Coping With Side Effects

Most patients will experience some side effects from their treatment, but great progress has been made in treating or minimizing many of them. If you are experiencing side effects, please make sure to let your doctor or nurse know so they can track your progress and offer ways to help.

Here is a guide to the most common side effects and how to manage them.

Common Side Effects

Anxiety

It is very common for a person to feel anxious when facing a new or stressful situation. We all feel worried at times in our day-to-day lives. People may experience anxiety as nervousness, tension, panic, fear, or feeling like something bad is going to happen. Anxiety can also be experienced as physical symptoms such as upset stomach, sweaty palms, fast heartbeat, shaking, or flushed face.

Although it is normal to feel anxious when facing a life-threatening illness and intensive treatment, there are things that may help you decrease the feelings of anxiety or learn to cope with it. Most importantly, get professional help when you need it.

Important Signs and Symptoms

Report symptoms to your doctor or nurse during clinic hours today if you are experiencing:

Feelings of dread and apprehension for several days
Physical symptoms such as sweaty palms, shaking, and rapid heartbeat (which can also be side effects of treatment)
Wide mood swings that you cannot control

What You Can do at Home

It will help if you can learn how to cope with anxiety. Try these things, and see if it helps.

Recognize that anxiety during treatment is normal and so is getting help for it.
Try to understand what thoughts trigger your anxiety. For example, if you are anxious about a medical procedure, ask yourself what it is about the procedure that is upsetting. Then ask yourself how you would change the procedure so it doesn’t make you so anxious. Staff may be able to help make those changes, so talk with them about it.
Get the facts. For example, if you are worried about pain or discomfort, ask for information on how to manage pain or discomfort.
Think about doing things that are pleasant and relaxing. This can help reduce anxiety. Relaxation is a skill that can be used to counteract anxiety. It’s nearly impossible to be relaxed and anxious at the same time.

Get Professional Help When Needed

If anxiety doesn’t improve despite your efforts to reduce it, discuss it with your nurse, doctor, or social worker. Or ask for a referral to a mental health counselor.

Body-Image Changes

Some people experience weight loss or gain, a loss of stamina, or skin reactions during their treatment. Though most of these side effects are temporary, they can still have an impact on your self-esteem. Paying attention to skin care, diet, exercise, and attitude are healthy ways to cope with body image changes. Finding ways to express your feelings about the changes is very important.

Cancer treatment can affect your body and your life in ways that are hard on your self-esteem. Weight loss or gain, loss of stamina, skin reactions, and puffy face can all be distressing if you think of your body as being who you are. Fortunately, most of these side effects of therapy are temporary.

The first step is to direct your energy and thoughts toward what you can and will do for yourself. Paying attention to skin care, diet, exercise, and attitude are healthy ways to cope with body image changes. Finding ways to express your feelings about the changes is very important.

Important Signs and Symptoms

Report symptoms to your doctor or nurse during clinic hours today if you are:

Feeling very sad or very angry most of the day
Losing interest in life because of changes in your body
Not taking care of yourself (not exercising, dressing, or caring for your skin)

You may benefit by talking to your social worker or a mental health counselor.

What You Can do at Home

Maintain a confident and positive self image.
Express your feelings to a trusted family member, friend, nurse, or social worker.
Talk with other people who have had similar treatment about what they did and how they coped with changes in body image.
List your best points. Then list your options for what you would like to try to maintain a good body image.
Laugh! Humor is a fine way to cope. Treat yourself to funny movies, TV shows, books, or even people.
Take advantage of programs to help you look your best during cancer treatment.

Consider Using a Hair Alternative

Buy or borrow a wig. Fred Hutchinson Cancer Center provides one complimentary wig to Fred Hutch patients for hair loss. For a wig fitting, contact the Patient & Family Resource Center. Most offices of the American Cancer Society can give you information or help you get a wig.
Learn where to buy or get a free wig or hair piece, and how to get help with head shaves and wig fittings.
Use a headwrap. Making headwraps out of scarves is easy. A headwrap can complement your looks. The emphasis should be on color and texture rather than on complicated tying techniques. The book Beauty and Cancer, by Diane Doan Noyes and Peggy Mellody, gives instructions on headwraps (as well as skin care, makeup, clothing, nutrition and exercise).
Try turbans, scarves, hats, or caps. Head coverings enhance appearance, protect against drafts, and help retain body heat.

Wear Attractive and Comfortable Clothing

Wear colorful clothing. Chemotherapy and radiation tend to make skin pale, sallow, or ruddy. Colors and interesting patterns can decrease the intensity of changes in skin tone.
If your face becomes very round or puffy, wear a V-shaped neckline.
If you have lost a lot of weight, try a round or oval neckline.
Avoid any garment that might puncture or break your central intravenous line, such as pins or front-clasping underwire bras. Soft fabrics drape best over catheters.

Take Care of Your Skin

Select skincare products that you like that are inexpensive, fragrance-free, hypoallergenic, and alcohol-free.

Cleanse your skin twice a day. Mild soap and water is the most basic cleanser and is especially good for oily skin. Cleansing creams are good for dry and normal skin because of their moisturizing effect. All cleansing products should be applied gently to avoid pulling the delicate surface of your skin. Use caution to avoid bruising the skin.
Use a moisturizer to help skin retain its moisture.
Avoid alcohol-based products.
Avoid hot water.
Wear sunscreen or protective clothing when outside.
Report any skin changes, such as rash or inflammation, to your doctor or nurse.
Get help from Fred Hutch’s oncology store, Shine, where trained staff can help you find products that are most appropriate for you. Contact Shine at (206) 606-7560. Located one block west of REI in downtown Seattle.

Build Stamina With Exercise

Talk to your doctor before beginning any new exercise program.
Exercise daily. Exercise is one of the simplest and most effective ways to reduce stress, increase stamina, and gain a feeling of well-being.
Begin slowly with low-intensity exercise, such as walking. Let your body be your guide. Your body will tell you what your limits are. Don’t overdo it. A good rule of thumb is to never be out of breath; you should always be able to talk.

Fatigue

Fatigue is an unusual whole-body tiredness not relieved by sleep. During cancer treatment, fatigue can be caused by intensive treatments, medications, low levels of circulating red blood cells, and side effects. Learn what you can do at home to help.

Being tired is a very common experience for patients. Fatigue is a daily lack of energy, an unusual or excessive whole-body tiredness not relieved by sleep. There are a number of things that cause fatigue: intensive treatment, medications, a lower-than-normal number of circulating red blood cells, stress, decreased nutrition, nausea, vomiting, mouth sores, taste changes, heart burn, diarrhea, disruption of normal resting and sleep habits, or feelings of depression. It usually takes time to work out ways to live with fatigue.

Emergency Signs and Symptoms

Your caregiver should call 911 IMMEDIATELY if you, the patient, cannot be awakened.

Urgent Signs and Symptoms

Call your Fred Hutch clinic or the after-hours phone number NOW if you are:

Dizzy
Too tired to get out of bed or walk to the bathroom

Important Signs and Symptoms

Report symptoms to your doctor or nurse during clinic hours today if you experience:

Worsening fatigue
Staying in bed all day
Other symptoms in addition to increased fatigue like:
- Increased weakness or exhaustion
- Drowsiness or confusion
- Loss of balance
- Having to catch your breath

What You Can Do at Home

There are ways to take care of yourself and deal with fatigue.

Establish regular rest and sleep periods.
Set up a regular daily schedule for nap and sleep times.
Keep active during the day to sleep better at night.
Play soft music or turn on the TV as background noise.
Meditate or pray.
Ask a nurse or family member for a back rub to help you sleep or rest.
Keep a diary for one week to monitor fatigue levels. Note what you think may be contributing factors.
Conserve your energy.
Rest between bathing, treatments, and exercise.
Do things or be active only for short intervals.
Plan activities, such as exercise, visiting, or trips, when you’re feeling the most rested and energetic.
Decide on the most important activities for the day. Be realistic.
Exercise regularly. This helps reduce fatigue. It sounds contradictory, but it helps.
Eat snacks between meals to keep up energy.
Plan ahead and organize your work.

Intimacy and Sexuality Self Care

Chemotherapy, radiation, and surgery can cause physical and emotional changes that may affect your sexuality and intimate relationships. Your care team can offer guidance on addressing your concerns.

Managing Care at Home

An important part of your care during cancer treatment is the care you will receive at home from yourself, your family, and your caregiver. Our patients and staff have developed a list of suggestions for managing care at home.

Here are some suggestions for managing care at home, developed by Fred Hutch patients and staff to help you.

Ask questions of your doctor and nurse. Do not make assumptions. If you are not sure, use the phone numbers provided, and call your clinic or the after-hours phone number.
Remember that you are a member of the health care team, and your input is important. Keep your nurse and doctor informed of any issues, questions, or concerns you may have.
Review the symptom sheets your health care team gave you, if you are experiencing any symptoms.
Review hints for self-care if you are the patient or the caregiver.
Ask your family and friends for help before you are too fatigued.
Keep a list of what friends can do, and delegate. For example, one person could drive you to an appointment, another could make a meal, and another could go to the grocery store. See tips for getting the help you need.
Organize your day as the patient and as the caregiver into manageable segments.
Develop a schedule for each day and each week with your family and your caregiver. This process allows everyone to be in agreement with the goals for the day or week, as the case may be. If everyone is working with the same agenda, the tension within a family usually decreases.
Stop by the Patient & Family Resource Center to pick up free copies of the informative National Cancer Institute publications, Taking Time and When Someone in Your Family Has Cancer.

The staff at Fred Hutch is here to support you as the patient and as the caregiver. Tell your physician or nurse if you need more support. Call your social worker for additional emotional support.

Memory and Concentration Problems

Changes in memory and concentration are common throughout treatment. In most cases, the changes are temporary. Your memory and concentration will improve after treatment is complete and you start feeling better. Until then, we have tips to help.

Changes in memory and concentration are common throughout treatment. In most cases, the changes will be temporary. Your memory and concentration will improve after your treatment is complete and when you start feeling better.

Memory and concentration problems may be situational and vary day by day due to stress, pain, medications, menopause, aging, and fatigue. Since you may have good and bad days, you may want to use routine strategies to assist you when you are having a bad day.

Urgent Signs and Symptoms

Call your Fred Hutch clinic or the after-hours phone number now if you feel:

Disoriented
Confused

Important Signs and Symptoms

Report these symptoms to your doctor or nurse during clinic hours today if you are:

Forgetting things more quickly and more often than usual
Finding it harder to read more than a paragraph or a page at a time
Finding it difficult to keep your mind from wandering.

If problems persist or affect day-to-day living to a large degree, discuss the symptoms with your nurse or doctor. Or, ask your nurse or doctor about a referral to a neurophysiologist, who evaluates memory.

What You Can Do at Home

Learn how to cope with temporary changes in memory and concentration

Write down important information. Keep these notes on a notepad that is small enough to keep with you at all times.
Establish consistent daily routines.
Have a regular sleep time and eat nutritious snacks and meals.
Manage your stress.
Keep distractions to a minimum.
Ask people to repeat things.
Keep a list of questions for your doctor. Write the answers down.
Tape record important conversations or conferences.
Get important information in writing. Ask people to write it down for you.
Place notes around the house to remind you of things.
Keep an appointment calendar.
Use a device to remind you to take your medications, such as a watch with an alarm that can be programmed to go off at times when medications need to be taken.
Keep things in a designated place—for example, always keep your keys in the same place.
Be understanding with yourself, and know that these temporary changes are to be expected.
Ask your doctor to review your medications.

How Can I Keep My Mind Active?

Puzzle books: Crossword puzzles are known to improve mental skills.
Sudoku: Similar to a crossword puzzle but with numbers instead.
Card games: Start with a shuffled deck of cards and a stopwatch. Sort the cards into separate piles, one for each suit (diamonds, clubs, spades, and hearts). Do this three times daily. A typical young adult can do this in 35 seconds. Keep practicing this task until you can do it in that amount of time!
- Creative Whack Pack, a card pack that has ideas for stimulating creative thinking and alternate problem-solving methods.
- Play and learn other card games such as bridge, rummy, pinochle, canasta, cribbage, black jack, and solitaire.
Games: Play stimulating games such as chess, checkers, Scrabble, and other games you enjoy.
- Nintendo Playstation’s Brain Age is a game developed by neuroscience researchers to improve mental abilities and hand-eye coordination.
Hobbies: Learn a new skill, such as knitting or crocheting, or a new sport. Try writing and brushing your teeth with the opposite hand from the hand you usually use.
Conversations: Enjoy a cup of coffee with a friend and discuss world events.
Languages: Learn a new language. Rosetta Stone has CDs that you can purchase in various languages.
Read books: Join a book club, or attend a book reading. A few suggestions include:
- The Better Brain Book, by David Perlmutter and Carol Colman;
- Whole Brain Thinking, by Jacquelyn Wonder and Priscilla Donovan;
- Carved in Sand, by Cathryn Jakobson Ramin (the story of her struggle with early-onset memory loss).
Web sites: A couple of suggestions include:
- Postit Science is a site where you can try out a couple of the exercises from the Brain Fitness Program, which has been used to help veterans with traumatic brain injuries recover some of their capabilities

Nausea and Loss of Appetite

It is not unusual for patients to experience nausea and vomiting at some time during treatment. There are many new ways to help control and treat these side effects of chemotherapy and radiation.

Many patients experience nausea and vomiting as side effects of chemotherapy and radiation. Contrary to what most people think, nausea and vomiting have little to do with your stomach. A number of things can trigger nausea and vomiting:

Chemotherapy agents
Radiation
Persistent pain
Poor kidney and liver function
Medications, such as some narcotics
Infections of the gastrointestinal tract
Electrolyte disturbances
Graft-versus-host disease

Great progress has been made in preventing and treating nausea and vomiting. Some patients have little or no nausea and vomiting and keep eating during most of the treatment process. Anti-nausea (antiemetic) medications are often started before radiation and chemotherapy and then continued on a regular schedule. Even if you do not feel nauseated, you should take the medications. The fact that you have not vomited means that the medicine is working. Many antiemetics can make you feel tired or sleepy. Some people will feel jittery and restless.

Urgent Signs and Symptoms

Call your Fred Hutch clinic or the after-hours phone number immediately if:

You have uncontrolled (constant) nausea and vomiting
There is blood or “coffee-ground” like material in the vomit
Medicines are not kept down because of vomiting
You have weakness or dizziness, along with nausea and vomiting
You have severe stomach pain while vomiting

Important Signs and Symptoms

Report these symptoms to your doctor or nurse during clinic hours today if:

Nausea persists without control from anti-nausea medications
You have projectile vomiting

What You Can Do at Home

Follow these steps to prevent nausea and vomiting or manage symptoms well.

Take your anti-nausea medicine as instructed before nausea starts.
Prior to chemotherapy, lie down in a quiet place for 15 to 20 minutes and relax.
Wear loose-fitting clothes.
Use distraction, relaxation, or deep-breathing techniques such as tapes, visualization, or hypnosis techniques. Try breathing through your mouth.
Keep your mouth clean. Rinse with water often.
Rest in a chair after eating, keeping your head elevated.

Information About Your Anti-Nausea Medications

If you notice that your anti-nausea medicine does not control your nausea, let your nurse know. Different medicine may be used to better control the nausea.
Do not increase the amount of medicine you take without checking with your nurse, doctor, or pharmacist first.
Do not take any over-the-counter medicines without checking with your nurse or doctor first.
Some anti-nausea medicines can cause drowsiness or sleepiness. Do not drive a car or operate any dangerous equipment when you are taking them.
Do not drink alcohol while taking anti-nausea medicines.
If the medicines seem to make you nervous or jittery or cause any unusual sensations, let your nurse know.
Since anti-nausea medicines can make you drowsy, it is advisable to have your caregiver stay with you throughout this treatment period.

Maintain Nutrition and Fluid Intake

Eat small meals during the day so your stomach is not too full.
Eat and drink slowly so only small amounts enter your stomach at one time.
Avoid eating and drinking one hour before and one hour after chemotherapy.
Stay away from sweet, fatty, or fried foods.
Drink cool, clear, fruit juices.
Eat dry food, like toast or crackers, to help ease nausea.
Avoid odors that bother you. If food smells make you sick, avoid being in the kitchen when food is being prepared.
Avoid extreme temperatures in your food.
Keep a wide choice of foods available.

Pain

Taking care of your pain will help you sleep better, feel stronger, and manage your illness more effectively. Most pain can be treated with medication, treatments such as physical therapy, or both. Fred Hutch also has a pain clinic, which specializes in managing the complex pain related to cancer.