Side Effect Management During Treatment
Cancer and the treatments for cancer can cause many side effects that all patients and caregivers should be aware of. Relieving side effects, also called symptom management, palliative care, or supportive care, is an important part of cancer care and treatment. Talk with your health care team about any symptoms you or the person you are caring for experiences, including any new symptoms or a change in symptoms so your symptoms can be managed and treated. It is always a good idea to keep track of your side effects. One good way to do that is to keep a journal of how you are feeling. Below is a list of the common side effects of cancer treatment. To learn about person experiences, see the profiles about “how I knew I had stomach cancer“.
Attention, Thinking, or Memory Problems
Cognitive problems, also referred to as cognitive dysfunction or “chemo brain,” occur when a person has trouble processing information, which includes mental tasks related to attention span, thinking, and short-term memory. Up to 75% of cancer patients experience cognitive problems during treatment, and up to 35% continue to experience problems for months after treatment has finished. These difficulties usually vary in severity and can make it hard to complete daily activities. Patients who experience serious cognitive problems are encouraged to talk with their doctor, nurse, social worker, or another member of the health care team about ways to manage these issues.
Cognitive problems include difficulties in many areas such as:
- Trouble concentrating, focusing, or paying attention (short attention span)
- Mental “fog” or disorientation
- Difficulty with spatial orientation
- Memory loss or difficulty remembering things, especially details like names, dates, or phone numbers
- Problems with comprehension or understanding
- Difficulties with judgment and reasoning
- Impaired arithmetic, organizational, and language skills such as not being able to organize thoughts, find the right word, or balance a checkbook
- Problems performing multiple tasks (multitasking)
- Processing information slower
- Behavioral and emotional changes such as irrational behavior, mood swings, inappropriate anger or crying, and socially inappropriate behavior
- Severe confusion (delirium)
The severity of these symptoms often depends on the person’s age, stress level, history of depression or anxiety, coping abilities, and access to emotional and psychological resources.
Although cancer survivors commonly use the term “chemo brain” to describe difficulty thinking clearly after cancer treatment, people who do not receive chemotherapy may report similar symptoms. Continuing research into the wide range of cognitive problems experienced by people with cancer has shown they can be caused by a number of factors in addition to chemotherapy including:
- Radiation treatment to the head and neck, or total body irradiation
- Brain surgery in which areas of the brain may be damaged or disrupted during a biopsy or the removal of a cancerous tumor
- Hormone therapy, immunotherapy, and other medications such as anti-nausea medications, antibiotics, pain medications, immunosuppressants, antidepressants, anti-anxiety medications, heart medications, and medications to treat sleep disorders)
- Infections, especially those of the central nervous system (brain and spinal cord), and infections that cause a high fever
- Brain cancer
- Other cancers that have metastasized (spread) to the brain
- Other conditions or symptoms related to cancer or cancer treatments, including anemia, sleep problems, fatigue, hypercalcemia (high blood calcium), and electrolyte (a mineral in your body such as potassium and sodium) imbalances that can lead to dehydration or organ failure
- Emotional responses such as stress, anxiety, or depression
- Not having enough of specific vitamins and minerals such as iron, vitamin B, or folic acid
- Other brain or nervous system disorders unrelated to cancer
Cognitive problems caused by a reversible condition such as anemia or an electrolyte imbalance usually resolve after the condition is treated. Likewise, problems caused by a medication should go away after the medication is stopped. Problems related to cancer in the brain usually improve with treatment, but some symptoms may continue. Unfortunately, cognitive problems related to chemotherapy (“chemo brain”), radiation therapy, or other cancer treatments may continue indefinitely. You should always consult with your medical professional about management of these long-term cognitive problems which may include:
- Medications, including stimulants, cognition-enhancing drugs commonly used to treat Alzheimer’s disease, antidepressants, and opiate antagonists (drugs that block the actions of narcotics such as morphine)
- Occupational therapy and vocational rehabilitation to help people with the activities of daily living and job-related skills
- Cognitive rehabilitation (also known as neuropsychological rehabilitation) and cognitive training to help patients improve their cognitive skills and find ways to cope with cognitive problems
Strategies for coping with cognitive problems
The following strategies may help you better cope with attention, thinking, and memory difficulties and help keep you mentally sharp:
- Keep a log or checklist of daily reminders. Put it in a convenient location where you can look at it frequently throughout your day. If necessary, keep a duplicate copy at work.
- Take on one task at a time and avoid distractions.
- Carry around a small pad and a pen or pencil to easily write down notes and reminders. There are also a number of note-making apps available for most smartphones and tablets.
- Use a calendar or daily organizer to keep track of upcoming appointments, activities, and important dates.
- Place post-it notes around the house and workplace to remind you of important tasks. You may also want to set reminders using your phone or email calendar.
- Use word play such as rhyming to help you remember things.
- Get plenty of rest.
- Make time for physical activity, as it can increase mental alertness. Try walking, swimming, or gardening. Yoga or meditation can also help you relax and regain some mental clarity.
- Exercise your brain by doing brain-strengthening mental activities such as solving crosswords or puzzles, painting, playing a musical instrument, or learning a new hobby.
- Don’t be afraid to ask questions at your doctors’ appointments even if you feel like you are repeating yourself. Then keep track of the important facts you discuss with your doctor using a special notebook or a voice recorder. If it is too overwhelming, ask a friend or family member to go to the appointment with you so he or she can take notes and review them with you after the visit.
- Talk with your employer if you are having problems at work. Discuss potential ways your employer could support you such as modifying your workload and deadlines.
- Prepare for the next day by setting out the things you will need the night before.
- Color code or label certain cabinets or drawers where you store things around your home.
- Put things, such as car keys, back in their designated place after you use them so they will be easy to find the next time you need them.
- Eliminate clutter.
- Make sure important phone numbers are stored in your cell phone or are visibly displayed next to your home phone. You may also want to carry a small address book in case you forget to bring your cell phone when you go out.
- Ask family and friends for help. If you need additional assistance to cope with cognitive problems, talk with your doctor or other health care team members about counseling and other resources.
Cancer-related fatigue is a persistent feeling of physical, emotional, or mental tiredness or exhaustion related to cancer and/or its treatment. This type of fatigue is different than other types of fatigue, such as when a healthy person does not get enough rest, because it interferes with a person’s usual functioning, does not reflect his or her level of activity, and does not improve with rest. Most people receiving cancer treatment experience fatigue, and some cancer survivors have fatigue that lasts for months and sometimes years after finishing treatment.
It is important to talk with your health care team about any symptoms of fatigue you may experience, including any new symptoms or a change in symptoms. Diagnosing and relieving side effects, also called symptom management, palliative care, or supportive care, is an important part of your cancer care and treatment.
How fatigue affects your quality of life
Fatigue often negatively affects the overall physical, psychological, social, and economic well-being of a person with cancer. For some, it is slightly bothersome, while for others the experience can be overwhelming. Fatigue may influence your:
- Daily activities
- Hobbies and other enjoyable activities
- Social relationships
- Mood and emotions
- Job performance
- Feeling of well-being and sense of joy
- Attitude toward the future
- Ability to undergo treatment
Screening and diagnosing fatigue
Ask your medical professionals for an evaluation of your level of fatigue when you are first diagnosed with cancer and then ask that your level of fatigue be assessed throughout treatment and into recovery. In addition, your health care provider should perform this evaluation each year and any time you develop symptoms of fatigue. This evaluation is part of a comprehensive screening called distress screening that evaluates your emotional health and quality of life.
Not all of the causes of cancer-related fatigue are well understood, and your fatigue may be the result of more than one cause. To help find the best way for you to manage your fatigue, your doctor will work with you to look at several factors:
- Fatigue history. As part of your fatigue history, you may be asked to describe your fatigue on a scale from “no fatigue” to “most fatigue.” Your doctor may also ask when the fatigue began, when you feel most tired, how long it lasts, if it has changed over time, and what makes it better or worse.
- Health changes related to cancer. Your doctor may take a blood sample or perform other tests to learn more about potential cancer-related causes of your fatigue, such as if it is worsening, has spread, or has come back after treatment.
- Other health conditions. Other factors can cause or worsen fatigue. Your doctor may ask questions or recommend tests to find out if another health condition is affecting your level of fatigue.
Treating the causes of fatigue
The first step in managing fatigue is to treat any medical cause of fatigue or any condition that is contributing to fatigue.
- Managing pain. Living with constant pain will almost always make a person feel exhausted. Many of the medications prescribed for the treatment of pain also cause drowsiness, sleepiness, and fatigue. Your doctor can help you understand the pain management options available and give you information about common side effects of pain medications.
- Managing depression, anxiety, and stress. Dealing with cancer may lead to feelings of distress, depression, and anxiety, which often increase feelings of exhaustion and complicate treatment. Managing stress and treating depression and anxiety usually make a huge difference in a patient’s level of fatigue.
- Getting enough sleep. Stress, pain, and worry often interfere with a person’s ability to sleep through the night. In some cases, medications may also disturb normal sleep patterns. For those who are chronically tired, sleep may come in spurts at different times of the day or evening. Not feeling refreshed by sleep or being unable to sleep more than one to two hours will contribute to feelings of exhaustion and will likely affect your mood and ability to function.
- Eating healthy. Eating well and drinking enough fluids are important to maintaining an adequate weight and meeting your body’s nutritional needs. If available, consider talking with a nutrition counselor or registered dietitian (RD) at your treatment center. He or she can provide helpful hints on eating a well-balanced diet, as well as on eating when there is a lack of taste and during times of nausea and vomiting.
- Treating anemia. Many patients with cancer have anemia, which is a decrease in the number of circulating red blood cells. Anemia may be caused by the cancer or cancer-related treatments. Patients who have anemia report a feeling of extreme and overwhelming fatigue. The treatment for anemia may include nutritional supplements, drugs, and/or blood transfusions.
- Managing medication side effects. Medications used to treat cancer also contribute to fatigue. For example, it is common for fatigue to appear after treatment at the following times:
A few days after chemotherapy
A few weeks after beginning radiation treatment
· After treatment with immunotherapy such as interferon alpha (Alferon, Intron A, or Roferon-A) and interleukin (Proleukin)
In addition, medications used to manage other side effects may contribute to fatigue such as those used to manage pain. (See above.)
Co-existing medical conditions. People with cancer may also have other health conditions in addition to cancer, especially if they are older. These conditions can also cause or worsen fatigue and may include heart problems, lowered lung and kidney function, hormone problems, arthritis, and nerve problems.
Strategies to cope with fatigue
Along with treating and managing the medical causes of fatigue, many patients find that lifestyle changes can help them better cope with fatigue.
- Physical Activity. Staying physically active or increasing your activity level can help relieve cancer-related fatigue. Start slowly and gradually increase your activity levels. Walking programs are generally considered safe for most survivors. Once you are healthy enough for physical activity, try to aim for or build up to 150 minutes of moderate activity, such as fast walking, cycling, or swimming per week plus two to three strength training sessions per week. Talk with your doctor about the level and types of physical activity best for you. Many survivors, particularly those who have a higher risk of injury due to the cancer, its treatment, or other health conditions, benefit from working with a physical therapist or exercise specialist who can find the best ways to increase or maintain their physical functioning.
- Therapy and counseling. Talking with a therapist or counselor specially trained to work with cancer survivors can help reduce fatigue. Specifically, a type of counseling called cognitive behavioral therapy or behavioral therapy can help patients reframe their thoughts about fatigue and improve poor coping skills and/or sleep problems that could contribute to fatigue.
- Mind-body strategies. There is some evidence that mindfulness-based approaches, yoga, and acupuncture can reduce fatigue in cancer survivors. Touch therapy, massage, music therapy, relaxation, a form of touch therapy called reiki, and a type of relaxation/meditation called qigong may also be beneficial for reducing fatigue, but more research is needed on these strategies. If you are interested in pursuing mind-body strategies to help manage your fatigue, talk with your health care team for a referral to professionals who specialize in using these methods for cancer survivors.
- Medications and supplements. Some medications that make people feel more alert and awake may help manage fatigue for patients who are receiving cancer treatment or have advanced cancer. However, there is not much evidence that they are helpful for cancer survivors, but research on supplements such as ginseng and vitamin D is ongoing.
Mouth Sores or Mucositis
Mucositis is inflammation inside the mouth and throat that can lead to painful ulcers and mouth sores. It occurs in up to 40% of people receiving chemotherapy. In addition to chemotherapy, radiation therapy to the head and neck area may cause mucositis. Relieving side effects, also called symptom management, palliative care, or supportive care, is an important part of cancer care and treatment. Talk with your health care team about any mucositis symptoms you may experience including any new symptoms or a change in symptoms.
The best way to manage mucositis is to prevent it before it starts or to treat it early. Sucking on ice chips immediately before and during each chemotherapy treatment may prevent mucositis caused by certain types of chemotherapy such as fluorouracil (5-FU, Adrucil) injections. If mucositis occurs, your doctor may recommend a local anesthetic, such as a mouthwash solution that contains lidocaine (sometimes called Magic Mud, Magic Mouthwash, or Triple Mix) or analgesics (drugs such as acetaminophen [Tylenol] or prescription pain medication). Unless your doctor tells you otherwise, it is important to avoid taking aspirin during cancer treatment. Other drugs to prevent and treat mucositis are currently under investigation.
It is also wise to take special care of your mouth during cancer treatment. The following suggestions may help:
- Brush your teeth gently with fluoride toothpaste several times a day. Sometimes if the mucositis is severe, a toothette can be used instead of a toothbrush. A toothette is essentially a sponge on a stick.
- Floss gently.
- Rinse or gargle with a solution of saltwater and baking soda (1/2 teaspoon of salt plus 1/2 teaspoon of baking soda in a glass of water), and avoid mouth rinses that have alcohol in them.
- Minimize the time that you wear your dentures. Avoid wearing them at night, and consider removing them between meals to help minimize irritation.
- Choose foods that require little or no chewing.
- Avoid acidic, spicy, salty, coarse, and dry foods.
People receiving radiation therapy to the head and neck should see an oncologic dentist (a dentist with experience treating people with head and neck cancer) before beginning treatment. Because radiation therapy can cause tooth decay, damaged teeth may need to be removed. Often, tooth decay can be prevented with proper treatment from a dentist before beginning radiation therapy.
Nausea or Vomiting
Nausea and vomiting are common side effects of many cancer treatments. Nausea is feeling the urge to vomit or throw up. Vomiting may happen in expectation of treatment, within 24 hours after treatment, or two or more days after treatment.
Causes of nausea and vomiting
For people with cancer, nausea and vomiting may be caused by the following:
- Radiation therapy, especially to the stomach, brain, spinal cord, abdomen, and pelvis. People who receive total body radiation therapy have the highest risk.
- Cancer that has spread to the brain
- Blocked intestines, also called bowel obstruction
- Electrolyte imbalance, which is the loss of minerals such as potassium and sodium in the body
- Infections or bleeding in the gastrointestinal system (stomach and intestines)
- Heart disease
- Other medications
People who are more likely to have nausea and vomiting from chemotherapy include the following:
- People who have previously vomited after cancer treatment
- People who often have motion sickness
People who are anxious before cancer treatment people younger than 50, especially women
Mild nausea and vomiting can be quite uncomfortable, but it usually does not cause serious problems. Severe vomiting, such as vomiting a lot and often, can cause dehydration, electrolyte imbalance, weight loss, and depression. In addition, severe vomiting may lead some patients to stop cancer treatment.
Managing nausea and preventing vomiting
Relieving side effects, also called symptom management, palliative care, or supportive care, is an important part of cancer care and treatment. Many people find that behavioral treatments can help control nausea and vomiting. Methods such as distraction, relaxation, and positive imagery can help change the expectation and fear of nausea and vomiting. Talk with your health care team about any symptoms you experience including any new symptoms or a change in symptoms. There are also many medications that your health care team can prescribe for you to try. In some situations, your doctor may be able to recommend another treatment plan that is less likely to cause vomiting.
Peripheral neuropathy is a type of nerve damage outside of your brain and spinal cord, called the peripheral nervous system, and it can cause numbness, tingling, pain, muscle weakness, and other changes. Peripheral nerves carry information back and forth between your brain and spinal cord, called the central nervous system, and the rest of the body. Depending on which nerves are affected, you may notice a change in sensation, especially in your hands and feet, such as numbness, tingling, or pain; muscle weakness, called myopathy; and changes in organ function, resulting in constipation or dizziness.
Peripheral neuropathy can occur in relation to diseases such as cancer, diabetes, or thyroid disorder; nutritional deficiencies, such as a deficiency in vitamin B12; or inherited conditions such as Charcot-Marie-Tooth disease. Cancer treatment may also cause this disorder or make it worse. Although neuropathy can be difficult to treat, there are some treatments and lifestyle changes that may be helpful.
Cancer-related risk factors
Peripheral neuropathy is a relatively common side effect. Although anyone diagnosed with cancer is at risk for this condition, these factors can increase the risk:
- Tumor location. A tumor pressing on a peripheral nerve or one that grows into a nerve may damage the nerve.
- Chemotherapy. Specific types of chemotherapy, particularly in high doses, can injure peripheral nerves. These drugs include the following:
Platinums, including cisplatin (Platinol), oxaliplatin (Eloxatin), and carboplatin (Paraplatin)
Taxanes, including docetaxel (Docefrez, Taxotere) and paclitaxel (Taxol)
Thalidomide (Synovir, Thalomid)
Vinca alkaloids, including vincristine (Vincasar), vinorelbine (Navelbine), and vinblastine (Velban)
- Radiation therapy. Radiation therapy may cause nerve injury. Although it may take several years for symptoms to appear.
- Surgery. Neuropathy may develop after an operation on the lung or breast or after the amputation of a limb.
- Cancer-related disorders. Paraneoplastic disorders, which are rare disorders triggered by the immune system’s response to cancer cells, may cause peripheral neuropathy. Shingles, a viral infection that often presents with pain and a rash and may develop in people with weakened immune systems, may also result in neuropathy.
It is important to let your doctor know if you already have symptoms of neuropathy before starting treatment or if you have any of the other risk factors (listed below) that are associated with peripheral neuropathy.
Other risk factors
In addition, having any of the following pre-existing conditions, which are known to cause neuropathy, may put people with cancer at greater risk for developing the disorder:
- Alcohol abuse
- Infections such as HIV-AIDS
- Autoimmune diseases such as lupus and rheumatoid arthritis
- Hypothyroidism (an underactive thyroid)
- Kidney disease or kidney failure
- Hereditary peripheral neuropathy conditions such as Charcot-Marie-Tooth disease
- Lead poisoning or pesticides
- Extreme stress
Neuropathy symptoms and their severity vary from person to person, depending on which nerves are damaged and how many nerves are affected. Symptoms may develop during cancer treatment or shortly after. Neuropathy may also progress slowly, developing or worsening after treatment has ended; this occurs most commonly with those who receive platinum drugs and drugs called taxanes. There are three types of peripheral nerves that can become damaged, causing a wide range of symptoms:
- Sensory nerves. Peripheral neuropathy usually affects your sense of touch and feeling in the nerves in the hands and feet. Most people with cancer who develop neuropathy feel tingling, burning, a buzzing “electrical” sensation, or numbness. It usually starts in the toes and fingers and can continue along the hands and feet toward the center of the body. You may feel as though you’re wearing tight gloves or stockings, even though you aren’t. Nerve damage may also result in an uncomfortable sensation in your hands or feet that may be worse when you touch something. In addition, objects on your feet that usually aren’t painful, such as a shoe or bedcovers, may cause pain. You may notice an overall heightened sense of pain; the painful sensations are commonly described as pinching, sharp stabs, burning, and electrical shocks. You may notice a loss of sensation, making it difficult to feel hot and cold temperatures or to know if you’ve injured yourself. Another symptom is loss of position sense, which is knowing where your feet and hands are in space. This may make walking or picking up objects more difficult, especially if you are in a dark room or working with small objects.
- Motor nerves. These nerves send information between your brain and muscles. When these nerves are injured, you may have trouble walking and moving around. Your legs and arms may feel heavy or weak, causing balance and coordination problems. It may become difficult to use your hands and arms, and you may have trouble with everyday tasks such as brushing your teeth. In addition, you may experience muscle cramps and notice muscle loss in the hands and feet.
- Autonomic nerves. These nerves control involuntary body functions such as blood pressure and bowel and bladder function. Symptoms include an inability to sweat normally; gastrointestinal issues such as diarrhea and constipation; dizziness or lightheadedness; trouble swallowing; and sexual dysfunction.
If you have any of these symptoms, talk with your doctor or another member of your health care team so that you can get help managing these symptoms.
Preventing neuropathy related to chemotherapy
Currently, there is no good evidence that any medications, vitamins, or supplements can help you avoid neuropathy. Research on several antidepressants and other medications is ongoing but has not shown a consistent and/or strong benefit in preventing peripheral neuropathy from chemotherapy. There are no vitamins or supplements which can prevent neuropathy from chemotherapy.
Managing and treatment of neuropathy
Relieving side effects, also called symptom management, palliative care, or supportive care, is an important part of cancer care and treatment. Talk with your health care team about any symptoms you experience, including new symptoms or a change in symptoms.
How peripheral neuropathy is treated depends on the cause and the related symptoms. Many people recover fully from the disorder over time, in a few months or a few years. Sometimes the condition may be more difficult to treat and may require long-term management. Work with your doctor to diagnose and eliminate the cause of your neuropathy and manage symptoms. There are a number of methods available that may provide some relief:
- Medication. Although medication cannot reverse the neuropathy, it may relieve the pain. However, it does not relieve the numbness. The most common medications to treat neuropathic pain are anticonvulsants and antidepressants such as duloxetine (Cymbalta). Over-the-counter pain medications may be recommended for mild pain. Prescription nonsteroidal anti-inflammatory drugs or very strong painkillers called analgesics may be prescribed for severe pain. Topical treatments such as lidocaine patches and creams, may also help control pain. However, the medications used to manage neuropathy are related to your specific situation and the cause of your neuropathy.
- Better nutrition. Eating a diet rich in B vitamins (including B1 and B12), folic acid, and antioxidants may help manage neuropathy. You should also eat a balanced diet and avoid drinking too much alcohol.
- Physical and/or occupational therapy. Physical and/or occupational therapy can keep muscles strong and improve coordination and balance. Therapists can often recommend assistive devices that may allow you to more easily complete your usual daily activities. Regular exercise may also help reduce pain.
- Complementary medicine. Massage, acupuncture, and relaxation techniques may help decrease pain and reduce mental stress. Additional tips include placing stress mats for feet in your home and work environment, and wearing shoes with a rocker bottom sole.
Safety at home
Depending on your symptoms, these tips may help you avoid injury in your home if you have sensory or motor difficulties:
- Keep all rooms, hallways, and stairways well lit.
- Install handrails on both sides of stairways.
- Remove small area rugs and any other clutter that could cause you to trip or slip.
- Install grab bars in the shower or handgrips in the tub, and lay down skid-free mats.
- Use a shower seat in the shower.
- Use a thermometer to check that any water you bathe in or use is below 110 degrees Fahrenheit, or set your water heater accordingly.
- Clean up any spilled water or liquids immediately.
- Use non-breakable dishes.
- Use potholders while cooking and rubber gloves when washing dishes.
- If you drive, make sure you can fully feel the gas and brake pedals and the steering wheel and that you can quickly move your foot from the gas pedal to the brake pedal.
- If prescribed, use a cane or walker when moving from one room to the other.
People with cancer may develop sores, rashes, and other skin conditions caused by cancer or cancer treatment. For some people, skin conditions are especially difficult to cope with because they cause visible changes to the body. They may also cause itching, pain and discomfort. People receiving medication called targeted therapies may also experience specific skin problems.
Some skin conditions may get better over time, while others may not go away. Relieving side effects, also called symptom management, palliative care, or supportive care, is an important part of cancer care and treatment. In most cases, the best way to manage skin problems is by preventing them before they begin. Let your doctor or other member of your health care team know if you have any sores, wounds, rashes, or other problems with your skin right away. It is also important to let a member of your health care team know if you are having any pain or discomfort on your skin, even if you cannot see a skin problem. Sometimes pain or discomfort is the first sign that a skin condition is beginning.
Management of common skin conditions
People with cancer may experience the following skin conditions:
- Chemotherapy extravasation. Chemotherapy extravasation is the term used to describe what happens when chemotherapy given through an IV (a small needle and tube that is inserted directly into the vein) leaks onto the skin. Chemotherapy drugs that touch the skin can cause pain or burning. If left untreated, this can also cause a wound to develop. If you have pain or burning when you are receiving chemotherapy, tell someone on your health care team right away. If an extravasation happens during your treatment, a member of the health care team will likely stop the chemotherapy and clean the area around the IV. Your health care team will also instruct you on how to care for it at home. Then you will receive chemotherapy through another vein or by another method.
- Radiation-related skin problems. When radiation treatment kills cancer cells, it also kills some healthy cells. This can cause the skin to peel, itch, or hurt. Damage to the skin from radiation treatment often starts after one or two weeks of treatment. In most cases, it gets better a few weeks after treatment is finished. If skin damage from radiation treatment becomes a problem, your doctor may change the dose or schedule of your radiation treatment until the skin condition improves. One way to prevent radiation induced skin burns is with the daily application of a topical (for the skin) corticosteroid such as mometasone cream (Elocon, Momexin). Make sure you do not apply creams within four hours of the radiation treatment. If you see any open sores or areas where the skin is moist, it may be an infection and should be treated with topical or oral antibiotics.
- Necrotic wound. Some cancers cause wounds to develop or make it difficult for wounds to heal. A necrotic wound is a wound that is surrounded by dead skin or, sometimes, dead muscle tissue. A necrotic wound cannot heal when it is surrounded by dead skin or tissue. Removing the dead skin or tissue either surgically or by applying a special gel to the skin is the first step in treating a necrotic wound. If you have a wound that is not healing, tell a member of your health care team right away. A skin culture may be obtained to determine if there is an infection, and you may need topical or oral antibiotics.
- Pressure ulcers (bed sores). Pressure ulcers are sores that are caused by constant pressure on one area of the body. They often form on the heels of the feet or the sacrum (tailbone). Ulcers are less likely to form on parts of the body where there is a thicker layer of fat. For patients who are bedridden, an air- or water-pad that lies on top of the mattress helps prevent ulcers. Special beds called “low-air-loss beds” or “air-fluidized beds” may also help prevent ulcers or stop ulcers from worsening. There are treatments that provide comfort and pain control for ulcers as well as treatments that prevent them from getting worse.
- Malignant wounds. Malignant wounds form when cancer breaks the skin and causes a wound. Malignant wounds may be caused by many forms of cancer, but they are more common in people with skin cancer. Malignant wounds can easily become infected and be very painful. They may leak a large amount of fluid or blood. The odor from a malignant wound can also be overpowering. This odor can sometimes be managed by placing an odor absorber in the room such as cat litter, charcoal, or by introducing another odor, such as a burning candle, vanilla, vinegar, or coffee. Keep in mind that fragrances and perfumes can be irritating to some patients and may cause nausea. Topical antibiotics such as metronidazole (multiple brand names) may be effective in reducing odor. Talk with a member of your health care team if you have a wound.
- Pruritus (itchy skin). Some people with cancer develop pruritus. Pruritus is more common in people with some cancers than others, such as leukemia, lymphoma, multiple myeloma, or other cancers. Kidney or liver failure, thyroid problems, a drug reaction or allergic reaction, dry skin, hives, and other skin infections can also cause pruritus. Pruritus that is caused by an irritant such as a drug can be treated by stopping the use of that drug. Moisturizers, antihistamines, steroid medications, and cooling or painkilling creams or gels may also help relieve pruritus. Talk to a member of your healthcare team if you experience itching.
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