By Alison Massey, as told to Susan Bernstein
There is a perception that chemotherapy is similar to treatments from 20 or 30 years ago. They think it will have intolerable side effects, but we’ve made great progress in managing the toxicities that come with these cancer drugs. People think that chemotherapy will make them sick, but that is not the case. Each individual treatment regimen has its own side effect. If you look at the list of possible side effects, people can get confused. Most people will experience side effects, but no one experiences every possible side effect.
Generally, people will be a little tired or have low energy level for a few days. But between your treatments, we hope you can live your normal life. We have many people who continue to work in between their treatments.
Nausea is another common side effect, but we’ve made progress on how to manage the nausea you may feel during treatment as well. We can offer patients a range of anti-nausea medications. Some treatments cause hair loss, and if this is the case, we let you know upfront. It is important to note that the vast majority do not cause hair loss, although some may cause hair thinning. We certainly have ways to help you manage these issues, including offering a prescription for wigs or other resources. With hair thinning, we can also check with some labs or enlist our dermatology colleagues to help you.
Fatigue is the main thing you may experience with radiation. Radiation can cause inflammation in your body because it kills cancer. It is the inflammation that causes the side effects. Depending on what is radiated, you may feel pain. For example, if you are receiving radiation from the lung, the esophagus could be involved because the radiation may be close to that area of your body. If this is the case, you may experience swallowing pain or difficulty swallowing. You may even feel that the food is stuck after you swallow it. People exposed to radiation may not realize that it may affect the swallowing of food.
Sometimes people will need radiation for a painful lesion. While receiving radiation in a specific location for people with advanced lung cancer, you may have a flare-up of this pain. In the end, the hope is that the pain will go away. During this time, we can also treat you with pain medications or steroids such as dexamethasone to reduce the inflammation that is causing the pain.
Checkpoint inhibitors [immunotherapy medications for lung cancer] They can have side effects, but they differ from chemotherapy because they affect your immune system. These medicines can make your immune system overactive, causing side effects. Sometimes, we see patients develop dermatitis, which manifests as a rash, or they have colitis that causes diarrhoea, or pneumonia in your lungs, which can cause shortness of breath or a cough. Checkpoint inhibitors may also cause arthritis or myositis, which is inflammation of your muscles. Sometimes, we can see swelling in your joints. It is important that if patients notice any new symptoms while taking checkpoint inhibitors, that they tell us so that we can begin treatment. The sooner you tell us about these side effects, the sooner we can treat and reverse them.
Anxiety and depression are two things we deal with a lot during cancer treatment. In my experience, people may feel lost when they are first diagnosed. But once you’ve found your oncologist and the entire cancer support team, and know you have a plan of attack for your cancer, most people feel better. Many fear cancer treatments and the potential impact of treatment on your quality of life. We let people know that they can still live their lives and should continue to do the things they enjoy.
Your mood and outlook may depend on where you are in the course of cancer treatment or the progression of the disease. Early on, most people are more efficient and have less stress. Some people may still be able to work. Others may need to loiter at home for a few days after each treatment. Our goal is not to remain in bed throughout your cancer treatment. Keep an active schedule as often as you can. Know that you will be tired after treatment and plan for those 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. Many times anxiety may be the cause of this insomnia. Your mind is racing, so you can’t sleep. Also, some of the medications you take for nausea or steroids for infections can worsen your condition and cause insomnia. And sometimes a nagging cough can disrupt your sleep.
Some people with lung cancer may need to use supplemental oxygen. In my experience, people struggle with the idea of wearing oxygen because, like the association with hair loss, now people on the outside are able to see that they’re sick. But from a medical point of view, it is important to wear them if you need to.
Loss of sexual function is something we can see in both men and women. In my experience, men are more upfront about this, so speak up, ladies, if you have any concerns! Erectile dysfunction can affect men during cancer treatment. Women may experience vaginal dryness or pain during intercourse. If this happens and you tell us, we can refer you to a sexual health doctor. Treatments can also affect women’s menstrual cycles. If you are a woman who could become pregnant, you should be careful to use birth control while you are being treated for cancer.