Tips for Caregivers on Coping With Cancer Symptoms and Drug Effects

NEW YORK—Coping with cancer and the side effects of treatment can be difficult and frustrating for caregivers as well as patients. Frances K. Barg, MEd, Coordinator for Cancer Control Education, University of Pennsylvania School of Nursing, and Mary Pat Lynch, CRNP, MSN, AOCN, graduate faculty, Oncology Advanced Practice Nurse Program, University of Pennsylvania School of Nursing, had some tips for caregivers and answers to their questions at a Cancer Care, Inc. teleconference. They reviewed a number of things caregivers can do to help relieve the most common problems.

Pain. Often people in chronic pain do not look like they are in pain because they have lived with it for so long. That can make it hard for other people to believe they are having pain, which can add to the patient’s distress. But pain is whatever the patient says it is.

Fatigue. A decrease or lack of energy is not the only sign of cancer-related fatigue. Fatigue symptoms can include inability to concentrate, increased irritability, nervousness, anxiety, and impatience, the speakers said. Do not assume that nothing can be done. Balance the diet with complex carbohydrates, encourage exercise, ensure adequate water intake, and ask the physician to check the patient’s hemoglobin level.

One caregiver said she worried that she was pushing her husband beyond his limits when encouraging him to go for walks. Ms. Barg suggested that she and her husband track when in the day his energy spurts seemed to occur and take their walks at those times. “Slowly increasing exercise and doing some walking, however short, is usually going to be helpful to try to build some energy and stamina,” Ms. Barg said.

Mobility problems. Promote the conservation of energy by spacing activities with rest periods. Encourage the patient’s involvement with activities of daily living as much as possible, and do not do everything for them.

Eating problems. Do not force feed or display anger if the patient is unable to eat. Caregivers can interpret rejection of food as a rejection of love. Also when patients change their eating habits, it can upset family members who fear that the cancer is growing worse.

Learning more about the reasons for these eating changes and what can be done about them can give caregivers confidence about their role. The patient should be encouraged to participate in meal planning and to choose appealing foods that are high in protein, and caregivers should ask their physician for help and whether appetite-stimulating medication would be useful.

When the patient refuses treatment. One caregiver asked what to do when the patient doesn’t want to go back to the doctor. The woman described her husband as terminally ill with a brain tumor and partially paralyzed. “It’s very frustrating to him and to me,” she said.

Even if the treatment isn’t making the cancer better, there’s never nothing to do, Ms. Barg answered. “We always have things we can do to make the patient more comfortable and make the caregiver feel better about how the patient is doing. So I think it is very important for you to be in touch with the health care provider so that any symptoms can be addressed. There also may be services that could come into the home.”

It is understandable when patients become very ill from the disease and its treatment to decide they don’t want treatment at this point, Ms. Lynch added. “That’s a very legitimate choice for someone to make, and hospice care or palliative care may be indicated,” she said.

Communication. The speakers offered suggestions to a caregiver who said she dealt “with a very, very noncommun-icative cancer patient”—her husband.

“If someone wasn’t a great communicator before they became sick, it’s rare that all of a sudden they are going to start to talk about their feelings,” Ms. Barg noted. She suggested that the woman try things that made her husband more likely to talk in the past.