Minimizing the Side Effects Of Chemotherapy Atif Hussein, MD, MMM, FACP Memorial Cancer Institute Hollywood, FL
The Cell Cycle The Cell Cycle
Cancer Cell Characteristics • • • • • • •
Unchecked & Uncontrolled Growth Loss of contact inhibition Loss of capacity to differentiate Increased growth fraction Chromosomal Instability Capacity to metastasise Altered biochemical properties
Chemotherapy Side Effects • Chemotherapy targets cells which are dividing rapidly. • Chemotherapy cannot distinguish between normal cells and cancer cells • Healthy Cells which have a high rate of growth and multiplication include cells of the bone marrow, hair, GI mucosa and skin.
Chemotherapy Side effects • Side effects may be drug specific e.g. anthracyclines and cardiotoxicity, vinca alkaloids and neuropathy/constipation, bleomycin and pulmonary fibrosis • Severity of side effects varies between drugs. • Side effects often occur 7-14 days post treatment.
COMMON CONCERNS WITH CHEMOTHERAPY • • • • • • • • • •
• Hand-Foot syndrome • Emotional needs • Stress • When to call the nurse
Side Effects: Gastro-Intestinal • • • • •
Nausea & Vomiting Diarrhea & constipation Loss of appetite Taste Changes Mucositis
Everyone Worries About Nausea and Vomiting • Not everyone experiences nausea. • Nausea and vomiting can occur before, during or for several days after receiving treatment. • Take anti-nausea medication as prescribed. • Let your nurse or doctor know if you’re unable to keep medications down, drink fluids, or your anti-nausea medication doesn’t work.
Nausea and Vomiting: Patient-specific risk factors • Higher-risk groups: – Young – Female – High pretreatment expectation of nausea
• Negative risk factor: high alchohol consumption
Nausea and Vomiting: Stratification • High (level 4) – >90% risk of emesis without treatment