Chemotherapy targets rapidly dividing cells to fight cancer. While effective against malignant cells, this process also affects healthy, rapidly growing cells found in the hair, mouth, gastrointestinal tract, and bone marrow. The resulting side effects can significantly impact a person’s quality of life during and after treatment. Management strategies involve both medical interventions and practical, day-to-day adjustments to help patients tolerate treatment and maintain strength. This article details actionable steps to manage the most common physical effects of chemotherapy.
Strategies for Managing Nausea and Vomiting
Chemotherapy-Induced Nausea and Vomiting (CINV) is a common side effect, but modern medicine offers powerful preventative measures. The most effective approach involves taking medication before the chemotherapy infusion, rather than waiting for symptoms to begin. Oncologists prescribe a combination of antiemetics, such as a serotonin (5-HT3) receptor antagonist, a neurokinin-1 (NK1) receptor antagonist, and a corticosteroid, depending on the chemotherapy’s risk level.
Patients must adhere strictly to the prescribed antiemetic schedule, which often involves taking medication for several days following treatment to manage delayed CINV. Breakthrough nausea, which occurs despite preventative treatment, can be managed with rescue medications like dopamine antagonists. Consistent communication with the care team is essential to ensure the medication regimen is optimized for individual needs.
Non-drug adjustments provide supplementary relief for CINV. Dietary management should focus on consuming small, frequent meals throughout the day to prevent the stomach from becoming too full. Choosing bland, low-fat, and easily digestible foods, such as toast, crackers, or clear broths, helps minimize digestive distress.
Avoiding strong food odors is helpful; patients often opt for cold or room-temperature foods that emit less aroma. Consuming ginger, in the form of ginger ale, tea, or supplements, can help settle the stomach. Techniques such as deep breathing and guided distraction can also complement physical treatments by managing anticipatory nausea.
Counteracting Chemotherapy-Related Fatigue
Chemotherapy-Related Fatigue (CRF) is a persistent exhaustion that is distinct from normal tiredness and often not relieved by rest. Managing this side effect requires a structured approach centered on energy pacing and selective activity. “Energy banking” involves prioritizing necessary tasks and scheduling them during times of peak energy, often in the morning.
Conserving energy means delegating tasks and taking short, planned rest periods throughout the day before feeling depleted. While rest is necessary, excessive daytime napping can disrupt the nighttime sleep cycle, ultimately worsening fatigue. Maintaining a consistent sleep schedule and practicing good sleep hygiene helps maximize the restorative nature of sleep.
Engaging in light, structured physical activity is an effective strategy for managing CRF. Gentle exercise, such as a 15 to 30-minute walk approved by the oncology team, can improve physical conditioning and energy levels more effectively than complete inactivity. Starting with low intensity and duration, then slowly progressing, is recommended to capture the benefit of exercise without causing further exhaustion.
Essential Nutritional and Hydration Support
Maintaining adequate nutritional status and hydration is important for tolerating chemotherapy and supporting recovery. Patients should aim to consume at least 64 ounces (about 2 liters) of fluid daily to prevent dehydration, which can worsen nausea and fatigue. Water, clear broths, and electrolyte-rich beverages help replace fluids and minerals lost, particularly if vomiting or diarrhea occurs.
Chemotherapy often causes taste changes (dysgeusia), leading to foods tasting bland, metallic, or overly sweet. Using plastic utensils can help mitigate the metallic taste, while experimenting with strong flavors like lemon, mint, or tart foods can make meals more appealing. Good oral hygiene, including rinsing the mouth before and after eating, can also help cleanse the palate and improve taste perception.
To combat appetite loss and prevent weight loss, focus on nutrient and calorie density in small volumes. Incorporating healthy fats and proteins, such as by adding butter, oils, cream, or nut butters to meals, can increase caloric intake without significantly increasing portion size. Drinking liquid supplements, smoothies, or milkshakes can be an easier way to consume necessary calories and protein when solid food is unappealing.
A weakened immune system, often due to low white blood cell counts (neutropenia), requires attention to food safety to prevent infection. Handwashing with soap and warm water for at least 20 seconds before preparing or eating food is mandatory. Foods with a high risk of containing harmful bacteria should be avoided, including:
- Raw or undercooked meats.
- Unpasteurized dairy products.
- Food from bulk bins.
- Food from salad bars.
Managing Other Common Physical Symptoms
Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect characterized by numbness, tingling, or pain, typically in the hands and feet. Protecting the affected limbs is important; this includes wearing warm gloves and socks in cold temperatures, as cold can exacerbate the tingling sensation. Patients should inspect their hands and feet daily for any cuts or sores, as reduced sensation can make injuries go unnoticed.
For painful CIPN, the serotonin-norepinephrine reuptake inhibitor duloxetine is often the first-line pharmaceutical treatment recommended. Physical and occupational therapy can also be beneficial, helping patients maintain balance and fine motor skills that may be affected by nerve damage. Acupuncture has shown promise as a complementary therapy for some patients experiencing CIPN symptoms.
Mouth sores, or mucositis, occur because chemotherapy damages the rapidly dividing cells lining the mouth and throat. Management is centered on maintaining oral hygiene and choosing soft, non-irritating foods. Rinsing the mouth several times a day with a mild solution of baking soda or salt dissolved in water can keep the mouth clean and soothe irritation. Foods that should be avoided to prevent further irritation include:
- Spicy foods.
- Acidic foods.
- Crunchy foods.
- Very hot or cold foods.
Skin and nail changes are frequent, as these cells are sensitive to chemotherapy. Dry, itchy skin is common and should be managed with mild, unperfumed, alcohol-free moisturizers applied two to three times daily, especially after bathing. Protecting the skin from the sun is important, as many chemotherapy drugs increase sun sensitivity, requiring the use of broad-spectrum sunscreen (SPF 50+) and protective clothing.
Nails may become brittle, discolored, or develop ridges. Keeping nails short and avoiding artificial nails reduces the risk of trauma or infection. Wearing gloves while washing dishes or gardening helps protect the nails and skin from harsh chemicals and excessive moisture. Any sign of infection, such as swelling or discharge around the nail bed, should be reported to the healthcare team promptly.