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The featured experts include Thomas Smith, MD, Virginia Commonwealth University Health System; Jamie Von Roenn, MD, Robert H. Lurie Comprehensive Cancer Center, Northwestern University; and Georgia Decker, MS, RN, CS-ANP, Integrative Care and Oncology Nursing Society.

Question 1: My aunt has cancer and over the last four months she has lost a significant amount of weight. She says she just doesn't feel like eating. Could this be a side effect of treatment or a sign she is giving up? Her outlook is actually pretty good and we are concerned that the weight loss may further jeopardize her health. What should we do?

Reply to Question 1: Weight loss is often preventable. It just means that she is using more calories than she is receiving, and could be a side effect of the treatment or the cancer, or both.

If it seems to be just the appetite, then megestrol acetate (Megace) suspension 200-800 mg orally each day will stimulate the appetite in about half of those who try it.

To increase calories when one does not feel like eating, milkshakes made with ice cream are a rich source of calories. High calorie foods like candy bars, cheese, and potato chips are also a good way to put on the calories.

Make sure you inform your health-care professionals about the weight loss and loss of appetite. Weight loss and loss of appetite may also be due to mouth sores from treatment, intestinal side effects from treatment, pain, depression, diabetes or other complications of treatment, or growth of the cancer.

Depression is quite common among cancer patients, and is often missed by busy health care professionals. In one study, we recognized it only 17% of the time! If your aunt has lost interest in activities, or if you ask her "are you depressed?" and she says yes, then tell the doctor.

Question 2: My husband is on various pain medications that seem to make him constipated. Any advice on ways I could help make him more comfortable?

Reply to Question 2: Constipation is a common problem—any decent pain medicine will slow down the bowels. First, always use something to keep the bowel movements flowing. We use Senna, Senokot-S, and others as the first treatment. Start with one tablet a day, but increase the number of tablets to as many as needed to keep the bowels moving.

Second, if he is really constipated already, try magnesium citrate to get things moving. It is available at most drugstores or grocery stores and is clear and tasteless. We recommend a shot glass every hour until the bowels start moving. Then, use Senna daily.

Question 3: My 12-year-old daughter will be starting cancer treatment soon. The doctor has warned us that she will probably loose her hair. What is the best way to prepare her for this? As a pre-teen, she is already extremely self-conscious.

Reply to Question 3: I don't treat children, but this bothers people from childhood to octogenarians. If she has longish hair, and is going to lose it, she can donate it to Locks of Love so that someone will benefit!

Cutting her hair short, under her own control, may lessen the pain. And, going to a decent wig shop will let her get something that matches. Most children's hospitals or cancer centers provide these services. Ours has cosmetologists who could help her make the best of a bad thing. The American Cancer Society Look Good, Feel Better program can help and provide free consultations with professionals.

Above all, do something to help rather than just accept it. Adolescence is hard enough.

Question 4: Are there things I could do after my thyroidectomy to help lessen scarring? For instance, a survivor told me she moisturizes her scar routinely with cocoa butter. Does that help?

Reply to Question 4: I checked with our expert plastic surgeon, Andrea Pozez, MD, who offered this advice:

My recommendations are any moisturizer at night and sunscreen during the day. I am fond of Mederma, which is a silicon-based gel as the moisturizer, but this is subjective preference. And, yes, cocoa butter and massage therapy help. A study in the Journal of Burn Care Rehabilitation showed that massage with cocoa butter improved mood and physical symptoms. I can't tell from the literature if there is any effect on the scar itself from cocoa butter. And, of course, internal application of chocolate is always indicated.

Question 5: I received radiation treatment 17 years ago. During the past year, I have been suffering from increasing paralysis, and it has been suggested this is as a long-term result of the radiotherapy. An MRI scan has confirmed it is not a recurrence of the tumor. Please comment.

Reply to Question 5: This needs further investigation—don't just accept it as a long-term effect of radiation therapy. I would be worried about scar tissue, a new type of cancer like a sarcoma, or benign causes like degenerative arthritis possibly due to the radiation therapy, but you need to know the cause. The MRI is very helpful to rule out recurrence of most cancers, but ask the neurologist/neurosurgeon about the cause of paralysis.

My radiation therapy expert, Douglas W. Arthur, MD, adds this advice: A return to the radiation oncologist is needed for correlation between dose/location of treatment with neurologic findings to see if it could be a possible explanation. At Virginia Commonwealth University, a set of right-sided neurologic symptoms has been blamed on left-sided radiation only to later find underlying brain metastases. These extremely late effects can be seen but should only be attributed to radiation therapy after all else is excluded. The radiation therapist will be best able to confirm that the radiation was delivered in a way that could have caused the problem. This is important to determine if there is a helpful intervention.

Question 6: My father seems to be having an increasingly difficult time chewing his food and swallowing it. Is this common? How can we help him?

Reply to Question 6: Yes, it is common, and it may be treatable. Try to figure out why he is having trouble chewing and swallowing. Is this a new problem, or worsening of an old one? Is he getting treatment that is causing mouth sores, or sores in the esophagus or stomach? Has he been checked for yeast or other infections in the mouth and esophagus? Is he taking a medicine that could affect his swallowing?

If there is no good reason found for his swallowing problem, then work on high-calorie liquid foods such as ice cream, milkshakes, or instant breakfast drinks. If it is due to the cancer blocking the esophagus, then stents can be placed to open it up temporarily. Sometimes this is due to a late effect of radiation or surgery too, and stents or dilation can be helpful.

Make sure you tell the health-care professionals about this problem! Sometimes people don't want to bother us with these issues, but we need to know. He could quickly lose calories and weight without being able to swallow.

Please check back next week for more answered questions. In addition, feel free to post a question.

More Information

Managing Side Effects

Question 1: I am undergoing radiation treatment and am tolerating it fairly well. The only complaint is that I am so exhausted. At first, I was able to keep-up with most of my day-to-day activities, but now I am just too run down. Any suggestions on how I can increase my energy level?

Ms. Decker: Regular sleep and rest patterns are important, as you might suspect. However, so is moderate exercise. Begin with a stroll for the first few times and then gradually increase your pace and/or distance. Eating a well-balanced diet that combines carbohydrates and proteins at all meals and snacks (you should eat small amounts and about every three hours) will stabilize your blood sugar level and assist in reducing some of the fatigue.

Question 2: My mother has always been a bit anemic (event prior to the cancer diagnosis). Her treatments, however, have caused the problem to become worse and she is experiencing numerous symptoms – fatigue, muscle weakness, dizziness, etc…  I have read that some of this can be controlled through medication and some through diet. She lives alone and is not taking very good care of herself.  What do you suggest?

Ms. Decker: Iron-rich foods such as liver and green, leafy vegetables will assist her body as it attempts to return to normal. Medications for anemia should also be considered since your mom probably cannot eat sufficient quantities of iron-rich foods. The elderly do require some surveillance in terms of nutrition and supportive care. Perhaps a home care nursing agency can assist her with these needs. Your health-care professional can assist you with this. It is also imperative that an accurate cause or causes of her symptoms is/are identified. You also might want to have your mom assessed for depression. Fatigue and depression can have similar symptoms.

Question 3: I have lost my taste while on docetaxel (Taxotere). I had my last dose last week. How long will it take to get my taste back?

Ms. Decker: This will vary from person to person but generally the return of taste will be gradual. There are no absolute answers except that maintaining a good nutritional status is very important. A referral to a dietitian or nutritionist may prove to be helpful.

Question 4: I have been diagnosed with numerous small brain tumors. My doctors are recommending six weeks of whole brain radiation. I am very worried about the side effects. What can I expect?

Ms. Decker: Whole brain radiation has been associated with fatigue and memory loss. The degree of severity of these side effects will vary. In anticipation of having them, plan ahead. Make lists, stock your refrigerator with healthy, pre-prepared and frozen foods and accept the help of friends and neighbors. The side effects that you do experience will be gradual in onset and so, you will have time to augment your plan.

Question 5: I have just completed the fourth of nine rounds of chemotherapy for lung cancer. I have had absolutely no side effects and am very concerned that the treatments may not be working.

Ms. Decker: Lack of side effects does not mean there is no therapeutic effect. The measure of treatment effect will be in follow-up tests that will determine your response to treatment. It is important that you discuss this with your health-care professional.