Tips to help your patients cope with the side effects that make the workday difficult.
The list of side effects from cancer treatments--including surgery, radiation and chemotherapy--is seemingly endless, from nausea to embarrassing bowel problems.
But if there's a bright spot, it's this: typically not every side effect strikes each patient, and only a handful impact greatly a patient's ability to work. And there are solutions to reduce or banish the side effects, according to our panel of experts. The panel includes:
- Joanne Hambleton, RN, breast cancer survivor and vice-president for nursing and patient services, Fox Chase Cancer Center, Philadelphia.
- Andrea Barsevick, PhD, RN, AOCN, director of nursing research, Fox Chase Cancer Center, Philadelphia.
- Emily Walsh, NP, nurse practitioner, Memorial Sloan-Kettering Cancer Center, New York.
Here are details about side effects you are most likely to hear about from your patients and how to help them to cope so they can work through them--and stay on the job as much as possible.
By far, fatigue is the number one complaint you're likely to hear from patients after surgery, chemo or radiation therapy. If your patient is on medication to keep up the white blood cell count, these medications can add to the fatigue.
Knowing the typical patterns of fatigue can help your patients schedule work and time off when needed. The fatigue that hits after chemo tends to be predictable. For instance, it can hit a day after the treatment, last for several days, then subside.
Fatigue after radiation tends to be cumulative--getting progressively worse as the number of treatments increases.
Remedies: Your patients may groan when they hear the suggestion, but the best remedy to decrease fatigue--or ward it off--is exercise. In a series of studies, Victoria Mock of Johns Hopkins University has found that exercise--even during cancer treatment--can help manage fatigue.
In one study, she assigned 52 women undergoing chemo or radiation for breast cancer to either exercise 90 minutes a week on three or more days or to continue their usual regimen, which was less activity. Those who exercise had much less fatigue and emotional distress and said they functioned better physically.
In another study, Mock's team found that women who stuck with a home-based, moderate-intensity walking program had less fatigue that those who didn't.
How to make your patient a believer? If she is sedentary, tell her to start out gradually, even walking 15 minutes a day.
Another remedy: remind your patient to listen to her body and prioritize. Suggest she complete the most pressing work tasks first; that will reduce stress, which can also bring on fatigue. At work, suggest she take rest breaks when possible. Even a short break can help her regain energy.
The motto should be to pace yourself, not to cocoon and give up. Tell your patient: Do what you can, then take a break.
Getting enough sleep can help, too, recognizing this can be a challenge because some of the cancer medications can interfere with sleep. Some pre-medications given to patients before chemotherapy, for instance, can make it difficult to sleep temporarily.
Due to the anti-emetic drugs that have become common-place, nausea and vomiting are not as often an issue with patients, but nausea in particular can remain a problem. If your patient has a history of motion sickness, she may be more likely to experience nausea.
Remedies: Anxiety about getting nausea can fuel it, so you might determine how worried your patient is about having it and try to allay her fears, telling her about remedies or actions to take if it occurs.
Among the do-it-yourself options: eating ginger or drinking ginger ale, listening to soothing music, doing guided imagery.
Eating five small meals throughout the day rather than three large ones can help with both nausea and fatigue. So can avoiding fried foods, very rich foods or spicy foods. Sucking on hard candy sometimes helps. Staying hydrated, drinking at least 8 glasses of water a day, is also known to help.
Mouth sores and other problems such as dry mouth are most common after radiation therapy for head and neck cancers. As mouth sores get worse, the mouth can become painful.
Remedies: Suggest your patient pay closer attention to mouth care, using a gentle mouthwash. Frequent sips of water can help with dry mouth. So can chewing sugar-free gum or chewing on sugar-free hard candy.
Exercising the jaw muscle can help mouth symptoms. Suggest your patient open and close the mouth 20 times as wide as possible without causing pain. Repeat three times a day.
You may suggest mouth gels if the pain persists. Remind your patient to check in with the dentist--ideally before radiation but if there's not time, during or after treatment.
If the problems persist with dry mouth, your patient may need a prescription medicine to increase saliva.
Constipation or Diarrhea
While diarrhea is more likely to interfere with your patient's workday, both problems can hamper functioning on the job.
Constipation can be a side-effect of the anti-nausea drugs. Diarrhea can occur after radiation therapy for colon cancer, for instance. It can also accompany the use of some chemotherapy drugs
Constipation Remedies: You can suggest a stool softener or an increase in dietary fiber to relieve constipation. Drinking at least 8 glasses of water a day can help, as can walking or other exercise.
Diarrhea Remedies: For diarrhea, you can suggest an over-the-counter diarrhea remedy, provided the primary care provider approves. Eating five or six small meals is better than eating three large meals. Low-fat, low fiber foods are easier on the stomach than spicy, high-fat or high-fiber foods.
Remind your patient that diarrhea can become a serious side effect if dehydration occurs. Tell her to mention diarrhea to you each time it occurs so you can be sure it is treated promptly and properly.
Keeping a positive but realistic attitude about minimizing side effects can help your patients, too. How to help them do that?
- Remind your patient to be realistic about what she can do. If a job requires extensive travel, for instance, it may be better to cut back temporarily. Trying to do too much increases stress, which can make side effects worse.
- Keep the big picture in focus. Some patients need to work despite side effects purely for economic reasons, but for many, the job is an important part of their life that provides much satisfaction. Working as much as possible, despite the side effects, may help them maintain their optimism about their cancer recovery and life in general. Being around coworkers, especially supportive ones, can help patients stay positive.
Both websites include vast amounts of information on side effects from radiation therapy and chemotherapy.
Mock's studies are published in the journal Psycho-Oncology (online Oct. 14, 2004: vol. 14: pp.464-477) and in Cancer Practice (online Jan. 30, 2002: vol. 9, pp.119-127).