Chemotherapy

Introduction

Chemotherapy and targeted therapy are both cancer treatments used to kill cancer cells. Most chemotherapy drugs can be given either by: intravenously, subcutaneously or taken orally. They stop the cancer cells from growing and spreading in the body. The treatment regimen will depend on the tumor type, location & the physical condition of the patient.  

Possible side effects and management: 

Suppressed marrow function

• Lowered body  resistance
  • Observe for any signs and symptoms of infection like fever,  chills, sore throat, ear pain, cough, more sputum or change  in color of sputum, pain when urinating and mouth sores.
  • Seek medical advice immediately if fever occurs. (Temperature higher than F 100°or T 38°)
  • Maintain good personal hygiene and nutritional status through a balanced diet.
  • Avoid to contact with people who are sick or having a cold. Stay away from crowded area / animals.
• Impaired blood clotting function 
  • Avoid to take anti-coagulant medication, e.g. Aspirin and Warfarin.
  • Observe for any bruising, bleeding or blood in urine.
  • Maintain hydration and report brownish urine that may indicate bleeding.
  • Inform your doctor for any unexplained bruising or bleeding. 
• Anemia 
  • Observe for any signs and symptoms of anemia include fatigue, headache, dizziness, restless, breathless, irregular heartbeat (palpitation) and dry skin.
  • Regular blood tests monitoring for checking bone marrow function. 

Nausea, vomiting, and decreased appetite 

• Try small frequent meals and maintain a balanced diet.
• Avoid spicy and greasy food.
• Drugs will be given to alleviate the symptoms. For better outcome, take the drugs 30 minutes before meal.
• Seek medical advice as soon as possible if it is severe.  

Sore mouth 

• No tobacco and alcohol.
• Avoid hot, spicy and acidic food.
• Use soft toothbrush to brush teeth.
• Maintain good mouth hygiene, e.g. frequent mouth wash with normal saline during daytime, before and after meal. (Normal saline: put one teaspoon table salt dissolved into 1-liter warm water and change daily.) 

Diarrhea

• Avoid to take alcohol and caffeinated drinks, such as tea and coffee.
• If it occurs, avoid milk products and high fiber diet.
• Drink plenty of fluid to prevent dehydration.
• Take the anti-diarrhea drugs as instructed.
• Seek medical advice as soon as possible if it is severe. 

Hair loss

• Before receiving chemotherapy, consider to cut hair short, prepare a hat, scarf or wig.
• Hair loss is temporary. It will grow again when chemotherapy is completed.  

Changes in menstrual period / menopause 

• May have irregular periods or stop having periods during chemotherapy.
• Some may even have early menopause.  

Infertility 

• Chemotherapy may cause infertility. 

Hepatitis 

• It is more common among patients who are hepatitis B carriers, but can also occur in non-carriers. 

Skin rash 

• Skin rash may appear. Inform your doctor for assessment. 

Darkened skin & cracked nails 

• Stay out of sunlight, wear protective clothing (e.g. hat or long sleeves) or use sunscreen while having chemotherapy. 

Bladder irritation 

• Observe for any pain when urinating, frequent urination and blood in urine.
• Drink plenty of fluid.
• Doctor may prescribe specific medication to relieve the symptoms.

Numbness, tingling in hands & feet 

• Inform us if you have these symptoms. 

Tinnitus/ hearing loss 

• Inform us if you have these symptoms. 

Risk of kidney function 

• Drink plenty of fluid and keep a detailed intake and output record during chemotherapy. 

Risk of heart function

• Special examinations may be arranged whenever necessary. 

Heart Symptoms 

• Observe for any chest pain (angina), palpitation / irregular heart beat (arrhythmia) and difficult breathing when lying down (heart failure).
• Inform us if you have these symptoms.  

Risk of lung function 

• Special examinations may be arranged whenever necessary. 

Stomach pain / bleeding 

• Drugs will be given to protect your stomach and take the drugs as instructed. 

Phlebitis / Tissue damage due to the leakage of drugs 

• During chemotherapy infusion or after completion, it may cause phlebitis or hardening of veins. It occurs locally only and temporarily for 1 to 2 weeks and it will be resolved. Doctor may prescribe drugs according to specific conditions.
• Sometimes anti-Cancer drugs may leak from blood vessels during injection or infusion occasionally and the damage may be severe (e.g. persisted redness & pain, blisters, and ulcer formation etc.). Rarely operation may be needed to remove the damaged tissue.
• Inform the nurse or doctor if you have redness, swelling, pain or burning sensation at the injection site while having chemotherapy. 

Joint or muscle pain 

• These symptoms will be resolved in a few days. 

Fluid retention

• Swelling of ankles or weight gain.
• Normally it is very mild and will return to normal when chemotherapy is completed. 

Hypersensitivity

• Drugs will be given before the chemotherapy treatment for prevention.
• You will be closely monitored for any signs and symptoms of hypersensitivity reactions e.g. rash, hives, itchiness, redness, swollen, blistered or peeling skin with or without fever, flushing, wheezing, tightness in the chest or throat, trouble breathing, swallowing or talking, unusual hoarseness, swelling of the mouth, face, lips, tongue, or throat & angioedema (rare).
• Inform doctor if you have such symptoms after chemotherapy. 

Hand-foot syndrome 

• Palms of the hands or soles of the feet tingling, numbness, painful, swollen or redness.
• Inform doctor if you have such symptoms. 

High blood pressure 

• During and after the whole chemotherapy regimen, blood pressure needs to be monitored regularly for 2 to 3 times per week.
• If blood pressure maintains on high side, anti-hypertensive drugs may be prescribed. 

Flu symptoms

• It may persist for several days and will be gradually disappeared. 

Albuminuria 

• Albuminuria may occur and affect renal function. Inform your doctor for assessment.

Nasal bleeding 

• Mild nasal bleeding will be stopped spontaneously or by applying direct pressure to the nose using tissue paper.
• If the bleeding occurs over 10 minutes, seek medical advice as soon as possible if it is severe. 

Diarrhoea (Irinotecanrelated) 

• There are two kinds of diarrhea: Early and Delayed.
• Early diarrhea (within 24hrs) may be associated with abdominal cramps, sweating, malaise, salivation, lacrimation or visual disturbance. If it occurs, inform doctor/nurse. It can be treated with special medication.
• Delayed diarrhea (i.e. occurs after 24 hrs or a few days).
  • Take Imodium 4mg at FIRST sign of diarrhea (loose stool, cramping, etc.), then repeat 2mg per 2 hrs until 12 hours free of diarrhea.
  • Take plenty of fluid.
  • Back to hospital if ANY: 
    1) Fever
    2) Diarrhea not subsided within 24 hrs
    3) Diarrhea x 7 times or more/ day
    4) Having both vomiting & diarrhea

Swallowing or breathing discomfort/ Numbness in hands and feet (Oxaliplatin- related) 

• You may have sensation of trouble breathing or swallowing (exposure to cold may worsen the side effect). Stay calm. This is temporary only.
• Numbness and tingling in hands or feet.
• Prevention: avoid cold temperatures, avoid touching cold objects, avoid washing hands with cold water and avoid cold drinks or cold food. 

This chemotherapy scheme may lead to severe complications that result in treatment-related death.

The mortality rate is less than 3%. Rarely, chemotherapy can induce cancer. 

Attention:

1. You should return for blood tests as instructed. These results are necessary for arranging your chemotherapy treatment and monitoring your condition.
2. You should avoid other “anticancer” drugs, including Chinese herbs, that are not prescribed by our doctors during chemotherapy. They may have unpredictable adverse effects.
3. You may have normal sex life during chemotherapy. Contraception is needed for both partners. Barrier method of contraception (e.g. condom) is the recommended option. If pregnancy is suspected, you should inform the doctors or nurses immediately.
4. Female patients should avoid breast feeding during chemotherapy and 6 months thereafter because the anticancer drugs may pass into the human milk and it is harmful to the baby.
5. You should consult the doctors before having any vaccination.

Remarks:

This is general information only and the list of complications is not exhaustive. Other unforeseen complications may occasionally occur. In special patient groups, the actual risk may be different. For further information please contact your doctor. 

Reference

Hospital Authority – Smart Patient Website

Hong Kong Anti-Cancer Society - Chemotherapy Information Booklet

Hong Kong Cancer Fund -  Cancer information

American Cancer Society