Patient Education: Chemotherapy Side Effects
by Mackenzie Gignac
Receiving the news of a cancer diagnosis can be heavy news to bear. A common source of stress for patients are the worries about undergoing chemotherapy treatment. Although chemotherapy generally comes with side effects, these effects are manageable. Dr. Stephen Walker, Haematology Registrar at St Vincent’s Hospital Melbourne, explains more about chemotherapy’s common side effects and how they can be managed.
What are Common Side Effects I can expect with Chemotherapy?
The most common chemotherapy regimen that is used for blood cancers is R-CHOP, which is a combination of standard chemotherapy agents and an immunotherapy agent, Rituximab. With R-CHOP patients do sometimes experience immediate side effects that occur on the day of chemotherapy treatment. Because of the use of immunotherapy, patients potentially could experience reactions from the infusion such as fever, chills, rash, or shortness of breath. These are managed by slowing or temporarily interrupting the rituximab infusion by experienced nurses, who are constantly watching the patient for infusion reactions. Nausea (sickness) is another common concern of patients. The reality is that the drugs we use to prevent nausea these days are extremely effective, and therefore most patients experience no or little nausea during chemotherapy, provided they take their preventive medications as prescribed.
Other side effects might occur days to weeks following the chemotherapy treatment. Patients might find that they are more lethargic or tired than usual. Dr. Walker says that these symptoms might start to be noticed over time, ‘Lethargy and fatigue is often cumulative and can happen with later cycles of chemotherapy as well.’ Another potential toxicity to be aware of is risk of infection due to Neutropenia (low white cells, the cells that fight infection in the body). ‘The risk is typically highest day 8-14 following chemotherapy, but does depend on which chemotherapy the patient is receiving,’ advises Dr. Walker.
What are my Options to Help Me Manage These Effects?
‘Chemotherapy can be difficult, but it should never be intolerable or cause profound suffering,’ says Dr. Walker. Side effects are common with chemotherapy, but they are not something you should suffer in silence about. ‘If it’s reaching that point then we need to change or adjust something in your treatment.’
‘Although there are general things that can be done, there needs to be a dynamic approach to symptoms as they arise,’ says Dr. Walker. It is important for patients to have a discussion with their doctor about any side effects they notice through treatment so that their doctor can tailor an approach to help them mitigate the toxicities of treatment.
However, there are some broad approaches that can be taken to combat the side effects of nausea and fatigue. Nausea is often treated through the use of anti-nausea medication. Doctors tend to prescribe anti-nausea medication preventively to try and reduce the risk of this response. This can then be further tailored to the patient’s symptoms.
Dr. Walker encourages light physical activity to fight against lethargy and fatigue. ‘Gentle activities such as going for a regular walk or a short bike ride are shown to be beneficial to patient’s lethargy and fatigue, but more strenuous exercise can be counterproductive,’ says Dr. Walker.
Do Side Effects get Worse with Each Treatment Cycle?
Not all symptoms get worse with subsequent cycles. Some side effects can get worse as treatment continues, but this varies on a patient-by-patient basis. Some patients can experience nerve damage from ongoing treatments, leading to a feeling of numbness in the fingers and toes.
Again, it is important to have an open discussion with your doctor about the side effects you are experiencing, so they can take a personalised approach to manage any side effects. ‘We really do rely on patients telling us what their symptoms and experiences have been like so that we can tailor the treatment to them,’ says Dr. Walker.
Do the Side Effects Differ Depending on Type and Stage of Cancer?
The stage and type of blood cancer will have an influence on what chemotherapy drugs your haematologist will choose for your treatment. Different drug agents present different side effects, so, yes side effects can vary depending on the type of cancer.
For instance, more aggressive types of Lymphoma such as Diffuse Large B Cell will require multiple agents to be put together in a multi-drug regimen to treat the cancer. Lower-grade Lymphomas can be treated with one or two drugs. ‘It’s not as simple as saying more drugs are more toxic, but generally if there are more agents then there is more potential for toxicities,’ says Dr. Walker.
How Long After Chemotherapy Will it Take to Feel Better?
The period of recovery often depends on the intensity of the chemotherapy regimen. ‘The ability for the bone marrow and more rapidly regenerating tissue to recover can happen over a period of 2-4 weeks,’ says Dr. Walker. Additionally, a full recovery in terms of energy, fatigue and getting back to normal life can take longer. Even at around 3-6 months after recovery patients often feel tired in a way they may not have felt prior to their diagnosis.
However, patients that remain physically active tend to have a quicker recovery than patients who are less active. Doing some physical activity on a semi-active basis is shown to be helpful for chemotherapy recovery to help return to a normal life.
How Much Time Should I Take Off Work or School to Deal with Chemo?
Dr. Walker says that this is very treatment-specific and needs to be addressed on a case-by-case discussion with your doctor. R-CHOP chemotherapy takes 4.5 months to complete and another few months to recover. Typically for an aggressive Lymphoma 6 months is reasonable. For some other treatment options, patients continue to work, just taking days off when they need to be in the hospital to receive chemotherapy.
Can the doctors at the Melbourne Blood Specialists help those seeking treatment for blood cancers?
Yes, when you are referred to the Melbourne Blood Specialists our haematologists will do a comprehensive review and tailor a treatment plan that works best for you.