Understanding and Managing Chemotherapy Side Effects

With better control of side effects from chemotherapy, treatment is going more smoothly for many people with cancer.

The goal of chemotherapy is to destroy cancer cells.

Traditional chemotherapies work by killing cells that divide rapidly. But as they wipe out fast-growing cancer cells, they also can damage fast-growing healthy cells.

Damage to healthy blood cells, for example, can lead to side effects such as fatigue or infection. Chemotherapy can also damage the cells that line mucous membranes throughout the body, including those inside the mouth, throat and stomach. This can lead to mouth sores, diarrhea or other issues with the digestive system. And damage to cells at the hair roots, or follicles, can lead to hair loss.

Each person with cancer reacts differently to chemotherapy and its potential side effects. Fortunately, doctors now have ways to reduce and even prevent these side effects. In this booklet, you’ll find practical information on managing side effects from chemotherapy so that your treatment goes as smoothly as possible.

To help you get relief, your doctors and nurses need to know specific details about your symptoms. By keeping a side effects journal and bringing it with you to medical appointments, you can have this kind of information ready to share with your health care team. Some of the things you may want to write down in your journal include:

• The date and time a side effect occurs

• How long it lasts

• How strong it is—for example, if you experience pain, how strong is it on a scale from 1 to 10, with 1 being the least amount of pain and 10 the most intense?

• How your daily activities are affected—did any side effect of your medication keep you from sleeping, eating, walking, working or exercising?

• Any other questions or concerns that come up between appointments with your health care team

Good communication with your doctors and nurses is especially important if you decide to take part in a clinical trial. Clinical trials are studies that test new treatments to see how safe and effective they are for patients.

Your doctor, who knows the most about your specific type and stage of cancer, can guide you in making a decision about whether a clinical trial is right for you.

Your Support Team

When you are diagnosed with cancer, you’re faced with a series of choices that will have a major effect on your life. Your health care team, family members and friends will likely be an invaluable source of support at this time. You can also turn to these resources:

Oncology social workers provide emotional support for people with cancer and their loved ones. These professionals can help you cope with the challenges of a cancer diagnosis and guide you to resources. CancerCare ® offers free counseling from professional oncology social workers who understand the challenges faced by people with cancer and their caregivers. We can work with you one-on-one to develop strategies for coping with treatment and its side effects.

Oncology social workers can also help you communicate with your doctor and other members of your medical care team about the health care issues that are important to you.

Support groups provide a caring environment in which you can share your concerns with others in similar circumstances. Support group members come together to help one another, providing insights and suggestions on ways to cope. At CancerCare. people with cancer and their families can participate in support groups in person, online or on the telephone.

Financial help is offered by a number of organizations to assist with cancer-related expenses such as transportation to treatment, child care or home care.

To learn more about how CancerCare helps, call us at 800-813-HOPE (4673) or visit www.cancercare.org.

Chemotherapy-Induced Nausea and Vomiting (CINV)

When chemotherapy enters the body, sensors in the digestive system and brain detect its presence as a foreign substance. In a complex series of signals among the brain and the mouth, stomach, small intestine and bloodstream, the medication stimulates the “vomiting center” in the brain. Several chemicals, including ones called serotonin and substance P, are released, triggering the nausea and vomiting reflex. This is the body’s effort to get rid of the foreign substance.

Some people experience CINV within the first few hours of receiving chemotherapy. Doctors call this reaction “acute nausea and vomiting.” Other patients don’t feel symptoms the day of chemotherapy but may develop nausea and vomiting during the next few days. This condition is called “delayed nausea and vomiting.”

You shouldn’t assume that nausea and vomiting that occurs a day or two after treatment isn’t related to chemotherapy. It’s important to tell your doctor or nurse when you experience these symptoms, no matter when they occur.

Because some people getting chemotherapy expect to feel ill, they start experiencing symptoms even before their treatment begins. This is referred to as “anticipatory nausea and vomiting.” Sometimes, the sights, sounds or smells of the treatment room can trigger this reaction.

Treating Nausea and Vomiting

Drug companies have been developing anti-nausea medications for the past 40 years. Your doctor will decide which drugs to prescribe based on the type of chemotherapy you are getting and how much nausea and vomiting might be expected. Sometimes, patients receive anti-nausea drugs intravenously through a needle inserted into a vein. Other antinausea medications are available in pill or liquid form to take by mouth, as a skin patch or as a suppository (a soft cone- or cylinder-shaped capsule containing medication that dissolves in the rectum).

After chemotherapy, you may also be given anti-nausea medications to take at home. It’s important to understand how these drugs should be taken. To prevent CINV, some medications are designed to be taken for several days, whether you feel nauseous or not. Others are meant to be taken only when you

feel nauseous. If you have questions about when you should take your anti-nausea medication, be sure to call your doctor or nurse.

It is vital that you have a clear understanding of the order in which you take your medications—both chemotherapy (whether intravenously or by mouth) and anti-nausea drugs— as well as the times at which you take them.

If you are taking the medications as directed and you continue to have CINV, contact your doctor right away. It’s very important to stay hydrated (keep fluids in your system) so that the body’s salts, or electrolytes, stay in balance and the cells can work properly. See “Coping With Nausea and Vomiting” on the right side of this page for tips on staying hydrated.

Generally, anti-nausea drugs fall into the following categories:

Corticosteroids. Related to the natural hormone cortisol, corticosteroids are widely used to help prevent CINV. They have been used successfully for many years, especially to prevent delayed nausea and vomiting. Corticosteroids such as dexamethasone may be given in many different forms and are often combined with other anti-nausea medications for the most benefit.

Serotonin antagonists. This type of medication blocks natural substances from sending a signal to the brain that causes vomiting. Palonosetron (Aloxi) continues to work for days after a single injection. It can prevent both acute and delayed nausea and vomiting. Other serotonin antagonists available in the United States include ondansetron (Zofran and others), granisetron and dolasetron (Anzemet), which can all be given as a pill or injection. Ondansetron and granisetron are both available in liquid form, and ondansetron also comes in a tablet that dissolves in the mouth. These forms of medication are especially helpful for people who have trouble swallowing pills or keeping them down when they are feeling nauseous.

Dopamine antagonists. Metoclopramide (Reglan and others) and prochlorperazine are two commonly used medicines in this class of drugs. They are often prescribed for “breakthrough” nausea and vomiting—that is, symptoms not already controlled with other types of medications.

NK-1 inhibitors. This is the newest class of medicines to prevent CINV. Aprepitant (Emend and others) is used when patients receive chemotherapy that is very likely to cause acute or delayed nausea and vomiting. Available as a capsule, aprepitant is taken before a chemotherapy session and for two days afterward. A related drug, fosaprepitant dimeglumine (Emend for Injection), is delivered intravenously and converted to aprepitant in the body.

Cannabinoids. These medications contain a purified form of the active ingredient found in marijuana. For a number of years, doctors have prescribed dronabinol (Marinol and others) tablets as an anti-vomiting drug. In 2006, the U.S. Food and Drug Administration approved nabilone (Cesamet) tablets, which can control CINV in cancer patients who have not been adequately helped by other anti-nausea medications. Like marijuana, dronabinol and nabilone can cause sedation (relaxation or sleepiness) and mood changes.

Motion sickness treatments. Like cannabinoids, these types of medication are helpful in reducing any nausea or vomiting that lingers more than a few days after chemotherapy. Scopolamine (Transderm Scop) comes as a patch to be placed on the skin behind the ear. Although scopolamine was not originally intended for people on chemotherapy, it can be used to treat CINV.

Anti-anxiety drugs. Medications such as lorazepam (Ativan and others) are used to sedate patients and to help block nausea and vomiting. Sedatives can be given intravenously and in pill form. To avoid becoming dependent on such medications, a careful schedule should be worked out with your doctor or nurse.

Stomach acid blockers. Known as proton pump inhibitors and histamine H2-receptor antagonists, these medications block the formation of stomach acid. This reduces indigestion and heartburn, which can sometimes lead to nausea and vomiting. All of these drugs can be bought without a prescription, and they are often available in less-expensive, generic forms. Be sure to talk with your doctor first before using over-thecounter drugs. Examples of these drugs include omeprazole (Prilosec and others), lansoprazole (Prevacid and others), pantoprazole (Protonix and others), cimetidine (Tagamet and others), famotidine (Pepcid and others) and ranitidine (Zantac and others).

Coping With Nausea and Vomiting

In addition to medical treatments for nausea and vomiting, there are things you can do to ease symptoms. For example:

• Eat and drink slowly. Try having small meals throughout the day instead of a large breakfast, lunch and dinner.

• Avoid sweet, fried or fatty foods, as well as foods with strong odors. Eating foods cold or at room temperature can help you avoid strong smells.

• Be sure that you fully understand your doctor’s and nurse’s instructions for taking anti-nausea medicines.

• Wear loose-fitting clothing that doesn’t bind or add stress to your body.

• Rinse your mouth often to eliminate any bad taste. Use a solution made up of one quart of plain water, half a teaspoon of table salt and half a teaspoon of baking soda. It’s important to maintain good oral care, and rinsing is part of that.

• Try ginger to help relieve nausea. Sipping on ginger tea may be effective, as well as eating ginger lollipops or drops.

• Be sure that you are drinking enough fluids. Drinks that provide important electrolytes include Gatorade and Pedialyte, an over-the-counter solution made for infants that can be used by adults as well. If you find you cannot drink enough water and other fluids, your doctor may prescribe intravenous (IV) fluids.

• Ask your nurse or doctor about proper nutrition, which is especially important during this time. Your health care team can recommend a registered dietitian to help guide you on food and health.

• Find out from your doctor if any other medicines you may be taking require special precautions.

Fatigue

Feeling tired—really tired—may be tied to a number of factors:

• Cancer treatment

• The cancer itself

• The emotional aspects of coping with cancer and cancer pain

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