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Managing versus Preventing Side Effects: What Is the Difference?

December 2022 Vol 8 No 6
Lillie D. Shockney, RN, BS, MAS, HON-ONN-CG
University Distinguished Service Professor of Breast Cancer,
Professor of Surgery, Johns Hopkins University School of Medicine
Co-Developer of Work Stride—Managing Cancer at Work
Johns Hopkins Healthcare Solutions

At the end of 2022, are there still oncologists who are telling their patients with cancer, “Plan on the following side effects from these systemic treatments…”?

What happened to all the evidence-based research that has proved that many side effects of cancer treatment can be prevented today, or at the very least diminished and controlled?

So, if you are a patient going through chemotherapy, immunotherapy, targeted therapy, hormonal therapy, or radiation therapy, ask your treating doctor, nurse practitioner, or nurse navigator about this.

It’s time for you to advocate for yourself, so you could get help in a proactive way to prevent, or at least reduce, the side effects from cancer treatment rather than letting you get really sick, and then trying to reduce these side effects, which is much, much more difficult.

Power Walking Before Radiation

If the treatment team knows that 100% of patients with cancer who are receiving radiation will have chronic fatigue as a major side effect, then we need to get you out to do power walking for 30 minutes, 5 times a week. This has proved to diminish chronic fatigue from radiation therapy by 71%!

This information was presented at oncology conferences nationally all the way back to 1998, and was again presented at the American Society of Clinical Oncology meeting in 2020—but patients with cancer are still often not being informed about power walking to prevent chronic fatigue from radiation therapy.

Anti-Emetic Medication Before Chemotherapy

If specific chemotherapy drugs are known for causing nausea and vomiting, doesn’t it make sense to give you a prescription for one of the medications called “anti-emetics” that can prevent those miserable side effects before they even get started?

It is a lot harder to get in front of the train once that train has left the station. So, if you are about to start chemotherapy, ask your doctor or nurse navigator if that chemotherapy is known to cause nausea and vomiting, and if so, ask for an anti-emetic medication.

Again, speak for yourself if your cancer team does not provide the information.

Strategies for Hair Loss

Hair loss is also known to accompany certain chemotherapy medications. Several options are now available to prevent or reduce hair loss.

Cool or cold caps are becoming more frequently used for that, but only by patients who are made aware of this option. So speak up for yourself!

And if hair loss is expected, we know when the hair will fall out. Ask your nurse practitioner or nurse navigator when to expect this side effect to kick in, so you could proactively plan to get fitted for a wig before you even start with the chemotherapy, rather than being surprised by it while driving a car, and having your scalp start itching and seeing handfuls of hair coming out. (This is also a great way to have an accident! I know a patient who actually had this happen.)

Hot Flashes from Hormone Therapy

Hot flashes and night sweats from hormonal therapy, which is used for several types of cancer, including breast and prostate cancer, can keep you awake at night and disrupt your daily activities. Several methods are now available to prevent hot flashes.

  • Consider getting a Cooling Pillow or Chillow Pillow, which are available at many big-box stores and online.
  • Wear layered cotton clothing that you can peel off as needed.
  • Avoid hot beverages and spicy foods that can trigger these side effects.
  • If still having problems, ask for a prescription such as Effexor to quell these side effects.

Ask for Help

So how should you plan for side effects from cancer treatment? Plan on requesting help to prevent or diminish these side effects, so that they have as little impact on you and your life as possible.

We want you to continue being active and enjoying your life, spending time with family and friends, and even going to work most days.

That is all possible when your treatment team is proactive about preventing your treatment side effects. And if your team is not proactive about that, don’t hesitate to ask for help.

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