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Cancer treatment can result in many side effects. As cancer treatment is personalised to each patient, the side effects that emerge may vary from individual to individual. There is hence an emphasis on post-treatment management to ensure the best possible care for the patient following treatment. Dr See Hui Ti, Senior Consultant, Medical Oncology shares more.

Cancer treatments such as chemotherapy and radiation treatment are common methods aimed at killing fast-growing cancer cells.

As these drugs travel throughout the body and/or affect normal tissues surrounding the radiated tumor, they can, as a result, affect normal, healthy cells. It is this damage to healthy cells that causes side effects when undergoing treatment.

While side effects are usually highly reversible, and not always as bad as one might expect, it is perfectly normal to be worried about it.

Why early detection matters

Any risk of side effects is dependent on the amount and type of chemotherapy and radiation prescribed to the patient. Generally, the higher the stage of the cancer, the more chemotherapy treatment is required and hence the larger the dose of radiation.

We thus often stress the importance of early detection for screenable cancers so that we can potentially reduce the need to prescribe complex chemotherapy and radiation.

There have been vast improvements in the ability to prescribe chemotherapy with less side effects; as well as using advanced radiation techniques such as IMRT (Intensive Modulated Radiation Therapy) that reduces the risk to normal tissue surrounding the cancer. Nevertheless, cancer treatment for early stages is still associated with the least short- and long-term side effects.

Long-term vs short-term side effects of cancer treatment

Most side effects of cancer treatment are temporary and reversible—hence why they are called short-term side effects. These include: hair-loss, nausea and vomiting, constipation or diarrhea, weight gain or weight loss, mouth ulcers and rash. They also include risk of low blood count, which is a critical side effect which can be managed with supportive growth factors if appropriate.

Long-term accumulative side effects of treatments, compared to short-term side effects, can occur in patients with terminal cancer, who may require chemotherapy treatment for life. Some rare examples include cardiac toxicities due to maximal dose used for one particular group of chemotherapy called anthracyclines. Doxorubicin which is used for sarcoma or bone cancers are needed in a very high dose at least for 6 cycles. This can potentially lead to the risk of heart failure even after the cancer has been cured, due to the patient living a long time, who then go on to develop atherosclerosis and heart diseases due to pre-existing conditions, where then heart failure can happen due to accumulative causes.

However, this also means that the patient has lived long enough with their cancer in order to accumulate these side effects.

Short term side effects last for a week or so after chemotherapy and radiation, and for the duration of the treatment. Long term side effects accumulate and may surface years later.

Doctors will do their very best to prevent short- and long-term side effects by using supportive therapy adjunct to chemotherapy. It is hence important that a patient discuss their past medical history and cooperate with their doctors when it comes to managing side effects.

How to manage side effects of cancer treatment

The patient is the partner of the doctor, so it is critical that patients work together with their doctors to address any concerns pertaining to their treatment.

Generally, what patients can do on their own is to maintain a healthy lifestyle, eat enough nutrition, exercise and destress. They should not engage in self harming activities such as excessive alcohol intake, smoking and eating an unhealthy diet. Instead they should focus on getting the best nutrition, stopping smoking and drinking, and exercise in moderation.

It is also important to stress that when it comes to maintaining health, supplementation may not be useful; it is far more powerful to derive all our nutrients from a healthy and balanced diet. However, unless a patient is on immunotherapy, patients should supplement their diet with a probiotic.

At the end of the day, it is important to remember that chemotherapy and radiation are life-saving treatments, and there is greater benefit in receiving treatment than declining treatment out of fear and concerns of long-term side effects.