Side Effects

During the treatment, the communication with the Oncology Medical team is key.  Reporting Side effects is great help for both patient and doctors. Tracking them and reporting the level of inconvenience is the duty of the patient (see some interesting templates). Most of them can be treated and the doctor will adjust the dosage if required. 

Also, if during the treatment the patient experiences any issue such as rash or fever for example, it is highly recommended to get in touch or visit ER. 

Treatments are quite often known for their side effects. Here below, the most common side effects with few advice to prevent them and hopefully cope better. In any case, all these side effects must be reported to the medical team who will evaluate intensity and potential treatment adjustment required. 

Chemotherapy

There are various types of Chemotherapy drugs administrated depending on the type of Cancer and the staging. It can be administrated by pills or  intravenous via caths. Side effects will then depend on the protocol (drug used, number and dosage of the sessions). Below side effects are the main potential ones knowing that some might also apply to other treatments (such as fatigue during radiotherapy, fertility during hormonotherapy):

• Fatigue & “Chemo brain”: fatigue can be intense during the treatment phase. Acknowledged it and accept help. Adjust your day and plan your week accordingly. If you are working, you might need to adjust your work load and plan for power-naps. The “chemo brain” refers to the lack of focus, poor memory and overall the foggy brain that many experience during chemo. Taking notes, preparing lists, and simply asking family, friends and colleagues to repeat information and be understanding will be the best way to handle. 

Radiotherapy

If above side effects might occur during other treatments than Chemo, the below are specific to Radiotherapy.  

• Skin: During the radiotherapy treatment, the skin of the treated area will be sensitive. Using a moisturizing cream (with high concentration of Urea) daily after the session will prevent or decrease intensity of the burn sensation. Aloe Vera gel will help soothing irritation sensation, and healing creams for burn might be required. Avoid tight and wired bras if the breast area is treated. If the area treated involves the throat and face, use an electric razor to shave. In any case, keep the skin dry and clean using sensitive skin body wash, avoid warm baths.

• Nausea & Vomiting, Loss of appetite and taste: preventive treatments are generally prescribed for nausea and vomiting. If they are not enough, it is definitely to be shared with the Oncologist. Treatment might result in a loss of taste (taste buds impacted) and appetite. Eating in small portions, slowly, and adjusting the diet can help (no spicy, greasy or fried food, no sodas), try to eat room temperature and seating. Last but not least, avoid strong smells and perfumes.
• Diarrhea, Heart burn (acidity) and Constipation: Digestion might experience a real roller-coaster. The doctor can help with comfort medication and from a diet point of view avoiding dairy (soya can be a great alternative), alcohol, acid food (coffee, tomatoes, citrus, pineapple, nuts). Drink a lot of water room temperature. Your doctor will be able to refer you to a Dietitian if needed.
• Mouth sores: Acidity might result into painful reflux and mouth sores. Wash your teeth gently after each meal and seek advice of the Medical team. Specific mouth wash might be prescribed. 
• Immunity: the white cells count might drop resulting in an immunity drop. It is advisable to avoid eating raw food, crowded places and contagious people (wearing a mask can be a precaution), wash hands very regularly, avoid touching wounds but disinfect them carefully using gloves if necessary, shave with an electric razor and brush teeth very gently taking special care of the gum. Contact the medical team in case of any sign of infection.  
• Red blood cells & Platelets: Treatments might also result in low red cell and platelets count. It adds up to the low energy and results into a longer healing process. Again, these are side effects which are closely monitored by the Oncology team with regular blood test. 
• Hair loss: The most famous potential side effect! While emotionally difficult, it is not the biggest medical concern. In the vast majority of the cases, hair grows back at the end of the treatment. Depending the used drug or treatment, hair fall start progressively (use of soft shampoo and limit the styling) or can be quite sudden (eyelashes and eyebrows generally stay longer). Cold caps used during chemo sessions might prevent or slow down the fall. There are nevertheless quite uncomfortable and expensive for non guaranteed results. It is advisable to buy head scarves or a wig before the beginning of the chemotherapy. Also, every patient adopt a very different approach: while some try to keep hair for long, some others will cut it shorter and shave when the fall starts. They will feel better being in control. Some more detailed advice are listed in the Look Good page.
• Skin: The skin tends to be more sensitive to the sun and more drier in general. Moisturizing creams (with high concentration of Urea), sensitive skin cosmetics & body wash help. More specifically, Hands and feet might be more specifically impacted: tip of fingers peeling off, and blisters on the sole of the feet. Moisturizing creams used proactively can prevent the hands & feet syndrome. If blisters appears, wearing flat, inner leather sole open shoes are the most comfortable.
• Nails: Certain chemo drugs will also damage nails. Cutting (or filing) them short, and refraining from doing “mani-pedi” which are too aggressive during cancer treatments (just push cuticles using an cuticle remover) are key. Maintain hands and feet in cold gloves during chemo session might prevent nails to break. Specific silicium formula Nail polish also protect efficiently nails during the whole duration of treatment if used proactively and continuously (mate base coat are suitable for gents). Some more detailed advice are listed in the Look Good page.     
• Muscles, Joints pain & Neuropathy: Some treatments will impact the mobility as muscles are weak, joints painful, and the neurological system impacted (electric sensations in arms & legs, numbness in fingers, poor body balance. Based on the patient feedback, Doctors will evaluate the intensity of the concern with clinical examination during follow up appointments. Specific treatment might be prescribed as well.
• Fertility & Sexuality: Treatments and their side effects will impact the sexuality and fertility. Depending on the age of the patient, menstrual cycles will be interrupted for the duration of the treatment or permanently (quite often after 40 years old). Symptoms of menopause might also appear (hot flashes, dryness etc). Couples are advised to use birth control as pregnancies are not recommended during cancer treatments due to the toxicity of the various drugs used. When defining and discussing the protocol with the oncologist, openly discuss future family planning before starting the treatment (egg freezing might be possible).

Area specifics:

• Head: If the head is treated, focus and emotions might be impacted. Advice shared in the “chemo brain” section can help. Also, hearing issues and head ache can appear. 
• Neck or throat: Eating can be difficult due to swallowing issues and change of taste. Softening the food or eating liquid (smoothies, shakes, soups etc) can help. In that case, a Dietitian consultation is advisable. Mouth sore (see above advice), mouth dryness and cavities are also part of the side effects if the radiotherapy involves that area.    
• Thorax: If the radiotherapy treats the breast after a mastectomy, the reconstruction will need to be planned accordingly. In some cases, when radiotherapy involves thorax area some other side effects such as cough or shortness of breath will need to be monitored in order to screen potential Radiation pneumonitis (sometimes symptoms appear post treatment).  
• Abdomen: All above digestive side effects (diarrhea, constipation, acidity) my occur if the abdomen is treated. Above advice are applicable and dietitian consultation advisable.
• Hip area: Treating that area with radiotherapy might involve side effects such as bladder issues (drink water and pass urine often), fertility & sexuality issues, menopause symptoms, digestive issues.