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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.

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.

    • 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.
    • 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.
    • Nausea and vomiting are common side effects of chemotherapy and other treatments. Symptoms vary from mild stomach upset to severe vomiting. The cause of nausea is not fully understood. However, chemotherapy damages cells of the mucous membranes that line the mouth, stomach and intestines.
    • There are several ways to help manage nausea and vomiting during cancer treatment. These include:
      • Take anti-nausea medicine.
      • Eat small snacks and meals.
      • Avoid spicy, acidic foods.
      • Chew gum or suck on hard candy.
      • Try complementary therapies such as relaxation techniques and acupuncture.
    • 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.
    • Infrequent bowel movements or stool that is difficult to pass may be caused by treatments, certain medicines, changes in diet, or reduced physical activity.
    • To treat constipation, eat high-fiber foods, drink plenty of liquids, increase physical activity and use medicines recommended by a doctor.
    • 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.
    • 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.
    • Pain may be caused by the cancer treatment or the cancer itself. Managing pain is important. Pain may lower the body’s immune system, increase the time it takes to heal, make sleep difficult, and affect mood.
    • It is important to talk with the medical team about pain management. Keep track of pain levels and follow instructions for pain medicines. Many patients also get relief from complementary therapies such as acupuncture, biofeedback, hypnosis, and massage therapy. Pain and palliative care specialists can help develop a personalized plan to meet patient needs.
    • Bleeding and bruising, also known as thrombocytopenia, may be caused by treatments such as chemotherapy and targeted therapy. These treatments can reduce the number of platelets that help blood to clot. When platelet counts are low, bruising and bleeding may occur.
    • Doctors may recommend that patients avoid certain medicines such as aspirin and ibuprofen. Patients may also need to take extra care to prevent cuts and scrapes. When bleeding occurs, press down firmly in the injured area until bleeding stops. For bruising, ice areas that are affected. Seek medical care if an injury occurs, and report any changes in bruising or bleeding to a doctor.
    • 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.
    • Cancer treatments, especially chemotherapy, often cause painful sores in the mouth and throat. Dry mouth, changes in taste, and sensitivity to hot, cold, or acidic foods are also common. Pain and swelling in the mouth and throat can interfere with swallowing and make it hard to eat.
    • To manage mouth and throat problems, check the mouth daily for sores or white spots. Choose foods that are soft, wet and easy to swallow, and drink plenty of liquids to reduce the chance for mouth infection. Use a lip balm for dry, cracked lips. The medical team may also recommend a special mouth rinse to help ease pain and heal sores.
    • Cancer treatments can harm infection-fighting white blood cells of the immune system. This lowers immunity and puts a patient at risk for infection (immunocompromised). During treatment, doctors monitor white blood cell counts regularly. Infection risk can also be increased by anything that gives germs a chance to enter the body. This includes wounds and cracks in the skin, irritation of mucous membranes, and medical devices such as feeding tubes, catheters, and ports.
    • To reduce risk of infection:
      • Wash hands often.
      • Stay away from people who are sick.
      • Avoid crowds.
      • Keep wounds clean.
      • Watch for signs of infection.
      • Make sure foods are cooked properly.
    • The possible loss of fertility is an important side effect for families to consider before starting treatment for pediatric cancer. Loss of fertility may be temporary or permanent. It also may not happen at all. Certain treatments pose a greater risk to fertility than others. Options to help preserve reproductive health may be available depending on the specific disease, type of treatment, and age of the child. Risks to reproductive health and any available options should be discussed with the medical team before treatment begins.

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

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