Caring for the carersession three Managing treatment side effects.

Caring for the carer—session three

Managing treatment side effects

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Managing treatment side effects

Side effects• all treatments cause side effects of some type• side effects depend on which organ is being

affected by the treatment in question• your loved one will not experience all the side

effects we discuss in this talk• side effects are experienced by each individual

according to their own health and sensitivities.

Fatigue

Strategies to help

• education • exercise—gentle and building• activity and rest patterns • nutrition and hydration • consult health professionals if problem

continues.

Cognitive changes

Symptoms of ‘chemo brain’• difficulty concentrating• memory loss• inability to think clearly• word finding difficulties• taking longer to complete tasks that were once

quick and easy to do• difficulty with new learning.

Help with cognitive changes• discuss memory and thinking changes openly

with your loved one• suggest keeping a journal of chemobrain

symptoms to discuss with their doctor• suggest asking the doctor if chemobrain

symptoms could be related to anything that could be easily treated.

Help with cognitive changes• encourage good nutrition, exercise and sleep • encourage use of memory prompts—diaries,

calendars, lists, memory boxes• encourage memory exercises• refer to Managing treatment side effects fact

sheet for further strategies.

Mouth problems—mucositis• inflammation of lining of mouth and throat• can cause painful ulcerated lesions with

bleeding and infection• can make it difficult to swallow, eat and drink• temperature should be monitored four hourly—

report any elevation near 38oC— if over 38oC come into hospital.

Strategies to help• education• encourage oral care:

– bland mouth washes – brush teeth with soft toothbrush and gentle toothpaste– remove and brush dentures– flossing

• pain control

• assist with dietary modification.

Dietary tips for sore mouth• ensure food is soft and soothing• encourage person to keep mouth moist• avoid offering:

– irritating, acidic foods and juices– spicy or salty foods– rough or dry foods

• refer to Help with eating and drinking problems and Sore mouth and throat—what can I eat? fact sheets.

Mouth problems—Xerostomia (dry mouth) • encourage person to keep mouth moist and

clean• increase water intake • no lemon/glycerine swabs or alcohol mouthwash• refer to Eating and Drinking Problems fact sheet.

Mouth problems—taste changes• encourage good oral hygiene • offer new foods and flavour combinations• sauces, gravies and marinades to add flavour • use straws to bypass taste buds• try other sources of protein if red meat tastes

strange.

Mouth problems—oral thrush• fungal infection of the mouth• side effect of chemotherapy or antibiotics• common if white blood cell count is low and

mouth is dry• can cause:

– oral discomfort– bad taste in mouth– decreased oral intake.

Strategies to help• encourage good oral hygiene• assist with taking anti-fungal medication• encourage fluids and keeping mouth moist• encourage removal of dentures when medication

is used• discourage eating or drinking for 15 to 20

minutes after application.

Vaginitis or Enteritis• wash bottom area thoroughly after every

toilet visit• may require salt baths if area becomes inflamed • discourage sexual intercourse whilst these

membranes are inflamed.

Nausea, vomiting and retching• nausea—feeling sick in your stomach• vomiting—throwing up stomach contents• retching—unproductive involuntary motion of

vomiting

Strategies to help• education • relaxation and stress management• previously useful strategies • reduce smells and noises • offer small frequent meals • medications as prescribed.

Problems with eating• dysphagia—difficulty swallowing • mouth problems:

– mucositis– taste alterations– Xerostomia—dryness of mouth– oral thrush

• Cachexia • weight gain from treatments• anorexia—abnormal loss of desire to eat

Tips to avoid weight loss• small regular meals and snacks• avoid too much fluids with meals• nutritious high energy foods and drinks.

High energy, high protein food

Constipation• excessively hard and dry bowel movements

often with abdominal and rectal pain• may be from:

– reduced physical activity, lack of time or privacy for toileting, low amount of fibre and/or fluid in the diet

– complications of disease or treatment.

Strategies to help• education—diet, perianal hygiene, relaxation,

increase physical activity if possible• watch for fatigue and weakness • exercise—assist with mobility and daily routine

as needed• monitor intake and output and consult health

professionals if problem continues.

Diarrhoea• increase in stool volume, frequency, or fluid

content—different to usual pattern • may be result of disease, infection, diet,

treatment.

Strategies to help• education• watch for fatigue and weakness • assist as needed • watch intake and output• medications • if diarrhoea does not settle, or pain, or change in

contents—seek medical advice.

Blood changes—anaemiaReduced amount of red blood cells circulating in

the body which decreases the amount of oxygen in the system.

Strategies to help• education—signs and symptoms, treatment

plan, self-care strategies: – nutrition– patterns of activity and rest– adequate sleep– self-administration of any medications

• health professionals for blood transfusions as needed.

Blood changes—neutropenia• white cells are part of the immune system.

Neutrophils are one of the white cells • health professionals watch the neutrophil count

as a low count means the person is at risk of infection

• neutropenia is a low neutrophil count.

Strategies to help• education• if friends/family ill—should not visit• strict hand washing and food safety • no fresh flowers/plants• wear gloves and a mask when gardening• shopping• check temperature• consult health professionals.

Blood changes—thrombocytopaenia• low platelet count• risk of bleeding.

Strategies to help• see health professionals to check blood counts• may require platelet transfusion if the count is

really low or if bleeding occurs• avoid activities where cuts, bumps, scrapes may

occur.

Pain• unpleasant sensory and emotional experience • may be actual or possible tissue damage• pain is whatever the person who is experiencing

it says it is, and exists when they say it does • not everyone with cancer experiences pain.

Strategies to help• pain relief • note pain that does not settle and report• note when pain does occur • note relief measures that work at times • eating and drinking.

Alopecia• Hair loss

– range in severity– other sites– not all drugs cause this.

Strategies to help• education• wigs, scarves, hats, caps, turbans• hair regrowth may differ• scalp care • hat/head covering• ‘Look Good Feel Better’ program—The Cancer

Council Queensland—131120.