Side Effects of Chemotherapy

The side effects of systematic cancer treatment may be acute, self-limited and mild or can be chronic, permanent and potentially life threatening in nature. Chemotherapy is a major treatment mode that is recommended to a number of patients in co relation with other treatment modalities such as radiation and surgery. It may include a number of cycles, but is the best non invasive mode to treat cancer. Over the years chemotherapy has evolved and the newer medicines have fewer side effects and harmful aspects. Please note that the side effects experienced by patients may differ from individual to individual.

Types of Side Effects:

1. Extravasations – Leakage or infiltration of drug into the subcutaneous tissues. Vesicants drugs that extravasate are capable of causing tissue necrosis or sloughing. Irritant drugs cause inflammation or pain at the site of extravasation.
2. Infusion Reactions: Hypersensitivity, Anaphylaxis, and Cytokine-Release Syndrome

• Type I hypersensitivity reactions (may or may not be immune mediated) are the most common in chemotherapy. These are induced types of reactions. These reactions characteristically occur within 1 hour of receiving the drug. Common manifestation of a grade 1 or 2 type I reaction include flushing, urticaria, fever, chills, rigors, dyspnea, and mild hypotension. Grade 3 and 4 reaction may involve bronchospasm, hypotension requiring treatment. With appropriate premedication , the incidence of the hypersensitivity reactions has markedly decreased. commonly used premedications include dexamethasone, diphenhydramine, and an H2-histamine antagonists such as cimetidine, ranitidine, or famotidine.
• Cytokine-release syndrome, which is commonly referred to as infusion reaction, is a syndrome complex that occurs most frequently when monoclonal antibodies are administered. It may be managed by short term cessation of the infusion, administration of histamine blockers, and restarting the infusion at slower rate.

1. c) Nausea and Vomiting

Nausea and vomiting can be distressing enough to the patients to cause extreme physiologic and psychological discomfort , culminating in withdrawal  from therapy. The goal of therapy is to prevent the three phases of nausea and vomiting: that which occurs before the treatment is administered (anticipatory), that which follows within the first 24 hours after the treatment (acute), and that which occurs more than 24 hours after the treatment (delayed).

1. Other short term complications related to cancer chemotherapy

• Stomatitis and other oral complications – Good oral hygiene and treatment of symptoms should be continued.
• Fatigue – It is a subjective feeling that is disproportionate to the level of exertion. Interventions include exercise, education, energy conservation and activity management, measures to optimize sleep quality, massage and behavioral therapies
• Diarrhea – Treatment related to diarrhea is often symptomatic. In absence of obvious inflammation & infection, treat with nonspecific treatment for diarrhea as opoids (loperamide, diphenoxylate, and codeine), anticholinergics (atropine and scopolamine) or both.
• Constipation – Chronic constipation in cancer patients is a problem that is more easily prevented than treated.
• Altered nutritional status
• Neurotoxicity
• Palmar-Plantar Erythrodysesthesia (PPE) or Hand-Foot Syndrome – PPE is a dose limiting and occurs because of drugs extravasation in the microcapillaries of the hands and foot due to local everyday trauma or by drug concentration and accumulation in sweat glands found in the palms and soles with resultant tissue damage.
• Skin reactions
• Hair loss – It is a common side effects of chemotherapy, although it doesn’t happen to everyone.
• Anemia – Chemotherapy lowers the amount of red blood cells, which carry oxygen around the body.
• Sex and fertility issues – Some chemotherapy medicines can also reduce fertility in men and women. This is often temporary, but can be permanent in some cases.
• Infection – Chemotherapy can reduce body’s ability to fight infection. This makes more likely to pick up infections that could make seriously ill.