Common Side Effects of Chemotherapy and its Management
Chemotherapy is the use of single or combination of drugs to interfere or inhibit cancer cell proliferation, thereby damaging or killing cancer cells.
Chemotherapy, in destroying cancer cells throughout the whole body, can also damage normal cells, causing "Side Effect". In general, different chemotherapy regimens induce different kinds of side effects and the severity of side effects varies from person to person. Fortunately, most side effects are transient and disappear at the end of chemotherapy and with appropriate medications, can be prevented.
Most Common Side Effects & Its Management
1. Nausea & Vomiting
Chemotherapy-induced nausea and vomiting (CINV) can be categorized into three types: Acute CINV (symptoms begin within 24 hours after receiving chemotherapy), Delayed CINV (Symptoms begin 24 hours or up to five days or even longer after receiving chemotherapy) and Anticipatory CINV (symptoms begin 24 hours before chemotherapy). Emetic responses can be triggered by more than one pathway, including peripheral (Gastrointestinal) and central system pathways. Hence, no one antiemetic can completely protect every person from nausea and vomiting associated with chemotherapy. In practice, a combination of antiemetics, 5-HT3 receptor antagonist and corticosteroid (Dexamethasone) prevent acute emesis by 70-80%, but with less improvement on delayed emesis (50%). In 2004, a new antiemetic (Aprepitant) targeting new pathway for CINV was made available in Hong Kong to solve the unmet need of emesis therapy for both acute and delayed nausea and vomiting.
Aprepitant (Brand name:EMEND) is a selective high-affinity antagonist of human substance P/neurokinin 1 (NK1) receptors which target substance P, a key neurotransmitter involved in the emetic pathway in brainstem vomiting center, indicated for acute and delayed CINV protection.
In a recent local clinical study, antiemetics in combination with Aprepitant shows better quality of life and superior protection against nausea and vomiting associated with chemotherapy versus conventional antiemetic therapy in patients with breast cancer[Pauletta1] . 1
Apart from medications, patients are advised to avoid drinking or eating too much before chemotherapy to minimize the chance of having a stomach upset.
Take small feeds slowly, and avoid fried, fatty or greasy foods during chemotherapy.
Try to consume high protein nutrient supplement in case of loss of appetite.
2. Oral mucositis
Oral hygiene is extremely important for patients suffering from oral mucositis. They are advised to rinse with normal saline after meals and to use dental floss to remove food particles at least once per day apart from brushing the teeth.
Prescription mouthwash should be used in case of inflammation or swelling of gum tissues as determined by doctors. Commercial mouthwashes are not recommended because of the subsequent drying effect on the oral mucosa. In the meantime, avoid food which will irritate the oral mucosa, especially acidic or salted foods. A liquid diet or soft food with lukewarm temperature is highly recommended.
White Blood Cells, especially Neutrophils are immune cells to protect human body against invasive bacteria. Patients should ensure high personal and environmental hygiene standard when white blood cell count becomes low. Always keep clean and wash the hands before meals.
Patients are not encouraged to eat overnight or rare food, avoid as far as possible crowded place and keep away from people infected with flu or communicable diseases.
4. Stomach Disturbance
Metabolism and peristalsis of GI tract is susceptible to chemotherapy toxicity resulting in different level of stomach disturbance. Diarrhea and constipation are common side effects of chemotherapy.
In case of Diarrhea, eliminate intake of irritating food, such as milk, high-fiber food or greasy food. When condition is serious, anti-diarrhea drugs prescribed by doctors would be necessary.
Drink water at least 8-10 cups a day. Food with high fiber content (prune or prune juice etc.) and exercise can facilitate the frequency and ease of defecation. Patients are advised to consult doctors immediately if condition deteriorates.
5. Dermatological Irritation
Transient redness or rashes surrounding the site of injection are common dermatological toxicity of chemotherapy. Other dermatological effects, such as hyperpigmentation, dry skin and itchiness may appear in one to two weeks after chemotherapy. Patients should ward off from sunshine to prevent pigmentation.
Medical Professionals may prescribe anti-irritating medicines to relief the dermatological effects. For patients with severe side effects doctors would need to consider stopping the chemo drugs.
Hair loss is the result of the irritation of hair follicles caused by chemotherapy. Normally, hair loss starts within a few weeks after chemotherapy and ceased at the end of chemotherapy.
Although hair loss is only short-term, it can be the most devastating side effect. Reason being that it not only affects the physical appearance of patients, but also constantly reminds patients that they are cancer victims. Sharing with family members and cancer peers can help relieve their emotional stress.
Many cancer patients are scared of chemotherapy because of the hearsay about its awful side-effects, so much so that some patients start to vomit before receiving chemotherapy. In fact, more and more medications have been developed nowadays to manage and reduce the impact of side effects associated with chemotherapy. Together with the aforementioned management methods and with the care from medical professionals, patients can now enjoy a much better quality of life during chemotherapy treatment.
The above information is for reference only, please consult doctor for details prior medications.
1. B. C. Zee, W. Yeo, F. K. Mo, W. Lau, A. Poon, L. Chan, W. M. Ho
. J Clin Oncol 26: 2008 (May 20 suppl; abstr 20549)