Managing the Side Effects of CML Treatment

Managing side effects

Here are a few tips for managing the different side effects of CML treatment.

Cardiac effects

Tyrosine kinase inhibitors (TKIs) are drugs used as a form of targeted therapy to treat various forms of cancer.

TKI medications, such as Gleevec, can affect your heart’s rhythm. This isn’t a common side effect, but it can happen. You may have the sensation that your heart is racing or skipping beats while taking TKIs like Gleevec.

If you have heart issues, like arrhythmia, before treatment, be sure to tell your doctor.

They may want to order an EKG before you begin your medication and schedule follow-ups to monitor any heart changes during your treatment.

Fatigue

You may experience extreme tiredness or fatigue while in treatment for CML. These are common symptoms among those being treated for cancer in general.

Try to rest when you can. Light exercise, like walking, swimming, and cycling, and staying hydrated may also help with your fatigue.

Anemia and low red blood cell count can sometimes worsen your tiredness. Your doctor can test your blood to determine your levels and prescribe medications to treat the anemia and help with your fatigue.

Nausea

You may feel nauseous or lose your appetite, especially during chemotherapy treatments, but not everyone has this side effect.

You might experience nausea if:

• you’re a woman
• you’re younger than age 50
• you’ve had morning sickness during pregnancy
• you have a history of motion sickness

Your doctor can recommend certain anti-nausea medications. Ondansetron (Zofran), alprazolam (Xanax), and metoclopramide (Reglan) are just a few that may help.

In addition to medication, eating small meals that appeal to you can help combat nausea. It also helps to drink plenty of fluids and stay away from triggers, like unpleasant smells.

Practicing meditation and deep breathing exercises are additional ways to help relax your body and combat nausea.

Hair loss

Chemotherapy may kill healthy cells that help with hair growth. You may lose hair over various parts of your body — your eyelashes, armpit hair, pubic hair, etc. — not just on your head.

There isn’t a lot you can do to prevent hair loss. You may start to lose your hair about 2 to 4 weeks into treatment.

The good news is that hair loss is usually temporary.

Hair generally starts growing back about 3 to 6 months after you’ve completed chemo. When it grows back, it may be a different color or texture.

Doctors are exploring potential ways to prevent hair loss. Though they haven’t been extremely effective, they’ve seen some positive results.

Hair loss prevention methods include:

• Cryotherapy. In this treatment, you place ice packs on your head to slow blood flow to your scalp. Some people have had success with this method, but it may carry a risk of cancer recurring in the areas treated with the ice packs.
• Rogaine. This drug doesn’t stop hair loss, but it may help your hair return faster after treatment.

If you’re feeling self-conscious about hair loss, it may help to treat yourself to something that makes you feel good when you look in the mirror, like a new hat, or fun makeup.

You can also connect with a support group to talk with others who understand and share your experience.

Diarrhea

Diarrhea is one of the most common side effects of TKI drugs. Chemotherapy can also kill the cells in your intestines and lead to diarrhea.

Beyond that, the stress and anxiety of going through cancer treatment can upset your stomach from time to time.

Diarrhea is a side effect that should discuss with your doctor, especially if you experience any of the following symptoms:

• six or more loose stools in a day for 2 days or more
• blood in your diarrhea
• inability to urinate for 12 hours or longer
• inability to keep down liquids like water
• weight loss
• constipation in combination with diarrhea
• swollen abdomen
• fever over 100.4˚F (38˚C)

If you have diarrhea, make sure you’re drinking lots of water and other liquids. One of the main concerns is dehydration.

As well, stick to low-fiber foods. For example:

• bananas
• rice
• applesauce
• toast

Stay away from other foods that may irritate your intestines, such as:

• dairy products
• spicy foods
• alcohol
• caffeinated beverages
• oranges
• prune juice
• foods high in fat and fiber

Probiotics may help. You can find these gut-healthy microorganisms in foods like yogurt or in dietary supplements.

These bacteria aid in restoring your normal digestion. Some names you may encounter include Lactobacillus or Bifidobacterium. Your doctor may be able to suggest certain probiotic supplements.

Depression

Another side effect linked to TKIs is depression. You may also experience feelings of depression related to your cancer in general, and the drugs could make it worse.

It’s important to tell a loved one and your doctor if you’re having these feelings, especially if they continue for 2 weeks or longer.

Engaging in regular exercise can help to ease depression. So can seeking counseling to talk about your cancer and your feelings. Surrounding yourself with a network of supportive people may also help.

Your doctor can help you locate and make referrals to support groups. Talking to people who are going through similar issues is invaluable.

It’s important to remember that your feelings are valid. Going through cancer treatment is tough.

What isn’t necessarily normal is being unable to eat or sleep, feeling restless or confused, having trouble breathing, or having your feelings interfere with your daily life.

Talk to your doctor about these feelings. Call 911 if you have thoughts of suicide.

Know that help is available.

Rashes and other skin issues

TKIs may cause rashes and other skin issues such as mouth sores. Almost 90 out of 100 people taking TKIs experience this side effect.

Skin issues may start about 2 weeks into your treatment. Tell your doctor if you experience this side effect, because early treatment is the key to keeping it well managed.

Your doctor may prescribe hydrocortisone cream, tetracycline, or oral minocycline (Minocin).

While these drugs may not stop your rash from occurring, they can help slow the development of your skin issues and lessen the severity.

Wearing sunscreen can help to protect your skin from UV light, which can make your rash worse. Read labels carefully and try choosing sunscreens that don’t contain irritating alcohol.

Wearing clothing with long sleeves or legs is another option.

Choosing mild soaps and detergents, skipping hot showers, and choosing hypoallergenic makeup whenever possible can also help manage your skin issues.

Mouth sores

Mouth sores are another common side effect of TKI therapy. Your doctor can prescribe what’s commonly known as “magic mouthwash” to help with this side effect.

You would use it every 4 to 6 hours. Avoid eating or drinking for 30 minutes after using it.

Other things you can do:

• Brush and floss regularly.
• Skip spicy foods and hot foods and drinks.
• Eat soft foods.
• Use milder toothpaste or simply use baking soda to brush your teeth.
• Rinse your mouth with saline several times per day.

When to see your doctor

Managing side effects can help you relax and feel more comfortable during treatment. Tell your doctor what you’re experiencing and ask how your medical team might be able to help you.

For example, there are different medications that can help relieve certain issues. Your doctor may also be able to recommend lifestyle changes that can lessen side effects.

It’s also a good idea to tell your doctor if you notice anything unusual or if a side effect is deeply affecting your everyday life. Contact your doctor if you experience any of these symptoms:

• fever over 100.4˚F (38˚C) or uncontrolled shivering
• unusual bleeding or bruising, like blood in your urine or a nose bleed
• nausea or vomiting that keeps you from taking your medications or eating and drinking
• severe stomach issues, like diarrhea, cramping, or constipation
• shortness of breath and coughing
• new rash or itching
• headache that won’t let up
• pain or soreness, swelling, or pus anywhere on your body
• episodes of self-injury

Treatments for CML

Oral medications called tyrosine kinase inhibitors, or TKIs, are a popular option for people in the chronic stage of myeloid leukemia.

These medications block the protein tyrosine kinase from growing and multiplying cancer cells.

This treatment is quite effective. Most people who take TKIs eventually go into remission.

Available TKIs include:

• imatinib (Gleevec)
• dasatinib (Sprycel)
• nilotinib (Tasigna)
• bosutinib (Bosulif)
• ponatinib (Iclusig)

Along with medications, you may receive chemotherapy treatments. Chemotherapy is taken by mouth or given intravenously (in your veins). It works by killing cells that multiply quickly.

While this treatment can kill leukemia cells, it may also kill off other fast-growing cells, like those that make your hair or the tissues in your mouth and in your gut, among others.

Takeaway

It’s important for you to report any changes in your health to your doctor. That said, some side effects may be unavoidable. Your doctor can help you identify lifestyle changes and other ways to reduce side effects.

Remember that you and your doctor are partners in your treatment. Your doctor knows the treatments and potential side effects, but you know your body. Make sure to communicate how you’re feeling.