Infection

Patients who are undergoing chemotherapy or radiation therapy have poor immunity as these drugs or drugs will affect the WBC count which is the main stay of body's immune system. Due to these patients are at higher risk of infection. The most common symptom of infection is fever and other symptoms include

1. Pus from wound
2. Cough, cold and mucous
3. Shortness of breathing
4. Redness swelling of any part of skin
5. Chills and sweat
6. Swelling and pain in throat, mouth ulcers
7. Change of color and pain in gums
8. Irritation or pain during urination

Coping with infection

1. Maintain proper hygiene
2. Wear Masks in public places and during hospital visits
3. Wash hands regularly
4. Take hygienic food
5. Change of bedrolls and pillow covers regularly
6. Masks can be used to avoid contact
7. Antibiotics should be stocked for SOS as per physicians’ prescription

Fatigue

Fatigue is an important and common symptoms experienced by cancer patients. During history taking by the doctor, patient must report fatigue, experienced by them as it may be due to important clinical reasons which are pertinent to disease and treatment

Reasons for Fatigue

1. Part of surgery
2. Due to radiation therapy
3. Chemotherapy induced fatigue
4. Emotional distress
5. Other co morbid conditions like diabetes, thyroid problems, heart disease etc.

Managing Fatigue

1. Maintain a regular sleep schedule and adhere to it
2. Exercise regularly and avoid doing exercise in the evening
3. Avoid alcohol, caffeine, nicotine
4. Limit naps during day time
5. Take warm bath and listen to light music before bedtime
6. Yoga and breathing exercise would do lot good to manage fatigue and positive energy

Nausea and Vomiting

Nausea and vomiting are the most common adverse events that normally seen during cancer treatment. Many of the chemotherapy drugs and radiation therapy induced nausea and vomiting. Nausea a feeling like vomiting and vomiting is reflex controlled by a center in brain. Many factors like smell, taste, motion, anxiety, poor blood flow, drugs can induce the vomiting and nausea. Cancer patients who are undergoing treatment suffering normally of nausea and vomiting. The common causes for this are Chemotherapy drugs that are administered during treatment and radiation therapy. In some conditions the nausea and vomiting are more likely to occur such as

1. Heavy meals
2. Constipation
3. Strong odours
4. Spicy food
5. Use of excessive tea, coffee or carbonated drinks
6. Constipation
7. Female gender
8. Electrolyte imbalance
9. Increased body fluid
10. Renal Disease
11. Experiencing anxiety
12. Presence of infection

Certain lifestyle modifications along with medications prescribed by the physician will be helpful in relieving the symptoms of nausea and vomiting in patients who are undergoing cancer treatment. The modifications are :

1. Avoid heavy meals and eat food in small meals several times a day.
2. Avoid spicy and greasy foods.
3. Avoid strong odours.
4. Eat before the treatment starts.
5. Rather than heavy meals eating foods that's are soft and easy to digest would help.
6. Increase fluid intake in small portions.
7. Sit in upright position for at least one hour after meals.
8. Sucking hard candies like lemon candies helps.
9. Maintain oral hygiene especially after vomiting episodes. Rinse mouth after eating thoroughly.
10. Wear lose clothes.
11. Stay in well ventilated room in relaxed and calm atmosphere.
12. Always keep medications for nausea and vomiting prescribed by doctor at your bedside and take the medicines as per physician order.

Hair loss

Hair loss is a common side effect of chemotherapy and radiation therapy which can significantly alter the appearance. Hair loss may begin several weeks after first cycle of chemotherapy drug administration Chemotherapy drugs attack on rapidly dividing and growing cells of the body, but unable to distinguish between cancer cells or useful cells like cells of hair follicles. Hair loss can occur all over the body. In most cases, once the treatment gets over, hair re-growth occurs.

Coping with treatment induced hair loss during cancer treatment

1. Use a soft hairbrush and gently style the hair
2. Use of mild shampoos like baby shampoo to wash the hair
3. Avoid daily hair wash
4. Avoid hair dryers or avoid high heat when hair drying with dryers
5. Have shorter hair cut, shorter hair style will help to adjust the appearance later.
6. Wigs can be used which suits the appearance
7. Avoid hair coloring and other hair related chemicals
8. Use of hat or a scarf during outdoors can be considered
9. Satin pillows can be used to reduce friction
10. Hair growing medicines could be considered if physician advices

Oral Care

Most cancer patients undergoing chemotherapy and / or radiation therapy develops oral complications which needs to address on high priority as this may interrupt and complicate the cancer treatment. Certain oral complications occur only during active treatment while some persist for years. If these complications are not taken seriously, sometimes it becomes life threatening.

Coping Common Oral Complications

1. Taste Alterations:

   Patients undergoing treatment may feel change in taste. They find food altered taste or tasteless due to which they avoid food. This results in poor intake of food and weakness.

   In this case patients can use candies regularly, try variety in food.

2. Xerostomia

   Xerostomia occurs due to abnormal salivary gland function due to which mouth dryness occurs. This results in infection, speaking problems, difficulty in swallowing and chewing.

   In this case sucking candies will help along with chewing gum. Doctor can prescribe artificial saliva to treat dry mouth.

3. Mucositis

   Mucositis is the most common complication that the patients come across. This is due to the inflammation of mucous membranes. Mucositis increases the risk for infection and patients intake of food also get suffered and nutritional gets compromised. Due to this entire cancer treatment gets affected.

   Antibiotics, topical anesthetics and pain killers would be helpful prescribed by doctors

4. Oral and Gum Bleeding

   Oral and gum bleeding is also seen in many patients due to decreased platelets and clotting factors as cancer treatment directly affects bone marrow and causes myelosupression.

   Clean teeth with soft tooth brush thoroughly and use proper antimicrobial mouth wash to rinse more often. Frequent use of mouth wash will reduce the bleeding and keep oral hygiene proper

5. Infections

   Infections are very common oral complications that is seen in cancer patients. Bacterial infection is least common while fungal and viral infection is very common. Both fungal and viral infections may be extremely disturbing for the patient as it may accompany pain, inflammation and ulceration.

   Bacterial infections can be managed easily by proper antibiotics. Viral and fungal infections are difficult to manage and require attention. Anti viral and anti fungal therapy is required which may be topical to systemic therapy prescribed by doctor.

6. Tooth Demineralization and Loss of Enamel

   Radiation therapy and some drugs in chemotherapy results to tooth demineralization and loss of enamel

   Tooth demineralization and loss of enamel can be prevented by using toothpaste with high fluoride content.

Peripheral Neuropathy

Few drugs in chemotherapy interfere with peripheral nervous system (PNS) and causes damages to PNS. Due to these damages, tingling, numbness in extremities of hand and foot and moderate to severe pain occurs. Apart from these patient may experience

Symptoms of Peripheral Neuropathy:

• Joint or muscle cramps
• Weakness all over
• Trouble hearing
• Ringing or buzzing in ears
• Fine control in hand movements
• Trouble during walking

Such symptoms should be reported to the doctor, which can be controlled and well managed by proper medications and physiotherapy

Sexuality

Chemotherapy may cause changes in sexual behavior of an individual. Any treatment modality whether it is chemotherapy, radiotherapy or surgery may causes such changes. Changes in sexual behavior may relate to desire, arousal, orgasm or resolution. In some case it may be in whole phase or in some it may relate to one or two phases. Such changes may be temporary or permanent.

Coping with changes in sexual behavior

1. Usually one can have sex during treatment unless your doctor advice otherwise.
2. Some chemotherapy drugs can be found in semen or vaginal fluid, so better to use protect sex especially during childbearing age
3. Consult your doctor for problems related to erection in men, vaginal dryness in women for proper medication
4. Avoid sex during internal radiation therapy (Brachytherapy) since radiation source is inserted inside the body.

Nutrition

During cancer treatment patient may undergo various side effects. Due to this their overall general health becomes very weak. Maintaining good balanced nutrition is very important which includes proteins, vitamins and minerals which will help the body to heal and fight infections.

Common Problems

The problems that normally come across by patients are

1. Nausea and vomiting
2. Loss of appetite
3. Mouth ulcers
4. Change in taste and smell
5. Dry mouth
6. Diarrhea
7. Constipation

Management Tips

Following tips along with proper medications advised by physician can help to reduce or cope with such problems

1. If patient is suffering from nausea and vomiting then

   1. Eat small meals and more frequent meals
   2. Eat cold food to avoid strong smell
   3. Eat no-greasy food
   4. Eat more of dry food like bread, biscuits, toast etc
   5. Get anti-emetic medicines from the doctor

2. If patient is suffering from loss of appetite then

   1. Eat small and frequent meals
   2. Exercise and walking will help to increase appetite
   3. Ask doctor for appetite stimulants

3. If patient is suffering from mouth ulcers and infection then

   1. Avoid acidic food
   2. Use blended food
   3. Practice oral hygiene and rinse mouth thoroughly with mouth wash
   4. Ground and coarse foods that can irritate in mouth and throat should be avoided
   5. Ask doctor for proper medication to treat mouth ulcers and mouth wash

4. If patient is suffering from change in taste and smell then

   1. Rinse mouth with cold water after any episodes of vomiting
   2. Eat cold or lukewarm food to avoid any smell of food
   3. Suck hard candies to avoid nausea
   4. Get different types of food to reduce monotonous taste

5. If patient is suffering from dry mouth then

   1. Suck hard candies frequently that reduces mouth dryness
   2. Chewing gum also helps to reduce dry mouth
   3. Take fluids often
   4. Ask doctor for artificial saliva

6. If patient is suffering from diarrhea then

   1. Avoid taking fiber content is your food
   2. Reduce intake of fatty food and dairy products that softens the stools
   3. Take enough fluids and minerals especially sodium and potassium to balance fluid loss and minerals
   4. Ask doctor for medication if problem worsens

7. If patient is suffering from constipation then

   1. Get lots of fluids especially warm beverages
   2. Increase fiber in your diet
   3. Ask doctor for medication for constipation

Pain Management in Cancer Patients

Most cancer patients experience pain during their treatment journey. Understanding the sources and management strategies for cancer-related pain is crucial for improving patient quality of life and treatment outcomes.

Sources of Cancer Pain

Cancer-related pain can originate from two primary sources:

• Disease-related pain: Pain originating from tumors and lesions affecting surrounding tissues, organs, and structures
• Treatment-related pain: Pain resulting from cancer treatments including chemotherapy, surgery, and radiotherapy

Classification of Pain Intensity

1. Mild to Moderate Pain

This level of pain can be effectively managed using medicines commonly called NSAIDs (Non-Steroidal Anti-Inflammatory Drugs). These medications help reduce inflammation and provide relief for patients experiencing lower intensity pain.

2. Moderate to Severe Pain

This level of pain requires immediate attention and specialized management using opioid medications. Opioids are extremely regulated drugs in India and require proper follow-up and supervision by qualified physicians. Patient monitoring and adherence to prescription guidelines are essential for safe and effective treatment.

3. Neuropathic and Burning Pain

This specialized type of pain requires a combination approach using antidepressants along with standard pain management medications. Neuropathic pain often responds better to adjuvant therapies rather than traditional analgesics alone.

Non-Pharmacological Pain Management

Complementary Therapies

Apart from medications, several non-drug approaches can provide significant relief from cancer pain:

• Yoga: Helps improve flexibility, reduce stress, and manage pain through mindful movement and breathing techniques
• Exercise: Gentle, appropriate physical activity can help maintain muscle strength and reduce pain
• Heat Therapy: Heat padding and warm compresses can provide localized pain relief and muscle relaxation
• Massage Therapy: Helps by stimulating nerves and muscles, which aids in the relaxation of muscle spasms and reduces tension

Benefits of Integrated Approach

The combination of pharmacological and non-pharmacological treatments offers the most comprehensive approach to cancer pain management. This integrated strategy not only addresses the physical aspects of pain but also helps patients maintain an active role in their care, contributing to better psychological well-being and overall treatment outcomes.

All pain management strategies should be implemented under proper medical supervision. Regular follow-up with healthcare providers ensures optimal pain control while minimizing potential side effects and complications.

Sleep Loss

Patients undergoing cancer treatment may experience sleep disorders. They may not get proper sleep, leading to inadequate rest. This can be caused by anxiety, depression, or general discomfort.

Reasons for not feeling well and anxiety may include:

• Side effects of treatment
• Cancer pain
• Breathlessness

Consult a doctor for appropriate medication, which may include antidepressants, pain management, and other medications to reduce the side effects of treatment.