Health Tips

Battling cancer is a tough journey. Chemotherapy, one of the treatment modalities for cancer, it’s often riddled with unpleasant side effects and anxious feelings. Nonetheless, chemotherapy is one of the few best shots for cancer patients to get better from the disease and hopefully put the cancer into long-term remission.

There are various types of cancer chemotherapy and each of them may have different side effect profiles. This article aims to provide a general overview on the adverse effects one may expect from cancer chemotherapy.

Fatigue/Tiredness

It’s important to note that fatigue can due to:

• The cancer itself /symptoms due to the disease.

• Side effects from the chemotherapy.

• The emotional aspects of dealing with cancer and cancer pain

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Moderate to severe tiredness is a very common complaint after receiving chemotherapy. Many cancer patients tend to feel tired a lot of the time or after doing easy tasks. It can help to:

• Get plenty of rest

• Avoid doing tasks or activities that you do not feel up to

• Ask your friends and family for help with everyday tasks

• Get time-off or make necessary work arrangements with your employers (e.g. switch to part time) so that you have time to rest besides working

• Do light exercise, such as walking or yoga, if you're able to – this can boost your energy level, but be careful not to push yourself too hard

If you feel extremely tired, weak, out of breath, lightheadedness, chest pain or cold hands and feets, you might have anemia (low red blood cells). Read on.

Anemia

Many of the side effects associated with chemotherapy come from the fact that chemotherapy ‘kills’ the cells in your body indifferently—whether that’s cancer cells or normal, healthy cells. Chemotherapy has an effect called myelosuppression, which means it suppresses bone marrow activity. Red blood cells, the one responsible for carrying oxygen around your body, are one of the many cells whose amounts get reduced greatly. As a result, many cancer patient suffer from anaemia:

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Your doctor would also prescribe you with haematinics, which is a group of medications that increase red blood cells. They include:

• Vitamin B complex tablets

• Iron tablets

• Folic acid

• Vitamin C

Nausea and vomiting

Many chemotherapy can cause severe nausea and vomiting, to the point that anti-nausea medications are often given before chemotherapy to prevent that from happening. This condition is known as chemotherapy-induced nausea and vomiting (CINV). Examples are metoclopramide, granisetron and aprepitant. Besides, here are tips to cope with nausea and vomiting associated with chemotherapy:

• Eat and drink slowly. Try having small frequent meals throughout the day instead of the usual portion of breakfast, lunch, and dinner.

• Avoid sweet, fried, or fatty foods, as well as foods with a strong smell. Eating cold foods or at room temperature can help to avoid strong smells.

• Ensure full understanding of doctors and pharmacists instructions on taking anti-nausea and vomiting medicines.

• Ensure a sufficient supply of the correct drugs.

• Consume adequate fluids. Ask a doctor, pharmacist or dietician about proper nutrition during this time.

• Do not starve for long periods, as this may make the nausea worsen.

• Find out from doctor or pharmacist if any other medicines taken may require special precautions

Hair loss

Hair loss is a common side effect of chemotherapy, although it does not happen to everyone. Chemotherapy drugs such as doxorubicin, epirubicin, paclitaxel, docetaxel and etoposide are particularly prone to result in hair loss. Depending on the type of drug received, hair (body hair and scalp hair) may be unaffected, thinned, or completely fall out.

The hair loss is almost always temporary. Your hair should start to grow back soon after your treatment has finished. But sometimes the hair that grows back is a slightly different colour or has different textures, although the changes are usually temporary. Head covers such as scarves, hats and wigs may be considered.

Infections

Similar reason that cancer chemotherapy causes anaemia, chemotherapy can also reduce white blood cells, the troops in our body system that help to fight against infections. Therefore, cancer patients who receive chemotherapy are more prone to infections that would have been otherwise tolerated by healthy individuals. 

Fever (≥38.0°C) is a sign that may suggest an infection. If you receive cancer chemotherapy and develop fever, it’s important that you visit the hospital immediately. Do not treat it lightly or simply take medications to reduce fever. This is because if it’s an infection and it is not treated promptly, it can develop into life-threatening sepsis or even death.

Sore mouth

Sometimes chemotherapy can irritate the lining of the mouth, leading to mucositis. Symptoms tend to develop a few days after treatment starts. Mouth sore or mucositis can cause pain in the mouth, mouth ulcers, infection and making it difficult to swallow, ear or drink.

To cope with mucositis:

• Avoid salty, spicy or dry food, avoid drinks containing caffeine or alcohol.

• Eat food at room temperature rather than food served hot.

• Practice good oral hygiene to prevent infection.

• Use a soft bristle toothbrush or an oral sponge (rinsing the bristles in hot water can make them even softer)

• Gargle regularly (avoid gargles that contain alcohol)

• Drink plenty of water

• Try sipping cups of water throughout the day to avoid dry mouth.

• If wearing dentures, remove them once the mouth becomes sensitive.

• Inform the doctor if you experience a tooth or gum problem. They can refer to dentist for further management before chemotherapy starts

Your doctor may also prescribe you with certain mouth gargles to prevent or relieve mucositis, such as:

• Lignocaine 2% viscous solution

• Benzydamine HCl 0.15% solution (Difflam®)

• Thymol gargle

If you develop fungal mouth infection (white patches in mouth), or are at higher risk for one, the doctor may also prescribe you with nystatin oral suspension, which is an antifungal medication. You should take the prescribed amount of suspension and swirl it in your mouth for as long as possible, then swallow it. Avoid eating and drinking for at least an hour.

If you have multiple mouth washes and nystatin oral suspension to use, you should use the nystatin oral suspension last.

Others

Other common side effects of cancer chemotherapy also include:

• Constipation

• Diarrhoea

• Numbness and tingling in hands

• Skin sensitivity to light and sun

• Easier to bleed

• Skin and nail changes

• Loss of appetite

• Sex and fertility issue

Photo by National Cancer Institute on Unsplash

While cancer chemotherapy may seem to bring about many unpleasant and anxiety-inducing side effects, you don’t have to face them alone. It’s important to rely on your loved ones for emotional support. Your doctor, nurse, pharmacist and other healthcare professionals are also there to help and guide you through the cancer chemotherapy process. Consult your doctor or pharmacist if you have any side effects.

References

1. Ministry of Health - Systemic Protocol Third Edition (2016)

2. Pharmaceutical Services Division - Cancer Drug Counselling: A Guide for Pharmacists

Cover image credit: Photo by insung yoon on Unsplash

Written by

Ms Joyce Toh