By Alison Massey, as told to Susan Bernstein
There is a perception that chemotherapy is the same as treatment 20 or 30 years ago. They think it will have side effects that are not tolerable, but we have made significant progress in managing the toxicities associated with these chemotherapy drugs. People think chemotherapy will make them sick, but that’s not the case. Each individual regimen has its own side effect profile. If you look at the list of potential side effects, people may be overwhelmed. Most people will experience side effects, but no one will experience all possible side effects.
Generally, people will feel a little tired or have a dip in energy levels for a few days. But between your treatments, we hope you can live your normal life. We have many people who continue to work between treatments.
Nausea is another common side effect, but we have made advances in how to treat any nausea you may experience with your treatments. We can offer patients a range of anti-nausea medications. Some treatments cause hair loss and if this is the case we will let you know in advance. 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 remedies. With hair thinning, we can also check out certain labs or have our fellow dermatologists help you.
Fatigue is the main thing you may experience with radiation. Radiation can cause inflammation in the body where it kills cancer. It is the inflammation that causes the side effects. Depending on what is being irradiated, you may have pain. For example, if you receive lung radiation, your esophagus may be involved because the radiation may be close to that area of your body. If so, you may experience pain when swallowing or difficulty swallowing. You may even feel food sticking after you swallow it. People who have radiation may not realize that it may affect swallowing food.
Sometimes people need radiation for a painful lesion. While receiving radiation to a specific site for people with advanced lung cancer, you may experience flare-ups of pain. Ultimately, the hope is that the pain will go away. During this time, we may also treat you with pain medication or steroids such as dexamethasone to minimize the inflammation that is causing the pain.
Checkpoint brakes [immunotherapy medications for lung cancer] can have side effects, but they are different from chemotherapy because they affect the immune system. These drugs can overactivate your immune system, leading to side effects. Sometimes we see patients develop dermatitis, which manifests as a rash, or develop colitis which causes diarrhoea, or pneumonia in the lungs, which can cause shortness of breath or coughing. Checkpoint inhibitors can also cause arthritis or myositis, which is inflammation of your muscles. Sometimes we can even see swelling in your joints. It is important that if patients notice any new symptoms while taking their controller, they let us know so we can start 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 very often during cancer treatment. In my experience, people can feel lost when they are first diagnosed. But once you find your oncologist and your entire cancer support team, and you know you have a plan of attack to treat your cancer, most people feel better. Many people 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 they should continue to do what they enjoy.
Your mood and outlook may depend on where you are in your cancer treatment or the progression of your disease. Early on, most people are more functional and have less fatigue. Some people might still win. Others may need to stay home for a few days after each treatment. Our goal is that you do not lie in bed the entire time you are undergoing cancer treatment. Keep an active schedule as much as you can. Realize that you will be tired after the treatment and plan those days. And don’t forget to ask for help if you need it!
Getting a good night’s sleep can also affect your mood and quality of life. Many of our patients have insomnia. Anxiety can often cause insomnia. Your mind is racing, so you can’t sleep. Also, some of the medications you take for nausea or steroids for inflammation can speed you up and cause insomnia. And sometimes an annoying cough can disturb your sleep.
Some people with lung cancer may need supplemental oxygen. In my experience, people struggle with the idea of wearing oxygen because, like the association with hair loss, people on the outside can see that they are sick. But from a medical point of view, it is important to wear it if you need it.
Loss of libido is something we see in both men and women. In my experience, men are more vocal about this, so ladies, if you have any concerns, speak up! Erectile dysfunction can affect men during cancer treatment. Women may experience vaginal dryness or pain during intercourse. If this happens and you let us know, we can refer you to a sexual health specialist. Treatments can also affect a woman’s menstrual cycle. If you are someone who could become pregnant, you should be careful to use birth control while you are undergoing cancer treatment.