sideeffects

Treatment side effects are not uncommon and can vary from person to person. Most treatment plans try to keep side effects to a minimum, but it is important to keep your health care team informed of any changes so they can help you manage them.

Coping with Side Effects

brain tumor quoteLife is not about waiting for the storm to pass. It’s about learning to dance in the rain.-Vivian Greene

Side effects of brain tumor treatment depend upon the treatment plan – surgery, chemotherapy, or radiation – and the patient’s overall health status. Discussion of potential side effects and the likelihood of them developing is important, so the patient and their caregivers (family, friends) can make appropriate treatment decisions together with their medical team.

In addition to physical side effects, there may be emotional and social effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies. The medical team needs to know about any side effects the patient is experiencing, even if they feel it’s not serious. Also, side effects can last beyond the treatment period, called a long-term side effect. Treatment of both types of effects is an important part of patient care.

NAUSEA AND VOMITING

Doctors may prescribe anti-emetics (anti-nausea and anti-vomiting) even before these symptoms arise. This is because it is mostly a universal response to the cancer treatment. For anti-emetics to be effective, the patient must take it as prescribed – round the clock. Too much at one time is clearly not healthy. Too little, the anti-emetic is rendered ineffective.

Other ways to reduce nausea and vomiting:

  • Drink plenty of fluids (in small amounts if necessary) throughout the day
  • Eat several small meals throughout the day. The goal is nutrition.
  • If you can, eat a light meal a few hours before your scheduled treatment. It’s like an athlete gearing up before an event.
  • Bring some hard candy, mentholated drops or mints with you

Internal self-imagery, massage, acupuncture and biofeedback where the patient focuses energy on feeling good and becoming healthy have been proven effective as well.

FATIGUE

Fatigue is a huge issue with many treatments, particularly cancer treatment. To combat your fatigue start with the basics:

From you:

  • Set priorities for activities, but understand how to balance activity and rest. Priority of course being to enjoy the physical activity.
  • Ask friends and family for help
  • Try yoga, book memories, visuals of places visited or places you want to see.
  • Maintain a well balanced diet
NEUTROPENIA

A low number of neutrophils – a type of white blood cell – means that you have a greater risk of infection. Neutropenia is difficult to prevent during treatment but there are ways to offset this side effect. Frequent hand washing is one method of reducing exposure to infection. There is also a treatment with growth factors that has been proven to be beneficial. Growth factors are proteins that stimulate bone marrow. Bone marrow is responsible for white blood cell production. Growth factor treatment is typically a simple injection under the skin.

DIARRHEA

There are a number of steps you can take to minimize and/or prevent diarrhea:

  • Be sure to hydrate – recommended fluid intake is 6 to 8 glasses per day (water, juice, decaffeinated herbal tea)
  • Avoid alcohol and caffeine
  • Eat 4 to 5 small meals throughout the day
  • Eat bland, low-fiber foods. Be sure the food is high in protein, calories and potassium.
  • Do not ingest: foods high in fat, beverages very cold or very hot

There are some over-the-counter medications that can help control diarrhea but you should consult with your doctor who may have different instructional dosages from the standard directions. There are also some prescription anti-diarrheal medications that may be considered. For the discomfort associated with this symptom, there are creams one can use in the rectal area before using the toilet. Keeping the area clean, taking warm showers or baths are also highly recommended.

CONSTIPATION

The flip-side of the pain and discomfort of diarrhea is constipation. This symptom cannot only be uncomfortable and distressing, it can also impact on your ability to take in the nutrients necessary for your health.

The more “regular” methods to prevent and/or minimize constipation are:

  • Plenty of fluids – (in this case a bit of caffeine can get things moving)
  • Foods high in fiber – fresh fruits, vegetables and whole grains
  • Exercise – long, slow walks are hugely beneficial if your energy level is low

Another option is over the counter medications:

  • Stool softeners, such as Colace
  • Gentle laxavites, such as Senn
  • Milk of Magnesia – for this laxative you need to consult with your doctor since it should not be taken within 1 hour of other medications containing magnesium
MOUTH SORES

It is important to visit your dentist to check on the health of your teeth and gums before starting treatment. Once you have begun treatment, check your mouth twice daily for any mouth sores so you can catch them in the early stages. Proper dental hygiene – brushing teeth, application of lip balm – should be practiced thirty minutes after each meal.

If mouth sores do develop, you may be prescribed special solutions for rinsing your mouth, topical pain medication, or for medication to coat the oral lining.

Ways to promote healing and decrease levels of discomfort:

  • Be sure to hydrate throughout the day, preferably through a straw
  • Eat soft foods
  • Avoid foods that may irritate – hot and spicy, greasy/fried, foods that are: salty, sugary, crunchy or high in citrus
  • Avoid caffeine, alcohol, carbonated drinks and tobacco
DRY MOUTH

Dry mouth can be extremely uncomfortable. To keep your mouth moist, try taking frequent small sips of water or sucking on ice cubes. Broth or sauce added to food may make it easier to swallow. Additionally, you can try sugar-free gum or sugar-free hard candies. For severe cases, there are prescription medications – such as Salagen – which will stimulate saliva production. There are also artificial saliva substitutes in the form of a spray or gel.

SKIN AND NAIL REACTIONS

If not treated early, skin and nail side effects can quickly become severe. A localized rash may not be severe enough for treatment. But if it spreads and causes itchiness and pain, you may be prescribed a corticosteroid cream or an antibiotic gel. For severe rashes, an oral antibiotic and/or a steroid may be prescribed as well. To care for your skin, gentle soaps and moisturizers are encouraged. Avoid very hot baths, scratching at the rash and exposure to the sun. To care for your nails, be sure to keep them trimmed and avoid excessive exposure to water.

SIDE EFFECTS AFTER SURGERY

Surgical side effects include: an increase in current symptoms, damage to normal brain tissue, brain swelling, and seizures. Other symptoms, such as muscle weakness, mental changes and decreases in any brain-controlled function can occur.

Combinations of these side effects may happen. These side effects are most noticeable shortly after surgery, frequently declining over time. In certain cases, the side effects do not go away.

SIDE EFFECTS AFTER CHEMOTHERAPY

Chemotherapy is used to damage or kill rapidly growing cancer cells – but it can also affect normal tissue. Since chemotherapy is usually given intravenously the drugs reach most body organs.

Common side effects of chemotherapy are: nausea, vomiting, hair loss, and loss of energy. The immune system is often depressed, resulting in an increased susceptibility to infections. Other systems, such as the kidneys and the reproductive organs, may also be damaged by chemotherapy. Most of the side effects decline over time, though some may persist.

SIDE EFFECTS AFTER RADIATION

Like chemotherapy, the radiation used to destroy cancer cells can also affect normal cells in the surrounding area. Most patients do not experience any side effects until a few weeks into their treatment, and with palliative care and time, side effects will gradually disappear after therapy is complete. Remember that the treatment can affect each patient differently, and you may not experience these particular side effects.

Some of the most common side effects include: • Poor appetite • Fatigue • Hair loss • Muffled hearing • Skin irritation • Short-term memory loss • Brain tissue swelling (resulting in headaches) • Worsening of old symptoms

LONG TERM SIDE EFFECTS (Late Effects)

The side effects listed above tend to occur during treatment up until a few months after treatment. Late effects can occur months to many years after cancer treatment. Chances of this varies, depending on the areas included in the field of radiation and the radiation techniques that were used, as newer ones continue to be developed and improved.

Though the risk is low, patients should be aware of these possible late effects: Radiation can cause changes in the brain tissue. Blood supply may be reduced to certain areas of the brain as small blood vessels may slowly become scarred and blocked. Symptoms range from mild to severe, depending on the extent of radiation damage.

Late Effects on brain function include: • Problems thinking clearly • Difficulty managing tasks previously found easy • Poor memory • Confusion • Personality changes • Headaches similar to migraines that come and go (called SMART attacks) • Symptoms similar to those from the original tumor

For mild late effects, the first treatment option is steroids.  Some patients may need surgery to remove an area of dead tissue – typically for those suffering late effects after radiosurgery.

CHEMO BRAIN

For years people with cancer have worried about, joked about, and been frustrated by the mental cloudiness they sometimes notice before, during, and after cancer treatment. Even though its exact cause isn’t known, it can happen at any time when you have cancer. This mental muddle is commonly called chemo brain.

It is important to note that though the term used is chemo brain, these symptoms of mental sluggishness can occur after radiation treatment and immunotherapy treatment as well. There is a vague, distressing mental change that cancer patients sometimes notice. They describe it as “a cloudiness or fog”. Many cancer patients shrug it off or laugh it off – but these mental effects are real. Called “chemo brain”, these mental effects might last a short time – or they might last for years. These changes can make it difficult for people to go back to their school, work, or social activities. At the very least, chemo brain can make these activities drain a lot of mental effort. Chemo brain affects everyday life for many people with – and survivors of – cancer.

Examples of Chemo Brain

  • Memory lapses
  • Trouble concentrating – lack of focus, short attention span or “spacing out”
  • Trouble remembering details – names, dates, perhaps significant events
  • Trouble multi-tasking
  • Disorganized, slow thinking and processing
  • Trouble remembering common words or the ability to find the proper word to finish a sentence

Most doctors define chemo brain as a decrease in mental “sharpness” – being unable to remember certain things and having trouble finishing tasks or learning new skills. How long chemo brain lasts is a major factor in how much it affects a person’s life. When it starts, how long it lasts, and how much trouble it causes can vary greatly. For most people, brain effects happen quickly and only last a short time. Others have long-term mental changes. People who are having problems are well aware of the changes in their thinking. Typically, patients dismiss these issues and neglect to tell their cancer care team about this problem until it impacts everyday life.

Causes of Chemo Brain
While chemo brain symptoms usually start during and/or just after treatment, there are some cases where the symptoms start and even get worse after treatment is over. Many cancer treatments, including certain kinds of chemo and radiation, can cause short-term, long-term and delayed problems.

There may be more than one cause of chemo brain, especially for the short-term symptoms. Patients with brain tumors, both benign and malignant, have real “brain” problems even if they haven’t had chemo. Other patients notice problems from hormone treatments, such as those used to treat breast or prostate cancers. While for others, problems start after surgery. So along with typical chemo and radiation therapies, many different things can impact brain function.

For instance, brain function problems could be caused or worsened by any one or any combination of these factors:

  • The cancer itself
  • Other drug therapies: steroids, anti-nausea, or pain medicines
  • Surgery and the anesthesia
  • Infection, nutritional deficiencies, or low blood counts
  • Sleep problems and/or fatigue
  • Hormone changes or hormone treatments
  • Accompanying illnesses (i.e. diabetes or high blood pressure)
  • Patient age
  • Mental state (depression, stress, anxiety, or other emotional pressure)

Managing Chemo Brain
To help sharpen your mental abilities and manage chemo brain, here are some examples:

  • Get enough rest and sleep.
  • Use a detailed daily planner or your smart phone.
  • Exercise your brain. Take a class, do word puzzles, or learn a new language.
  • Exercise. Regular physical activity is good for your body, improves your mood, makes you more alert, and decreases fatigue.
  • Healthy eating – especially vegetables. Studies have shown that eating more vegetables is linked to maintaining brain power as people age.
  • Set routines– Pick a certain place for commonly lost objects and put them there each time.
  • Don’t try to multi-task. Just focus on what you’re doing “here and now”.
  • Ask for help. Your friends and loved ones can help with daily tasks to reduce distractions – which will help you save mental energy.
  • Track your memory problems. Keep a diary of when you notice problems and what’s going on at the time (medicine protocol, time of day, and situations you may find it more difficult to stay focused).
  • Accept instead of deny. Many patients have noted that being able to laugh about things you can’t control can help one cope.

Remember (pun intended) that your friends, family and your doctors are all resources from which you can draw upon to help you navigate this symptom. While it may seem like a huge setback, you have survived an incredibly pernicious cancer. The brain is actually able to rewire itself. It just takes time, patience, and – as you have clearly shown – the will to keep embracing life.

NEUROPATHY

Peripheral nerves are the nerves located outside of the body’s brain and spinal cord. Peripheral neuropathy is described as sick or injured nerves. Many diseases and conditions can cause nerve damage. In patients with cancer, radiation treatments, chemotherapy, or the cancer can be the cause of nerve damage. Symptoms of peripheral neuropathy depend on the type of nerve(s) affected and where the nerve is located in the body.

If nerves to the skin are affected symptoms may include:

  • Numbness and tingling (pins and needles feeling)
  • A feeling of compression on a body part
  • Extreme sensitivity to touch
  • Burning feeling in toes or fingers
  • Loss of ability to feel hot/cold

If nerves to the internal organs are affected symptoms may include:

  • Dizziness
  • Constipation
  • Bladder difficulties
  • Sexual problems

If nerves to the muscles are affected symptoms may include:

  • Dizziness
  • Constipation
  • Bladder difficulties
  • Sexual problems

Patients with neuropathy symptoms are strongly encouraged to tell their doctor or nurse right away. This is because if nerve damage is due to a drug, the drug may be stopped. If the nerve damage is because of a tumor, then the tumor may need to be treated. And if the neuropathy is due to a vitamin deficiency, then vitamins may be prescribed.

Possible Treatments
There are methods to deal with peripheral neuropathy, though it may take a means of trial and error for each patient to determine which treatment works best. Sometimes it may require a combination of methods to decrease or completely eliminate the symptoms. You are advised to tell your doctor or nurse what treatments for neuropathy work best so a plan can be designed.

Some treatments for neuropathy are outlined below:

  • Exercise As long as the exercise is approved and prescribed by a doctor, and supervised by a physical therapist, this can increase strength, circulation, and coordination to the damaged areas. Not only is exercise important for the brain, it increases circulation and with neuropathy it is important to keep as much muscle strength and function as possible.
  • Pain Medicines
    • Non-narcotic pain relievers (Tylenol, Motrin)
    • Narcotics – these can almost always relieve the pain of neuropathy, but the side effects can be a problem
    • Topical anesthetics – in the form of creams and sprays, these have been proven to relieve some painful sensations of neuropathy
    • Tricyclic antidepressants – these can decrease the chemicals in the brain that transmit pain signals
    • Anti-convulsants – while it may seem an “extreme” pharmaceutical measure, anti-convulsants can help calm down the nerves and the central nervous system.
  • Alternative/Complimentary Treatments (CAM) There is not a lot written to support the effects of complimentary and alternative treatment of peripheral neuropathy. Massage can increase circulation and promote relaxation, but in some conditions massage could be harmful. Check with your doctor before having massage therapy. The same goes for acupuncture and any herbal remedies about which you may have read.
LATE EFFECTS ON HORMONES

When the pituitary gland is near the treatment area, hormone imbalances can develop in the future. The pituitary gland controls your • Thyroid gland • Steroid levels • Growth • Water balance in the body • Fertility,

Hormone replacement therapy can be used to correct any imbalances.

SECOND BRAIN TUMORS

In very rare cases, patients who received radiation therapy may develop another brain tumor many years after initial treatment.  This is because, while radiation kills cancer cells, it is also a risk factor for developing them. Unfortunately, tumors caused by previous radiotherapy are often malignant and tend not to respond very well to treatment.

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