tune dosages to reduce pain.
• You may begin to feel pain again if your body gets used to the medicine. Talk to your doctor about changing the medicine or increasing the dosage.
• Provide your doctor with an updated list of medications (including dosages and timings) at each visit.
• Consider other methods for reducing pain, such as acupuncture and massage. Talk to your doctor about these and other ideas.
• If addiction to pain medication is a concern, please talk to your doctor. Typically, when these medicines are taken correctly, addiction is not a problem. 

Loss of appetite

It is common for lung cancer survivors to not feel like eating or to feel that food tastes different than it did before. However, it is important to eat well in order to stay strong and energized.

Here are a few tips to help you eat adequately:

• Distract yourself. Eat with family or friends or watch television while you eat.
• Choose foods that are high in calories or protein, such as milkshakes or chicken, to keep you nourished.
• Get moving. Being more active can help increase your appetite.
• If the food tastes metallic, try eating with plastic forks and spoons.
• Even if you don’t feel like it, try to eat a bite or two at mealtimes.

Hair loss

During lung cancer treatment, sometimes the cells in the body that make hair are damaged. This can cause the hair to fall out. If your hair does fall out, be sure to protect your scalp by applying sunscreen or wearing a hat or scarf when you are outdoors. The good news is that this side effect is usually temporary and the hair typically begins to grow back a few months after the treatment is over.

If you are concerned about hair loss, there are a few options for you to consider:

• Treat your hair as gently as possible. Try using a mild shampoo and drying off with a soft towel.
• Consider getting a short haircut.
• If you opt to shave your head, be sure to use an electric shaver so you don’t cut your scalp.
• If you choose to get a wig, go shopping while you still have hair so you can match the wig to your current hair color.

Skin and nail changes

The good news is that most skin and nail changes go away once treatment is over. Nevertheless, the changes in skin and nails during treatment can be embarrassing and uncomfortable.

Here are a few suggestions for reducing those unwanted side effects in skin and nails:

• Be careful what you put on your skin. Use mild soaps and avoid products containing alcohol or perfume.
• Protect your skin from the sun. Wear protective clothing or use sunblock and lip balm. Avoid tanning beds.
• Be gentle with your skin. Shave less often. Try dusting cornstarch on skin folds, such as those under your arms, behind your knees, or under your breasts.
• Take shorter showers using warm, not hot, water. Pat yourself dry; do not rub.
• Keep nails clean and short.
• Use gloves when gardening, washing dishes, or cleaning the house.
• Talk to your doctor or nurse about specific products to help with skin and nail changes.

Numbness/tingling

Some types of chemotherapy can cause nerve problems, including tingling, numbness, and burning sensations. Often, these feelings begin in the hands or feet. Some simple lifestyle adjustments can help reduce the risk of falling or hurting yourself.

• To minimize the chance of falls, move rugs out of your way and put bathmats in the shower. Install railings, wear sturdy shoes, and use a cane.
• Be extra cautious in the kitchen and shower. Regularly use hot pads to protect yourself when cooking. Before getting into a bath or shower, ask someone to confirm that the water is not too hot.
• Protect your hands and feet. Wear shoes inside and outside your home. Check your feet and hands for cuts every day.
• Ask for help. Buttoning clothes, opening jars, and using pens can become difficult and frustrating. So, plan to slow down and give yourself more time to get things done.

Swelling

Swelling in the body can be caused by chemotherapy, hormone changes, or even dietary changes. But taking some small steps can help prevent swelling.

• Be comfortable. Wear loose clothing, and make sure your shoes are not too tight. Whenever possible, sit with your feet propped up. Avoid walking or standing for long periods of time.
• Avoid salt. Check food labels and avoid eating foods that are high in sodium, such as ham, bacon, chips, and canned soup. Do not add extra salt or soy sauce to your food.
• Ask your doctor if special socks that reduce swelling in legs and feet could be helpful.

Vision problems

These problems usually happen within 2 weeks of starting crizotinib (Xalkori). Tell your doctor right away if you have any change in vision, such as:

• Flashes of light
• Blurred vision
• Light hurting your eyes
• New or increased floaters