Do What You Can to Ease Side Effects of Treatment for Primary Bone Cancer

It’s likely that you will have physical concerns since your cancer may cause symptoms and your treatment may cause side effects. In this section, you’ll learn more about how to respond to some of the most common side effects and symptoms from treating bone cancer.

Here are some common side effects from treatment for bone cancer and how to ease them. You may not have all of these. They are listed in alphabetical order so you can find help when you need it.

Anemia (low red blood cell levels)/tiredness and fatigue

Tiredness is a common symptom and side effect from chemotherapy and radiation treatments. It is also a symptom of anemia, which is a low red blood cell count, diagnosed from blood tests. Anemia is commonly seen with cancer treatments. It can also be caused by a B12 vitamin or iron deficiency, which your doctor may find in a blood test. Whatever the cause, you may feel only slightly tired or you may suffer from extreme fatigue. 

Your doctor will take blood samples from you for tests throughout your treatment. Red blood cells carry oxygen throughout the body. If your body does not have this oxygen, you may feel tired. Decreased red blood cell counts can be caused by small amounts of blood loss, chemotherapy, or radiation.

If your doctor tells you that you have anemia, take these actions to feel better:

• Add mild exercise, such as walking, to your daily routine.

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

• Drink plenty of water. Dehydration adds to fatigue.

• Take action to treat a poor appetite because eating improperly can make you tired. 

• Take short rests when you’re tired. Avoid long naps during the day so that you can sleep well at night.

• If your fatigue is severe or chronic, ask for help with routine tasks that can drain your energy, such as grocery shopping or housework. Some people reduce their hours at work.

• Talk with your doctor about medications or treatments that may help manage your anemia.

Anxiety and depression

Many people may feel blue, anxious, or distressed after being told they have cancer. These feelings may continue or come back during treatment.

Taking these actions may ease your mental stress:

• Ask your doctor about medications for depression and anxiety.

• Consider joining a cancer support group or finding a cancer “buddy” who can help you cope.

• Talk with your family or friends.

• Consider seeking help through counseling.  

• Try relaxation techniques and deep breathing.  

Appetite loss

People who eat well during cancer treatment maintain their strength better, are more active, and lower their chances of infection. When you’re being treated for cancer, a diet high in calories and protein is usually best. But being treated for primary bone cancer, especially with chemotherapy, can sometimes damage intestinal cells or affect areas of the brain controlling appetite. Side effects of treatment can change the way food tastes to you or reduce your appetite. Try these tips to stimulate your desire to eat:

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

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

• Eat small meals throughout the day instead of three large ones.

• 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 their biggest appetite.

• Get plenty of fluids to help control your body temperature and improve food elimination. In addition to water, fruit juices, and other liquids, try gelatin, pudding, soups, popsicles, and ice cream.

• Drink liquids outside of meals to avoid early fullness.

• If you can, increase your activity level. Doing so may stimulate your appetite.

• Keep snacks handy to eat when you are hungry and eat snacks at bedtime.

• If you develop a strange taste in your mouth that limits your appetite, try mint tea or hard candies ro get rid of it.

• Consider liquid meal replacements when you don't feel like eating.

On days you don’t feel like eating at all, don’t worry about it. Try again the next day. If you find your appetite doesn’t improve in several days, talk with your doctor or nurse.

Breathing difficulty

You may find it hard to breathe because of swelling from surgery, pressure from a tumor, some chemotherapy drugs, or because radiation to the chest has damaged your lungs. Try these tips for making breathing easier:

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

• Sit upright because it will give your lungs room to expand.

• Sleep with the head of your bed raised or sleep in a recliner.

• Talk with your doctor about any breathing difficulty you may be experiencing, as there may be medications that could help.

Bruising or bleeding

Your doctor will take blood samples from you for blood tests throughout your treatment. One thing your doctor is checking for is your platelet level. Many types of chemotherapy can cause low platelet levels, as can the cancer itself. Lowered platelet levels are called thrombocytopenia. Without enough platelets, your blood may not be able to clot. And this may lead to bruising or bleeding.

If your doctor tells you that your platelet count is low, take these actions to stay healthy:

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

• Shave with an electric razor because it is less likely to cut you.

• Use a soft toothbrush to prevent bleeding gums.

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

• Call your doctor if you develop a rash, bleeding, or easy bruising.

• Tell your doctor if you take medications that can affect platelet function, including aspirin or ibuprofen.

• When seeing other doctors or your dentist, let them know that your platelet count is low.

Constipation

This may be a side effect of chemotherapy or some pain medicines. Constipation may include difficult or infrequent bowel movement. It can range from mildly uncomfortable to painful. Taking pain medications can also lead to constipation, so it’s wise to take these preventive actions. These same steps may also give you relief if you are already constipated:

• Drink plenty of fluids, especially water and prune juice. Warm or hot fluids may be particularly helpful in the morning.  

• Eat foods high in fiber. These include cereals, whole grains, fruits, and vegetables.

• Exercise.

• Take stool softeners or a laxative only as prescribed by your doctor.

• Do not ignore the urge to have a bowel movement. 

Diarrhea

Diarrhea includes loose or frequent bowel movements, or both. It may be a side effect of external radiation therapy. Many drugs can also cause bowel changes. Diarrhea may lead to dehydration if you don’t take these precautions:

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

• Avoid milk and milk products if these seem to make the diarrhea worse.

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

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

• If nothing else works, ask your doctor about medications that may help.

Hair loss (alopecia)

Losing your hair can be upsetting because it is a visible reminder that you are being treated for cancer. Keep in mind that your hair will grow back after chemotherapy. However, it may not grow back after radiation. Try these coping tips:

• Consider cutting your hair before treatment starts.

• Protect your head from the sun with sunscreen and hats or scarves.

• Avoid too much hair brushing and heat exposure with curling irons and hair dryers.

• When brushing hair, use a wide-toothed comb.

• Think about getting a wig, hat, or scarf before your hair loss starts. That way, you can get a wig that matches your hair.

• Get a prescription for a wig from your doctor because it may be covered by insurance.

Increased infections

Throughout your treatment, your doctor will take small samples of your blood. One thing he or she is checking is your levels of white blood cells. Without enough white blood cells, your body may not be able to fight infection. Many types of chemotherapy can cause low white blood cell counts.

If your doctor tells you that your white blood cell count is low (called neutropenia), take these actions to avoid infection:

• Avoid crowds or people with colds.

• Call your doctor right away if you have any signs of infection. Signs include a temperature of 100.5 degrees Fahrenheit or higher, severe chills, cough, pain, burning during urination, or any sores or redness.

• Wash your hands often or use hand sanitizer throughout the day to kill germs.

Mouth sores (mucositis)

Some types of chemotherapy may cause a sore mouth or mouth sores. Mouth sores may hurt and make eating an unpleasant experience.

To prevent sores in your mouth, take these actions:

• Brush your teeth after meals and before bedtime. Floss every day if this is part of your normal routine and with your doctor's permission. 

• Keep your mouth and lips clean and moist.

• Use sugar-free candies or gums to increase moisture in your mouth.

To ease the pain if you get sores in your mouth, take these actions:

• Avoid alcohol and mouthwashes containing alcohol because they may irritate the sores.

• Avoid hot, rough, or spicy foods because they may irritate the sores.

• Suck on ice chips.

• Eat foods that are refrigerated, soft, and smooth.

• Avoid tobacco because it may irritate the sores. Smoking can also make you more susceptible to sores.

• If your sores don’t improve, ask your doctor about topical mouth medications.

• Take over-the-counter pain medication, such as Tylenol (acetaminophen), if necessary. Ask your doctor first.)

• Call your doctor or nurse if your temperature reaches 100.5 degrees Fahrenheit or higher.

Nausea or vomiting

Nausea or vomiting can occur with chemotherapy or radiation treatment for cancer. It may range from barely noticeable to severe. These are the different types of nausea:

• Acute-onset nausea and vomiting. This occurs within a few minutes to several hours after chemotherapy. The worst episodes tend to be five or six hours after treatment. The symptoms end within the first 24 hours after treatment.

• Anticipatory nausea and vomiting. This is learned from previous experiences with vomiting. As you prepare for the next dose of chemotherapy, you may anticipate that nausea and vomiting will occur like it did before, which triggers the actual reflex.

• Breakthrough vomiting. This occurs despite treatment to prevent it. It requires added treatment.

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

• Refractory vomiting. This occurs after one or more chemotherapy treatments. Essentially, you’re no longer responding to antinausea treatments.

To prevent nausea, most of which can be prevented, take these actions:

• Ask your doctor about getting a prescription medicine to control nausea and vomiting. Then, make sure you take it as directed. If you are vomiting and cannot take this medicine, call your doctor or nurse.

• If you have nausea and vomiting even though you are taking your medicine, call your doctor or nurse. Your medicine can be changed.

To help ease nausea or vomiting if you have it, try these tips:

• Ask your doctor or nurse about using acupressure bands on your wrists. These bands may help to decrease your nausea.

• Ask your doctor or nurse to help you learn a relaxation exercise. This may make you feel less anxious and more in control, and decrease your nausea.

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

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

• Try eating foods and drinking beverages that were easy to take during a previous illness when you had the flu or were nauseated. These might be bland foods, sour candy, pickles, dry crackers, ginger ale, flat soda, or others.

• Try resting upright for an hour after meals.

Pain

You may have pain from the cancer itself or from surgery. Try these tips to ease the pain:

• Change your activity level. See if you feel better if you rest more or move around more--either may help.

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

• Take your pain medications regularly; don’t wait for your pain to become severe. Talk with your doctor or nurse about your options for pain relief. Some people don't like to take pain medication, but doing so can actually help your healing. If you don’t control pain well, for example, you may not want to cough or turn over often, which you need to do as you recover.

• Use relaxation techniques, such as yoga or meditation, or guided imagery exercises. Ask your doctor or nurse where you can learn more about these.

Skin dryness or irritation

This may be a side effect of some kinds of chemotherapy or from external radiation. To get relief, try these tips:

• Ask your doctor or nurse what kind of lotion you can use to moisturize and soothe your skin. Don’t use any lotion, soap, deodorant, sunblock, cologne, cosmetics, or powder on your skin within two hours after radiation treatment because they may cause irritation. Don’t apply heat or cold to the area treated with radiation. Bathe only with lukewarm water, because it’s less dehydrating.

• Apply moisturizer immediately after bathing or showering.

• Don’t bandage skin treated with radiation. If you must bandage it, use paper tape, and ask your nurse to help you place the dressings so that you can avoid irritation.

• Don’t scratch, rub, or scrub skin treated with radiation. After washing, gently blot dry.

• If you must shave the area treated with radiation, use only an electric shaver because it’s less irritating. Don’t use lotion before shaving. And don’t use hair-removal products. Both can irritate your skin.

• Keep your nails well trimmed and clean, so you don’t accidentally cut yourself.

• Protect skin treated with radiation from sun exposure by covering it up and wearing sunscreen of at least 15 SPF (sun protection factor).

• Wear loose, soft clothing over the area treated with radiation. Cotton underwear can help prevent further irritation.

Weakness in your limbs

You may develop weakness in your limbs from bone cancer treatment. This can be a result of spending more time in bed or because of pain in the joints or legs. Weakness can be a direct side effect of chemotherapy and radiation, as well. Regular activity is important to improve muscular strength and to prevent new problems. A physical therapist can help you regain your strength by showing you some exercises to do. These exercises keep the muscles in the limb strong and flexible. As soon as the limb is strong enough, you can use it normally. A routine exercise program is important.

It is important to keep your joints moving. You may have stiffness in your joints, especially near areas where you had surgery or radiation. This stiffness will make moving painful and reduce your mobility. Doing easy exercises can prevent this stiffness. The physical therapist can show you how to do daily exercises to prevent stiffness that can be done on your own. You may also try these tips to prevent weakness:

• Take pain medications as prescribed by your doctor. 

• Change positions every couple of hours while you are resting. 

• If your doctor has advised a walker, brace, or cane, use it as prescribed.