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Managing Cancer Side Effects: A Patient’s Guide

Dr Donald Poon

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Cancer treatment may involve the burden of side effects, the severity of which vary depending on the type and stage of cancer, the treatment received as well as individual’s responses to therapies. Managing cancer side effects, therefore, is an important part of the cancer treatment journey. In this article, we outline the side effects of different cancer treatments, their nature and causes, and ways to cope with them. We will also address frequently held misconceptions about these side effects. 

First, let us start with finding out what causes cancer side effects. 

How cancer causes side effects

The wide-ranging side effects and complications of cancer can occur due to 2 main causes – cancer treatment and cancer itself.  

The side effects of cancer itself

Commonly known as the symptoms of cancer, these side effects are extremely diverse, depending on the type, location, and stage of cancer. Chief complaints include fatigue, pain, changes in appetite, and weight loss. Cancer can also lead to skin discoloration and rashes, and in some cases, cause pathological changes such as dyspnea (i.e., difficulty breathing), fever, night sweats, blood clots, bleeding, bruising and anaemia.

Specific cancers also manifest with their own symptoms, though not always. For instance, colorectal cancer can cause a change of bowel habits, such as constipation, diarrhoea, difficulty passing motion, abdominal pain or blood in stools. Breast cancer, as another example, often shows up as a lump in the breast, which may or may not be painful. Brain cancer can cause persistent headaches while liver cancer may lead to jaundice (i.e., yellowing of the skin and eyes), typically in advanced stages. 

Make sure you have all the unusual symptoms checked and diagnosed by a professional. They are not always associated with cancer. In the event they are indeed malignant, early detection often results in better treatment outcomes. 

The side effects of cancer treatment

Cancer therapies such as chemotherapy, radiotherapy and targeted therapy may involve side effects, such as pain, fatigue, nausea and vomiting, digestive distress, skin and hair problems. The severity and duration of these side effects vary with the dosage, duration, type of treatment administered as well as individual’s responses to the treatment. 

The good news is that advances in oncology have drastically reduced the impact of side effects. For instance, a number of chemotherapy agents, such as adjuvant chemo agents used after colorectal surgery, do not cause hair loss. In the case of known side effects, supportive therapies such as anti-nausea medication can be prescribed together with chemotherapy drugs to prevent these side effects before, during, and after chemotherapy.

Administration methods have also vastly improved. An increasing number of chemotherapy today can be conveniently given as oral pills, rather than intravenously. Advanced techniques to administer radiotherapy, including Selective Internal Radiation Therapy (SIRT) – also known as Trans-arterial Radioembolisation (TARE), or Stereotactic body radiation therapy (SBRT), are designed to minimise damages to the surrounding tissues, thereby reducing side effects (learn more about these technologies here). 

The existence of these side effects, more so in the past than nowadays, has given rise to a blanket misconception that cancer treatments are toxic and generally do more harm than good to the body. The fact is that doctors always recommend a treatment by weighing its pros and cons, based on a patient’s preferred treatment outcome, scientific reports of possible side effects and their probabilities, a patient’s known medical history, among other factors. In the event a side effect occurs, supportive measures can be prescribed to lessen their impact. 

Although we can expect modern cancer drugs to cause fewer and less severe side effects, it is essential that the patients discuss the risks of side effects related to their treatment with their oncologists and play an active role in managing them. 

Types of cancer treatment and their respective side effects

Possible side effects of chemotherapy

Chemotherapy uses drugs to destroy cancer cells, typically by targeting fast-growing cells. As chemo drugs travel throughout the body, healthy non-cancerous cells can be affected. These damages are the cause of chemotherapy side effects. 

Of note, chemotherapy is a treatment method and not one drug. There is not a single chemotherapy drug that can treat all types of cancer. Various chemo agents are available for different cancers, and also for achieving different treatment outcomes for the same cancer type. 

Most frequently reported side effects of chemotherapy include nausea, vomiting, hair loss, and fatigue. However, it does not mean that chemo drugs always cause all of these side effects. Some chemotherapeutic agents are more potent than others. The dosage given is another factor, which is often more aggressive to treat cancer in advanced stages than in early stages. Additionally, the response to these medications differs from one person to another. 

You can work with your doctor to understand the side effects of the specific chemo drugs recommended to you, and how to balance the benefits and risks of these pharmacological agents. 

Possible side effects of radiation therapy

Radiation therapy uses high-energy beams to destroy cancer cells. Side effects of radiation therapy stem from damages to healthy cells surrounding the treatment site. They can include fatigue and skin changes. Other side effects are often site-specific. For instance, radiotherapy to the pelvic area might cause changes in bowel or bladder function, and radiotherapy to the head and neck might cause dysphagia (i.e., difficulty swallowing), mouth and throat problems, and consequently, poor appetite. 

Luckily, the technology of radiation therapy is constantly improving. Advanced targeting techniques can limit the exposure of nearby tissues and significantly lower the risk of side effects. 

While radiotherapy is generally well tolerated, in rare cases, exposure to radiation can leave latent long term effects which only develop months or years down the line, such as development of cataracts, or a secondary cancer. If you receive radiation therapy, make sure you are aware of its possible side effects and discuss all your concerns with your doctor.

Possible side effects of oncological surgery

Oncological surgery refers to the surgical removal of cancerous cells or tumours. Similar to other surgeries, side effects can include pain, swelling, infection and scarring. Some tumour removal surgeries may be extensive enough to cause side effects to the functions of your body, which may precipitate temporary or permanent lifestyle changes. Examples include the need for a colostomy bag after certain colorectal cancer surgeries, or dietary modifications after a gallbladder removal surgery, i.e., a cholecystectomy, to treat gallbladder cancer. 

Possible side effects of targeted therapy

Targeted therapy treats cancer by targeting specific proteins that fuel the growth of the malignant tumour with the objective of disrupting this process. This approach has the advantage of precise targeting. Healthy cells are less likely to be affected. Thus, targeted therapy often causes a different set of side effects from those of chemotherapy. Skin problems are the most common, such as rash, dry skin, itchiness, redness, acne and pimples. Other side effects may include diarrhoea, hypertension and hypothyroidism.

As each targeted therapy drug has a different working, its side effects are often specific. Do consult your oncologist for the side effect profile of the agents recommended for you. 

Possible side effects of immunotherapy

Immunotherapy is a relatively new yet promising cancer treatment. It works by activating the body’s immune system to fight off cancer. As such, side effects can be similar to having a flu, including fatigue, body ache, body weakness, and fever. They usually pass quickly after patients start their treatment. 

More serious side effects may occur when the immune responses are overactive and start to attack healthy cells in the body – a phenomenon known as autoimmune reaction. This type of side effects may include inflammation of the lung, liver, colon, hormonal problems and skin complications. 

Though a promising therapy in the oncology field, much remains to be researched about aspects of how immunotherapy works and their side effects, especially latent ones. If immunotherapy is recommended for you, make sure you are aware of possible side effects and work closely with your doctor to treat any side effect that arises. 

Possible side effects of hormonal therapy

Hormonal therapy uses drugs to suppress or cut off the supply of hormones that make cancerous tumours grow. Hormone-sensitive cancers can be treated in this manner, such as breast or ovarian cancer that relies on oestrogen to develop, and prostate cancer that needs androgens to grow. 

The changes in hormone levels induced by hormonal therapy can cause side effects. Women undergoing hormonal (endocrine) therapy for breast cancer may experience menopausal symptoms while some men receiving hormonal therapy for prostate cancer report erectile dysfunction. These can be temporary or permanent. Other side effects include fatigue, nausea and vomiting, diarrhoea, joint pain, reduced interest in sex and fertility issues. 

Common cancer side effects and how to deal with them

As we covered above, there are a variety of side effects that differ from treatment to treatment and patient to patient. Below is a list of the common side effects that cancer patients face across treatments. The purpose is to raise awareness that no patient is alone in fighting cancer side effects. In most cases, effective medications and therapies are available to relieve their burden on the cancer patients. Do discuss with your oncologists how you can take advantage of them.  

Below are common cancer-related side effects and how to manage them.

Pain – This is the most frequently reported symptom among cancer patients. Cancer causes pain at the site of the tumour, as well as in surrounding areas. Pain can also be a side effect of cancer treatment such as surgery or radiation therapy, among other factors. Talk to your doctor about pain relief measures. Painkillers and other therapies including psychotherapy, massage therapy, and physiotherapy are available as treatments.

Fatigue –  Cancer-related fatigue (CRF) is a chronic form of tiredness, exhaustion, and generalised body weakness that does not go away with adequate rest. Fatigue is one of the most common symptoms among cancer patients, which can lead to delaying or dropping out of therapies. There are medications available to manage fatigue in the short term. However, they are not for everyone and not for the long term. Eating well, staying active as you can comfortably tolerate, engaging in mind-body wellness and relaxation techniques, and avoiding exertion can provide relief. Research has also shown that ginseng can improve fatigue for many patients and is well absorbed in the long run (more about ginseng in the section Medications to Relieve Side Effects below).

Shortness of breath – This can be particularly common in lung cancer patients. The tumour presses on nearby organs, blood vessels, and nerves, which causes difficulty breathing. Pursed lip breathing technique can help with mild to moderate symptoms. Patients with severe symptoms needed to be taken care of urgently by healthcare professionals. They may need medication, oxygen, or the relief from inhalers or nebulizers. 

Nausea and vomiting – When chemotherapy or radiotherapy is known to potentially cause nausea and vomiting, patients are often prescribed anti-nausea medication to prevent the symptom. However, report to your doctor if this side effect persists or causes discomfort to you. 

Loss of appetite – Cancer causes changes in the body that affect appetite, making it difficult to eat and maintain a healthy weight. You will need to make adjustments to your diet regime to maintain good nutrition. Loading up during breakfast, eating smaller meals at shorter intervals during, and having more soft and liquid food are some of the practical ways to overcome poor appetite. Read our article on how to boost nutrition during cancer treatment for details. 

Mouth soreness – This can occur to patients receiving chemotherapy or radiation therapy in the head and neck. Difficulty drinking and eating, changes in taste and loss of appetite often follow. You may want to try soft food, smoothie, yogurt to get nutrition with less discomfort. Applying ulcer gel and cream will help you heal faster.  

Digestive distress – This can result from the side effects of chemotherapy, targeted therapy or radiation to the abdomen or pelvic area, or cancer that affects the gastrointestinal tract. Symptoms include diarrhoea, constipation, and bowel obstruction. Talk to your doctor if you experience these side effects. There are laxatives to ease constipation and probiotics to restore gut microbiome after diarrhoea.  

Hair loss – Hair loss can result from the cancer treatment, or the severe stress that comes from learning about the diagnosis and the long therapeutic process. Your hair is most likely to grow back gradually about eight to twelve weeks after your chemotherapy ends. You may want to consider shaving your hair off completely to avoid the distress and inconvenience of seeing them falling out in bunches. Avoid hair colouring, limit use of hair dryers, and use a scarf, cap, wig or turban to protect your bare scalp from sunburn. These accessories, and a wig, will help you look better and boost your self confidence.

Skin and nail problems – Changes in the skin colour and texture, such as dryness, redness, and rashes, often occur with cancer. You can also see changes in nails such as brittleness. Report to your doctor, ask for skin cream and lotion for your particular side effect and apply them regularly.

Immobility – The weakness and fatigue that cancer patients experience may lead to partial or complete immobility. However, getting out of bed and being active can help with blood circulation, prevent pressure sores due to lack of mobility and improve your appetite and mood. Remember to consult your doctor for the appropriate level of physical activity you can do and always listen to your body as you move around or exercise. 

Immunosuppression – This term refers to a lowered immunity level, caused by cancer itself or its treatment. You may hear the doctor mention neutropenia, which is one of the features of immunodeficiency. People with neutropenia have a lowered level of a type of bacteria and virus-fighting white blood cell called neutrophil. Immunocompromised individuals may be more susceptible to infections or recurrent infections, such as cold, flu, pneumonia, skin infections and food borne diseases. They are often advised to avoid crowded places, practise stringent hygiene and food safety, get vaccinated and treat infections as early as possible. 

Depression, anxiety, and grief – Cancer can take a toll on the patient’s mental health, causing sleep disruption, weight loss, and damaged self-esteem. Over time, the emotional stress can lead to depression, anxiety, and grief. Aside from antidepressant medications the doctor can prescribe you, connecting with loved ones, families and friends, counsellors and support groups can do wonders for your mental health.

Financial burdens – The treatment of cancer causes financial burdens due to the cost of medical treatment, counselling, guidance, and support. This adds up to emotional and physical stress of the cancer patient. Plan out financial matters with someone you trust and ask for help if needed. As the saying goes, health is wealth. 

Common Side Effects of Cancer

4 Ways to cope with side effects of cancer

As cancer-related side effects are wide-ranging, we need more than one way to cope with them. Below are the 4 major methods cancer patients can rely on to manage the impact of cancer side effects: 

We will go into each of these methods below.

Medications to relieve cancer side effects

There are a variety of medications that manage cancer-related side effects, such as pain, nausea, and vomiting. Your doctor might recommend medications to help manage your side effects. Be sure to report to your doctor promptly if symptoms persist or worsen, for prescription adjustment if necessary. Also inform your doctor of other medications you are taking, and vaccinations you plan to receive, as therapies that suppress the immune system such as immunotherapy or certain types of chemotherapy can affect your immunity and make you immunocompromised.

Here are some commonly prescribed medications to deal with cancer side effects:

For nausea

Anti-nausea (antiemetic) medications prevent nausea and vomiting caused by cancer treatment.

For pain management

Pain medications such as acetaminophen, ibuprofen, and opioids will help you deal with the pain caused by cancer.

For fatigue

Stimulant medications such as methylphenidate and modafinil can be very effective in managing fatigue for some patients in the short term. Ginseng – a well-known and well-researched herbal medicine – has also shown to provide relief over time to many patients experiencing fatigue. A systematic review suggests that taking 2,000mg of American ginseng daily improves symptoms of cancer-related fatigue (CRF). 

When taking ginseng supplements, be sure to buy them from credible sources. You can ask your oncologist for recommendations if you are unsure which brand and dosage to take. 

For anaemia

Erythropoiesis-stimulating agents (ESAs) such as epoetin alfa and darbepoetin alfa stimulate the production of red blood cells, helping you deal with anaemia.

For constipation

Laxatives accelerate bowel movement to improve symptoms of constipation.

For depression and anxiety

Antidepressant medications such as fluoxetine, sertraline, and citalopram are commonly prescribed for cancer patients.

Palliative treatment to improve your quality of life

Palliative treatment is a type of care that aims to improve the quality of life for people with serious illnesses, such as cancer. It can include a variety of therapies, such as pain management, symptom management, and emotional and spiritual support. Palliative therapy has shown to help cancer patients manage the side effects of cancer and improve their overall quality of life. 

Pain management is one aspect of palliative therapy. Cancer often causes pain, and palliative therapy helps cancer patients manage pain through the use of medication, physical therapy, and other types of treatments. Cancer patients can work with their healthcare professionals to develop a pain management plan that works for them. Symptom management is another aspect of palliative therapy. This includes targeting other side effects of cancer.

Emotional and spiritual support is also an important aspect of palliative therapy. In the absence of psychological support, emotional stress can lead to depression, anxiety, and grief. Palliative therapy is vital for patients to cope with these emotions through counselling, support groups, and other types of therapy. 

Research demonstrated that palliative therapy is effective for cancer patients by improving their overall quality of life. For example, a study published in the Journal of Clinical Oncology found that cancer patients who received palliative care reported improved quality of life, reduced symptoms, and higher satisfaction with care. Another study showed that palliative care can actually improve the quality of life of patients with advanced cancer, including metastasis and inoperable tumours. 

As palliative treatment is highly customisable, patients can opt for specific therapies they prioritise, or go for holistic care in all aspects of their well-being during cancer treatment. Note that palliative care is not the same as hospice care. Palliation can be given alongside curative treatment, and start as early as diagnosis is confirmed, while hospice care is typically given to a patient when curative treatments have failed and it is clear that the patient will not survive for long. 

To learn more about where and how to get palliative care, read our dedicated article on palliative care for cancer, and enquire about it from your oncologist. 

Nutrition and fitness to counter cancer side effects

Nutrition and fitness play an important role in helping with the side effects of cancer. Eating a healthy diet and staying physically active will aid cancer patients in managing side effects such as fatigue, nausea, and weight loss.

Good nutrition also allows cancer patients to maintain a healthy weight, which is beneficial during treatment. A diet rich in fruits, vegetables, whole grains, and lean protein provides the essential nutrients needed to help the body recover from cancer treatment. Cancer patients are encouraged to work with a registered dietitian who can provide guidance on how to maintain a healthy diet during treatment.

Studies found that physical activity improves the quality of life for cancer patients. According to a study published in the Journal of Cancer Research and Clinical Oncology, physical activity reduces fatigue and other symptoms, improves cardiovascular fitness, and enhances the quality of life in cancer patients. Additionally, exercise lowers the risk of cancer recurrence and improves survival rates.

Do consult with their healthcare professional before starting any exercise program, for guidance on the types of exercise that are safe and appropriate for your case.

Addressing psychological and spiritual needs to support cancer recuperation

Experts believe that addressing the psychological and spiritual needs of cancer patients aids in their efforts to cope with the emotional stress of their illness. In fact, many guidelines recommend psychotherapy today as part of the management of cancer. This helps the patient accept their diagnosis and cope with it better. A study found that cancer patients who participated in counselling and support groups reported improved psychological well-being and quality of life. 

Psychotherapy also improves the compliance of patients to the treatment. Furthermore, there is some evidence that appropriate psychological guidance can improve the prognosis of patients. If you experience symptoms such as insomnia, weight loss, anxiety, it is essential to report them to your doctor for intervention.

Apart from counselling and psychotherapy, support groups made up of volunteers and peers who share similar experiences with you can provide a huge emotional relief. In Singapore, there are groups for different cancers and different stages of illness. You can select a suitable organisation from the list of popular self-help groups as recommended by Singapore Cancer Society or by joining the activities organised and listed by National Cancer Centre Singapore.

4 Ways to Cope with Side Effects of Cancer

Takeaway message

Advances in oncology have drastically improved cancer treatment and the severity and range of side effects that come with the disease and its treatment. Yet, side effects still exist, which, as we discussed above, are temporary and reversible in most cases. If you experience them, know that you do not have to suffer and there are measures to alleviate their negative impact on your well-being.

Battling cancer side effects boils down to taking a holistic approach that includes being aware of the possible side effects and how to counter them, working closely with your healthcare team, taking medications as prescribed, eating a healthy and balanced diet, exercising regularly and managing stress. With the right approach, it is possible to manage the side effects of cancer and maintain a good quality of life.

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