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Kidney Cancer: Managing Treatment Side Effects
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Kidney Cancer: Managing Treatment Side Effects

March 21, 2017

Kidney Cancer: Managing Treatment Side Effects

Treatment for kidney cancer can cause side effects. The side effects vary from person to person. The side effects you may have depend on the kinds of treatment you have, your overall health, and other factors.          

Side effects of kidney cancer treatment can include:

  • Anxiety or depression

  • Appetite loss

  • Bleeding problems

  • Bloating and swelling

  • Constipation

  • Diarrhea

  • Hair loss (alopecia)

  • Infection

  • Low sex drive (low libido)

  • Menopausal symptoms

  • Mouth and lip sores

  • Nausea and vomiting

  • Nerve damage (peripheral neuropathy)

  • Pain

  • Scarring

  • Shortness of breath (dyspnea)

  • Skin irritation

  • Sleep problems (insomnia)

  • Trouble thinking and remembering

  • Tiredness (fatigue)                     

Read below to see ways to manage each of these side effects during your treatment.

Anxiety or depression

Some people may feel worried, sad, or stressed when dealing with cancer. These feelings may continue during treatment. You may also worry about how you will look after the treatment. You may have mood changes as a side effect of treatment. These may be mild or serious. Seek help right away if have:

  • Frequent crying

  • Extreme sadness

  • Loss of interest in things you once enjoyed

  • Severe changes in mood

  • Thoughts of suicide

Make sure to:

  • Talk with your family or friends. Express your concerns.

  • Ask your health care team, health care team, or social worker for help. They can connect you with a support group. It can help to talk about concerns with people who have gone through the same experience.

  • Speak to a counselor. A professional therapist can help you cope with stress and other feelings.

  • Talk with your spiritual advisor. A priest, minister, or rabbi can help you during this time.

  • Ask your health care team about medicines. If depression or anxiety makes it hard to cope with daily life, your health care team may recommend medicines to help.

  • Keep active. Maintain your social activities as much as possible. Keep physically active, too. Walk, ride a bike, go to the gym.

  • Get group support. Join a cancer support group or find a cancer “buddy” who can help you cope.

Appetite loss

Many cancer treatments cause a loss of appetite. Chemotherapy can damage cells in the gastrointestinal tract. Or it can affect areas of the brain that control appetite. Radiation can change the way food tastes to you. It can make it hard for you to swallow, or reduce your appetite. Immunotherapy and chemotherapy can also leave a strange taste in your mouth.

Patients who eat well during cancer treatment maintain their strength better, are more active, and are better able to lower their risk of infection. Your body needs energy from food to heal itself. When you're being treated for cancer, a diet high in calories and protein is best. Maintaining your weight is a good way to know if you're giving your body the energy it needs.

Some people may gain weight as a side effect from steroids or anti-nausea medicines. If this is the case for you, focus on getting a balanced diet and increasing your activity level. Now is not the time to go on a diet.

Ask your health care team to refer you to a registered dietitian if you are having trouble with your appetite. Also, try these tips to stimulate your desire to eat:

  • If you can, eat foods high in protein several times a day. These include milk, cheese, yogurt, meat, fish, eggs, beans, peanut butter, and nuts. Protein helps build and repair tissue. Cancer treatments cause you to use more protein than usual.

  • If you are underweight, add high-calorie foods to help you gain or maintain your weight. These include margarine or butter, sugar, honey, jams, jellies, cream cheese, dried fruit, gravies or sauces, mayonnaise, and salad dressing.

  • Eat what sounds appealing, and worry less about eating “healthy” if you are having problems maintaining your weight.

  • Drink plenty of water, fruit juices, and other liquids. Also try gelatin, pudding, soups, fruit bars, and ice cream to increase your fluid intake.

  • Eat small meals during the day instead of large ones.

  • Keep snacks handy to eat when you are hungry.

  • Eat with friends or play your favorite music at mealtime to boost your appetite.

  • Eat your biggest meal in the morning. Many people getting treatment for cancer find this is when they have the most appetite.

  • If you can, increase your activity level. This may boost your appetite.

  • On days you don't feel like eating, don't worry. Try again the next day. If you find your appetite doesn't improve in several days, talk with your health care provider.

  • Suck on sugar-free candies or chew sugar-free gum if you have a strange taste in your mouth from treatment.

Bleeding problems

Some kinds of chemotherapy or other treatments may reduce your blood platelet count. Platelets help your blood clot normally. Thrombocytopenia is when you don’t have enough platelets. This can make it hard for your blood to clot, and puts you at risk of excess bleeding.

During your treatment, your health care team will take small samples of your blood for testing. If your platelet count is low, you can take steps to avoid injuries that could lead to uncontrolled bleeding. Make sure to:

  • Call your health care team if you develop a rash, bleeding, or bruising.

  • Protect your skin from cuts, scrapes, and sharp objects.

  • Shave with an electric razor. This causes less irritation and risk of cuts to the skin.

  • Take steps to prevent constipation, which can lead to hemorrhoids and bleeding.

  • Use a soft toothbrush to prevent bleeding gums.

Bloating and swelling

Some chemotherapy and biological therapy medicines cause your body to retain water. This excess water will go away when your treatment ends. Also, your kidneys may not be working normally. This can also cause you to retain water. Here's what you can do for relief:

  • Don’t eat salty foods, or add salt to your food.

  • Take a diuretic or water pills (diuretics) for severe water retention, if advised by your health care team.

Constipation

Constipation is when bowel movements are difficult or don’t happen often enough. It can range from mildly uncomfortable to painful. Some pain medicines can lead to constipation. To help prevent and relieve constipation:

  • Drink plenty of fluids water and fruit juices, such as prune juice.

  • Eat foods high in fiber, such as cereals, whole grains, fruits, and vegetables.

  • Exercise regularly.

  • Take stool softeners or a laxative, if advised by your health care team.

Diarrhea

Diarrhea is when bowel movements are loose or happen too often. It may lead to dehydration. Radiation and many chemotherapy and other medicines can cause diarrhea. Take these steps if you have diarrhea:

  • Ask your health care team about medicines that may help.

  • Avoid gas-producing vegetables, dried fruit, fiber cereals, seeds, popcorn, nuts, corn, and dried beans.

  • Avoid milk and dairy foods if they make things worse.

  • Eat low-residue, low-fiber foods, such as the BRAT diet (bananas, rice, applesauce, toast).

  • Drink more fluids, such as water and broth. This is to help prevent dehydration.

Hair loss (alopecia)

Radiation, chemotherapy, and some other treatments can cause hair loss. Losing your hair can be upsetting because baldness is a visible reminder that you are being treated for cancer. But keep in mind that your hair will likely grow back after treatment. Kidney cancer treatments do not often cause severe hair loss, however.

If you have hair loss:

  • Consider cutting your hair shorter if it starts to thin.

  • Think about getting a wig if it thins a large amount.

  • Protect your scalp from sun and temperature changes with sunscreen, hats, and scarves.

Infection

Many types of chemotherapy and other treatments can cause low white blood cell counts. This is called leukopenia. This may also be a side effect from immunotherapy for kidney cancer. Without enough white blood cells, your body may not be able to fight infection. You may have symptoms of infection, such as fever, chills, or inflammation at the site of an injury.

During your treatment, your health care team will take samples of your blood for testing. If your health care team tells you that your white blood cell count is low, take these actions to stay healthy:

  • Ask your health care team if you need to take antibiotics to help prevent infections.

  • Avoid crowds and people with colds.

  • Avoid fresh flowers and plants, which can carry mold.

  • Don’t eat fresh, unwashed, uncooked fruits and vegetables and other foods that might carry germs. Wash and peel raw produce before eating it.

  • Wash your hands often during the day to kill germs. Have people around you do the same. Bathe daily. This is to help to keep the amount of bacteria on your skin lower. Don't touch your eyes or nose unless you've just washed your hands.

  • Call your health care team right away if you have any signs of infection. Signs may include a temperature of 100.5° F (38.1° C) or higher, chills, a cough or hoarseness, lower back or side pain, painful or difficult urination, or any sores or redness.

Low sex drive (low libido)

Depression and fatigue from many types of treatment can affect your sex drive. There are steps you can take to help you cope with these changes. Make sure to:

  • Talk with your health care team. They may be able to refer you to a counselor who specializes in sexual issues.

  • Talk with your partner. Be open about the changes in your desire or ability to have sex. Explore new ways to share affection and intimacy.

Menopausal symptoms

Some types of chemotherapy can damage the ovaries. They can cause menopausal symptoms in women who have not yet reached menopause. Symptoms can include hot flashes, vaginal dryness, mood swings, and weight changes. Periods may be irregular or may stop, and you may not be able to get pregnant. However, some women may still be able to get pregnant during treatment:

  • Talk with your health care team ways to manage menopausal symptoms. You may use lubricants for vaginal dryness or do special exercises. You may want to talk with a counselor about mood swings or signs of depression.

  • Talk to your health care team about birth control before treatment begins.

  • Get regular pelvic exams.

  • Report any unusual vaginal bleeding to your health care team.

Mouth sores and dryness

Radiation and some types of chemotherapy can cause mouth and lip sores. These sores are called mucositis. They may hurt and make eating difficult. Radiation to your chest or neck may also cause dry mouth called xerostomia. To ease these problems:

  • Brush your teeth after meals and before bedtime. Floss every day if your health care team says it's OK to do so.

  • Rinse your mouth with lukewarm water with salt or baking soda several times a day.

  • Keep your mouth clean and moist. Use lip balm to keep your lips moist.

  • Suck on sugar-free candies or chew sugar-free gum to help increase moisture in your mouth.

To ease the pain if you get sores in your mouth:

  • Ask your health care team about topical mouth medicines.

  • Don’t use mouthwash that contains alcohol. It may irritate the sores.

  • Don’t eat hot, rough, or spicy foods. These may irritate the sores.

  • Don’t use tobacco. It may irritate sores, or make you more to get sores.

  • Eat soft and pureed foods that are easy to swallow if you have a dry mouth.

  • Sip water often.

  • Take over-the-counter pain medicine, such as acetaminophen, if needed.

  • Call your health care team if you have a fever of 100.5° F (38.1° C) or higher.

Nausea and vomiting

Nausea and vomiting may result from almost all types of treatment for kidney cancer. It may be very mild to severe. Understanding the different types of nausea may help. The types include:

  • Acute-onset nausea and vomiting. This occurs within a few minutes to several hours after chemotherapy. The worst episodes tend to be 5 to 6 hours after treatment. The symptoms end within the first 24 hours. Immunotherapy with interleukin-2 (IL-2) tends to cause nausea during the whole treatment. Nausea gets worse at the end of the cycle.

  • Delayed-onset vomiting. This develops more than 24 hours after treatment.

  • Anticipatory nausea and vomiting. These are learned from previous experiences with vomiting. As you prepare for the next dose of chemotherapy, you may anticipate that nausea and vomiting will occur as it did before. This can trigger the actual symptoms.

  • Breakthrough vomiting. This is vomiting that occurs despite treatment to prevent it. It requires other types of treatment.

  • Refractory vomiting. This occurs when you're no longer responding to antinausea treatments.

To help prevent nausea:

  • Ask your health care team about taking a prescription medicine to control nausea and vomiting. Make sure you take it as directed. If you are vomiting and cannot take medicine, call your health care team.

  • If you have nausea and vomiting while taking anti-nausea medicine, call your health care team. They can change your medicine, or add other medicines.

To help ease nausea or vomiting:

  • Ask your health care team about using acupressure bands on your wrists. These may help to decrease your nausea.

  • Ask your health care team to help you learn a relaxation exercise. This may make you feel less anxious and more in control, and can decrease your nausea.

  • Do not eat fatty or fried foods, very spicy foods, or very sweet foods.

  • Eat foods that are at room temperature or cold. The smells from hot foods may make your nausea worse.

  • Take medicines with food, as directed.

  • Try eating foods and drinking beverages that were easy to take or made you feel better when you had the flu or had nausea in the past. These might be bland foods, sour candy, pickles, dry crackers, ginger ale, flat soda, or others.

Nerve damage (peripheral neuropathy)

If you have numbness, tingling, or weakness in your hands and feet, you may have nerve damage called peripheral neuropathy. Some types of chemotherapy and other treatments are known to cause this. Other signs of this problem are ringing in your ears or feeling too hot or cold. Nerve damage can make you more at risk for injury.

If you have these symptoms, you’ll need to take care to protect yourself from injury:

  • Clear your home of clutter. Put away throw rugs so that you don’t trip or fall.

  • Take extra care when walking and moving so that you don't fall. Less sensitivity in your feet can alter your balance.

  • Take extra care when driving. You may have trouble feeling the gas and brake pedals. Ask friends and family to drive you.

  • Use warm, not hot, water for bathing. This is to prevent burns. Use a shower chair or railing to reduce your chance of slipping in the tub.

  • If your daily activities are too difficult, ask your health care team to refer you to an occupational therapist or a physical therapist. They can help teach you new ways of doing things so you can stay as active as possible.

Pain

Bone pain can be the result of surgery and biological therapy, such as interferon-alpha, for kidney cancer. Try these tips to ease muscle, joint, or bone pain:

  • Talk to your health care team about taking aspirin or ibuprofen to help relieve headaches and muscle cramps.

  • Take other pain medicines as directed by your health care team. Take the medicine regularly. Don't wait for your pain to become severe. If you take pain medicine, take steps to avoid constipation. This is a common side effect of some pain medicines.

  • Try changing your activity level. You may feel better if you rest more, or move around more.

  • Distract yourself with music, funny videos, or computer games.

  • Use heat, cold, relaxation methods, such as yoga, meditation, or guided imagery. Ask your health care team where you can learn more about these.

If you are recovering from surgery, expect to be some pain for a few days. You’ll be given medicine to help control the pain. Talk with your health care team about your pain control if you need more pain control.

Scarring

Any surgery leaves scars. The size and color of the scar depend on the size of the cancer, its location, the type of surgery, and how well your skin heals. Your health care team will use methods to hide the scar as much as possible. Make sure to:

  • Ask about wound care.Your health care team can recommend ways to aid healing. Most often, though, your body's natural healing abilities are the best and simply take time.

  • Be patient.Healing continues over time after that. Early on, the scar may be red or bumpy. It takes about a full year for a scar to fade.

  • Follow up with your health care team.If you are worried about the scar's appearance in a few months or a year, talk with your health care team. He or she may advise options to make the scar less noticeable.

Shortness of breath (dyspnea)

There are many causes of shortness of breath in people with cancer. Some of these, such as a blood clot in the lungs or pneumonia, need to be treated right away. Breathing problems can also be a side effect of the biological treatment for kidney cancer, interleukin-2. If you develop breathing problems, you should let your health care provider know right away.

Feeling short of breath may make you feel anxious, which can make breathing problems worse. Talk with your health care provider or nurse about what can help. Also try these tips if you feel short of breath:

  • Don’t bend over. This compresses your lungs and makes it harder to get the air you need. Wear slip-on shoes to avoid bending down to tie laces.

  • Avoid things that make your breathing worse, such as high humidity, cold air, pollen, and tobacco smoke.

  • Sit upright. This will give your lungs room to expand.

  • Sleep with the head of your bed raised. Or, sleep in a reclining chair.

  • Ask family or friends for help with activities that make you short of breath.

  • Ask your health care team to show you how to use relaxation exercises.

  • Use pursed-lip and abdominal breathing. Ask your health care team for instructions on how to do this.

  • Ask about your health care team about medicines that may help. These may include steroids, inhalers, or diuretics for dyspnea. If you have a cough, medicines that suppress cough or break down mucus can help. An inhaler medicine may help for chronic coughing.

Skin irritation

Radiation treatment can cause dry or red skin in the area being treated. Also, you may have dryness, itching, or a rash in the area of biological therapy injections. Here’s what you can do for relief:

  • Wear loose, soft clothing over the treated area.

  • Don't scratch, rub, or scrub treated skin. Wash gently, and blot dry gently.

  • Only use paper tape if you apply a dressing to the area. Ask your health care team to help you place the dressing so that you can prevent more irritation.

  • Don't apply heat or cold to the area. Bathe only with lukewarm water.

  • If you must shave the area, only use an electric shaver. Don't use lotion before shaving. Don’t use hair-removal products.

  • Keep your nails well-trimmed and clean so that you don't damage sensitive skin when you touch it.

  • Protect your skin from the sun. Cover the treated area and wear sunscreen with at least SPF 30.

  • Ask your health care provider what kind of lotion is best to soothe your skin.

  • Ask your health care provider if soap, deodorant, sunscreen, perfume, cosmetics, or powder is safe to use on your skin.

  • Use topical ointments and steroid creams for itchy skin rashes, if prescribed.

Sleep problems (insomnia)

Insomnia can be caused by anxiety, depression, or your cancer treatment. Use these tips to improve your rest:

  • Avoid long naps during the day. These can disrupt nighttime sleep.

  • Avoid caffeine and tobacco, especially close to bedtime. These are stimulants that can disrupt sleep.

  • Don't eat, drink fluids, or exercise close to your bedtime.

  • Keep a regular bedtime schedule.

  • If you don't fall asleep in 15 minutes, get up, do something else, and try again later.

  • Use your bed only for sleeping, not watching TV.

Trouble thinking and remembering

Chemotherapy and biological therapy can cause mild problems with thinking and memory. Fatigue can worsen the problem. Taking these actions can help:

  • Make lists.

  • Write down important information you need to remember.

  • Use other tools to help organize your life. These tools may include calendars, pill dispensers, or alarm clocks.

  • Tell your medical team about any cognitive changes. Your team can assess any cognitive concerns and suggest treatments that can help you and your family manage the changes. 

Tiredness (fatigue)

Tiredness is a very common side effect. It can be a result of anemia caused by low red blood cell levels. Red blood cells carry oxygen around the body. Decreased red blood cell counts can be caused by blood loss, chemotherapy, or radiation, or the cancer itself. Other things can cause fatigue, such as dehydration or not eating enough. Tiredness can last several weeks after treatment ends. You may feel only slightly tired, or you may suffer from extreme fatigue.

Taking these actions may help increase your energy levels:

  • Balance activity with rest. Save your energy for important tasks.

  • Add mild exercise, such as walking, to your daily routine.

  • Drink plenty of fluids to prevent dehydration.

  • If your fatigue is severe or chronic, ask for help with routine tasks that can drain your energy. These can include grocery shopping or housework. You may also need to reduce your hours at work.

  • Take action to treat a poor appetite.

  • Take short rests when you feel tired. Avoid long naps during the day. These can disrupt nighttime sleep.

  • Talk with your health care team about your fatigue and what be causing it. Some medicines or treatments may help.

Talking with your health care team

Getting treatment for cancer can be tough on the mind and body. Keep talking with your health care team about ways to make the process easier. Work together to ease the affect of symptoms on your daily life.

 

Updated:  

March 21, 2017

Sources:  

Overview of the Treatment of Renal Cell Carcinoma, UpToDate

Reviewed By:  

MMI board-certified, academically affiliated clinician,Stump-Sutliff, Kim, RN, MSN, AOCNS