It’s common to experience side effects with cancer treatment. You may find relief from side effects of chemotherapy, as well as from symptoms of gynecologic cancer, through palliative care and integrative therapies; acupuncture and acupressure; dietary changes; and more.
Chemotherapy works by targeting cancer cells, which are cells that rapidly divide as they grow in the body. But some normal cells that also grow quickly can be hurt by chemotherapy drugs. OCRA researchers are working to develop therapies for ovarian cancer and other gynecologic cancers that attack cancer cells but leave healthy cells unharmed. Until we develop better targeted treatments, side effects often accompany treatment. Your doctor has many tools and drugs to effectively manage many side effects of chemotherapy.
Don’t be afraid to talk to your doctor about side effects you are having. No one needs to suffer — physically, emotionally or spiritually — during cancer treatment. Your doctor can connect you with a palliative care team to support you throughout your treatment
Read on for tips on how to manage common side effects of chemotherapy for gynecologic cancer, and for questions to ask your doctor about treatment and side effects.
Managing Side Effects of Treatment for Ovarian Cancer and Other Gynecologic Cancers
Blood-producing cells in the bone make a range of blood cells that fight infection, help blood clot, and carry oxygen to all parts of the body. When chemotherapy damages the white blood producing cells, you become susceptible to infections because of a shortage of white blood cells, or with the platelet producing cells you can bruise or bleed easily because of a shortage of platelets. Try to avoid cuts and scrapes, wash your hands often, avoid crowds and people with colds, coughs or other infectious diseases. Drink plenty of fluids and bathe daily, using moisturizer to soften dry and potentially cracked skin.
Chemotherapy can also cause patients to feel weak and tired because of a shortage of red blood cells. Understand your energy level and make accommodations. Do things you enjoy when you have the energy but rest or take naps when you feel the need to. Although exercise when you are tired seems counterintuitive, many women find activities, such as walking or gentle yoga, invigorating. Talk to your doctor before doing any exercise routine. Eating well is very important, too.
Throughout chemotherapy your nurses and doctors check for low levels of blood cells. If levels are too low, medicines are available to boost them up.
Most people being treated for cancer will lose their hair. The hair will eventually grow back, but can be slightly different in color and texture. You may choose to wear a wig, so that the loss of hair doesn’t become an outward manifestation of your disease as you go about your life. In anticipation of hair loss from chemotherapy, you may even have a party to cut it, or decide to donate your hair to make wigs for others with cancer.
Some chemotherapy drugs create taste changes in patients. Food may taste salty or bitter but usually tastes normal again once treatment is over. During this time, you may find it helpful to switch metal utensils for plastic. Non-alcoholic mouthwash and other products can decrease dryness of the mouth. It is important to eat nutritious food when undergoing chemotherapy. Your doctor may recommend that you see a nutritionist to help you eat right during this time. Eating smaller meals, a few times a day, is often recommended, as is trying to relish food and making it pleasant to experience, like dining with friends and family. Smoking, using tobacco and consuming harsh foods or alcohol increase the severity of these side effects.
Nausea and vomiting, or chemo belly
Often patients feel nauseated before a cycle of chemotherapy because of prior experience. Anti-anxiety drugs and complementary medical techniques, such as meditation, relaxation training or ginger, can help. Nausea and vomiting that occurs after chemotherapy can be treated with anti-emetics (anti-nausea) medications. Eating and drinking slowly and after vomiting, and staying hydrated, are very important. These side effects must be managed during chemotherapy treatments because uncontrolled vomiting and nausea can interfere with ability to receive treatments.
Diarrhea is a common side effect of chemotherapy that usually occurs in the days immediately following a chemotherapy treatment. Patients with diarrhea need to remember that they can become dehydrated quickly and should be sure to hydrate themselves.
Drink plenty of fluids, eat high fiber foods, move around and get as much exercise as you are comfortable doing (check with your doctor), try to be consistent with your bowel activity and take a fiber laxative. Talk to your doctor before taking any anti-constipation remedy.
Managing mouth and lip sores: Use a soft toothbrush to avoid injuring your mouth and keep your mouth moist, by drinking plenty of fluids. Avoid spicy and harsh foods that can be irritating to your mouth.
Certain chemotherapy drugs can cause peripheral neuropathy, an increase in numbness caused by damage to the nerves that transmit signals between extremities and the central nervous system. This damage to the nerves often causes a tingling sensation or loss of control in the hands or feet. Acupuncture or massage and physical therapy may lessen these side effects, which are usually temporary and improve or resolve when chemotherapy treatment stops. You may also discuss medications, such as vitamin B or alpha lipoic acid, with your doctor to prevent neuropathy. Some patients also find that ice mittens and booties during taxane therapies can alleviate nerve problems.
Sexuality and Intimacy Issues
Interest in sexual intimacy often decreases for chemotherapy patients for many reasons, including additional stress and the side effects of treatment. Being diagnosed with cancer can change not only your body, but your relationship with yourself, and your relationship with others. Learning to trusting your body again, regain a positive self-image, and reconnecting to your sexual self can feel challenging. When you are ready to engage in sexual activity, try to sustain open communication with partners, and consider taking the following actions:
- Make time for rest before and after sexual activity to preserve energy.
- Use water-soluble lubricants, as your vagina may be drier than usual due to hormonal changes. Daily moisturizers, pelvic floor physical therapy, or dilators may also be helpful.
- Experiment to find comfortable positions and avoid those that will tire you quickly.
- Remember, intimacy can mean more than intercourse — the goal is for you to be able to enjoy sex and intimacy in the ways you want, and how you feel most comfortable.
Many people experience forgetfulness and have trouble with concentration after receiving chemotherapy. This absentmindedness is often temporary; however, about 15 percent of chemo patients experience permanent problems. Since the cause is unknown, no treatment exists for this side effect. Those who have experienced this side effect offer several suggestions for dealing with it:
- Minimize distractions while performing important tasks.
- Keep a daily organizer/journal to keep track of appointments.
- Use the calendar on your computer and voicemail messages to remind yourself of meetings.
The National Cancer Institute offers detailed information about managing side effects of chemotherapy.
Some treatments, as well as anxiety and other physical and emotional symptoms surrounding diagnosis and treatment, can contribute to insomnia, which is defined by having difficulty sleeping at least three nights per week for a period of one month or more. Patients who receive steroids as part of their treatment regimen may be more likely to experience insomnia, and may benefit from taking the steroid earlier in the day, with doctor’s approval.
If you are experiencing insomnia, it’s important to tell your medical team, particularly before taking any supplements which may interfere with treatment. Your medical team may suggest cognitive behavioral therapy, and share strategies to improve relaxation, sleep routine and sleep behaviors.
Cancer introduces new psychological, emotional and physical pressures that can understandably lead to increased stress. Though stress is normal, having elevated levels of stress can have an impact on your body, leading to increased blood pressure, heart rate, and blood sugar. If you find that stress, or distress, are interfering with your everyday activities, you may benefit from methods of stress management such as counseling or talk therapy, social support settings, an exercise routine, or medication.
It is common for those in treatment, and even their loved ones, to experience feelings of sadness, grief, and a wide range of emotions when faced with cancer. Depression can occur from the realities of having a cancer diagnosis, from hormonal changes post hysterectomy, and as a side effect of some treatment therapies. The added stress of managing changes in schedules, uncertainty, and the everyday challenges of disease and treatment are a lot for anyone to deal with.
It is very normal to experience some depression and feelings of intense grief at time of diagnosis and even when completing treatment. However, if you or a loved one are experiencing severe and lasting periods of sadness, it is important to tell your doctor. The American Cancer Society estimates that 1 in 4 people with cancer will experience clinical depression, and recommends that those experiencing symptoms of clinical depression reach out to a medical professional.
Removal of the ovaries (bilateral oophorectomy) will result in what is called surgical menopause. Symptoms of surgical menopause can feel intense, and include hot flashes and night sweats; vaginal dryness; loss of bone density; change in libido and sexual function; and increased risk of cardiovascular disease. If you need relief from menopausal symptoms, your doctor may recommend options such as hormone therapy, vaginal estrogen, or medications that can safely decrease your symptoms. You can also ask your doctor about lifestyle and dietary changes, home remedies, and alternative medicines that may help with menopause symptoms.
Hormonal changes caused by menopause, as well as treatment itself, can cause excessive sweating. You may experience sweating during the day, as hot flashes, or through night sweats. Sweating may be experienced as a hot feeling in certain parts of the body; dampness; fever followed by intense sweating; chills; or drenching sweats. If sweating is a persistent issue, it may be helpful to track when it occurs, and then talk to your doctor about your current medications, and the possibility of over-the-counter or alternative options to help control sweating.
Questions for your doctor about chemotherapy
Here are some questions the National Cancer Institute suggests you might consider asking a doctor before you start chemotherapy:
- When will treatment start? When will it end? How often will I have treatment?
- Which drugs will I have?
- How do the drugs work?
- Do you recommend intravenous and intraperitoneal chemotherapy for me? Why?
- What are the expected benefits of treatment?
- What are the risks of treatment? What side effects might I have?
- How can I prevent or treat these side effects?
- How much will chemotherapy cost? Will my health insurance pay for all of the treatment?