Side Effects of Advanced Pancreatic Cancer Treatment: How to Manage What You Can

The goal of advanced pancreatic cancer treatment is to slow the spread of cancer cells in your body while trying to maintain or improve your quality of life. Managing side effects is an important part of that. Here's a look at the side effects you might have, how your doctors can help, and what you can do at home.

Your doctor can check for issues like anemia or depression that may be causing fatigue. They can also review your treatments. Some kinds, including chemotherapy, can make you tired and may be able to be adjusted. Your doctor may also refer you to an occupational therapist who can provide tips to combat fatigue and weakness so you can keep doing things that are important to you.

Save your energy for things you truly want or have to do. Taking on too much may wipe you out. Upping your physical activity can give you more energy, so if you're able to, try a short daily walk. Avoid napping if possible. It may make you feel more tired. Staying hydrated and eating protein-rich foods like eggs, beans, lean meats, nut butters, and protein shakes can also help fight fatigue.

Different medications can help settle your stomach and stop you from throwing up. Some of these, like meclizine, metoclopramide, and prochlorperazine, block signals from the part of your brain that triggers nausea. Steroids and sedatives are sometimes also helpful. Tell your doctor if you can't swallow a pill. They can prescribe medication as a tablet that dissolves in your mouth or give it to you in an IV or syringe pump.

An empty stomach can make your upset stomach worse. Try eating small, frequent meals, even if you can only keep down crackers, and sip peppermint or ginger tea when you can. Avoid sweet, spicy, or fried foods. You can also try a Sea-Band or another acupressure wristband that you buy at the store. Research shows that pressing a specific point inside your wrist can help with nausea from chemotherapy.

Your doctor can prescribe anti-diarrhea medication that slows your digestion or relieves cramping. If you're not digesting food well, pancreatic enzyme replacement therapy (PERT) can help your body break down the carbohydrates, fats, and protein in food. Your doctor can also run tests to look for other treatable causes of your diarrhea. That could include small intestinal bacterial overgrowth (SIBO), in which you have too much bacteria in your gut, and bile acid malabsorption (excess bile in your intestine).

Over-the-counter anti-diarrhea drugs can slow your digestion or make your stool more solid. Ask your doctor which kind to try. Also, stick to low-fat foods, foods with soluble fiber, like oatmeal, and foods with pectin, like applesauce. Avoid greasy fried foods, rich desserts, whole or 2% milk, and any foods that cause you to have gas. They can make diarrhea worse. Drink plenty of fluids to replace the liquids that you lose. Besides water, try broth, sports drinks, and fruit juices.

Your doctor can treat any symptoms that are making it hard for you to eat. They can also prescribe medication to improve your appetite. For instance, megestrol acetate is a manmade hormone that makes you feel hungrier as a side effect. Olanzapine, an antipsychotic medication that changes your brain chemistry, is also used to help people with cancer gain weight. Your doctor can also connect you to a dietitian or nutritionist for more meal tips.

Set phone alerts that remind you to eat every two to three hours. Keep foods on hand that taste good and are easy to prepare. Distracting yourself with a book, audiobook, or movie may help you eat more. When you have the energy, treat meals like a special event. For instance, you could invite loved ones to join you, set the table with special dishes, or turn on your favorite music.

Talk to your doctor as soon as you have belly pain. It’s easiest to treat when you catch it early. For medium to strong cancer-related pain, your doctor could prescribe an opioid drug. Some antidepressant and antiseizure medications can help relieve tingling and burning pain. Based on where you live, medical marijuana may be another option. If the pain is from a tumor pressing on your nerves, surgery may help shrink it.

The traditional Chinese practice of acupuncture uses very thin, sterile needles to stimulate special points on your body. It’s been shown to improve many different types of pain in people living with cancer. Other treatments you could try for belly pain include meditation, relaxation, hypnosis, physical therapy, and hot or cold compresses. Check with your doctor before trying any of these strategies, and share your current health and treatment plan with new providers.

Pain medication can help you eat and drink more comfortably. For instance, lidocaine is a special numbing mouth rinse that you use before meals. Gelclair is another medication that helps protect and soothe your mouth. Other rinses contain steroids, which can help in severe cases, or antibiotics, if your mouth sores are infected. Since mouth sores are often due to chemotherapy, your doctor can also adjust your dosage or the type that you get.

Choose soft, moist foods (like yogurt) over ones that are hard and dry (like chips or raw vegetables). Avoid spicy foods as well as drinks that are high in acid, like orange juice. Cold foods like ice cream and popsicles can provide short-term relief from the pain, and eating more protein-rich foods may help your mouth sores heal more quickly. Using a straw to drink liquids may be helpful.

If you don't get dehydration under control quickly, it can lead to issues like low blood pressure and kidney and liver damage. Your doctor can give you fluids by IV (through a vein) if you're dehydrated. They'll also look for the reason that you're low on fluids to try to prevent you from getting dehydrated again. You may need medication to help manage symptoms like nausea and diarrhea. Your doctor could also suggest that you regularly have oral rehydration drinks.

Have a glass of water as soon as you wake up, then keep a water bottle with you throughout the day so you remember to keep drinking. You might find that iced or cold fluids, including ice chips, are easiest to get down. Foods like soups, fruits, vegetables, and yogurt can help you stay hydrated, too. If you feel dizzy or weak when you stand up, or if you have a fast heart rate, call 911 right away.

If a tumor blocks the bile tube that goes from your liver to your pancreas, bilirubin, which is found in bile, can back up in your blood. You could have yellowed skin and eyes, dark urine, pale stools, and itching. Your doctor may remove the tumor during surgery or put a small tube (stent) into your bile duct to open it up. A drug called cholestyramine, which binds with bile, can help ease itching on your skin.

Avoid things that make your liver work harder. Unless your doctor gives you different advice, that includes over-the-counter pain relievers, herbal supplements (even if they're "natural"), and alcohol. Support your liver health by trying to get enough rest, drinking plenty of water, and eating healthy foods like fruits, vegetables, lean proteins, and whole grains. To distract yourself from itching, try relaxation exercises, guided visualization, or gentle massage.

The steps that your doctor takes will depend on which blood cells are low. If you don't have enough white blood cells, you're at risk of infection. Your doctor can prescribe a medication that raises them. Low red blood cells can make you feel tired and short of breath. Your doctor could give you a daily iron pill or iron supplement by IV. In some cases, you may need a blood transfusion. A platelet infusion can help with low platelets.

Wash your hands often. If you don't have access to soap and water, use hand sanitizer. Try to stay away from big crowds and people who are sick, and ask someone else to clean up after your pet. Do your best to avoid getting cuts and scrapes, and take care even when you blow your nose, shave, and brush your teeth. Your doctor may suggest that you also eat more iron-rich foods like eggs, beans, and leafy greens.

Call your doctor the same day that you notice new or worsened symptoms like pain, vomiting, confusion, bleeding, rashes, or depression. If it's after office hours, talk to the doctor on call. Call 911 or get to a hospital right away if you have bleeding that won't stop, trouble breathing, chest pain, a seizure, fainting or passing out, or you have thoughts of hurting yourself or others.