Managing side effects of cancer treatment

Anxiety is a normal reaction to cancer. It may increase feelings of pain, interfere with sleep, cause nausea and interfere with the quality of life and family. Most patients who have not had an anxiety condition before their cancer diagnosis will not develop an anxiety disorder associated with their cancer.

It may be difficult to distinguish between normal fears associated with cancer and abnormally severe fears that can be classified as an anxiety disorder. Signs of severe fear may include panic attacks that involve distressing symptoms such as racing heart, sweating, shaking, shortness of breath, nausea, or feeling faint. Other signs of severe fear may also involve excessive avoidance of certain situations, muscle tension, intrusive thoughts and excessive rumination, recurrent nightmares, memory problems, and difficulty sleeping.

Treatment depends on how anxiety affects your daily life. Treatment can include providing management of uncontrolled symptoms such as pain, providing information and support, counseling and/or medication.

Looking good is not a matter of vanity. Studies show that people who are pleased with how they look have more energy, more resilience and a better attitude. This helps them handle the ups and downs of cancer treatment more easily.

The Faith and Hope Boutique at the Abramson Cancer Center and the Penn Parenting Resource Center, formerly Solutions for Women, at Pennsylvania Hospital feature many items chosen specifically for cancer patients. Personal image programs also give patients ideas on how to look their best.

The Look Good, Feel Better Workshop is a free program at the Abramson Cancer Center and the Abramson Cancer Center at Pennsylvania Hospital provided in conjunction with the American Cancer Society. The workshop teaches beauty techniques to women who are actively undergoing cancer treatment to help them combat the appearance-related side effects of radiation and chemotherapy.

For more information about the program at the Abramson Cancer Center, call 215-615-0651, or visit the events calendar at the Abramson Cancer Center at Pennsylvania Hospital.

Some types of cancer treatment may affect a patient’s blood counts.

• White blood cells help to fight infections
• Platelets prevent bleeding and bruising
• Red blood cells carry oxygen throughout a patient’s body

Low blood counts can be treated, but treatment options may be different for each patient based on severity and health history. Patients should discuss treatment options with their doctors if they experience any of the following symptoms:

Symptoms of Low White Blood Cells (Neutropenia)

• Fever of 100.5° F or greater. You may experience a fever while undergoing chemotherapy. If your fever is greater than 100.5 F, you should contact your health care provider or go to the emergency department.
• Chills or sweats
• Cough, increased mucous production, shortness of breath or painful breathing
• Soreness or swelling or ulcers in the mouth
• Pain, burning, urgency, frequent urination or foul-smelling urine
• Redness, pain or swelling of any area of skin or drainage tubes
• Confusion or listlessness, especially in older adults, can sometimes be a symptom of infection

Symptoms of Low Platelets (Thrombocytopenia)

• Excessive bruising of the skin
• Tiny, pinpoint red spots on the skin (called petechiae)
• Bleeding gums or nosebleeds
• Excessive bleeding from a small cut, or bleeding that won’t stop even after pressure has been applied
• Dark urine or blood in the urine
• Blood in stool or from the rectum when after a bowel movement; black-colored stools
• Menstrual bleeding that is heavier than usual, lasts longer than usual or occurs between periods

Symptoms of Low Red Blood Cells (Anemia)

• Weakness or fatigue
• Shortness of breath
• A faster heart beat or chest pain

If you have received or are receiving certain types of cancer treatments, you are at an increased risk for osteoporosis, or decreased bone density. This condition creates an increased risk of fracture of those bones affected, most often the hips, spine, and wrists.

Those at risk include:

• Women who have early menopause or decreased estrogen production due to cancer therapy 
• Men who have decreased testosterone production
• Treatment with ifosfamide, methotrexate, radiation to the brain or weight bearing bones (spine, hips, legs) or allogeneic stem cell or bone marrow transplant
• Survivors of childhood cancers
• Long-term use of corticosteroids
• Patients who have had their stomach surgically removed

If you have had chemotherapy for cancer, you may experience memory, concentration and attention problems after treatment. This is sometimes called “chemo brain.” Many survivors report they have problems paying attention, finding the right word, or remembering new things.

Research is starting to explore why some people develop problems with memory and concentration while others don’t. People who have had chemotherapy or have had radiation to the head area are at higher risk for these problems.

You should speak to your physician or nurse if you:

• Have memory and thinking problems
• Think a medicine could be causing or adding to the problem
• Suffer from depression or anxiety, which can cause problems with concentration and memory

Support groups can be helpful when transitioning from active treatment to survivorship, allowing you to talk to others who may have similar experiences.

Cancer treatments, medications, lack of fiber, fluids, and movements, can often cause constipation. If you experience constipation, check with your doctor or nurse before using over-the-counter laxatives, stool softeners or enemas.

Some ideas for relieving constipation symptoms including eating:

• Fresh raw vegetables and fruits, especially those with skins (unless white blood cell count it low)
• Bran, whole grains and cereals, granola, wheat germ flakes
• Dried fruits, especially dates, prunes and apricots
• Prune juice
• Dried beans
• Fresh fruit juices, except apple juice
• Warm or hot fluids, especially in the morning

Other things that can help relieve constipation include:

• Getting as much physical activity as possible
• Attempting a bowel movement at a regular time each day, preferably after breakfast
• Avoiding chocolate, cheese, eggs or fatty fried foods

Oncology certified registered nurses and registered dietitians are available to help with symptom management.

Many cancer treatments can cause dehydration. Dehydration is preventable and can be the result of nausea, vomiting, diarrhea, and/or inadequate fluid intake.

Depression is a disabling illness that affects about 15 to 25 percent of cancer patients. Everyone who is diagnosed with cancer will react to the diagnosis in different ways and may not experience serious depression or anxiety.

Sadness and grief are normal reactions to the crises faced during the cancer journey and will be experienced at times by most people. Major depression is not simply sadness, but has common symptoms that can be diagnosed and treated. Just as patients need to be evaluated for depression throughout their treatment, so do family caregivers, who may be an increased risk for depression.

Mild symptoms of depression can be distressing and may be helped with counseling. However, when symptoms are intense and long lasting, or when they keep coming back, more intensive treatment is needed.

Symptoms can include feeling sad or empty most of the time, being tearful, losing interest in activities, weight and appetite changes, difficulty sleeping, feeling slowed down or sped up, having no energy, feeling excessively guilty or worthless, having difficulty concentrating or making decisions, or thinking about dying or suicide. Of course, some of these symptoms may be the direct result of your treatment or disease and not due to depression, so you should discuss your concerns with your medical team.

Penn Medicine offers psychological and spiritual counseling. For more information about counseling services or to make an appointment, call 800-789-7366 (PENN).

Some cancer medications can cause diarrhea and can be serious because it can lead to dehydration if not properly managed. It is important for you to check with your doctor or nurse to see if you should be taking any medications to manage this side effect.

Some foods are helpful for relieving diarrhea:

• Bananas
• White Rice
• Applesauce
• Tea
• White Toast
• Yogurt
• Peanut Butter

Staying hydrated is very important. Drink six to eight glasses of liquid each day, including Gatorade or coconut water to help replace minerals lost.

Dry mouth can be a debilitating side effect of many medications, cancer drugs, and radiation to the head and neck. Dry mouth may affect speech, taste, swallowing, and the use of dentures. The extent of dry mouth is dependent upon the dose of radiation and the technique used.

Fatigue is a common side effect of cancer treatment. Radiation therapy, chemotherapy, surgery and other treatments may cause you to have less energy.

Being tired can impact work, concentration, and participation in family or social activities. Even after cancer treatment ends, it may be a while before you feel strong again. The following tips can help conserve energy.

• Prioritize activities
• Delegate things that are less important
• Take short rests as needed
• Walk or exercise when you are able
• Get a good night’s sleep
• Eat frequent, small, nutritious meals for more energy
• Ask about medicines to help with fatigue

Our Cancer Rehabilitation Program addresses the needs of patients who are experiencing symptoms like fatigue and loss of physical function.

Today, many patients who survive cancer can expect to live normal and productive lives. For some, returning to a “normal” life includes having children. However, cancer treatment can potentially cause infertility or problems with reproductive organs due to the effects of medical, radiologic or surgical treatments used to combat cancer.

Penn Fertility Care has been a pioneer and today remains a leader in the treatment, services and programs offered to patients who have become infertile due to the effects of cancer.

Swelling or puffiness in the face, hands, feet or abdomen can result from the fluids administered during chemotherapy or the chemotherapy itself and should be discussed with your doctor or nurse. Here are some tips to try to manage your swelling:

• Limit salt intake-salt can be present in foods such as soups, frozen or canned food, processed meats, cheese and soy sauce, for example
• Avoid tight clothing
• Elevate your feet

Contact a doctor if the swelling becomes uncomfortable- if you experience no urine output for 12 hours or dark or bloody urine, contact your doctor or nurse immediately.

A common side effect of chemotherapy is hair loss. Some chemotherapy drugs have no effect on hair loss while others cause mild hair thinning or complete hair loss. The result is usually temporary and most people experience significant hair re-growth three to five months after treatment is completed.

Penn Medicine is proud to offer the clinically proven PAXMAN Scalp Cooling System technology for our cancer patients in the Philadelphia region. This system is a groundbreaking intervention that reduces hair loss caused by chemotherapy for patients with breast and ovarian cancer, fallopian tube cancer and primary peritoneal cancer. The Paxman Scalp Cooling System is the only FDA-approved scalp cooling system based upon an investigational clinical trial.

Urinary incontinence is the inability to control urine flow. Incontinence can range from a small amount of urine leaking when you sneeze or cough, to a complete lack of control.

Some cancers and cancer treatments may cause incontinence. Using the restroom regularly, avoiding caffeine, spicy food, alcohol, and carbonated drinks can help prevent urinary incontinence.

Insomnia is an extremely common problem for cancer patients. However, many patients fail to report this symptom to their healthcare provider. This likely occurs because insomnia may be viewed as a normal reaction to a cancer diagnosis and treatment.

To treat insomnia, the underlying cause must be addressed such as pain, nausea, depression and hot flashes. If the insomnia persists, a combination of pharmacologic and psychological therapy may help.

The effect of cancer treatment on sexual intimacy is different for everyone. Some people are unaffected, while others have changes in their desired level of activity. Some find the experience brings them closer to their partner. Others may find sexual activity to be less important for a time. These feelings are not unusual.

If problems arise, don’t delay getting information or counseling. Speak to your doctor or nurse about any concerns you have. He or she can provide advice or information about people who can help.

Eating well during cancer treatment can be difficult at times but good nutrition during treatment can help decrease hospitalizations and delays in treatment and promote general well-being.

If you suffer from a loss of appetite during cancer treatment, there are several things you can do to help. Eating small and frequent meals, consuming meals that are high in calories, and trying new foods can improve your appetite. It is important to keep yourself well-nourished during treatment, maintain your weight as much as possible, and to stay hydrated.

If you are undergoing cancer treatment at Penn Medicine, or have completed cancer treatment, you may benefit from nutrition counseling services. For more information about nutrition counseling, speak with your physician or nurse.

Lymphedema is chronic swelling that happens when the lymphatic fluid is not moving properly. It is caused by poor function of lymph nodes or lymph vessels. Lymphedema results in chronic swelling that leads to tissue inflammation and scarring. The swollen body part feels harder to touch and heavier than the non-swollen side. People who have had lymph nodes removed during their cancer treatment have an increased risk for developing lymphedema.

Lymphedema Risks

The risk of lymphedema increases with the greater the number of lymph nodes removed, receiving radiation therapy, being overweight, having active cancer, or having an infection/injury to the at risk body part. Not all swelling in the body is lymphedema. Patients should be sure to discuss swelling anywhere in their body with their physician, nurse or therapist.

How is Lymphedema Treated?

The best recognized treatment for lymphedema is complete decongestive therapy (CDT), a treatment program by a physical therapist.

Decrease Your Chances of Lymphedema

No research demonstrates that lymphedema can be prevented, but the risk of developing it can be reduced or moderated by understanding how to reduce the demand placed on the arm’s lymphatic system.

Some things patients can do to decrease your risk for lymphedema are:

• Take good care of the skin to reduce the risk of infection and injury
• Avoid constricting blood flow
• Maintain ideal weight
• Exercise with care

The Cancer Rehabilitation Program and the lymphedema program at Pennsylvania Hospital can help patients prevent or treat lymphedema.

Mouth sores can be a painful side effect of cancer treatments and/or radiation to the head and neck. Although they usually heal within two weeks, here are some things you can do to help mouth sores:

• Avoid commercial mouthwash with alcohol
• Keep your mouth clean
• Eat soft foods when your mouth sores are present

Contact your physician if you are unable to eat or drink.

There are different types of nausea that can be experienced during cancer treatment.

• Anticipatory nausea is a learned response, and can be the result of anxiety prior to coming for treatment. Patients may respond best to stress reducing medications or relaxation techniques.
• Chemotherapy induced nausea can start with the onset of treatment or be experienced several hours later.

Cancer treatment may damage your nervous system, and cause neuropathy, or problems with nerve function.

Common symptoms include:

• Tingling, burning, weakness, or numbness in the hands or feet
• Sudden, sharp, stabbing, or electric shock pain sensations
• Loss of sensation of touch
• Loss of balance or difficulty walking
• Clumsiness
• Trouble picking up objects or buttoning clothes
• Hearing loss
• Jaw pain
• Constipation
• Being more or less sensitive to heat and cold

Treatments for neuropathy include medications, topical creams and pain patches. Other treatment approaches include acupuncture, physical therapy and exercise.

Neutropenia is a blood condition characterized by a deficiency of neutrophils, a white blood cell that defends the body against bacterial and fungal infections formed in the bone marrow. Chemotherapy medications are the most common cause of neutropenia, but other medications can also be a cause.

A low neutrophil count greatly increases the risk of developing an infection. There are various levels of neutropenia with the lower level indicating a higher risk of infection.

Pain during cancer care can have many causes including the cancer itself putting pressure on or damaging organs, nerves or bones, certain cancer treatments like surgery, radiation, chemotherapy, and growth factors, other diseases such as arthritis, infections, and blocked blood vessels.

Treatment for cancer pain usually includes the use of medications and is based on the underlying cause. Talk to your physician to learn more about effectively managing your pain.

Shortness of breath, medically known as dyspnea, can be caused by several factors. The treatment depends on the cause and may include medications, a blood transfusion, physical therapy, or respiratory therapy.

Coping with the stress of cancer and treatment side effects is challenging. Many cancer patients experience anxiety and feelings of depression. Feeling overwhelmed, hopeless, isolated, tearful, and having difficulties concentrating are common. Speaking with a counselor or practicing relaxation techniques helps some cancer patients feel better. Relaxation techniques can help with sleep, energy and reducing anxiety.

There are different methods to help relieve day-to-day stress. A simple relaxation exercise that can be done through the day includes:

• Finding a quiet place
• Staring at an object or close the eyes and thinking of a peaceful scene
• Taking a deep breath in through the nose and breathing out through the mouth, pushing all of the air out of the lungs
• Placing one hand on the abdomen while taking a breath in through the nose and letting it out through your mouth, focusing on the way the muscles are working to help breathing

At Penn Medicine, we offer a variety of counseling and integrative oncology services to help you manage the stress of ongoing cancer treatment.

A change in the way food may taste and/or smell can often be a side effect of cancer or cancer treatments. Here are a few tips and resources for improving the taste of your meals and decreasing any unpleasant odors. Patients who feel they need help managing these side effects may benefit from meeting with a registered dietitian.

• If certain foods taste bland, experiment with spices and herbs or condiments
• Add cleaned mint, orange or lemon slices to water
• Reduce lingering unpleasant tastes by practicing good oral hygiene
• Suck on hard candies like lemon drops or root beer barrels
• If you are bothered by smells while cooking, ask for some help in the kitchen preparing meals or open a window or oven fan
• Serve foods at room temperature to reduce strong smells