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Life During Treatment

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The person with cancer will likely experience treatment-related side effects during treatment. Many cancer patients experience decreased quality of life because of the side effects.

The following side effects can develop or worsen during the course of treatment, which can then negatively impact quality of life1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 1, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.:

  • Fatigue2Curt GA. Like pain, this is a symptom that physicians can and should manage. BMJ. 2001;322:1560.
  • Changes in speech (e.g., hoarseness, loss of voice)1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 1, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.
  • Pain1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 1, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.
  • Changes in hearing (over 85 percent of patients with head and neck cancer who had chemoradiation therapy experienced hearing loss)3Pearson SE, Meyer AC, Adams GL, Ondrey FG. Decreased hearing after combined modality therapy for head and neck cancer. Am J Otolaryngol. 2006 Mar-Apr;27(2):76-80.
  • Decreased salivation, which often increases dental caries and other dental problems1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 1, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.
  • Problems swallowing (e.g., delayed swallowing or other complications)1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 1, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.
  • Decreased ability to eat1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 1, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

Of all the side effects, cancer-related fatigue often has the most profound impact on quality of life.

Here are some strategies that can be implemented to manage cancer-related fatigue.

Changes in the level of fatigue

Of the common side effects of head and neck cancer treatments, the one with the greatest negative effect on patients’ quality of life is often fatigue. In one study, 60 percent of patients ranked fatigue as having the strongest impact.2Curt GA. Like pain, this is a symptom that physicians can and should manage. BMJ. 2001;322:1560. In other words, fatigue bothered them more than changes in speech, problems swallowing or even pain.

Your loved one is likely to experience fatigue during treatment. Approximately 70 to 80 percent of people who underwent radiation therapy, chemotherapy or a combination of these therapies (chemoradiation therapy) experienced fatigue.5, Smets EM, Garssen B, Schuster-Uitterhoeve AL, de Haes JC. Fatigue in cancer patients. Br J Cancer. 1993 Aug;68(2):220-4.6, Vogelzang NJ, Breitbart W, Cella D, et al. Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. The Fatigue Coalition. Semin Hematol. 1997 Jul;34(3 Suppl 2):4-12.7, Henry DH, Viswanathan HN, Elkin EP, Traina S, Wade S, Cella D. Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the U.S. Support Care Cancer. 2008 Jul;16(7):791-801.8Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR. Cancer-related fatigue: the scale of the problem. Oncologist. 2007;12 Suppl 1:4-10. Moreover, cancer-related fatigue can be so severe that 32 percent of patients cannot perform their daily routines.5Smets EM, Garssen B, Schuster-Uitterhoeve AL, de Haes JC. Fatigue in cancer patients. Br J Cancer. 1993 Aug;68(2):220-4.

There are strategies that can be implemented to decrease cancer-related fatigue. Be aware that fatigue can have many different underlying causes, so your loved one may need to consult with a health care professional to evaluate, identify and treat the underlying causes.4Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cancer-Related Fatigue V.1.2017. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 1, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

The following strategies have been recommended by the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) to decrease cancer-related fatigue4Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cancer-Related Fatigue V.1.2017. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 1, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.:

  • Assess and report the level of fatigue daily.4Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cancer-Related Fatigue V.1.2017. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 1, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org. Encourage your loved one to use a diary or worksheet (or record this information for your loved one) to monitor fatigue daily. The fatigue description should include the severity of fatigue (none, minor, moderate, advanced) and the times of the day when your loved one experiences more or less fatigue.
  • Schedule routines or activities during the time of day when your loved one is likely to experience the least fatigue, based on the findings from the diary or worksheet.4Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cancer-Related Fatigue V.1.2017. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 1, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.
  • Ask your loved one if you and/or other caregivers can perform some daily tasks.4Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cancer-Related Fatigue V.1.2017. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 1, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.
  • Encourage your loved one to initiate and maintain a daily exercise program (i.e walking, jogging, swimming, or lifting light weights.) 4Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cancer-Related Fatigue V.1.2017. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 1, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org. Researchers evaluated exercise among patients with head and neck cancer and found that 80 percent did not participate in moderate to vigorous exercise.9Rogers LQ, Courneya KS, Robbins KT, et al. Physical activity and quality of life in head and neck cancer survivors. Support Care Cancer. 2006 Oct;14(10):1012-9. Even low-impact exercise such as walking daily reduced fatigue, improved quality of life and enabled patients to perform activities of daily living.10, Dimeo F, Rumberger BG, Keul J. Aerobic exercise as therapy for cancer fatigue. Med Sci Sports Exerc. 1998 Apr;30(4):475-8.11, Dimeo F, Schwartz S, Wesel N, Voigt A, Theil E.Effects of an endurance and resistance exercise program on persistent cancer-related fatigue after treatment. Ann Oncol. 2008;19(8):1495-1499.As the caregiver, you may want to consider doing an exercise program with your loved one with cancer. Levels of anxiety decrease among both people with cancer and caregivers who participated in exercise programs.12Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012 Jul-Aug;62(4):243-74.
  • Encourage your loved one to participate in less rigorous physically based therapies such as yoga or massage therapy.4Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cancer-Related Fatigue V.1.2017. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 1, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.
  • Encourage your loved one to work regularly with a counselor or psychologist.4Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cancer-Related Fatigue V.1.2017. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 1, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.
  • Use medications. Your loved one’s cancer care team will first evaluate underlying causes of fatigue. Some people develop anemia as a side effect to chemotherapy treatment, which in turn leads to cancer-related fatigue. Clinicians use erythropoietin to treat anemia.13Minton O, Richardson A, Sharpe M, Hotopf M, Stone P. A systematic review and meta-analysis of the pharmacological treatment of cancer-related fatigue. J Natl Cancer Inst. 2008 Aug 20;100(16):1155-66. If anemia is not contributing to your loved one’s fatigue, the health care professional may consider using stimulants.14Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cancer and Chemotherapy-Induced Anemia V.2.2017. © National Comprehensive Cancer Network, Inc 2016. All right reserved. Accessed December 1, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

Follow-up

Although many treatment-related side effects develop during or shortly after treatment, some side effects may worsen or occur months to years after therapy.

For example, researchers observed that among people who had chemoradiation therapy, swallowing dysfunction often worsened between three months to one year after therapy.13Minton O, Richardson A, Sharpe M, Hotopf M, Stone P. A systematic review and meta-analysis of the pharmacological treatment of cancer-related fatigue. J Natl Cancer Inst. 2008 Aug 20;100(16):1155-66.

Therefore, follow-up surveillance and management of side effects will continue after treatment. In the next section, Life After Treatment, we will review side effects that emerge or worsen during the first 2 years after treatment.

Trying to create a normal or a new-normal environment is important. You want to be comfortable with what you’re doing to take care of him, and you want him to be comfortable in his new condition. You don’t want him to feel like he is any different. Lynn H. (wife of a tongue cancer survivor)

References

1 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 1, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

2 Curt GA. Like pain, this is a symptom that physicians can and should manage. BMJ. 2001;322:1560.

3 Pearson SE, Meyer AC, Adams GL, Ondrey FG. Decreased hearing after combined modality therapy for head and neck cancer. Am J Otolaryngol. 2006 Mar-Apr;27(2):76-80.

4 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cancer-Related Fatigue V.1.2017. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed December 1, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

5 Smets EM, Garssen B, Schuster-Uitterhoeve AL, de Haes JC. Fatigue in cancer patients. Br J Cancer. 1993 Aug;68(2):220-4.

6 Vogelzang NJ, Breitbart W, Cella D, et al. Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. The Fatigue Coalition. Semin Hematol. 1997 Jul;34(3 Suppl 2):4-12.

7 Henry DH, Viswanathan HN, Elkin EP, Traina S, Wade S, Cella D. Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the U.S. Support Care Cancer. 2008 Jul;16(7):791-801.

8 Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR. Cancer-related fatigue: the scale of the problem. Oncologist. 2007;12 Suppl 1:4-10.

9 Rogers LQ, Courneya KS, Robbins KT, et al. Physical activity and quality of life in head and neck cancer survivors. Support Care Cancer. 2006 Oct;14(10):1012-9.

10 Dimeo F, Rumberger BG, Keul J. Aerobic exercise as therapy for cancer fatigue. Med Sci Sports Exerc. 1998 Apr;30(4):475-8.

11 Dimeo F, Schwartz S, Wesel N, Voigt A, Theil E.Effects of an endurance and resistance exercise program on persistent cancer-related fatigue after treatment. Ann Oncol. 2008;19(8):1495-1499.

12 Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012 Jul-Aug;62(4):243-74.

13 Minton O, Richardson A, Sharpe M, Hotopf M, Stone P. A systematic review and meta-analysis of the pharmacological treatment of cancer-related fatigue. J Natl Cancer Inst. 2008 Aug 20;100(16):1155-66.

14 Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cancer and Chemotherapy-Induced Anemia V.2.2017. © National Comprehensive Cancer Network, Inc 2016. All right reserved. Accessed December 1, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.