Cancerindia
Dealing With Cancer Treatment

Bone Health

Loss of bone mass is common as people age. Cells that help rebuild bone don't get replaced at the same rate, resulting in bones that become thin and porous (full of tiny holes). This condition, called osteoporosis, is the most common type of bone disease. People with osteoporosis are more likely to suffer fractures and painful disabilities because of weakened, fragile bones.

More than 80% of osteoporosis cases occur in post-menopausal women, who have lower levels of estrogen, a vital hormone for bone density. Bone loss can also occur in men or women with poor nutrition, inadequate intake of calcium and vitamin D, or who are confined to bed for long periods due to illness.

Cancer treatments can also contribute to bone loss. Possible causes of cancer-related osteoporosis and bone fractures include :

  • Some chemotherapy drugs can decrease calcium levels in the body
  • Radiation therapy to the pelvic region, especially for women over the age of 65
  • Spread (metastasis) of cancer to the bone from the original tumor site
  • Hormone therapy to suppress testosterone in prostate cancer patients
  • Steroid treatments
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Tips for Bone Health

There are steps that can help reduce your risk of bone loss and promote strong, healthy bones during cancer treatment.

Early detection: A bone density scan can determine if bone loss is occurring. A scan can be performed before, during and after cancer treatment.

Calcium: This mineral maintains bone health and strength. Calcium decreases as we age, so it's important to replace it with diet or a supplement. Calcium-rich foods include cheese, yogurt and broccoli, or choose from calcium-fortified foods such as orange juice, milk and pasta.

Vitamin D helps your body absorb and retain calcium. Vitamin D is manufactured in the skin using energy from sunlight and can also be found in vitamin D fortified food, such as milk

Bisphosphonates: these prescription medications slow the rate of bone loss and may even help promote new bone growth.

Exercise: Weight-bearing physical activity (walking, dancing, stair climbing, and jumping rope) stimulates production of bone-forming cells and also helps build muscles, providing more stability.

Maintain a healthy weight: a nutritionally-balanced diet is crucial to healthy bones. People who are underweight are more prone to bone loss and fractures.

Prevent falls: Take steps to make your environment free of dangers that could cause a fall. Don't leave papers or magazines on the floor, and remove scatter rugs and other clutter that can trip you up.

Chemobrain

Chemobrain, formally known as cognitive dysfunction, is a symptom reported by many cancer patients. Chemobrain, or difficulty in efficiently processing information, is a legitimate, diagnosable condition that may be caused by chemotherapy treatment, the cancer itself, or secondary medical conditions such as anemia.

Always tell your doctor about any changes in your thinking. He or she may refer you to a neuropsychologist. Neuropsychological evaluations for chemobrain are considered medical procedures, not a mental health benefit, and as such are covered by health insurance.

Symptoms of Chemobrain

  • Difficulty concentrating on a single task
  • Problems with short-term memory; forgetting details of recent events
  • Feeling mentally “slower” than usual
  • Confusing dates and appointments
  • Misplacing objects
  • Fumbling for the right word or phrase

These symptoms generally will fade after chemotherapy ends, but each patient is different. Some may take a year or more after treatment to feel normal again; others may never regain full cognitive function.

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Treatment

Not many treatments for chemobrain currently exist, although some patients may find relief from stimulants such as Ritalin®, commonly used to treat Attention Deficit Hyperactivity Disorder (ADHD). Ritalin can help improve mental focus, concentration and stamina in cancer patients.

People can use the following coping strategies to minimize the effects of chemobrain :

Exercise: Even five minutes of mild to moderate activity may improve mental function.

Memory Aids: Using a notebook, planner or list to keep track of things as they come to mind. A small recorder can also come in handy.

Treat fatigue and sleep problems: these conditions can worsen chemobrain symptoms.

Manage depression and anxiety: easing stress and elevating mood can ease chemobrain symptoms.

Minimize distractions: A more soundproof environment, like an office or a cubicle in a different location can decrease distractions and improve concentration in the workplace.

Diabetes Management

There are two types of diabetes :

Type I (formerly known as "juvenile" diabetes) occurs when the pancreas either produces no insulin at all, or produces an insignificant amount to handle blood sugar. Type I diabetes, which typically strikes people under 30 but can occur at any age, can only be treated with insulin.

Type II (sometimes called "adult onset" diabetes) occurs when the pancreas produces insulin, but the body has become resistant to it. Obesity is a major cause of insulin resistance. Fat cells are literally stretched and lose their insulin receptors, so they cannot absorb the blood sugar. Type II diabetes can be managed with healthy eating, regular exercise (at least 5-7 days a week), oral medications and/or insulin when necessary.

Diabetes & Cancer

Certain types of cancer may lead to an increased risk of both Type I and Type II diabetes, including pancreas, liver and colorectal cancers. However, the cancer-diabetes connection is still being explored by researchers.

Although cancer treatments don’t cause diabetes, high blood sugar must be aggressively managed during treatment. Radiation therapy, steroids and certain chemotherapy drugs can cause blood sugar levels to rise.

For cancer patients with pre-existing diabetes, their doctor may have to supplement their regular insulin with a fast-acting insulin to bring levels back to normal. For patients who don’t have pre-existing diabetes, high blood sugar levels are managed with a "sliding" insulin regimen, starting out with larger doses and then tapering off as sugar levels normalize.

Endocrinologists and Internal Medicine Specialties department has a diabetes progam to help cancer patients cope with their disease. Inpatients can be referred by their nurse, dietician or other member of their health care team. Outpatients must be referred by a doctor.

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Fatigue

Fatigue is the most common symptom experienced by cancer patients. Fatigue is treatable; however, most patients do not report symptoms to their doctor in the belief that it may not be "important." Cancer-related fatigue can have a serious impact on quality of life, as well as physical symptoms.

Just having cancer can cause fatigue. Other causes include :

  • Aggressive surgery, chemotherapy or radiation treatments
  • Chemotherapy - induced anemia
  • Sleep disorders
  • Emotional distress
  • Pre - existing medical conditions : uncontrolled diabetes, thyroid problems, heart disease or rheumatoid arthritis
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Coping with Fatigue

  • Exercise regularly. A 20-minute walk can help you relax, but don’t exercise in the evening.
  • Limit naps if possible. If you must nap, keep it under 30 minutes, and do something active right after waking.
  • Avoid alcohol, caffeine, chocolate, and nicotine in the evening.
  • Turn off the TV one hour before bedtime. Listen to quiet music or take a warm bath instead.
  • Keep a regular sleep schedule, even on weekends.
  • Do not read, watch TV or work in the bedroom.
  • If you haven’t fallen asleep in 15 minutes, go to another room. Avoid mental stimulation and return to bed when you feel sleepy. If you still can’t fall asleep, get up again and repeat these steps as necessary.

Dealing with Cancer Treatment

Cancer and the aggressive therapies used to treat it can result in side effects. Learn more about some of the common symptoms and how to manage them.

Hair Loss

Most cancer patients who undergo chemotherapy will experience hair loss, which can significantly alter their appearance. Chemotherapy drugs target rapidly-growing cells in the body, but cannot distinguish between cancer cells and other fast-growing cells like hair follicles. Hair loss can occur all over the body: head, face, limbs, underarms and pubic area.

Whether or not hair loss occurs depends on the type and dosage of the cancer drug. Ask your doctor if your chemotherapy treatment will result in hair loss so you can be prepared.

Hair loss usually begins 7-21 days after treatment begins, and starts to grow back after treatment ends, although some people start getting hair back during treatment. The time it takes to re-grow hair can vary from 3-12 months. Occasionally, the new hair will have a different texture or color.

Chemotherapy - induced hair loss cannot be prevented, but there are ways to cope :

  • Consider cutting your hair short or shaving your head once hair loss begins
  • Use mild shampoos and soft hair brushes
  • Avoid blow dryers, curling irons, and other hot appliances
  • Keep your scalp clean and moisturized to prevent skin problems
  • Protect your scalp from the sun with hats, wigs or sunscreen
  • Be creative: use colorful scarves, turbans or hats. Make sure headwear is not too tight or irritates the scalp.
  • Wigs are an option, although good-quality wigs can be expensive. Some insurance plans may help cover the cost of a wig.
  • Embrace your baldness !
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Infections

Patients who are receiving chemotherapy or radiation may be at risk of infection. The most common sign of infection is a fever.

Other symptoms include :

  • Chills or sweats
  • Cough, mucous production, shortness of breath or painful breathing
  • Soreness or swelling in your mouth, ulcers or white patches in your mouth, or a change in the color of your gums
  • Pain or burning during urination or an odor to your urine
  • Redness, pain or swelling of any area of your skin
  • Redness, pain, swelling or drainage from any tube you may have (e.g., Hickman catheter, J-tube, urinary catheter)
  • Pus or drainage from an open cut or sore

Consult to your physician immediately with above symptoms.

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Lymphedema

What is lymphedema ?

Lymphedema is a collection of protein-rich lymphatic fluid, usually in the arm or leg. It is caused by interruption of normal lymphatic flow often due to surgery, radiation, infection or trauma. It is the protein in the fluid that makes it difficult to treat. The protein acts as a magnet for more swelling and serves as a food source for infections.

What causes it ?

With normal lymphatic flow, the amount of fluid going into the arm or leg is equal to the fluid that is going out. In lymphedema, the amount of fluid going in is greater than the amount that can go out because of the damage to the "transport system". It is sort of like the plumbing in an old house where the pipes are narrow. As long as the water is just a trickle, the plumbing can handle it. But when there is a lot of water, it goes out too slowly and backs up until it overflows.

When can it start ?

Lymphedema occurs most commonly in women who have had breast surgery with removal of lymph nodes, followed by radiation therapy. It can appear weeks, months or even years after the initial surgery. It may also occur following injury or infection. In each case, normal drainage of the lymphatic fluid is interrupted.

Will it go away by itself ?

Although there are cases when lymphedema has spontaneously resolved and never recurred, for most patients it is a chronic problem requiring an ongoing effort to control.

How is lymphedema treated ?

A treatment plan is based on evaluation by the therapist. It may include one or more of the following elements :

Skin care

Avoidance of injury and infection, good hygiene and proper moisturization is very important. We will teach you proper skin care.

Exercise

You may be instructed in stretching exercises to loosen up the tissues in the region or specialized exercises to help move the fluid out. You will be given written instructions for these exercises.

Bandaging

This is a precise technique which uses cotton low-stretch bandages to apply constant pressure on the limb. Bandaging is usually done in combination with other methods.

Massage

Two basic types of massage are used to treat lymphedema. Manual lymph draining is a precise and gentle form of massage that helps mobilize the fluid and direct it to other pathways. Soft tissue mobilization (or myofascial release) is a type of massage used to release scar tissue and other tightness that might be contributing to the swelling. Sometimes massage is taught to patients or family members to carry out at home.

Compression Garments

These are elastic fabric garments similar to a girdle or support stocking that apply pressure to the arm or leg to help move fluid out and keep new fluid from collecting.

Medicine

Sometimes antibiotics or other medications are prescribed as part of your treatment plan.

Lymphedema Surgery

Lymphedema can often be managed with therapy and self-care. However, for many patients, surgery may help reduce the severity and symptoms of lymphedema. Surgical procedures involve bypassing the lymphatic system to drain off excess fluid and relieve swelling.

Surgeons can perform a lymphaticovenular bypass, a variation of lymphovenous bypass. Two to five small incisions measuring an inch or less are made in the arm or leg using tiny microsurgical tools. The surgeons redirect the lymphatic fluid to small veins (venules) to allow for drainage, thus alleviating lymphedema. The procedure takes about 2-4 hours under general anesthesia. The hospital stay is less than 24 hours.

Almost anyone suffering from lymphedema of the arm or leg is a candidate for bypass surgery. However, patients who have had the condition for a shorter time tend to have better results. Results will vary from patient to patient. Some will see a significant improvement in their lymphedma symptoms, while others may experience no improvement at all. A complete cure from lymphedema should not be expected.

While the surgery may result in significant improvement of the lymphedema, continued therapy such as wearing of the compression garment, massage, skin care and exercise is recommended to obtain the best result. Lymphedema therapy should be resumed 4 weeks after the surgery.

Managing Medications

Cancer treatment usually involves taking a lot of medications. In addition to drugs directly related to treatment, cancer patients may also be taking medications for pain, nausea, low blood counts and other treatment- or cancer-related symptoms. Some patients may have to take up to 20 pills a day, and keeping track of medications can be a challenge. With some organization, you can make sure you're taking the right medication at the right time, and avoid dosing errors.

Organizing your medications can make your life simpler and help you get the most benefit possible from your treatment.

Keep a Record of Your Medications

Maintain a master list of all of your medications. This record should include basic information such as your name, home and work phone numbers, blood type, medical conditions, emergency contact information, your doctor’s name and phone number and a list of any food or drug allergies. Keep the drug list with you and bring it to every doctor's appointment.

Include the following information about specific drugs :

  • Name and strength of the medication
  • Dosage instructions
  • The color of the pill
  • What you are taking it for
  • When you began taking it
  • Any food or drug interactions
  • Any over-the-counter medications, vitamins and herbal supplements you’re taking. Some of these can interact with your prescription medication and possibly interfere with their effectiveness.
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Organizing Medications

There are a variety of ways to help you remember when to take your medications. Choose the system that works best for you.

Pill organizers: These containers, available in different shapes and sizes at drug stores, have compartments for the pills to be taken each day, or at different times of the day. Some have child safety locks, reminder alarms and automatic pill dispensers. There are also an assortment of alarms and watches that signal you when it’s time to take medication.

Create your own organizer: Place each day’s pills in a small cup (or two cups if you take medications at two different times of day). If you must take pills several times throughout the day, an empty egg carton can be an effective organizer. Number the 12 sections of the carton for 12 hours of the day. Place the medication you need to take at that time in the proper container.

Charts and calendars: Write your drug schedule on a calendar, and cross items off when you have taken those pills. You can also use different-colored stickers on the lids of each medicine bottle. Every time you take the medicine, place a sticker of the same color on the calendar as a visual reminder of which pills you’ve taken.

Nausea

Many chemotherapy drugs and radiation cause nausea (upset stomach), but there are medicines to prevent nausea and vomiting. Please talk to your doctor or nurse if you are having nausea. You can either take medicines by mouth or intravenously (through a vein) when you have chemotherapy. Unfortunately, some patients still have some nausea. If the medicines do not help you, please go to the nearest hospital right away. You may need fluids if you have not been able to eat or drink.

Peripheral Neuropathy

Certain chemotherapy treatments can cause damage to the peripheral nervous system, which include all nerves outside the brain and spinal cord. The condition is called peripheral neuropathy, which commonly causes tingling, burning, weakness or numbness in the hands and/or feet.

Other symptoms of peripheral neuropathy include :

  • Loss of balance
  • Clumsiness
  • Difficulty picking up objects and buttoning clothing
  • Walking problems
  • Jaw pain
  • Hearing loss
  • Stomach pain
  • Constipation

If you have one or more of these symptoms, report them to your doctor immediately. Medications may be able to reverse peripheral neuropathy, and physical therapy can help you maintain normal function.

Oral Care

Good oral care is important during cancer treatment. Some chemotherapy drugs can cause sores in the mouth and throat, as well as dryness, irritation or bleeding. Mouth sores can become infected, so it's important to to practice good oral hygiene and to tell your care team about any symptoms.

To keep your mouth, gums and throat healthy during cancer treatment :

  • See your dentist before starting chemotherapy to have your teeth cleaned and to address problems such as cavities, abscesses, gum disease or poorly fitting dentures
  • Brush your teeth and gums after every meal with a soft toothbrush and a gentle touch
  • Rinse your toothbrush well after each use and store it in a dry place
  • Avoid commercial mouthwashes that contain a large amount of salt or alcohol
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Pain Management

About one-third of patients being treated for cancer experience pain, which can take many forms. It may be short-lived or long-lasting, mild or severe, or affect one or a few organs, bones or organ systems. Since each patient’s pain is unique, cance pain management treatment plans must be tailored to address individual needs.

Causes of Cancer Pain

Pain from the tumor: Most cancer pain occurs when a tumor presses on bone, nerves or organs. The pain may vary according to location. For example, a small tumor located near a nerve or the spinal cord may be very painful, while a larger tumor elsewhere may not cause discomfort.

Treatment-related pain: Chemotherapy, radiotherapy and surgery can cause pain. Also, certain painful conditions are more likely to occur in patients with a suppressed immune system, which often results from these therapies.

Post-operative pain: Acute, short-term pain resulting from surgery. Relieving post-op pain helps people recuperate from surgery more quickly and heal more effectively.

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Treating Cancer Pain

Cancer pain is very treatable. About nine out of 10 cancer pain patients will find relief using a combination of medications. Many medicines are used for cancer pain management. Some drugs are general pain relievers, while others target specific types of pain. Most pain drugs require a prescription.

Mild to moderate pain

Non-opioids: Examples are acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen. Most non-opioids can be purchased over-the-counter without a prescription.

Moderate to severe pain

Opioids: Examples are morphine, hydromorphone, oxycodone, hydrocodone, codeine, fentanyl and methadone.

Tingling & burning pain

Antidepressants: Examples are amitriptyline, imipramine, doxepin and trazodone. Taking an antidepressant does not mean that you are depressed or have a mental illness.

Antiepileptics: Examples include gabapentin. Taking an antiepileptic does not mean that you are going to have seizures.

Pain caused by swelling

Steroids: Examples are prednisone and dexamethasone.

How Pain Medicine is Taken

Most pain medicine is taken by mouth (orally). Oral medicines, either in pill or liquid form, are easy to take and usually cost less than other kinds of medicine. Other methods for administering pain drugs include :

  • Rectal suppositories
  • Transdermal patches
  • Injections
    • Subcutaneous - medicine is placed just under the skin using a small needle
    • Subdermal and intramuscular - Injections are placed more deeply into the skin or muscle; not recommended for long-term cancer pain treatment
    • Intravenous - medicine is placed directly into a vein through a needle that stays in the vein, allowing patients to adjust how much medicine they receive
    • Epidural or intrathecal - medicine is placed directly into the spine using a small tube, providing relief for several hours

Non - Drug Pain Treatments

Your doctor or nurse may recommend certain non-drug treatments for cancer pain management to supplement your pain medication. These treatments will help make your medicines work better and relieve other symptoms, but they should not be used instead of medication.

  • Biofeedback: A technique that makes the patient aware of bodily processes normally thought to be involuntary (blood pressure, skin temperature and heart rate). Patients can gain some conscious voluntary control of these processes, which can influence their level of pain.
  • Breathing and relaxation exercises: These methods focus the patient’s attention on performing a specific task, instead of concentrating on the pain.
  • Distraction: A method used to divert the patient’s attention to a more pleasant event, object or situation.
  • Heat or cold: Using temperature to facilitate pain control with packs or heating pads.
  • Hypnosis: A focused state of consciousness that allows the patient to better process information.
  • Imagery: Using soothing, positive mental images that allow the patient to relax.
  • Massage, pressure and vibration: Physical stimulation of muscles or nerves can facilitate relaxation and relieve painful muscle spasms or contractions.
  • Transcutaneous electrical nerve stimulation (TENS): A mild electric current is applied to the skin at the site of the pain.

When Medicine Is Not Enough

Some patients have pain that is not relieved by medicine. In these cases the following treatments for cancer pain management can be used to reduce pain :

Radiation therapy: This treatment reduces pain by shrinking a tumor. A single dose of radiation may be effective for some people.

Nerve blocks/implanted pump: Certain nerve blocks, temporary or permanent, may help relieve some painful conditions. Implanted pain pumps can also provide relief in some patients.

Neurosurgery: nerves (usually in the spinal cord) are cut to relieve the pain.

Surgery: When a tumor is pressing on nerves or other body parts, operations to remove all or part of the tumor can relieve pain.

Sexuality & Cancer

Cancer treatment can cause a variety of sexual changes. Even though the causes may be different – surgery, chemotherapy, hormone treatment or radiation – the resulting changes are often similar. Some patients experience changes in all phases of sexual response (desire, arousal, orgasm, resolution), while others experience none.

The most common sexual change for cancer patients is an overall loss of desire. For men, erection problems are also a common problem. For women, vaginal dryness and pain with sexual activity are frequent. Most men and women are still able to have an orgasm even if cancer treatment interferes with erections or vaginal lubrication, or involves removing some parts of the pelvic organs. However, it is common for patients to need more time or stimulation to reach orgasm.

Cancer treatment side effects, such as fatigue, nausea, vomiting, diarrhea, constipation, hair loss, weight changes, scars and sensitivity to tastes and smells may leave you feeling exhausted and uncomfortable. These side effects consume so much energy that sex may be low on your priority list at times. Although medications are available to treat many of these symptoms, some of these same drugs can decrease sexual desire or make it harder to reach orgasm.

Coping with Sexual Changes

When sexual changes do occur, they generally do not improve right away, often persisting until a good remedy is found. Finding the most helpful remedy may take time and patience because sexual changes can be caused by both psychological and physical factors.

Furthermore, treatment-related sexual changes caused may be long-term or permanent. Talk with your health care team before treatment to learn about what to sexual changes to expect from your cancer or cancer treatment. By knowing what may happen, you may be better prepared and more knowledgeable about potential sexual changes. If problems do occur, discuss them with your team and find out how to get help.

It is usually safe to have sex during cancer treatment unless your doctor tells you not to. Talk with your doctor before participating in sexual activities.

If you are having sex during chemotherapy, you may wish to use barrier protection, such as condoms or dental dams (for oral sex), since chemotherapy chemicals can be found in semen or vaginal fluid. More importantly for patients in their childbearing years, a pregnancy during or just after chemotherapy can be complicated by birth defects.

Radiation therapy from an external machine does not make you radioactive or endanger your partner in any way. If you are undergoing brachytherapy, in which radioactive seeds are implanted in your body, you may have to stop sexual activity for a brief period until the strongest radiation has left the body.

Sex can be a problem if you have bleeding in the genital area if you have recently had surgery or if your immune system is very weakened.

Sleep Loss

Some people with cancer have a hard time sleeping. Some can’t fall asleep, while others can’t stay asleep. Overall, many patients just can’t get enough rest. This may be a problem you have had your whole life, or it may be new. The causes could be anxiety, depression or just not feeling well. You may have a medical condition, such as a breathing problem or side effects from medicine. If you are not sleeping well, please talk with your doctor or nurse.

Coping with Sleep loss

  • Exercise regularly. A 20-minute walk can help you relax, but don’t exercise in the evening.
  • Limit naps if possible. If you must nap, keep it under 30 minutes, and do something active right after waking.
  • Avoid alcohol, caffeine, chocolate, and nicotine in the evening.
  • Turn off the TV one hour before bedtime.Listen to quiet music or take a warm bath instead.
  • Keep a regular sleep schedule, even on weekends.
  • Do not read, watch TV or work in the bedroom.
  • If you haven’t fallen asleep in 15 minutes, go to another room.Avoid mental stimulation and return to bed when you feel sleepy. If you still can’t fall asleep, get up again and repeat these steps as necessary.
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Stress Reduction

People have many emotions, including love, grief, fear, anger and joy, and many patients feel stress at times. To keep emotions from getting out of control, manage your feelings and stress by learning how to cope better. You may use a breathing method, start an exercise routine or try a new hobby. Also, please talk to your doctor or nurse about your feelings and the amount of stress in your life. For example, let them know if fear is keeping you from making decisions about your treatment, or if you are having conflict in your relationships.

You may feel better by connecting with other patients. Or counseling may help, and your doctor can give you a referral to the Psychiatry Service.

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