Nisbetiye Mah. Yücel Sok. No:6
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What is chemotherapy?
Chemotherapy implies the use of chemical substances to treat a tumor. It is a very important part of the treatment of tumors along with the surgery and radiotherapy.
Chemotherapy aims to destruct and kill all tumor cells or to stop their growth. One agent or several agents are administered through various routes.
Who are authorized to administer chemotherapy?
The branch of medicine that deals with chemotherapy is called Medical Oncology, and the physicians of this medical discipline are called Medical Oncologist.
Medical oncology is a separate medical discipline, and medical oncologist is an internist who specializes in the treatment of tumor. As the treatment of tumor is a matter of teamwork, it must be performed at healthcare facilities where all members of the team are available.
The team should consist of a surgeon specialized in the tumor surgery, a radiation oncologist specialized in radiotherapy, and a medical oncologist specialized in chemotherapy and patient care (supportive care).
What is the aim of chemotherapy?
Depending on the type of tumor and the patient’s characteristics, chemotherapy can be given for a variety of reasons.
- To destruct the tumor completely and to improve the patient
- To prevent the spread of tumor
- To stop or slow down growth of the tumor
- To eliminate the symptoms caused by the tumor
Though chemotherapy is an effective treatment method, it may not, sometimes, eliminate the tumor completely, but can treat only the symptoms of the tumor in order to provide the patient with a more comfortable life.
The only treatment option is chemotherapy in certain tumors. On the other hand, chemotherapy is used consecutively or synchronously with other treatment methods (surgery and radiotherapy) in other tumors.
What are the administration routes of chemotherapeutic agents?
Intravenous route (the most common one)
Intravenous chemotherapeutic agents are usually given through an infusion set or adding them into isotonic sodium chloride, and they are infused at certain intervals. The patient may be hospitalized if the procedure will last for a long time.
In some cases, you take chemotherapeutic pills, tablets or capsules at home. In this case, you need to clearly understand the instructions for use and you should consult your doctor if you have any question. Moreover, you should contact your doctor, if you notice any side effect.
Administration into body cavities
Depending on the status and location of the disease, chemotherapeutic agent(s) may be administered into the abdominal cavity, pleura, and urinary bladder. However, such procedures must be performed in a healthcare facility under the supervision of a medical oncologist.
Does chemotherapy cause hair loss? What should be done?
Chemotherapy can cause a temporary hair loss two or three weeks after the treatment, depending on the type and dose of the chemotherapeutic agent(s). However, your hair starts to re-grow immediately after the chemotherapy is completed. The changes in your hair color and structure will spontaneously disappear. You should not let hair loss cause emotional distress. You can create temporary solutions through accessories such as a wig, head scarf or hat.
How do doctors select drugs for chemotherapy?
Chemotherapy drugs to be administered are decided by a medical oncologist depending on a variety of factors such as the type of tumor, its spread, age of patient, general condition, and other existing diseases (heart disease, hypertension, diabetes mellitus, and kidney disease). Moreover, doses and dosage schedule of the drugs are also decided by the medical oncologist based on various factors.
Does use of other medications during chemotherapy pose risk?
Some drugs may interact with chemotherapeutic agents and lead to serious side effects. Before chemotherapy is started, you should inform your doctor or nurse about the name, dose and dosage schedule of all drugs you take at home. It is necessary to keep in mind that the medicines such as aspirin, painkillers, common cold medicines, herbal drugs, nutritional supplements, and vitamins, which are not considered as drug by patients, may interact with chemotherapy drugs. Therefore, you should not take any drug during the treatment until you consult your doctor.
Is there any side effect of chemotherapy?
As chemotherapy kills the cells that are growing and dividing, it may damage the healthy cells with such characteristics. Such cells are found in the bone marrow, digestive system, reproductive system, and hair follicles. Therefore, the side effects are more common in these parts of the body.
The most common side effects are nausea, vomiting, hair loss, and fatigue. Most of the side effects appear as long as you receive chemotherapy and they disappear when your treatment is ended.
What are side effects of chemotherapy?
Fatigue and Anemia
Chemotherapy damages the ability of bone marrow to produce red cells and decreases the oxygen-carrying capacity of your body. Such condition usually results in anemia that is characterized by insufficient oxygen supply to tissues, resulting in a dysfunction. Anemia may lead to fatigue, dizziness, and shortness of breath.
Anemia implies low count of red blood cells in your body and it can be manifested by fatigue, weakness, chest pain, palpitation, shortness of breath, and dizziness.
Microbial Contamination and Infection
As chemotherapy will cause a decrease in the number of white blood cells that fight off the germs in your body, you can get sick easier during chemotherapy. Therefore, you should take more care of your health while you are on chemotherapy.
It is a common side effect, but it does not necessarily emerge. Your doctor will inform you about whether your chemotherapy drugs will lead to hair loss. You should not hesitate to share your feelings if hair loss makes you feel depressive.
Loss of Appetite
Chemotherapy may cause a decrease in your appetite, and the loss of your appetite may result in weight loss, weakness and fatigue.
Consider the following recommendations to manage your loss of appetite:
- Eat in a calm and comfortable environment with your family and friends
- Prefer to consume food with protein
- Try to find a solution if you complain about nausea, mouth sore or similar problems that cause decrease in your appetite
- Gather your strength by eating food with high nutritional value when you feel good
- Remember that you should eat even if you have lost your appetite
Nausea and Vomiting
Nausea is one of the most important chemotherapy-related complaints. Chemotherapy may cause vomiting due to its negative effect on your stomach and the relevant center in your brain.
Which tests are required to evaluate the side effects?
Complete blood count
This test quantifies the white blood cells that fight off the germs and are produced by the bone marrow, hemoglobin that carries the oxygen, and the platelets that stop bleeding.
Certain tests that are analyzed in the fresh urine specimen or a 24-hour urine specimen are used to determine whether you have any problem with your kidney, bladder and urinary tracts. You should have this test if your doctor considers it necessary.
Some biochemical tests, such as serum urea, creatinine, glucose, and liver enzyme, determine whether our organs function properly. It is known that chemotherapy drugs vary in side effects.
Your doctor will order different biochemical tests, depending on the type of chemotherapy. You should have the relevant tests a day before your chemotherapy or in a pre-scheduled date, and you should visit your doctor to have you test results reviewed.
Your platelet count can decrease depending on your chemotherapy drugs. Decreased platelet count increases the risk of bleeding.
The measures you can take in case of low platelet count
- Do not take any medicine (including aspirin and painkillers) without consulting your doctor
- Do not consume alcoholic beverages unless it is allowed by your doctor
- Do not have sexual intercourse
- Protect yourself
- Do not use any blade, and prefer to use an electric shaver
- Be careful when you use scissors, knives and other sharp objects
- Do not walk barefoot
- Brush your teeth with a soft toothbrush. Do not use any dental floss or toothpick
If you are already bleeding
Use a clean towel to firmly compress the bleeding site, until your bleeding stops.
If you have subcutaneous bleeding
Hold an ice pack on the relevant area of your body for 20 minutes.
Take care of your nutrition
- You may need to prefer the foods that are rich in protein. The good options are meat, peanut butter and egg.
- You may need to prefer the foods that are rich in iron. The good options are red meat, green-leafy vegetables (for instance, spinach), white beans and legumes.
You should consult your doctor to determine which foods and beverages are right for you.
Side Effects of Chemotherapy
Though chemotherapy drugs kill cancer cells, normal and healthy cells of the body are also affected depending on the drugs administered and the reaction of your body. It is difficult to predict the side effects that a certain patient will face; interpersonal variations apply. Constipation, diarrhea, high risk for infection, and edema are some of the side effects.
Constipation is a condition that is characterized by lower defecation frequency, hard stool and painful and uncomfortable defecation. Some chemotherapy drugs, a sedentary lifestyle, and inadequate nutrition may cause constipation.
To prevent constipation:
- Prefer fiber-rich and pulpy foods (whole wheat bread, muesli, fruits, vegetables, nuts, and legumes etc.).
- Drink plenty of fluids to increase your bowel movements.
- Try to do gentle exercises and walk for 15-30 minutes in order to help elimination of the constipation.
Chemotherapy may change your bowel habits. It is not significant to a certain extent, but if your diarrhea lasts long or if it is severe and painful, you should immediately contact your doctor.
Consider the following recommendations to control your diarrhea
- Prefer easily digestible foods such as banana, apple puree, white rice, boiled potatoes, pasta and white bread.
- Use your drugs recommended by your doctor for diarrhea regularly.
Increased Risk of Infection
As chemotherapy will reduce your white blood cells (leukocytes) that fight off the germs, the risk of infection may increase during chemotherapy. However, it is possible to reduce the risk with some precautions that can be taken.
- Take care of the hygiene of your hands, face, mouth and body. Wash your hands frequently. Moreover, you can take a shower. Use soap and water. You can also use disinfectant liquids when necessary.
- Do not cut your nails deeply, and do not have a manicure.
- Brush your teeth with a soft-bristled toothbrush at least twice a day, in the morning and at evening.
- Try not to get hurt.
Chemotherapy may cause edema (excessive fluid retention) in the body. Some types of cancer also lead to edema. You should consult your doctor if you recognize edema on your face, arms, legs, and lower abdomen.
Following recommendations can be useful to prevent swelling
- Prefer to wear comfortable and loose clothes and shoes
- Lie on the bed and relax by elevating your feet whenever possible
- Do not consume too salty foods
- Do not stand for hours, and avoid walking too much
As chemotherapy kills the cells that are growing and dividing, it may damage the healthy cells with such characteristics. Such cells are found in the bone marrow, digestive system, reproductive system, and hair follicles. Therefore, the side effects are more common in these parts of the body. However, most side effects appear during chemotherapy, and they disappear when your treatment is ended.
Difficulty Swallowing and Mouth Sores
Mouth sores that are also known as mucositis may appear in the mucosa of the mouth or the throat during chemotherapy due to various reasons such as failure to renew cells of the mouth cavity and the esophagus, hypersensitivity of the body against bacteria and viruses, inadequate fluid intake, and improper oral care.
Such sores pose a great danger for health if they are infected. In addition, dryness of the mouth as well as difficulty chewing and swallowing may also appear.
To prevent the abovementioned symptoms
- Take care of your dental and oral health. Consult your dentist to consider any possible risk of dental cavity and inflammation before being started on chemotherapy. As bleeding problems may occur when you start taking chemotherapy, it may be difficult to have a dental care procedure.
- Brush your teeth with a soft toothbrush after each meal and before bedtime.
- Prefer to consume soft and digestible foods.
- Avoid eating very hot foods.
- Keep your mouth and lips moisturized.
- Stay away from cigarette and tobacco products.
Nutrition during chemotherapy
During the treatment, a healthy and balanced nutrition is very important in order to cope with the side effects of chemotherapy, to be protected from the risk of infection, and to improve the healing of normal tissues damaged by chemotherapy drugs. Good nutrition implies eating all nutrients in a balanced manner.
Daily nutrition should include nutrients from the following five main groups:
- Vegetables and fruits: 2 servings for each
- Meat, chicken, fish, egg: 3 servings
- Cereals: 4 servings
- Milk and dairy products: 2 servings
- Fluids (water, fruit juices, tea, coffee, meat broth, and soup): 8-12 glasses
Nutritional considerations during chemotherapy
- Be sure that your nutrition plan includes nutritional elements from the abovementioned main groups
- Eat well-cooked food, and be sure that the food products you buy are reliable
- Wash raw vegetables and fruits very well
- Do not eat grapefruit during your chemotherapy because it changes the effects of some chemotherapy drugs
- Drink plenty of fluids
- Try to consume foods rich in protein such as meat, fish, legumes and egg
- Avoid eating fatty foods
- Try to consume boiled food and vegetables