Alison Massey, as told to Susan Bernstein
The perception is that chemotherapy is like a treatment from 20 or 30 years ago. It is thought to have intolerable side effects, but we have made significant progress in managing the toxicities associated with cancer drugs. People think chemotherapy makes them sick, but it doesn’t. Each regimen has its own side effect profile. If you look at the list of possible side effects, people can be overwhelmed. Most people experience side effects, but no one gets every possible side effect.
Usually, people will feel a bit tired or their energy levels will drop for a few days. However, we hope that you will be able to lead a normal life between treatments. There are many people who continue to work between treatments.
Nausea is another common side effect, but we have also made progress in treating nausea during treatments. We can recommend several anti-nausea medications to patients. 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 can cause hair thinning. There are definitely ways to help manage these issues, including prescribing wigs or other resources. In the case of hair thinning, we can also check certain laboratories or involve our dermatologist colleagues for their help.
Fatigue is the main thing you may experience during radiation. Radiation can cause inflammation in the body as it kills cancer. Inflammation causes the side effects. Depending on what they are emitting, you may be in pain. For example, if you receive radiation to your lungs, your esophagus may also be affected because the radiation may be close to that area of your body. If so, you may have pain or difficulty swallowing. You may even feel that the food is stuck after you swallow it. People who receive radiation may not realize that it can affect how they swallow food.
Sometimes people need radiation for a painful lesion. While patients with advanced lung cancer are receiving radiation at a particular site, pain may flare up. Eventually, the hope is that the pain will go away. During this time, you may be treated with pain relievers or steroids such as dexamethasone to minimize the inflammation that causes the pain.
Checkpoint inhibitors [immunotherapy medications for lung cancer] they can have side effects, but they are different from chemotherapy because they affect the immune system. These drugs can overactivate the immune system, leading to side effects. Sometimes we see patients develop skin inflammation that shows up as a rash, or colitis that causes diarrhea, or pneumonia that can cause shortness of breath or a cough. Checkpoint inhibitors can also cause arthritis or myositis, which is inflammation of the muscles. Sometimes we can even see swelling of the joints. It is important that if patients experience any new symptoms while taking the checkpoint inhibitor, 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 that 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 know you have a plan of attack for your cancer, most people feel better. Many people are afraid of cancer treatments and the potential impact of treatment on quality of life. We let people know that they can still live their lives and continue to do what they enjoy.
Your mood and outlook may depend on where you are in the cancer treatment process or the progression of the disease. Early on, most people are more functional and less tired. Some people can still work. Others need to hang out at home for a few days after each treatment. Our goal is to keep you out of bed while you are being treated for cancer. Keep to an active schedule as much as you can. Realize that you will be tired after treatment and plan for those days. And don’t forget to ask for help if you need it!
Good sleep can affect your mood and quality of life. Many of our patients have insomnia. Anxiety can often cause this insomnia. Your brain is racing so you can’t sleep. In addition, some medications can cause nausea or steroids can increase inflammation and cause insomnia. And sometimes an annoying cough can disturb your sleep.
Some people with lung cancer need to use supplemental oxygen. In my experience, people struggle with the idea of wearing oxygen because, like hair loss, people on the outside now see that they are sick. But it is medically important to wear it if you need it.
Loss of sexual function can be observed in both men and women. In my experience, men are more vocal about this, so ladies, let me know if you have any concerns! 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 doctor. Treatments can also affect a woman’s menstrual cycle. If you are someone who could become pregnant, be sure to use birth control during cancer treatment.