You can greatly assist patients by initiating conversation about the side effects they’re experiencing — or are likely to experience — and how these issues can be managed in the workplace specifically. Remind your patients that while many side effects can be addressed with lifestyle changes — such as diet or exercise — others may require adjustments to treatment or additional medication in order to be resolved. It is also crucial to emphasize the importance of reporting and symptoms or side effects to you and their physician.
Once patients know the importance of talking about side effects, review with patients those that are typical as well as suggested remedies. These may include:
Remind your patients that pain is a common side effect, caused by the cancer itself or by the treatment. Suggest that your patients:
- Keep a log of the pain, noting the time it occurs and what they were doing.
- Rate the severity of the pain on a scale of 1 to 10 (10 being the worst ever). Then you and the physician can discuss options with the patient — such as medication, or relaxation breathing or a combination thereof — to make the pain more tolerable.
Although it is one of the most common side effects, fatigue is also one of the most disturbing for those trying to work. It can affect concentration and memory as well as the ability to function, both physically and emotionally. Suggest that your patients:
- Rate their fatigue on a scale of 1 to 10 (10 being worst) and report it to you if it reaches 4 or 5.
- Figure out any pattern to the fatigue so they can anticipate periods of lower energy and plan around them. For instance, many patients say fatigue peaks a day after chemo, lasts for several days, then subsides. Fatigue after radiation, however, tends to be cumulative, becoming progressively worse as the number of treatments increases. Paying attention to the pattern can help with planning treatments and any needed time off work.
- Take short naps if possible, even at work. (Recommend that patients ask their supervisor to accommodate them by putting a cot in a quiet room.)
- Work smart. Curtail all but crucial travel, hold meetings on the Internet or phone rather than in person and telecommute on the heaviest traffic days.
- Prioritize. Completing the most pressing work tasks first will reduce stress and increase feelings of productivity at the end of the day.
- Exercise (or get some sort of physical activity) daily. Exercise has been shown to not only prevent fatigue, but to decrease it once it has set in. The exercise can be as simple as a home-based, moderate-intensity walking program. If walking is not possible, even low-intensity, gentle movements can be beneficial. And remind patients that they should always check with their doctor before beginning any exercise program.
Nausea and Vomiting
If your patients complain mostly of nausea and vomiting, remind them that:
- Many anti-nausea remedies are available and their doctor can recommend the one that’s best for them. If it doesn’t work well, another one may.
- Dietary changes can help keep nausea and vomiting at bay. Eating five small meals a day, instead of three big ones, can help with nausea (as well as with fatigue). Staying well hydrated, eating small amounts of bland, room-temperature food (crackers and pretzels are good) and eating easy-to-digest foods can help as well.
- Some non-medical mind-body approaches are worth investigating, including self hypnosis, relaxation exercises, guided imagery and biofeedback, in combination with progressive muscle relaxation.
Changes in Appearance
Dry skin, weight fluctuations, hair loss — when it comes to maintaining an image at work during and after treatment, men and women with cancer face a whole new set of challenges. Encourage your patients to consult the experts:
- Hairdressers and barbers can offer advice on hair loss and help with wigs.
- Local department stores and support organizations such as Look Good Feel Better can advise on makeup.
- Dermatologists can prescribe skincare remedies.
- Encourage your patients to buy clothes to accommodate any weight gain or loss they experience. Ill-fitting clothing is a constant reminder of the changes that are happening.
Hair loss is a tangible reminder of the cancer. It exposes patients to the world and can make them feel vulnerable and helpless. Returning to work can be particularly challenging when self-esteem and confidence are compromised.
- Talk to your patients about whether they should expect hair loss with their treatment and, if so, when it is likely to happen. That way they can be prepared psychologically and, if they choose, can get wigs or scarves in advance.
- Additionally, emphasizing that their hair will grow back can help patients to maintain a positive mindset.
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.
- 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.
It is quite common for patients undergoing chemotherapy to experience this mental fog. Marked by lack of concentration, memory or thinking skills, chemo brain can be especially challenging for patients who are trying to work. Suggest that they:
- Get a full workup from their primary care physician. The evaluation may uncover other reasons for fatigue and cognitive problems, such as depression.
- Ask about medications that may help their chemo brain.
- Ask about simple remedies such as coffee (unless patients have a health reason to avoid it) to help combat their daze.
Additionally, the following tips may be useful for patients who are struggling to maintain focus at work:
- Carry a single notebook, rather than having one at work, one at home, one in the car, etc. This reduces the number of items your patient needs to keep track of.
- Write down a list of priorities. Patients should determine their priorities, then focus on each task that needs to be addressed, one at a time.
- Resist multi-tasking. Trying to juggle multiple activities at once can greatly hamper concentration. Suggest to patients that they minimize exposure to distractions such as mobile phones, the Internet, etc., as much as possible.
- Rehearse everything, including presentations, project updates and phone calls.
- Ban clutter. Clearing their work area is another way for patients to minimize distractions.
- Listen to music. It’s hard for anyone to stay tense when their favorite song is playing.
- Head outside. Sunlight and fresh air can help patients de-stress and regain focus. Eating lunch outside, taking strolls during breaks or suggesting that a one-on-one meeting with a colleague be a walk-and-talk affair are ways to increase time outdoors during the work day.
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.
- For constipation, you can suggest a stool softener or an increase in dietary fiber to relieve constipation. Drinking at least eight glasses of water a day can help, as can walking or other exercise.
- 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.
It is also important for patients to pay attention to stress levels, which can exacerbate symptoms of chemo brain. You may wish to make referrals for talk therapy, occupational therapy, biofeedback or relaxation training if necessary. Additionally, below are a few basic tips that can help patients manage stress at work:
- Take regular breaks. Encourage patients to listen to their bodies instead of pushing themselves too hard. It’s a good idea for them to break for lunch daily, and take additional, short breaks throughout the day. Or, perhaps, take 10-20 minutes to meditate quietly.
- Breathe. People under stress tend to breathe in short, shallow breaths that do little to bring in oxygen and a lot to increase tension in the chest and shoulders. If your patient often feels panicky or tense, tell them to take a few moments to breathe deeply. Getting more oxygen into the body will slow the heart rate, decrease blood pressure and relieve that sense of panic.
- Exercise is one of the most effective ways to combat stress, so advise your patients to incorporate brief periods of exercise into the workday. Suggest that at lunchtime they consider taking a yoga class or heading to the gym to hop on the treadmill (if they’re cleared by their physician to do so). Patients might also consider taking short breaks throughout the day to stretch or do simple exercises in their desk chair.
- Just say no. Patients should try to set boundaries at work that enable them to decline certain types of requests, such as staying late for non-essential projects. Although it can be difficult to say no, doing so can help them become a better employee; they won’t be overburdened with extra projects and won’t feel trapped by every ask they receive. The key to setting effective boundaries in the workplace is crafting language that feels natural for your patient and communicates the “no” message in a way that is still professional and team oriented.
- Laugh. Laughter can reduce the physical symptoms of stress by increasing the flow of oxygen throughout the body and releasing feel-good endorphins in the brain.
Keeping a positive but realistic attitude about minimizing side effects can help your patients, too. How to help them do that?
- Remind your patients to be realistic about what they 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.
If your patient has other side effects, or needs more help with these side effects, you can turn for guidance to the National Cancer Institute and American Cancer Society.
Both websites include vast amounts of information on side effects from radiation therapy and chemotherapy such as:
- National Cancer Institute: Radiation Therapy Side Effects
- National Cancer Institute: Chemotherapy and You
- National Cancer Institute: Late Side Effects of Cancer Treatment
- American Cancer Society: Side Effects A-Z