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Life During Treatment

12964132During your treatment, you will likely experience treatment-related side effects.
The following side effects can worsen during the course of treatment and can negatively impact your quality of life1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.:

  • Fatigue2 Curt GA. Like pain, this is a symptom that physicians can and should manage. BMJ. 2001;322:1560.
  • Changes in your 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.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.
  • Pain1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.
  • Changes in hearing; over 85 percent of patients with head and neck cancer who had chemoradiation therapy experienced hearing loss3 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.
  • 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.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.
  • 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.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.
  • Decreased ability to eat1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.
http://vimeo.com/66246237

Let’s look more closely at a few of the side effects that have the most profound impact on quality of life and strategies that can be implemented to manage them. In addition, we will briefly review policies to obtain time off from work for medical treatment if you need time off to receive treatment and/or manage side effects.

Changes in your level of fatigue

When patients were asked which cancer-related symptoms had the most impact on their quality of life, 60 percent of patients ranked fatigue as having the strongest impact.2 Curt GA. Like pain, this is a symptom that physicians can and should manage. BMJ. 2001;322:1560.

You may experience fatigue as you are undergoing treatment; this is one of the most prevalent symptoms among patients who have cancer. Approximately 70 to 80 percent of patients who underwent radiation therapy, chemotherapy or a combination of these therapies (chemoradiation therapy), experienced fatigue.4, Smets EM, Garssen B, Schuster-Uitterhoeve AL, de Haes JC. Fatigue in cancer patients. Br J Cancer. 1993 Aug;68(2):220-4.5, 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):4-12.6, 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):791-801.7 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. Moreover, cancer-related fatigue can be so severe that 32 percent of patients could not do their daily routines.5 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. It may be harder for you to plan and commit to other activities.

There are strategies that you can do to try to decrease your cancer-related fatigue. Be aware that fatigue can have many different underlying causes, so you may need to consult with a health care professional to evaluate, identify and treat the underlying causes.8Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cancer-Related Fatigue V.1.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed Jan 22, 2014. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

The following strategies have been recommended by the NCCN Clinical Practice Guidelines In Oncology (NCCN Guidelines®) for Cancer-Related Fatigue to decrease this cancer-related symptom8Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cancer-Related Fatigue V.1.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed Jan 22, 2014. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.:

  • Assess and report the level of fatigue daily.8Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cancer-Related Fatigue V.1.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed Jan 22, 2014. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc. You may want to consider using a diary or worksheet to monitor fatigue. Report the severity of fatigue (none, minor, moderate, advanced) that you are experiencing and other related observations that you may have, such as the times of the day when you may have more or less fatigue.
  • Plan and schedule routines or activities during the time of day when you are likely to have the least fatigue.8Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cancer-Related Fatigue V.1.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed Jan 22, 2014. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.
  • You may consider entrusting a caregiver to perform some daily tasks for you.
  • Initiate and maintain a daily exercise program. In a study evaluating exercise among patients with head and neck cancer, over 80 percent of patients reported that they did not participate in moderate or vigorous exercise.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.Even low impact exercise, such as walking daily, has been found to reduce fatigue, improve quality of life and enable 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):1495-1499.12, Curt GA. Like pain, this is a symptom that physicians can and should manage. BMJ. 2001;322:1560.13 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.
  • Evaluate your psychosocial needs with a counselor or psychologist and consider initiating treatments, such as regular counseling or therapy.8Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cancer-Related Fatigue V.1.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed Jan 22, 2014. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.
  • Consider using medications. Your health care professional will evaluate underlying causes of fatigue. Some patients who experience cancer-related fatigue, however, develop anemia as a side effect to chemotherapy treatment. Your health care professional will then decide if a medication would be helpful. Erythropoietin, for example, is used to treat anemia and also reduces cancer-related fatigue.14 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. If anemia is not contributing to your fatigue, your health care professional may consider using other stimulants to improve your level of energy.8Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cancer-Related Fatigue V.1.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed Jan 22, 2014. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.
I think once it started, I felt better because I felt like not only was he seeing doctors every day, but we were doing something. There was a light at the end of the tunnel. Bonnie S. (wife of a tonsil cancer survivor)

References

1 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

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

5 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.

6 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.

7 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.

8 Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Cancer-Related Fatigue V.1.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed Jan 22, 2014. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

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

13 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.

14 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.

15 Doyle C,Kushi LH,Byers T, et al.2006 Nutrition, Physical Activity and Cancer Survivorship Advisory Committee; American Cancer Society.Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin.2006;56:323-353.

16 Ogama N, Suzuki S. Adverse effects and appetite suppression associated with particle beam therapy in patients with head and neck cancer. Jpn J Nurs Sci. 2012 Jun;9(1):28-37.

17 Hoffman B. Cancer survivors at work: a generation of progress. CA Cancer J Clin. 2005 Sep-Oct;55(5):271-80.

18 Blank PD. The economics of the employment provisions of The Americans with Disabilities Act: Part I – workplace accommodations. DePaul Law Rev. 1997;46(4):877-914.