Why are you still all up in my business chemo?

The overall good news is that we are getting better and better at helping patients survive cancer. Awesome! Whoohoo! The double-edged sword side of this is that as people are surviving longer and longer, we are getting to know more and more about late side effects from chemotherapy.

So, what is a late side effect? A late side effect is a side effect that you experience after treatment is over. These can occur even years later. What?! These late side effects can result from any type of cancer treatment. So far I have experienced significant neuropathy, muscle pain, headache, nausea, severe hypothyroidism, renal dysfunction, “chemo brain”, stomatitis, significant fatigue, cough, shortness of breath and hot flashes. I may be forgetting a few but those are the ones that come immediately to mind. To be honest with you, I am kind of over it. Enough already!

The main types of cancer treatment so far are chemotherapy, hormone therapy, surgery, radiation, targeted therapy and immunotherapy. Let’s look at each one. Now, before I go into this, I want to remind everybody that technically we all get counselled and have to sign a consent form before receiving any kind of cancer treatment in the first place. Some places do it better than others. Most sit down and do a one on one chemo teaching session in which the patient can ask questions and get clarification. This is a great opportunity to really START to appreciate what you are getting yourself into. Unfortunately, after this great teaching session, there is usually still a 20 plus page consent form that you are supposed sign as well. I’ll tell ya, nothing undermines your confidence like thinking you just covered all your bases and then you get this huge document plunked in your lap that you are supposed to pour through to make sure you really get it. I think a lot of us do our best but there is no way to digest all that additional info efficiently in a short amount of time, but we sign it anyway because we really want that cancer gone. This is a tough spot for any patient to be in because you really want that cancer gone, but you don’t fully realize what you possibly consented for in exchange. Yes, I am talking about side effects and other potential cancers. This is what we are going to talk about.

Let’s look at the kind of late side effects that are possible with each type of treatment. First let’s look at chemotherapy. Chemotherapy can cause a multitude of late side effects like early menopause, hearing loss, increased risk of other cancers, lung disease, nerve damage, reduced lung capacity, osteoporosis, and dental problems.

Now let’s look at radiotherapy. Radiation therapy can cause all kinds of late issues as well, such as cavities, tooth decay, increased risk of other cancers, coronary artery disease, increased stroke risk, hypothyroidism, heart and vascular problems, early menopause, intestinal problems, memory problems, osteoporosis, infertility and lymphedema.

Surgery is another mode of targeted cancer treatment. The main side effect of surgery is infection risk, at the time. The main late effect of surgery is lymphedema in the area that was operated on.

Hormone therapy is another type of cancer treatment. With hormone therapy comes the risk of blood clots, hot flashes( for men and women), menopause, sexual side effects, osteoporosis and the risk of other cancers.

The last two main categories of cancer treatment are immunotherapy and targeted therapy. These are still new enough that we don’t know a lot about possible late side effects. Lucky me, I fall into this group. Actually, I fall into the immunotherapy and the chemotherapy group. I’ll keep you posted.

The point I want to make is that it is not all in your head when you are still having symptoms long after chemo. We really don’t know a way to prevent them. If you are having them though, make sure to speak up to your doctor and make sure something else is not going on. Even when your cancer is over, it is still your job to continue to advocate for your health.

Dr. Katz

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