Side Effects of Chemotherapy and How to Manage Them Effectively

Julie Gleason, ARNP 
Cedar Valley Cancer Center

Chemotherapy is given for a variety of reasons in breast cancer management. Chemotherapy is given in the adjuvant setting when the cancer has already been removed, and we are trying to provide assurance that it will not come back. Chemotherapy is given in the neoadjuvant setting, or when the tumor needs to shrink prior to surgery. It is given in the metastatic setting to slow down disease progression, with attempts to increase quality and quantity of life.

Regardless of the reason for giving chemotherapy, side effects are undoubtedly expected, and can be bothersome. That said, side effects are manageable with the right tools. Never be afraid to speak with your doctor regarding proper management of your side effects. Most chemotherapies cause a decrease in the blood counts. White blood cells, red blood cells, and platelets are made in your bone marrow.

While chemotherapy is meant to “kill off” cancer cells, unfortunately, the chemotherapy does not target the cancer cells specifically, and healthy cells are also “killed off” prematurely. Lower amounts of white blood cells can make you more at risk for infection. The best prevention is good hand washing, avoid sharing cups and utensils, and avoid sick people. Always call your physician for any fevers, chills, signs of infections, or other concerns.

You can become very ill without a very high fever. Lower red blood cells, also called anemia, can cause fatigue. Red blood cells carry oxygen to the rest of the body, so when decreased, you may feel more short of breath with exertion, or weak, and tired. Eating a well-balanced diet can help combat fatigue, along with getting enough rest, and continuing to exercise, when able. Lower platelet counts may cause increasing bleeding or bruising.

Be sure to notify your physician if you are taking aspirin, NSAIDs (such as Ibuprofen or Aleve), or blood thinners. Monitor for increasing bruising or bleeding of any kind, bloody noses, bleeding gums, or blood in the stools.

Many chemotherapies cause nausea, vomiting, diarrhea, constipation, or stomach upset. The same chemotherapy can give one person constipation and another person diarrhea. Keeping bowels moving regularly not only decreases stomach upset, but decreases risk of infection. If you are having trouble with nausea,

SPEAK UP!
Do not try to “grin and bear it.” Not all nausea medications are created equally, and one might work when another didn't. Talk with your doctor about the management of your nausea, so you are able to continue to eat and drink and stay healthy throughout treatment. Nausea medications are used in combination to be most effective.

Over the counter anti-diarrheal medication can be used for diarrhea, and stool softeners for constipation. There are prescription medications for more severe cases. Eating smaller meals and more bland food choices may be necessary during the few days after receiving chemotherapy. Continuing to drink fluids, especially water, is important regardless. 8-10 glasses of water daily is ideal when going through chemotherapy treatment. Poor appetite, taste changes, and mouth sores may be a side effect of your treatment.

Sometimes, you won't feel like eating, but as I mentioned above, drinking fluids is very important. Eating smaller meals throughout the day, instead of three large meals, helps you get the nutrition you need. Food may not always taste good, and you may have to alter what you're eating based on how things taste on certain days. Mouth sores can make it difficult to eat and drink. Gargling with salt water may alleviate some symptoms, but talk with your doctor as prescription medication may be necessary to heal the sores.

Hair loss is probably one of the biggest challenges for women undergoing chemotherapy treatment. Not all chemotherapies cause hair loss so talk with your doctor, or their staff, prior to starting a new therapy. Hair loss may be gradual, or abrupt, and affects all areas of the body where hair grows. It often starts after 1-2 cycles of treatment. Hair can take a while to grow back, and may not grow back the same color or texture.

Make sure and talk with your clinic about the hair replacement sites in your area if you are interested in purchasing a wig. Wigs may help you gain self-confidence after losing your hair, however, wigs can become warm, and itchy, and many patients choose to wear hats, bandanas, or scarfs instead. Regardless of what you choose to wear, make sure you feel as comfortable as possible.

I suggest keeping a diary of your symptoms in order to better communicate with your physician how you're feeling on a daily basis. Write down the days you have chemotherapy, and the side effects you experience on the following days. Also keep track of what you've tried at home to alleviate the symptoms.

Write down the medications you've taken, the foods you've eaten, etc. This helps your doctor take better care of you, which will help you during your battle with breast cancer. As a reminder, there are other side effects more specific to certain chemotherapy regimens, so please listen to your provider, and ask for a specific education appointment for more information, if one is not provided for you.

You deserve to know how this is going to affect you, and more importantly, how you can combat these side effects at home. Remember, every patient is different and will not have all side effects listed. Make sure to ask questions, talk with other breast cancer patients, join support groups, and discuss your needs on a regular basis with your treating physician.

Be strong in your fight with breast cancer!

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