Managing Side Effects
While you are undergoing immunotherapy, targeted therapy, chemotherapy, and/or radiation therapy, you may experience side effects that may make eating more difficult, food less appealing, and tasks more difficult to accomplish. Side effects vary in severity and duration from person to person. They may also vary with treatments and during different phases of treatment and recovery. Often the most severe side effects occur in the early days of treatment and gradually subside as your body adjusts to treatment. Most side effects disappear after treatment ends. Unfortunately, growing cancer can cause similar symptoms, and sometimes it is difficult to distinguish between side effects caused by the treatment and the progression of the disease.
Asymptomatic Side Effects
Asymptomatic side effects means that the treatment does not produce obvious symptoms that you can feel. These side effects can decrease white blood cell production, cause elevations in liver enzymes, or changes in kidney function. Left untreated, these effects can eventually cause serious symptoms and conditions.
Asymptomatic side effects are detected and monitored by blood tests. Depending on your treatment, you will receive regular blood tests for liver function, kidney function, and/or blood cell counts. Abnormal test results may indicate a need to treat your side effects or change your cancer treatment.
Symptomatic Side Effects
These side effects cause symptoms that you can feel, and may be uncomfortable. However, there are recommendations and approaches that you can try until you find the one that works best for you. Your doctor and other members of your health care team can help you find ways to address the problems you are experiencing.
You may notice side effects like fever, chills, headache, and muscle aches when you’re getting adjuvant therapy for melanoma, particularly immunotherapy. Some of the acute side effects go away after the first few weeks of therapy, but other chronic side effects may take weeks or months to become evident or prominent.
Side effects may be taken as one indication that therapy is working, although some patients will experience no symptoms, even when therapy is effective. Patients who experience severe side effects may need to reduce or temporarily interrupt treatment. These actions have not been shown to reduce treatment effectiveness.
Tips to Manage Your Symptoms: A-B-C Approach
To help relieve your discomfort, follow this simple A-B-C approach:
Analgesics such as acetaminophen can help prevent or partially relieve fever and headache.
Bedtime administration of your therapy may allow you to sleep through your symptoms.
Conserve your energy; try to get plenty of rest.
Drink plenty of fluids; keep yourself well hydrated before and during therapy.
Eat balanced meals; make sure you are getting an adequate amount of calories in your diet.
Focus on the positive; maintain a healthy mental outlook.
Feeling fatigued due to melanoma treatments such as immunotherapy, chemotherapy, and radiation therapy is common.
You may notice a feeling of intense tiredness or weakness that’s not usually relieved by rest or sleep. Just remember that fatigue is usually temporary. You will feel stronger and more energetic in the weeks after treatment ends.
If fatigue persists, it may be due to anemia, too few red blood cells in the bloodstream resulting in reduced oxygen to tissues and organs. Anemia is treatable by blood transfusion, iron replacement, or hormones that stimulate red cell production.
Tips to Ease Fatigue: Activities
- Pace your activities for the day. Be sure to include periods of rest between activities that tire you out.
- Set realistic goals. Increase or decrease your activities as needed.
- Don’t be afraid to ask for and accept help with chores: delegate!
- Look for ways to save your energy. For example, prepare meals sitting down instead of standing. Limit trips up and down the stairs.
- Try to maintain rhythm in your movements; this helps save energy.
- Take time to rest or take naps.
- Save time for activities you enjoy. Plan them as part of your day.
- Plan a short period of light activity each day, such as a walk or a stroll. You may actually feel more tired if you are completely inactive.
- Rest your eyes periodically.
- Keep a “fatigue diary” to monitor your patterns of fatigue. This will help you plan your activities for the time of day when you have the most energy.
Tips to Ease Fatigue: Environment
- Work in a well-ventilated and lighted room.
- Arrange your environment to minimize bending or reaching.
- Maintain a moderate pace; however, use a slower pace if the room is hot or humid.
- Use music for relaxation or stimulation.
Tips to Ease Fatigue: Eating and Drinking
- Eat a balanced diet with an emphasis on complex carbohydrates such as dried beans and peas, whole-grain breads and cereal, oatmeal, polenta, brown rice, vegetables, and whole-grain pastas. Complex carbohydrates provide long-lasting energy as well as important vitamins and minerals.
- Drink at least 8 glasses of fluids a day, unless your doctor has restricted the amount of fluids you can drink. This will help flush out the by-products of cell destruction that may cause fatigue.
- Avoid foods and beverages that contain caffeine, especially in the evening.
Nausea is a common side effect of melanoma therapies, including immunotherapy. Besides the obvious discomfort it causes, nausea can prevent you from getting enough food and needed nutrients. Feelings of nausea are usually temporary and will disappear in the weeks after treatment ends.
Tips for Managing Nausea
- Nausea and vomiting can be controlled effectively by a number of anti-nausea drugs, also known as anti-emetics. These medications are often started before the beginning of cancer treatment and are continued for as long as nausea is likely to occur. Talk to your doctor about medicines that may help your nausea.
- Being active may slow the process of digestion. It is best to rest in a sitting position for about an hour after meals.
- If nausea is a problem in the morning, try eating dry toast or crackers before getting up.
- Wear loose-fitting clothes.
Foods and Nausea
- Some foods that minimize nausea include toast and crackers, yogurt, sherbet, pretzels, angel food cake, oatmeal, skinned chicken (baked or broiled), fruits and vegetables that are soft or bland (such as canned peaches), clear liquids (sipped slowly), and ice chips.
- Avoid fatty, greasy, fried, spicy, or hot food with strong odors.
- Avoid sweets such as candy, cookies, or cake.
- Try to eat frequent, small meals instead of three large meals.
- Avoid eating or staying in rooms that are stuffy, too warm, or have cooking odors that might disagree with you.
- Hot or warm foods may aggravate nausea. Eat foods at room temperature or cooler.
- Don’t force yourself to eat favorite foods when you feel nauseated. You may end up permanently disliking your favorites.
Drinking and Nausea
- Drink or sip liquids throughout the day, except at mealtimes. If drinking from a glass is distasteful, using a straw may limit feelings of nausea.
- Avoid liquids at mealtime. Drinking liquids with meals can cause a full, bloated feeling.
- Hot drinks may aggravate nausea. Drink cool or chilled beverages. Try freezing favorite beverages in ice cube trays.
There is no foolproof way to improve the flavor or smell of food because each person is affected differently by illness and treatments. However, the National Cancer Institute offers the following tips to help make your food taste better:
Tips for Managing Altered Taste and Smell
- Choose and prepare foods that look and smell good to you.
- Do not introduce new tastes when offensive odors are present.
- Avoid foods that cause an unpleasant taste.
- Serve foods at room temperature
- Try tart foods such as oranges or lemonade that may have more taste. A tart lemon custard might taste good and will also provide needed protein and calories. (Do not try this if you have a sore mouth or throat.)
- If red meat (such as beef) tastes or smells strange, substitute with chicken, turkey, eggs, dairy products, or fish that doesn’t have as strong a smell.
Tips on Flavoring
- You can help the flavor of meat, chicken, or fish by marinating it in sweet fruit juices, sweet wine, Italian dressing, or sweet-and-sour sauce.
- Try using small amounts of flavorful seasonings such as basil, oregano, or rosemary.
- Try using bacon, ham, or onion to add flavor to vegetables.
Tips on Oral Care
- Visit your dentist to rule out dental problems that may affect the taste or smell of food.
- Talk to your dentist about special mouthwashes and good oral care.
Loss of appetite or a poor appetite are a common result of immunotherapy, targeted therapy, chemotherapy, and radiation therapy. Once you adjust to treatment or treatment ends, your normal sense of taste and smell will return.
- Physical factors that affect your appetite include nausea, vomiting, and changes in your taste or smell.
- Psychological reasons that may reduce your appetite include being upset or depressed about having cancer.
Tips for Improving Appetite
The following suggestions may help make mealtimes more relaxed so that you feel more like eating:
- Stay calm, especially at mealtimes. Don’t hurry your meals.
- Try changing the time, place, and surroundings of meals to make them more appealing. Try a candlelight dinner. Set a colorful table. Listen to soft music while eating. Eat with others or watch your favorite TV program while you eat.
- Eat whenever you are hungry, even at bedtime. Frequent small meals throughout the day may be better than three large meals.
- Add variety to your menu. Try new recipes.
- Have healthy snacks handy. Taking just a few bites of the right foods or sips of the right liquids every hour or so can help you get more protein and calories.
Clinical depression is not something you can “shake off” or talk yourself out of. It is believed to result from a chemical imbalance in your brain that can be treated with medications. It does not mean you are “crazy” or “mentally ill”. You did not bring the depression upon yourself.
Fortunately, many symptoms of depression can be identified and treated. For any patient with cancer, an important part of their care is the monitoring and treatment of any serious depression.
Drugs used to treat melanoma, particularly interferon, may induce depression or worsen pre-existing depression. It is very important for patients to inform their doctors about any symptoms of depression, past or present, before starting interferon therapy and during the course of treatment.
Negative thoughts and feelings caused by depression make some people feel like giving up. It is important to realize that these negative views are part of the depression. When treatment starts to work, positive thinking replaces negative thinking, and your mood lifts.
Common symptoms of depression include:
- Sad, anxious, or “empty” mood that lasts for several weeks
- Loss of interest in previously enjoyable activities
- Decreased energy, fatigue, being “slowed down”
- Difficulty concentrating, remembering, making decisions
- Feelings of guilt, worthlessness, helplessness
- Irritability or restlessness
- Excessive crying
- Chronic aches and pains with no apparent cause
More serious symptoms include:
- Thoughts of suicide
- Persistent difficulty eating or sleeping
- Continuing lack of interest in activities of daily living
- Persistent feelings of breathlessness or sweatiness
- Inability to experience pleasure in anything
If you have been experiencing these symptoms for 2 weeks or longer, or these feelings are severe enough to interfere with normal functioning, contact your doctor immediately. Your doctor may prescribe medication and may refer you to a mental health professional. When depression is treated effectively, your psychological outlook and quality of life can improve significantly.
Tips to Help Yourself Manage Your Depression
- Make sure to continue treatment until symptoms improve. If you are taking anti-depressant medication, do not stop it unless your doctor tells you to do so.
- Make the effort to engage in conversations or daily activities with other people.
- Don’t take on more responsibilities than you know you can handle.
- Break larger tasks into smaller ones.
- Participate in activities that may make you feel better.
- Mild exercise, such as walking, may help your mood.
- Expect your mood to improve gradually, not immediately.
- Hold off making important decisions until the depression has lifted.
- Let your family and friends help you.
- Realize that negative thinking is a part of depression and will disappear with treatment.
- Be assured that, with time and treatment, you will begin to feel better.