Chemotherapy is used in treatment of cancer globally. However, there are several side effects that need to be managed effectively in order to improve quality of life of patients and their adherence to the treatment. Many patients drop out or delay their treatment due to these side effects and so it is important to understand the side effects and ways to manage them.
The most critical side effects of chemotherapy are chemotherapy-induced nausea and vomiting (CINV), cancer cachexia, oral mucositis, chemotherapy-induced neutropenia, and chemotherapy-induced anaemia.
- Chemotherapy-induced nausea and vomiting (CINV): It is the most common and critical side effect of chemotherapy, affects 70-80 per cent patients receiving chemotherapy. CINV can result in loss of energy as the body is not able to consume necessary vitamins and minerals from food, loss of appetite and taste, dehydration, and slow healing of wounds. A patient generally has CINV for about seven to 10 days after chemotherapy and this needs to be controlled through appropriate medicines. Earlier patients had to take multiple drugs at regular intervals per chemotherapy cycle to effectively manage CINV but with recent advancements in supportive care in cancer, a proven medicine that needs to be taken only once per chemotherapy cycle is available in India.
- Cancer cachexia or wasting syndrome, characterised by weight loss, muscle atrophy, fatigue, weakness and significant loss of appetite in someone not actively trying to lose weight occurs usually at the advanced stages of cancer. It is most commonly seen in pancreatic and gastric cancer. Recent therapies for the cachectic syndrome involve a multi-disciplinary approach with diet modification and or exercise along with necessary medications.
- Oral mucositisis an inflammation of the mucosa of the mouth ranging from redness to severe ulceration. It is a common, debilitating complication of chemotherapy and radiotherapy, affecting about 40 per cent of patients. Oral mucositis usually begins five to 10 days post initiation of chemotherapy and lastsupto six weeks or more. Different treatments for mucositis include general oral care protocols, topical anaesthetics, antiseptics, antibacterial, antifungal and antiviral agents,mucosal barriers and coating agents, mucosal cell stimulants, psychotherapy and others.
- Chemotherapy-induced neutropenia (CIN): It is caused when the amount of white blood cells called neutrophils significantly drops due to chemotherapy. At present, CIN is managed by delaying and reducing dose of chemotherapy treatment with hematopoietic growth factors and with intravenous antibiotic therapy. Reducing chemotherapy may compromise treatment outcomes in potentially curable malignancies, such as early stage breast cancer and non-Hodgkin’s lymphoma.
- Chemotherapy-induced anaemia (CIA): It is a frequent complication of malignancy. CIA risk varies depending on the type of chemotherapy, the stage and type of cancer, the number of chemotherapy cycles and patient's overall health. CIA treatment includes providing supportive care through transfusion with packed red blood cells (PRBC) or administration of erythropoiesisstimulating agents (ESAs), with or without iron supplementation.
While new medicines for cancer treatment are being introduced, improving quality of life of patients remains a challenge due to the treatment side effects. Supportive care in cancer is a comprehensive approach for effective management of these side effects and awareness about supportive care medications needs to increase among all stakeholders as cancer continues to spread rapidly in the country.
The Writer is Dr Shyam Aggarwal Senior Consultant, HOD,Medical Oncology at SIR GANGA RAM HOSPITAL, DELHI