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CHEMO BRAIN, THE “ITCHIES” & MORE

Helping your loved one deal with the after-effects of cancer treatment

BY:MARGARET FARLEY STEELE

The more than 11 million cancer survivors in the United States today are living proof that cancer treatments are better than ever. But, along with strides in survivorship, medical researchers now know that when treatment ends, after-effects will likely emerge.

The most common complaints—memory loss, fatigue, skin sensitivity, neuropathy and nausea—are bothersome at the least and potentially serious. Effects may show up soon after treatment or months—even years—later, and should be discussed immediately with the healthcare team.

Memory & Cognitive Function
For decades, cancer survivors have reported memory lapses and changes in cognition after heavy chemotherapy or cranial radiation. Many have difficulty with concentration, word retrieval, multitasking or learning new skills. Some misplace things and lose their sense of direction, forgetting where they parked the car. This is called "chemo brain," says Carolyn Messner, DSW, LCSW-R, director of education and training at Cancer Care, Inc., in New York. "They're not going crazy."

Steps you can take to assist your loved one include:
  • Attend doctor appointments and important meetings. Don't have your loved one go alone. Record discussions with doctors on tape (with permission) or by taking notes, and write down questions between appointments.
  • Use technology. An electronic calendar or PDA can be a great memory aid.
  • Help make to-do lists. Arrange the tasks in order of priority.
  • Make extra sets of keys. If keys are often misplaced, leave a duplicate set with someone trustworthy. Likewise, keep copies of important documents.
  • Tie a ribbon to the car's antenna. This will help your loved one identify her vehicle.
  • Point out landmarks when leaving home. This is especially helpful if the sense of direction is impaired.
  • Encourage note-taking. Write down important phone numbers and keep copies by the phone and in the wallet.
  • Suggest new activities. Simply listening to new music, reading a new book or watching a different TV show can stimulate the brain, Dr. Messner says.
  • Ask about expected symptom duration. Knowing how long symptoms are likely to last can help you anticipate difficulties.
  • Help find a support group. Talking with others facing a similar situation can relieve anxiety.
  • Try various approaches. "It's natural to become frustrated," adds Dr. Messner, "but it could be trial and error until you find a solution."

Skin Changes
Dry, itchy skin, acne and rashes frequently occur after cancer treatment. Radiation often causes skin to darken, induces dermatitis and makes skin hypersensitive to the sun.

"Chemotherapy effects usually clear up; radiation effects can last indefinitely," says Eric Bernstein, MD, associate professor of dermatology at the University of Pennsylvania. After treatment, he notes, skin will be more susceptible to irritants, allergens and infection; anything beyond a minor skin irritation should be evaluated by a physician, preferably a dermatologist. Some chemotherapy causes acne that is difficult to treat. Also, because wounds to radiated skin heal slower, he adds that "it's critical to have a chronic or unchanging wound looked at." Radiated skin, he cautions, is also more susceptible to skin cancer.

Recommended behaviors include:

  • Stay out of direct sunlight. Protect skin with a wide-brimmed hat, protective clothing and sun block.
  • Avoid scratching irritated skin.
  • Don't bandage the irritated area without a doctor's say-so.
  • Avoid aftershave lotions.
  • Use an electric razor.
  • Wear loose-fitting clothes near inflamed skin.
  • Other tips: Use only mild skin products on the affected area. Products recommended by Dr. Bernstein are made by Lindi Skin, Hylunia and Hymed. Always cleanse gently and pat dry. When skin can tolerate it, mild bleaching agents or alpha-hydroxy acid peels might help, he says, but only with a physician's approval.

Peripheral Neuropathy
This form of nerve damage often occurs after chemotherapy or radiation of the spine. Tingling in the hands and feet, and numbness or loss of balance are common symptoms that can vary from mild to severe. Your loved one might have trouble picking things up, buttoning clothes or tying shoes. In some cases, Dr. Messner points out, neuropathy even affects hearing. A doctor can assess the damage, estimate its duration, and prescribe medication to relieve symptoms. Unfortunately, it's nerve damage and could continue forever.

Because sensation can be diminished in affected extremities, take the following precautions:

  • Check regularly. Look for cuts and abrasions that might not have been felt.
  • Don't go barefoot. Not even at home, and make sure shoes are properly fitted.
  • Protect hands and feet from temperature extremes. Wear gloves and warm socks in cold weather; test your loved one's bath water and dishwater to make sure they're not dangerously hot; replace worn pot holders with thick oven mitts.
  • Assist with meal preparation. Peeling potatoes and other vegetables can be difficult and dangerous, and food and knives could be easily dropped.
  • Keep rooms well lit. This helps prevent falls and accidents.
  • Use non-skid mats. This is imperative in the tub and shower as well as under area rugs.
  • Consult a doctor. Talk to a physician specializing in rehabilitative medicine if driving ability is compromised.

Digestive Issues
Nausea and appetite loss are common, as are changes in what foods one likes and dislikes. Other common occurrences include diarrhea, vomiting and changes in one's sense of taste. Having access to nutritionists who are knowledgeable about cancer treatment is helpful, but their services often are not covered by insurance.

While these symptoms persist, the Cleveland Clinic recommends:

  • For changes in taste: Try chilled foods. Also, cleaning the mouth before meals can improve taste, as can strong flavorings and seasonings. Liquid nutritional drinks help provide adequate intake of vitamins and minerals.
  • For nausea: Listen to relaxation tapes; eat frequent small meals rather than three big ones; eat and drink slowly. Avoid spicy, fatty and fried food. Also, drink before or after—rather than during—meals. Rest after eating. Consume the most food at the time of day nausea is least bothersome. If symptoms persist, a doctor might prescribe anti-nausea medication or recommend acupuncture or self-hypnosis. Persistent vomiting could result in dehydration and should be reported to the doctor right away.
  • For diarrhea: Drink at least six 8-ounce glasses of fluids daily—water, broth, pulpless fruit juice or flat soda all work. Avoid caffeine. Also avoid fruits and vegetables with skin and seeds (such as berries and grapes) and gas-producers (such as broccoli, corn and cabbage).