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Side Effects

Side effects are health problems resulting from cancer treatments. Local treatments such as radiation therapy tend to affect the area of the body treated. Medicines that travel throughout the body, such as chemotherapy, have side effects that are more widespread. Doctors plan treatments to limit side effects as much as possible while still effectively treating cancer.

Pediatric cancer patient hugging mom

Side effects are hard to predict. Some patients may have mild side effects, while other patients may have more severe problems. The same patient can have different side effects from one course of treatment to another.

Most side effects of cancer treatment get better after therapy ends. But living with side effects can be hard, both physically and emotionally. The medical team can help patients prepare for side effects and manage them if they occur.

Other Common Side Effects of Childhood Cancer Treatments

Certain side effects are more common. Coping with these problems is often a process, and families have to figure out what works best for them. However, there are strategies that can help.

  1. Patients often feel tired and weak during cancer treatment. Children may not have the energy for usual daily activities, and they may be less interested in doing things they normally enjoy. Children often sleep more and need more rest after activity. Fatigue is usually greatest in the days immediately after a chemo treatment. Energy levels may gradually increase until the next treatment. Doctors also monitor red blood cell counts to check for anemia which can be a cause of fatigue. It can also help to know that the “no energy” feeling is normal and will get better.

    Ways to help fatigue include:

    • Eat a healthy diet.
    • Have a regular sleep routine.
    • Be active and get some exercise when possible.
    • Plan extra rest in the days after treatments.
  2. Cancer treatments can affect thinking, concentration, and memory. Patients may have trouble thinking clearly, finding words, and processing information. For patients on chemotherapy, this mental fog is often called “chemo brain.” This side effect usually gets better after treatment ends. However, some patients have long-term and late effects related to memory and cognition, particularly after radiation to the head and neck.

    There are some things that families can do to help children manage memory and concentration problems. These include:

    • Have a consistent schedule or routine.
    • Get enough rest.
    • Be physically active.
    • Use puzzles and games for mental practice.
    • Write things down and use reminders to help with memory.
  3. Cancer treatments may cause soft, loose, or watery bowel movements. This is common in patients receiving some types of chemotherapy or targeted therapy.

    Anti-diarrhea medicines can help with symptoms. Many patients also find that eating smaller meals and following a special diet reduce diarrhea and stomach upset. Problems can result from diarrhea including dehydration and skin irritation. Patients should drink plenty of fluids and keep the anal area dry and clean.

  4. Many children lose their appetites during cancer treatment. Some medicines may also change the way food tastes or smells. Good nutrition and maintaining a healthy weight is critical to fighting cancer.

    To manage nutrition:

    • Choose healthy foods when possible.
    • Eat smaller, more frequent meals and snacks.
    • Drink plenty of fluids.
    • Get regular physical activity.
    • Test different foods or meal/snack schedules to see what works best.
    • Keep a journal to track appetite, foods, and physical activity.
  5. Hair loss due to cancer treatment is common. The cells that cause hair to grow are fast-growing cells, like cancer cells, and are often harmed during treatment. During chemotherapy, hair loss usually occurs all over the body including body hair and even eyelashes. Many people begin to see hair loss 2-3 weeks after starting chemo. Usually, hair begins to grow back 2-3 months after chemotherapy ends. Radiation therapy may also cause hair loss around the area being treated. Hair usually grows back 3-6 months after radiation treatment ends.

    To manage hair loss, treat hair gently using a soft bristle brush or wide-tooth comb. Use a mild shampoo to clean hair and scalp. It may help to cut hair short or shave the hair before it starts falling out. Patients often choose to wear hats or scarfs – selecting styles that fit their personalities. Wigs are available in small sizes and specially designed to fit children. Some of the cost may be covered by insurance.

  6. Cancer treatments can cause a variety of skin problems. Radiation therapy may cause the treated area to become dry or discolored. Rashes, peeling, and blistering may also occur. Chemotherapy can also harm skin cells, causing skin changes including rashes, redness, and itchy, dry skin.

    To manage skin sensitivity and irritation, use mild soaps, lotions and creams. Avoid products that may cause further irritation. Keep skin moisturized, and try not to scratch itchy skin. Pay attention to breaks in the skin that can lead to infection. Protect the skin from the sun by wearing a hat, long-sleeved clothing, and sunscreen.

Coping with Side Effects

Dealing with side effects can be very difficult. Patients and families often feel overwhelmed physically and emotionally. Some side effects can be hard to discuss. It is normal to feel frustrated, sad, angry, embarrassed or self-conscious. But, because every treatment and experience is different, it is important to let the care teams know about symptoms.

Medicines are available to address many issues such as pain, nausea, constipation, and diarrhea. Many patients benefit from consultation with palliative care or pain specialists who work with the primary medical team to manage side effects and provide comfort.

Patients and parents also figure out things that make symptoms better and worse and ways to help them get through the day. As much as possible, try to:

  • Eat healthy foods
  • Do some physical activity
  • Maintain a good sleep routine

Parents and older children may consider keeping a record of side effects. A journal or mobile app can be used to keep track of:

  • Symptoms and their severity
  • When they occur
  • What seems to help?

In addition to medications, many patients find help by using coping strategies such as:

  • Relaxation
  • Deep breathing
  • Massage
  • Biofeedback
  • Play therapy
  • Music and art therapy

Talking to other children and families can provide additional ideas and support for managing side effects. It can help to know that others are going through—or have gotten through—the same thing. Although it may take some problem solving and planning, it is possible to have better control over side effects.

Reviewed: June 2018