Treatment for metastatic colorectal cancer often comes with side effects. Nausea, diarrhea, skin changes, fatigue, pain, and other symptoms can affect how you feel day to day.
Knowing what to expect and having a plan for managing symptoms can make treatment feel more manageable. It can also help to know that you don’t have to manage these symptoms alone.
USC Norris Comprehensive Cancer Center’s Dr. Heinz-Josef Lenz, a colorectal cancer expert, emphasizes the importance of preparing patients before treatment begins and involving palliative care when symptoms become difficult to manage.
Knowing what to expect from treatment
Different treatments for metastatic colorectal cancer can cause different side effects. Chemotherapy may cause nausea, diarrhea, fatigue, and other symptoms. Targeted therapies can have their own side effects, including skin reactions. Immunotherapy can cause immune-related side effects that, although less common, can sometimes become serious.
Because side effects can vary from person to person, understanding what is normal—and what should prompt a call to your cancer care team—is an important part of treatment.
Dr. Lenz says his team prepares patients before they begin chemotherapy. “Patients are really well informed about the chemotherapy and the side effects, so we do chemo training before patients start,” he shares.
That preparation can include medications to prevent or control nausea, instructions for managing diarrhea, and guidance about when to contact the care team.
Having a plan in place can make it easier to respond when a side effect occurs rather than wondering what you should do.
When should you call your cancer care team?
Not every side effect is an emergency, but you shouldn’t feel that you have to figure that out by yourself.
Dr. Lenz encourages his patients to contact the care team when something unusual happens. Sometimes the answer may simply be reassurance or a recommendation for something you can do at home. Other times, symptoms may need to be evaluated quickly.
He also emphasizes being proactive. For example, people receiving an EGFR-targeted antibody may develop an acne-like skin rash. Rather than waiting for the rash to become severe, his team prepares patients to act quickly.
The goal is to recognize symptoms early and address them before they become more difficult to control.
Some side effects require more urgent attention
While many chemotherapy and targeted-treatment side effects can be managed with medications and supportive care, some less common side effects can be more serious. This is particularly important for people receiving immunotherapy. Immune checkpoint inhibitors can cause inflammation in different organs, including the colon, lungs, and pituitary gland.
Dr. Lenz specifically points to immune-related conditions such as colitis, hypophysitis and pneumonitis as side effects that require close attention. Pneumonitis, for example, can affect the lungs and may sometimes require intensive treatment or hospitalization.
“We advise patients who are under immunotherapy, if anything changed, let us know,” he emphasizes.
Symptoms can sometimes be easy to dismiss. Dr. Lenz notes that an immune-related problem can even be hidden by something as seemingly general as fatigue.
If you’re receiving immunotherapy and develop a new or worsening symptom, let your oncology team know. Don’t assume that a new symptom is simply a normal part of treatment.
What is palliative care and when might you need it?
The term palliative care can be confusing. Some people hear it and immediately think it means hospice or that their cancer treatment is ending. Palliative care is different.
Palliative care is specialized medical care focused on relieving symptoms, managing side effects, and improving quality of life. It can be provided alongside cancer treatment and can be especially helpful when symptoms such as pain become difficult to control.
Dr. Lenz says that when he refers a patient to palliative care, he makes this distinction clear. “Palliative is really treating the symptoms.”
Palliative care specialists are experts in managing symptoms such as pain, nausea, fatigue, shortness of breath, and other problems that can affect your quality of life. They can work together with your oncology team to help you feel as well as possible while you receive cancer treatment.
For Dr. Lenz, palliative care is part of a collaborative approach. “We work very closely to it. We have a very good palliative care group. I’m so happy with that, because we’re working hand-in-hand, and they understand their role and my role.”
That teamwork is important. Your oncologist focuses on treating the cancer, while the palliative care team brings additional expertise in controlling symptoms and supporting your overall well-being.
Palliative care doesn’t mean giving up treatment
One of the biggest misconceptions about palliative care is that receiving it means you have stopped fighting cancer. That is not necessarily the case.
Palliative care can be introduced at the same time as active cancer treatment. In fact, managing side effects effectively may make it easier for some people to continue treatment and maintain their quality of life.
Hospice is different. Hospice generally focuses on comfort and quality of life when someone is nearing the end of life, and cancer-directed treatment is no longer the focus.
Dr. Lenz describes having conversations with patients when the balance between treatment and quality of life changes. He says there may come a point when the time and energy required for treatment no longer make sense for a particular person.
“Your time is very important, I don’t want to disrespect and utilize the time you have left.”
That decision is personal and should be made together with your care team, based on your goals, preferences, overall health and how treatment is affecting you.
There are things you can do to prepare
Managing treatment side effects is a team effort, and Dr. Lenz believes patients should have the information and tools they need to participate actively in their care. His team provides written guidance about what to do when side effects occur, along with information about nutrition and exercise.
“I make the patient part of the team. They’re responsible to do that. It’s not only me doing all the work, they have to do their own homework and their own part of the whole treatment,” he says.
That doesn’t mean you need to manage everything yourself. Instead, it means knowing what symptoms to watch for, understanding when to call your care team, and asking for help when you need it.
Nutrition can also become complicated during treatment. Dr. Lenz notes that chemotherapy can affect the digestive tract, and some people experience nausea or diarrhea. Dietary needs can vary significantly depending on your symptoms and treatment, so it is important to talk with your oncology team or a registered dietitian before making major dietary changes or taking supplements.
The same is true for exercise. Staying physically active can be beneficial for many people with cancer, but the right type and amount of activity depends on your health, treatment, and energy level.
You don’t have to wait until symptoms become severe
Side effects are a common concern when starting treatment for metastatic colorectal cancer, but they should not be something you feel you have to simply endure.
Ask your cancer care team before treatment begins:
- What side effects should I expect from my treatment?
- Which symptoms should prompt me to call?
- Who should I contact after hours?
- What medications or other strategies can I use to prevent or manage side effects?
- Could palliative care help with any symptoms I am experiencing?
- Would a registered dietitian, physical therapist or another supportive-care specialist be helpful?
Most importantly, tell your care team when something changes. Early communication can make it easier to manage symptoms and identify potentially serious side effects.
Learn more about second opinions and biomarkers for metastatic colorectal cancer, here.
