Managing Side Effects and Pain Related to Metastatic Colorectal Cancer

Metastatic colorectal cancer (mCRC), or end-stage colorectal cancer, can cause many symptoms that affect your daily life. Side effects from treatment can also be challenging to manage. Understanding how to deal with these symptoms and knowing when to ask for help can make a big difference in your quality of life.^1,2

Fatigue

Fatigue is very common in people with mCRC. It can be caused by the cancer itself or the treatments you receive, like chemotherapy. Fatigue is more than just being tired. It may feel like no amount of sleep can make you feel better.¹

You can help manage fatigue by:¹

• Getting enough rest and sleep at night
• Taking short naps during the day
• Getting some physical activity during the day
• Planning your schedule around when you have the most energy
• Eating healthy, well-balanced meals

Talk with your doctor if your fatigue becomes overwhelming. They may be able to adjust your treatment regimen or offer other ways to help.¹

Change in bowel habits

Changes in bowel habits are another common side effect of mCRC and mCRC treatment. These changes may include diarrhea, constipation, feeling like you must go to the bathroom more often, or inability to control your bowel movements.^1,2

To manage bowel changes, try:^1,2

• Following the dietary plan that has been set for you by your doctor and dietitian
• Drinking plenty of water to stay hydrated
• Asking your doctor about any medicines that might help with diarrhea or constipation

Tell your doctor if your bowel symptoms change or become severe.

Appetite changes, nausea, and vomiting

Nausea and vomiting are common side effects of cancer treatment. They can cause you to lose your appetite and even lead to weight loss. If you are having these side effects, try eating bland foods and avoiding caffeine and alcohol. Some medicines can also help relieve nausea and vomiting.^1,2

Some people with metastatic cancer, like mCRC, develop cachexia. Cachexia is a serious metabolic condition that can lead to loss of appetite, unintentional weight loss, fatigue, and muscle wasting. It can be very serious. Talk with your doctor if you are experiencing these symptoms. They can put a plan in place to manage your side effects and pain so you can eat.¹

Ostomy bags

If you have an ostomy due to mCRC, learning to manage your ostomy bag is important for your comfort and health. An ostomy allows waste to leave your body through an opening in your stomach – called a stoma – and collect in a bag.³

Here are some tips for managing your ostomy bag:³

• Change the bag regularly – Empty the bag when it is about one-third full to avoid leaks. Change the whole system (bag and skin barrier) as needed.
• Clean the skin around the stoma – Gently clean your skin with warm water. Make sure your skin is completely dry before attaching the bag.
• Check for irritation – Look at the skin around your stoma for any redness, swelling, or sores. If you notice any irritation, tell your doctor or ostomy nurse.

It can take time to get used to an ostomy bag. Do not hesitate to ask your healthcare team for advice. It also may be helpful to join a support group for people with ostomies.³

Neuropathy

Some treatments for mCRC can cause neuropathy. Neuropathy is nerve damage that leads to tingling, numbness, or pain in the hands and feet. Neuropathy can make doing everyday tasks difficult.^1,2,4

While neuropathy cannot be cured, there are ways to manage it:^1,2,4

• Avoid extreme temperatures.
• Wear gloves when doing tasks that involve your hands, such as washing dishes.
• Wear shoes with good support to help protect your feet.
• Ask your doctor about medicines, like opioid pain medicines or antidepressants, that can help with the symptoms of neuropathy.

If you begin to have neuropathy, tell your doctor right away. They may be able to adjust your treatment to prevent the symptoms and pain from getting worse. Or they may prescribe you a medicine that can help with the symptoms.^1,2,4

Pain management

Several types of medicine can help control pain for people with mCRC:^2,4,5

• Over-the-counter (OTC) medicines, such as acetaminophen or ibuprofen, may help with mild pain.
• Prescription pain medicines, such as opioids, may be prescribed for more severe pain.
• Nerve-blocking medicines and antidepressants can help with neuropathy-related pain.

Your doctor will work with you to find the right pain management plan. Never take more medicine than your doctor recommends, and let them know if your pain is not well controlled.^2,5

Mental health struggles

Dealing with end-stage colorectal cancer can take a huge toll on your mental health. It is normal to feel anxious, distressed, or depressed. In fact, about 8 to 24 percent of all people with cancer experience depression. Many people also experience fear or worry about the future.^5,6

To manage mental health challenges, you can try the following:^1,6

• Talk to a counselor or therapist who has experience with cancer patients.
• Join a support group where you can share your feelings with others who understand.
• Practice journaling as a way to process your emotions.
• If you can, do some physical movement every day.

If your distress becomes too much to handle, talk to your doctor. They may suggest medicine or other resources to help you feel better.⁶

When to consider palliative care

Palliative care is specialized medical care that focuses on improving your quality of life. It is not the same as hospice care, which is only for people who are nearing the end of life. Palliative care is for anyone who has a serious illness and wants help managing symptoms and stress.⁷

You can receive palliative care at any stage of mCRC. It can help with pain, fatigue, emotional distress, and other symptoms. Ask your doctor whether palliative care might be right for you.⁷

When to contact your doctor

Cancer treatment can come with many side effects and pain. But you do not have to suffer alone. Your doctor may be able to help relieve some of these side effects if they are aware of them.¹

Also, it is important to recognize any medical emergency that may occur. Contact your doctor if you experience any of the following:¹

• Severe or unexpected side effects or pain
• Sudden or severe fatigue that keeps you from doing daily activities
• New or worsening neuropathy symptoms
• Any unusual side effects that your cancer care team did not tell you about
• Feeling very anxious, depressed, or unable to cope

Managing side effects and pain from metastatic CRC can be difficult, but you do not have to do it alone. Always reach out to your healthcare team if you have questions or need help.