Chemotherapy side effects

The downside of chemotherapy is that it is a non-selective treatment, and in addition to cancer cells, it can also damage other cells in the body that divide rapidly, such as skin, intestinal and blood cells, which is why this type of treatment often causes frequent side effects. Here are some of the more common side effects, along with tips on how to alleviate and cope with them. Side effects are mostly temporary and stop after treatment ends, and their occurrence and intensity are very individual. Before using chemotherapy, it is important to weigh the risks and benefits for each individual patient. It should be emphasized that the negative connotation that chemotherapy has acquired over time, where it is still mostly depicted in films as a therapy for patients at the very end of life and as a therapy that causes significant harm, is now outdated. Namely, the approach to treatment has changed significantly over the years, and the use of supportive therapy alongside chemotherapy allows most patients to tolerate the treatment satisfactorily.​

Can I work during chemotherapy treatment? There are patients who cope with their illness more easily if they continue to be active in business, i.e. if they continue to work regularly. The possibility of working during chemotherapy depends on the type of chemotherapy being used, the patient's general condition before the start of treatment, and the side effects of the treatment. As a rule, a significant part of patients tolerate chemotherapy relatively well and can perform tasks that are not too physically demanding. A good strategy is to decide whether to continue working after the first few cycles of treatment, when the patient can assess the extent to which chemotherapy affects their ability to work. During chemotherapy treatment, the patient needs frequent check-ups with their oncologist. After a predetermined number of cycles of therapy, the patient will be referred for follow-up treatment, which most often includes imaging tests and tumor markers (you can read about diagnostics in a separate article), but also other tests if necessary. The results of the treatment can only be determined based on the tests. Side effects of treatment or routine blood tests cannot provide any information about the above.

Figure 1. Nausea and vomiting are among the most common side effects of chemotherapy, but today, with supportive treatment, they can be reduced to an acceptable level in most patients. It is important to control them to prevent nutritional status disorders and dehydration.

Below are some of the most common side effects:

Nausea and vomiting. Nausea is a feeling of discomfort in the stomach that may or may not lead to vomiting. There are several types of nausea, the main ones being anticipatory (before the start of therapy, caused psychologically), acute (developing soon after administration or already during therapy) and delayed. It is important to control nausea and vomiting in order to prevent nutritional status disorders and dehydration. Today, antiemetics (anti-nausea medications), of which there are several types, are routinely administered before each chemotherapy. It should be remembered that not all cytostatics cause nausea to the same extent, and the type (strength) of antiemetics is adjusted accordingly. Patients can additionally take antiemetics at home if necessary, and they will be prescribed by your oncologist or family doctor. It is also important to drink plenty of fluids (water and/or other drinks) to prevent dehydration, and to adjust your diet. Patients themselves can already sense which foods do not suit them and cause nausea, most often it is very fatty, sweet or spicy food. If the smell of food bothers you, ask others to prepare your food, focus on colder dishes that do not have such a pronounced smell or wait for the food to cool before consumption. As for food and the application of therapy, it is usually convenient for patients to eat before the application of chemotherapy, so as not to feel weak. After the therapy, it is recommended not to eat or drink for at least 1 hour. Psychological support is important for anticipatory nausea.

Diarrhea. It refers to frequent loose or watery stools, and the severity of diarrhea is determined by the number of stools per day. If it lasts for a long time, the body loses necessary water and nutrients and can lead to dehydration or nutritional status disorders, which in severe cases can be life-threatening. Chemotherapy can lead to diarrhea, or it can worsen existing diarrhea in a patient. How to help yourself? It is necessary to drink plenty of fluids, general recommendations are 8 to 12 glasses per day. In severe forms of diarrhea, the patient will need to receive intravenous infusions for a short period. It is recommended to eat smaller and lighter meals (6 to 8 per day) instead of large meals, and to include foods rich in potassium and sodium, which are lost in the stool during diarrhea. Keep the anal region clean and dry. Some patients find it helpful to rinse with warm water. It is definitely important to talk to your doctor, who can prescribe anti-diarrhea medications, which are very effective in many patients.

Fatigue and general weakness. Fatigue is a common side effect of many types of cancer treatment, including chemotherapy, immunotherapy, radiotherapy, bone marrow transplant and surgery. Conditions such as anaemia, pain, some medications and emotions can further worsen fatigue, so these conditions should be treated if present. With cancer-related fatigue, rest does not help in all patients, and is one of the most difficult side effects to deal with. Patients are advised to create an activity and rest plan. Choose activities that relax you, such as listening to music, reading, meditating or spending time with friends. The psychological component is very important, and relaxation can help conserve energy and reduce stress. Patients can also exercise. Moderately demanding activities are recommended during treatment - it is not good to overexert yourself, but it is certainly not advisable to spend too much time sitting or lying down. Among the best choices of activity is walking, for which more steps during the day have been shown to improve the prognosis for cancer patients. When planning a vacation, patients can take a short nap (up to 1 hour) during the day. Too much sleep can have the opposite effect - making the person irritable and making it difficult to sleep at night. Do the activities that are important to you during the time of day when you have the most energy. Nutrition is also important, and an experienced nutritionist can help you with this. Foods rich in protein and calories can help maintain strength. It is also necessary to drink plenty of fluids. Given the psychological component present in many patients, consulting a psychologist can help with dealing with difficult emotions.

Loss of appetite and weight loss. Cancer therapy can reduce appetite or lead to changes in taste and/or smell. The problem can be further aggravated by damage to the oral mucosa, nausea and fatigue. Be sure to see your doctor if you notice a decrease in appetite, do not wait until you become weak due to difficulty eating. During treatment, it is important to eat well so that the body has the strength to endure the demanding treatment process. It is important to drink plenty of fluids to prevent dehydration (with reduced food intake, we also consume less fluid!). Choose healthy and nutrient-rich foods. Eat small meals (5-6 per day), even when you are not hungry. Your doctor may also prescribe appetite-enhancing medications and dietary supplements with a high protein and healthy fat content, in order to maintain adequate calorie intake. Dietary supplements containing eicosapentaenoic acid (EPA) are recommended, which helps reduce systemic inflammation mediated by malignant disease. Physical activity is also important, as it has an effect on increasing appetite.

Infection and leukopenia/neutropenia. What are white blood cells (leukocytes) and why is it important to monitor their number during oncology treatment? Infection occurs when infectious agents such as bacteria, viruses, fungi or parasites multiply in a specific place in the body and cause tissue damage. Some forms of oncology treatment, such as chemotherapy, can increase the risk of infection, which occurs due to a decrease in the blood count, of which leukocytes are a component. Blood cells are a group of cells that are frequently renewed and therefore divide rapidly, and it is on such cells that chemotherapy has the greatest effect. Due to the decrease in the number of leukocytes, patients treated with chemotherapy are at increased risk of infection, because the function of these cells is to fight infectious agents. Stress, poor diet and insufficient sleep can further weaken the immune system and increase the risk of infection. A particularly dangerous condition is febrile neutropenia, which indicates very low levels of neutrophils (a special type of leukocyte) in the presence of an elevated body temperature. Such patients are very susceptible to infections, and at the same time have a weakened immune system that can hardly fight them, which is a life-threatening situation and requires hospital treatment, often with the use of intravenous antibiotics. For this reason, before each application of oncological therapy, it is necessary to check the blood count so that in the case of lower leukocyte (and/or neutrophil) values, the therapy can be postponed until their recovery, and in order to reduce the risk of harmful consequences for the patient accordingly.

Peripheral neuropathy. Some forms of oncology treatment, such as chemotherapy with oxaliplatin, can lead to damage to the peripheral nerves in some patients, which is called peripheral neuropathy. As a rule, the nerves that transmit sensation are damaged, which can lead to symptoms such as tingling, numbness, and a feeling like pins and needles in the fingers and toes. In some patients, motor nerves may also be affected, which is manifested by muscle weakness. Patients may have problems with balance, or with everyday activities such as buttoning buttons or opening containers. A small number of patients may develop a more severe form in which the patient has difficulty moving due to symptoms. Patients are advised to keep their hands and feet warm, while avoiding contact with cold objects. If you need something from the refrigerator, put a glove or cloth over your hand. Some doctors recommend the use of vitamin B, but there is no adequate evidence for this. As a rule, peripheral neuropathy depends on the dose of the drug used, that is, the longer the treatment lasts and the higher the dose, the greater the risk of its occurrence. That is why regular check-ups with your doctor during treatment are very important, so that the condition can be recognized in time. If the symptoms are severe, the dose of the drug that caused the problem can be reduced or even the therapy can be permanently discontinued. Regular monitoring can prevent peripheral neuropathy from remaining permanently present, and with timely response, the symptoms will resolve over time in the vast majority of patients.

Anemia. Anemia means a reduced number of red blood cells. Red blood cells contain hemoglobin, which is responsible for delivering oxygen from the lungs to all cells in the body. Anemia is therefore a condition that can make you feel tired, short of breath, and dizzy. Other signs of anemia can include dizziness or fainting, headache, rapid heartbeat, and/or pale skin. Cancer treatments such as chemotherapy and radiotherapy, as well as the malignant disease itself that affects the bone marrow, can cause anemia. You will need to have blood tests to detect anemia, and its treatment is based on your symptoms and the causes of anemia. If your red blood cell or hemoglobin levels drop too low, you may be a candidate for a red blood cell transfusion to artificially replenish these cells. Here are some steps you can take yourself if you have fatigue caused by anemia: Save your energy and ask for help. Choose the most important things to do each day. When people offer to help, let them. They can take you to the doctor, prepare meals, or do other things you are too tired to do. Balance rest with activity. Take short naps during the day, but be aware that too much bed rest can make you feel weak. You may feel better if you take short walks or do some exercise every day. Eat and drink enough. It is important to give your body enough materials to rebuild blood cells. Talk to your oncologist to find out what foods and drinks are best for you (most often this is a diet with enough protein). If your body stores are depleted, your doctor will prescribe iron supplements or other nutritional supplements.

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