The National Cancer Institute has created an excellent resource guide called Chemotherapy and You. It is written for people who are receiving chemotherapy for cancer. Your family, friends, and others close to you may also want to read this book.
This book is a guide you can refer to throughout your chemotherapy treatment. It includes facts about chemotherapy and its side effects and also highlights ways you can care for yourself before, during, and after treatment.
Why Side Effects Occur
The Treatment Cycle
Risks and Complications
Neulasta® and Neupogen®
Why Infection Is a Concern During Chemo
Aranesp® and Procrit®
Nausea and Vomiting
Difficulty Swallowing (Dysphagia)
Appetite and Weight Loss
Nerve and Muscle Effects (Neuropathy)
Managing Your Emotional Side Effects
Taking Care of Yourself
Massage Therapy and Bodywork
Benefits of Walking
Relaxation and Medication—A Winning Combination
Deep Breathing: In with the Good Air
Using Your Imagination to Feel Better
Short-term side effects occur because many chemotherapy drugs act on normal cells as well as cancer cells. Fast-growing cells are the most affected. This includes cells that make up hair, skin, the digestive tract and blood. Chemotherapy can also affect certain other cells, such as those in the nervous system and organs (such as heart, kidneys, liver and lungs). They may also impact a woman’s fertility. Some chemotherapy drugs may have long-term effects. For example, another cancer could occur at a later time as a result of taking chemotherapy. If you have any questions regarding this matter, please ask your doctor or nurse.
Chemotherapy is given in cycles. First, you have a treatment. Then time is set aside for the body to build healthy cells before the next treatment. During this resting time, the body goes through different phases as it mends. One phase is the “nadir period.” During the nadir period, certain blood cells decrease in number. Your doctor or nurse will help you learn what to expect during this phase of your cycle.
There are some risks with chemotherapy. The benefits usually outweigh the risks. The following are possible long-term side effects of chemotherapy:
- Organ damage (such as to the heart, kidneys, liver or lungs)
- Lasting nerve damage
- Another cancer, which may occur at a later time
- Blood Counts
White blood cells (WBCs) are cells of the immune system that protect the body from foreign invaders, such as bacteria and viruses. Without enough WBCs, the body cannot fight infection and disease.
These medications are given to protect patients from chemotherapy-related infections.
Chemotherapy reduces the number of white blood cells (infection fighters) and neutrophils (immature white blood cells) produced in bone marrow. When Neulasta or Neupogen is given, it signals the bone marrow to produce more neutrophils.
A blood test called a “CBC” (complete blood count) will be done routinely to monitor the white blood cells (WBC) and number of neutrophils. These injections are given at least 24 hours after completion of a chemotherapy cycle.
Neulasta is a one-time injection given after each cycle that provides 14 days of coverage. Neupogen can be given daily for up to 14 days, depending on the type of chemotherapy.
The most common side effect experienced by patients is bone pain. Tylenol® or Ibuprofen® works well at controlling pain. If you have other pain medications (for example, Vicodin®), these are also acceptable to use. Also try comfort measures (such as a heating pad, hot bath, shower or relaxation techniques) for discomfort.
Chemotherapy helps fight cancer, but one of the side effects can be infection. Infection occursbecause anticancer drugs can also affect normal cells, including cells that produce WBCs. If neutrophils (WBCs) decrease in your body, you are at an increased risk for developing an infection.
Signs and Symptoms of Infection
- Temp of 100.5° F or greater
- Chills and shaking
- Sore throat or cough
- Stiff neck/headache
Ways to Prevent Infection
- Wash hands frequently
- Do not tear your cuticles
- Don’t change kitty-litter boxes
- Use an electric shaver instead of a razor, to prevent cuts to your skin.
- Avoid people who have illnesses you can catch (such as the flu, chicken pox or a cold)
and children who have been recently vaccinated with a live virus (for example, chicken pox or FluMist® vaccine)
Hemoglobin is a protein in red blood cells that contains iron and carries oxygen throughout the body. If the Hgb count is too low, a person may be anemic and may feel tired and fatigued.
Hematocrit is the percentage of red blood cells in the blood stream. When the Hct is too low, a person is anemic.
Signs and Symptoms of Anemia:
- Feeling weak or tired
- Loss of energy (mental or physical)
- Shortness of breath
- Back and leg pain
- Feeling your heart pounding with mild exercise (such as walking up stairs)
Patients who are on chemotherapy can develop what is called “chemotherapy-induced anemia.” When a person is anemic, he or she feels weak and tired and has a loss of energy, both mentally and physically.
Aranesp or Procrit is given to help stimulate bone marrow, which increases the production of red blood cells. With more red blood cells in the body, oxygen levels are increased in the tissues. That, in turn, provides you with more energy.
A blood test called a “CBC” (complete blood count) will be done routinely to monitor the hemoglobin (Hgb) and hematocrit (Hct). Aranesp and Procrit are injections started when Hgb or Hct is lower than normal.
Platelets help to make your blood clot so that you stop bleeding when you cut yourself, etc. Sometimes the platelet count becomes too low. If your platelet count is too low, you should:
- Protect yourself from injury
- Use an electric shaver instead of a razor
- Apply pressure to cuts and ice to bruises
- Avoid alcohol
- Do not take aspirin or medications that contain aspirin unless authorized by your physician
Call your doctor immediately if any of the following develop:
- Bruising or small red dots under the skin
- Black, tarry stools
- Bleeding gums or nose bleeds
- Blood in the urine or stool
- Any bleeding that cannot be controlled in a reasonable amount of time
- Headache with a rapid onset and sharp, pinpoint area of pain
Cancer treatments may cause nausea and/or vomiting. Today, our options for preventing or controlling this side effect have greatly improved. New medications are available that work on the part of the brain that controls nausea and vomiting.
These medications are usually very effective. If you have had chemotherapy, be sure to take your nausea medications as instructed by your chemotherapy nurse.
Call your doctor if you:
- Have taken your nausea medication and still have nausea and/or vomiting
- Have vomited three or more times
- Have no appetite or are unable to eat or drink in a 24-hour period
Some people experience nausea following chemotherapy and some do not. The good thing to know is that there are many medications called “antiemetics” which help to control nausea. If one doesn’t work for you, or has unpleasant side effects, let your doctor or nurse know so he or she can give you a different one to try.
Also, some people may find that they have to take the antimetic as often as they can or even before they feel nauseated to best control nausea.
Follow these tips to help you eat enough if you experience this side effect:
- Try eating bland, soft foods. Avoid spicy, greasy or very sweet foods.
- Avoid foods with strong odors or smelling foods while they cook. Cold foods generally
have fewer odors to them.
- Eat foods slowly and in small amounts at a time.
- Try not to eat a “favorite food” when you are feeling nauseated, since this may cause
you to permanently dislike this food.
- Wear loose-fitting clothes.
- If you find nausea always occurs after radiation or chemotherapy treatments, avoid eating one to two hours before.
- Rest after meals to allow time for digestion. While doing so, avoid laying down, especially flat on your back, after a meal or snack.
- Avoid drinking large amounts with meals, since this can make you feel full or bloated. Instead, try sipping liquids between meals throughout the day.
- Using ginger is helpful for some people who are experiencing nausea. Use the following
guidelines for dosages and administration. Note: ginger should be used with caution in people taking drugs that affect blood clotting, medications used to treat high blood pressure and diabetic medications. Consult your physician and/or pharmacist if you are uncertain whether this applies to you.
- 250 mg. dried ginger – four times a day or 1 tsp. fresh ginger root boiled in 1-2 cups water and taken as tea four times a day or 1.5-3 ml. ginger tincture taken up to four times a day
The best way to prevent vomiting is to control nausea (see above suggestions). Even though you may not be able to eat normally if you are sick to your stomach, it is very important to know how to keep your body from becoming dehydrated. Also, inform your physician and/or nurse if vomiting becomes severe or lasts for more than a day or two.
Do not eat or drink anything until you have the vomiting under control. Once the vomiting is under control, try taking clear liquids (anything that is, you can see through, such as water or broth).
Begin with 1 teaspoon every 10 minutes, increase the amount to 1 tablespoon every 20 minutes and finally, try 2 tablespoons every 30 minutes.
If you then feel you are ready to try more substantial foods, begin with bland, low-fat foods, such as plain pasta, crackers or toast. Continue to eat these foods in small amounts at a time, but consume them as frequently as possible.
When you vomit, you lose electrolytes, such as potassium and sodium. If you continue to vomit and do not replace these lost electrolytes, it becomes difficult for your body to function properly.
Here are some suggestions of foods and drinks that are rich in electrolytes:
- Gatorade or other sports drinks
- Boiled or mashed potatoes
- Peaches or peach nectar
- Fat-free broth or bouillon
- Pedialyte® juice or popsicles
Chemotherapy drugs destroy the normal cells of your body, especially those normal cells that are produced at a rapid rate. For example, the cells lining your mouth and throat can be affected. Because of this, some anticancer drugs can cause sores in the mouth and throat, a condition called “stomatitis.”
Treatment can also affect your gums and cause mouth tissues to become dry and irritated, which is temporary. Ask your doctor, nurse or dietitian if there are medications or supplements you can take to help manage the pain and speed up the healing process.
Stomatitis can often be prevented or lessened by using the following:
- Mix 1/2 teaspoon salt plus 1/2 teaspoon baking soda in 16 oz. of warm water; use a mouthful of this rinse three to five times per day.
- Swish, pouch, gargle and spit.
- You may rinse with fresh water afterwards.
Other helpful advice:
- Try room-temperature or cold foods and beverages and avoid hot foods and drinks.
- Drink water or nonacidic juices (for example, apple or grape juice). Eating artificially sweetened candy or gum, and using artificial saliva sprays for dry mouth can also help.
- Avoid spicy, acidic, salty, crunchy, crusty or chewy foods.
- Try drinking through a straw.
- Avoid alcohol.
- Keep your mouth clean.
- Eat soft or liquid foods.
Ask your doctor to watch for signs and symptoms of possible mouth sores or signs of infection in the mouth. Mouth sores may include:
- A burning feeling in the mouth
- A red, irritated oral lining
- A swollen, inflamed tongue
- Sores in mouth
- Treatment is based on the extent of the mouth sores.
Call your doctor if:
- Rinsing with the above solution does not start to heal the sores
- Mouth sores are painful
- You experience any of the following, which could indicate an infection:
- Soft, white patches
- Dry, brownish-yellow areas
- Moist, creamy white areas
- Painless, dry, yellow ulcers
- Open areas on the lips or mouth
Some types of cancer or treatment for cancer can cause swallowing problems. If you have already been having difficulty swallowing, treatment can sometimes make this better or worse.
When people have trouble drinking or eating, they might avoid doing so. This can lead to weight loss and even dehydration. You may find it helpful to try the foods listed above, but do inform your physician, nurse or dietitian if difficulty swallowing is preventing you from eating or drinking enough.
Ask your doctor for medication if you have pain swallowing. If you experience coughing, gagging or choking when eating or drinking, always inform your physician, nurse or dietitian. When food goes down the “wind pipe” instead of the “food pipe,” this is very serious since it can lead to pneumonia. If this occurs, you may even be referred to a speech or swallowing specialist, who will determine the best way for you to get nutrition safely.
You may find it difficult to eat during treatment for a number of reasons. The side effects of treatment, fatigue or depression can cause a loss of appetite. Although your appetite may not be normal, it is important to eat enough calories and protein to prevent weight loss during treatment—even if you have been told in the past to lose weight.
Weight loss during cancer treatment can affect your body’s ability to tolerate the treatments, decrease your energy level and strength (often due to loss in muscle mass) and weaken your body’s immune system. In some cases, you may even find it necessary to think of adequate nutrition as one component of your treatment rather than simply eating for pleasure.
Tips for eating with a poor appetite:
- Eat more on days when you feel well.
- Choose your favorite foods that are easy to prepare and serve.
- Eat five to six meals a day.
- Eat when you are relaxed and in a pleasant environment.
- Ask your physician, nurse or dietitian if nutritional supplements would be helpful to you.
- Try mild to moderate exercise, as it can stimulate the appetite.
- Increase your calories and protein (see specific suggestions at the end of this section).
Different types of cancer treatments can affect the way foods taste and/or smell to you.
Fortunately, these changes usually go away once treatment is over. In the meantime, it is important to find foods that are acceptable, or to modify foods to help them taste better to you.
Tips for coping with taste alterations:
- Have a variety of foods available since certain foods can taste different by the day—even by the hour.
- Try adding seasonings such as sauces, herbs, spices or onions to your foods to change the flavor.
- Avoid foods with strong odors if the smell of food bothers you. Warm foods have a stronger scent, which lingers during the cooking process. You may do better with cold or room temperature foods, such as chicken, tuna, egg or seafood salad, green salads, fruit salads and pasta salads.
- Dry mouth can affect the way foods taste. Try to sip water continuously throughout the day, and be fastidious about mouth care. Talk to your doctor and/or dentist if you are having other mouth problems.
- If you find that red meat tastes bitter, try chicken, fish, turkey, lamb, peanut butter, cheese, eggs, beans or vegetables instead.
- Try eating or drinking something sour and use plastic silverware if you experience a metallic taste.
- Chemotherapy can cause minor skin problems, such as redness, itching, peeling, dryness
- Your nails may become brittle.
- Avoid unprotected exposure to the sun—use sunscreens of SPF 30 or higher, hats and sunglasses.
- Use soothing, alcohol-free lotion to reduce itching, scratching and dryness.
Call your doctor if you:
- Have a rash or an existing rash that worsens.
- Have other skin reactions.
- Have bad sunburns.
Constipation is defined as a decrease in the frequency of bowel movements, with an increase in difficulty and discomfort. Constipation can be a very common side effect of pain medication or certain chemotherapy drugs.
Constipation can cause you to feel full or bloated and make it difficult to eat enough. Suggestions to decrease or eliminate constipation include the following:
- Drink plenty of fluids each day. Drink at least eight to ten 8-ounce glasses of non-caffeinated fluid. Tea, hot lemon water and juices (such as prune juice) are effective.
- Increase your intake of high-fiber foods such as fresh fruits, fresh vegetables, whole-grain cereals, breads, and crackers, dried beans, peas and popcorn. Eat the skin on fruit and potatoes.
- Add prunes, dried apricots and other dried fruits and nuts to your diet.
- Get some exercise, such as walking, every day. Talk to your doctor about the type and amount that is right for you.
If you experience constipation, you may take any over-the-counter laxative and/or stool softener to increase bowel motility. Products include the following:
- Milk of Magnesia® Metamucil®
- Senokot-S® Citrucel®
- Dulcolax® (oral or suppository) Colace®
- Fleet® Enema Peri-Colace®
- If you have just started or are currently taking medication for pain, especially a narcotic, it is important to start a bowel regimen immediately (such as a laxative and/or stool softener). If you are also on one of several particular chemotherapy drugs—specifically, Cisplatin®, Velban®, Vincristine® or VP-16®—it is suggested that you use a daily stool softener.
Call your doctor if you:
- Have no bowel movements in 48 hours and/or if you have severe abdominal pain.
The overall goal is to have a bowel movement every one to two day(s). Because responses vary, use the guidelines below to find a regimen that works best for you.
If, at any time, the dosage of your pain-relieving medication is changed, you may also need to increase or decrease your daily dose of laxative. See your doctor if you believe a change in laxative dose may be necessary.
- Take two Senokot-S® tablets (a generic form is available at your pharmacy) at bedtime.
- If you do not have a bowel movement in the morning, take two Senokot-S tablets after breakfast.
- If you do not have a bowel movement by evening, take three Senekot-S tablets at bedtime.
- If you have not had a bowel movement by the next morning, take three Senokot-S tablets after breakfast.
- If there is no bowel movement within 48 hours after starting this protocol, add Dulcolax® suppository or Fleet® enema after breakfast, while continuing to take three Senokot-S tablets in the morning and three Senokot-S tablets in the evening.
- Once you start having bowel movements, use the two steps prior to the last step you took as your daily laxative protocol. For example, if you achieved a bowel movement after Step 4, use Step 2 and Step 3 (that is, two Senokot-S tablets in the morning and three Senokot tablets at bedtime) as your daily regimen.
Remember, constipation is a common side effect of many medications. A daily bowel regimen helps to prevent this potentially troublesome side effect.
Call your doctor if:
- There is no bowel movement within 96 hours after beginning this protocol—your doctor can provide additional instructions.
Chemotherapy destroys the cancerous cells and the normal cells of your body, especially those normal cells that are produced at a rapid rate.
The cells lining your stomach and intestines divide at a rapid rate. As they are destroyed, you may develop diarrhea. The severity of diarrhea varies in individuals. The number of your bowel movements may increase, and the stool consistency may range from very soft to liquid. Diarrhea caused by chemotherapy is temporary. The cells lining your stomach and intestines will regenerate.
The diarrhea will usually stop if your drug dose is decreased or if the drug is withheld for several days. Radiation therapy directed to portions of the abdomen and pelvis containing portions of the bowel results in thinning of the mucous membrane lining of the inner wall of the bowel.
This causes an increase in bowel motility and a decrease in absorption of fluids, resulting in more frequent and watery bowel movements or diarrhea.
The following measures are recommended to assist in the control of diarrhea:
- A low-residue diet may control some of the diarrhea.
- Imodium-AD® (Loperamide HCI) may be used. This medicine is available as an over-the-counter drug in your pharmacy. It acts by slowing intestinal motility. The suggested dose is one caplet or one teaspoonful after a diarrhea stool. This can be repeated every four to six hours should diarrhea persist. You can take up to eight tablets of Imodium per day. The medication should not be taken once the diarrhea has stopped.
- Kaopectate® (an over-the-counter medication) may also be used.
- It is important that you increase your fluid intake if you experience diarrhea. Drink room temperature liquids, and drink beverages between meals instead of during meals. Try to eat foods and drink liquids that will replenish electrolytes you may be losing, such as sodium and potassium. Examples include Gatorade®, Pedialyte®, popsicles, fat-free broth or bouillon, peaches or peach nectar, bananas and potatoes.
- The severity of diarrhea may be decreased if you drink boiled milk and eat cottage cheese, low-fat cheese, yogurt, applesauce, rice and bananas instead of your regular meals. Nutmeg also decreases the motility of your gastrointestinal tract. Strong spices and herbs stimulate the tract and are to be avoided. When the diarrhea diminishes, gradually add your regular diet to these foods. If you cannot tolerate milk, do not
Call your doctor if you:
- Have more than three episodes of diarrhea even after taking Imodium-AD and/or Imodium
Follow this diet if you have diarrhea or loose stools. The diet consists of smooth and easily digested foods. It is low in roughage and omits all raw and cooked fibrous foods, as well as spicy and gas-forming foods.
Your eyes may be more sensitive to light or the sun while you are receiving chemotherapy. Wear sunglasses to protect your eyes whenever you are in bright light. Continue regular eye exams, and let your eye doctor know you are taking chemotherapy.
Call your doctor if:
- You experience excessive tearing and blurred vision.
- You experience vision changes, even if you wear prescription glasses or contacts.
Fatigue is a feeling of tiredness that can keep you from doing the things you normally do or want to do. Fatigue is very common among people receiving cancer treatments. Factors such as cancer itself, low blood counts, nutritional problems and sleep problems contribute to fatigue, but the exact cause is unknown.
Signs of fatigue:
- You feel weary and exhausted. The exhaustion may be physical, emotional, and/or mental.
- Your body, especially your arms and legs, feels heavy.
- You have less desire to engage in normal activities, such as eating or shopping.
- You find it hard to concentrate or think clearly.
What you can do to manage your fatigue:
- Rest and sleep—These are important, but don’t overdo it. Too much rest can decrease
your energy level. In other words, the more you rest, the more tired you will feel.If you have trouble sleeping, talk to your doctor or nurse.
- Activity—Stay as active as you can. Regular exercise, such as walking several times each week, may help.
- Nutrition—Drink plenty of liquids. Eat as often as you can, and eat nutritious foods.
- Energy Conservation—You can do more by spreading your activities throughout the day. Take rest breaks between activities. Rest breaks save energy for the things you want to do. Let others help you with meals, housework or errands. Do not force yourself to do more than you can manage.
- Energy Restoration—Participate in activities that you enjoy and make you feel good. Many people enjoy visiting with friends and family or looking at pleasant pictures. Try to take in these activities at least three times per week.
Here are some tips to help you cope with fatigue:
- Plan your day so that you have time to rest.
- Take short naps or breaks rather than one, long rest period.
- Eat as well as you can, and drink plenty of fluids.
- Take short walks, or do light exercise, if possible.
- Try easier or shorter versions of activities you enjoy.
- Try activities that are less strenuous, such as listening to music or reading.
- Keep a diary of how you feel each day. This will help you plan your daily activities.
- Join a support group and share your feelings with others.
- You can learn coping hints from talking about your situation: (A nurse can put you in touch with a support group in your area)
- Save your energy for the most important things.
- Become comfortable having others do some things that you usually do.
- See what helps you feel less tired and make those activities a priority for you.
When rest is not the best treatment for cancer treatment:
- You may be advised to “take it easy” and “get plenty of rest.” Sometimes, staying in bed over a long time can slow your body down and cause you to feel even more tired.
What can family or significant others do to help with cancer treatment?
- Do not push yourself to do more than you can do. Ask your family or friends to help you with
tasks you find difficult or taxing, such as mowing the lawn or grocery shopping.
- It may be difficult for family members to understand if rest does not make your fatigue go away. Explaining that the fatigue you feel is different from the fatigue you had before treatment may help them to understand.
Call your doctor if you:
- Have been too tired to get out of bed for the past 24 hours.
- Feel confused or cannot think clearly.
- Feel your fatigue becoming worse.
- Get dizzy.
- Feel loss of balance when walking or when getting out of bed or getting out of a chair.
- Fall and hurt yourself.
- Have trouble waking up.
- Have a problem catching your breath.
- Have a sudden increase in fatigue.
- Ask your nurse or social worker about wellness programs that can help you
manage your fatigue.
Some anticancer treatments can cause changes in how the nerves throughout your body function. These are called “peripheral nerves” and are located outside the brain and spinal column.
Your body contains two types of peripheral nerves—sensory and motor. Sensory nerves help you feel pain, touch, temperature, position and vibration. Motor nerves help you move and maintain muscle tone. Other things that can affect these nerves are diabetes, medication for other conditions, nutritional imbalances and alcohol usage.
These changes often start slowly and worsen as your treatment continues. Once chemotherapy is stopped, these changes may lessen slowly over time. In some cases, they may not completely disappear. Tell your doctor if you cannot button your clothes, your handwriting changes or you are having problems walking or hearing.
Hair is a very important part of a person’s self-image. If you experience hair loss, you may experience stress from the change in your appearance, scalp sensitivity and a loss of body heat through the scalp.
If you plan to get a wig, it is important to do so before you lose your hair so it is easier to match your original color and style. Things that may hasten hair loss include excessive hair brushing or styling with bobby pins, curlers or curling irons, hair dyes and permanents that contain bleach, peroxide or ammonia.
Suggestions for hair and scalp care before and during hair loss include the following:
- In cold temperatures, you will need to wear a hat, scarf or cap outdoors. In sunny weather, you will need to wear a head covering outdoors and a sunscreen with an SPF greater than 15.
- Wash hair regularly with a mild shampoo such as baby shampoo, a pH-balanced shampoo, or one for dry or damaged hair.
- If you use a blow dryer, keep it on the “cool” setting and hold it at least four inches from the head.
- You may wish to use a cream rinse to help remove tangles.
- Use a soft bristled brush or a wide-tooth comb to remove tangles.
- If you are undergoing radiation therapy to the scalp, wear loose-fitting caps or cotton scarves to allow the scalp to breathe. Avoid rubbing or scratching the scalp.
- As often as possible, do not wear a wig during the course of radiation treatments.
- You may wish to wear a soft cotton cap to bed to keep warm and to catch shedding hair.
- Blot hair dry with a towel to avoid excessive rubbing of the scalp.
During hair regrowth, you may experience stress from the change in your appearance, as well as from scalp sensitivity. New hair is often fragile as it grows back in. It may be helpful to follow the suggestions listed above, before and during hair loss.
Lea’s Wig Salon
328 W. Milham Rd.
Empire Beauty School
6091 Constitution Blvd.
Villa Hair Salon
4213 W. Main Ste. 2A
The Hair Shed
68 East Michigan Mall
Battle Creek, MI
Allegan Hair Studio
146 Grand St.
D Gist Salon
518 Quaker St.
South Haven, MI
Berrien County Cancer Services
7301 Red Arrow Highway
Cleopatra’s Hair Hut
136 N. Rowland St.
Chicago Pike Inn & Spa
215 E. Chicago St.
Precision Cut & Design
380 N. Behnke Rd.
American Cancer Society
Patients at risk for lymphedema include those who have had lymph nodes removed or radiation to an area of the body with lymph nodes as part of their cancer treatment. Lymphedema can occur in the body area affected by surgery or radiation (i.e., the arm, leg, head and neck, breast, or genitalia.) Although breast cancer treatment is the most common cause of secondary lymphedema, lymphedema also can be the result of burns, trauma, venous disease, infection, inflammation, or immobility.
Patients at risk should be aware of ways to lower risks and watch for signs and symptoms of complications from lymphedema. Complications include infection, pain, loss of function, and deep vein thrombosis.
- Use neutral soaps to avoid excessive drying
- Use moisturizing cream
- Inspect skin folds and keep them clean and dry
- Inspect for cuts, scrapes, abrasions and insect bites
- Wear protective gloves and garments when working outdoors
- Use sunscreen and insect repellents
- If injury occurs, wash with soap and water; apply topical antibiotics, and monitor for redness, pain or swelling. If swelling occurs, contact a clinician immediately
- Maintain a healthy weight and exercise routine
- Monitor limbs after exercise; gradually build up duration and intensity of exercise, avoiding heavy resistance; and discuss embarking on exercise programs with a clinician
- Avoid wearing tight garments, underwear, or jewelry on affected areas of the body
- Use compression garments as directed by a clinician; discuss during air travel
- Avoid blood pressure and blood draws or venipuncture on affected limbs, if possible
- Should lymphedema occur, seek early treatment from a trained therapist to prevent and minimize progression
Note: Based on information from Lymphedema Framework, 2006; National Lymphedema Network Medical Advisory Committee, 2008c.
Managing Your Emotional Side Effects
Treatment can affect your overall health, threaten your sense of well-being, disrupt day-to-day schedules and put a strain on personal relationships. Schedules may have to be readjusted. Family life may be disrupted because clinic visits take time and effort. Procedures can be painful and frightening, and financial stress can add burdens.
Emotions such as fear, anxiety, anger or depression are perfectly normal and understandable, but can be very disturbing. Give yourself time, to adjust to the stress and pressure of your diagnosis and treatment. Take one day at a time and set priorities to help yourself keep from feeling overwhelmed.
Become an expert at setting aside relaxation time for yourself. Enjoy your hobbies, or try to find some fun things that make you laugh or smile.
There are many sources of support—please ask for help!
- Doctors and nurses
- Counselors and social workers at WMCC and in the community
- Friends and family members
- Classes including Survivorcise and Livestrong at the Y
- Support groups
- Your church
In addition, WMCC will try to help address any needs or concerns you may have. Please ask!
Sexuality is an intimate form of communication that involves not only intercourse, but touching, verbal expression and other demonstrations of affection. Neither cancer itself, nor any therapy for the disease, can destroy one’s sexuality.
However, changes in body image through chemotherapy drugs, radiation, surgery or use of appliances may occur. These changes may be temporary or permanent. They may have positive, negative or no effect on your perception of sexuality.
Fertility can be affected adversely by both chemotherapy and radiation therapy. These effects can be either permanent or temporary. Feel free to address this issue with your physician, nurse, social worker or counselor.
If you are concerned about your ability to have children, ask about this prior to the initiation of any therapy. Information concerning agencies that deal with this issue (such as sperm banking) is available. Pregnancy is still possible while on chemotherapy, so birth control should be considered.
The effects of chemotherapy are many and varied. Below is a list of general categories of medications and their possible effects on sexuality:
- Antihypertensives—(high-blood-pressure medications) May cause erectile dysfunction,
decreased vaginal lubrication, delayed ejaculation.
- Antidepressants—May decrease erections or decreased vaginal lubrication.
- Tranquilizers—May decrease anxiety, which could improve sexual function (for example, tranquilizers may relax pelvic muscles, positively impacting orgasm); large doses of tranquilizers may delay ejaculation or decrease erections or vaginal lubrication.
- Recreational drugs—May cause euphoria and/or increase self confidence and tactile pleasure or may block sexual arousal and pleasure; may cause extended, painful erections or painful ejaculations.
- Anticholinergics—May affect arousal (for example, decreasing erections and vaginal lubrication).
- Opioids—May increase enjoyment of sex by reducing pain; may cause constipation, interfering with sexual activity; long-term opoids may retard ejaculation.
- Hormones—May lower sperm and testosterone levels in males and decrease sexual desire; secondary sex changes (such as deepening of the voice or increased facial hair) may affect body image.
- Alcohol—May decrease sexual drive or desire, vaginal lubrication, or erections; may decrease inhibitions and thereby interfere with use of safe sex, thus increasing risk of infections.
- Antiadrenergics—May decrease sexual drive or desire, vaginal lubrication or erections.
- Endocrine drugs—May cause hot flashes, mood swings, or painful intercourse due to decreased vaginal lubrication.
- Chemotherapy drugs—May cause alopecia (hair loss), stomatitis (mouth sores), fatigue, anorexia, decreased immunity, amenorrhea (no menstrual periods), lowered ovarian function, absent or defective sperm, retrograde ejaculation and/or decreased vaginal lubrication.
Radiation therapy affects patients in different ways, depending on the site of the radiation field, amount of radiation delivered, the patient’s previous level of health and beliefs about radiation. Listed below are some of the side effects that may occur:
- Decreased blood flow to the genitals from vascular scarring resulting in erectile dysfunction or decreased vaginal lubrication.
- Pelvic radiation may cause urethral irritation (women may experience pain with penetration, and men may feel pain with ejaculation).
- Concern about possible recurrence of cancer.
- Alteration of sexual patterns.
- Decreased skin sensitivity due to nerve damage.
- Skin changes (for example, the skin becomes too tender for the partner to touch, or skin texture or color changes).
- Fatigue (possible loss of libido).
- Vaginal stenosis (narrowing).
- Decreased vaginal sensation.
- Concern about bleeding.
- Radiation therapy may also impair fertility, depending on the dose to the testes or ovaries.
- Reproductive organs are shielded whenever possible to minimize potential damage.
For additional information, the following agencies may be contacted and can provide literature:
American Cancer Society
Planned Parenthood Organization
Sexuality Information and Education Council of the United States
United Ostomy Association Inc.
It is important to eat well during your cancer treatment. Eating well helps you maintain your strength and energy level during treatment. Good nutrition helps your body recover faster and feel better after treatment. It also strengthens your immune system to help your body fight the disease.
Cancer and its treatments can affect the way your body uses nutrients, and can increase the loss of certain nutrients. It is important to replenish these nutrients by taking in adequate nutrition. Side effects from treatment are possible but do not happen to everyone. It is important to be aware of side effects of treatment that can occur and to know how to manage them. This section provides you with information on maintaining good nutrition before, during and after cancer treatment.
West Michigan Cancer Center Registered Dietitians
You may find that you have more questions about nutrition and cancer, even after you have read this section. Also, if you are already following a special diet prescribed for you by your doctor, you may need to know how to fit nutrition for cancer treatment into your current meal plan.
In either case, it may be beneficial to you to meet with one of West Michigan Cancer Center’s registered dietitians (RD). Ask your doctor for a referral to a dietitian to obtain an appointment. The letters RD after one’s name signify that a person has successfully completed a four-year degree in nutrition, an internship and a national examination.
Through referral from your doctor, a registered dietitian is available for complimentary consultations should questions or concerns arise throughout your treatment and beyond. Once you’ve received a referral, ask the schedulers on either floor for the dietitian’s availability and an appointment time. Generally, you can be scheduled at or near a time when you are already planning to be at West Michigan Cancer Center.
If you have head/neck cancer and will be receiving chemotherapy and radiation treatment, your doctor will be talking to you regarding a feeding tube at the start of treatment. You may not need it at the start of treatment; however, by the middle of treatment, you will be pleased that this is available to you.
- Take a trip to the grocery store. Buy a variety of favorite foods that will be convenient and easy to prepare.
- Make food ahead of time. If possible, prepare large quantities of favorite foods and freeze in small containers when you’re feeling well for consumption later.
- Discuss possible side effects of your treatment with your doctors and nurses. Be aware that these may or may not occur, and know how to handle them if they do.
- If you are taking any vitamin, mineral, herbal or dietary supplements, ask your physician and dietitian if you can continue taking them during treatment. There may be an interaction between these and other medications you are currently taking, or treatments you may receive in the future.
- Avoid large doses of antioxidants including vitamin C, vitamin E, vitamin A, beta-carotene and selenium during treatment. However, standard amounts of these nutrients found in multivitamins with minerals, and in foods, are not of concern.
- There are many resources available to you. West Michigan Cancer Center has copies of the Eating Hints for Cancer Patients booklet available to you. This is published by the National Cancer Institute and can also be ordered by calling 1-800-4CANCER (1-800-422-6237).
It is important to take care of yourself while undergoing treatment. Your body needs extra care during this time.
- Get plenty of rest.
- Eat a well-balanced diet. Your body needs to build strength and help itself heal. WMCC has a dietitian available to help you.
- Plan your activities when you feel well. Include recreation in your regular routine.
- Think positively. Remember the treatment is helping you fight cancer.
- Exercise if you can. Simple exercises like walking, dancing or swimming will help you feel better about yourself, improve sleeping, improve eating and get rid of tension and anger.
- Take care of yourself so you can feel in control of your life again.
- Ask questions about your chemotherapy or radiation treatments. You will be less afraid if you know what to expect.
- Counseling is available through our Social Work department. You may also wish to meet with a professional psychologist. Our social workers can assist you with a referral.
- Join a support group. You can talk and share experiences with other people who have cancer in these groups.
- Practice deep breathing. When feeling anxious, focus on breathing from your diaphragm to help calm yourself.
- Join one of our classes.
Massage and bodywork are wonderful ways to help reduce physical discomforts, anxiety, fatigue and depression. You can increase your feeling of well-being and reclaim your body by reuniting it with your heart, soul and mind.
Massage is one way to interrupt the pain cycle in your body. Pain causes a stress reaction in the body. The muscles around the site of the pain may contract. This reduces circulation and holds waste products in that area. With chronic pain, the connective tissue in the area also hardens, further impairing circulation. Massage can interrupt this cycle, reducing stress, improving circulation, promoting elimination of wastes, reminding the body how to relax, improving sleep, increasing energy and supporting the body in the healing process.
There are many different kinds of healing touch that may be beneficial in a therapy session. Some techniques use very light touch but can have profound results. Most massage therapists are trained in several techniques, such as Swedish massage, polarity, myofacial release, acupressure and reflexology. Massage sessions may include a combination of techniques, depending on the challenges you are having in your body and the goal of the session. One thing you can count on is that massage will feel good!
A massage session with a professional massage therapist is a chance to receive good, nurturing touch in a relaxing, nonjudgmental environment. If you have experienced surgery or are undergoing numerous treatments and procedures, it is a great way to begin working towards accepting the changes in your body, reclaiming your body as a source of pleasure and restoring hope. If you think that you would like to add massage and bodywork to your treatment plan, check with your doctor to confirm that these are appropriate treatments for you.
- Scientific studies have shown that walking can decrease some side effects of cancer and its treatments. In one study, people with cancer who exercised regularly had less fatigue and less nausea than people who did not exercise.
- Exercise and activity increase your sense of well-being.
Where Can You Walk?
- Most likely, you can walk in your neighborhood or local mall. Many shopping centers open their doors early for walkers.
- Schools. Some have an indoor and/or outdoor track that is open to the public during certain hours. They may also have a large gym and/or long hallways where you can walk.
- Try neighborhood parks. Most have trails and walking paths.
- Fitness centers and health clubs typically offer places to walk. They may also have treadmills, if you like walking in place.
- You can walk in your own home. You may want to purchase a treadmill. Or, if you cannot walk too far, a few trips up and back down a hallway or around the outside of your house may be a beginning goal.
- For more information on area walk paths, please visit:
Tips on Safe Walking
- Ask your doctor if it is all right for you to walk and if there are any precautions you need to take before walking.
- Walk with someone if possible. Family members and friends can make walking more enjoyable. Dogs are good companions and good motivators, too.
- Wear comfortable and supportive shoes that fit well. Walking or running shoes are good
choices. Also, wear socks without holes to avoid blisters.
- Wear clothes that have light or bright colors so others can see you easily. If you walk at night, wear some kind of reflective clothing.
- Always tell someone else that you are going for a walk. Let them know where you are going and how long you expect to be gone. Take quarters in case you need to call home. Always carry some form of identification with you.
- Wear layers of clothing so that you can take something off if you get too warm.
- Drink fluids often, especially in hot weather. Water is best.
- Know your latest blood counts. You should never walk alone if your platelets are below 20,000 or if your hemoglobin is below 10.
- Do not walk at all if you have a fever.
- Some soreness in your joints and muscles is expected when you first start walking. If the soreness does not go away in three to four days, call your doctor or nurse.
- If you experience dizziness, shortness of breath, pain, leg cramps, nausea, palpitations (that is skipping heartbeats) or chest pain, STOP and rest. Find a place to sit down. If you do not feel better quickly, call for help. Do not walk if you have any of these problems before you start to walk.
- Learn to do some basic stretches after you are done walking.
Steps to Success
- Set a goal for yourself. Set your goal low to start.
- Start with a five to ten minute walk and increase by two minutes every week. Decrease your goal if you keep feeling fatigued for two to three hours after walking. Increase as you feel ready.
- Try to walk every day or every other day. Most people limit their walks to 20-60 minutes.
- If you have been ill or do not exercise regularly, keep your walk short.
- Walk at a steady pace. If you feel tired or short of breath, slow down.
- Decide where you are going to walk and determine the distance. Planning out several different routes will add variety to your walks so you will not get bored. Do not walk so far that you are too tired to walk back.
- If you have to walk alone, listening to music may help you keep pace and increase the pleasure of walking. Keep the volume low enough to hear other pedestrian or traffic noise around you.
- Keep track of your walks in a diary or calendar or on a map. Seeing how well you are doing can motivate you to keep going. Always remember to stretch after walking to maintain flexibility and prevent injury.
- If you need blood drawn, do not go for your walk until after you have had your lab tests done.
- If you feel like walking on the day you get your treatment, please take it easy. You may tire more easily.
- Do not walk if you have a fever or if you are unable to eat or drink.
- If you get blisters or sores on your feet, clean the area two to three times a day. Soaking your feet in a pan of warm Epsom salt water will make them feel better. Apply an antibiotic ointment such as Polysporin®. Cover with a Band-Aid®. Do not walk for exercise until the sore or blister has healed. Call your doctor or nurse if the sore or blister becomes red, drains yellow fluid or does not heal in three to four days, especially if your white blood count is low. Also, try to figure out what caused the blister. Old, thin socks? Shoes that do not fit well? The suggestions here are for walking that will help keep you fit. Walking in this manner will NOT give you an aerobic workout.
Medication can take care of a lot of pain, but sometimes it’s helpful to use alternative methods of pain control, too. Relaxation techniques can be helpful in controlling your pain. There is good medical evidence that learning how to relax can help lower blood pressure in some people with hypertension.
There is data that suggests concentrated relaxation helps to reverse the symptoms of heart disease in patients with clogged arteries. And for years, people have used various methods to relax and ease the stress and tension of everyday life. There are many ways to relax, but they all hinge on a central idea—relaxing the body by relaxing the mind.
One way is to focus on your breathing. The idea is to rest your mind from other thoughts and just concentrate on your breathing—the sound, feel, speed and process of it. If the focus is lost and thoughts of anything else intrude, simply refocus on your breathing. After a while, it becomes easier to concentrate fully on breathing. This deep concentration leads to relaxation of the mind, and relief from stress-induced pain.
If you find it difficult to concentrate on breathing, try speaking a sound and repeating it over and over. Focus on the sounds, allowing everything else to leave your mind (for example, the sound of the ocean, a waterfall, etc.).
For some people, these simple techniques can work wonders. If you have any questions about whether concentrated relaxation can help you, just ask your doctor, nurse or the social worker.
One of the most time-proven methods to help you relax and better deal with pain is also one of the simplest: breathing. While this activity is usually something you do without thinking, taking some time out to concentrate on your breathing can free your mind and body from outside stresses, leaving you relaxed and in a better state emotionally and physically to deal with your pain. And controlled, deep breathing is something that practically all patients can do, regardless of their condition.
- To start out, find a time and a place where you won’t be bothered by the immediate distraction of the outside world.
- Choose a location where the phone won’t ring and there aren’t any people around to interrupt your relaxation exercise. This could be a bedroom, a quiet office or even outdoors—anywhere that you can sit or lie with your spine straight.
- Close your eyes or focus on the ground in front of you.
- Take a moment to focus on every part of your body.
- Now breathe easily from your diaphragm. Breathe as slowly and deeply as is comfortable.
- Falling asleep is always possible when you reach a state of relaxation like this, but unless you feel you need to sleep, try to stay awake by concentrating on your breathing. The longer you continue the deep breathing, the more relaxed you’ll become.
- Keep it up for anywhere from a few minutes to 20 minutes at a time, and you should really begin to feel the calming effects of this relaxation technique.
Deep breathing exercises have been recommended as a daily practice by many health professionals. Practiced regularly, this technique can become a helpful part of your regular routine.
Studies have shown that using relaxation techniques can help reduce pain. Biofeedback is a way to “listen” to how your body feels, using technology to measure whether relaxation techniques are working.
To use biofeedback properly, you should work with a professional. Biofeedback training usually consists of one-hour sessions, once or twice a week for several weeks.
Here’s how it works:
- You are connected to the biofeedback equipment by a trained specialist.
- Electrodes are placed on appropriate muscle groups.
- Temperature sensors are placed on one of your fingers.
- You will be instructed to relax or asked to listen to a relaxation tape.
- As you begin to relax, you will be able to hear a tone or read a dial to show you just how much you are relaxing.
- Between sessions, patients must practice biofeedback at least twice a day, using an instructional tape.
- Once you learn to use relaxation techniques properly and to monitor your ability to relax, you can practice on your own without the help of a specialist.
- For referral information, contact our social worker.
Imagination can provide a source of pain relief for some people. Everyone uses their imagination as a means of relaxing or cheering up when they daydream. It is an escape from everyday pressure. With practice, you can feel this sense of escape whenever you need to, using your imagination at its most powerful. This is the aim of a technique called “guided imagery”: to guide your imagination so you can use it to help yourself feel better.
Working with a trained professional such as a nurse, social worker or psychologist, you can learn to focus on an image that will allow for a short escape when pain flares up. Guided imagery makes use of a scene as a trip to a favorite place, like a walk through the countryside.
The professional will help you select a favorite image and relive it slowly and in as much detail as possible. This is done by describing out loud the image and the feeling you associate with it. As the image becomes more “real” and more pleasurable, you begin to relax and to release any pain you might feel.
After going through this process, many people feel the same sense of peace that comes after a soothing nap. These feelings can have a positive effect on how you feel overall. The description of the image can be tape recorded so that you can “relive” the experience and practice it to make it more vivid.
You can record several images and listen to them until you can experience them without the tape. You can also use any of a variety of professional guided imagery tapes available through WMCC. Your imagination can help you remember good times and ease any pain in the process.