Should I follow a special regimen during chemotherapy?
Chemotherapy takes a toll on your body – both physically and emotionally. Some patients prefer to be in hospital during therapy and others choose to attend procedures as an outpatient, while other patients prefer to remain active and can successfully combine their daily routine with a course of chemotherapy. As your individual reaction to the chemo drugs is hard to predict, it’s difficult to say just how long you’ll be able to cope with this long-term treatment. In addition, you might find that the first course of treatment is well-tolerated by your body, but problems occur later, or vice versa.
During chemotherapy many patients complain of fatigue, which prevents them from not only enjoying life, but also from completing everyday tasks. The reasons for fatigue can be numerous – not enough relaxation (sleep), stress, the battle between the drugs and the cells of your tumour, your body’s attempts to rejuvenate damaged healthy cells or to replace healthy cells that have been destroyed (which requires a lot of energy), a lack of nutrition (nausea, vomiting), anaemia caused by chemotherapy or leukopenia (a reduction in the number of white cells, which can prevent your body from fighting off infection). Therefore, don’t try to be a hero by continuing to do all of the housework and definitely don’t try to keep up with your usual workload. Listen to your body and instead of feeling guilty about the work that you haven’t done, simply relax. This means a full night’s sleep as well as relaxation during the day, perhaps several times. Talk about this with your family and colleagues, so there aren’t any misunderstandings. Chemotherapy is an incredibly heavy load to bear for your body and it has earned the right to relax. Your energy resources aren’t infinite, so don’t waste them at the beginning of treatment. Ask your doctor for sleeping pills, drugs to help you relax or look for other opportunities (relaxation, yoga, aromatherapy, acupuncture, etc.). Don’t forget to be mobile (as long as it makes you happy and doesn’t make you even more fatigued) and to get some fresh air (sleep by an open window, air out your rooms more often). Talk to your relatives beforehand about who can help look after your children or drive them where they need to go, do the shopping, prepare meals, do housework (cleaning, laundry, ironing and other chores). During treatment you need an easier daily regimen and as much relaxation as you think you need.
Eat well and often.
This is not only one of life’s pleasures but also an essential part of your daily life. Your sense of taste and smell can be altered during chemotherapy and you can also experience nausea and/or vomiting and diarrhoea as well as the inflammation of the mucous membranes of your mouth and digestive tract. All this will affect your diet in many different ways. Patients most often complain of nausea or even vomiting during the first few days after chemotherapy. This is a difficult time for both the patient and their loved ones. It’s simply so bad for the patients that they just want to curl up into a ball and escape from the rest of the world. Some people completely lose their appetite. Usually anti-nausea medications are prescribed, which can be taken orally or injected via an IV. The situation is also alleviated by delivering intravenous detoxification agents in the first couple of days after chemotherapy. Patients are often worried that this process might flush out all of the chemotherapy drugs, but this isn’t true. These drugs already reach their targets and begin to work within a few hours. Afterward, the by-products of the chemotherapy, the toxins and dead cells must be expelled from the body. Ask your doctor about this process. If side effects are very acute, then it’s best to place an anti-nausea tablet under your tongue or to get an injection. But you definitely have to eat, as proper nourishment is the only way to deliver the nutrients your body needs and to ensure that you don’t develop a substantial nutritional deficiency. Latvia has many professionally trained nutrition specialists. Consult them for advice and create a diet plan together to create the most balanced menu possible during your treatment. Please have faith in these specialists, because sometimes oncologists or even your family doctor may not be competent in this field. If your loved ones ask how they can help – ask them to make an appointment for you with a nutrition specialist. Under no circumstances should you resign yourself to the common phrase – yes, sometimes it’s like that, but it should pass. You’ll only lose time. It’s important to keep track of your body mass index, changes in your weight and to evaluate the risk of nutritional deficiencies during chemotherapy. Drugs can be helpful such as appetite stimulators, anti-nausea medications and antidiarrhoeals, drugs to relieve constipation, pain relievers and steroids, but none of these medications can provide essential nutrients, which is why eating is so important during chemotherapy. I still haven’t found any literature on a particular diet for cancer patients during chemotherapy. Specialists from different countries offer different recommendations, so it’s best to rely on the advice of a nutrition specialist. It’s necessary to ensure not only a sufficient number of calories, but also the proper intake of proteins and micronutrients, which is why eating a large amount of food simply isn’t enough. Exactly what you’re eating and how it’s prepared is important, so the food isn’t only flavourful and doesn’t irritate your sense of smell, but that it’s also easy to prepare and eat. For example, some food can be frozen ahead of time, so when you’re too tired to prepare something in the kitchen you can simply heat them up. Chemotherapy isn’t the proper time to deliberately lose excess weight. I’ll discuss this in more detail in another blogpost entitled How to live with your disease.
Keep a journal.
It will not only help you to better navigate the course of your disease, but, as I’ve been told by many patients, it also has an undeniable therapeutic effect. Whatever’s been put on paper has in some way been released from you. A diary will also help you to more accurately voice your doubts and confusion, and to more accurately describe what you’ve noticed or felt to the doctor. It’s common for a patient to be so worried when he shows up for an appointment that he forgets to ask important questions. If they have a journal with them, the conversation can be much more substantive. Your doctor can’t guess what your biggest concern is, so be more insistent. Write down questions that you’d like to ask your doctor before your appointment. Record the dates of appointments, times, when you’re scheduled to have specific examinations, but also what drugs you’ve been using and the dosages, as well as any side effects you may have had. Entrust your doubts, pain, sorrows and difficulties to your journal, as well as your joys, things that you like or things that you have read, heard, etc. Writing a journal can also have a soothing effect and many patients recognise this. A problem in your mind can be less traumatic once it’s put on paper.
Read books and magazines.
Many patients have told me that they’ve felt so bad during chemotherapy that they didn’t even want to think about reading a book. I agree, but there are definitely times when ‘’book therapy” is much more preferable to thinking about your current state or sliding into depression. Read something light, engaging and funny. The plot isn’t important. The most important thing is to escape from your situation for a while. Latvia also has a wide range of magazines, some of which also touch on subjects that are interesting to cancer patients. Do a crossword puzzle or maybe sudoku. A magazine subscription can be a good way for loved ones to cheer up a cancer patient. You can also give any other books or magazines lying around your house as a gift to take a patient’s mind off their troubles.
Find joy in a hobby.
If not exactly during chemotherapy, then you should at least try to find a way to keep yourself occupied to give your mind a break at home. You could try knitting, embroidery, crocheting or decoupage. I also recommend organising your old photo albums, writing your memoirs, especially about your children and your school days, or perhaps researching your family tree. You can hire an art therapist or find a variety of hobbies online or try an online adult education course. Some of my patients have told me that they have learned new skills such as bookbinding, macramé and jewellery making, which have become a therapeutic hobby. There are many good ideas and offers on Pinterest where you can get lots of tips, ideas and solutions, which are easy to follow and often filmed step-by-step.
Listen to music. Good music can do wonders. There’s a good reason why there’s a field called music therapy (Latvia also has these specialists), which allows you to take a break, relax and to enter a light trance or to simply feel pleasure. I already wrote about listening to music with headphones while receiving chemotherapy. But music can also play in the background at home or at work. Ideally, you should have playlists for a number of different moods, situations and times of day. Ask your friends for help or visit a music therapist. This is useful regardless of age. Every generation has its own tastes, just as every person has their own favourite music. One person can seek solace in Bach, while someone else might find help by listening to heavy metal music and you don’t have to feel ashamed if folk-rock makes you happier than Mozart. Music therapy is one of the integrative (a combination of different methods) fields of therapy. Music therapy and its effect on cancer patients has been thoroughly studied and has been proven to have a positive effect. Music relieves tension and improves one’s mood, it can have a calming effect and can even help with pain and shortness of breath. Studies of healthy volunteers showed that music increases the number of NK cells (natural killer cells), which is an important component of the immune system. In this case, it’s better to listen to calm, peaceful music (classical, pan flutes, acoustic guitar, etc.). The music you listen to shouldn’t be disturbing or bring back unpleasant memories. But patients have even told me, for example, that the rhythm of Bolero has really motivated them. To each his own. Music should sooth, not disturb. I wholeheartedly encourage you find a music therapist, even if you’ve had musical training. The therapist will help you find the most suitable piece of music and you might even be able to play something, too.
Watch movies and concerts.
This can be a good way to kill time while undergoing chemotherapy or in between cycles at home. You can watch by yourself or with someone else. Ask your friends for recommendations about films to rent, stream or download. They can be films about nature, animals or people of other cultures. You can find many good shows, plays and films in Latvian in the www.lsm.lv archive. It can also be encouraging to virtually visit the world’s best museums, whose art and artefacts are available on their websites. Culture connoisseurs can also find world-class performances in their entirety online, especially on YouTube. Once again, ask your friends and family to help you find something that suits you best.
Record your future plans.
When I make this suggestion to patients, many are disheartened, because they think that they don’t have much time left. But that’s not true. Everyone has a future, some longer, some shorter. It’s important to prepare yourself for these kinds of thoughts. This could be a visit from an old friend or a relative you haven’t seen for some time, a visit to places from your childhood or just doing something that you’ve always wanted to do. Patients are often thankful for such an opportunity, which may not have occurred to them. To some extent, putting your legal and financial affairs in order is also a part of these future plans. I remember a patient from the Jurmala clinic, a piano teacher from England, who told me that he could now fully enjoy the life that he had left because he had already put his affairs in order and even carefully planned his funeral. I’ve never heard such a courageous confession from a Latvian, but it can serve as a recommendation for others. Future plans could also include how you imagine your garden, house or apartment might look and what you still might want to learn or do.
Play games. This is also a way to spend time with your loved ones and how to escape from thoughts about your disease. Any game will do including cards, chess, checkers or the local Latvian games “circus” or “riču-rača”. Today, a huge variety of board games are available. Games can also be a wonderful way to spend time with your children or grandchildren. Puzzles are also a great way to concentrate on something apart from your disease. A patient once told me how she set herself a goal of completing a 5,000-piece puzzle during chemotherapy. Once that was finished she bought another one and became so enthralled that she often forgot about her illness. This method won’t work for everyone, but there are also many other ways to cope. It can, however, be a great gift for a cancer patient. Embroidery, colouring mandalas and similar pursuits can also be helpful.
Many chemotherapy drugs have photosensitizing and phototoxic effects. This means that during chemotherapy your skin can be more sensitive to ultraviolet radiation and you can be more susceptible to sunburn. These undesirable effects can be caused by specific drugs (5-fluorouracil, methotrexate, vinblastine, docetaxel, doxorubicin, etoposide, gemcitabine, etc.) or a combination of these drugs, which can exacerbate this toxic effect. This type of reaction can last for the duration of your chemotherapy and will gradually diminish after it’s finished. Therefore, take every precaution to protect yourself from the heightened effects of the sun. When possible, avoid being out in the sun between 10:00 and 17:00. Wear appropriate clothing to protect yourself from the sun as well as a hat and sunglasses. Use sunscreen with a high SPF number (such as 50). Don’t even think about tanning beds. Sunburn is actually a widespread inflammatory affliction and the body will mobilise its resources, resources which are needed to fight cancer, to mitigate its effects. You should also avoid rooms with high temperatures or being outside in extreme heat. This can also sap your energy.
Can I use vitamins and nutritional supplements?
I’ve heard this question from patients both during chemotherapy and also afterward. There are very few carefully planned studies that have tackled this question. It has been observed that vitamins and antioxidants can negatively influence the effect of the planned chemotherapy. For example, large doses of vitamin C can reduce the effect of tamoxifen in patients with breast cancer. On the other hand, it’s also been observed that vitamins and nutritional supplements can have a positive effect, reducing side effects. Whether you should use them after chemotherapy is another question. However, the majority of oncologists recommend a carefully considered, balanced diet that will provide the body with all of the nutrients, vitamins, minerals and natural antioxidants that it needs, at least during chemotherapy.