Fatigue as a side effect

Chemotherapy drug treatments can be effective, but they also seem to be linked to intense fatigue. Drugs that often cause cancer-related fatigue are vinblastine, cisplatin and vincristine.

The severity of fatigue may vary by individual, but almost 90 percent of cancer patients experience some level of fatigue related to cancer treatment at some time during therapy. It is also known that the symptoms from fatigue can last for months or years after cancer treatment.

Specifically, fatigue can be caused by cancer-related anemia or low thyroid function and can intensify with emotional distress or depression related to the cancer treatment. A patient with fatigue may feel weak, forgetful, have decreased energy level and an inability to concentrate.

Drug Treatments to Reduce Fatigue

Physicians treat cancer patients that suffer from fatigue in a similar way to patients with anemia. Doctors use drugs that produce hormone and stimulants such as Ritalin (methylphenidate) and Provigil (modafinil).

Other Treatments to Reduce Fatigue

None-drug treatments such as exercise, diet and conserving energy have been shown to reduce fatigue.

Exercise

Doctors put their patients on a low-intensity exercise regimen to avoid the loss of too much muscle mass that can lead to fatigue more easily than someone that does some sort of physical activity. Too much high-intensity exercise is not good for cancer patients since it can put the immune system at risk.

Diet

Cancer patients can monitor their diet to help reduce fatigue. If a patient doesn’t maintain the proper nutrition by eating the right foods, this will contribute to fatigue. It is recommended that a cancer patient gets at least 15 calories per pound of his or her body weight. Proper amounts of protein are also important to help rebuild and repair body tissue. The recommended amounts of protein are 0.5 to 0.6 grams for every pound of body weight. Patients should have a minimum of 64 ounces of fluids per day and limit their intake of alcoholic and caffeine beverages. It is recommended to supplement their diet with a multivitamin that gives them 100% of the recommended daily nutrients.

Conserve energy

Cancer patients should organize their tasks ahead of time and try to schedule rest periods to help save energy throughout their day. The following are some recommendations to conserve energy:

– Take time in the day to rest
– Take multiple short naps or breaks instead of one long break
– Save energy for important tasks
– Get help to delegate some tasks
– Moderate pace is better than rushing through tasks

Oral Mucositis – Sores in Mouth and Throat

Some chemotherapy drugs can cause sores in the mouth or throat because they inhibit the replacement of the healthy cells. The condition that causes sores in the mouth is known as stomatitis, and a comparable condition in the throat is known as pharyngitis.  

The lining of the mouth starts to become pale and dry. As time goes on, the mouth and throat may become red, sore and inflamed. The patient may have trouble eating, talking or swallowing. Eventually, the condition can lead to painful, bleeding ulcers and possibly infection. This condition normally develops approximately 5 to 14 days after chemotherapy treatment has taken place. These conditions eventually heal once chemotherapy treatment has ended. 
 
It has been determined that up to 75 percent of patients who receive high-does chemotherapy get oral mucositis and approximately 40 percent of patients that receive standard-dose chemotherapy experience this side effect. 

  
Drugs That Cause Oral Mucositis 
 
Some chemotherapy drugs such as methotrexate and 5-FU have shown to cause a higher incidence of oral mucositis than some others. If the patient is treated early, it can lessen the severity of the symptoms. 
 
Treatments to Reduce and Relieve Incidence of Oral Mucositis 
 
There are some common none-drug treatments to help reduce the severity of oral mucositis. 

Following are some steps that can be taken to help the healing process: 

– Keep the mouth clean and moist 
– Brush teeth with a soft toothbrush or swab 
– Stay away from mouthwashes; rinse with salt or baking soda solutions 
– Stay away from foods and juices that are acidic 

There are some medications that have been recommended and administered to cancer patients to help alleviate pain from oral mucositis. They include the following: 
 
– Tylenol liquid (acetaminophen) – helps relieve pain but doesn’t heal sores 
– Kepivance (palifermin) – this drug is used for severe cases of oral mucositis in patients with  
  blood cancers 
– Gelclair (hyaluronate)- relieves pain by creating a protective barrier and coating the oral  
  mucosa 
– Saforis (glutamine) – a new drug known to be effective in preventing and treating oral mucositis 

Anemia

Chemotherapy drug treatments can cause anemia, a condition that results in a low red blood cell count (RBCs). Symptoms such as fatigue, weakness, increased heart rate, dizziness and shortness of breath result because there aren’t enough red blood cells to carry nutrients and oxygen to the body tissues. These symptoms can also inhibit the intensity of the cancer treatment.  
 
Most patients treated with chemotherapy drugs are likely to get anemia. Patients with lymphoma, myeloma and leukemia are also susceptible to anemia because these diseases grow within the bone marrow and squeeze out more healthy red blood cells. Some patients may not get anemia because of cancer, but some may already have a tendency toward it such as premenopausal women.  
 
A doctor can determine whether or not a patient has anemia by evaluating the concentration of hemoglobin in the blood and the hematocrit levels. 
 
– Red blood cells contain a protein called hemoglobin that carries oxygen to the muscles and organs.  If the number of RBCs is low, the hemoglobin concentration is below the normal range. 

The normal range for women is 12 to 16 grams per deciliter and 14 to 18 grams per deciliter for men. 
 
– The percentage of total blood volume occupied by RBCs is known as hematocrit. The normal hematocrit levels should be between 37% and 52%. Usually, these percentages are higher in men than in women. 
 
Normal Adult Values-Male             Female 

RBC                          4.5 – 6.0 M/ul4.2 – 5.4 M/ul 

Hemoglobin (HgB)14 – 18 g/dL12 – 16 g/dL 

Hematocrit (Hct)40 – 52%37 – 47% 

  
 
Drugs That Cause Anemia 
 
Overall, most chemotherapy drugs can cause anemia because they tend to lower blood cell counts due to their toxic effects on bone marrow that is responsible for producing blood cells.  
 
Some cancers cause anemia due to blood loss. Cancers that have an impact on the genitourinary or gastrointestinal tracts may cause bleeding. Tumors are another cause of bleeding, they can bleed from within.  

 
Treatments to Reduce Anemia 
 
If a cancer patient shows signs of severe anemia, a blood transfusion can be given to return the RBC levels to a proper level. This option is normally only used in very severe cases because blood transfusions may present some risks. 
 
A more common approach taken to maintain the proper RBC levels is to use a drug called Procrit or Epogen (epoetin alfa). This substance acts like the body’s naturally-occurring substance, erythropoietin, by stimulating red blood cell production. Epogen is usually administered once a week by an injection to boost the hemoglobin levels.  
 
A more recent drug used to treat chemotherapy-induced anemia is Aranesp (darbepoetin alpha), approved for use in 2002, it has the same characteristics as the naturally-occurring erythropoietin. 

Nausea and vomiting and hair loss

Nausea and vomiting

Chemotherapy drugs can cause nausea and vomiting because they irritate the stomach lining and the duodenum. This results in activating the part of the brain that triggers vomiting. It can also be triggered through intestinal blockage and inflammation that are likely chemotherapy effects.

Drugs That Cause Nausea and Vomiting

The severity of nausea and vomiting side effects vary by patient. Some of the chemotherapy drugs that are most likely to cause nausea and vomiting are cisplatin, dacarbazine, mechlorethamine, melphalan, daunorubicin, carmustine, procarbazine, lomustine and others.

Treatments to Reduce Nausea and Vomiting

It is a common practice to control nausea and vomiting by administering some drugs before chemotherapy treatment begins. Some drugs are administered alone or in combination with others to prevent or reduce nausea and vomiting side effects. These drugs are known as anti-emetics and include the following: Ativan (lorazepam), Compazine (prochlorperazine), Reglan (metoclopramide), Zofran (ondansetron), Phenergan (promethazine), and Aloxi (palonosetron).

There are some non-drug treatments to help control nausea and vomiting such as:

– ginger ale or ginger tablets
– soothing music
– relaxation exercises

Hair Loss

Cells formed in hair follicles divide rapidly. It is this characteristic that makes hair loss, also known as alopecia, a common side effect during chemotherapy. The amount of hair loss varies among patients. The patient’s drug treatment schedule and drug dose can also determine the severity of hair loss. This side effect may start with a tingling sensation when the patient’s first strands of hair start to fall out. Hair loss can also occur on the patient’s legs, arm, face (eyebrows and eyelashes), and in the nose.

Drugs That Cause Hair Loss

The chemotherapy drugs that have shown to cause significant hair loss have been drugs such as Adriamycin (doxorubicin), Taxotere (docetaxel) and Taxol (paclitaxel). Other chemotherapy treatments that have shown to cause significantly less hair loss are drugs such as Oncovin (vincristine) and Gemzar (gemcitabine).

Treatments to Reduce Hair Loss

Recently, other treatments have been used that are referred to as “targeted agents” that do not cause hair loss since they are directed only at the existing cancer cells. These agents are Herceptin (trastuzumab) and Gleevec (imatinib).

In other cases where traditional chemotherapy drugs are used, the hair may start to grow back at its normal pace after the chemotherapy treatment has ended. Hair loss from chemotherapy is difficult to prevent with alternative methods; however, it is suggested to use mild hair products, soft brushes, and try to avoid harsh chemicals such as dying and perming products.

Patients can choose to use head coverings such as caps, scarves, hairpieces or wigs. The National Cancer Institute suggests that if a patient does choose to get a wig, it is advised to get it before the hair loss side effects so that it can be colored to match your natural hair color.  

Patients should check with their health insurance company to make sure whether or not the cost of the wig or hairpiece is covered. Some policies do cover them as part of cancer treatment.

Side Effects of Chemotherapy Drugs For Cancer Treatment

When a person is cancer-free and in good health, their cells grow, die and then divide and regenerate in a natural, controlled manner.  Cancer cells on the other hand, tend to divide at an uncontrolled rate and reproduce rapidly. Chemotherapy drugs are used to attack cancer cells and keep them from multiplying uncontrollably.  
 
The chemotherapy drugs are transported through the blood and eventually access the cancer cells. The problem with chemotherapy drugs is that when they attack cancer cells, they can also attack the healthy cells. In most cases, the healthy cells can survive, but sometimes the attack on the healthy cells results in side effects. For the most part, the side effects are only temporary and last as long as the length of the chemotherapy drug treatment. 
 
The type of chemotherapy side effects can vary based on the type of cancer the patient is diagnosed with, the type of chemotherapy drugs that are used for treatment, and how the patient’s body reacts to the drugs.

Religion and Spirituality

Some patients may take solace in their religious or spiritual beliefs after receiving their diagnosis.  Patients can often experience an outlet of their pent-up emotions through prayer and meditation.  Many studies have shown that patients who employ such practices have better psychological outlooks during treatment than those who do not.  Also, many clergymen have been trained in counseling techniques similar to those of mental health professionals.  For those patients with religious backgrounds, such spiritual guidance can be very helpful both to them and to their families.  

Also, activities such as meditation, reflection and journaling about the experience can alleviate much of the emotional turmoil in a patient’s mind.  Simple meditation can clear the mind of distracting or negative thoughts.  Slow, steady breathing can improve mental functions and regulate heart rate.  Reflection on one’s life and accomplishments can show the patient that their life is worthwhile and improve their outlook during the most stressful stages of therapy.  Writing a journal about the process can also help the patient work through their emotions in a constructive manner.  Each of these methods is useful in developing a strong mental attitude and aiding in physical healing.

Recovery and Recurrence 

Patients who complete their treatment regimen and receive a cancer-free prognosis may feel as if a massive burden has been lifted from their backs.  In the most literal sense, they have a new lease on life.  While the most arduous part of the recovery process may be over, the work to maintain their health truly begins.  The staff at the Mayo Clinic recommends that patients who have finished treatment continue to take part in all of the activities they started during their recovery.  These include staying with a healthy diet, regular exercise and other healthy habits such as avoiding tobacco and alcohol.

During follow-up exams, some cancers can show signs of recurring at or near the same location in the body where the first tumors appeared.  Many patients will feel the same type of distress and anxiety that they experienced during their initial diagnosis.  Others may start to believe that the time, effort and money spent on combating the initial cancer has been wasted; they may not feel strong enough to go through the same battle all over again. 

One of the advantages that patients who receive a diagnosis of a recurrence can use is that they are much more prepared than they were the first time.  They also have access to many more educational, emotional and social resources and understand the process much better than they did after their initial diagnosis.  Also, in most cases, the treatment schedule will be much easier; patients may experience less discomfort and doctors will be able to treat the patient more effectively and with less “trial and error”. 

A patient who experiences a cancer diagnosis understands it as a life-changing event, both for themselves and everyone in their life.  While the disease and treatment can affect every aspect of daily life, many tools exist today to help deal with the impact.  In order to cope with this trying situation, patients should start asking questions without fear and anxiety.  From there, they should take the information they’ve gathered to form plans and organize details to smooth out the long and arduous process.  Numerous health care professionals and cancer survivors understand that, when fear wins, the patient loses. 

Alternative Cancer Treatments

While many scams and get-rich-quick schemes involve “alternative cancer therapies”, many reputable hospitals and non-profit organizations are also researching non-traditional therapy methods that can offer many of the same benefits.  The study of Complimentary and Alternative Medicine (CAM), while still relatively new, has shown promise to patients who are looking for ways to gain the benefits of current modes of treatment while alleviating many of the painful side effects.  Some of these alternatives include: 

  • Acupuncture to manage pain  
  • Dietary supplements to maintain energy 
  • Yoga and other stretching exercises to keep up muscle strength and flexibility 
  • Therapeutic activities (e.g. art therapy) to combat depression and anxiety

Patients often find comfort in these methods for several reasons: 

  • The patient is taking an active approach to their treatment regimen.  This approach helps the patient to feel less like a “lab rat” or a “guinea pig” than in a clinical setting. 
  • The patient understands how these methods can add to the effectiveness clinical treatment sessions. 
  • Most CAM methods are administered in more welcoming and inviting environments.  These settings allow the patient to take a break from the cold, sterile surroundings of hospitals and doctor’s offices.

Patients should always check with their doctor or health care professional regarding CAM methods.  They should also attempt to do thorough research on the costs and benefits of different CAM treatments. 

Side Effects of Treatment

Another major issue that patients deal with on a consistent basis during treatment is the side effects of the various remedies. Radiation therapy can cause hair loss and digestive problems. Chemotherapy sessions can leave a patient feeling lethargic and depressed. Prescription medications can cause mood fluctuations and disruptions in sleep patterns. Some other side effects that patients could encounter include:

  • Constipation

  • Diarrhea

  • Fatigue

  • Incontinence

  • Low White Blood Cell Count/Weakened Immune System

  • Mouth Sores

  • Nail and Skin Discoloration

  • Nausea

  • Nerve Damage

  • Sexual Inability

  • Shortness of Breath

  • Vomiting

In fact, many patients may fear the treatment side effects more than the damage done by the disease itself. Such fears may make patients hesitant to accept traditional treatment methods. Doctors often prescribe additional medications for the purpose of managing these effects (e.g. opioids for pain, antidepressants for mood swings, antibiotics for infection)

Nutrition and Health

Many patients undergoing cancer treatment often deal with a loss of energy and appetite during the process. Other side effects include weight loss and intestinal or digestive problems. Everyone involved in the patient’s treatment schedule should recommend that the patient maintain a healthy, nutritious diet. Such a diet will give the patient the energy that they will need during treatment and lessen the impact of severe weight loss.

Nutritional balance in a patient’s diet in these stages is critical to the recovery process. Many patients may read or hear about someone promoting an “anti-cancer miracle diet” that promises to treat, or even remove, the cancer without the harmful side effects of traditional therapies. However, most of these fad diets emphasize taking in massive quantities of one type of food, drink or vitamin supplement at the expense of any others. If the patient has such concerns, they should ask their doctor to recommend a nutritionist. These specialists can create and, in many cases, prepare healthy recipes that will meet the patient’s special nutritional needs.

Health care professionals will also recommend that patients refrain from tobacco and alcohol consumption, foods loaded with fats and sugars, and activities that disrupt healthy sleeping and eating patterns. Regular, non-strenuous exercise activities such as walking or bicycling should also help patients grow healthier both physically and psychologically. Simple exercises can improve blood flow, regulate breathing and increase efficacy of treatments.

Social Interaction

Patients often feel some trepidation about broaching the subject of their cancer diagnosis and treatment to their friends, bosses and co-workers. Although they hope that this new fact would not change their friends’ view of them, such is not often the case. Some friends may withdraw out of awkwardness, unsure as to how best to respond. Others may back away out of some innate fear of contagion. Still others may be overly inquisitive or obsequious, treating the patient as a fragile china doll and fearful that they may break. Employers may make plans to alter or lessen patients’ workloads, causing resentment from co-workers. For example, employers fearful of clients’ reactions to the patient’s diagnosis may move patients whose primary duties involve face-to-face interactions with clients away from such direct contact positions.

Just as is the case in dealing with the family, the best avenue for dealing with other people is to be honest and open in answering all questions. Patients should express their gratitude for those who express their sympathy and understanding. They should also be prepared to answer the concerns of those who may feel that the disease will impact their relationships, either personally or professionally. Patients can also take this opportunity to address any issues their employers may have in terms of both their ability and availability to carry out their duties during treatment.

Support groups also provide excellent avenues for a patient to have a level of social interaction. These groups can give the patient something that no other group involved in the process can: the voice of experience. For patients at the beginning of their treatment regimen, they can chat with (either in person or online) other group members who have moved into more advanced phases of treatment and can let them know what to expect as their treatment progresses. Such groups can pass advice, share stories and reinforce the idea that the patient is not alone in their process. Groups can serve the purpose of both emotional support and educational resource and many are tailored to the patient’s age, background and specific form of the disease.

The journal Social Science and Medicine published a study that showed a statistical link between social support and recovery:

“Coping was assessed half a year after surgery, while benefit finding was examined 12 months post-surgery. Correlational and path analyses showed a link between personal resources (self-efficacy) as well as social resources (received social support) and benefit finding. The effect of self-efficacy disappeared when coping was specified as a mediator between the resources and benefit finding. Social support retained a direct effect on benefit finding. The results emphasize the predictive quality of resources for recovery and adjustment after surgery and the mediating role of coping.“

Whether it is through family, friends or peer groups, patients should realize that they are not alone in their efforts. Any constructive social outlet can help patients understand that they have resources to communicate their ideas in spite of the disease. As patients at one highly esteemed cancer center say in their television commercial, “I have cancer, but it doesn’t have me.”