The problem with chemotherapy drugs is that while they are busy attacking the cancer cells, they inadvertently kill other cells in the body as well. This is because chemo drugs target cells that replicate frequently because cancer cells replicate frequently. However, we have a lot of other groups of cells in our bodies that regularly divide including hair cells, skin cells, blood forming-cells in the bone marrow, and cells that line our mouth and gastrointestinal tract. Thus, many of the side effects are an unfortunate consequence of chemotherapy.
While many of the side effects are unavoidable, patients experience them to different degrees. You know your body best, and while it is not necessary to call the clinic with every abnormal symptom you experience, do call your cancer care team if you experience a sudden or intense change in your symptoms or if they persist for more than a few hours. If your symptoms do not involve any of the following, or if they do not last more than a few hours, keep a journal of your symptoms and be sure to address them at your next visit with your physician.
If you have trouble breathing or shortness of breath call 911 right away.
Call your doctor immediately if you experience the following symptoms:
– Fever of 100.4 F or above (taken by mouth) or chills
– Signs of infection (redness, warmth, discharge, bad smell coming from wound site)
Call your doctor within 24 hours if you notice any of the following:
- Intense abdominal pain or other acute (sudden, new onset) pain
- Swelling, redness and pain in one leg or arm and not the other
- Vomiting (more than 4-5 times in a 24 hour period)
- Headaches or vision changes
- A wound that bleeds for 15 minutes or more or severe bruising
- Swelling of the mouth and/or trouble swallowing
- Bloody stool or blood in your urine
- Black or tarry stools
- No urine output in a 12-hour period
- Extreme fatigue (unable to carry on normal self-care activities)
- Mouth sores
- Yellowing of the skin or eyes
- Coughing up blood
- Unable to drink or eat for 24 hours or have signs of dehydration: tiredness, thirst, dry mouth, dark and decreased amount of urine, or dizziness
- Sudden weight gain and/or swelling
The physician can incorporate medications and/or supplements so that the side effects of chemotherapy treatments are less severe. Additionally, the physician can refer the patient to a dietician to help ensure appropriate nutrition. Another preventative measure that can be taken is to frequently wash hands and avoid being around people who are ill, as during treatment the immune system is weakened.
It is also necessary to inform the cancer care team of the medications the patient takes, including over the counter medications, herbal supplements, vitamins and essential oils. Even if these medications are taken infrequently, it is recommended to at least discuss these medication anything that was not prescribed by the physician with the physician as some may have unintended consequences or interact with prescribed medications. For example, some multivitamins may make certain chemotherapy treatments less effective.
Side effects vary depending on which chemotherapy medications are used. Certain cancers respond best to specific chemotherapy medications; often this is based on the patient’s biological markers and personal goals. Ideally, the patient can have a conversation with the cancer care team prior to beginning treatment and select the best option for her. However, if during the course of the therapy, the side effects become intolerable, talk to the oncologist as there may be flexibility in treatment regimens, including lowering the doses, timing the doses and/or trying other chemotherapy combinations.
As there are a variety of different chemotherapy regimens, here is a list of questions that the Mayo Clinic recommends asking the cancer care team prior to starting chemotherapy:
What side effects are most common with the drugs I’m receiving?
How do these compare with the side effects of other treatments?
What can I do to prepare for these side effects?
What can I do to decrease the chances that I’ll have them?
What side effects are dangerous and should prompt a call or visit to the clinic?
May I call you anytime if I have these side effects? What phone number should I use?
Additionally, some chemotherapy agents can cause infertility. Because of this, if the patient would like to become pregnant after undergoing treatment, she could ask if there are any fertility-sparing options.
After your treatment, most of the side effects should subside.
Along with the physical symptoms you experience, it is common for cancer to take an emotional toll not just on the patient, but also on her family. Please know you are not alone in this and there are many people able to help. For instance, the Cancer Support Community has a free support helpline for anyone affected by cancer: 1-888-793-9355.
– Managing cancer-related side effects: https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects.html
– Coping with cancer: https://www.cancer.gov/about-cancer/coping
– Chemotherapy and You: Support for People with Cancer: https://www.cancer.gov/publications/patient-education/chemo-and-you
– Cancer Support community: http://www.cancersupportcommunity.org/find-support
Alexandra Bader is a second year medical student at the University of Arkansas for Medical Sciences. She holds a Master’s in Global Health from The Karolkinska Institute in Stockholm, Sweden. She became interested in medicine while working as a Patient Advocate and English/Spanish language interpreter at a Federally Qualified Healthcare Clinic in St. Paul, Minnesota. Although she is from Minnesota and enjoys the snow and cold, she has grown very fond of the Natural State. Alexandra is interested in women’s health and passionate about social justice and global medicine and plans to incorporate both into her future career as a physician.