By Alison Massey as told to Susan Bernstein
There is a perception that chemotherapy is like treatments from 20 or 30 years ago. They believe it will have side effects that are intolerable, but we’ve made significant strides in addressing the toxicities associated with these cancer drugs. People think chemo will make them sick, but that’s not the case. Each individual treatment regimen has its own side effect profile. When you look at the list of possible side effects, people can get overwhelmed. Most people experience a side effect, but nobody gets every possible side effect.
In general, people are a little tired or have a drop in energy for a few days. But between your treatments we hope you can go about your normal life. We have many people who continue to work between their treatments.
Nausea is another common side effect, but we’ve made advances in treating nausea that you may also experience with your treatments. We can offer patients a range of anti-nausea medications. Some treatments cause hair loss and if that’s the case we’ll let you know in advance. It’s important to note that the vast majority do not cause hair loss, although some can cause hair loss. We definitely have ways to help you deal with these issues, including prescribing wigs or other remedies. In the case of hair loss, we can also check certain laboratories or consult our dermatological colleagues.
Fatigue is the main thing you can experience with radiation. Radiation can cause inflammation in your body as it kills the cancer. It’s the inflammation that causes the side effects. Depending on what is being irradiated, you may experience pain. For example, if you receive radiation to the lungs, your esophagus may be affected because the radiation may be near that area of your body. If this is the case, you may experience difficulty swallowing or swallowing. You may even feel food getting stuck after swallowing it. People who have radiation may not realize that it can affect food swallowing.
Sometimes people need radiation of a painful lesion. In people with advanced lung cancer, while you are being irradiated at a specific site, you may experience a flare-up of this pain. Ultimately, the hope is that the pain will go away. During this time we may also treat you with painkillers or steroids such as dexamethasone to minimize the inflammation that is causing pain.
checkpoint inhibitors [immunotherapy medications for lung cancer] can have side effects, but they are different from chemotherapy because they affect your immune system. These drugs can overactivate your immune system, leading to side effects. Sometimes we see patients develop dermatitis, which presents as a rash, or colitis, which causes diarrhea, or pneumonia, which can cause shortness of breath or a cough. Checkpoint inhibitors can also cause arthritis or myositis, which is inflammation of your muscles. Sometimes we can even see swelling of your joints. It is important that patients who experience new symptoms while taking a checkpoint inhibitor let us know so we can start treatment. The quicker you tell us about these side effects, the sooner we can treat and reverse them.
Anxiety and depression are two things we deal with very often during cancer treatment. In my experience, people can feel lost when they are first diagnosed. But once you’ve found your oncologist and your entire cancer support team, and know you have a plan of attack to treat your cancer, most people feel better. Many are afraid of cancer treatments and the potential impact of the treatment on your quality of life. We let people know that they can still live their lives and should keep doing the things they enjoy.
Your mood and outlook may depend on where you are in your cancer treatment journey or disease progression. In the beginning, most people are more functional and tire less. Some people may still be able to work. Others may need to stay home for a few days after each treatment. Our goal is that you don’t stay in bed all the time during cancer treatment. Keep an active schedule as much as possible. Be aware that you will be tired after the treatment and plan for these days. And don’t forget to ask for help if you need it!
Good sleep can also affect your mood and quality of life. Many of our patients suffer from insomnia. Oftentimes, anxiety can cause this insomnia. Your mind is racing so you can’t sleep. Also, some of the drugs you take for nausea or steroids for inflammation can rev you up and cause insomnia. And sometimes an annoying cough can disturb your sleep.
Some people with lung cancer may need to use supplemental oxygen. In my experience people struggle with the idea of carrying oxygen because now, as well as the association with hair loss, people can see from the outside that they are sick. But from a medical point of view, it is important to carry it when you need it.
Loss of sexual function is something we see in both men and women. In my experience, men are louder about this, so speak up ladies if you have any concerns! Erectile dysfunction can affect men undergoing cancer treatment. Women may experience vaginal dryness or pain during intercourse. If this happens and you tell us, we may refer you to a sexual health doctor. Treatments can also affect women’s menstrual cycles. If you are someone who could become pregnant, you should be careful to use contraception while being treated for cancer.