Side Effects

Cancer Treatment Side Effects

Authors of the "Side Effects" sections are Linda U. Krebs, RN, PhD, AOCN, FAAN, assisted by Linda Burhansstipanov, MSPH, DrPH (Cherokee Nation)

What are side effects?

• A problem that occurs when treatment affects healthy tissues or organs
• Almost all cancer surgery, chemotherapy, radiation and other medical treatments (Immunotherapy) have side effects
• Treatment side effects depends on the type of cancer being treated and the type and dose of treatment being given
• Everyone has different reactions to treatments and therapies
• Even if you have severe side effects, you are not going to feel like this forever
  • Some side effects last for years
  • Many side effects are temporary and will go away when the treatments are over (hair loss)
  • There are medicines that are available today to help with the side effects of cancer and cancer treatments
• The most common side effect of cancer treatment is fatigue
• Examples of side effects are:
  • Fatigue
  • Pain
  • Swelling
  • Diarrhea
  • Nausea and vomiting
  • Sexuality/intimacy changes
  • Decreased blood cell counts
  • Mouth sores
  • Hair Loss

Types of Side effects

• Acute – occur during or shortly after treatment
  • Such as diarrhea, nausea, or skin rash
  • Not generally within minutes, but within days to weeks and while the treatment is still being given 
  • Usually resolve with time
• Chronic/long term – continue months to years after treatment
  • Can be managed but do not completely resolve 
  • Chronic side effects come months to years later and may be different than the acute side effects – some patients will have chronic diarrhea,  urinary incontinence, erectile dysfunction or permanent hair loss.  This depends on the site irradiated, the dose, etc. 
  • Doctors look at the exact tissue treated, the dose and fractionation used 
    • How many grays given at each dose
    • "Gray" is the measure of radiation, usually seen in centigrays
    • Used to be called rads –[1cgy=1rad] used around the world
  • The method of delivery and other factors to determine how much radiation therapy is going to be helpful and not damaging
• Late – not present or identified during or right after treatment
  • Develop based on effects of treatment on organ systems (heart, bones, etc.) 
  • May be a result or of psychological process related to having cancer or being treated for cancer (depression/anxiety)
  • Often confused with chronic (long term) side effects
  • Late side effects occur years to months after treatment
  • They are be related to effects of the cancer or cancer treatment
  • They are not the same as chronic or long term side effects that continue on following treatment
  • Late effects include 
    • Heart disease
    • 2nd malignancies
    • Infertility
    • Problems with bones, teeth and so on
  • Factors influencing development
    • Type of treatment (radiation, chemotherapy, surgery, etc.)
    • Exact tissue and amount of tissue treated/removed
    • Dose of chemo /radiation given
    • Method of delivery
    • Individual factors
       

Ways Providers Manage Side Effects

• Manage your depression or pain with antidepressants or analgesics (pain medicines)
• Treat your anemia with erythropoietin, iron supplements, folic acid and/or transfusions (see anemia)
• Manage your sleep disorders by learning about ways to improve rest and sleep
• This may include prescribing sleeping pills
• Make sure that you are not dehydrated (from not drinking enough fluids)
• Make sure that your electrolytes and body hormones and other substances are at their normal levels
• Provide oxygen tanks or pumps if you are short of breath
• Reduce or stop any medications that are not needed
• In some cases give you psycho-stimulants (such as Ritalin) or low dose corticosteroids (such as prednisone) to boost you energy
• Suggest or let you use herbs, vitamins or other natural remedies (be sure to talk with your provider about any natural remedies you take:  They may affect the way your treatment works)