Split Fingers and Other Surprising Side-Effects of Targeted Therapies
There are a lot of side-effects that nobody really talks about, but that have a real-world impact on patients. It seems to me that so much energy online goes into the fear-mongering about “slash, burn, and poison” intended to drive patients away from conventional treatments, and the required myth-busting efforts to educate patients about the realities of new cancer treatments, that smaller, less common side-effects might simply be lost in the shuffle when it comes to patient awareness and preparedness. One such side-effect that I have dealt with a lot is the “split finger,” where the tips of the fingers (and especially along the nail bed) split open like deep paper cuts.
Comparing treatment side effects
With the rising prevalence of targeted therapies, which are generally much less toxic than traditional chemotherapies, there has been a lot of consideration about how comparitively, they have far fewer side-effects for many patients. And certainly, most of the side-effects that come with targeted therapies do seem to be easier to endure. But these are still relatively new cancer medications and, as such, a lot of their side-effects are still coming to light. Additionally, when comparing them to chemotherapy drugs, it should be noted that many of the modern chemotherapies are already easier on the patient than older chemo drugs.
Great leaps have been made in cancer treatment over the last two decades, providing generally more effective treatments that are also somewhat gentler than their forebears. Though it was often difficult, I recall my experience with chemotherapy being much less of a burden than I had been led to believe it would be. Still, while I am extremely glad that I went through my 40 rounds of chemo over the course of more than two and a half years, it is not an experience I will rush to replicate. So when it turned out that I had a newly-actionable mutation, I was excited about the prospects of new therapies that might avoid the fatigue and chemo brain, nausea, mouth sores, acne, and generally ill feeling that chemotherapy had often left me with.
My experience with targeted therapy
My first attempt at a targeted treatment was exciting in that my mental processes cleared up immediately, along with a boost in physical energy. While my oncologist warned me that there would be some difficult side-effects with possible sores and a rash, I told him for months that it was my favorite treatment. Even after the rash became pervasive and I had my first taste of split fingertips and infected nail beds. Because, I explained, I felt so good otherwise. Unfortunately, it turned out that I did not respond well to that treatment, so I tried another.
The second targeted treatment had absolutely no side-effects for me. None. My skin cleared up quickly. Unbelievably, I found that I had even more energy, both mentally and physically. I began making plans to go back to work full-time. It was overly optimistic, however, as it turned out that I had no response at all to this drug. Fortunately, there was a clinical trial waiting in the wings and the timing was perfect for me to join.
With my expectations suitably lowered by my first two experiences with targeted therapies, I was less-than-thrilled when it turned out my new side-effects were the worst I had yet experienced. In less than a week, I had a stronger acne rash than what I experienced with chemo and my first targeted treatment combined. It was cruel the way it attacked my scalp and face, oozing one day, bloody the next, tight, dry and burning right after — but I still felt great in every other way. The first month was progressively more painful on the surface, but I was figuring out ways to manage. And then the results were stunning, better than any response I had since my initial rounds of chemo. I figured that I could adapt to more of this.
Taking care of my evolving skin changes
While figuring out ways to treat my evolving rash, I also discovered that I needed to invest in disposable gloves and “finger cots,” little disposable sleeves that slide over each finger to protect the tiny cuts I now have on each of them. But such is the beauty of modern cancer treatment — there is a solution out there for pretty much any problem you encounter. These treatments are so new that even the best oncologists are still scrambling to solve every new patient discomfort. And in cases like mine, where the drug is still in the clinical trial stage, there simply is not enough data to know what to expect for every patient in advance.
But as these newer treatments gain prominence and more patients share their experiences, we will all be more prepared going in. I was lucky to have a box of disposable gloves under my kitchen sink, so I did not have to wait until the finger cots came in the mail to regain my ability to do simple things like type or wash the dishes without pain. I am still surprised by how many patients do not even know what finger cots are, as they struggle with bandages and other ways to protect their fingers.
Making treatments tolerable
Knowledge is one of the most important resources we can share. Conventional cancer treatment is tough, but it can be extremely effective and worthwhile. Even with surprising side-effects, as uncomfortable as they may be, there are ways to make the treatment tolerable. In the span of less than two weeks, I had gone from screaming in pain in the shower to having a fabulous day at a water park. It was just a matter of figuring out the right combination of palliative treatments for my skin, supportive medications (a tetracycline style antibiotic and topical steroids), and tools like those finger cots to protect the open wounds. Now I know that I can do this, side-effects and all.
Editor’s Note: We are extremely saddened to say that on October 21, 2018, Jeffrey Poehlmann passed away. Jeffrey’s advocacy efforts and writing continue to reach many. He will be deeply missed.
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