Chemotherapy

Chemotherapy is the use of medicines to treat cancer. It is a systemic treatment; which means that the drugs travel through the bloodstream to all parts of the body. These medicines prevent and control rapidly growing cancer cells. Certain normal cells also grow rapidly, and are maybe temporarily affected by the drugs. This is the reason for the experience of side effects.

Chemotherapy drugs are given in cycles; that is, a combination of drugs may be given every 3 weeks or two weeks or once a month. Chemotherapy cycles are carefully scheduled to allow normal cells to recover and to allow reduced white blood cell count to rebound back to an acceptable range.

Chemotherapy Aims At:
  • Destroying all cancer cells especially small cells that may have sustained through the surgery
  • Decreasing the chances of the cancer coming back
  • Controlling the growth and the spread of the tumor
  • Reducing the size of the tumor so that surgery may be performed

Chemotherapy is primarily given intravenously; thus there is a need to start an IV line. Some people have veins that are difficult to access. If this is the case , make sure to have plenty of fluids before having the IV placed. A warm towel around the arm will also help the veins relax and enlarge. Once the IV is placed, there is no pain. If you do feel any pain or notice leakage or swelling, inform the nurses immediately.

Remember

People react to treatment in different ways. Not everyone undergoing chemotherapy will experience all the side effects.

Different chemotherapy drugs have different side effects. It is helpful to ask your doctor about the specific side effects which may be caused by your own treatment. It is important to remember that you probably won't get every side effect that is listed. Each individual reacts differently. For some people, the side effects are minimal while others experience no side effects at all. Thus, everyone taking chemotherapy has:

  • Different drugs
  • Different doses
  • Their own treatment plan
What are the Pros & Cons of Chemotherapy?
The side effects of chemotherapy can be unpleasant. But it can help to try to see the problems in relation to the benefits of the treatment. Remember that almost all side effects are short term and will begin to go once treatment is finished. If you find the treatment or side effects troublesome, make an appointment and tell your doctor. You may be able to:
  • Take medicines to help
  • Have your treatment changed or the drug dose reduced to minimize the side effects
Where do you Get Side Effects?

Chemotherapy damages dividing cells, so the parts of your body where normal cells divide frequently are likely to be affected by chemotherapy. For instance, the hair is growing all the time. The skin and the lining of the mouth and digestive system are constantly renewing themselves. The blood cells also constantly replace themselves. To do this, the cells of all these body tissues must constantly divide to produce a steady supply of new cells. Thus, the parts of your body most affected are the:

  • Mouth
  • Digestive system
  • Skin
  • Hair
  • Marrow (the spongy material that fills your bones and produces new blood cells)
Mouth & Chemotherapy

Some chemotherapy drugs can cause following problems in your mouth:

  • A sore mouth
  • Mouth Ulcer

These side effects are often referred to as mucositis and can happen about 5 to 10 days after you start taking the chemotherapy. They clear up in 3 to 4 weeks. Some chemotherapy drugs cause your taste to change. Food may taste

  • Salty
  • Bitter
  • Metallic

Your taste goes back to normal soon after the treatment is over.

Helpful Hints on Coping with these Side Effects
  • Avoid foods that taste strange to you, but try them every few weeks as your taste may have gone back to normal
  • Choose foods that have strong flavors (e.g. herbs, spices, marinades and sauces) if all your food tastes the same
  • Clean your mouth and teeth gently every morning, evening and after each meal
  • Use a soft bristled or child's toothbrush
  • Remove and clean dentures every morning, evening, and after each meal
  • If your toothpaste stinks, or brushing your teeth makes you feel sick, try a 'bicarbonate of soda' mouth wash instead (one teaspoon dissolved in a mug of warm water)
  • Warm salt water gargles can be soothing
  • Baking soda and warm water rinses sooth mouth sores and ulcers
  • Avoid mouthwashes that contain alcohol
  • Use dental floss daily but be very gentle, so you don't harm your gums
  • Keep your lips moist by using Vaseline or a flavored lip balm
  • Avoid neat spirits, tobacco, hot spices, garlic, onion, vinegar and salty food when your mouth is sore
  • Choose meals that are moist with gravies and sauces, to make swallowing easier
  • Try to drink at least one and a half liters (3 pints) of fluid a day; tea or coffee, fruit, vegetables, juices, soft drinks or water. Eating fresh pineapple can keep your mouth fresh and moist but avoid acidic fruits (e.g. oranges, grapefruit) if your mouth is sore
  • Chewing gum can help you to produce more saliva to keep your mouth moist If you have difficulty swallowing, have soft foods and chew food thoroughly
  • Avoid foods which irritate your mouth such as very salty or spicy foods, citrus fruits or rough foods like toast.
Your digestive system & Chemotherapy Diarrhea

Some chemotherapy drugs irritate the lining of the digestive system and can cause diarrhea. It usually happens in the first few days after your chemotherapy. Diarrhea, can easily dehydrate a person. It is important, therefore, to drink plenty of water. If you can't drink enough, or you think you are losing more fluid than you can replace by drinking, you must see your doctor. Diarrhea can also irritate the anus, cause soreness. You can apply a soothing cream to give relief.

Hints on Managing Diarrhea:

Some chemotherapy drugs irritate the lining of the digestive system and can cause diarrhea. It usually happens in the first few days after your chemotherapy. Diarrhea, can easily dehydrate a person. It is important, therefore, to drink plenty of water. If you can't drink enough, or you think you are losing more fluid than you can replace by drinking, you must see your doctor. Diarrhea can also irritate the anus, cause soreness. You can apply a soothing cream to give relief.

  • Eat less fiber (raw fruits, fruit juice, cereals and vegetables)
  • Drink plenty of liquid to compensate for the fluid loss
  • One may need to take a complete multi-vitamin and mineral supplement
  • Symptoms can also be managed with medication, which will slow down your gut and so help to reduce the diarrhea.

When there is no more diarrhea you should be able to slowly start eating the food you have been avoiding

Constipation

Some chemotherapy drugs can cause constipation. This can be because the drug affects the nerve supply to the bowel for a while. Mild laxatives during the chemotherapy can be beneficial. If you are constipated for more than 3 days, you should tell your doctor. To avoid constipation drink plenty of fluids and eat plenty of fresh fruit and vegetables. If you can't manage the food, don't worry too much, but make sure you substitute it with liquids.

Hints on How to Manage Constipation

Some chemotherapy drugs irritate the lining of the digestive system and can cause diarrhea. It usually happens in the first few days after your chemotherapy. Diarrhea, can easily dehydrate a person. It is important, therefore, to drink plenty of water. If you can't drink enough, or you think you are losing more fluid than you can replace by drinking, you must see your doctor. Diarrhea can also irritate the anus, cause soreness. You can apply a soothing cream to give relief.

  • Eat more fiber, raw fruits, cereals, fluids and vegetables
  • Dried fruits like prune, apricots and raisins may help to make your bowels work
  • Fiber absorbs fluid, so drink plenty of fluids
  • Ask your doctor for a suitable laxative if change in the diet does not work.

If you are worried about the effects of chemotherapy on your digestive system, make an appointment to see your doctor to discuss any problems you have Loss of appetite: Loss of appetite could occur due to several reasons: nausea, fatigue, mouth sores, ulcers, or loss of taste. Loss of appetite could also be caused by depression. Talk to your doctor or nurse as they get you the appropriate help.

Helpful Hints to Cope with Loss of Appetite
  • Eat when you feel hungry
  • Eat several small meals and snacks throughout the day
  • If you are worried about losing weight, ask your doctor to prescribe a 'meal in a drink' such as Fresubin - between chemotherapy treatments. You can have these as well as regular meals
  • If you really don't feel like eating during treatment - you can make up for lost calories between treatments. It is, however, very important to drink enough fluid
  • Try to eat high calorie foods to keep your weight up
  • Don't fill your stomach with a large amount of liquid before eating
  • Try to relax and enjoy what you are eating
  • A short walk before a meal may improve or give you an appetite

Nausea/Vomiting

Nausea/vomiting are common experience for patients with cancer. It depends on the type and dosage of the chemotherapy drug. There are ways in which this side effect can be managed. For example, anti-sickness treatments are a part of the kit to be taken post chemotherapy.

Hints on How to Manage Nausea & Vomiting
  • Avoid foods that are spicy, fatty or greasy, very sweet, and those with strong smells (foods that are warm tend to smell stronger)
  • Avoid having large meals (eat small meals throughout the day)
  • Avoid lying down immediately after a meal
  • Eat and drink slowly
  • Rinse mouth with lemon after eating
  • Keep a clove in your mouth
  • Avoid unpleasant smells
  • Suck on ice cubes or hard candies
  • Distractions such as TV, music, or reading might be helpful while eating
  • Meditation and breathing exercises can also help
  • Get some fresh air
  • Do not force yourself to eat when you are feeling nausea

In case of persistent nausea please contact your doctor or nurse

Hair Loss

Chemotherapy attacks rapidly growing cells, such as hair roots. The experience of hair loss depends on the drug that is advised. Hair loss can affect all areas of the body, such as the scalp, armpit, eyelashes and eyebrows. It is important to remember that hair loss is temporary. The color and texture of the hair may change and as witness always for the better. Hints on how to manage Hair loss:

  • Be gentle with your hair
  • Be patient
  • Consider cutting or shaving your hair: This will help the hair grow out evenly. It will also save you the embarrassment or sadness of seeing your hair fall. Some people also feel some itchiness or irritation as their hair is falling; shaving it will minimize this. (Note: This could be done even before the start of chemotherapy)
  • Protect your head: your scalp will need protection from the sun. A scarf and hat will help. Apply sunscreen
  • Consider buying a wig
Skin

Due to chemotherapy you may notice changes in your skin. It may lose elasticity or become dry and patchy. Patchiness and dark patches could also be caused due to low platelet count in the blood. Hints on how to manage Skin problems:

  • Massage skin with baby oil, vaseline, or olive oil (for breast cancer patients the movement is always from the finger to the shoulder)
  • Avoid scratching (especially mosquito bites)

Low Blood Counts:

During chemotherapy, changes in the bone marrow cells must be carefully monitored. Bone marrow cells consist of red blood cells, which carry oxygen; white blood cells, which fight infection; and platelets; which help blood to clot. As these are rapidly dividing cells, chemotherapy drugs may also attack them. Fortunately, time is all that is needed for the bone marrow to recover. Usually during chemotherapy, the white blood cell counts drop, causing susceptibility to infections. Before each chemotherapy cycle, blood count is monitored; if the blood count is low, treatment will be delayed in order to avoid serious complications.

Hints on Reducing Exposure to Infections
  • Maintain good personal hygiene (for example wash your hands before and after meals; wash your hands properly especially after using the toilet)
  • Eat cooked vegetables; avoid raw foods and undercooked meat
  • Avoid exposure to germs: Stay away from people who have the flu or cold and cough
  • Try and stay away from crowded places like movie theaters, shopping malls, and markets
  • Try and eat home cooked food only; and avoid leftover or stale food
  • Foods should be stored properly in the fridge.
  • Eggs should be cooked thoroughly (the yolk should be cooked)
  • Avoid any form of injury, cuts or burns. In such cases clean with warm water and apply antiseptic cream.
Fatigue

Patients receiving chemotherapy often complain of fatigue. Fatigue can be a direct result of the cancer itself, pain, lack of exercise, poor nutrition, or hormonal changes. Low red blood cell count; as a result of chemotherapy, could be another reason for dizziness or fatigue. Hints on how to cope with Fatigue

  • Take it easy, relax and take regular breaks
  • Do not overwork yourself
  • Do not indulge in strenuous activities during treatment
  • Drink plenty of fluids and maintain a healthy diet; this can help replenish nutrients in your body
Sexual & Reproductive Problems:

Sexual functioning and fertility could be affected by the cancer itself or by the cancer treatment. One might experience reduced or no sexual desire; this could be due to factors such as fatigue, worry about cancer and its treatment, feelings of physical unattractiveness may be due to surgery or hair loss, or general physical discomfort.

Men

Chemotherapy can cause low sperm count or erectile problems in men. These changes can result in temporary or permanent infertility. However some men can remain fertile during early stages of treatment. It is important therefore to avoid pregnancy during this period.

Women

Women can experience a change in their menstrual cycle; they may become irregular or may stop during chemotherapy. However, some women do remain fertile. It is important to avoid pregnancy during chemotherapy, so it important to use some form of contraception. One can also experience symptoms of menopause like vaginal dryness and hot flushes.

Hints on How to Manage Sexual & Reproductive Problems
  • Communicate with your partner
  • Be patient with yourself
  • Explore alternative ways of expressing physical love, such as touching and cuddling
  • Talk to your doctor about treatment options

It is safest to use a condom during sexual intercourse so to avoid any exposure to residues of chemotherapy that may be present. Old infections can also flare up (e.g., yeast infections).

"Chemo Brain"

Many patients experience some mild cognitive problems during chemotherapy. They may describe themselves as feeling “foggy”. They may have trouble remembering things, learning new things, finding the right words or completing certain tasks. Unfortunately, it is not yet known what triggers this; however, this could be caused by factors such as low blood counts, stress, hormonal changes, certain medications, depression or fatigue. This impairment is temporary and there are ways in which this can be managed.

Hints on How to Manage Chemo Brain
  • Exercise your body: Do only as much as possible and advisable; e.g., walking
  • Exercise your mind: Crossword puzzles, sudoku have been found to help
  • ExpKeep lists of tasks that need to be preformed
  • Start a regular routine
  • Ask for help from friends and family

References

Cukier, D., Gingerelli, F., Makari-Judson, G., & McCullough, V.E. (2004).
Coping with Chemotherapy and Radiation. McGraw-Hill: New York.

Coping With Cancer

 




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