COPING WITH SIDE EFFECTS
Fatigue may be caused by chemotherapy, radiotherapy or other medicines. Cancer itself may also cause fatigue or low red blood cells (anemia). Realizing that fatigue is common for people with cancer, and asking for help, are important first steps in coping with it. If ongoing fatigue is a problem, talk to your doctor. They may be able to suggest things to help you. Eat nutritious food and stay hydrated to keep your energy levels up. Plan to physical activities with your doctor’s approval- be it a walk or exercise.
NUTRITIONAL AND DIETARY PROBLEMS
Nutritional problems can happen to people who have ovarian cancer. These problems may be worse if you have advanced cancer. They can include:
1. Loss of appetite
2. Weight loss
3. Feeling and being sick (nausea and vomiting)
4. Difficulty swallowing
5. Loss of or changes in taste: metallic taste
Sore mouth: dry mouth and ulcers.
These problems can be a result of your cancer, treatment, tiredness, pain, and depression. Always talk to your doctor if you develop any of these symptoms. There are anti-sickness medications (anti-emetics) and natural therapies that can help prevent and treat these side effects.
LOSS OF APPETITE AND WEIGHT LOSS
• The aim is to maintain your weight during treatment, even if you feel you’re carrying extra weight. If you notice you’re losing weight, ask to speak with a dietitian
• Eat small amounts often (e.g. every two to three hours). Try to eat before you get too hungry as an empty stomach can make you feel sicker.
• Have plenty of nutritious snacks on hand (e.g. nuts, crackers with cheese, yogurt, fruit, dried fruit, muesli bars, boiled egg).
• Try to make eating times relaxing and enjoyable. Eat with friends and family if possible.
• Accept offers of practical support from family or friends. Ask for nutritious meals that can be frozen and reheated.
• If you’re losing weight without trying, boost the energy content of your meals by adding an extra tablespoon of olive oil, butter, margarine or grated cheese to hot meals like pasta and rice dishes. You can add milk powder or cream to porridge, too. This adds calories without adding extra bulk.
• Eating enough protein is also important to help maintain your muscles. Include red meat, chicken, fish, eggs, tofu, legumes, nuts and dairy foods regularly across the day.
• A homemade smoothie made from milk, yogurt, and fruit is an easy way to boost your nutritional intake when you’re not feeling well.
• Ready-to-drink supplements like Sustagen® or Ensure® can be useful if you’re struggling to eat well. Your dietitian can recommend one that is appropriate for your needs.
FEELING AND BEING SICK
• Salty foods can help with nausea – try dry, salty crackers or pretzels (but not if you have mouth ulcers).
• Avoid fatty or fried food.
• Some people find cold foods easier to take than hot meals. Avoid being in a room full of cooking smells.
• Sip ginger in drinks or suck ginger sweets – ginger has anti-nausea properties that may help.
• Acupuncture can help with nausea.
Mouth care, taste changes and swallowing difficulties
• Keep your lips moist with lip balm. Suck on ice blocks or sip water regularly to keep your mouth moist. > If you have mouth ulcers, keep your mouth clean and moist by using regular mouthwashes (alcohol-free) and salt gargles.
• Avoid rough, crunchy or dry foods (such as crisps, nuts, dry biscuits) and choose foods that are moist instead (like casseroles, stews, soups, pasta sauces).
• Try chewing on sugar-free gum or sucking on mints.
• If food tastes bland, try to boost the flavor of your meals by using fresh herbs, lemon juice or other sauces (example, soy sauce).
• If you notice a metallic taste in your food, try a small piece of fresh fruit or juice just prior to eating, or sucking mints and boiled sweets between meals. Some people find using plastic cutlery rather than metallic cutlery helps.
• People with cancer have pain for many reasons. It may be caused by cancer, the treatment or something else. The main causes include:
• Side effects of chemotherapy, radiotherapy or surgery.
• Spread of cancer to other organs in the body.
• Blockages in organs such as the bowel.
• A tumor pressing on nerves, organs or bone.
• Bone fractures if the tumors spread to the bones.
• Muscle stiffness due to less movement than usual or tension.
It can be very frightening to be in pain. You may worry about having a lot of pain due to your cancer or its treatment. It may help you to know there is usually something that can be done to help most types of cancer pain. There are different types of pain, such as nerve pain, bone pain, chronic pain, referred pain, and muscle pain. Each one may be relieved using different treatments or pain-relieving drugs. Talk to your doctor to work out the cause of your pain and how to best manage it.
Hair loss is usually temporary. If it happens, it will start about two weeks after your first treatment. Hair generally starts to return after your final treatment ends. Your hair will grow back once you finish chemotherapy, usually within weeks or months. While your hair is falling out, your scalp can feel itchy, tender and hot. Losing your hair can be difficult to cope with as it makes cancer obvious to others. Many women say losing their hair is one of the hardest parts of having cancer. It helps to remember that hair loss is almost always temporary. Some women who have very long hair may be able to cut their hair before treatment and donate it to make wigs. In case of hair loss, it’s a great help to be prepared and think about ways to lessen the shock before you start chemo. Cold caps are not suitable for everyone having chemotherapy. You would need to discuss this option with your specialist doctor.
Constipation may be caused by your cancer treatment, anti-sickness (nausea) or pain-relieving drugs. It can also be a result of cancer affecting the bowel or being less active when you are unwell. It is important to let your doctor know if you are constipated, as leaving it too long can lead to more serious problems.
Some chemotherapy drugs, radiotherapy, and antibiotics can cause diarrhea. Stress, anxiety, and infections can also cause diarrhea. Talk to your doctor if you have diarrhea, stomach pain or cramps.
Some chemotherapy drugs, especially platinum-based chemotherapy, can damage your inner ear – this is called ‘ototoxicity’ and can result in loss of hearing high- pitched sounds, ringing in your ears (tinnitus) or dizziness. This can be very distressing. Let your doctor know if you notice any change in your hearing or if you have ringing in your ears or dizziness.
Chemotherapy may cause skin problems including redness, itching, dryness, and breakouts, while radiotherapy can cause dry or red skin in the area being treated.
The bowel can sometimes become blocked as a result of surgery or due to the cancer growing. This blockage is called a bowel obstruction. Symptoms include nausea, vomiting, and abdominal pain and cramps. Contact your doctor as soon as possible if you have any new or different symptoms. A bowel obstruction can often be relieved with a simple treatment in hospital. Sometimes a further operation may be necessary.
Ovarian cancer can cause a build-up of fluid in the abdomen known as ascites. This causes bloating, swelling and discomfort. Fluid can also build up in the lungs, which is called pleural effusion. This can be painful and make you short of breath. Talk to your doctor if you have any symptoms that suggest fluid is building up in your abdomen or lungs. There is a simple procedure your doctor can use to drain away the fluid and relieve your discomfort.
After having chemotherapy, many women have problems with their short-term memory, concentration, and processing information. This is often called chemo brain. Regardless of its exact cause, it is a real and distressing problem. It can help to know that many other women have the same problem. You can do practical things to help, and the problem usually improves with time. Don’t be hard on yourself when you forget things or feel a bit confused. Just take a break and acknowledge it is a side effect from your treatment. Talk to your doctor or another member of your healthcare team if you have ongoing concerns about your memory or concentration.
INFECTION AND CHANGES IN YOUR BLOOD COUNTS
Chemotherapy can reduce the number of white blood cells (neutropenia) in your body, and this can increase your risk of developing infections. Your white blood cell count will be checked regularly during treatment, and if a blood test shows your count is low, your medical oncologist may delay the next round of chemotherapy. If you feel like you have a fever, it is important you seek help immediately. It is important to have a thermometer at home in case you feel you have a fever. Febrile neutropenia is a serious situation and needs urgent medical intervention. If your temperature reaches 38 degrees or over, you should attend the emergency department immediately. Seek urgent help if you have any unusual symptoms that may indicate you have an infection such as a fever, sore throat, shaking (chills), diarrhea, vomiting, burning when you pass urine, redness or swelling around a wound or your chemotherapy device (like PICC line, Hickman line).
Treatments can also affect your level of red blood cells and platelets. If your red blood cells become too low (anemia), you may need to have a blood transfusion. Decreased platelets can lead to serious problems such as bleeding that won’t stop. Seek immediate help if you have a nosebleed or notice you are bruising easily. Bleeding or bruising is a rare side effect of chemotherapy caused by a drop in blood platelets. Your doctor will keep a close eye on your platelet count during treatment, but always let them know if you are bruising more easily than usual, are bleeding from your gums or nose, or have blood in your bowel motions.
Surgery for ovarian cancer can involve cutting the tissue around the bladder and ureter. Most women will have difficulty emptying their bladder in the days after surgery, and so a catheter is used to drain away urine. Sometimes, it may take a little longer for bladder function to return to normal, but ongoing problems are very rare. Radiotherapy may cause an irritable bladder. It can sometimes cause longer-term problems with urinary function. Menopause can also cause urinary tract changes including frequency, burning, and incontinence. Tell your doctor or nurse about any urinary symptoms.
NERVE PROBLEMS: PERIPHERAL NEUROPATHY
Some types of chemotherapy can cause nerve problems. More common symptoms include tingling, burning or numbness in your hands and feet. This is called peripheral neuropathy and occurs gradually over time. It may get worse with each treatment when it happens. In severe cases, peripheral neuropathy can lead to difficulty walking and unbuttoning clothes. Symptoms usually improve after treatment ends. Let your doctor know if you experience any symptoms of peripheral neuropathy.