Cancer treatment guide: Common side effects and how to manage them

Understanding your or your loved one's cancer treatment plan can help you understand the aims and likely outcomes of treatment. 

It can also help you prepare to manage any side effects or symptoms of both the cancer and its treatment.

What type of cancer treatments in Singapore are there? 

There is a range of different treatments used for different sorts of cancer. Some treatments are used in combination with each other, and some cancer treatment regimes can begin with one type of treatment and move on to another.

A cancer treatment plan is developed and recommended on an individual basis by oncologists - doctors who specialise in cancer treatment. There are different treatments targeted to different types of cancer, different stages of cancer, and whether or not a cancer has spread.

A cancer treatment plan will also take into account a person's existing state of health and functional ability. Some aggressive cancer treatments may not be suitable for everyone, particularly people who are already frail and have severe co-existing health conditions.

Cancer treatments can take the form of one or more types of therapy, including:

• Surgery
• Chemotherapy
• Radiation therapy
• Targeted therapy
• Immunotherapy

Common physical side effects of cancer treatments

Some cancer treatments can have widespread effects on the body, and unpleasant side effects. Chemotherapy and radiotherapy can damage healthy cells as well as cancerous ones.

Some medications used for cancer treatment can seriously affect the immune system, making cancer patients both more likely to develop infections, and more likely to become seriously unwell when they do.

The side-effects of cancer treatment can sometimes feel worse than the effects of having the cancer up until that point, and sometimes that can be overwhelming, and affect a person's willingness to continue treatment.

Side effects are common, which means that oncology teams are experienced in helping people manage them, and help is at hand.

Appetite loss

Loss of appetite can be a result of other symptoms caused by cancer and side effects of cancer treatments, such as nausea and vomiting, pain, fatigue, depression and sore, dry mouth.

Taking steps to improve these other symptoms can help, but a poor appetite is still closely associated with cancer treatment. Having nutritious, small but nutrient-dense meals can help limit weight loss and maintain energy.

Supplements like build-up drinks and high-calorie soups and puddings are available for people at risk of malnutrition and problematic weight loss. Eating smaller, more frequent meals can help with feelings of fullness and bloating.

Some chemotherapy agents can affect a person's sense of taste and smell, impacting their enjoyment of food. Shifting the focus onto interesting and enjoyable textures or temperatures can help; ice cream can soothe a sore mouth, and icy drinks can be refreshing even when it's hard to taste them.

Hair loss

Some chemotherapy agents cause thinning of the hair, and sometimes this hair loss can be very severe and affect other facial and body hair too.

Wigs, hats and scarves are available and can be very effective, and just talking over your feelings about hair loss with a loved one can help too.

Dry mouth

Staying well-hydrated is important, but sometimes cancer treatment can cause a dry mouth that's hard to manage. Good oral hygiene is important, and regular mouth care can help keep the delicate tissues of the mouth moist and comfortable.

Products are available to enhance or mimic natural saliva production, and there are effective treatments for other problems like oral thrush.

Nausea and vomiting

There are some home remedies for nausea which work well for some people, such as peppermint tea, or nibbling a ginger biscuit.

However, some cancer treatments can cause problematic nausea and vomiting, and oncologists generally expect people to need some anti-sickness medication ("antiemetics") as a routine part of many treatment regimes.

If you're having problems with nausea, medications can help and there are a few different types that your doctor can prescribe - if one isn't working well for you, they may be able to recommend a different one. Staying hydrated and eating when you're able to is important to help you stay healthy.

Fatigue

Having cancer in itself can cause extreme fatigue, and some cancer treatments can also be a cause of fatigue, or exacerbate this symptom if it's already present.

Feeling drained, constantly exhausted, and unable to enjoy normal life activities is one of the most distressing things about serious illness and intensive therapies.

There is no easy way to "get rid of" fatigue, but there are ways to manage it so you can enjoy your life as much as possible. It may be possible to notice a pattern of fatigue and changing ability in line with a treatment regime, and to plan your days around the times when you're feeling most capable and alert.

Allowing yourself to rest when you need to is important; anyone having treatment for cancer is already under a lot of physical and emotional stress, so being kind to yourself is key.

Getting enough rest, eating a nutritious diet and, if possible, getting a little gentle exercise and fresh air can help with symptoms of fatigue. You may need to adapt the activities you enjoy a little; if you feel too tired to read, try an audiobook; if socialising feels overwhelming, try short meetings with close friends.

Pain

Pain is one of the most difficult, draining problems associated with cancer and with some cancer treatments.

Oncology teams work very closely with pain specialists to help patients manage this distressing symptom.

There are lots of good, safe painkillers available, and specialists can help find the right medication or combination of medications to help manage pain.

Fertility/sexuality

Some cancer treatments can affect fertility, and people who may later wish to start a family should discuss this with their oncologist before starting treatment. Both men and women can have their fertility affected by some forms of cancer treatment, and there are a number of options for those affected.

Sexual interest and function can also be affected by some cancer treatments, and as a result of the emotional impact of a serious disease, changing body and self-image, and other symptoms.

An understanding and empathetic partner and open communication can help, and if sexual dysfunction is causing a serious problem, a member of the oncology team may be able to give specific advice.

Some cancer treatments are not safe during pregnancy, so it's important to take steps to avoid becoming pregnant while having certain treatments. Ask your oncologist if you have any concerns.

Constipation

Constipation can become a serious problem - being less active, having a poor appetite, and some medications for pain can slow down the gut and cause constipation. There are a variety of gentle laxatives available, and even gentle exercise and including a little more fibre in the diet can help too.

Common emotional side effects of cancer treatments 

The emotional and psychological effects of having cancer and going through cancer treatment can be complex. Just being told that you or a loved one has a serious illness, possibly an illness that may lead to the end of life can cause a wide range of deep emotions.

There is no right or wrong way to feel about cancer treatment; grief, loss, anger, denial and a sense of hopelessness are all common emotions when faced with a serious diagnosis, whether that diagnosis is life-threatening or not.

As well as the primary emotional response to having a serious illness, the physical effects of cancer and cancer treatment can also cause a rollercoaster of difficult emotions.

Being less able to do the things you love, having to take time off from work, and feeling tired and unwell can be difficult to cope with. It is difficult to live with pain, and many people worry about their family, finances, and the practicalities of illness.

For those whose cancer is not likely to be curable, the thought of death and of leaving one's family and friends behind them can be very difficult to come to terms with.

The physical impact of living with cancer can have a huge bearing on a person's psychological and emotional wellbeing, so sometimes treating the physical side effects can reduce some of the emotional impact.

When to call a doctor 

Cancer treatments are notorious for having unpleasant side effects - not all do, and not everyone has the same experience even from the same treatment, but people's perception of cancer treatment is generally negative.

Although some unpleasant side effects are normal, help is available to help manage them. The very fact that these side effects are common means that doctors are experienced in helping people manage them.

Cancer and some cancer treatments can make some people more likely to become unwell in other ways, however, so it's important to know when symptoms are a normal side effect, and when they could be a sign of something more serious.

It's important to get urgent medical help for symptoms that could indicate other conditions.

Signs of infection

Some cancer treatments can seriously affect the immune system's ability to fight off infections - you can become more prone to developing an infection and more likely that it will become serious if you do.

Infections can lead to sepsis, a life-threatening condition where the body's reaction to infection can begin to damage its own organs and tissues. A very high temperature, shivering chills, flu-like symptoms, shortness of breath and chest pain should be urgently assessed by a medical professional.

Other signs of serious infection could be a productive cough, blood in the urine, or confusion.

Chest pain

Chest pain can be a sign of serious conditions including blood clots in the lungs, pneumonia, and heart conditions like arrhythmias and myocardial infarction (heart attack).

Some cancers and some cancer treatments can increase a person's likelihood of developing blood clots, particularly causing pulmonary emboli (PEs) - clots in the lungs, and deep vein thromboses (DVTs) - clots in the deep veins, typically in the legs.

Symptoms of a PE include chest pain and shortness of breath, and a DVT can cause heat, pain and swelling - usually in one leg but occasionally in both.

Shortness of breath

Shortness of breath can be a symptom of a PE, chest infection, or heart problems. It can also be a simple side-effect of being generally unwell, but if you are experiencing shortness of breath that is out of the ordinary for you, it's important to get it checked out urgently.

Confusion

Confusion is a very classic sign of a potentially serious infection. Urinary tract infections and severe chest infections are common culprits for causing severe systemic infections leading to life-threatening sepsis. Signs of sepsis are a medical emergency and usually need hospital treatment.

Fever

A fever is a high temperature - over 37.8°c is not normal, and over 39.4°c is a very high fever. It isn't necessary to have a thermometer to suspect a fever, however; feeling very hot or very cold, shivering and feeling unwell are enough to know that something isn't right.

A person with a fever may feel hot to touch, but that isn't always a reliable way to tell. Sometimes people with a fever feel very cold and shiver, but it's important that they don't try and wrap up and get warmer.

A very high fever can cause convulsions and even seizures, and is a sign of a severe infection or sepsis.

People with compromised immune systems and underlying serious illnesses can become very sick, very quickly. If you suspect that symptoms might be caused by something serious, seek medical help straight away.

If ongoing side effects are hard to manage, get advice from your oncology team or GP as soon as possible.

Continuing treatment

If you have side effects that are making you reluctant to continue your cancer treatment, it's important to talk to your doctor before you make any treatment decisions or stop taking any medication.

You need professional input when you're weighing up the pros and cons of cancer treatments and considering other options.

If side effects of cancer treatment - fatigue, pain, nausea and so on - are making it harder to look after yourself, having the support of dedicated carers can make all the difference.

A personalised cancer care package can help take off some of the burdens of activities of daily living with a serious illness or with unpleasant side effects, leaving you free to spend your time and energy on the things that matter most.

ALSO READ: Nausea, vomiting, loss of taste - what can you eat during cancer treatment?

This article was first published in Homage.