SIDE EFFECTS OF CHEMOTHERAPY

Anti-cancer drugs work by preventing cells from growing and dividing. The effect is strongest on cancer cells, but normal tissues can also be affected. The most common side effects include nausea, fatigue, menopausal symptoms and hair loss. The side effects will vary with the drug used, and with your own tolerance to it

While it is important to be prepared for possible side effects of chemotherapy, it is equally important not to assume that you will have all, many, or even a few of them. Many people go through chemotherapy without significant ill effects.

Addison R. Tolentino, MD – “Most of the side effects… we can control.”

Nausea

Nausea used to be one of the most distressing side effects of many chemotherapy drugs. Today there are several effective antiemetic (antinausea) medications that can eliminate or decrease this problem. In addition, you may want to explore such complementary therapies as meditation and relaxation to help relieve your discomfort.

Fatigue

High doses of chemotherapy can make you feel tired, especially on the first day after each treatment. Adjust your schedule so that you can rest if you want. Many patients find that given some flexibility they can keep a fairly normal level of activity. If you feel unable to function at a reasonable level, tell your oncologist about it. Your drug dose may be too high, and may need to be readjusted. Your physician may recommend medications to help your body rebuild red blood cells, and raise your energy level.

Neuropathy

Certain chemotherapy drugs, particularly oxaliplatin, will cause numbness in your fingers and toes called neuropathy of neurotoxicity. The side effect may be so severe that you may have difficulty holding a cup in your hands. Clinical trials now in progress will determine whether this serious side effect can be decreased by shortening treatment time.

Bone Marrow Suppression

Bone marrow cells, which produce red blood cells, white blood cells, and platelets in your blood, are particularly affected by chemotherapy, and may lose some, or all, of their function, leading to lower blood cell counts. Red blood cells (RBC’s) transport oxygen. A low red blood cell count, called anemia, will generally give you fatigue. White blood cells (WBC’s) help fight infection. A normal WBC count is in the 5,000-10,000 range.

 

Platelets help the blood clot. A platelet count below 100,000 can predispose to bleeding, such as excessive bleeding from wounds, or slow bleeding into the stomach or intestine, which could appear as black stools.

Your chemotherapy dose may need to be lowered, or the treatment delayed, to avoid dangerously impairing the ability of the bone marrow to produce blood cells.

To avoid compromising the treatment by delaying or decreasing your chemotherapy, your doctor may give you medications called colony stimulating factors, such as Neulasta, to encourage your bone marrow to produce more blood cells, and protect you from complications.

Raising your white cell count will help you fight off infections. Raising your red cell count will give your blood more capacity to carry oxygen, and will improve your strength.

Infections

When your white blood cell count is low, your body may not be able to fight off infections. Most infections come from bacteria normally found on the skin, in the intestines, and in the genital tract.

Signs of Infection

• Fever over 100 degrees Fahrenheit

• Sweating and chills

• Loose bowels

• A burning feeling when you urinate

• A severe cough or sore throat

• Unusual vaginal discharge or itching

• Redness, swelling, or tenderness around a wound

Be alert to signs that you might have an infection, and report them to your doctor right away. This is especially important when your white blood cell count is low. If you have a fever, don’t use aspirin, acetaminophen (Tylenol), or any other medicine to bring your temperature down without first checking with your doctor.

Other Side Effects

Some of the other side effects of chemotherapy may include mouth sores, intestinal problems, and vaginal dryness.

When chemotherapy affects the lining of the intestine, the result may be diarrhea. You can try to eat smaller portions more often, and avoid high fiber foods.

Oral Care During Cancer Treatment

• Eat foods cold or at room temperature

• Choose soft foods, such as ice cream, milkshakes, or baby food

• Avoid irritating, acidic foods, or spicy food

• Consider artificial saliva to moisten your mouth

• Drink plenty of liquids

• Suck on ice chips, popsicles, or sugarless hard candy

• Moisten dry foods with butter, margarine, gravy or sauce

If you develop sores in your mouth, be sure to contact your doctor or nurse because you may need medical treatment for the sores.

Vaginal dryness can be relieved with a variety of personal lubricant products readily available.

 

Some drugs may have other, even less common side effects, for example, a condition known as hand-foot syndrome, which causes redness and itching of palms and soles. Make sure your physician reviews with you the side effects that may be expected from your particular drug combination.

Do I Need Chemotherapy?

Many patients are reluctant to face chemotherapy, because they carry the old misconception that chemotherapy is something that makes you deathly ill, or makes your hair fall out. Much has changed in recent years. Today there are very effective drugs that can greatly reduce—and sometimes eliminate—the side effects of chemotherapy, making the experience much more tolerable than it was rumored to be in the past.

Do you personally need chemotherapy? It depends on the stage of your tumor.

If you have early (stage I) colon or rectal cancer, your physician is not likely to recommend chemotherapy. Stage I tumors have not spread, and the chances are very good that surgery will remove the entire tumor and cure the disease.

There is no agreement on whether stage II colon cancer needs to be treated with chemotherapy in addition to surgery. The decision may depend on your physician’s specialty. The use of chemotherapy in stage II colon cancer is controversial because patients with stage II cancers have an excellent chance of cure by surgery alone. There is no evidence at this time that postoperative chemotherapy helps these patients live any longer.

If you have stage II and III rectal cancer, chemotherapy is a good choice, and may be combined with radiation therapy. If you have stage III colon cancer, your chances of cure with surgery alone are less, so chemotherapy will be used to decrease the possibility that cancer cells are left behind, and to help prevent cancer from coming back (recurring) after surgery.

If you have stage IV or recurrent colon cancer and are too ill to have surgery, or have chosen not to have surgery for personal reasons, chemotherapy may be your main (primary) treatment. Chemotherapy will not cure advanced-stage colon cancer, but it can relieve some symptoms and may slow cancer growth.

Your physicians will help you evaluate objectively the expected advantages and disadvantages of chemotherapy. There are tests that can assess your risk of recurrence and the potential effectiveness of chemotherapy. Be sure to ask your healthcare team about these tests.

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