Chemotherapy Side Effects: Pain, Hair Loss, Anemia

by National Cancer Institute

(Page 4 of 10)

Pain

Chemotherapy drugs can cause some side effects that are painful. The drugs can damage nerves, leading to burning, numbness, tingling or shooting pain, most often in the fingers or toes. Some drugs can also cause mouth sores, headaches, muscle pains, and stomach pains.

Not everyone with cancer or who receives chemotherapy experiences pain from the disease or its treatment. But if you do, it can be relieved. The first step to take is to talk with your doctor, nurse, and pharmacist about your pain. They need to know as many details about your pain as possible. You may want to describe your pain to your family and friends. They can help you talk to your caregivers about your pain, especially if you are too tired or in too much pain to talk to them yourself.

You need to tell your doctor, nurse, and pharmacist and family or friends:

• Where you feel pain.
• What it feels like - sharp, dull, throbbing, steady.
• How strong the pain feels.
• How long it lasts.
• What eases the pain, what makes the pain worse.
• What medicines you are taking for the pain and how much relief you get from them.

Using a pain scale is helpful in describing how much pain you are feeling. Try to assign a number from 0 to 10 to your pain level. If you have no pain, use a 0. As the numbers get higher, they stand for pain that is getting worse. A 10 means the pain is as bad as it can be. You may wish to use your own pain scale using numbers from 0 to 5 or even 0 to 100. Be sure to let others know what pain scale you are using and use the same scale each time, for example, "My pain is 7 on a scale of 0 to 10."

The goal of pain control is to prevent pain that can be prevented, and treat the pain that can't. To do this:

• If you have persistent or chronic pain, take your pain medicine on a regular schedule (by the clock).

• Do not skip doses of your scheduled pain medicine. If you wait to take pain medicine until you feel pain, it is harder to control.

• Try using relaxation exercises at the same time you take medicine for the pain. This may help to lessen tension, reduce anxiety, and manage pain.

• Some people with chronic or persistent pain that is usually controlled by medicine can have breakthrough pain. This occurs when moderate to severe pain "breaks through" or is felt for a short time. If you experience this pain, use a short-acting medicine ordered by your doctor. Don't wait for the pain to get worse. If you do, it may be harder to control.

There are many different medicines and methods available to control cancer pain. You should expect your doctor to seek all the information and resources necessary to make you as comfortable as possible. If you are in pain and your doctor has no further suggestions, ask to see a pain specialist or have your doctor consult with a pain specialist. A pain specialist may be an oncologist, anesthesiologist, neurologist, neurosurgeon, other doctor, nurse, or pharmacist.

Hair Loss

Hair loss (alopecia) is a common side effect of chemotherapy, but not all drugs cause hair loss. Your doctor can tell you if hair loss might occur with the drug or drugs you are taking. When hair loss does occur, the hair may become thinner or fall out entirely. Hair loss can occur on all parts of the body, including the head, face, arms and legs, underarms, and pubic area. The hair usually grows back after the treatments are over. Some people even start to get their hair back while they are still having treatments. Sometimes, hair may grow back a different color or texture.

Hair loss does not always happen right away. It may begin several weeks after the first treatment or after a few treatments. Many people say their head becomes sensitive before losing hair. Hair may fall out gradually or in clumps. Any hair that is still growing may become dull and dry.

How can I care for my scalp and hair during chemotherapy?

• Use a mild shampoo.
• Use a soft hair brush.
• Use low heat when drying your hair.
• Have your hair cut short. A shorter style will make your hair look thicker and fuller. It also will make hair loss easier to manage if it occurs.
• Use a sun screen, sun block, hat, or scarf to protect your scalp from the sun if you lose hair on your head.
• Avoid brush rollers to set your hair.
• Avoid dying, perming, or relaxing your hair.

Some people who lose all or most of their hair choose to wear turbans, scarves, caps, wigs, or hair pieces. Others leave their head uncovered. Still others switch back and forth, depending on whether they are in public or at home with friends and family members. There are no "right" or "wrong" choices; do whatever feels comfortable for you.

If you choose to cover your head:

• Get your wig or hairpiece before you lose a lot of hair. That way, you can match your current hair style and color. You may be able to buy a wig or hairpiece at a specialty shop just for cancer patients. Someone may even come to your home to help you. You also can buy a wig or hair piece through a catalog or by phone.

• You may also consider borrowing a wig or hairpiece, rather than buying one. Check with the nurse or social work department at your hospital about resources for free wigs in your community.

• Take your wig to your hairdresser or the shop where it was purchased for styling and cutting to frame your face.

• Some health insurance policies cover the cost of a hairpiece needed because of cancer treatment. It is also a tax-deductible expense. Be sure to check your policy and ask your doctor for a "prescription."

Losing hair from your head, face, or body can be hard to accept. Feeling angry or depressed is common and perfectly all right. At the same time, keep in mind that it is a temporary side effect. Talking about your feelings can help. If possible, share your thoughts with someone who has had a similar experience.

Anemia

Chemotherapy can reduce the bone marrow's ability to make red blood cells, which carry oxygen to all parts of your body. When there are too few red blood cells, body tissues do not get enough oxygen to do their work. This condition is called anemia. Anemia can make you feel short of breath, very weak, and tired. Call your doctor if you have any of these symptoms:

• Fatigue (feeling very weak and tired).
• Dizziness or feeling faint.
• Shortness of breath.
• Feeling as if your heart is "pounding" or beating very fast.

Your doctor will check your blood cell count often during your treatment. She or he may also prescribe a medicine that can boost the growth of your red blood cells. Discuss this with your doctor if you become anemic often. If your red count falls too low, you may need a blood transfusion or a medicine called erythropoietin to raise the number of red blood cells in your body.

Things you can do if you are anemic (See the section "Fatigue")

• Get plenty of rest. Sleep more at night and take naps during the day if you can.
• Limit your activities. Do only the things that are essential or most important to you.
• Ask for help when you need it. Ask family and friends to pitch in with things like child care, shopping, housework, or driving.
• Eat a well-balanced diet. (See the section "Eating Well During Chemotherapy.")
• When sitting, get up slowly. When lying down, sit first and then stand. This will help prevent dizziness.

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