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What is Chemotherapy?::
The word chemotherapy was previously used to mean the use of medicines (or drugs) to treat any disease. Today, chemotherapy, or ‘chemo’ for short, is most often referred to in connection with the use of certain types of medicines (medication) to treat cancer.
Surgery and radiation therapy are used to remove, destroy or damage the cancer cells in a specific localized area. Chemotherapy medications, which are usually given by mouth or by injection, can travel throughout the body via the bloodstream, and treat cancers that have spread to other parts of the body.
Sometimes chemotherapy is the only treatment that will be needed, but it may be used with surgery or radiation therapy, or with both.
- Chemotherapy may be used to shrink a tumor before surgery or radiation therapy – neoadjuvant therapy
- Chemotherapy may be used after surgery or radiation therapy to help destroy any remaining cancer cells – adjuvant therapy
There are more than 100 chemotherapy medications and although a single ‘chemo’ medication can be used to treat cancer, they generally work better when used in certain combinations. Your ‘chemo’ treatment may include more than one medication and this is called combination therapy. A combination of medications with different actions may work together to kill more cancer cells and reduce the chancer may become resistant to any one particular ‘chemo’ medicine.
Taking other medicines while on chemotherapy
Other medicines may sometimes interfere with the effects of the ‘chemo’ treatment. In order to ensure that your cancer treatment is the most effective that it can be, you must advice your doctor or nurse about all medicines and non-prescription medicines, vitamins, herbs and supplements you are taking.
- Give your doctor a list with the name of each medication you are taking, who proscribed it, the reason you take it, the dose you take and how often you take it
- Include all preparations you may be taking; e.g. aspirin, herbal, dietary and vitamin supplements
Your doctor will advise you if you should stop taking any of these medicines or preparations before starting chemotherapy. Once your ‘chemo’ treatments have started, remember to check with your doctor before taking any new medicines or supplements, and before you stop taking one are currently taking.
Side – effects of chemotherapy::
Although chemotherapy is an effective way to treat man types of cancer, it also carries a risk of side-effects. The type and level of chemotherapy side-effects will depend on the medicine being given.
Chemotherapy medicines are used to kill the fastest-growing cancer cells, but they travel throughout the body they can also affect normal, healthy cells and cause side-effects. The normal cells most likely to be affected are: blood forming cells in the bone marrow, how follicles; cells in the mouth, digestive system and reproductive system.
As a result, the most common side-effects are:
- Nausea and vomiting
- Hair loss
- Sore mouth and gums
- Increased bruising and bleeding
- Increased changed of infection
Patients may become discouraged by side-effects, but many can be prevented or treated, or the doctor may be able to change the medicine or treatment schedule. Most side-effects gradually disappear after treatment ends and they healthy cells recover. The time it takes to get over them and regain energy, will vary from person to person and depends on many factors, including your overall health, and the specific medicines you received.
- Every person does not get every side-effect, and some experience few
- The severity of side-effects varies from person to person
- Discuss side-effects with your doctor, ensuring you are aware of which side-effects are most likely to occur with your chemotherapy, how long they might last, how serious they might be, and when should seek medical attention for them
- Your doctor may prescribe medications to prevent some side-effects
- Although side-effects may be unpleasant, they must be measured against the treatment’s ability to destroy the cancer cells.
Managing side-effects of chemotherapy::
As with medicine, you may experience side-effects while being treated with ‘chemo’ medication. Some people have moderate side-effects that can be managed and there are steps that you can take to help manage some of the side-effects you may experience.
Make sure to talk to your doctor or nurse about any side-effects or concerns you have.
Nausea and Vomiting
Nausea and vomiting are two of the most common side-effects associated with chemotherapy and can be classified into three categories – acute, delayed and anticipatory.
Acute nausea and vomiting occurs within 24 hours after chemotherapy. Some people may vomit within 12 hours of the treatment and others between 12 to 24 hours.
Delayed nausea and vomiting starts more than 24 hours after chemotherapy and may continue for 6 to 7 days.
Anticipatory nausea and vomiting occurs before, during or after the second and subsequent courses of therapy especially if the previously used emetic (vomiting) control was not effective. This is a learned or conditioned response of the body, triggered by visual, taste, smell, and environmental factors associated with the previous chemotherapy, if nausea and vomiting were experienced.
Fortunately there are medications which help in the prevention of chemotherapy-induced nausea and vomiting (antiemetic’s). Remember that different medications work for different people and it may be necessary to try more than one antiemetic is not effective, work with your doctor and nurse to find the one that works the best for you.
Tips for coping with nausea and vomiting
Eating and drinking
- Eat and drink slowly
- Eat frequent small meals, not large ones, this way you won’t feel so full
- Don’t drink liquids with your meals. Drink liquids at least an hour before or after mealtime
- Stay away from sweet, fried or fatty foods
- Eat foods cold or at room temperature as they will have less smell/ odour
- Chew your food well to assist digestion
- If your nausea is bad in the morning, try dry foods like cereal, toast or crackers (but not if you have a dry and/ or some sore mouth)
- Drink cool, clear liquids (apple juice, tea or flat ginger ale)
- Suck on ice cubes or mints
- Try to avoid smells that bother you, e.g. cooking smells, smoke or perfume
- Don’t lie flat for at least two hours after eating, rather rest in a chair
- Wear loose-fitting clothes
- Breathe deeply and slowly when you feel nauseous
- Distract yourself – chat with friends or family, listen to music, or watch a movie or TV show
- Use relaxation techniques e.g. meditation
When chemotherapy affects the cells that line the intestine (digestive system), the result can be diarrhoea, and certain cancers can themselves cause diarrhoea. Diarrhoea is generally defined as 2 more loose stools in a 4-hour time period, and is sometimes mostly an inconvenience. The duration and severity of diarrhoea will depend on what is causing the signs and symptom. Talk to your doctor about what you can expect and how long the diarrhoea may last.
If your symptoms persist or get worse, it could be a sign of something more serious, and diarrhoea can also lead to other problems such as severe dehydration.
Tips for coping with diarrhoea:
- Eat smaller amounts of food, but eat more often
- Stay away from high-fiber food
- Whole grain breads and cereals
- Raw vegetables
- Fresh and dried fruit
- Eat low-fiber foods such as:
- White bread
- White rice or noodles
- Creamed cereals
- Ripe bananas
- Canned or cooked fruit without skins
- Cottage cheese
- Mashed or baked potatoes without skin
- Pureed vegetables
- Chicken or turkey without the skin
Mouth Sores / Stomatitis::
Chemotherapy treatment can cause the mouth and throat to become dry and irritated, to bleed, and to develop sores. These sores are not only painful, they can become infected by the many germs that normally live in your mouth, and infections can be hard to fight during chemotherapy. So it is important to use good oral care to try and prevent them.
Ways to keep mouth, gums and throat healthy:
- See the dentist before starting chemotherapy to ensure teeth are cleaned, and any cavities, abscesses, gum disease or poorly fitting dentures are seen to
- Ask the dentist about:
- The best ways to brush and floss teeth during treatment
- What toothbrush, floss and toothpaste the dentist recommends
- If there is a special rinse or gel that can be used to help prevent cavities
- Brush teeth and gums gently with an extra soft toothbrush after every meal
- Rinse toothbrush well after each use and store it in a dry place
- Don’t use commercial mouthwashes as they usually contain an irritating salt or alcohol
If sores develop in the mouth (stomatitis), contact your doctor or nurse to see if there is anything that can be applied directly to these sores.
Tips to help you eat if you have mouth sores / stomatitis:
- Eat food at cold or room temperature
- Choose soft, soothing foods such as:
- Ice cream
- Baby food
- Soft fruits ( bananas, applesauce)
- Mashed cereals
- Soft-boiled or scrambled eggs
- Cottage cheese
- Macaroni and cheese
- Custards and pudding
- Pure foods in the blender to make them smoother, easier to eat
- Avoid irritating and acidic foods such as:
- Citrus fruit or juice (orange, grapefruit, lemon)
- Spicy or salty foods
- Rough, coarse or dry foods, e.g. raw vegetables, granola, toast
Tips to cope with a dry mouth:
- Ask your doctor or nurse about products to moisten your mouth
- Drink plenty of liquids – carry a water bottle with you and take regular sips
- Moisten dry foods with butter, margarine, gravy, sauces, or both
- Drunk crisp, dry foods in mild liquids
- Eat soft and pureed foods
- Use lip balm often on dry lips
Loss of Appetite::
While having chemotherapy there may be days when you just don’t feel like eating because of nausea, a sore mouth, or feeling tired or depressed. It is important to do everything possible to keep your food and fluid intake up while having chemotherapy as it can help you to:
- Keep up your weight and your body’s store of nutrients
- Keep up your strength and energy
- Better tolerate the treatment related side-effects
- Lower your risk of infection
- Heal and recover more quickly
Tips for coping with loss appetite:
- If you feel full after a small amount, try eating small amounts more frequently
- If you never feel hungry, eat according to a schedule rather than relying on appetite
- Limit fluids during meals, as liquids can fill you up
- Vary the colour and texture of food, try new foods and recipes
- Create a pleasant atmosphere for meals, e.g. candlelight and soft music, eat with friends or family
- Regular moderate exercise may help stimulate your appetite – check with the doctor about exercising
Tips to help manage skin/nail problems:
- Take quick, warm showers rather than long, hot showers/ baths
- Apply creams or lotions liberally and while skin is still moist
- Avoid perfume, cologne and aftershave lotion – they usually contain alcohol which dries skin
- For acne, try to keep your face clean and dry
- Use a sunblock and avoid direct sunlight – wear long-sleeved cotton shirts, hats and long pants
- Wear gloves for washing dishes and gardening
These are skin problems which demand promt attention.
Advise the doctor or nurse immediately if:
- Sudden or severe itching develops
- Skin breaks out in a rash or hives
- Wheezing or trouble breathing develops
These symptoms may indicate an allergic reaction which requires immediate attention.
The Earliest symptom of Hand-foot syndrome is a painful sensitivity of hands and feet and some ‘chemo’ medicine may cause this syndrome. It progresses from sensitivity to redness and swelling on the hands and soles of the feet. The redness looks like sunburn and it may blister and in severe cases from sore. The affected skin can also become dry and peel. It is important to advise your doctor or nurse about any Hand-foot syndrome symptoms, even if they are mild, as treating early can help prevent severe cases.
Hair Loss (Alopecia)::
Not all ‘chemo’ medicines cause hair loss, and your doctor will advise you if your treatment is likely to cause hair loss.
For some people losing their hair is very upsetting, but it will almost always grow back after the treatment is over. It may however grow back with a different texture, color or fullness. Hair loss can occur on all parts of the body, not just the head. The loss of hair usually begins after a few treatments, and it may fall out gradually or in clumps. If any hair remains it may become dull and dry.
Sometimes when people lose their hair they wear a turban, scarf, cap or wig. If you would prefer to use a wig and want to match your natural color, texture and style, it is best to shop fore one before you lose a lot of hair. If you choose not to cover your head, make sure to use a sunscreen to protect your scalp from the sun.
Tips for hair and scalp care:
- Have your hair cut short – it will look thicker and fuller
- Use mild shampoos and soft hair brushes
- If you must use a dryer, use a low heat setting
- Don’t use brush rollers to set hair
- Don’t dye or perm hair
- Use gentle creams or lotions on your bald scalp if it is dry, itchy
- Use a satin pillowcase
Sexual Function and Fertility::
‘Chemo’ medicines may, but do not always affects a personal sexual organs and functioning. The possible side-effects depend on the medication used and the age and general health of the individual person.
When men receive chemotherapy it may lower the number of sperm cells, reduce their ability to move, or cause other abnormalities. These changes can result in shorter- or long-term infinity affecting the ability to father a child. This does not, however, affect the ability to have sexual intercourse.
Because permanent sterility (infertility) may occur, it is important to discuss this issue, and the option of ‘banking’ sperm for future use, with your doctor before starting ‘chemo’ treatment.
Chemotherapy treatment may have harmful effects on chromosomes of sperm cells, so it is important that men and their partners use an effective means of birth control while undergoing the ‘chemo’ treatment. Ask your doctor when it is safe to stop using birth control.
When women receive chemotherapy it can damage the ovaries and reduce the amount of hormones they produce, resulting in short-or long-term infertility to fall pregnant). It is important to discuss this possibility with your doctor before starting ‘chemo’ treatment.
The effect of ‘chemo’ on your hormones may result in following side-effects:
- Menstrual periods may become irregular or stop completely
- Menopause-like symptoms, e.g. hot flashes and itching, burning, or dryness of vaginal tissues. This can make intercourse uncomfortable, but the symptoms can often be relieved by using a water-based vaginal lubricant
- Vaginal infections are more likely
Tips to help prevent infection:
- Avoid oil-based lubricants such as petroleum jelly
- Always use a condom for sexual intercourse
- Wear cotton underwear and pantyhose with a ventilated cotton lining
- Don’t wear tight slacks or shorts
The doctor may prescribe a vaginal cream or suppository to reduce the chances of infection. Vaginal infections should be treated right away.
Although it may be possible to have ‘chemo’ treatment during pregnancy, it is not advisable because some ‘chemo’ medicines may cause birth defects. Doctors generally advise women of childbearing age to use birth control throughout their treatment.
If you are considering pregnancy after completing chemotherapy, discuss it with your doctor.