How does targeted therapy work?
Targeted therapy is used to keep cancer from growing and spreading. To become cancer cells, normal cells go through a process called carcinogenesis. Cancer cells may then grow into tumors or reproduce throughout a body system, like blood cancers do.
Scientists have learned a lot about the molecules that are part of this process and the signals a cell gets to keep this process going.
Targeted therapy disrupts this process. The drugs target certain parts of the cellularchanges and signals that are needed for a cancer to develop and keep growing. These drugs are often grouped by how they work, or what part of the cell they target.
When most people think of enzymes, the first ones that come to mind are the ones that help digest (break down) the food we eat. But there are many other kinds of enzymes in our bodies. They help control nearly everything our cells do.
Some targeted therapies block (inhibit) certain proteins, or enzymes, that are signals for cancer cells to grow. These drugs are called enzyme inhibitors. Blocking these cell signals can keep the cancer from getting bigger and spreading. So even if the tumor is not getting smaller, its out-of-control growth has been changed. This may give regular chemo a better chance to work. Slowing or stopping out-of-control growth may also help people live longer, even without adding other drugs.
Enzyme inhibitors may be called different names based on the enzymes they block:
· Tyrosine kinase inhibitors
· mTOR inhibitors
· Proteosome inhibitors
· Growth factor inhibitors
· Signal-transduction inhibitors
· Multi-targeted kinase
A multi-targeted kinase drug blocks many different enzymes. It may also be called a multikinase inhibitor.
Some targeted therapies change proteins within the cancer cells and cause the cells to die. These are called apoptosis-inducing drugs. (Apoptosis is the medical word for cell death. These drugs cause, or induce cell death.) Many cancer treatments (including radiation and chemo) cause cell changes that lead to apoptosis. But targeted drugs in this group are different, because they are aimed right at the parts of the cell that control whether cells live or die.
Angiogenesis is the process of making new blood vessels. (The term comes from 2 Greek words: angio, meaning blood vessel, and genesis, meaning beginning.) In most cases, this is a normal, healthy process. As the human body grows and develops, it needs to make new blood vessels to get blood to all of its cells. As adults, we don’t have quite the same need for making new blood vessels, but there are times when angiogenesis is still important. New blood vessels, for instance, help the body heal wounds and repair damage.
But in a person with cancer, this same process creates new blood vessels that give a tumor its own blood supply and allow it to grow and spread. Angiogenesis inhibitors target and stop (or inhibit) this process—they stop the tumors from making new blood vessels. This helps cut off the tumors’ blood supply, and without blood, tumors can’t grow.
Many of these drugs work by blocking vascular endothelial growth factor (called VEGF). VEGF is a family of protein growth factors made by some tumors. These VEGF proteins can attach to the VEGF receptors of blood vessel cells. This causes new blood vessels to form around the tumors. Blocking this process prevents angiogenesis, which would form new blood vessels to feed tumors so they could grow.
Types of targeted therapy used today
Today many different types of targeted therapies are used to treat cancer. Looking at examples helps a person understand how these drugs work. A few of the more commonly used targeted therapies are listed here, but this is not a complete list. There are many different targeted therapies in use and new ones are coming out all the time. There are 2 main types of targeted therapy drugs: antibody drugs and small-molecule drugs. Some targeted therapy drugs are actually antibodies—man-made versions of immune system proteins that have been designed to attack certain targets on cancer cells. The other type of targeted therapy drugs are not antibodies. Since antibodies are large molecules, this other type of drug is called a “small-molecule” targeted therapy drug.
What’s the goal of targeted therapy treatment?
Depending on the type of cancer and its stage (if and how far it has spread), targeted therapy can be used to:
· Cure the cancer
· Slow the cancer’s growth
· Kill cancer cells that may have spread to other parts of the body
· Relieve symptoms caused by cancer
Your doctor will talk to you about the goals of your therapy before you start treatment.
Will targeted therapy drugs be my only treatment for cancer?
Sometimes treatment with a targeted therapy drug will be the only treatment you need. But in most cases, targeted therapy is used along with other treatments such as chemo, surgery, and/or radiation therapy.
Getting targeted therapy treatment
How are targeted therapy drugs given?
The most common way to give these drugs is as a pill (by mouth) or into a vein (intravenous or IV). IV drugs are given in these ways:
· The drug can be given quickly through the catheter right from a syringe over a few minutes. This is called an IV push.
· An IV infusion can last 30 minutes to a few hours. A mixed drug solution flows from a plastic bag through tubing that is attached to the catheter. The flow is often controlled by a machine called an IV pump.
· Continuous infusions are sometimes needed and can last from 1 to 7 days. These are always controlled by electronic IV pumps.
When the drug is given by mouth you are given pills to take at home. If you take a targeted therapy drug by mouth, it’s very important to take the exact dose, at the right time, for as long as it has been prescribed.
Where will I get treated?
The place you get your treatment depends on which drugs you are getting, how the drugs are given, the drug doses, your hospital’s policies, your insurance coverage, what you prefer, and what your doctor recommends. Based on these factors, targeted therapy may be given:
· At home
· In your doctor’s office
· In a clinic
· In a hospital’s outpatient department
· In a hospital
Some of these settings may have private treatment rooms, while others treat many patients together in one large room. It’s important to be in a setting that is comfortable for you. Talk to your doctor or nurse ahead of time so that you know what to expect your first day.
How often will I need to get treatment and how long will it last?
How often you get the targeted therapy drug and how long your treatment lasts depend on the kind of cancer you have, the goals of the treatment, the drugs being used, and how your body responds to them. You may get treatments daily, weekly, or monthly.
Sometimes they are given in on-and-off cycles. The breaks allow your body to build healthy new cells and regain its strength.
Does targeted therapy hurt?
Getting a targeted therapy drug should not hurt beyond the discomfort of the needle stick needed to put in the catheter for medicines given IV (into a vein). If you feel pain, burning, coolness, or anything unusual while you are getting the medicine, tell your doctor or nurse right away.
What are clinical trials?
Clinical trials are carefully designed research studies that test promising new cancer treatments in human volunteers. Many targeted therapies are being studied in clinical trials, and you may want to talk to your doctor about whether this is an option for you. Patients who take part in research studies are the first to benefit from these treatments.
These patients can make an important contribution to medical care because the study results will also help other patients. In a clinical trial, you get either standard treatment or a new treatment that’s thought to be as good as – or maybe better than – the standard treatment. Studies are never done to see if you would recover from cancer without treatment at all. As with any other medical treatment, you decide whether you want to be in the study, and you are free to withdraw from a clinical trial at any time and seek other treatment options.
Can I take other medicines while I am getting targeted therapy?
Some medicines may interfere with the effects of your treatment. To be sure that your treatment works as well as it can, tell your doctor or nurse about any and all prescription and non-prescription medicines, vitamins, herbs, and supplements you are taking.
· Make a list of the name of each drug, the dose, how often you take it, the reason you
take it, and who prescribed it (if applicable).
· Be sure to include the things you may not think of as medicines, even those you take
every now and then. This includes aspirin, herbal and dietary supplements, vitamins, minerals, and all over-the-counter medicines.
Your doctor will tell you if you should stop taking any of these medicines before you start treatment. After treatment starts, check with your doctor before taking any new medicines or supplements and before stopping the ones you already take.
How will I know if the drug is working?
Your cancer care team will measure how well your treatments are working with certain tests. These may include physical exams, blood tests, bone marrow biopsies, and imaging tests such as scans and x-rays. Ask your doctor about the test results and what they show about your progress. You may have side effects from treatment, but these side effects can’t tell you that the treatment is working.
How do I give my permission for this treatment?
As with standard chemotherapy, you will be asked to give your written permission to be treated with a targeted therapy drug. This should be based on your understanding of the drug your doctor recommends. Know the answers to all of these questions before you sign the consent form.
· Which targeted therapy drug will I be given?
· How will the drug be given to me?
· How often will I need to take this drug?
· How long will my treatments last?
· What side effects could I have from these drugs?
· What is the purpose of this treatment (is it meant to cure, slow cancer growth, help
· How likely is this treatment to be successful?
The specifics of the consent form may vary from state to state, but the form usually states that your doctor has explained your condition to you, how the treatment will benefit you, the risks, and the other options available to you. Your signature on the form means that you have gotten this information and are willing to be treated with this drug. This process is called informed consent.
Side effects of targeted therapy drugs
What causes side effects?
Although targeted therapy drugs don’t affect the body the same way that standard chemo drugs do, they still cause side effects. Side effects from these drugs depend largely on what the drug targets. Some drugs target substances that are more common on cancer cells, but are also found on healthy cells. So these drugs may affect healthy cells, too, causing some side effects. When drugs attack more than one target, side effects are more likely. Also, drugs that act as angiogenesis inhibitors affect new blood vessel formation all over the body, not just for cancers. This can lead to side effects, as well.
What should I know about side effects?
· Every person doesn’t get every side effect. Some people get few, if any.
· The severity of side effects varies greatly from person to person. Be sure to talk to
your doctor and nurse about which side effects are most likely with your treatment, how long they might last, how bad they might be, and when you should call the doctor’s office about them.
· Although side effects can be unpleasant, they must be measured against the need to
fight the cancer.
· Your doctor may give you medicines to prevent some side effects before they happen
or to treat certain side effects once they occur.
· Many people have no long-term problems from targeted therapy drugs.
How long do side effects last?
Most side effects slowly go away after treatment ends and the healthy cells recover. The time it takes to get over some side effects and regain energy varies from person to person. It depends on many factors, including your overall health and the drugs you were given. Because many targeted therapy drugs are still quite new, it’s hard to say how long you can expect side effects to last. We do know that some of the side effects from standard chemo drugs can last a lifetime, such as when the drug causes long-term damage to the heart, lungs, kidneys, or reproductive organs. We still don’t know if targeted therapy drugs cause these kinds of long-term changes.
Patients often become discouraged about how long their treatment lasts or the side effects they have. If you feel this way, talk to your doctor. You may be able to change your medicine or treatment schedule. Your doctor or nurse may be able to suggest ways to reduce problems or discomfort.
What are common side effects?
You are not alone if you have questions about side effects. Before cancer treatment starts, most people worry about whether they will have side effects and, if so, what they will be like. Here’s a review of some of the most common side effects caused by targeted therapy drugs. We also share some tips on how to manage them.
Many of the targeted therapy drugs can cause a rash or other skin changes. In fact, more than half the people taking these drugs have some skin effects. These problems usually develop slowly over days to weeks—they are not signs of a drug allergy.
In contrast, allergic reactions to drugs tend to start suddenly, usually within minutes to hours after taking the drug. They may include hives (raised skin welts that often go away within a day or so), and intense itching. An allergic reaction often includes other serious symptoms such as trouble breathing, dizziness, tightness in the throat or chest, or swelling of the lips or tongue. If you have these kinds of symptoms, get emergency help and call your doctor right away.
Why do targeted therapies cause skin changes?
Some targeted therapy drugs target the epidermal growth factor receptor (EGFR) protein, which tells the cancer cells to grow and divide. The problem is that normal skin cells also have a lot of EGFR, and they must grow quickly to maintain the skin’s surface layer.
Drugs that target or block EGFR often affect skin cells, too. They turn off the signal for skin cells to grow normally and make it harder for them to retain moisture.
Some drugs target other proteins, such as vascular endothelial growth factor (VEGF). These proteins help tumors build and keep a blood supply, but they also seem to be important to the very small blood vessels in the hands and feet. Damage to these tiny blood vessels can cause hand-foot syndrome (described later).
Researchers have noticed that people who are getting radiation therapy at the same time they get targeted drugs often have worse skin problems in the area that receives radiation.
What kind of skin changes can targeted therapies cause?
Changes in how your skin feels: Your skin may start off feeling like it’s sunburned, before any redness or rash shows up. Even though it doesn’t look different, the sensation can be disturbing. You may notice this change on your face as early as the first week of treatment.
Rash: The most common skin change is a rash. The risk of getting the rash and how bad it is depends on the type of cancer and the type and dose of the targeted therapy drug used to treat it. The rash is mild for most people. It often looks like acne (but with no blackheads) and shows up on the scalp, face, neck, chest, and upper back. In severe cases it can affect other parts of the body.
The rash most often starts as skin redness and swelling and is often worst within the first few weeks of treatment. By about the 4th week of treatment, the skin usually crusts and gets very dry and red. In the weeks after that, round, flat or raised red spots and pimples with pus in the center often appear. The rash can itch, burn, or sting, and may feel tender(painful) when you touch it. It may get better or stay about the same during the rest of treatment, but it should completely go away about a month after treatment is stopped.
The rash can be very distressing and make a person feel self-conscious around others. It might be painful and can lead to infections. Prevention and treatment are discussed later.
Dry skin: The skin can become very dry and scaly and may even crack open. Cracking can happen by itself or come with the rash. Cracking tends to be worse when it happens with the rash.
Itching: Many of the skin changes, like rash or dryness, can cause itching. Steps to prevent and treat skin changes, as discussed later, can help with itching. Some people may need to take medicine by mouth, such as diphenhydramine (Benadryl®), to get relief.
Red, sore cuticles (the areas around the nails): Some targeted therapies cause swollen, red, open, and painful skin sores around the fingernails and toenails. (This can look a lot like an infection or an ingrown nail.) This most often happens to the big toes and thumbs.
These sores may become infected. Nails may also become brittle and grow more slowly.
Hand-foot syndrome: Hand-foot syndrome (HFS) has been linked to many cancer treatment drugs, including some targeted therapies. The cause of this syndrome is not known for sure. It may have to do with damage to the tiny blood vessels in the hands and feet, or with the drugs themselves leaking out of the blood vessels and causing tissue damage.
A painful sensitivity of the hands and feet is the earliest symptom of HFS. Then, redness and swelling start in the palms of the hands and the soles of the feet. This redness looks a lot like sunburn and may blister. In severe cases, the blisters can open up and become sores. The affected skin also can become dry, peel, and crack. It may burn, tingle, or feelnumb.
HFS can be painful and can affect your ability to walk and do your normal activities. If it becomes severe, pain medicines may be needed. Let your doctor know if you are having
HFS symptoms—even if they are mild. Treating HFS early can help keep it from getting worse. Like the other skin changes discussed, it can be treated, and there are things you can do to try to prevent it.
Changes in hair growth: Hair on your head can become thin, dry and brittle, or even curly. Long-term use of targeted therapy may lead to bald patches or complete loss of scalp hair. Facial hair for both men and women may grow faster than usual, including longer, thicker, curly eyebrows and eyelashes that may need to be trimmed. But in some men, facial hair growth slows down. Eyebrows may thin out as well. These changes usually don’t happen right away, but you may notice them later as treatment goes on.
Some people notice sores on the scalp and other areas with hair. Scars that result from these sores may keep your hair from growing back after treatment is finished.
Changes in hair or skin color: Some of these drugs can cause the skin or hair to turn a yellowish color during treatment. In a few people, hair becomes darker. This tends to go away once treatment ends.
Changes in and around the eyes: The eye itself may burn, and become dry or red. In some, the eyelids get tender, swollen, or inflamed, and crusts may be seen in the lashes.
In a few people the eyelids may turn inward or outward. Distorted eyelids or prolonged dryness can damage the clear part of the eye (the cornea). Talk with your doctor or nurse about managing these changes to avoid injury, pain, or infection.
Can skin changes be prevented?
You can do some things to help prevent skin changes or at least to try to keep them under control. You should start to do them as soon as targeted therapy treatment begins—before any problems start. Starting good skin care before side effects begin may help to keep the problems to a minimum. Your doctor may ask you to do the following:
· Use a mild soap or body wash and shampoo that do not contain alcohol, perfume, or
· Take baths instead of showers, and try oatmeal bath products to soothe your skin.
· Bathe with cool or lukewarm (instead of hot) water. Avoid hot, humid places.
· Moisturize your skin at least 2 times a day with a thick cream that contains no
alcohol, perfume, or dye. Right after you bathe, while your skin is still damp, is the best time to do this.
· Do not use laundry detergents or fabric softeners with strong perfumes.
· Stay out of the sun. Wear hats, long sleeves, and sunscreen if you are outside during
the day. Sunlight seems to trigger the rash in some people.
· Use a sunscreen with SPF of at least 15 and zinc oxide or titanium dioxide at least 1
to 2 hours before going out, if you will be outside during the day. Wear cotton clothes and a hat, too.
· Though the rash may look like acne, acne medicines do not work on it—they can dry
it out and make it worse.
· If the soles of your feet are tender, gel shoe inserts may help.
· Wear shoes that fit well and aren’t too tight. Thick, soft socks may help if you have
shoes that are big enough for the extra bulk.
· Some makeup brands, such as Dermablend®, can cover the rash without making it
Ask your doctor or nurse if there are other things you can do to help lower the chance of skin problems getting worse.
What should I do if I have skin changes?
It’s very important to tell your doctor or nurse right away about any rashes or skin changes you notice. Left untreated, rashes can get worse and lead to infection, which can delay or even cause your doctor to stop treatment. Do not treat your skin with over-thecounter medicines or stop taking your targeted therapy without talking to your doctor first.
Your doctor may give you a skin cream or a medicine to take by mouth to treat the skin changes you have. Use these medicines the way the doctor tells you to and start them right away. Let your health care team know if your skin gets worse, or is not getting better after 2 weeks of treatment. Be sure to let your doctor or nurse know if:
· You notice a burning feeling, redness, or rash. There are creams you can use to try to
keep it from getting worse.
· Your skin is dry, flaking, or cracked. Moisturizing cream may help with this.
· Your skin is itchy. There are creams and gels you can use to ease itching. There are
also some medicines you can take by mouth to try to stop the itching.
· The area around your fingernails or toenails becomes sore or red. Creams and soaks
can help with this. But your health care team needs to watch to be sure you don’t get an infection.
· You have very dry, red, or tender eyes, or if you notice eyelashes growing inward
toward the eyeball.
· You get sores on your scalp or other areas with hair. You will want to get them
treated to help prevent scars that may block hair growth later.
Try to avoid exposure to sunlight. Even after treatment is over, you may find that you are more sensitive to the sun’s rays than before.
Can skin changes be treated?
Because these skin problems are linked to newer drugs, the best ways to handle them are still being studied. But doctors can help you manage them using what’s already known about these kinds of changes.
The doctor will need to check your skin fairly often to figure out the problem, the best course of action, and whether treatment is helping. You will probably need extra doctor visits while the problem is being brought under control.
Mild changes: Patients with mild skin changes may not need any treatment. These changes include rashes that are only in a limited area, that are not causing any distress, and are not infected. Heavy skin creams or ointments that contain no alcohol, perfume, or dye can sometimes help with dryness. Be sure to talk with your nurse or doctor before using anything on your skin.
The doctor also may prescribe a mild corticosteroid cream (such as hydrocortisone) or antibiotic gel (such as clindamycin) to put on the rash. Careful cleansing and clean, warm, wet cloths laid over your closed eyes may help if your eyelids are crusty or swollen.
The dose of the targeted therapy drug is usually not changed, and the patient is closely watched to see if the rash gets better or worse.
Moderate changes: These include a rash over a larger area of the body or skin changes causing mild distress from itching or soreness, but with no signs of infection. The skin may be treated with hydrocortisone cream, clindamycin gel, or pimecrolimus (Elidel®) cream. The doctor may also prescribe an antibiotic such as doxycycline or minocycline to be taken by mouth. Drops or ointments may be prescribed to help with eye problems.
The dose of the targeted therapy drug is usually not changed, and the patient is closely watched to see if the rash gets better or worse.
Severe changes: These are bad rashes that cover a lot of skin, cause itching and soreness that affect the patient’s quality of life (such as sleep problems or pain), and are likely to get infected. Treatment is much like that used for moderate changes, including a topical cream or gel (hydrocortisone cream, clindamycin gel, or pimecrolimus cream), as well as an antibiotic such as doxycycline or minocycline that is taken by mouth. Along with this, a course of corticosteroid pills, such as methylprednisolone (Medrol®) or prednisone, is often given.
The targeted therapy drug dose is often reduced when a person has severe skin changes. Expect to see your doctor often during this time. If the rash does not get better in 2 weeks, the targeted drug is often stopped until the skin changes improve. It may then be re-started with continuing skin care.
A note about steroid skin creams and gels
Steroids that are spread on the skin in the form of creams, ointments, or gels can help many skin problems. They can be used for up to 7 days after the problem has gone away. But it’s important to know that using steroid creams for too long can actually cause skin problems, and can make you more likely to get a skin infection. For this reason, steroid creams should not be used more than 14 days in a row. Many doctors suggest that patients who are given steroids to put on their skin use it in cycles. For instance, you might use it every day for 14 days, and then stop using it for a 7 day break. This cycle can be repeated as long as you have skin problems, or until your doctor tells you to stop.
Skin rash as a sign that treatment is working
There’s some thought that the skin rash may be a sign that the targeted therapy is working (the worse the rash, the better the treatment is working). But long-term follow-up is needed to link the rash to outcomes. People with no rash or with only a mild rash should not assume that the treatment is not working.
The 2 most important things you can do are to take good care of your skin when you start targeted therapy and let your doctor know right away about any skin changes you may have.
High blood pressure
Some targeted therapy drugs can raise your blood pressure. There isn’t really anything you can do to prevent this, but your doctor will watch your blood pressure closely if you are on a drug with this side effect. Some people need medicine to bring their blood pressure down to a safe level.
Problems with bleeding or clotting
Angiogenesis inhibitors interfere with the formation of new blood vessels. This can lead to problems with bruising and bleeding. Bleeding, such as from the stomach and intestines, can be severe and threaten life. These drugs can also cause clots in the lungs and legs, as well as heart attacks and strokes. These problems are rare, and there is no way to prevent them. If you have a problem like this, you may need to stop taking the targeted therapy drug.
Problems with wound healing
By blocking the formation of new blood vessels, angiogenesis inhibitors also interfere with wound healing. This can lead to old wounds (cuts) opening up again and new wounds not closing. It can also lead to holes opening up in the stomach or intestine (these are called perforations). Because these drugs interfere with wound healing, they are usually stopped before any planned surgery.
Other side effects
Other less common side effects have also been linked to treatment with targeted therapies. These include:
· Nausea and vomiting
· Mouth sores
· Shortness of breath
· Feeling tired all the time (fatigue)
· Swelling in your hands and feet
· Low blood cell counts
Your health care team will watch you closely during treatment and will check your blood cell counts often. Side effects can and should be treated as early as possible. It’s important that you tell your health care team about any changes in how you feel or anything you notice that’s new or unusual. Tell them right away so they can treat any problems and try to keep them from getting worse.
Some of these drugs also affect the heart and interact with other drugs and even foods.
When to call your doctor
When you are getting cancer treatment, you are likely more in tune with your body than you ever have been in your life. You notice every physical change and imbalance. Do not take any physical symptoms you have lightly.
Some side effects are fleeting and minor, but others may be a sign of serious problems. You should not be the judge. Tell your doctor or nurse about any changes you notice. Let them decide if anything needs to be done.
Be sure to tell your doctor right away if you have any of these symptoms during cancer treatment:
· A fever of 100.5°F or greater (taken by mouth)
· Bleeding or unexplained bruising
· A rash or allergic reaction, such as swelling of the mouth or throat, severe itching,
trouble breathing or swallowing
· Intense chills
· Pain or soreness at the chemo injection site or catheter site
· Unusual pain, including intense headaches
· Shortness of breath
· Long-lasting diarrhea or vomiting
· Bloody stool or blood in your urine
Other questions you may have
Can I drink alcohol?
Small amounts of alcohol can help you relax and increase your appetite. But alcohol may interact with some drugs so that they don’t work as well, or it may make the side effects worse. Be sure to ask your doctor if you can drink beer, wine, or any other alcoholic beverages.
Should I take vitamin or mineral supplements?
There’s no single answer to this question, but one thing is clear: No diet or nutritional plan can “cure” cancer. Taking vitamin and mineral supplements or any other complementary and alternative medicine should never take the place of medical care.You should not take any supplements without talking to your doctor first.
For more information, please call us or visit our Web site to get our Guidelines for Using Complementary and Alternative Methods and Complementary and Alternative Methods for Cancer Management.
Do I need to protect my loved ones from exposure to my targeted therapy drug?
Although there are guidelines for protecting those close to you while on standard chemo, little has been written about what’s needed while on targeted therapy. Even though these drugs tend to have less severe side effects, anyone taking a targeted therapy drug should avoid exposing their loved ones to the drug unnecessarily. This does not mean that you need to avoid close contact with loved ones while you are on treatment. It means that you should be careful about exposure to the drug itself or any body fluids that could contain the drug. If you are taking the drug at home, you should keep your pills safe from children and pets. Ask your health care team about precautions you and your family should take.
What about my sex life?
Some people feel closer than ever to their partners and have an increased desire for sex during treatment. Some notice 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 treatment. These stresses may include:
· Worries about changes in how you look
· Anxiety about health, family, or finances
· Side effects
A partner’s concerns or fears also can affect the sexual relationship. Some may worry that physical intimacy will harm the person who has cancer. Others may be afraid they might “catch” the cancer or be affected by the drugs.
You and your partner can clear up many of these misunderstandings by talking about sexual concerns with your doctor, nurse, or a counselor. Though you may find it hard to do, talk to a health professional 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 hard for you to talk to each other about sex or cancer, or both, you may want to talk to a counselor who can help you communicate more openly.
If you were comfortable with and enjoyed sex before starting treatment, chances are you will still find pleasure in physical intimacy during treatment. But you may find that intimacy takes on new meaning. Hugging, touching, holding, and cuddling may become more important, while sexual intercourse may become less important.
Pregnancy and targeted therapy
It may be possible to get pregnant during treatment, but it should be avoided because targeted therapy drugs may cause birth defects. Doctors advise women of childbearing age – from the teens through the end of menopause – to use birth control throughout treatment.
If a woman is pregnant when her cancer is discovered, it may be possible to delay treatment until after the baby is born. For a woman who needs treatment sooner, the doctor may suggest starting treatment 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.
Talk to your doctor if you and your partner are considering pregnancy after completing treatment.
Thoughts, emotions, and targeted therapy treatment
What about my memory and thinking?
Research has shown that cancer treatment can impact the thinking functions of the brain (known as cognitive functioning) for up to 10 years after treatment. This is commonly called chemo brain or chemo fog. But whether targeted therapy drugs given without chemo or radiation can cause chemo brain is not known at this time.
Some of the brain’s activities that can be affected by cancer treatment are concentration, memory, comprehension (understanding), and reasoning. The changes that are found in patients are often very subtle, but the people who have these problems are very aware of the changes in their ability to think.
If problems with thinking are interfering with your daily life, there are memory retraining exercises and programs, as well as other treatments that may help you retain or improve your memory and problem-solving abilities. You can also learn strategies that may help you cope with the loss of cognitive function. Ask your doctor if he or she can recommend a health professional who can help. You can learn more in our document called Chemo Brain.
What emotional effects can I expect?
Cancer treatment can bring major changes to your life. It can affect your overall health, threaten your sense of well-being, disrupt your daily routines, and put a strain on your relationships. It’s normal and understandable for you and your family to feel sad, anxious, angry, or depressed. There are ways to cope with these emotional side effects, just as there are ways to cope with the physical side effects.
You can draw support from many sources. Here are some of the most important ones:
Doctors and nurses
If you have questions or worries about your cancer treatment, talk with members of your health care team. If they are unable to give you the help you need, they can refer you to other health professionals who can help you.
Counseling and mental health professionals
Counselors can help you express, understand, and cope with the emotions caused by cancer and cancer treatment. Depending on what you want and need, you might want to talk with a psychiatrist, psychologist, social worker, sex therapist, or member of the clergy.
Friends and family
Talking with friends or family members may help you feel a lot better. Often, they can comfort and reassure you in ways that no one else can. But you may find that you have to make the first move. Many people do not understand cancer and may withdraw from you because they’re afraid of your illness. Others may worry that they will upset you by saying the wrong thing.
You can help relieve others’ fears by talking openly with them about your illness, your treatment, your needs, and your feelings. You can correct mistaken ideas and let people know that there’s no one “right” thing to say. Once people know they can talk with you honestly, they may be more willing and able to open up.
Coping tips for everyday life
· Try to keep your treatment goals in mind. This can help you keep going on days when it gets rough.
· Eat well. Your body needs food to rebuild tissues and regain strength.
· Learn as much as you want to know about your disease and its treatment. This can lessen your fear of the unknown and increase your feeling of control.
· Exercise if you can and if your doctor says it’s OK. Using your body can help you fight fatigue, build your appetite, and make you feel better about yourself.
· Keep a journal or diary while you’re being treated. Recording your activities and thoughts can help you understand the feelings you have as you go through treatment.
It may also help highlight questions you need to ask your doctor or nurse. You can use your journal to record side effects. This will help you when you talk about them with your doctor and nurse. Write down the steps you take to cope with side effects and how well those steps work, too. That way, you’ll know what worked best for you in case you have the same side effects again.
· Try new hobbies or go back to one you loved before. Learn new skills.
· Take it easy. You may not have as much energy as usual, so try to get as much rest as
you can. Let the small stuff slide and only do the things that are most important to you.
Agha R, Kinahan K, Bennett CL, Lacouture ME. Dermatologic challenges in cancer patients and survivors. Oncology. 2007;21:1462-1472.
Braiteh F, Kurzrock R, Johnson FM. Trichomegaly of the eyelashes after lung cancer treatment with the epidermal growth factor receptor inhibitor erlotinib. J Clin Oncol. 2008;26:3460-3462.
Burtness B, Anadkat M, Basti S, et al. NCCN Task Force Report: Management of Dermatologic and Other Toxicities Associated With EGFR Inhibition in Patients With Cancer. J Natl Compr Canc Netw. 2009;7 Suppl 1:S5-S21. Community Oncology Conference Highlights. Managing toxicities of EGFR inhibitors. 2008;5:202-203.
Esper P, Gale D, Muehlbauer P. What kind of rash is it? Deciphering the dermatologic toxicities of biologic and targeted therapies. Clin J Oncol Nurs. 2007;11:659-666.
Kyriakou F, Kountourakis P, Papamichael D. Targeted agents: review of toxicity in the elderly metastatic colorectal cancer patients. Targ Oncol. 2011;6: 245-251.
Lacouture ME, Mitchell EP, Piperdi B, et al. Skin toxicity evaluation protocol with panitumumab (STEPP), a phase II, open-label, randomized trial evaluating the impact of a pre-emptive skin treatment regimen on skin toxicities and quality of life in patients with metastatic colorectal cancer. J Clin Oncol. 2010;28(8):1351-7.
Lacouture ME, West DP, Tigue CC, Knox K, Bennett CL. Cutaneous toxicities of targeted cancer therapies. Community Oncology. 2008;5(7):413-414.
Li T, Perez-Soler R. Skin toxicities associated with epidermal growth factor receptor inhibitors. Targ Oncol. 2009;4(2):107-19.
Lynch TJ, Kim ES, Eaby B, et al. Epidermal growth factor receptor inhibitor-associated cutaneous toxicities: an evolving paradigm in clinical management. Oncologist. 2007;12:610-621.
Moore SH, O'Connell MJ, Wilkes GM. Optimizing Outcomes for Metastatic Colorectal
Cancer Patients: An APN Roundtable Discussion. Institute for Medical Education & Research. March 2008.
Source from www.cancer.org.