Treatment for Chemotherapy Side Effects
CancerWise - December 2007
By Darcy De Leon
One of the most common questions asked by cancer patients undergoing chemotherapy is what the side effects might be and how they will be controlled during treatment.
“Side effects will vary per patient and chemotherapy drug,” says Judith Smith, Pharm.D., a board-certified oncology pharmacist and an associate professor in M. D. Anderson’s Department of Gynecologic Oncology in the Division of Surgery. “In general, different medications can be taken to help prevent or manage side effects before chemotherapy or after, as needed.”
Myriad chemotherapy side effects range from nausea and nerve damage to low blood count and diarrhea. They occur because chemotherapy is designed to interfere with the growth of cells. Unfortunately, this includes healthy cells, such as hair, brain and nerve cells, says Smith, who works in the institution’s Gynecologic Oncology Center.
Considering the number of possible side effects, it’s important for patients to know what the treatment options are.
Anti-nausea medication can be taken:
- Orally (an hour before chemotherapy)
- Through an IV (30 minutes before chemotherapy)
"After chemotherapy, patients should take an anti-nausea medicine as soon as they start feeling even the slightest bit nauseous,” Smith says. “If patients have nausea during the first cycle, they should plan to take the anti-nausea medicine around the clock with the next cycle. There are multiple medications to use for the prevention and management of nausea and vomiting that your health care team can discuss with you.”
Neutropenia (low white blood cell count)
Neutropenia increases the risk of infection in chemotherapy patients.
Patients might be given either of these drugs or a combination of both:
Filgrastim (Neupogen®) – This short-acting medication can be given up to 72 hours before chemotherapy or 24 to 72 hours after chemotherapy.
Pedfilgrastim (Neulasta®) – This long-acting medication is given as one injection 24 to 72 hours after chemotherapy. It should not be given within two weeks of the next cycle of chemotherapy.
Anemia (low red blood cell count)
Anemia might make a patient feel tired, weak, dizzy and confused.
Medications that help raise hemoglobin (red blood cell) levels include:
- Epoetin alfa (Procrit®)
- Darbepoetin alfa (Aranesp®)
- Can be given weekly up to every three weeks
- Help stimulate red blood cell growth
- Must be accompanied by iron supplementation
Thrombocytopenia (low platelet count)
Patients with thrombocytopenia bruise and bleed easier. They also might have headaches, nose bleeds and blood in their urine or stool.
Oprelvekin, IL-11 (Neumega®) is one medication that:
- Helps raise platelet levels
- Has to be given continuously except the:
- Day before chemotherapy
- Day of chemotherapy
Potential serious adverse effects include pulmonary infiltrates (fluid collection in the lungs).
Currently, there are no other medications available to manage thrombocytopenia. Patients are asked to report bruising, bleeding and headaches to their doctors, Smith says.
Neuropathy (nerve damage)
Neuropathy occurs as a result of damage to the nervous system. It often is experienced as a burning, tingling pain or numbness. Nerve function may never go back to normal because nerves, like brain cells, do not regenerate.
To help prevent and lessen symptoms, patients might try vitamin B6. It’s best to use a B-complex vitamin rather than B6 by itself, Smith says.
Another option is glutamine, which is an amino acid supplement. Glutamine works for some patients, but not for everyone, Smith says. Glutamine, which generally comes in a powdered form, can be mixed with juice or applesauce. Smith recommends trying a dosage of four grams four times a day.
Constipation is a common, predictable side effect of all opioid pain medications. It is best to prevent constipation because it is difficult to treat effectively.
Patients should avoid fiber for management of opioid-induced constipation because it can make matters worse. “You’ll build up mass and have no way to move it,” Smith says. “Stimulant laxatives with stool softener are necessary to target nerves that stimulate bowel movements.”
There are both prescription and over-the-counter products available based on your doctor’s recommendations.
More than one loose stool twice a day constitutes diarrhea. Diarrhea can be associated with some chemotherapy agents such as irinotecan (Campto®) or often with radiation treatment.
Diarrhea medications are recommended only after symptoms occur (not as a preventive measure).
Recommended diarrhea medications include:
- Loperamide (Immodium®), up to eight capsules a day
- Prescription drugs:
- Diphenoxylate and atropine (Lomotil®)
- Cholestyramine (Questran®)
Pain is highly subjective, and it means whatever a patient perceives it to be. Every person has his or her own pain threshold. It is very important for each patient to report pain.
Uncontrolled pain can interfere with quality of life, the healing process and immunity. More than 90% of pain can be controlled with non-opioid, opioid and adjuvant drugs, Smith says.
Pain management is individualized for each patient. Medications can be increased in increments until the correct dose is reached for each episode of pain and then tapered off, if or when the source of pain is resolved.
Addiction to pain medications is very rare in cancer patients. Less than 1% of all cancer patients have any difficulties with addiction, Smith says.
The side effects of pain medication, such as drowsiness and nausea, often go away within the first few weeks of taking medication. Constipation also is a predictable side effect that can be prevented as discussed earlier.
"Well-controlled pain will lead to better quality of life and healthy healing," Smith says. "There are multiple medications for the management of pain that your health care team can discuss with you."
When in doubt, ask questions
These are just a handful of side effects and therapies to manage them, but Smith hopes the information stimulates patients to ask questions. When it comes to learning about chemotherapy and ways to manage side effects with medication, one source cancer patients can turn to is a clinical pharmacist, she adds.
“When questions arise, patients always can ask their doctors for a consult with a pharmacist at the center where they’re being treated,” Smith says. "It also is a good idea to keep a list of all your medications with you at all times and have all prescriptions filled at the same pharmacy so the pharmacist can screen for drug interactions and help prevent unnecessary toxicity."
M. D. Anderson resources:
- Chemotherapy: What It Is, How It Works (American Cancer Society)
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