Common side effects of Cancer Treatment
By Karen Sharkey
The information below is not meant to take the place of advice or medical treatment by your doctor.  These are suggestions are based on what I found useful from my own personal experience with cancer.  Consult your doctor for specific recommendations for your individual situation.

Oral side effects of cancer treatment

Dry mouth (Xerostomia) is a common side effect cancer treatment either from the chemotherapy, radiation treatment or the medications that help manage some of the symptoms caused by treatment.   Dry mouth that can contribute to an increased risk of tooth decay.  When there is a decrease in the amount of saliva present in the mouth food sticks to the surfaces of the teeth, gums, tongue and surfaces of the oral cavity making it harder to remove. When food and bacteria collect on the tongue, teeth and oral tissues this contributes to bad breath, inflamed tissues, bleeding gums, mouth sores, and tooth decay or cavities.  It’s not unusual to experience tender tissues during chemotherapy or radiation.  It is important to have consistent thorough oral hygiene habits for the duration of treatment, even if you don’t feel like doing it. Practicing good tooth brushing and flossing habits are a must. If you eat often or eat a lot of sweets it is a good idea to brush your teeth more often. Using products that contain Xylitol like sugar free gum, lozenges, mouth sprays, nasal sprays and rinses will also help to reduce the bacteria that cause decay while providing some relief for dry tissues.  Consult with your dentist or dental hygienist to determine what will work the best for your individual situation. 

What you can do to manage a dry mouth

• Sip water frequently throughout the day to assist with rinsing and moisturizing the mouth and swallowing.  There are toothpastes, rinses, moisturizing sprays, artificial saliva, nasal sprays, lozenges and chewing gum that can provide relief for parched tissues.  These products can help to furnish moisture during the day.  There are discs or lozenges that can be used in the mouth at night that provide relief from dry mouth. 

• Tart foods or beverages may help to increase saliva in the mouth.  Fruity teas will stimulate salivary flow.   *Do not use tart foods or beverages if you are experiencing a sore mouth or throat.  This may further irritate a sore throat or mouth.

• Suck on hard candy, popsicles, or chewing gum to help stimulate saliva production in the mouth.  When possible use natural sugar free products that are sweetened with Xylitol or Stevia rather than the artificial sweeteners on the market or table sugar.   Stevia doesn’t cause a change in blood sugar.  It is a natural sweetener and is very sweet so it only takes a little bit to achieve great results.  Xylitol helps to inhibit the bacteria that cause tooth decay.  It is made from fruit, corn or birch.  Sugar (table, organic or raw), honey, agave syrup, molasses, maple syrup, fructose and corn syrup feed bacteria, changes the ph in the mouth that can promote tooth decay, and may contribute to problems with Candida (yeast infections). 

• If you eat foods that are soft or pureed, these foods are easier to swallow.  Moisten foods with sauces, gravies, olive oil, coconut oil, or salad dressing to help with swallowing.

• Keep your lips moist with lip balms or salves to avoid cracking or splitting lips and corners of the mouth.    *See Oral Care Kare ‘n Tote for Dry Mouth 

Swallowing difficulties: 
Chewing your food thoroughly will make it easier to swallow.  Chewing food longer will assist with proper digestion. Take smaller bites can make it easier to swallow. It is much easier to swallow foods when you are not feeling rushed, stressed or upset.  Listen to your favorite music while you eat.  It will help you relax during your meal.      

Mouth sores:
Mouth sores often accompany chemotherapy; sucking on ice, eating popsicles or other frozen or very cold foods are soothing to the sores.  The freezing effect of these foods helps to deaden the nerves in the mouth so that some of the sensitivity is diminished for a short time. With the mouth desensitized the sores are less tender and this can make chewing and swallowing more comfortable temporarily.  Often long enough to get through a meal. 

If you experience a sore mouth or gums see your doctor to determine if the soreness is a result of your treatment and not an unrelated dental problem.  Take good care of your teeth and gums and choose foods that don’t irritate your mouth and gums.  If necessary your doctor may prescribe medication for your mouth.  A compounding pharmacy can make up a soothing anesthetic prescription mouth rinse or spray to use prior to eating to make chewing and swallowing more comfortable. 

Food suggestions when experiencing mouth sores; shakes, smoothies, bananas, apples sauce, peaches, pears, apricot nectar, watermelon, cottage cheese, yogurt, mashed potatoes, noodles, macaroni and cheese, custard, pudding, jello, scrambled eggs, oatmeal, or other cooked cereal, pureed or mashed vegetables like peas and carrots or pureed meats may be easier to eat.  You can also mix foods with a little olive oil, margarine, butter, thin gravy, or sauce to make it easier to swallow.  Using a straw may help make drinking liquids more comfortable.  Drinking warm bouillon or broth may sooth a sore throat. Swish with lukewarm salt water to sooth sores. 

Foods to avoid with mouth sores include: acidic foods like oranges, grapefruit, lemons, tomato sauce and juice.  Spicy foods, salty foods, raw vegetables, granola, toast, crackers and tortilla chips will also aggravate a sore mouth.  Avoid commercial mouthwashes with alcohol.

Coughing: 
Drinking water may help moisten a dry throat.  Use cough drops or gum (sugar free with Xylitol or Stevia) to help lubricate the throat.  Using Natural nasal spray (with Xylitol) or throat spray may help to moisten and coat the nasal passages and throat. Use a cool mist vaporizer to add moisture into the air, to make it easier to breath without drying out the throat.

Your throat may feel hoarse and swollen by the end of the day. 
Sucking on ice or popsicles can give the throat some relief.  Drink plenty of fluids every day.  If you enjoy drinking tea don’t drink it piping hot.  Let it cool down some, it will be easier on your throat.  Bouillon may be soothing for your throat.

Nausea and Vomiting may occur the first day after chemotherapy, or three days later or not at all.  Our bodies are all so different and tolerate treatment in various ways.   Nausea may be diminished with the use of mild herbal tea like Mint, Ginger or Hibiscus. Avoid caffeinated teas when possible.     Foods that may be easier to tolerate with nausea are: dry toast, crackers, pretzels, sherbet, yogurt, angel food cake, cream of wheat, rice or oatmeal, boiled potatoes, rice or noodles, skinned chicken broiled or baked, canned peaches, pears or applesauce, clear liquids, ice chips, carbonated drinks, and tea. 

Avoid fatty, greasy, fried foods, very sweet foods like candy or cookies, spicy or hot foods, and strong odors.  Eat small amounts of food slowly.  Eat before you get hungry.  Drink less at a meal, sip liquids throughout the day instead.  Eat foods that are at room temperature or cooler, hot foods may increase nausea.  Rest after meals, activity will slow down digestion.

Fragrances in soap, air freshener, shampoo, and lotion or hand sanitizer may also trigger nausea.  Purchase products that are natural and unscented. 

Keep track of when nausea occurs in a journal.  Note the cause of nausea if possible (food, smell, emotional upset) and change your diet or schedule to manage it.  Talk with your doctor about the nausea you are experiencing.  They may be able to make a change in your treatment to eliminate this symptom. 

Metallic taste or a change in taste or sense of smell can occur during treatment.  Sometimes altered taste; bitter or metallic taste is noticed when eating meat or other high protein foods during cancer treatment.  For most people changes in taste and smell go away when their treatment ends. 

Tips:  Choose foods that smell good to you.  If red meat smells strange to you try chicken or fish.  Marinade meat with juices, Italian dressing, or sweet and sour sauce to change the flavor.  If smells bother you try serving foods at room temperature, turn on kitchen fans when cooking or cook outdoors if the weather permits.  Use onions, leeks,  garlic or spices that you can tolerate to improve the smells and flavors of foods.

Genitourinary Changes

Vaginal dryness is often a side effect caused by hormonal changes after going through chemotherapy, surgery, menopause or other taking medications.  Hormonal changes can lead to dry, fragile vaginal tissues.  Using natural water based lubricants or moisturizers like Oceanus Naturals or Yes can be very beneficial.  Personal lubricants can be used to moisten dry tender tissues as well as make intimate relations more comfortable. Some people have had success using Vitamin E as a lubricant or moisturizer.  Avoid using oil based lubricants with latex condoms. The book, Intimacy After Cancer - A Woman’s Guide is a valuable resource that answers questions women may have about changes their bodies go through with cancer treatment and how to regain intimacy and confidence.   *See Intimate Details Kare ‘n Tote   

Bladder - Avoid caffeine and alcohol as it irritates the bladder and dehydrates the body.  Drink plenty of water every day.  Drink unsweetened cranberry juice to prevent bladder irritation if you are prone to bladder infections.  Add a few drops of Stevia will sweeten the juice if needed. 

Bowel problems:

Diarrhea may be caused from many things; chemotherapy, radiation of the abdomen; infection, food sensitivities, stress or emotional upset to name a few things.  Work with your doctor to determine the cause of your diarrhea so it can be treated successfully.  Be mindful that diarrhea causes dehydration which means your body doesn’t have enough water to work efficiently. Drink plenty of liquids to replenish what you lose with diarrhea.  Eat small amounts of food throughout the day instead of 3 large meals. Eat plenty of foods that contain sodium and potassium to help your body work properly.  Eat foods like bouillon or broth to replace sodium and bananas, peach or apricot nectar, and boiled or mashed potatoes to replace potassium.  Drink liquids that are room temperature, limit foods and drinks that contain caffeine like coffee, black teas, sodas and chocolate.  Milk or milk products contain lactose and can make diarrhea worse for some people.  Try these foods rice, potatoes, noodles, cream of wheat, eggs, canned and peeled fruits, well cooked vegetables, skinned chicken or turkey, lean beef or fish broiled or baked they often are easily tolerated with digestion is upset.

Constipation may result as a side effect from chemotherapy, medications used to manage symptoms of cancer treatment, lack of activity, not drinking enough fluids and eating foods that don’t provide fiber contribute to constipation also. To prevent or reverse constipation be sure to drink plenty of fluids every day this will help keep stools soft.  Drink a hot drink approximately a half hour prior to your normal time for a bowel movement. Talk with your doctor to see if you can increase the sources of fiber to your diet.  If your doctor Okays fiber, then try eating whole-grain breads and cereals, dried fruits, fresh fruits, fresh vegetables, or dried beans and peas (cooked). Get exercise everyday.  Talk to your doctor or physical therapist about what type of exercise is best for your situation. If you try these suggestions without a successful result, talk to your doctor about medication that may help ease constipation.  Be sure to check with your doctor prior to taking stool softeners or laxatives.  

Hot Flashes or Sweats may be noticed after surgery, cancer treatment or may be caused by some medications. Hormonal changes can bring on hot flashes and sweats too.  To help manage sweats/hot flashes drink plenty of water daily.  Ice water can help to cool you down.  Use a small ice pack to place on the back of neck, or chest to help cool off.  A cooling bandana works well to reduce that over heated feeling too.  Soak the bandana in water to prepare it, store it in a bag in the refrigerator to access it when needed to instantly cool down.  Carry a fan with you to move the air around you; this can help cool you off too. Ceiling fans work well to keep air circulating too.   Hot flash triggers to avoid; caffeine, sweets or carbohydrates, spicy foods, hot foods, hot  or stuffy rooms, saunas, hot tubs, hot beds, hot showers, smoking, food sensitivities, getting overheated, stressful situations and emotional upset.   

What you can do: Dress in layers.  When your body heats up remove a layer.  After you cool down you can put the layer back on to avoid getting chilled.  There are dry weave or moisture wicking shirts, blouses, t shirt, pants, shorts, dresses, skirts socks, hats and jackets available for daytime wear.   Bamboo fabric has natural moisture wicking qualities and is a renewable resource. 

At night use moisture wicking pajamas they can make the difference between getting to sleep and staying asleep versus getting up at all hours to change clothes and the bed.  You will still sweat, but the pajamas pull the moisture away from your body so you will not be as uncomfortable giving you a better chance to sleep through the sweats and resting better. Use light weight sheets on the bed and light blankets. There are moisture wicking sheets and pillow cases available as well.  Moisture wicking products are more expensive, but the investment is well worth the comfort that is achieved.  They definitely improve quality of life by a mile!

Other things you can do: turn down the thermostat when you can.  Get more exercise, walk, swim, try yoga, jumping on a mini trampoline,  tai chi, meditation techniques, relaxation exercises, visualization, or breathing exercises may be helpful.   

If you have tried many of these suggestions without successfully diminishing your hot flashes consult with your doctor to see if there are other options to help you manage them.

Hair loss
Preparing for hair loss as a result of chemotherapy can be an emotional event for many people, particularly women it was for me! Having a friend accompany you to have your hair cut short prior to starting chemotherapy can be helpful.  Choosing when to cut your hair vs. having it fall out randomly with chemotherapy may make it easier to accept hair loss and it will give you some control over the situation, make it happen when you want it to not randomly into your dinner or all over the shower stall or your pillow.  

It’s not unusual for your head and or scalp to feel tender or sore during hair loss. Use a mild, chemical free shampoo to keep the hair follicles free of build up while your hair is returning. This will assist with limiting the return of extremely kinky curly hair. Use a soft hair brush.  Be gentle with your scalp.  Ask the person that cuts your hair what chemical free products for thinning hair they would recommend.  Be open to how your hair returns.  My hair is a different color and texture than before cancer treatment.  I am just so happy to have it back! 

When you go outside use sunscreen 15 SPF or greater on your scalp if it is exposed to the sun or wear a wig, hat or scarf to cover your skin as it may be really sensitive to sunlight. It’s not worth risking sunburn.

If a wig is something that you think you may want to use, shop for a wig before you lose you hair so your natural hair color can be matched much more closely.  Some medical insurance companies may help cover the cost of a wig.  It’s worth the telephone call and time spent to find out if they do.

Find some cute hats and different colored scarves.  Learn to tie the scarves in different ways.  It will make you feel better if you can wear a scarf or hat that matches your outfit when you go out in public.  Your head will also stay warmer with a covering on it.  Don’t be surprised if you get chilled often on the back of your neck until your hair fully returns. A soft knitted or polar fleece hat or a hoody sweatshirt will work well to keep the chill off the back of the neck and head.  I also used ear muffs and a hat that had flaps to cover my ears when I was out walking to avoid getting chilled in cooler weather.

Fatigue, depression or lack of concentration
Many people say they experience some or all of these symptoms during cancer treatment. Fatigue can be related to a number of things like not eating, inactivity, low blood counts, depression, poor sleep, and side effects of medications.  If you have fatigue talk to your doctor about it, and decide what is causing the problem.  If you are depressed talk to your nurse or social worker about it and/or join a support group, be open about your emotions, talk about your fears and feelings.  Talking with others about what is bothering you can help you find ways address your worries and fears. 

Lack of concentration, fuzzy thinking or “chemo brain” I found very frustrating.  It was typically worse right after chemotherapy.  Typing email was really difficult for me, I was surprised at the mistakes that I made.  I would type what I wanted to say and save the email and proof it again a few days later before I sent it out to make sure it made sense. I had difficulty reading and figuring math in my head.  I worked on puzzles a lot to just keep my mind working even if it was slower for the first 2-3 days after my chemotherapy  treatments.  I forgot all sorts of things.  Even where my list was that I wrote to make sure I wouldn’t forget things.  I used sticky notes to remind me of things I needed to do. 

Learn about your treatment, possible side effects and ways of coping.  The more you know and can act on that knowledge that will help you feel more in control.  Don’t be afraid to ask your doctor questions.  Make a list of questions in your journal. 

Get enough rest. 
Plan your day to include times of rest or naps.  Don’t push yourself to do more than you can manage.  Do shorter versions of your usual activities.   Remember its ok to rest and nurture yourself.  You heal when you sleep. Take care of yourself; only you truly know how you feel and how exhausted you are.  You aren’t going to let anyone down by taking a nap.  If you are too tired by evening to stay up after dinner and visit with your partner, family or friends take a nap in the afternoon so you can spend time with them in the evening.  Or ask them to visit during the time of day that you have the most energy and save the other times of the day for rest. 

Insomnia
Some people experience insomnia this can contribute to feeling exhausted.  Often this occurs with hot flashes in the middle of the night.  Hormonal changes may contribute to this as well as some medications, stress and worrying.  Some ideas to help manage Insomnia are; get exercise daily preferably in the morning.  Don’t eat carbohydrates in the late evening.  Avoid caffeine.  Try a relaxing tea like Sleepy Time Tea, or use a natural relaxing salve like Badger Balm Nighty Night Balm on the bottoms of your feet, back of your neck and temples.  Supplements that may help with sleeping are Tryptophan or Melatonin.  Talk with your doctor to determine what dosage might work best for you.

Exercise
When possible make an effort get up and move around, get outside for a walk. This will help to alleviate stiffness and body aches caused by inactivity and curb cabin fever. The exposure to the sun and the fresh air will make you feel better. If you aren’t able to walk around very much because you are to unsteady or tire easily, then at least get outside for a while every day, sit and listen to the birds and enjoy the environment around you.   This will give you more energy and it will improve your mood. 

Dry skin
You may notice your skin becoming very dry especially on your lips, hands and feet.  You may notice cracking around our toes and fingernails.  Apply a moisturizer or salve to dry skin at least twice a day.  Avoid lotions that contain alcohol or glycerin as this can make the dryness worse.  Use a mild moisturizing soap when bathing.  Avoid hot water; it will also contribute to dry skin. When going outside apply sunscreen to any exposed skin. *Do not use a moisturizer within two hours of radiation treatment.  Apply aloe gel to radiation exposed skin.  Get your doctors advice regarding application frequency of lotion, oils, or Aloe gel and timing with radiation.