Hodgkin's Disease : Side Effects of Treatment

by National Cancer Institute

(Page 3 of 3)

Treatments for Hodgkin's disease are very powerful. It is hard to limit the effects of therapy so that only cancer cells are destroyed. Because treatment also damages healthy cells and tissues, it often causes side effects.

The side effects of cancer treatment depend mainly on the type and extent of the therapy. Side effects may not be the same for everyone, and they may even change from one treatment to the next. Doctors and nurses can explain the possible side effects of treatment. They can also lessen or control many of the side effects that may occur during and after treatment.

Radiation Therapy

The side effects of radiation depend on the treatment dose and the part of the body that is treated. During radiation therapy, people are likely to become extremely tired, especially in the later weeks of treatment. Rest is important, but doctors usually advise patients to try to stay as active as they can.

It is common to lose hair in the treated area and for the skin to become red, dry, tender, and itchy. There may also be permanent darkening or "bronzing" of the skin in the treated area.

When the chest and neck are treated, patients may have a dry, sore throat and some trouble swallowing. Sometimes, they have shortness of breath or a dry cough. Radiation therapy to the abdomen may cause nausea, vomiting, diarrhea, or urinary discomfort. Often, changes in diet or medicine can ease these problems.

Radiation therapy also may cause a decrease in the number of white blood cells, cells that help protect the body against infection, or platelets, cells that help the blood to clot. If that happens, patients need to be careful to avoid possible sources of infection or injury. The doctor monitors a patient's blood count very carefully during radiation treatment. If necessary, treatment may have to be postponed to let the blood counts return to normal.

Although the side effects of radiation therapy can be difficult, they can usually be treated or controlled. It may also help to know that, in most cases, side effects are not permanent. However, patients may want to discuss with their doctor the possible long-term effects of radiation treatment on fertility (the ability to produce children) and the increased chance of second cancers after treatment is over. (The "Followup Care 8" section includes more information about the chance for second cancers.) Loss of fertility may be temporary or permanent, depending on if the testes or ovaries received radiation and the patient's age. For men, sperm banking before treatment may be a choice. Women's menstrual periods may stop, and they may have hot flashes and vaginal dryness. Menstrual periods are more likely to return for younger women.

Chemotherapy

The side effects of chemotherapy depend mainly on the specific drugs and the doses the patient receives. As with other types of treatment, side effects may vary from person to person.

Anticancer drugs generally affect cells that divide rapidly. In addition to cancer cells, these include blood cells, which fight infection, help the blood to clot, and carry oxygen to all parts of the body. When blood cells are affected, the patient is more likely to get infections, may bruise or bleed easily, and may feel unusually weak and tired.

Cells in hair roots also divide rapidly; therefore, chemotherapy may lead to hair loss. Hair loss is a major concern for many patients. Some anticancer drugs only cause the hair to thin out, while others may result in the loss of all body hair. People may cope with hair loss better if they decide how to handle hair loss before starting treatment.

Cells that line the digestive tract also divide rapidly, and are often damaged by chemotherapy. As a result, side effects may include poor appetite, nausea and vomiting, and/or mouth and lip sores.

Most side effects go away gradually during the recovery periods between treatments or after treatment is over. Sometimes, however, chemotherapy results in a permanent loss of fertility.

Nutrition During Cancer Treatment

Eating well during cancer treatment means getting enough calories and protein to help prevent weight loss and regain strength. Good nutrition often helps people feel better and have more energy.

Some people with cancer find it hard to eat a balanced diet because they may lose their appetite. In addition, common side effects of treatment, such as nausea, vomiting, or mouth sores, can make eating difficult. Often, foods taste different. Also, people being treated for cancer may not feel like eating when they are uncomfortable or tired. Doctors, nurses, and dietitians can offer advice on how to get enough calories and protein during cancer treatment.

Recovery and Outlook

It is natural for anyone facing cancer to be concerned about what the future holds. Understanding the nature of cancer and what to expect can help patients and their loved ones plan treatment, anticipate lifestyle changes, and make quality of life and financial decisions.

Cancer patients frequently ask their doctors or search on their own for statistics to answer the question, "What is my prognosis?" Prognosis is a prediction of the future course and outcome of a disease and an indication of the likelihood of recovery from that disease. However, it is only an estimate. When doctors discuss a patient's prognosis, they are attempting to project what is likely to occur for that individual patient. The prognosis for Hodgkin's disease can be affected by many factors, particularly the stage of the cancer, the patient's response to treatment, and the patient's age and general health.

Sometimes people use statistics to try to figure out their chances of being cured. However, statistics reflect the experience of a large group of patients. They cannot be used to predict what will happen to a particular patient because no two patients are alike; treatment and responses vary greatly. The doctor who is most familiar with a patient's situation is in the best position to help interpret statistics and discuss the patient's prognosis.

When doctors talk about surviving cancer, they may use the term remission rather than cure. Although many people with Hodgkin's disease are successfully treated, doctors use the term remission because cancer can return. It is important to discuss the possibility of recurrence with the doctor.

Followup Care

People who have had Hodgkin's disease should have regular followup examinations after their treatment is over and for the rest of their lives. Followup care is an important part of the overall treatment process, and people who have had cancer should not hesitate to discuss it with their health care provider. Patients treated for Hodgkin's disease have an increased chance of developing leukemia; non-Hodgkin's lymphoma; and cancers of the colon, lung, bone, thyroid, and breast. Regular followup care ensures that patients are carefully monitored, any changes in health are discussed, and new or recurrent cancer can be detected and treated as soon as possible. Between followup appointments, people who have had Hodgkin's disease should report any health problems as soon as they appear.

Support for People with Cancer

Living with a serious disease is not easy. People with cancer and those who care about them face many problems and challenges. Coping with these problems is often easier when people have helpful information and support services.

Friends and relatives can be very supportive. Also, it helps many patients to discuss their concerns with others who have cancer. Cancer patients often get together in support groups, where they can share what they have learned about coping with cancer and the effects of treatment. It is important to keep in mind, however, that each person is different. Treatments and ways of dealing with cancer that work for one person may not be right for another — even if they both have the same kind of cancer. It is always a good idea to discuss the advice of friends and family members with the health care provider.

People living with cancer may worry about what the future holds. They may worry about holding their jobs, caring for their families, personal relationships, or continuing with daily activities. Concerns about tests, treatments, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team can answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, psychologist, or member of the clergy can be helpful to people who want to talk about their feelings or discuss their concerns. Often, a social worker can suggest groups that can help with rehabilitation, emotional support, financial aid, transportation, or home care.

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