Constipation

Chemotherapy
drug treatment can cause a patient to experience constipation, or the
uncomfortable passage of hard, dry stools that are infrequent. Some
symptoms include bloating, cramping, increased gas and pain. About 50
percent of cancer patients experience constipation. Other side effects
can occur from this condition such as decreased appetite and nausea.

Drugs That Cause Constipation

Some of the medications that increase the incidence of constipation are
opioid pain medications and chemotherapy drugs such as vincristine and
vinblastine.

Other Causes of Constipation

Other than medications there are other factor that can lead to an increase in the likelihood that a patient experiences constipation such as depression, decreased fluid or food intake, dehydration, low fiber diet and lack of physical activity.   

Drug Treatments to Reduce Constipation 

Following are some medications that may help reduce constipation during chemotherapy treatments:

  • Psyllium (Metamucil) 
    – Docusate sodium (Colace)   
    Bisacodyl (Dulcolax)  
    – Sorbitol and sodium phosphate (Fleet’s enema) 
    – Glycerin suppository 
    – Magnesium hydroxide (Milk of Magnesia)  
    Senna (Senokot)  
    – Lactulose (Chronulac)  
    – Magnesium citrate 

Non-Drug Treatments to Reduce Constipation 

Following are some non-drug methods to help reduce the incidence of constipation during chemotherapy drug treatment: 

  • stay physically active
  • try to drink at least 3 quarts of fluids per day
  • try to eat high-fiber foods
  • patients to tell their doctor if they don’t have bowel movement for more than three days

Diarrhea

Chemotherapy drug treatment can cause a patient to experience diarrhea, or the passing of an increased amount of a watery or loose stool multiple times throughout the day. Some symptoms include bloating, cramping, increased gas and pain. About 3 out 4 cancer patients experience diarrhea during chemotherapy treatment due to the attack on the cells in the digestive tract.

Drugs That Cause Diarrhea 

Some of the medications that increase the incidence of diarrhea are
dactinomycin, doxorubicin, docetaxel, methotrexate, irinotecan,
5-fluorouracil, antibiotics or antacids.

Also the dose of the chemotherapy drug can play a role in whether or not a patient experiences diarrhea.

Diarrhea
can lead to dehydration and is a common side effect of irinotecan
(CPT-11). Patient’s should tell a physician when diarrhea occurs and
follow his or her instructions to stop the condition.

Other Causes of Diarrhea

Other than medications there are other factors that can lead to an increase in the likelihood that a cancer patient experiences diarrhea such as
stress, anxiety, food allergies, when a patient receives radiation and
chemotherapy simultaneously, stomach tumor, nutritional supplements and
the length of treatment.

Non-Drug Treatments to Reduce Diarrhea

Following are some non-drug methods to help reduce the incidence of diarrhea during chemotherapy drug treatment


  •  
    – stay physically active 
    – try to drink at least 8-10 glasses of fluids per day (i.e. water, Gatorade, broth) 
    – try to eat small portions of low-fiber foods frequently (i.e. banana, rice, bread, chicken) 
    – avoid greasy, fatty, fried foods 
    – avoid vegetables and fruits 
    – limit caffeine beverages and extremely hot or cold beverages 
    – avoid whole grain bread, cereal, nuts, popcorn 
    – avoid gas-forming foods and beverages 
    – avoid alcohol, lactose-containing products and supplements

Over-the-Counter Medications to Reduce Diarrhea

Following are some over-the-counter medications to help reduce the incidence of diarrhea during chemotherapy drug treatment: 

  • Kaopectate®II caplets 
    Maalox®anti-Diarrheal caplets  
    Loperamide (Imodium®)  
    Pepto® Diarrhea control (follow instructions on container)

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 

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. 

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.”

Emotional Health

After many of the more pressing issues have been resolved, some patients still deal with serious emotional issues during the various treatment phases. Depression, anger, anxiety and frustration often occur with patients as they carry out the long and arduous process. For those patients with a previous history of substance abuse, the impact of the diagnosis may lead to a relapse into addiction as a means of escape. With the frequent need for pain medication that most treatment regimens prescribe, such patients could do more damage to themselves by abusing the drugs that they need to manage their condition.

The emotional aspect of the treatment schedule is almost as important as treating the disease itself. Oncologists, nurses, mental health workers and family members can all participate in this portion of the process. Family members and friends can be observant of the patient’s behavior and watch for any signs of mood changes or alterations in attitude. The patient may be depressed about a lack of progress or frustrated about attending treatment sessions, so the family should do what they can to encourage a positive outlook during this trying time. Health care professionals involved in the treatment routine should also keep an eye on the patient’s emotional barometer. Mental health care specialists can help the patient work through their tumultuous emotional issues and give them the best opportunity to complete their treatment successfully.

Another source of anxiety that patients encounter is the changes in their appearance that often arise from their treatment. Weight loss, hair loss and skin conditions often appear as side effects of radiation treatments and chemotherapy. In the case of breast cancer, patients may require a mastectomy (removal of the breast tissue). These alterations can significantly affect the patient’s self-esteem and self-image; the patient may not feel as attractive, young or vital as they did pre-diagnosis.

Many hospitals and specialty stores carry wigs, makeup and prosthetics to help patients deal with the changes in their appearance. Some cancer patients use these changes as an opportunity to experiment with their self-image. A patient that started treatment with long, blond hair, for example, may want to try a brunette bob wig. Another may use different shades of foundation and lipstick for a new look. Such activities can serve as a distraction from the more painful effects of treatment and allow the patient to forget about their condition for a brief moment.

Financial Issues

Another major concern for cancer patients is the expense involved in treatment.  Chemotherapy drugs, radiation therapy and prescription medications, while all proven to be effective, are far from affordable for most patients.  Blood tests, biopsies and office visits add to the cost.  Not only do treatment schedules themselves carry a high price tag, many patients must miss work due to doctor’s visits and medical side effects in addition to the weakness brought on by the illness itself.  For those patients with employer-paid health insurance benefits, some of the treatment costs may still not be covered by their respective policies.  For those without health insurance, the financial burden may be too much to overcome.

Many avenues are open for patients who may be overcome by rising medical bills.  Federal and state government programs such as Medicare and Medicaid offer coverage to eligible applicants.  The Veterans Administration has several programs available to those who have served in uniform.  Non-profit organizations such as CancerCare and the Patient Advocate Foundation can provide information on how to obtain financial aid for cancer treatments.

One avenue that many patients use to soften the financial impact of treatment is to participate in clinical trials.  Most cancer research facilities and pharmaceutical firms conduct clinical trials to judge the efficacy of new cancer treatments.  After they have successfully completed the animal testing stage, they look for human volunteers to test out their new therapies.  Patients incur no costs during these trails and receive careful supervision from the trial administrators and physicians during the course of the experiment.

For those patients concerned about cost issues during treatment, some questions that the American Society of Clinical Oncology recommends to ask are:

  • Will the person in charge of billing for services help me work with my health insurance company/provider?
  • If I need multiple visits to a doctor’s office, is there a policy where I can pay the co-pay only once or not at all (called a waiver)?
  • Are there ways to change my treatment schedule, if necessary, to work around my job or child care?
  • What expenses will I have if I join a clinical trial?
  • For medications for side effects, is there an over-the-counter medicine that has the same effect as the prescribed drug? Is it less expensive?
  • Is there free or low-cost transportation for patients at the medical center where I will have treatment?
  • If I have trouble paying for basic items, like food or heat, due to the cost of my cancer treatment, are there organizations that can help me?
  • Should I plan financially for long-term medical care, such as a nursing home or hospice care?
  • Where can I find out if my medical and related expenses can be deducted from federal income taxes?

Patients can find a comprehensive list of questions at Cancer.Net.

Another task that comes with managing the financial portion of treatment is dealing with the paperwork and bureaucracy involved in the process.  Hospital bills, insurance claims and other forms that require the patient’s attention can take away the vital energy that they need during treatment.  Financial professionals such as CPAs can help navigate through the red tape, pay household bills and keep everything on budget.  They can also help with finding out which treatment costs are tax-deductible and where to locate additional funding for treatment.

Internet Research and Telling the Family

Of course, many patients will begin their search for more information via the Internet.  Most hospitals, research clinics and treatment providers offer news and resources through their web sites.  Also, organizations such as the American Cancer Society and the National Cancer Institute give visitors access to a wealth of information on how to manage the various aspects of their treatment.   

One aspect of Internet research of which patients should be aware is the prevalence of misinformation, lies and outright scams that some unscrupulous people can perpetrate on someone desperate for a “miracle cure”.  Many websites that promote themselves as resources for cancer patients often contain misleading information, either as a result of incomplete or inaccurate research or as an attempt to sell their product.  These books, pills and diet plans, in the best cases, are as effective as placebos or, in the worst instances, can cause great harm to a cancer patient’s sensitive metabolism. 

Telling the Family 

After patients receive their diagnosis and their treatment information, the next step often involves telling their spouses and families.  For many patients, this step may be as emotionally difficult as when they first heard the news themselves.  Spouses may often feel the same sense of helplessness as patients; they may feel that this disease will take away their partner and that they can do nothing to stop it.  Young children may not entirely comprehend all of the physical ramifications of what could happen to their parent, but they will pick up on the emotional distress and become depressed, sad or angry.   

Most experts agree that the best way to combat these feelings is to keep the lines of communication open throughout the treatment schedule.  The patient should answer any questions, especially from younger children, as openly and honestly as possible.  One of the best ways to combat the feelings of helplessness that family members may experience is to include them in the therapeutic process.  Simple actions, such as organizing task lists and completing simple chores, can both alleviate the mental stress and add to the family’s feelings of contribution to the patient’s well being.   

The patient’s relationship with their spouse will undergo many of the more serious changes during treatment.  The patient may experience both physical and mental exhaustion during this time, so the spouse may have to take care of their normal household duties (taking out the trash, cooking dinner, dressing the children for school).  In addition, the nature of the couple’s physical relationship will also change.  Along with the lack of energy, the patient may have either lost their desire for sex or may be physically unable to perform.  These changes could cause resentment and anger to disrupt the relationship and add more stress onto their situation.  The spouse may then feel a measure of guilt for harboring these feelings against their ill partner.

Many psychologists, counselors and mental health professionals specialize in therapy for cancer patients and their families.  Even with the technology available to modern medicine, the idea of cancer is still very traumatic for both the patient and their loved ones.  These specialists can offer outlets for all the members of the family affected by the disease, the treatment and the consequences.  With the opportunities to alleviate much of the emotional stress caused by the illness, the patient and the family can focus on the other aspects of cancer therapy and potential recovery. 

Fertility or reproductive health may be an issue with patients and their spouses during treatment, especially if the reproductive organs are the ones affected by the cancer.  Doctors can give information on potential risks and outline options for couples that still hope to have children either during or after treatment.  Some techniques include protection of the reproductive organs during radiation treatment, tissue preservation of the organs for later reimplantation, hormone therapy and sperm/egg banking.