Health

Kidner cancer treatment side effects: How to cope


WOMENIn the past, treatment options for people with metastatic kidney cancer were few and far between. Surgery to remove the affected tissue is an effective and often long-lasting solution for people whose cancer is limited to the kidney. But for about 30% to 40% of people with kidney cancer that has spread to other parts of the body, the prognosis is grim.

Fortunately, things are much different today. Primo Lara, professor, clinician and director of the Comprehensive Cancer Center at the University of California, Davis. Also known as angiogenesis inhibitors or targeted therapies, these drugs block the formation of various types of blood vessels. feed cancer cells with oxygen and nutrients. “These drugs can prolong life, shrink tumors, and induce meaningful remissions,” says Lara.

More recently, Immunotherapy—Drugs that help a person’s immune system identify and destroy cancer cells — have also emerged as a highly effective treatment for metastatic kidney cancer. Today, patients often receive a combination of both immunotherapy and angiogenesis inhibitors. Lara says the combination therapy has provided significant benefits to people with end-stage kidney cancer.

While these new drugs can save lives, they can also cause side effects that range from diarrhea and skin rashes to fatigue and increased blood pressure. Meanwhile, people with localized cancers have difficulties related to treatment. And all kidney cancer patients face the psychological burden of grappling with the deadly disease.

While each person’s journey with kidney cancer is unique, experts suggest an arsenal of strategies that can help people manage their symptoms and side effects. “In most cases, we can help patients manage them so they can move on with the least amount of hassle,” says Lara.

Here you’ll find guidance on the most common symptoms of kidney cancer, the side effects of treatments, and some of the methods doctors and other clinicians can use to help every patient. who mitigates these challenges.

Loss of kidney function

Nearly all people with kidney cancer that has not spread to other organs undergo a surgery called a nephrectomy. During surgery, part or all of the affected kidney is removed. “A common complication of nephrectomy is that you lose some kidney function,” says Dr. Pavlos Msaouel, a clinician and cancer biologist at MD Anderson Cancer Center in Houston.

A little loss of functionality is not a big deal. (Msaouel points out that people can live normally with just one kidney.) However, the kidney’s job is to clean your blood. If their function declines significantly, this can cause a dangerous buildup of waste products or an imbalance of fluids in your blood. “It’s not really a side effect you feel at first – it usually just shows up in blood tests,” explains Msaouel. But over time, the loss of kidney function can cause a range of symptoms including fatigue, nausea, weakness, and brain fog. In severe cases, it can be deadly.

A mixture of lifestyle modifications and medications can help combat this loss of function. “A lot of lifestyle changes are things we should be doing,” Msaouel said. These include exercising regularly and monitoring your sodium and sugar intake. In some cases, you may also need to adjust the amount of protein in your diet. Medications, including blood pressure medications or blood cholesterol-lowering drugs, are also key medications.

Read more: Transforming cancer care, so patients no longer feel like a number

Hand and foot syndrome

This is one of the most common side effects in people taking vascular blocking drugs for metastatic kidney cancer. “These therapies are more targeted than classical chemotherapy – they are more focused on cancer cells – but they sometimes affect other tissues,” Msaouel said. In the case of hand-foot syndrome, also known as palmoplantar fasciitis, these drugs can affect the skin of the palms of the hands or soles of the feet. “This usually manifests as blisters,” he explains. It can also cause redness and swelling. Sometimes these skin problems can be so severe that people are unable to drive or participate in other essential activities.

To prevent hand, foot and mouth syndrome, clinicians often tell people taking these medications to take special care of their hands and feet. Msaouel says over-the-counter moisturizers can help prevent dry and blistering skin. “We might recommend that people avoid exposing their hands and feet to very hot water or to avoid wearing tight shoes,” he said. “We didn’t want too much friction or things that could irritate the skin.” If these precautions aren’t successful and someone develops redness or blisters, he says topical steroids — prescription skin creams to reduce inflammation — can be helpful. Therefore, pain-relieving creams such as those containing lidocaine can be used. “If, despite all this, it continues, then we can give the patient a few days or even weeks of rest until the symptoms subside; then we can restart with a lower dose,” Msaouel said. “Usually when we do that, if it comes back, it won’t be as bad.”

Hypertension

High Blood Pressure (hypertension) is a common side effect of some drugs for kidney cancer, especially vascular depressants that have become the mainstay of treatment for patients with metastatic cancer. High blood pressure can also arise from poor kidney function. Victoria Sinibaldi, a nurse practitioner and research associate in the department of oncology and urology at Johns Hopkins University School of Medicine.

Sinibaldi says that some lifestyle measures — again, a healthy diet and exercise — can help. But most people will need to take medication to make sure their blood pressure stays at a safe level. “It’s not uncommon for people to take two or three medications to control their blood pressure,” she said. In many cases, your primary care doctor – not your cancer team – will lead the way for controlling your blood pressure. “We talk about primary care doctors a lot because they really have clinical expertise in managing blood pressure,” she says.

Diarrhea

Unfortunately, diarrhea is another common difficulty for people with kidney cancer who are taking targeted therapy, immunotherapy drugs, or both. “Some patients have to go as much as every two hours, which is very important,” says Sinibaldi. Diarrhea is not only uncomfortable and inconvenient, but frequent diarrhea can also cause weight loss, malnutrition or severe dehydration.

Sinibaldi often asks patients to keep a diary that records all of their bowel movements as well as what they have eaten, which can help their care team identify problematic foods or activities. “Over-the-counter medications like Imodium can be helpful,” she says. Changing your diet can also make a difference. These can include cutting down on lactose, a sugar found in milk and other dairy products.

“We often refer people to a dietitian who can help them modify their diet,” says Msaouel of MD Anderson. While probiotics can be helpful in some cases, they can also cause problems, such as making diarrhea worse. “People get so excited and think they can fix things with probiotics, but they can be harmful,” he said. “This is something every patient needs to discuss with their oncologist.”

Psychological suffering

Often, talking about complications of cancer can focus on the body while ignoring the mind. “For people with kidney cancer, it’s not just the physical symptoms but also the physical symptoms,” says Dr. Jennifer S. Scherer, assistant professor of nephrology and palliative care specialist at New York University Grossman. emotional symptoms as well. School of Medicine. At all stages of a person’s cancer journey, anxiety, fear, uncertainty and emotional distress can make life challenging, she says. These can also contribute to a person’s feelings of pain, fatigue, and other physical symptoms. Scherer and other palliative care professionals can help people navigate these psychological obstacles.

“Patients also face uncertainty and complex medical decisions for which they may need knowledgeable help,” she said. Financial stress is another source of stress. “Paliative care looks at patients from a holistic perspective and ensures that their care plan can address all of these different areas.” She and her team often connect people with a psychologist or psychologist. They also arrange visits with a spiritual advisor such as a chaplain. But in many cases, her job involves spending time talking to patients and helping them work through their feelings and difficulties. “We try to meet patients where they are, and give them an open and safe space to talk about their illness,” says Scherer.

Read more: 4 important steps to take after a cancer diagnosis

Side effects of immunotherapy

Unlike vasodilators or other kidney cancer treatments, immunotherapy drugs inherently non-toxic. These drugs work by boosting the immune system’s activity in ways that help it identify and destroy cancer cells. “Most people who receive immunotherapy — 60 percent to 70 percent — will have minimal side effects,” says Lara. “But the other third will have more significant side effects, and these effects can be very unpredictable because they are the result of the immune system going overboard and attacking healthy cells. “

He said inflammation of the lungs, skin, thyroid or intestines were all relatively common in people taking these drugs. This inflammation can lead to symptoms like weariness, skin rash, breathing problems, weight loss, or diarrhea. “But any part of the body is fair game, so just any side effect is possible,” he said.

If these types of complications arise, steroids, anti-inflammatory drugs, or other medications that decrease immune activity can help control them, Lara says. It may also be necessary to temporarily reduce or even stop immunotherapy.

A careful balancing act

Each person is unique. Likewise, each person’s response to cancer treatment is unique. Experts say finding what works for a given person tends to prolong tinkering. Your care team will likely have to try different medicines in different doses before they determine the optimal treatment regimen for you.

This can be an ongoing process. Game plans that work for the last few weeks or months may need to be adjusted. Understanding this from the start can help you prepare for bumps in the road. “It’s important to manage patient expectations and provide plenty of information so they know what to expect,” says Lara.

Side effects are an unfortunate part of life for people with kidney cancer. But in most cases, they are manageable. As Lara said, “I would say that more than 95% of the time, we will find that sweet spot where the side effects are well tolerated and the quality of life is good.”

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