Tips for Patients

Targeted therapy is a type of cancer treatment that uses drugs or other substances to more precisely identify and attack cancer cells, usually while doing little damage to normal cells.¹⁸

Different targeted therapies cause different side effects. Common side effects of all EGFR inhibitors include skin problems, diarrhea, mouth sores, and loss of appetite.¹⁹ However, most side effect would slowly subside as the treatment ends.

- Care for skin problems: Patients may develop an acne-like rash on the face and chest, which in some cases can lead to skin infections.¹⁹ Other skin changes may include dry skin, itchiness, nail changes, and hand-foot syndrome.²⁰ Below are some advice that may help minimize skin problems:²⁰

• Use very mild soaps, body washes, and shampoos that do not contain alcohol, perfume, or dye.
• Bathe with cool or lukewarm (instead of hot) water.
• Moisturize skin at least twice a day with a thick emollient cream that has no alcohol, perfumes, or dyes.
• Wear loose, soft clothing.
• Stay out of the sun as much as possible. When going outside during the day, wear a hat and clothes with long sleeves.
• Use a broad-spectrum sunscreen with SPF of at least 30 and zinc oxide or titanium dioxide at least 1 hour before going out.
• Do not use acne medicines. They do not work, and may make skin dry and rashes worse.
• Try gel shoe inserts if the soles of feet are tender.
• Wear shoes that fit well and are not too tight.  
• Tell doctors immediately if any rashes or skin changes are noticed. Left untreated, rashes can get worse and lead to infections.

- Care for nails: During and after targeted therapy treatment, patients may find their finger nails and toenails have darkened and become brittle, and may also experience painful swelling and redness around their nails.^20,21 Things that may help with nail changes:^20,21

• Take extra care when cutting nails. Cut them evenly and keep them short.
• In the case of pain or redness, patients may soak fingers or toes in a mixture of white vinegar and water in equal amount
• To avoid infections, patients should maintain hygiene by gently washing hands and feet with mild soaps regularly.
• It is recommended that patients should wear soft shoes to avoid further aggravating their toenails.

- Diarrhea management: Targeted therapy could cause mild to serious diarrhea in patients. Serious diarrhea could result in dehydration and loss of electrolytes.   Patients should ensure to drink plenty of water, and avoid eating dairy products, oily foods, and foods high in fibre.²² 

- Care for month sores: If patients have mouth sores after targeted therapy treatment, eat soft, non-spicy foods. Besides, good oral care is important. Be sure to brush teeth, and see a dentist before and during treatment if needed.²¹ See Mouth Sores under Post-chemotherapy care section for more information.

- Loss of appetite: Loss of appetite is a common side effect of targeted therapy. It can begin with the refusal of the favourite foods and may also involve the loss of weight. Below are some useful advice for managing it:²³

• Eat only the amount of food a patient desires.
• Take small meals throughout the day, not necessarily to eat three regular meals each day.
• Eat with friends and/or with the family or with the radio or television on.
• Eat foods high in calories, easy to eat, such as porridge, puddings, yogurt, etc.
• Drink between meals instead of during the meal.

See Nutrition Tips for Lung Cancer Patients under Nutrition-related information section for more information.

_{18. ACS. Targeted Cancer Therapy. Available at: https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/targeted-therapy.html. Accessed: 6 May 2019.}

_{19. ACS. Treating Non-Small Cell Lung Cancer - Targeted Therapy Drugs for Non-Small Cell Lung Cancer. Available at: https://www.cancer.org/content/dam/CRC/PDF/Public/8706.00.pdf. Accessed: 6 May 2019.}

_{20. ACS. Side Effects of Targeted Cancer Therapy Drugs. Available at: https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/targeted-therapy/side-effects.html. Accessed: 6 May 2019.}

_{21. MASCC. Caring for Your Skin, Hair and Nails When on Targeted Therapies. Available at: http://www.mascc.org/assets/documents/skin_toxicity_egfri_patientbrochure.pdf. Accessed: 6 May 2019.}

_{22. HKACS. Fight Against Lung Cancer. Page 35. 2015 Edition. ISBN 978-988-15283-0-8.}

_{23. LCA. Loss of Appetite. Available at: http://www.lungcanceralliance.org/what-if-i-am-diagnosed/side-effect-management/loss-of-appetite.html. Accessed: 6 May 2019.}