Chemotherapy side effects can be treated in various ways
Published: Monday, July 11, 2011, 4:55 AM Updated: Monday, July 11, 2011, 4:58 AM
STATEN ISLAND, N.Y. — With the advent of improved supportive care, chemotherapy treatment has become a better tolerated, less toxic treatment. But it is still no cakewalk. Understanding the expected outcomes up front may make the journey easier.
In the dinosaur days, an overwhelming concern with chemotherapy was severe nausea and vomiting. Today, this is something well-tackled and controlled. We have potent medicines preventing and treating symptoms of nausea and vomiting. It is rare that any patient has to be admitted with uncontrolled vomiting.
In the current era, especially for breast cancer patients, the side effect of most concern is alopecia (hair loss), for which no prevention strategy exists. The good news is hair loss is reversible.
DRUG TREATMENTS
Although much better controlled, nausea and vomiting are still the most common side effects. In most cases, patients receive preventive medications prior to receiving chemotherapy. Patients are also prescribed medications to keep at home if needed. Commonly used medications include Compazine (Prochlorperazine), Lorazepam (Ativan), Ondansetron (Zofran), Granisetron (Kytril), Dolasetron (Anzemet), Palonosetron, Dronabinol (Marinol), Dexamethasone, Metoclopramide (Reglan) and Aprepitant (Emend).
Delayed nausea and vomiting (seven to 10 days after chemotherapy) is common with Adriamycin, Cisplatin, Cyclophosphamide. Dexamethasone, Aprepitant, Metoclopramide and Palonosetron are effective for managing delayed nausea and vomiting.
Although certain drugs are known to cause diarrhea, prevention can’t be strategized since not everyone experiences it. But the bowel condition can be treated with anti-diarrheals, such as Loperamide (Imodium) and Lomotil (Atropine/Diphenoxylate sodium). Hydration is essential. Drink eight to 10 glasses of water daily.
MOUTH SORES ISSUES
Other possible side effects of chemotherapy are oral ulcers and mouth sores. Treatment is supportive as sores will heal themselves in about a week. Oral hygiene is of foremost importance. Patients receiving medications that have a high propensity to cause mouth sores should use prophylactic mouthwashes, such as saline or baking soda mouthwashes. Patients on other medications may use mouthwashes when symptoms start.
The first symptom is usually pain, followed by breakdown of mucosa and ulcer formation. Local anesthetic mouthwashes (containing Xylocaine or Lidocaine) lessen pain sensation and make getting adequate nutrition easier. Benadryl, Betadine and Chlorhexidine mouthwashes may be used. Protective agents (Sucralfate and Kaopectate) may be used to cover ulcers and prevent pain or worsening. Avoid eating hot or spicy foods that may cause irritation.
CONSTIPATION
Constipation can be encountered during chemotherapy treatment simply because it disrupts routine. Use of pain medications also causes constipation. Laxatives such as Senokot, Colace, Miralax, Lactulose and Dulcolax may be used. Maintaining a high fiber diet and drinking adequate water helps.
BLOOD COUNTS
Chemotherapy can kill the newly formed platelet, red and white blood cells and decrease the regenerating capability temporarily. Blood counts are monitored periodically during treatment and if necessary, injections to boost blood counts or blood transfusions are used as methods to maintain adequate numbers.
Low white counts predispose a person to increased risk of infections. General precautions such as avoiding crowded places, hand washing, covering your mouth when coughing, eating well-cooked food (avoiding raw fruits and vegetables and washing them well when eating them) should be rigorously followed.
If someone is sick, stay away from him or her while on chemotherapy. Ask your doctor about appropriate vaccinations needed prior to initiation of chemotherapy. Low red cells (anemia) leads to increased tiredness, shortness of breath and dizziness. Low platelets can be associated with a higher risk of bleeding.
SKIN RASH, INSOMNIA
Skin rash is a common side effect of biologic agents (such as Cetuximab and Erlotinib). These drugs cause an acne like rash which may be limited to the face and upper torso, but in some severe cases may be generalized. This is usually treated with topical creams (Clindamycin or Hydrocortisone). In severe cases, oral antibiotics (Minocycline, Doxycycline or oral Clindamycin) may be used.
Insomonia is not reported as a common side effect of chemotherapy treatment, but it is a commonly encountered complaint. Routine disruption and physiology disruption may be additional reasons. Transient use of sleeping medicines may be discussed with the doctor. Melatonin, available over the counter, may be an effective alternative.
ALLERGIC REACTIONS
Risk of allergic reactions exists with almost all chemotherapy drugs. It is a common practice to administer medications to prevent allergic reactions prior to chemotherapy administration. Dexamethasone, Benadryl and Tylenol are commonly used. If an allergic reaction occurs, Solu-Medrol, Benadryl or an epinephrine injection are used for treatment.
FERTILITY ISSUES
Men and women of childbearing age may lose fertility as a result of chemotherapy treatment. If child bearing is desired in the future after completion of chemotherapy, fertility preservation techniques should be discussed with your doctor.
My blog post on fertility preservation in women provides some information about options for young women. Read it at blog.cancermantra.com.
This column is provided by the Richmond County Medical Society. The author, Dr. Seema Varma, is a medical oncologist at Staten Island University Hospital and Hospice Medical Director, University Hospice. Dr. Varma is an active member of the Richmond County Medical Society.
In the dinosaur days, an overwhelming concern with chemotherapy was severe nausea and vomiting. Today, this is something well-tackled and controlled. We have potent medicines preventing and treating symptoms of nausea and vomiting. It is rare that any patient has to be admitted with uncontrolled vomiting.
In the current era, especially for breast cancer patients, the side effect of most concern is alopecia (hair loss), for which no prevention strategy exists. The good news is hair loss is reversible.
DRUG TREATMENTS
Although much better controlled, nausea and vomiting are still the most common side effects. In most cases, patients receive preventive medications prior to receiving chemotherapy. Patients are also prescribed medications to keep at home if needed. Commonly used medications include Compazine (Prochlorperazine), Lorazepam (Ativan), Ondansetron (Zofran), Granisetron (Kytril), Dolasetron (Anzemet), Palonosetron, Dronabinol (Marinol), Dexamethasone, Metoclopramide (Reglan) and Aprepitant (Emend).
Delayed nausea and vomiting (seven to 10 days after chemotherapy) is common with Adriamycin, Cisplatin, Cyclophosphamide. Dexamethasone, Aprepitant, Metoclopramide and Palonosetron are effective for managing delayed nausea and vomiting.
Although certain drugs are known to cause diarrhea, prevention can’t be strategized since not everyone experiences it. But the bowel condition can be treated with anti-diarrheals, such as Loperamide (Imodium) and Lomotil (Atropine/Diphenoxylate sodium). Hydration is essential. Drink eight to 10 glasses of water daily.
MOUTH SORES ISSUES
Other possible side effects of chemotherapy are oral ulcers and mouth sores. Treatment is supportive as sores will heal themselves in about a week. Oral hygiene is of foremost importance. Patients receiving medications that have a high propensity to cause mouth sores should use prophylactic mouthwashes, such as saline or baking soda mouthwashes. Patients on other medications may use mouthwashes when symptoms start.
The first symptom is usually pain, followed by breakdown of mucosa and ulcer formation. Local anesthetic mouthwashes (containing Xylocaine or Lidocaine) lessen pain sensation and make getting adequate nutrition easier. Benadryl, Betadine and Chlorhexidine mouthwashes may be used. Protective agents (Sucralfate and Kaopectate) may be used to cover ulcers and prevent pain or worsening. Avoid eating hot or spicy foods that may cause irritation.
CONSTIPATION
Constipation can be encountered during chemotherapy treatment simply because it disrupts routine. Use of pain medications also causes constipation. Laxatives such as Senokot, Colace, Miralax, Lactulose and Dulcolax may be used. Maintaining a high fiber diet and drinking adequate water helps.
BLOOD COUNTS
Chemotherapy can kill the newly formed platelet, red and white blood cells and decrease the regenerating capability temporarily. Blood counts are monitored periodically during treatment and if necessary, injections to boost blood counts or blood transfusions are used as methods to maintain adequate numbers.
Low white counts predispose a person to increased risk of infections. General precautions such as avoiding crowded places, hand washing, covering your mouth when coughing, eating well-cooked food (avoiding raw fruits and vegetables and washing them well when eating them) should be rigorously followed.
If someone is sick, stay away from him or her while on chemotherapy. Ask your doctor about appropriate vaccinations needed prior to initiation of chemotherapy. Low red cells (anemia) leads to increased tiredness, shortness of breath and dizziness. Low platelets can be associated with a higher risk of bleeding.
SKIN RASH, INSOMNIA
Skin rash is a common side effect of biologic agents (such as Cetuximab and Erlotinib). These drugs cause an acne like rash which may be limited to the face and upper torso, but in some severe cases may be generalized. This is usually treated with topical creams (Clindamycin or Hydrocortisone). In severe cases, oral antibiotics (Minocycline, Doxycycline or oral Clindamycin) may be used.
Insomonia is not reported as a common side effect of chemotherapy treatment, but it is a commonly encountered complaint. Routine disruption and physiology disruption may be additional reasons. Transient use of sleeping medicines may be discussed with the doctor. Melatonin, available over the counter, may be an effective alternative.
ALLERGIC REACTIONS
Risk of allergic reactions exists with almost all chemotherapy drugs. It is a common practice to administer medications to prevent allergic reactions prior to chemotherapy administration. Dexamethasone, Benadryl and Tylenol are commonly used. If an allergic reaction occurs, Solu-Medrol, Benadryl or an epinephrine injection are used for treatment.
FERTILITY ISSUES
Men and women of childbearing age may lose fertility as a result of chemotherapy treatment. If child bearing is desired in the future after completion of chemotherapy, fertility preservation techniques should be discussed with your doctor.
My blog post on fertility preservation in women provides some information about options for young women. Read it at blog.cancermantra.com.
This column is provided by the Richmond County Medical Society. The author, Dr. Seema Varma, is a medical oncologist at Staten Island University Hospital and Hospice Medical Director, University Hospice. Dr. Varma is an active member of the Richmond County Medical Society.
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