My doctor said my treatment might compromise my immune system. How can I protect myself?


Brahm Segal, Chief of Infectious Diseases at the Roswell Park Cancer Institute in Buffalo, New York Photo courtesy of Brahm Segal

BRAHM SEGAL: Chemotherapy and radiation can reduce white blood cell counts and compromise the body’s ability to prevent infection. This condition—known as neutropenia—is most likely to begin within one week after receiving chemotherapy. Whether neutropenia occurs and its degree and duration depend on the type of chemotherapy you receive. Steroids also can suppress the normal functioning of the immune system.

While undergoing treatment, you can usually continue with normal activities. But if your doctor tells you that your white blood cell count is low or is likely to be low, it’s best to take preventive measures to avoid an infection. For cancer patients, even a minor infection can become serious and can lead to treatment delays.

Take simple steps to protect yourself: Avoid close contact with people who are ill. Wash your hands frequently. Don’t share food, dishes or other personal items. Limit the risk of food-borne illnesses by cooking meat and fish completely, and washing fruits and vegetables thoroughly.

It’s safe and recommended for most people undergoing chemotherapy or other cancer treatment to get an annual flu shot. A compromised immune system might make a flu shot less effective, but limited protection is better than no protection. Ask family members to stay current on their vaccinations to lower their risk to you.

For patients at the highest risk of infection, such as those undergoing intensive chemotherapy for leukemia, doctors might prescribe a preventive antibiotic. White blood cell-boosting medications may also help some patients at high risk.

Pay attention if you feel feverish or notice other symptoms, such as swelling, redness or tenderness of the skin, coughing or sneezing. See your oncologist or go to an emergency room immediately if you have a temperature of 100.4 degrees or higher. In the event of an infection, doctors will prescribe oral antibiotics or, in more serious situations, admit patients to the hospital to administer IV antibiotics.

Remember that spending time with friends and family and participating in activities you enjoy are important as you undergo treatment. Talk with your oncologist about how best to tailor preventive measures to protect your health without overdoing it.

PREVENTING INFECTION // Cancer.Net offers more tips on staving off infection during your treatment. // The Centers for Disease Control and Prevention explains what cancer patients and caregivers should know about the flu. // offers information on food and kitchen safety.

I was recently diagnosed with a second type of cancer. I’m having a harder time emotionally than I did with my first diagnosis. What can I do to cope?


Julia Rowland, Director of the Office of Cancer Survivorship at the National Cancer Institute in Bethesda, Maryland Photo courtesy of the National Cancer Institute

JULIA ROWLAND: More cancer survivors are living long enough to develop subsequent cancers that are not due to a recurrence or spread of an earlier disease. The number of people being diagnosed with second or even third cancers is on the rise in large part because doctors have gotten better at detecting and treating cancer.

For many, facing cancer again can be more difficult than their first cancer experience. When diagnosed with cancer for the first time, many people fear the unknown. By contrast, those who experience cancer again often worry about the known. They know firsthand the challenges that can come with treatment, including side effects and the burden the disease can place on friends and family. They may worry about mustering the energy, optimism or personal support to face treatment again.

If a new cancer is found, step back and take a deep breath. Remember that you made it through cancer before and you can do it again. That said, it’s also important to honor that sense of being overwhelmed or frightened.

Start gathering information to help manage this new journey with a new diagnosis. Find out whether the treatments your doctor recommends will be similar to those you had before, and learn about possible side effects. If you struggled with side effects after your first diagnosis, that doesn’t necessarily mean you will feel as sick this time around, since treatment may be different and advances in symptom management are happening regularly.

Provide your cancer care team with as much information about your original diagnosis and treatment as possible. Radiation and certain cancer drugs have dosage limits that may need to be considered. Having your survivorship care plan on hand can help provide these details.

It’s important to recognize that going through a cancer diagnosis and treatment alone makes the experience more difficult. Reach out to loved ones and find someone who has gone through a second cancer diagnosis for peer support. Remember: There are plenty of people out there who have experienced multiple malignancies and are still here today. You’ve done this before—you can do it again.

SURVIVING A SECOND CANCER // The Association of Cancer Online Resources hosts online communities where people can reach out to others who’ve had similar experiences. // The National Cancer Institute is conducting research to better understand second cancers. // Journey Forward helps survivors develop survivorship care plans.

My husband complains about the side effects from his treatment. How can I tell if they’re normal or if we should contact his oncologist?


Carrie Thompson, Hematological Oncologist at the Mayo Clinic in Rochester, Minnesota Photo courtesy of Mayo Clinic

CARRIE THOMPSON: Side effects are an unfortunate but expected part of many cancer treatments. Your loved one’s health care team most likely provided information about the most common side effects based on the diagnosis and treatment plan, but everyone responds to treatment differently.

If your husband experiences a severe or unexpected side effect that concerns either of you, it’s always best to err on the side of caution and call his cancer care team. There are no dumb questions. Cancer center nurses can provide supportive care, and at the very least, reassure you if the side effect is normal. Your provider can advise you on whether to come in for further evaluation or to call back if symptoms persist or worsen.

Very few cancer treatments cause debilitating side effects, and medications can help manage the most common ones, including nausea. These medications have greatly improved in the last 10 years. If nausea, pain, weakness or any other symptom becomes so severe that it affects quality of life, it’s time to call your doctor.

In some instances, your doctor may recommend you go straight to the clinic or emergency room rather than waiting for a call back. If your husband has a low blood count, for example, and he develops a fever, it’s a medical emergency. A fever is a sign of an infection, and aggressive antibiotics might be needed immediately. If your husband is suffering with uncontrollable pain or vomiting, he may need to go to the ER for IV medications.

One last piece of advice: You may have a long list of phone numbers. Ask your provider when it’s best to call the oncologist versus the surgeon and how to make contact. Keep those numbers handy. Don’t wait to call until the middle of the night, when it may be more difficult to reach your care team.

WHEN TO CALL // The American Cancer Society offers a guide on the most common side effects of cancer treatment. // Cancer Support Community offers tips on how to manage the side effects of treatment. // The National Comprehensive Cancer Network shares advice on when to go to the emergency room.