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Melanoma: Managing Treatment Side Effects


Melanoma: Managing Treatment Side Effects

Treatment for melanoma can cause side effects. The side effects vary from person to person. The side effects you may have depend on the kinds of treatment you have, your overall health, and other factors.

Side effects of melanoma treatment can include:

  • Anxiety or depression

  • Appetite loss

  • Bleeding problems

  • Bloating and swelling

  • Constipation

  • Coughing

  • Diarrhea

  • Hair loss (alopecia)

  • Infection

  • Low sex drive (low libido)

  • Menopausal symptoms

  • Mouth and lip sores

  • Nausea and vomiting

  • Nerve damage (peripheral neuropathy)

  • Pain

  • Scarring

  • Shortness of breath (dyspnea) and coughing

  • Skin irritation

  • Sleep problems (insomnia)

  • Swelling in your hand or arm (lymphedema)

  • Trouble thinking and remembering

  • Tiredness (fatigue)

Read below to see ways to manage each of these side effects during your treatment.

Anxiety or depression

Some people may feel worried, sad, or stressed when dealing with skin cancer. These feelings may continue during treatment. You may also worry about how you will look after the treatment. You may have mood changes as a side effect of treatment. These may be mild or serious. Seek help right away if have:

  • Frequent crying

  • Extreme sadness

  • Loss of interest in things you once enjoyed

  • Severe changes in mood

  • Thoughts of suicide

Make sure to:

  • Talk with your family or friends. Express your concerns.

  • Ask your health care team, health care team, or social worker for help. They can connect you with a support group. It can help to talk about concerns with people who have gone through the same experience.

  • Speak to a counselor. A professional therapist can help you cope with stress and other feelings.

  • Talk with your spiritual advisor. A priest, minister, or rabbi can help you during this time.

  • Ask your health care team about medicines. If depression or anxiety makes it hard to cope with daily life, your health care team may recommend medicines to help.

Appetite loss

Some cancer treatments cause a loss of appetite. Chemotherapy can damage cells in the gastrointestinal tract. Or it can affect areas of the brain that control appetite. Radiation can change the way food tastes to you. It can make it hard for you to swallow, or reduce your appetite. Immunotherapy and chemotherapy can also leave a strange taste in your mouth.

Patients who eat well during cancer treatment maintain their strength better, are more active, and are better able to lower their risk of infection. Your body needs energy from food to heal itself. When you're being treated for cancer, a diet high in calories and protein is best. Maintaining your weight is a good way to know if you're giving your body the energy it needs.

Some people may gain weight as a side effect from steroids or anti-nausea medicines. If this is the case for you, focus on getting a balanced diet and increasing your activity level. Now is not the time to go on a diet.

Ask your health care team to refer you to a registered dietitian if you are having trouble with your appetite. Also, try these tips to stimulate your desire to eat:

  • If you can, eat foods high in protein several times a day. These include milk, cheese, yogurt, meat, fish, eggs, beans, peanut butter, and nuts. Protein helps build and repair tissue. Cancer treatments cause you to use more protein than usual.

  • If you are underweight, add high-calorie foods to help you gain or maintain your weight. These include margarine or butter, sugar, honey, jams, jellies, cream cheese, dried fruit, gravies or sauces, mayonnaise, and salad dressing.

  • Drink plenty of water, fruit juices, and other liquids. Also try gelatin, pudding, soups, fruit bars, and ice cream to increase your fluid intake.

  • Eat small meals during the day instead of large ones.

  • Keep snacks handy to eat when you are hungry.

  • Eat with friends or play your favorite music at mealtime to boost your appetite.

  • Eat your biggest meal in the morning. Many people getting treatment for cancer find this is when they have the most appetite.

  • If you can, increase your activity level. This may boost your appetite.

  • On days you don't feel like eating, don't worry. Try again the next day. If you find your appetite doesn't improve in several days, talk with your health care provider.

  • Suck on sugar-free candies or chew sugar-free gum if you have a strange taste in your mouth from treatment.

Bleeding problems

Some kinds of chemotherapy or other treatments may reduce your blood platelet count. Platelets help your blood clot normally. Thrombocytopenia is when you don't have enough platelets. This can make it hard for your blood to clot, and puts you at risk of excess bleeding.

During your treatment, your health care team will take small samples of your blood for testing. If your platelet count is low, you can take steps to avoid injuries that could lead to uncontrolled bleeding. Make sure to:

  • Call your health care team if you develop a rash, bleeding, or bruising.

  • Protect your skin from cuts, scrapes, and sharp objects.

  • Shave with an electric razor. This causes less irritation and risk of cuts to the skin.

  • Take steps to prevent constipation, which can lead to hemorrhoids and bleeding.

  • Use a soft toothbrush to prevent bleeding gums.

Bloating and swelling

Some chemotherapy and biological therapy medicines cause your body to retain water. This excess water will go away when your treatment ends. In other cases, bloating may be due to lactose intolerance, or other causes. Here's what you can do for relief:

  • Don't eat salty foods, or add salt to your food.

  • Take a diuretic or water pills (diuretics) for severe water retention, if advised by your health care team.

  • Try lactose-free milk dairy foods. Or, eat fewer dairy foods that have lactose.

Constipation

Constipation is when bowel movements are difficult or don't happen often enough. It can range from mildly uncomfortable to painful. Some pain medicines can lead to constipation. To help prevent and relieve constipation:

  • Drink plenty of fluids water and fruit juices, such as prune juice.

  • Eat foods high in fiber, such as cereals, whole grains, fruits, and vegetables.

  • Exercise regularly.

  • Take stool softeners or a laxative, if advised by your health care team.

Coughing

A constant cough may increase pain, prevent rest, and make you tired. Talk with your health care team about options for relief such as:

  • Over-the-counter or prescription cough medicine

  • An inhaler

  • Deep breathing and effective coughing techniques

  • Tips for quitting smoking

Diarrhea

Diarrhea is when bowel movements are loose or happen too often. It may lead to dehydration. Radiation and many chemotherapy and other medicines can cause bowel changes. Take these steps if you have diarrhea:

  • Ask your health care team about medicines that may help.

  • Avoid gas-producing vegetables, dried fruit, fiber cereals, seeds, popcorn, nuts, corn, and dried beans.

  • Avoid milk and dairy foods if they make things worse.

  • Eat low-residue, low-fiber foods, such as the BRAT diet (bananas, rice, applesauce, toast).

  • Drink more fluids, such as water and broth. This is to help prevent dehydration.

Hair loss (alopecia)

Radiation, chemotherapy, and some other treatments can cause hair loss. Losing your hair can be upsetting because baldness is a visible reminder that you are being treated for cancer. But keep in mind that your hair will likely grow back after treatment.

Use these tips to cope:

  • Consider cutting your hair before treatment starts.

  • Think about getting a wig, hat, or scarf before your hair loss starts. That way, you can get a wig that matches your hair and you'll be ready with head coverings, if you choose to use them.

  • Protect your scalp from sun and temperature changes with sunscreen, hats, and scarves.

Infection

Many types of chemotherapy and other treatments can cause low white blood cell counts. This is called neutropenia. Without enough white blood cells, your body may not be able to fight infection. You may have symptoms of infection, such as fever, chills, or inflammation at the site of an injury.

During your treatment, your health care team will take samples of your blood for testing. If your health care team tells you that your white blood cell count is low, take these actions to stay healthy:

  • Ask your health care team if you need to take antibiotics to help prevent infections.

  • Avoid crowds and people with colds. Wear a surgical mask if you can't.

  • Avoid fresh flowers and plants, which can carry mold.

  • Don't eat fresh, unwashed, uncooked fruits and vegetables and other foods that might carry germs.

  • Wash your hands often during the day to kill germs. Have people around you do the same. Bathe daily. This is to help to keep the amount of bacteria on your skin lower. Don't touch your eyes or nose unless you've just washed your hands.

  • Call your health care team right away if you have any signs of infection. Signs may include a temperature of 100.5 degrees or higher, chills, a cough or hoarseness, lower back or side pain, painful or difficult urination, or any sores or redness.

Low sex drive (low libido)

Depression and fatigue from many types of treatment can affect your sex drive. There are steps you can take to help you cope with these changes. Make sure to:

  • Talk with your health care team. They may be able to refer you to a counselor who specializes in sexual issues, or to a sexual treatment program.

  • Talk with your partner. Be open about the changes in your desire or ability to have sex. Explore new ways to share affection and intimacy.

Menopausal symptoms

Some types of chemotherapy can damage the ovaries. They can cause menopausal symptoms in women who have not yet reached menopause. Symptoms can include hot flashes, vaginal dryness, mood swings, and weight changes. Periods may be irregular or may stop, and you may not be able to get pregnant. However, some women may still be able to get pregnant during treatment.

  • Talk with your health care team ways to manage menopausal symptoms. You may use lubricants for vaginal dryness or do special exercises. You may want to talk with a counselor about mood swings or signs of depression.

  • Talk to your health care team about birth control before treatment begins.

  • Get regular pelvic exams.

  • Report any unusual vaginal bleeding to your health care team.

Mouth and lip sores

Radiation and some types of chemotherapy can cause mouth and lip sores. These sores are called mucositis. They may hurt and make eating difficult.

To help prevent sores:

  • Brush your teeth after meals and before bedtime. Floss every day if your health care team says it's okay to do so.

  • Rinse your mouth with lukewarm water with salt or baking soda several times a day.

  • Keep your mouth clean and moist. Use lip balm to keep your lips moist.

  • Suck on sugar-free candies or chew sugar-free gum to help increase moisture in your mouth.

To ease the pain if you get sores in your mouth:

  • Ask your health care team about topical mouth medicines.

  • Don't use mouthwash that contains alcohol. It may irritate the sores.

  • Don't eat hot, rough, or spicy foods. These may irritate the sores.

  • Don't use tobacco. It may irritate sores, or make you more to get sores.

  • Eat soft and pureed foods that are easy to swallow if you have a dry mouth.

  • Sip water often.

  • Take over-the-counter pain medicine, such as acetaminophen, if needed.

  • Call your health care team if you have a fever of 100.5 degrees or higher.

Nausea and vomiting

Nausea and vomiting may result from almost all types of treatment for melanoma. It may be very mild to severe. Understanding the different types of nausea may help.

  • Acute-onset nausea and vomiting. This occurs within a few minutes to several hours after chemotherapy. The worst episodes tend to be 5 to 6 hours after treatment. The symptoms end within the first 24 hours. Immunotherapy with interleukin-2 (IL-2) tends to cause nausea during the whole treatment. Nausea gets worse at the end of the cycle.

  • Delayed-onset vomiting. This develops more than 24 hours after treatment.

  • Anticipatory nausea and vomiting. These are learned from previous experiences with vomiting. As you prepare for the next dose of chemotherapy, you may anticipate that nausea and vomiting will occur as it did before. This can trigger the actual symptoms.

  • Breakthrough vomiting. This is vomiting that occurs despite treatment to prevent it. It requires other types of treatment.

  • Refractory vomiting. This occurs when you're no longer responding to antinausea treatments.

To help prevent nausea:

  • Ask your health care team about taking a prescription medicine to control nausea and vomiting. Make sure you take it as directed. If you are vomiting and cannot take medicine, call your health care team.

  • If you have nausea and vomiting while taking anti-nausea medicine, call your health care team. They can change your medicine, or add other medicines.

To help ease nausea or vomiting:

  • Ask your health care team about using acupressure bands on your wrists. These may help to decrease your nausea.

  • Ask your health care team to help you learn a relaxation exercise. This may make you feel less anxious and more in control, and can decrease your nausea.

  • Do not eat fatty or fried foods, very spicy foods, or very sweet foods.

  • Eat foods that are at room temperature or cold. The smells from hot foods may make your nausea worse.

  • Take medicines with food, as directed.

  • Try eating foods and drinking beverages that were easy to take or made you feel better when you had the flu or had nausea in the past. These might be bland foods, sour candy, pickles, dry crackers, ginger ale, flat soda, or others.

Nerve damage (peripheral neuropathy)

If you have numbness, tingling, or weakness in your hands and feet, you may have nerve damage called peripheral neuropathy. Some types of chemotherapy and other treatments are known to cause this. Other signs of this problem are ringing in your ears or feeling too hot or cold. Nerve damage can make you more at risk for injury

If you have these symptoms, you'll need to take care to protect yourself from injury:

  • Take extra care when walking and moving so that you don't fall. Less sensitivity in your feet can alter your balance.

  • Take extra care when driving. You may have trouble feeling the gas and brake pedals. Ask friends and family to drive you.

  • Use warm, not hot, water for bathing. This is to prevent burns. Use a shower chair or railing to reduce your chance of slipping in the tub.

  • If your daily activities are too difficult, ask your health care team to refer you to an occupational therapist or a physical therapist. They can help teach you new ways of doing things so you can stay as active as possible.

Pain

If you have skin surgery, temporary pain in the area of the surgery is a common side effect. You may feel pain in the first few days to a week after surgery. You can treat pain with pain medicine as your health care provider advises. Only use approved pain medicine.

Biological therapy, such as interferon, can cause bone pain. Other treatments may also cause pain in other parts of the body. Try these tips to ease pain:

  • Talk to your health care team about taking aspirin or ibuprofen to help relieve headaches and muscle cramps.

  • Take other pain medicines as directed by your health care team.

  • Take the medicine regularly. Don't wait for your pain to become severe.

  • If you take pain medicine, take steps to avoid constipation. This is a common side effect of some pain medicines.

  • Try changing your activity level. You may feel better if you rest more, or move around more.

  • Distract yourself with music, funny videos, or computer games.

  • Use heat, cold, relaxation methods such as yoga, meditation, or guided imagery. Ask your health care team where you can learn more about these.

Scarring

Any skin surgery leaves scars. The same is true for surgery to remove skin cancer. The size and color of the scar depend on the size of the cancer, its location, the type of surgery, and how well your skin heals. Your health care team will use methods to hide the scar as much as possible. Make sure to:

  • Ask about wound care. Your health care team can recommend ways to aid healing. Most often, though, your body's natural healing abilities are the best and simply take time.

  • Be patient. Healing continues over time after that. Early on, the scar may be red or bumpy. It takes about a full year for a scar to fade.

  • Follow up with your health care team. If you are worried about the scar's appearance in a few months or a year, talk with your health care team. He or she may advise options to make the scar less noticeable.

Shortness of breath (dyspnea) and coughing

Feeling short of breath may make you feel anxious, which can make breathing problems worse. This side effect may not show up for several years after treatment. Many things may cause dyspnea and coughing. In cancer patients, causes may include:

  • A tumor that spreads to the chest cavity, lung, airway, or vein that carries blood through the chest to the heart

  • Blood clots or tumor cells that break loose and block a blood vessel in the lungs

  • Pneumonia, an infection of the lung

  • Lung scarring from radiation therapy or chemotherapy

  • Weakening of the heart by chemotherapy

  • Other problems the patient may have, for example, congestive heart failure, COPD, other lung or heart diseases, weakened breathing muscles, or nutrition problems

  • A history of smoking.

If you feel short of breath:

  • Don't bend over. This compresses your lungs and makes it harder to get the air you need. Wear slip-on shoes to avoid bending down to tie laces.

  • Don't climb stairs.

  • Avoid things that make your breathing worse, such as high humidity, cold air, pollen, and tobacco smoke.

  • Sit upright. This will give your lungs room to expand.

  • Sleep with the head of your bed raised. Or, sleep in a reclining chair.

  • Ask family or friends for help with activities that make you short of breath.

  • Ask your health care team to show you how to use relaxation exercises.

  • Use pursed-lip and abdominal breathing. Ask your health care team for instructions on how to do this.

  • Ask about your health care team about medicines that may help. These may include steroids, inhalers, or diuretics for dyspnea. If you have a cough, medicines that suppress cough or break down mucus can help. An inhaler medicine may help for chronic coughing.

Skin irritation

Irritated, red, dry skin can be a side effect of radiation therapy or topical chemotherapy. Some types of immunotherapy or other treatments might also affect the skin. These steps can help relieve skin irritation caused by these treatments. Make sure to:

  • Wear loose, soft clothing over the treated area.

  • Don't scratch, rub, or scrub treated skin. Wash gently, and blot dry gently.

  • Only use paper tape if you apply a dressing to the area. Ask your health care team to help you place the dressing so that you can prevent more irritation.

  • Don't apply heat or cold to the area. Bathe only with lukewarm water.

  • If you must shave the area, only use an electric shaver. Don't use lotion before shaving. Don't use hair-removal products.

  • Keep your nails well-trimmed and clean so that you don't damage sensitive skin when you touch it.

  • Protect your skin from the sun. Cover the treated area and wear sunscreen with at least SPF 30.

  • Ask your health care provider what kind of lotion is best to soothe your skin.

  • Ask your health care provider if soap, deodorant, sunscreen, perfume, cosmetics, or powder is safe to use on your skin.

Sleep problems (insomnia)

Insomnia can be caused by anxiety, depression, or your cancer treatment. Use these tips to improve your rest:

  • Avoid long naps during the day. These can disrupt nighttime sleep.

  • Avoid caffeine and tobacco, especially close to bedtime. These are stimulants that can disrupt sleep.

  • Don't eat, drink fluids, or exercise close to your bedtime.

  • Keep a regular bedtime schedule.

  • If you don't fall asleep in 15 minutes, get up, do something else, and try again later.

  • Use your bed only for sleeping, not watching TV.

Swelling in your hand or arm (lymphedema)

Treatment may include removing lymph nodes from your armpit or groin. This can cause swelling in your hand, arm, leg or foot. This swelling is called lymphedema. It is caused when excess lymph fluid collects in your tissue. It may occur right after surgery or it may happen later. It is more likely if you also have radiation therapy in your armpit or groin.

To reduce your risk or to improve symptoms of lymphedema:

  • Clean the skin of your arm or leg daily and use moisturizing lotion.

  • Do not sit in one position for more than 30 minutes.

  • Wear loose clothing. Do not wear clothing with tight elastic bands.

  • Wear loose jewelry.

  • Do your prescribed exercises regularly.

  • Keep regular follow-up appointments with your health care team.

  • Keep your arm or leg raised above the level of your heart when possible. Don't make rapid circles with your arm. This can cause fluid to collect in the lower part of your arm.

  • Watch for signs of infection. These include redness, pain, heat, swelling, and fever. Call the health care team right away if you have any of these symptoms.

  • See a lymphedema specialist for treatment.

  • Ask your health care team about wearing a compression garment.

To avoid injury and infection in your arm:

  • Don't have your blood pressure taken on an affected arm.

  • Don't have blood taken from an affected arm.

  • Avoid extreme hot or cold.

  • Don't use ice packs or heating pads.

  • Clean cuts with soap and water and then use antibacterial ointment.

  • Do not overwork the affected arm.

  • Take gentle care of your fingernails.

  •  Don't cut your cuticles.

  • Tell your health care team about any rashes.

  • Use an electric razor for shaving.

  • Use gauze wrapping instead of tape. Don't wrap too tightly.

  • Wear gloves when gardening and cooking.

  • Use thimbles when sewing.

Trouble thinking and remembering

Chemotherapy and biological therapy can cause mild problems with thinking and memory. Fatigue can worsen the problem. Taking these actions can help:

  • Make lists.

  • Write down important information you need to remember.

  • Use other tools to help organize your life. These tools may include calendars, pill dispensers, or alarm clocks.

Tiredness (fatigue)

Tiredness is a very common side effect. It can be a result of anemia caused by low red blood cell levels. Red blood cells carry oxygen around the body. Decreased red blood cell counts can be caused by blood loss, chemotherapy, or radiation, or the cancer itself. Other things can cause fatigue, such as dehydration or not eating enough. Tiredness can last several weeks after treatment ends. You may feel only slightly tired, or you may suffer from extreme fatigue.

Taking these actions may help increase your energy levels:

  • Balance activity with rest. Save your energy for important tasks.

  • Add mild exercise, such as walking, to your daily routine. It may help you sleep better.

  • Drink plenty of fluids to prevent dehydration.

  • If your fatigue is severe or chronic, ask for help with routine tasks that can drain your energy. These can include grocery shopping or housework. You may also need to reduce your hours at work.

  • Take action to treat a poor appetite.

  • Take short rests when you feel tired. Avoid long naps during the day. These can disrupt nighttime sleep.

  • Talk with your health care team about medicines or treatments that may help manage anemia.

Talking with your health care team

Getting treatment for cancer can be tough on the mind and body. Keep talking with your health care team about ways to make the process easier. Work together to ease the affect of symptoms on your daily life. 

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