Do What You Can to Ease Side Effects of Treatment for Melanoma
Your cancer may cause symptoms, and you will likely have side effects from your treatment. The side effects you have depend on your treatment, which depends on whether the cancer has spread and how far. In this section, you'll learn more about how to respond to some of the most common side effects of melanoma treatment.
Anxiety and Depression
Many people feel blue, anxious, or depressed after being told they have cancer. These feelings may continue or come back throughout treatment. In addition, you may experience mood changes as a side effect of treatment. These may be mild or serious. Seek immediate help if you experience any of the following signs or symptoms:
Loss of interest in things you once enjoyed
Severe changes in mood
Thoughts of suicide
Taking these actions may ease your mental stress:
Talk openly with your doctor about your concerns.
Talk to your priest, minister, or rabbi.
Talk to your family or friends.
Consider joining a cancer support group or finding a cancer "buddy" who can help you cope.
Ask your doctor about medications for depression and anxiety.
Consider getting a referral to a psychologist or psychiatrist.
Patients who eat well during cancer treatment maintain their strength better, are more active, and are better able to lower their chances of infection. Remember that your body needs energy to heal itself. Maintaining your weight is a good way to know if you're giving your body the energy it needs. When you're being treated for cancer, a diet high in calories and protein is best.
The problem is that treatment, especially chemotherapy, can damage intestinal cells or affect areas of the brain controlling appetite. Radiation can change the way food tastes to you, make it hard for you to swallow, or reduce your appetite.
Know that some people, however, can gain weight as a side effect from steroids or anti-nausea medications. If this is the case for you, focus on getting a balanced diet and increasing your activity level. Now is not the time to go on a diet.
Ask your doctor to refer you to a registered dietitian if you are having trouble maintaining your appetite. Also, try these tips to stimulate your desire to eat:
If you can, eat foods high in protein several times a day. These foods include: milk, cheese, cottage cheese, yogurt, meat, fish, eggs, beans, peanut butter, and nuts. Protein helps build and repair tissue, and cancer treatments cause you to use more protein than usual.
If you are underweight, eat high-calorie foods to help you maintain your weight. These include margarine or butter, sugar, honey, jams, jellies, cream cheese, dried fruit, gravies or sauces, mayonnaise, and salad dressing.
Get plenty of fluids to help control your body temperature and improve food removal. Drink water, fruit juices, and other liquids. Also try gelatin, pudding, soups, fruit bars, and ice cream to increase your fluid intake.
Eat small meals throughout the day instead of three large ones.
Keep snacks handy to eat when you are hungry.
Eat with friends or play your favorite music at mealtime to boost your appetite.
Eat your biggest meal in the morning. Many people getting treatment for cancer find this is when they have their biggest appetite.
If you can, increase your activity level. Doing so may stimulate your appetite.
On days you don't feel like eating at all, don't worry about it. Try again the next day. If you find your appetite doesn't improve in several days, talk with your doctor or nurse.
Throughout your treatment, your doctor will take small samples of your blood for testing. One thing he or she is checking for is the number of platelets in your blood. Certain kinds of chemotherapy may reduce your blood platelet count. Without enough platelets (a condition called thrombocytopenia), your blood may have difficulty clotting.
If your doctor tells you that your platelet count is low, take these actions to avoid causing injuries that could lead to uncontrolled bleeding.
Call your doctor if you develop a rash, bleeding, or bruising.
Protect your skin from cuts, scrapes, and sharp objects.
Shave with an electric razor, because it causes less irritation to your skin.
Take steps to prevent constipation, which can lead to hemorrhoids and bleeding.
Use a soft toothbrush to prevent bleeding gums.
Bloating and Swelling
Some chemotherapy and biological therapy drugs cause your body to retain water. This water retention will go away when your treatment ends. In other cases, bloating may be due to other causes.
Here's what you can do for relief:
Try to avoid adding salt to your food or eating salty foods.
If your bloating from water retention is severe, your doctor may prescribe a diuretic or water pill.
If your bloating is due to lactose intolerance, it may help to buy lactose-free milk or to go easy on dairy products that contain lactose.
Breathing Problems (Shortness of Breath, Called Dyspnea) and Coughing
Feeling short of breath may make you feel anxious, which can make breathing problems worse. This side effect may be caused by radiation damage to your lungs and may not show up for several years.
Many things may cause dyspnea and coughing. In cancer patients, causes may include the following:
A tumor that spreads to the chest cavity, lung, airway, or vein that carries blood through the chest to the heart.
Blood clots or tumor cells that break loose and block a blood vessel in the lungs.
Pneumonia, an infection of the lung.
Lung scarring from radiation therapy or chemotherapy.
Weakening of the heart by chemotherapy.
Other problems the patient may have, for example, congestive heart failure, COPD, other lung or heart diseases, weakened breathing muscles, or nutrition problems.
A history of smoking.
Talk with your doctor or nurse about what can help. Also try these tips:
Ask family or friends for help with activities that make you short of breath.
Ask your doctor or nurse to show you how to use relaxation exercises.
Avoid bending over because it compresses your lungs and makes it harder to get the air you need. Wear slip-on shoes.
Avoid climbing stairs since that can tax your breathing.
Avoid things that make your breathing worse, such as high humidity, cold air, pollen, and tobacco smoke.
Sit upright because it will give your lungs room to expand.
Sleep with the head of your bed raised or sleep in a recliner.
Use pursed-lip and abdominal breathing. Ask your doctor for instructions on how to do this.
Ask about medicines that may help, such as steroids, inhalers, or diuretics for dyspnea, and cough-suppressing medicine, medicines that break down mucus or an inhaler drug for chronic coughing.
Constipation is difficult or infrequent bowel movements. It can range from mildly uncomfortable to painful. Taking pain medications can lead to constipation, so it's wise to take these preventive actions. These same steps will give you relief if you are already constipated.
Drink plenty of fluids, especially water and fruit juices, such as prune juice.
Eat foods high in fiber, such as cereals, whole grains, fruits, and vegetables.
Take stool softeners or a laxative as prescribed.
A persistent cough may increase pain, prevent adequate rest, and promote fatigue. Talk with your doctor about these options for relief:
Ask about over-the-counter or prescription cough suppressants.
Find out whether an inhaler could help you.
Learn deep breathing and effective coughing techniques.
Try tips for quitting smoking.
Diarrhea is loose or frequent bowel movements. It may lead to dehydration. Radiation and many chemotherapy drugs can cause bowel changes. Take these steps if you have diarrhea:
Ask your doctor about medications that may help.
Avoid gas-producing vegetables, dried fruit, fiber cereals, seeds, popcorn, nuts, corn, and dried beans.
Avoid milk and milk products.
Eat low-residue, low-fiber foods, such as the BRAT diet (bananas, rice, applesauce, and toast).
Increase your intake of fluids, such as water and broth.
Hair Loss (Alopecia)
Losing your hair can be upsetting because baldness is a visible reminder that you are being treated for cancer. Chemotherapy and radiation can cause hair loss. Keep in mind that your hair will probably grow back after treatment.
Use these tips to cope:
Consider cutting your hair before treatment starts.
Think about getting a wig, hat, or scarf before your hair loss starts. That way, you can get a wig that matches your hair and you'll be ready with head coverings, if you choose to use them.
Because your scalp may be more sensitive to temperature and sun, protect it with sunscreen and hats or scarves.
Throughout treatment, your doctor will take samples of your blood for testing. One thing he or she is checking is your white blood cell count. Without enough white blood cells, your body may not be able to fight infection. Many types of chemotherapy can cause low white blood cell counts, which is called neutropenia. You may experience symptoms of infection, such as fever, chills, or inflammation at the site of an injury.
If your doctor tells you that your white blood cell count is low, take these actions to stay healthy:
Ask your doctor whether you need antibiotics to help prevent infections.
Avoid crowds and people with colds. Wear a surgical mask if you can't.
Avoid fresh flowers and plants, which might carry mold.
Avoid fresh, unwashed, uncooked fruits and vegetables and other foods that might carry germs.
Call your doctor right away if you have any signs of infection. Signs may include a temperature of 100.5 degrees or higher, severe chills, a cough or hoarseness, lower back or side pain, painful or difficult urination, or any sores or redness.
Wash your hands often throughout the day to kill germs. Have those around you do the same. Bathe daily to keep the number of bacteria down. Don't touch your eyes or nose unless you've just washed your hands.
Insomnia (Trouble Sleeping)
Insomnia can be caused by anxiety, depression, or your cancer treatment. Use these tips to improve your rest:
Avoid long naps during the day.
Avoid stimulants such as caffeine and tobacco, especially close to bedtime.
Don't eat, drink fluids, or exercise close to your bedtime.
If you don't fall asleep in 15 minutes, get up, do something else, and try again later.
Keep a regular bedtime schedule.
Use your bed only for sleeping, not watching TV.
Libido Changes (Decreased Sexual Desire)
Feelings of depression from having cancer or fatigue from many types of treatment can affect your sexual desires. Taking these actions may help you cope with these changes:
Discuss sexual problems with your doctor or with other members of your health care team. They may be able to refer you to a counselor who specializes in sexual problems or to a sexual treatment program.
Talk to your partner about changes in your desire or ability to have sex. Explore new ways to share affection and intimacy.
Some types of chemotherapy can damage the ovaries. They can cause menopausal symptoms in women who've not yet reached menopause. Symptoms can include hot flashes, vaginal dryness, mood swings, and weight changes. Periods may become irregular or may stop, and you may not be able to get pregnant. However, some women may still be able to get pregnant during treatment.
Talk to your doctor about birth control before treatment begins.
Discuss with your doctor ways to manage menopausal symptoms. You may use lubricants for vaginal dryness or do mild exercise. You might also talk with a psychotherapist about mood swings or signs of depression.
Continue with regular pelvic exams.
Report any unusual bleeding to your doctor.
Sores on your mouth and lips (called mucositis) may hurt and make eating unpleasant. Radiation and several types of chemotherapy can cause mouth sores. In addition, you may experience a strange taste in your mouth from immunotherapy or chemotherapy. Taking these actions can either help prevent or ease some of these problems.
To prevent sores, take these actions:
Brush your teeth after meals and before bedtime. Floss every day if your doctor says it's okay to do so.
Rinse your mouth with lukewarm water plus salt or baking soda several times a day.
Keep your mouth and lips clean and moist.
Suck on sugar-free candies or fruit bars or chew sugar-free gum to increase moisture in your mouth and to help with taste changes.
To ease the pain if you get sores in your mouth, take these actions:
Ask your doctor about topical mouth medications.
Avoid alcohol and mouthwashes containing alcohol because they may irritate the sores.
Avoid hot, rough, or spicy foods because they may irritate the sores.
Avoid tobacco because it may irritate or make you more susceptible to sores.
Call your doctor or nurse if your temperature reaches 100.5 degrees or higher.
Eat soft and pureed foods that are easy to swallow if you have a dry mouth.
Sip water often.
Take over-the-counter pain medication, such as Tylenol (acetaminophen), if necessary.
Nausea or Vomiting
Nausea or vomiting may result from almost all types of treatment for melanoma. It may be barely noticeable to severe. Understanding the different types of nausea may help.
Acute-onset nausea and vomiting occurs within a few minutes to several hours after chemotherapy. With chemotherapy, the worst episodes tend to be 5 to 6 hours after treatment, and the symptoms end within the first 24 hours. Immunotherapy with interleukin-2 (IL-2) tends to cause nausea during the whole treatment. Nausea gets worse at the end of the cycle.
Anticipatory nausea and vomiting are learned from previous experiences with vomiting. As you prepare for the next dose of chemotherapy, you may anticipate that nausea and vomiting will occur as it did before, which triggers the actual reflex.
Breakthrough vomiting means vomiting occurs despite treatment to prevent it. It requires other types of treatment.
Delayed-onset vomiting develops more than 24 hours after treatment.
Refractory vomiting occurs when you're no longer responding to antinausea treatments.
To prevent nausea, take these actions:
Ask your doctor about getting a prescription medicine to control nausea and vomiting. Then make sure you take it as directed. If you are vomiting and cannot take medicine, call your doctor or nurse.
If you have nausea and vomiting even though you are taking your medicines, call your doctor or nurse. They can change your medicine, or add other medicines.
To help ease nausea or vomiting if you have it, try these tips:
Ask your doctor or nurse about using acupressure bands on your wrists, which may help to decrease your nausea.
Ask your doctor or nurse to help you learn a relaxation exercise. This may make you feel less anxious and more in control, and decrease your nausea.
Do not eat fatty or fried foods, very spicy foods, or very sweet foods.
Eat foods that are at room temperature or cold. The smells from hot foods may make your nausea worse.
Take drugs with food, as directed.
Try eating foods and drinking beverages that were easy to take or made you feel better when you had the flu or were nauseated. These might be bland foods, sour candy, pickles, dry crackers, ginger ale, flat soda, or others.
Nerve Damage (peripheral neuropathy)
If you have numbness, tingling, or weakness in your hands and feet, you may have nerve damage called peripheral neuropathy. Some types of chemotherapy are known to cause this. Other signs of this problem are ringing in your ears or feeling too hot or cold.
If you have symptoms such as these, take precautions to protect yourself:
If your daily activities become too difficult, ask your doctor to refer you to an occupational therapist or a physical therapist. They can help teach you new ways of doing things so you can stay as active as possible.
Take extra care walking and moving so that you don't fall, since less sensitivity in your feet can alter your balance.
Take extra care when driving (you may have trouble feeling the gas and brake pedals). Ask friends and family to drive you places.
Use warm, not hot, water for bathing to prevent burns. Consider using a shower chair or railing to reduce your chance of slipping.
Bone pain can be the result of biological therapy, such as interferon. Try these tips to ease muscle, joint, or bone pain:
Talk to your doctor about taking aspirin or ibuprofen to help relieve headaches and muscle cramps.
Take other pain medications regularly as directed by your doctor. Don't wait for your pain to become severe. Also, take steps to avoid constipation, a common side effect of pain medications.
Change your activity level. See if you feel better if you rest more or move around more--either may help.
Distract yourself with music, funny videos, or computer games.
Use heat, cold, relaxation techniques such as yoga or meditation, or guided imagery exercises. Ask your doctor or nurse where you can learn more about these.
Although your surgeon will try to minimize the tissue removed, you may be left with a scar after surgery to remove your melanoma. Here are some ways to make your scars look better:
Ask for a plastic surgeon to be involved in your care. He or she can suggest reconstructive options to shrink or remove the scar.
Visit a make-up specialist for tips on how to conceal your scars.
Radiation treatment can cause dry or red skin in the area being treated. Also, you may have dryness, itching, or a rash in the area of biological therapy injections. Here's what you can do for relief:
Ask your doctor or nurse what kind of lotion you can use to moisturize and soothe your skin, and about any soap, deodorant, sun block, perfume, cosmetics, or powder before you put it on your skin during radiation treatment.
Don't apply heat or cold to the treated area. Bathe only with lukewarm water.
Don't bandage skin with tape. If you must bandage it, use paper tape. Ask your nurse to help you place the dressings so you can avoid irritation.
Don't scratch, rub, or scrub treated skin.
If you must shave the treated area, use only an electric shaver. Don't use lotion before shaving. And don't use hair-removal products. All can irritate your skin.
Protect your skin from sun exposure, especially between 10 a.m. and 4 p.m. by wearing sunscreen of at least 15 SPF (sun protection factor).
Ask your doctor or nurse about using topical ointments and steroid creams for itchy skin rashes.
Wear loose, soft clothing over the treated area.
Swelling in Your Hand or Arm (Lymphedema)
If your lymph nodes are removed from your armpit (or groin area), you may have swelling in your hand or arm (or leg or foot), called lymphedema, on the side where you had surgery. This is more likely if you also have radiation therapy to your armpit or groin. Lymphedema may occur right after surgery or it may happen later. It is caused when excess lymph collects in tissue.
To reduce your risk or to improve symptoms of lymphedema, here's what you can do:
Clean the skin of your arm daily and use moisturizing lotion.
Don't have your blood pressure taken on the affected arm.
Do not sit in one position for more than 30 minutes.
Do not use elastic bandages with tight bands.
Do your prescribed exercises regularly.
Keep regular follow-up appointments with your doctor.
Keep your arm or leg raised above the level of your heart when possible. Avoid making rapid circles with your arm to keep blood from collecting in the lower part of your arm.
Watch for signs of infection, such as redness, pain, heat, swelling, and fever. Call the doctor immediately if any of these signs or symptoms appears.
Wear loose jewelry and clothes without tight bands.
See a lymphedema specialist for treatment.
Ask your doctor or nurse about wearing a compression garment.
To avoid injury and infection in your arm, take these precautions:
Avoid extreme hot or cold, such as ice packs or heating pads.
Avoid needles in the affected arm.
Clean cuts with soap and water and then use antibacterial ointment.
Do not overwork the affected arm.
Take care of your fingernails. Don't cut your cuticles.
Talk to your doctor about any rashes.
Use an electric razor for shaving.
Use gauze wrapping instead of tape, but do not wrap so tightly that you cut off circulation.
Wear gardening and cooking gloves.
Use thimbles for sewing.
Thinking and Remembering Trouble
You may have mild problems with concentration and memory. These problems may occur during and after chemotherapy or biological therapy. Fatigue can worsen the problem. Taking these actions may help:
Make lists and write down important information.
Use other tools to help organize your life. These tools may include calendars, pill dispensers, or alarm clocks.
Tiredness and Fatigue
Tiredness is a very common symptom and side effect. It can be a result of anemia caused by low red blood cell levels. Red blood cells carry oxygen throughout the body. If your body does not have this oxygen, you may feel tired. Decreased red blood cell counts can be caused by blood loss, chemotherapy, or radiation, or the cancer itself. Other changes can also cause fatigue. Tiredness can last several weeks after treatment ends. You may feel only slightly tired, or you may suffer from extreme fatigue.
Taking these actions may help increase your energy levels:
Add mild exercise, such as walking, to your daily routine. It may help you sleep better.
Balance activity with rest. Save your energy for important tasks.
Drink plenty of fluids to prevent dehydration, which can lead to tiredness.
If your fatigue is severe or chronic, ask for help with routine tasks that can drain your energy, such as grocery shopping or housework. Some people reduce their hours at work.
Take action to treat a poor appetite because eating improperly can make you tired. As long as diarrhea isn't a problem for you, it may help to eat plenty of fruits, vegetables, and complex carbohydrates, such as whole-wheat bread.
Take short rests when you feel tired. Avoid long naps during the day so you can sleep well at night.
Talk with your doctor about medications or treatments that may help manage your anemia.