There are several other issues to consider when living with ovarian cancer. Many women desire to “take back” control of their lives after the ovarian cancer diagnosis is made. Some women feel as if control is incrementally removed from the very onset of the disease. By becoming knowledgeable about the disease and treatment options, you can begin to regain control and maintain an active partnership with your health care team. You can also take control by making specific choices about how to care for yourself physically, emotionally, and spiritually throughout treatment and beyond. For example, maintaining wellness through good nutrition is very important. Although treatment may alter your desire for food, alter taste and smell, or cause nausea and vomiting, eating a diet high in protein and carbohydrates is essential to restoring balance and health because of damage caused by the cancer and the treatment.

Physical activity is equally important to your physical and emotional well-being. Simple exercise such as walking can increase your appetite and improve your nutritional status, cause improved breathing patterns that aid adequate oxygenation of tissues, and stimulate the release of hormones in the brain that arouse feelings of euphoria (happiness) and reduce distress. Physical exercise does not need to be strenuous to be beneficial. Your health care team can help you design an exercise plan that is appropriate for your situation.

As an active participant in your health care, you will want to become informed about side effects before you select your treatment program so that you are aware of the answers to the following questions:

• What side effects commonly occur with each type of treatment or drug regimen?
• What is the likelihood that you will have those side effects, and how mild or severe they might be?
• Do the benefits of a specific treatment outweigh the potential side effects?
• Which side effects are more compatible with your lifestyle and expectations for your quality of life during cancer treatment?

Above all, in many instances with the treatment of ovarian cancer, you do have a choice about the type of chemotherapy drugs, radiation therapy, and/or surgery you want to receive. This is probably one of the most important conversations you will have with your oncologist as you discuss your disease, its prognosis, and treatment options.

Nearly every form of cancer treatment has some side effects. The incidence and management of side effects are as unique as you are. You may have only a few of the side effects usually associated with the therapy you are receiving. Being aware of what might happen can reassure you that certain side effects are “normal” and can help prepare you for what to do if they occur. Awareness can also help you to avoid certain side effects by selecting a different treatment course or by preparing you and your physician to be proactive in taking medications (such as for nausea and vomiting) that will prevent or ease the impact of the side effect itself. It is always best to contact your physician to report any concerns about how you are reacting to either the disease or its treatments. It is YOUR responsibility to report side effects to your physician and/or nurse.

The most common side effects of treatment for ovarian cancer can include, but are not limited to, fatigue, peripheral neuropathy, difficulty breathing, sore throat, coughing, nausea, risk of infection, diarrhea, mouth sores, and hair loss. Some other important and often difficult side effects to cope with include infection, pain, and emotional distress such as anxiety and depression. The good news is that there are specific approaches you can take to not only manage but also, in some circumstances, even prevent these challenging and worrisome side effects.

Fatigue is an overwhelming and consistent lack of energy that is not related to exertion or relieved with a good night’s sleep. Fatigue is one of the most significant long-term side effects of cancer treatment and is almost universally experienced by people undergoing cancer treatment. The most common cause for fatigue during or following cancer treatment (especially chemotherapy) is a low red blood cell count, also known as anemia. Fatigue may also be related to an iron-deficiency anemia and can be treated with iron supplements or enhanced diet, or fatigue may be caused by emotional distress such as depression and anxiety. Generally, fatigue will begin to subside within a few months after the end of treatment.

• Talk to your doctor about how your existing medical condition and treatment may be causing you to feel fatigued.
• If you have a low hemoglobin level (concentration of red blood cells in the blood), talk to your doctor about red blood cell growth factors that stimulate the production of red blood cells and reduce fatigue.
• Get plenty of rest. Take small naps throughout the day.
• Do some form of physical activity, starting slowly at first and working up to a level that is comfortable.
• Drink plenty of water during the day.
• Avoid caffeine and tobacco.
• Practice conserving your energy by asking for help from family and friends to help with chores, errands, or other tasks.
• Consider a gentle exercise or stress-reduction program such as Tai Chi or yoga.

Infection can occur after surgery, chemotherapy, and/or radiation therapy. Certain chemotherapy drugs have a more dramatic effect than others on the immune system by destroying not only the cancer cells, but healthy blood cells as well, including the white blood cells (called neutrophils) that help fight infection. Because a serious infection can be potentially life threatening, requiring hospitalization and the delay of scheduled treatment, prevention and control are the primary tools to manage this serious side effect.

• Talk to your doctor before starting chemotherapy to discuss the risk of this potential side effect and to discuss medications such as white cell growth factors that could help you avoid prolonged periods of low white blood cell counts (neutropenia).
• Call your doctor immediately if you have a temperature of 100.4°F or higher, pain, redness, swelling or pus at a surgical or central line site, severe chills, pain while urinating, or trouble breathing.
• Practice good hand-washing techniques and avoid crowds or people who might have contagious conditions, such as the common cold, flu, chicken pox to name a few.

Many people assume that nausea and vomiting are expected or inevitable with cancer treatment. Fortunately, significant advances have occurred in recent years that have revolutionized cancer therapy so that these side effects can be controlled effectively. This has not only improved quality of life for cancer patients, but has made it possible for patients to tolerate even more aggressive treatments for their disease. There are different treatments for nausea and vomiting depending on when these side effects are likely to occur and what is likely to cause them.

Chemotherapy-induced vomiting can be divided into 3 types: acute, delayed, and anticipatory. Acute nausea and vomiting usually occur within 24 hours of the chemotherapy treatment. Delayed nausea or vomiting generally begins 24 hours after the administration of chemotherapy and can persist for 6 to 7 days. Anticipatory nausea or vomiting is thought to be a learned response and typically occurs when the patient has experienced nausea and vomiting in previous treatment sessions.

Not all chemotherapy causes nausea and vomiting. Other cancer treatments, such as surgery and radiation, may also cause these side effects. For example, nausea may be a side effect of radiation to the esophagus or upper body. It is important, however, that nausea and vomiting be controlled not just to improve quality of life, but to keep you hydrated, rested, and relaxed. There are excellent medications available today that effectively control nausea and vomiting with most cancer treatments.

When patients receive chemotherapy drugs for ovarian cancer that are known to have higher risk for acute nausea and vomiting (within 24 hours of treatment), the American Society of Clinical Oncology (ASCO) recommends the use of what are called antiemetic medications, often in combination with another medicine called a steroid, before chemotherapy. Antiemetic medications such as ondansetron (Zofran®), granisetron (Kytril®), or dolasetron (Anzemet®), are often combined with a steroid such as dexamethasone. Doses of these medications are modified according to how much risk a specific chemotherapy drug has for causing nausea and vomiting.

The FDA has approved ondansetron (Zofran®) for the prevention of nausea and vomiting associated with surgery, chemotherapy, and radiotherapy. It is available as an intravenous solution, an oral liquid, a single-dose tablet, and as an orally disintegrating tablet for ease of use in patients who may have mouth sores, esophagitis, or difficulty swallowing. Ondansetron (Zofran®) is the only FDA-approved medication in its class that can be administered for one to two days following any chemotherapy and/or radiotherapy that is known to have moderately high risk for causing nausea and vomiting.

Granisetron (Kytril®) is available as an intravenous solution and an oral tablet and is approved by the FDA for prevention of nausea and vomiting associated with chemotherapy, radiotherapy, and surgery. The FDA has approved the use of dolasetron (Anzemet®) for the prevention of nausea and vomiting associated with chemotherapy and surgery. However, it should be used with caution in patients who have, or are at risk for, certain heart problems. Dolasetron is available as an intravenous solution and as an oral tablet.

Two studies examined a new antiemetic drug called aprepitant (brand name EMEND®) in patients undergoing cancer treatment with the chemotherapy drug cisplatin. In both studies, patients who received aprepitant suffered less nausea and vomiting than patients who received standard antiemetic drugs. Ted Trimble, M.D., of the National Cancer Institute’s Cancer Therapy Evaluation Program, agrees that “we still need to determine how best to use [aprepitant] in combination with other antiemetics when giving chemotherapy that does not contain cisplatin.” Nonetheless, he said, “aprepitant appears to be another useful drug to help control nausea and vomiting” which, besides making people feel miserable, “can also discourage them from continuing their cancer treatment.” (This paragraph is reprinted, in part, courtesy of the national cancer institute)

As with any medications, there are potential side effects when taking antiemetic therapy. Some of the possible side effects in all of the medications discussed above may include diarrhea, constipation, and headache.

Certain chemotherapy drugs, such as the platinum-based drugs (cisplatin or carboplatin), can cause peripheral neuropathy, which is a tingling, burning, weakness, or numbness in the hands or feet that can make it difficult to handle objects or even to manipulate your fingers. These same kinds of chemotherapy agents can also cause muscle weakness, hearing loss, ringing in the ears, difficulty walking, or seizures.

Any of the following symptoms should be reported to your physician immediately. Discuss the risk of these side effects with your oncologist before making decisions about your treatment regimen.

• If you experience peripheral neuropathy, be careful when grasping sharp or hot objects
• Use handrails when going up and down stairs
• Always wear shoes or house slippers with rubber soles to prevent falls
• Remove throw rugs or other objects in your home that might cause you to trip
• Avoid exposing your fingers and toes to very hot or very cold temperatures

Radiation therapy and many chemotherapy drugs can cause hair loss or alopecia. Some chemotherapy drugs cause people to lose some of their hair and some cause people to lose it all, including body hair, eyebrows, and eyelashes. Talk to your doctor about what you can expect regarding hair loss with your specific treatment regimen. Some helpful hints include the following:

• Use mild shampoos and soft hairbrushes
• Use low heat when drying your hair
• Buy scarves, wigs, hats, or a scalp prosthesis
• When buying a wig, try to do so before you lose your hair so the hair stylist can more easily match your color and preference
• Do not dye your hair or get a permanent or body wave
• Use sunscreen and wear a hat or scarf to protect your scalp from the sun
• Call the local American Cancer Society to see if a “Look Good…Feel Better” program is being held in your area

Ask your doctor if there are short-term side effects or side effects that can accumulate over time with certain cancer treatments.