Long Term Side Effects of Cancer Treatments

Mary Dowd & Catherine Masterson Clinical Nurse Specialists in Breast Care

University College HospitalGalway

• Cancer related fatigue.

• Chemotherapy induced peripheral neuropathy.

• Chemotherapy-related cognitive impairment.

Cancer Related Fatigue

• Fatigue is a daily lack of energy; an unusual or excessive whole body tiredness not relieved by sleep.

• It can be acute or chronic.

• Fatigue affects as many as 40% of breast cancer survivors.

Andrykowski et Al, 1998

Causes of Cancer Related Fatigue

• No single cause.

• Cancer related fatigue may be related to both the disease process and the treatments.

• Other causes e.g. anaemia, stress, poor nutrition

Assessment of Cancer Related Fatigue

• Talk to your doctor.

• Correct anaemia.

• Review your medications.

• Keep a diary for one week to identify the times when you either are most fatigued or have the most energy.

• Brief fatigue inventory.

Management of Cancer Related Fatigue

• Speak to your doctor• Rest• Stay active• Save your energy

– Plan, prioritise and delegate everyday activities• Get help

– Family, friends• Get support

– Family, friends, support groups• Eat well

Chemotherapy Induced Peripheral Neuropathy (CIPN)

• It is a disorder that occurs when nerves in your body’s peripheral nervous system are damaged.

• Patient can develop symptoms such as pain, numbness, tingling, burning, difficult picking up objects and constipation.

CIPN

• Symptoms tend to start farthest away from the head and move in closer over time.

• CIPN can start anytime after treatment starts and can progress with further treatments.

• Certain drugs are more liked to be associated with CIPD e.g. carboplatin, cisplatin, Taxol and Taxotere.

Treatment of CIPN

• Pain relief , type of pain relief will depend on the severity of the pain.

• Steroids, only for a short period.• Anti depressants, smaller doses than

those used to treat depression.• Anti-convulsants.• Other treatments such as acupuncture,

relaxation therapy

Treatment of CIPN• Take your pain relief before the pain becomes

severe. Take laxatives to treat constipation.• Avoid extremes of temperature, tight or snug

cuffs on clothing.• Control your blood sugar if you are a diabetic.• Be careful using sharp objects.• Wear gloves when gardening, cooking. Wear

shoes that cover your foot completely• Inspect your feet and hands regularly for skin

damage.

Definition of chemotherapy induced cognitive impairment

• Dysfunction, weakening or impairment of memory in patients who have been treated with chemotherapy for cancer.

Signs • Mental fatigue and mental cloudiness• Difficulty with memory/ information process, • Multitasking, organization and focusing attention

on tasks at hand.• Can negative effect on personal, academic and

professional lives.• Cognitive changes may severe enough to

interfere with a patients daily functioning, including employment abilities

• Feelings of anxiety and fear are common

Symptoms of chemo-induced cognitive impairment

• Deficits in attention• Difficulty in comprehensions or understanding• Inability to follow directions• Easily distracted • Lower processing of information• Difficulty with numbers and finance• Difficulty with details , names and dates• Gait and dexterity disturbances• Inability to recognize familiar objects• Inability to perform multiple tasks• Complaints of increasing memory difficulties• Behavioral changes and socially in appropriate behavior

• American Cancer Society 2008

Contributing Factors

• Pain, emotional/ physical exhausting, distracting and lead to poor concentration.

• Stress threat to survival , lack of concentration/ poor memory

• Cytokine-induced inflammatory reactions• Dehydration and electrolyte imbalance• Medications• Other factors

What can I do ?

• Talk to breast care nurse at follow up visits as you would for other side –effects

Helpful ideas• Acupuncture, dilates cerebral blood vessels,

improving blood flow and oxygenation • Antioxidant foods such as fruits/vegetables high

vitamin C and E• Increasing fluid intake prevents dehydration and

helps flush toxins from the body• Informing family and friends can generate

support/ understanding

Helpful ideas• Mental exercises such as crossword and

Sudoku puzzles, creates a positive feedback loop

• Physical exercise increases blood flow to the brain, improves oxygenation and reduces cytokine levels

• Relaxation activities decrease stress, listening to music, communing with nature and pursuing other hobbies can be soothing.