Common Side Effects From Chemotherapy
If you or a loved one is undergoing chemotherapy to treat cancer, you know that just getting through the day can be a challenge, due to the side effects of treatment. Understanding what causes these side effects and learning how to treat them may make it easier for to cope.
Cancer cells tend to grow fast, and traditional chemotherapy drugs are designed to target rapidly growing cells. Unfortunately, this includes not just cancer cells but certain normal cells as well, explains Eleonora Teplinsky, MD, medical oncologist at North Shore-LIJ Cancer Institute in Lake Success, New York. Cells in the mouth, hair, gastrointestinal tract, reproductive system, and bone marrow are the ones likely to be adversely affected by chemo drugs, she explains. “Hair loss, painful inflammation in the mouth, loss of appetite, fatigue, nausea, and decrease in blood counts are very common."
Here's a guide to common chemo side effects:
Certain chemotherapy drugs, which are meant to target specific molecules in cancer’s pathway, produce side effects that can affect skin, hair, and nails, explains Beth McLellan, MD, director of Oncodermatology in the Division of Dermatology of the Montefiore Einstein Center for Cancer Care. From rashes to inflammation to itchy, scaly skin, dermatological complaints during chemotherapy are common. “You may develop an acne-like rash, or inflammation around your nails. Another common symptom are painful calloused areas in the hands and feet.”You may get some relief by applying lotion to your skin. Don’t take long, hot showers since this can make your skin feel drier. Starting on an oral antibiotic right when you begin your chemotherapy may help prevent some types of rashes.
One of the most common side effects, fatigue tends to get worse at the end of a cycle of chemo treatment. The good news? It tends to dissipate when the chemo ends. To feel better, rest when you feel the need to, try to eat a well-balanced diet, drink plenty of liquids, and don’t be afraid to ask for help. Believe it or not, exercise can help with reducing fatigue. Ask your health care provider to recommend an appropriate exercise program.
Hair Loss (Alopecia)
Hair follicle cells are among the rapidly growing normal cells in the body that are affected by chemo, explains Dale Shepard, MD, medical oncologist at the Cleveland Clinic. You won’t necessarily lose your hair during chemo; sometimes it just becomes thinner. Hair loss will typically begin a few days after starting chemotherapy, and hair can fall out either in clumps or slowly. To help with hair loss, use a soft-bristle hairbrush and a mild shampoo, avoid using brush rollers, minimize your use of a hair dryer, and don’t get a perm or color your hair. Hair typically grows back after chemo, though it may be a different color or texture.
Because chemotherapy can affect bone marrow cells, which is where white blood cells are made, it’s common for a patient to experience a decrease in white blood cells, Shepard says. “The decrease in white blood cells is greatest about 7 to 10 days after patients receive chemotherapy for solid tumors."
When your white blood cell count is too low, it's more likely that you can get an infection since your body is unable to fight bacteria and viruses, Teplinsky says. To keep your white blood cell count from dropping too low, you may be given an injection of growth factor the days after chemotherapy. This can boost a person’s white cell count.
Often, when a chemo patient goes to the emergency room with a fever and low white blood cell count, which is known as febrile neutropenia, the source of the fever is not identified. “A source of infection may not be found despite blood cultures, chest X-rays and urine cultures,” Shepard says.
Since cancer drugs can affect bone marrow, patients are at risk not just for infection but for anemia, bleeding, and bruising.
Nausea and Vomiting
A common side effect of chemo, nausea may have many causes, according to Shepard. “Chemotherapy drugs have a direct effect on the gastrointestinal tract and activate receptors in the brain that respond to toxins by triggering nausea and vomiting." And some people who've already experienced nausea and vomiting from chemotherapy in the past may have anticipatory nausea. Before receiving chemotherapy, you will be given drugs to prevent nausea and vomiting and you should be sent home with a prescription for anti-nausea drugs to take at home if necessary.
Difficulty concentrating and remembering things can occur as a result of chemo, but you can combat the effects with some simple planning. Try to take care of chores for which you need the most concentration early in the day, get plenty of extra rest and sleep, and exercise to keep you feeling more alert. And be pro-active: keep a list close at hand of important information, keep a planner that will help you keep track of important activities, and maintain a list of important names and phone numbers, too.
If the side effects of chemo become intolerable, your doctor may advise a dose reduction, Teplinsky says. “But it's important to remember that if a physician has offered you chemotherapy, with careful monitoring for side effects, the benefits of chemotherapy do outweigh the risks."
Eleonora Teplinsky, MD, reviewed this article.
The Mesothelioma and Asbestos Awareness Center (MAAC), an online resource for people with mesothelioma, has an article on What to Expect During Your Chemotherapy Treatment. MAAC provides information about treatments, community groups, legal issues, and other resources, and while their site is focused on mesothelioma, many of their topics are relevant for patients with any form of cancer. Visit their site at maacenter.org.
“Chemo side effects.” American Cancer Society. Last revised June 9. 2015.
“Memory or concentration problems.” National Cancer Institute. Posted April 29, 2015.
Beth McLellan, MD. Phone interview on September 29, 2015.
Eleonora Teplinsky, MD. Email interview on September 28, 2015.
Dale Shepard, MD, PhD. Email interview on September 25, 2015.
What to Expect During Your Chemotherapy Treatment. The Mesothelioma and Asbestos Awareness Center. January 27, 2016.
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