NEW YORKEat your fruits and vegetables is generally good
advice, but patients undergoing cancer therapy also need to heed the following
warning: Wash them thoroughly, to prevent infection, said Stewart Fleishman,
MD, director of cancer supportive services, Beth Israel Cancer Center,
Continuum Health Partners, New York.
Dr. Fleishman offered commonsense advice to help cancer
patients cope with treatment side effects during a Cancer Care, Inc.
teleconference. "These are things that can be done before side effects
occur and as after-the-fact, practical things," he emphasized.
To help prevent infection while patients are immunosuppressed,
he said, "we tell them to avoid people sneezing in their face, not to get
into crowded elevators, and, if using public transportation, not to go in
during crowded times. But probably the best thing people can do to stay
infection free is to wash their hands!"
And wash those vegetables. When surfaces cannot be cleaned
adequately, vegetables may be sources of bacteria, he said, "introduced
into the system at a time when it really is hard for the body to fight off the
infection." Vegetables should be blanched in boiling water. Some patients
even microwave their apples and put them back in the refrigerator, he said.
He advised patients that their physicians may prescribe G-CSF
(Neupogen) to prevent infection by restoring white blood cell counts, as well
as antibiotics. "All of us are quite concerned about unnecessary use of
antibiotics when a healthy person has a viral illness, but in the cancer world,
we try to rush in with antibiotics sooner rather than later to avoid
Many people do not want to talk about their side effects, Dr.
Fleishman said. "They think the stiff upper lip is the best approach. But
the treatment team needs to know you’re having difficulties. It’s the first
step in getting care for the problem," he said.
One of the most common treatment-related problems is fatigue.
Erythropoietin (Epogen, Procrit) to prevent or treat anemia "could be
started a little earlier than is frequently the case to avoid extreme
fatigue," he said.
Iron supplements should only be taken under the supervision of
a physician. "Sometimes we give iron depending on the blood counts, but
many patients will take iron when they don’t need it and can take too
much," he said.
Mild exercise can help with fatigue, but patients often confuse
the type of exercise they need with the aerobic exercise programs often
recommended for people who have had a heart attack. The optimal amount of
exercise for people undergoing cancer therapy might really be something as
simple as just stretching the muscles, Dr. Fleishman said. "With cancer
therapy, too much exercise can work against you, causing fatigue."
The amount and type of exercise is also determined by the
physical shape a patient was in before treatment. "If people are not in
great shape before, maybe the trick is to start some gentle exercising under
the guidance of a good exercise therapist or physiologist, just to stretch out
some of those aches and pains," Dr. Fleishman said.
Pain can sometimes come from deconditioning. It can also be a
variant of neuropathy, he said. "Sometimes this is the body’s cry for
help that there is a strange substance going through. It reacts with pain or
aching," he said.
Depending on the kind of cancer, nonsteroidal anti-inflammatory
drugs (NSAIDs) may be of help but should be used after, not during,
chemotherapy or radiation therapy, Dr. Fleishman said. "Over-the-counter
or prescription anti-inflammatory drugs can interfere with blood clotting at a
time when platelet counts are down," he said.
Aches and pains can even be part of an allergic reaction to a
drug such as a taxane and may include hives or even welts, he added.
Treatment-related loss of hair is generally temporary, Dr.
Fleishman said, but he warned that radiation therapy to the head or scalp can,
in some cases, cause permanent hair loss.
"Many people have tried to avoid hair loss by using ice to
the scalp during chemotherapy," he said, "but there have been cases
where the cancer has spread to the scalp because the chemotherapy hasn’t been
active there, since the ice kept the blood supply low. So we haven’t been
able to advocate that in good conscience."
Recovery Is Slow
Dr. Fleishman said that how long the effects of chemotherapy
last depends on how much drug an individual has received and over what period
of time. "You can generally tell that the worst is over by when your hair
starts to grow back fully," he said. "The first regrowth is often
baby fine; this hair generally falls out, and adult hair comes in
But he told patients that hair regrowth patterns can vary.
"With some people, their hair starts to grow back during chemotherapy, and
then they start to worry that they are not absorbing the drugs," he said.
"That’s not so. Blood tests are much more sensitive for determining how
much chemotherapy you’ve absorbed."
Recovery from the effects of chemotherapy is generally slow.
"It’s a process of building your energy back. People think, ‘If it
takes 4 months for the chemo to be out of my system, in 4½ months I’ll be
jogging 3 miles a day.’ The truth," Dr. Fleishman said, "is you
have to start off from scratch, slowly starting to do all the things you did
before treatment. Starting gently before the chemo is fully out of your system
allows for an easier recovery afterwards."