A nurse’s perspective: the unknowns of treatment

By Alison Massey, told to Susan Bernstein

Chemotherapy feels like treatments from 20 or 30 years ago. They think it will have side effects that are not tolerable, but we have made significant progress in managing the toxicities that come with these cancer drugs. People think chemo will make them sick, but it doesn’t. Each individual treatment regimen has its own side effect profile. If you look at the list of possible side effects, people can be overwhelmed. Most people will experience a side effect, but no one experiences every possible side effect.

Generally, people will be a little tired or have low energy for a few days. But between your treatments, we hope you can live a normal life. We have many people who continue to work between their treatments.

Nausea is another common side effect, but we’ve also made progress in managing any nausea you may experience during your treatments. We can offer patients a range of anti-nausea medications. Some treatments cause hair loss, and if so, we’ll let you know up front. It is important to note that the vast majority do not cause hair loss, although some may cause thinning hair. We certainly have ways to help you deal with these issues, including providing you with a prescription for wigs or other resources. With thinning hair, we can also check some labs or bring in our fellow dermatologists to help.

Fatigue is the main thing you can feel from radiation. Radiation can cause inflammation in your body because it kills cancer. It is the inflammation that causes the side effects. Depending on what is being irradiated, you may feel pain. For example, if you are receiving chest radiation therapy, your esophagus may be involved because the radiation therapy may be close to this area of ​​your body. If so, you may have pain when swallowing or difficulty swallowing. You may even feel like food gets stuck after you swallow it. People who experience radiation may not realize that it could affect swallowing food.

Sometimes people will need radiation therapy for a painful lesion. When you receive radiation at a particular location for people with advanced lung cancer, you may have a flare up of this pain. Ultimately, the hope is that the pain will go away. During this time, we may also treat you with painkillers or steroids like dexamethasone to minimize the inflammation that is causing the pain.

Checkpoint Inhibitors [immunotherapy medications for lung cancer] can have side effects, but they are different from chemo because they work on your immune system. These drugs can overactivate your immune system, leading to side effects. Sometimes we see patients develop dermatitis, which appears as a rash, or colitis which causes diarrhea, or pneumonitis of the lungs, which can cause shortness of breath or cough. Checkpoint inhibitors can also cause arthritis or myositis, which is inflammation of your muscles. Sometimes you can even see swelling in your joints. It is important that if patients notice any new symptoms while taking a checkpoint inhibitor that they let us know so that we can initiate 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 face 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 support team, and know you have a plan of attack to treat your cancer, most people feel better. Many are afraid of cancer treatments and the potential impact of treatments on your quality of life. We’re letting people know that they can still live their lives and they should keep doing the things they love.

Your mood and outlook may depend on the progress of your cancer treatment or the progression of the disease. At first, most people are more functional and have less fatigue. Some people can still work. Others may need to stay home for a few days after each treatment. Our goal is for you to stay out of bed for the duration of your cancer treatment. Keep an active schedule as much as you can. Realize that you will be tired after your treatment and plan those days. And don’t forget to ask for help if you need it!

Sleeping well can also affect your mood and quality of life. Many of our patients suffer from insomnia. Often, anxiety can be the cause of this insomnia. Your mind is racing, so you can’t sleep. Also, some of the medications you take for nausea or steroids for inflammation can make you excited and cause insomnia. And sometimes a bothersome cough can disrupt your sleep.

Some people with lung cancer may need supplemental oxygen. In my experience, people struggle with the idea of ​​wearing oxygen because, like the association with hair loss, now people on the outside are able to see that they are sick. But from a medical point of view, it is important to wear it if you need to.

Loss of sexual function is something we can see in both men and women. In my experience, men are more vocal about this, so say so, ladies, 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 doctor who specializes in sexual health. Treatments can also affect women’s menstrual cycles. If you are a person at risk of becoming pregnant, you should be careful about using contraception during your cancer treatment.

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