Effects on Skin and Nails
You may have minor skin problems while you are having chemotherapy.
Possible side effects include redness, itching, peeling, dryness, and
acne. Your nails may become brittle, darkened, or cracked. They also may
develop vertical lines or bands.
You will be able to take care of most of these problems yourself. If
you develop acne, try to keep your face clean and dry and use
over-the-counter medicated creams or soaps. For itching, apply cornstarch
as you would a dusting powder. To help avoid dryness, take quick showers
or sponge baths rather than long, hot baths. Apply cream and lotion while
your skin is still moist and avoid perfume, cologne, or aftershave lotion
that contains alcohol. You can strengthen your nails with the remedies
sold for this purpose, but be alert to signs of a worsening problem
because these products can be irritating to some people. Protect your
nails by wearing gloves when washing dishes, gardening, or performing
other work around the house. Get further advice from your doctor if these
skin and nail problems don't respond to your efforts. Be sure to let your
doctor know if you have redness, pain, or changes around the cuticles.
Certain anticancer drugs, when given intravenously, may produce a
fairly dramatic darkening of the skin all along the vein. Some people use
makeup to cover the area, but this can become difficult and time-consuming
if several veins are affected, which sometimes happens. The darkened areas
usually will fade on their own a few months after treatment ends.
Exposure to the sun may increase the effects some anticancer drugs have
on your skin. Check with your doctor or nurse about using a sunscreen
lotion with a skin protection factor of 15 to protect against the sun's
effects. They may even suggest that you avoid being in direct sunlight or
that you use a product, such as zinc oxide, that blocks the sun's rays
completely. Long-sleeve cotton shirts, hats, and pants also will block the
sun.
Some people who have had radiation therapy develop "radiation
recall" during their chemotherapy. During or shortly after anticancer
drugs are given, the skin over the area that was treated with radiation
turns red--a shade anywhere from light to very bright--and may itch or
burn. This reaction may last hours or even days. You can soothe the
itching and burning by putting a cool, wet compress over the affected
area. Radiation recall reactions should be reported to your doctor or
nurse.
Most skin problems are not serious, but a few demand immediate
attention. For example, certain drugs given intravenously can cause
serious and permanent tissue damage if they leak out of the vein. Tell
your doctor or nurse right away if you feel any burning or pain when you
are getting IV drugs. These symptoms don't always mean there's a problem
but they always must be checked out at once.
You also should let your doctor or nurse know right away if you develop
sudden or severe itching, if your skin breaks out in a rash or hives, or
if you have wheezing or any other trouble breathing. These symptoms may
mean you are having an allergic reaction that may need to be treated at
once.
Kidney and Bladder Effects
Some anticancer drugs can irritate the bladder or cause temporary or
permanent damage to the kidneys. Be sure to ask your doctor if your
anticancer drugs are among the ones that have this effect, and notify the
doctor if you have any symptoms that might indicate a problem. Signs to
watch for include:
- Pain or burning when you urinate.
- Frequent urination.
- A feeling that you must urinate right away ("urgency").
- Reddish or bloody urine.
- Fever.
- Chills.
In general, it's a good idea to drink plenty of fluids to ensure good
urine flow and help prevent problems; this is especially important if your
drugs are among those that affect the kidney and bladder. Water, juice,
coffee, tea, soup, soft drinks, broth, ice cream, soup, popsicles, and
gelatin are all considered fluids. Your doctor will let you know if you
must increase your fluid intake.
You also should be aware that some anticancer drugs cause the urine to
change color (orange, red, or yellow) or to take on a strong or
medicine-like odor. The color and odor of semen may be affected, as well.
Check with your doctor to see if the drugs you are taking have this
effect.
Sexual Effects: Physical and Psychological
Chemotherapy may--but does not always--affect sexual organs and
functioning in both men and women. The side effects that might occur
depend on the drugs used and the person's age and general health.
Men
Chemotherapy drugs may lower the number of sperm cells, reduce their
ability to move, or cause other abnormalities. These changes can result in
infertility, which may be temporary or permanent. Infertility affects a
man's ability to father a child but does not affect his ability to have
sexual intercourse.
Because permanent sterility may occur, it's important to discuss this
issue with your doctor before you begin chemotherapy. If you wish, you
might consider sperm banking, a procedure that freezes sperm for future
use.
Men undergoing chemotherapy should use an effective means of birth
control with their partners during treatment because of the harmful
effects of the drugs on chromosomes. Ask your doctor when you can stop
using birth control for this purpose.
Women
Anticancer drugs can damage the ovaries and reduce the amount of
hormones they produce. As a result, some women find that their menstrual
periods become irregular or stop completely while they are having
infection.
If infection does occur, it should be treated right away.
Damage to the ovaries may result in infertility, the inability to
become pregnant. In some cases, the infertility is a temporary condition;
in other cases, it may be permanent. Whether infertility occurs, and how
long it lasts, depends on many factors, including the type of drug, the
dosage given, and the woman's age.
Although pregnancy may be possible during chemotherapy, it still is not
advisable because some anticancer drugs may cause birth defects. Doctors
advise women of childbearing age--from the teens through the end of
menopause--to use birth control throughout their treatment.
If a woman is pregnant when her cancer is discovered, it may be
possible to delay chemotherapy until after the baby is born. For a woman
who needs treatment sooner, the doctor may suggest starting chemotherapy
after the 12th week of pregnancy, when the fetus is beyond the stage of
greatest risk. In some cases, termination of the pregnancy may be
considered.
Sexuality
Sexual feelings and attitudes vary among people during chemotherapy.
Some people find that they feel closer than ever to their partners and
have an increased desire for sexual activity. Others experience little or
no change in their sexual desire and energy level. Still others find that
their sexual interest declines because of the physical and emotional
stresses of having cancer and getting chemotherapy. These stresses may
include worries about changes in appearance; anxiety about health, family,
or finances; or side effects, including fatigue and hormonal changes.
A partner's concerns or fears can also affect the sexual relationship.
Some may worry that physical intimacy will harm the person who has cancer;
others may fear that they might "catch" the cancer or be
affected by the drugs. Many of these issues can be cleared up by talking
about misunderstandings. Both you and your partner should feel free to
discuss sexual concerns with your doctor, nurse, or other counselor who
can give you the information and the reassurance you need.
You and your partner also should try to share your feelings with one
another. If it's difficult for you to talk to each other about sex, or
cancer, or both, you may want to speak to a counselor who can help you
communicate more openly. People who can help include psychiatrists,
psychologists, social workers, marriage counselors, sex therapists, and
members of the clergy.
If you were comfortable with and enjoyed sexual relations before
starting therapy, chances are you will still find pleasure in physical
intimacy during your treatment. You may discover, however, that intimacy
takes on a new meaning and character. Hugging, touching, holding, and
cuddling may become more important, while sexual intercourse may become
less important. Remember that what was true before you started
chemotherapy remains true now: There is no one "right" way to
express your sexuality. It's up to you and your partner to determine
together what is pleasurable and satisfying to you both.
The American Cancer Society has two free booklets on sexuality that may
be helpful-- one for women and one for men. Contact your local unit or the
national office for copies.
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