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Life During Treatment

The person with cancer will likely experience treatment-related side effects during treatment. Many cancer patients experience decreased quality of life because of the side effects.

The following side effects can develop or worsen during the course of treatment, which can then negatively impact quality of life:

  • Fatigue
  • Changes in speech (e.g., hoarseness, loss of voice)
  • Pain
  • Changes in hearing (over 85 percent of patients with head and neck cancer who had chemoradiation therapy experienced hearing loss)
  • Decreased salivation, which often increases dental caries and other dental problems
  • Problems swallowing (e.g., delayed swallowing or other complications)
  • Decreased ability to eat

Of all the side effects, cancer-related fatigue often has the most profound impact on quality of life.

Here are some strategies that can be implemented to manage cancer-related fatigue.

Changes in the level of fatigue

Of the common side effects of head and neck cancer treatments, the one with the greatest negative effect on patients’ quality of life is often fatigue. In one study, 60 percent of patients ranked fatigue as having the strongest impact. In other words, fatigue bothered them more than changes in speech, problems swallowing or even pain.

Your loved one is likely to experience fatigue during treatment. Approximately 70 to 80 percent of people who underwent radiation therapy, chemotherapy or a combination of these therapies (chemoradiation therapy) experienced fatigue. Moreover, cancer-related fatigue can be so severe that 32 percent of patients cannot perform their daily routines.

There are strategies that can be implemented to decrease cancer-related fatigue. Be aware that fatigue can have many different underlying causes, so your loved one may need to consult with a health care professional to evaluate, identify and treat the underlying causes.

  • Assess and report the level of fatigue daily. Encourage your loved one to use a diary or worksheet (or record this information for your loved one) to monitor fatigue daily. The fatigue description should include the severity of fatigue (none, minor, moderate, advanced) and the times of the day when your loved one experiences more or less fatigue.
  • Schedule routines or activities during the time of day when your loved one is likely to experience the least fatigue, based on the findings from the diary or worksheet.
  • Ask your loved one if you and/or other caregivers can perform some daily tasks.
  • Encourage your loved one to initiate and maintain a daily exercise program (i.e walking, jogging, swimming, or lifting light weights.) Researchers evaluated exercise among patients with head and neck cancer and found that 80 percent did not participate in moderate to vigorous exercise. Even low-impact exercise such as walking daily reduced fatigue, improved quality of life and enabled patients to perform activities of daily living. As the caregiver, you may want to consider doing an exercise program with your loved one with cancer. Levels of anxiety decrease among both people with cancer and caregivers who participated in exercise programs.
  • Encourage your loved one to participate in less rigorous physically based therapies such as yoga or massage therapy.
  • Encourage your loved one to work regularly with a counselor or psychologist.
  • Use medications. Your loved one’s cancer care team will first evaluate underlying causes of fatigue. Some people develop anemia as a side effect to chemotherapy treatment, which in turn leads to cancer-related fatigue. Clinicians use erythropoietin to treat anemia. If anemia is not contributing to your loved one’s fatigue, the health care professional may consider using stimulants.

Follow-up

Although many treatment-related side effects develop during or shortly after treatment, some side effects may worsen or occur months to years after therapy.

For example, researchers observed that among people who had chemoradiation therapy, swallowing dysfunction often worsened between three months to one year after therapy.

Therefore, follow-up surveillance and management of side effects will continue after treatment. In the next section, Life After Treatment, we will review side effects that emerge or worsen during the first 2 years after treatment.

Trying to create a normal or a new-normal environment is important. You want to be comfortable with what you’re doing to take care of him, and you want him to be comfortable in his new condition. You don’t want him to feel like he is any different. Lynn H. (wife of a tongue cancer survivor)

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