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Symptom Management:

Symptom Management

Side Effects of Treatment
Side Effects of Chemotherapy
Pain
Fatigue
Appetite Loss
Bladder Disturbances
Incontinence - Urinary
Bleeding
Constipation
Diarrhea
Dryness of the Mouth
Fluid and Electrolyte Imbalances
Hypercalcemia
Flu-like Syndrome
Hair Loss
Infection
Anemia
Itching
Lymphedema
Menopausal Symptoms
Nausea & Vomiting
Neurological Disturbances
Spinal Cord Compression
Peritoneal Effusions
Shortness of Breath
Skin Conditions
Sleep Problems (Insomnia/Oversleeping)
Sore Mouth
Swallowing
Bone Metastases
Coping
Anxiety
Depression
Grief
Sexuality Issues
Sexual Dysfunction
Side Effects of Chemotherapy

Definition

Chemotherapy is the use of medications to treat cancer. Chemotherapy drugs can’t tell the difference between certain types of normal cells and cancer cells. As a result, many of these drugs affect normal cells and cause side effects.

Chemotherapy is systemic, which means that the chemotherapy reaches most of the body through the bloodstream. If cancer cells are hiding out in different places of the body, chemotherapy can reach most of these areas and kill the cancer cells. Chemotherapy is recommended in a number of different situations:

  • following surgery to kill cancer cells that may be undetectable and have moved from the primary tumor to other sites (adjuvant chemotherapy)
  • before surgery to shrink the tumor so that it can be taken out by surgery (neoadjuvant chemotherapy)
  • with radiation therapy to “sensitize” the cancer cells so that they are more easily killed by radiation therapy (radiosensitizing chemotherapy)
  • as the primary treatment for cancers of the blood or lymph systems, because chemotherapy can reach and kill the cells in the bone marrow, lymph system, and other body areas (primary treatment)

Causes

Since chemotherapy cannot tell the difference between cancer cells and normal cells that divide frequently, some normal cells are temporarily damaged. Examples of normal cells that divide frequently and some associated side effects are listed in the table below.

Table 1

Body Area Affected

Possible Side Effects

Cells lining the mouth, throat, esophagus, intestines, and rectum

Mucositis or inflammation of the mucosa in one or several parts
Diarrhea
Nausea and vomiting
Stomatitis, or inflammation of the mouth mucosa

Cells in the bone marrow (where white, red and platelet blood cells are made)

Temporary decrease in the number of white, red, and platelet blood cells
Increased risk of:
infection (white blood cells help fight against infection)
anemia (red blood cells carry oxygen around the body
bleeding (platelets help the blood to clot or stop bleeding)

Cells lining the hair follicles

Loss of some or all of the hair on the scalp and body (alopecia)

Cells in the reproductive tract,(ovaries in women and testes in men)

Women
Irregular or absent (amenorrhea) monthly period
Temporary or permanent loss of fertility (depending upon the woman’s age and drug)

Men
Temporary or permanent inability to make sperm that live

Many of these side effects are common to most chemotherapy drugs. In addition, certain side effects depend upon the drug(s) the person receives. Each chemotherapy drug may have side effects that are specific to that drug. For example, gemcitabine may cause fever, and bleomycin can cause changes in the skin and nails (Wilkes et al, 2001). Other drugs can cause diarrhea (irinotecan), constipation (vincristine), or nerve damage to hands and feet (taxol, vincristine, cisplatin). Certain chemotherapy drugs can hurt some of the body’s organs and need special monitoring. For example, doxorubicin can cause heart damage, and cisplatin can cause kidney damage. Fortunately, much can be done to prevent this from happening.

Prevention

There are now many ways to reduce side effects or prevent them from happening again. Two of the most serious side effects are infection and bleeding. A third, anemia, is not life threatening but can lessen quality of life. Special medicines called growth factors can reduce these side effects or prevent them from happening again. In certain situations a doctor or nurse may recommend the following interventions:

  • Filgrastim (Neupogen® , G-CSF) or sargramostim (Leukine® , GM-CSF) can be given in shot form (injection) starting 24 hours or more after chemotherapy. These drugs help the bone marrow make more white blood cells to prevent infection with fever.
  • Epoetin alfa (Procrit® ) can be given in shot form (injection) to stimulate the bone marrow to make red blood cells to prevent anemia. This lessens the chance a person feels tired and fatigued.
  • Oprelvekin (Neumega® ) can be given in shot form (injection) to stimulate bone marrow to make more platelets that help the blood to clot.

The chance a person gets sick to their stomach (nausea and vomiting) after chemotherapy can be prevented or reduced by one or more anti-nausea medicines. In addition, there are many different antiemetics (drugs that prevent nausea and vomiting), so if one doesn’t work well, another may work better.

If a person is receiving a drug that is known to damage a body organ, then special tests are done before treatment is started and periodically during the treatment. That way, any changes in normal functioning can be found early and changes made before more damage can happen. For example, doxorubicin and daunorubicin may hurt the heart. Bleomycin and carmustine can hurt the lungs. Cisplatin can hurt the kidneys. In the case of cisplatin, extra fluid is given with the treatment, and sometimes a diuretic, to help flush the kidneys. This protects the kidneys from the chemotherapy.

Finally, sometimes people receiving chemotherapy don’t talk about their feelings. Usually people are very nervous about starting treatment. Anxiety may increase attention, so that it is easier to learn about chemotherapy and what to expect. Sometimes though, people are frightened of the unknown, and the anxiety can cause a dry mouth, fast heartbeat, and feeling sick. A way to prevent this is for the person receiving chemotherapy to ask their doctor or nurse if they could speak to a patient receiving the same chemotherapy. This takes away the fear of "not knowing" and most people are able to cope better when they know what to expect from someone who has already had chemotherapy.

Empower yourself with information.  Knowledge is power.
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