Practical Advice for Easing the Side Effects of Chemotherapy

NEW YORK—Eat your fruits and vegetables is generally good advice, but patients undergoing cancer therapy also need to heed the following warning: Wash them thoroughly, to prevent infection, said Stewart Fleishman, MD, director of cancer supportive services, Beth Israel Cancer Center, Continuum Health Partners, New York.

Dr. Fleishman offered commonsense advice to help cancer patients cope with treatment side effects during a Cancer Care, Inc. teleconference. "These are things that can be done before side effects occur and as after-the-fact, practical things," he emphasized.

To help prevent infection while patients are immunosuppressed, he said, "we tell them to avoid people sneezing in their face, not to get into crowded elevators, and, if using public transportation, not to go in during crowded times. But probably the best thing people can do to stay infection free is to wash their hands!"

And wash those vegetables. When surfaces cannot be cleaned adequately, vegetables may be sources of bacteria, he said, "introduced into the system at a time when it really is hard for the body to fight off the infection." Vegetables should be blanched in boiling water. Some patients even microwave their apples and put them back in the refrigerator, he said.

He advised patients that their physicians may prescribe G-CSF (Neupogen) to prevent infection by restoring white blood cell counts, as well as antibiotics. "All of us are quite concerned about unnecessary use of antibiotics when a healthy person has a viral illness, but in the cancer world, we try to rush in with antibiotics sooner rather than later to avoid infections."

Many people do not want to talk about their side effects, Dr. Fleishman said. "They think the stiff upper lip is the best approach. But the treatment team needs to know you’re having difficulties. It’s the first step in getting care for the problem," he said.

One of the most common treatment-related problems is fatigue. Erythropoietin (Epogen, Procrit) to prevent or treat anemia "could be started a little earlier than is frequently the case to avoid extreme fatigue," he said.

Iron supplements should only be taken under the supervision of a physician. "Sometimes we give iron depending on the blood counts, but many patients will take iron when they don’t need it and can take too much," he said.

Mild exercise can help with fatigue, but patients often confuse the type of exercise they need with the aerobic exercise programs often recommended for people who have had a heart attack. The optimal amount of exercise for people undergoing cancer therapy might really be something as simple as just stretching the muscles, Dr. Fleishman said. "With cancer therapy, too much exercise can work against you, causing fatigue."

The amount and type of exercise is also determined by the physical shape a patient was in before treatment. "If people are not in great shape before, maybe the trick is to start some gentle exercising under the guidance of a good exercise therapist or physiologist, just to stretch out some of those aches and pains," Dr. Fleishman said.

Pain can sometimes come from deconditioning. It can also be a variant of neuropathy, he said. "Sometimes this is the body’s cry for help that there is a strange substance going through. It reacts with pain or aching," he said.

Depending on the kind of cancer, nonsteroidal anti-inflammatory drugs (NSAIDs) may be of help but should be used after, not during, chemotherapy or radiation therapy, Dr. Fleishman said. "Over-the-counter or prescription anti-inflammatory drugs can interfere with blood clotting at a time when platelet counts are down," he said.

Aches and pains can even be part of an allergic reaction to a drug such as a taxane and may include hives or even welts, he added.

Treatment-related loss of hair is generally temporary, Dr. Fleishman said, but he warned that radiation therapy to the head or scalp can, in some cases, cause permanent hair loss.

"Many people have tried to avoid hair loss by using ice to the scalp during chemotherapy," he said, "but there have been cases where the cancer has spread to the scalp because the chemotherapy hasn’t been active there, since the ice kept the blood supply low. So we haven’t been able to advocate that in good conscience."

Recovery Is Slow

Dr. Fleishman said that how long the effects of chemotherapy last depends on how much drug an individual has received and over what period of time. "You can generally tell that the worst is over by when your hair starts to grow back fully," he said. "The first regrowth is often baby fine; this hair generally falls out, and adult hair comes in afterwards."

But he told patients that hair regrowth patterns can vary. "With some people, their hair starts to grow back during chemotherapy, and then they start to worry that they are not absorbing the drugs," he said. "That’s not so. Blood tests are much more sensitive for determining how much chemotherapy you’ve absorbed."

Recovery from the effects of chemotherapy is generally slow. "It’s a process of building your energy back. People think, ‘If it takes 4 months for the chemo to be out of my system, in 4½ months I’ll be jogging 3 miles a day.’ The truth," Dr. Fleishman said, "is you have to start off from scratch, slowly starting to do all the things you did before treatment. Starting gently before the chemo is fully out of your system allows for an easier recovery afterwards."