Managing the side effects of chemotherapy

You may think you know about chemotherapy, or chemo — the use of drugs to destroy cancer cells. You may know that it can be given through a vein, by mouth, directly into an artery or other body part, or even in a topical treatment. You may also know that people receiving chemo often experience unwanted side effects, such as hair loss.

However, you probably aren’t likely to know just how challenging receiving chemo can be until you or someone you love begins chemotherapy treatment.

Robyn Polesky, an oncology certified nurse with the David and Donna Long Center for Cancer Treatment at Sharp Grossmont Hospital, says that chemotherapy can be difficult for some, but is often very worthwhile, as it has the potential to cure the illness or prolong a person’s life. She says that knowing what to expect and how to manage some of the side effects can help.

While there are many side effects that can be caused by chemotherapy, Polesky says the two most common that patients report are fatigue and nausea. Here, she answers patients’ top three questions about these two challenging side effects.

• When will I begin to feel the side effects of chemo?
  Everyone is different in how they recover from treatment and when the side effects will kick in. The number one complaint people have after chemo is fatigue and many — but not all — experience nausea. Chemo is cumulative, so as you continue with treatments, the side effects may intensify and it may take your body longer to recover.
  
  You will likely receive nausea medication and steroids along with most chemo treatments. The steroids may give you a little extra energy for 24 to 72 hours post-treatment. Many patients report that they begin to feel fatigued a few days after treatment, once the steroids have worn off.

• Why does the fatigue I’m experiencing feel so different?
  Cancer- and chemo-related fatigue often feels different than everyday fatigue. It might feel like there’s never a time that you don’t feel tired and it can cause you to feel weak, weary, discouraged, irritable and even sad.
  
  Listen to your body, rest as needed and try the following tips from the American Cancer Society (ACS):
  • Try to save your energy for the things you most want to do.
  • Take brief naps.
  • Allow others to help you with tasks that can be tiring.
  • Distract yourself with music, reading or watching a favorite show.
  • Use deep breathing, meditation, yoga and other activities you enjoy to reduce stress.
  • Try to stick to a regular sleep schedule and get at least seven hours of sleep each night.
  
  According to the ACS, exercise can also help reduce fatigue. It helps you maintain muscle mass and strength, increases your appetite, and can reduce depression, stress, nausea and constipation.
  
  Moderation is key. Get out and take a walk around the neighborhood or in the park, but don’t overdo it. Get your body moving any way that feels comfortable. Whether you’re new to exercise or experienced, talk to your doctor about creating an exercise program to meet your interests, abilities and needs during treatment.

I’m often nauseous and don’t feel like eating. What can I do?
Quality nutrition during treatment is crucial, so it’s important to address nausea and other chemo-related eating problems. Try to eat even if it’s small amounts. Eating well can help you keep up your strength, increase your energy, maintain your weight and heal. Furthermore, an empty stomach can lead to increased acids, which can make you feel nauseous.

If you are nauseous, it is important to take your medication right away and don’t try to wait it out — it’s not going to get better. If your medications aren’t working, call your care provider’s office and they might be able to prescribe something else.

The ACS offers additional tips to deal with nausea while ensuring you get the nutrition you need:

• If the nausea only happens between meals, eat frequent, small meals and have a snack at bedtime.

• Drink clear liquids, such as ginger ale, apple juice, broth and tea served cold and sipped slowly. Also try ice pops or gelatin.

• Suck on hard candy with pleasant smells, such as lemon drops or mints; avoid tart candies if you have mouth sores.

• Eat food cold or at room temperature to decrease bothersome smells.

• Eat bland foods, such as breads, oatmeal, plain noodles and baked chicken.

• Avoid fatty, fried, spicy or acidic foods.

• Try small amounts of foods high in calories that are easy to eat — pudding, ice cream, sherbets, yogurt and milkshakes — several times a day.

• Use butter, oils and milk when cooking foods to raise calories.

Listen to your body and eat what sounds good and settles well in your stomach. You need fats, carbohydrates, water, vitamins and minerals. Fruits and vegetables are a good choice, just make sure the fruit is washed, and the vegetables are washed and cooked to kill off any bacteria. Along with chicken, fish, eggs, cheese, yogurt and lean red meat, nuts and nut butters are also a great source of protein and calories.

Hydration is also important to your recovery. Dehydration can increase your nausea, cause acid reflux and also lead to fevers.

Water and low-sugar sports drinks are good options for staying hydrated. Simply find something that tastes good to drink and make sure you drink enough throughout the day.
Nutritional drinks, such as Ensure, Boost and Glucerna, are a good alternative if you are unable to eat solid foods. These drinks provide the calories, protein and vitamins that are vital for healing.

“In short, give your body what it needs — fuel, hydration, movement and rest,” Polesky says. 

Talk to your cancer care team if you have any questions, or if your side effects drastically increase or you experience unusual pain, a rash or other allergic reaction, trouble breathing or a high fever.

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