To the Ones With Side Effects
Letters to my patients, day 7
You came to us in the peak of health — without pain or symptoms from the mass. It was an incidental finding on that CT scan. Imaging led to biopsies, culminating in your cancer diagnosis and starting treatment last week. Now you are here, at a post-chemo visit, nervous to reach out for help. You are starting to feel sick.
The nausea crept up over the weekend and knocked out any appetite you had. Your throat was still sensitive to cold drinks, and warm water never satisfies thirst in the same way. Your mouth feels dry and sticky and irritated and maybe even itchy? And every time you stand up, the room around you fades into the distance, a blurred haze.
But when the provider asks if chemotherapy went okay, you say yes. Because isn’t this how it’s supposed to feel?
No, you are not supposed to feel miserable.
While that was a standard state of being for patients with cancer many years ago (read more here), it does not need to be in your case. There have been advances in anti-nausea medications, adjustments in chemotherapy delivery and dosing to help with tolerability, mouth rinses to numb irritation or treat ulcers, increased use of appetite stimulants and anti-fungal therapy for thrush. And if one medication does not work after giving it a solid try, there are usually other options.
Full disclosure, there are still individuals who are very sick on chemotherapy. But as a whole, your quality of life during treatment can be much better than it used to be.
Tell your care team how you really feel.
I can’t leave the house because I am nervous about being incontinent — let’s get a stronger anti-diarrheal medication on board.
I am nauseated but having constipation — sometimes constipation can be a side effect of this anti-nausea medication, let’s switch to a different one.
My mouth is sore and my throat hurts, I can’t taste anything — that looks like thrush, here is a medication to kill the fungus. You’ll feel better soon.
I can’t sleep — let’s talk more about that, tell me what keeps you up at night. Is it frequent urination? Anxiety? Napping all afternoon? Fear? We can treat these or just talk through them.
I am not drinking enough water and feel lightheaded — you are dehydrated. We can give you IV fluids and anti-nausea medications to help.
My fingers are so numb that I couldn’t tie my son’s shoes this morning — we will decrease the dose of one of your chemotherapy medications, which is the biggest contributor to this neuropathy, to keep that from worsening.
We are here to help you, don’t hesitate to ask. Really.
Cancer treatment is not an easy journey. I know you were feeling perfectly fine before starting chemo, so it can be hard to see why this is even worth it. There will always need to be a balance between prioritizing quality of life and the treatment benefit. That is between you and your providers. Communication is the key — ask if there are any medicines to help you feel better or if continuing treatment is worth the intensity of your symptoms.
Take it one week at a time. You can do this.
If you are feeling sick after cancer treatment, take what you need:
It is okay to rest, my body is going through a lot.
This is worth it to me because it is reducing the risk of the cancer coming back, I can keep going.
I am so miserable that this is not worth it, I am allowed to ask for a change.
My care team wants to help me feel better, I will ask for help.
It’s okay to still be overwhelmed. I will take this one treatment at a time.
Thank you for being here,
This is part of a 31-day series of letters to my patients — those undergoing a work-up, diagnosis, or treatment for cancer. Topics are also focused on those caregiving and supporting individuals affected by cancer. This is not an easy journey, but you do not have to do it alone.
This is not intended to be medical advice — please consult your healthcare team for individual medical expertise.
Let me know what topics you hope to see this month! I have many of the days filled, but not all of them. I would love to hear your thoughts, experiences, or questions.
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