Managing Side Effects of Chemotherapy, with Jyoti D. Patel, MD

Last Updated: April 11, 2018

Dr. Jyoti Patel discusses the possible side effects of chemotherapy for cancer treatment.  She shares about the medical advances to managing these side effects and advice on how to talk to your health care team. 

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Side Effects of Chemotherapy

Managing Side Effects

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Side Effects of Chemotherapy: An Introduction

Dr. Jyoti D. Patel, MD: Chemotherapy causes side effects because they’re potent drugs that block cells that are replicating or dividing.  Cancer cells are often the ones that are moving most quickly. And other normal cells like your hair cells, the lining of your mouth or your gut are also ones that are replicating quickly. When chemotherapy is given it affects all of those cells; it’s trying to hit cells that are actively dividing. And there’s some spill over, although we think that we can get mainly cancer cells with chemotherapy sometimes we’ll have off target effects on those other sensitive cells.

Most people are very fearful of starting chemotherapy often because they’ve been touched by cancer at some point in their lives. They had the neighbor or the aunt or had to undergo chemotherapy 20 or 30 years ago and were in these, the people and the memories that they have are of people totally incapacitated by their chemotherapy.  We’ve come so far and in recent years we understand how to give good targeted medications that reduce nausea. We’re able to give drugs that are much less sdating. 

Often patients are able to get chemotherapy and continue to attend to their daily tasks.  Often they can go to work within a day or two.  They’re able to take care of their families and lead really full lives.  I think it’s hard when you’ve had some sort of history to begin your cancer journey that you recognize that truly we’ve come to a new chapter for many people.  And chemotherapy can be much more tolerable. 

Types of Side Effects

Dr. Patel:  Chemotherapy drugs cause a myriad of side effects. And I think that’s important when a patient or caregiver first meets a doctor. Your story of side effects that a friend of yours might have had when experiencing chemotherapy for colon cancer might be very different than the side-effects you might experience if you have a lymphoma.  So we know that there are side effects like lowering of blood counts that are common to many chemotherapy drugs, some chemotherapy drugs cause people to lose hair, others don’t. 

Some cause damage to nerves and others don’t. Some can cause diarrhea, others cause constipation.  Each side effect is unique. Almost universally chemotherapy causes fatigue.  And that is something that we are constantly battling.  But understand that a combination of drugs together and particular drugs can be very different for different diseases and in different patients. 

Learning About Possible Side Effects

Dr. Patel: It’s important when you begin a cancer treatment that you understand what drugs you’re getting, why you’re getting those drugs and what to expect from those drugs and by that I mean what kind of toxicities can one expect.  And it’s important to begin your journey with as much education as possible so to know that if I'm starting a drug what will my next three weeks be like?  Will I feel good for a few days?  What symptoms should I worry about in the next week? 

Should I call if there’s something out of the ordinary?  What should my expectations for work and family balance be like over the duration of my treatment?  All of that information up front can help. It can be really tough to get that information in bite sized pieces in many cases. Often people have been given a tough diagnosis and they start sort of this whirlwind of meet our social worker, meet the nutritionist, let’s start chemotherapy next week. 

By understanding the side effects that you may experience when you’re beginning your chemotherapy journey it’s very likely that you can reduce toxicity and side effects.  So the nurse that’s treating you, the physician that’s treating you, the physician assistant or advanced practice nurse will all give you a lot of information about toxicities you may or may not experience. 

Preventing and Decreasing Side Effects

Dr. Patel:  Things that we do routinely are we give drugs that decrease the likelihood of having an allergic reaction to chemotherapy.  So sometimes you’ll get steroids before you get a particular drug.  We have come so far in recent years in preventing nausea with good anti emetic agents.  And so you’ll often be prescribed oral drugs to take at home after you receive chemotherapy to prevent nausea.

So again you’ll get a myriad of drugs to take at particular time in your treatment.  I think the most important thing that you can do is to understand what side-effects you may experience and with that ask the question what can I do to prevent this?  And sort of that knowledge will help patients and caregivers through those first weeks of chemotherapy in particular. 

We have many patients who have minimal side effects and are able to continue working and caring for their families and leading normal lives on chemotherapy. And that’s really our goal for all patients.

There are many things that patients and their family members and caregivers can do together to decrease the side effects and toxicities of chemotherapy. So I always say being as healthy as you can be every day is important.  So making sure that you’re getting good nutrition, making sure that you’re as active as you can be.  A lot of that is listening to your body and there will be days that are good and you feel like taking a walk and being outside, there are other days that you feel worn out. 

Talking about Side Effects with Your Cancer Care Team

Dr. Patel: It’s important to be very in tune with your body. Some side effects are expected.  But if the toxicities are extreme we need to know, physicians need to understand that it may require that you’re metabolizing drugs differently that doses need to be reduced, delays need to be made and generally that does not compromise cancer therapy. 

Being really in tune to side effects such as neuropathy so that’s numbness and tingling in your fingers and toes. If you even start to develop that keeping those communication lines open with your physician may cause changes in drug or decreases in dose that would be appropriate in your cancer battle.  

There are a lot of side effects that are more difficult to describe.  We try to make it easy for patients to describe how much pain they’re having or if they’re having nausea or vomiting and those are question that we often ask directly.  But it’s important to know that there are other side effects that are much more difficult to quantify.

Problems concentrating, so that’s a side effect of a lot of chemotherapy, some people sometimes call chemo brain.  It’s often you’re under a lot of stress as a chemotherapy patient. Medications can cause problems with attention and can cause drowsiness.  The myriad, the amount of information that you’re taking in at one time can be overwhelming.  We need to hear about this because chemotherapy can cause some of those side effects. Spacing chemotherapy or adding different drugs to combat those side effects may be an important part of your treatment paradigm. 

People worry about telling us about anxiety.  They say of course I have anxiety.  I’ve just gotten a difficult diagnosis.  Clearly that is a good coping mechanism and is appropriate, but sometimes anxiety can get in the way of communication or of attending to symptoms that may alert us to other problems.  And so finding ways to cope with some of those side effects from becoming a cancer patient from chemotherapy is certainly important. 

Recent Advances in Supportive/Palliative Care

Dr. Patel:  In recent years we’ve made considerable progress in supportive care of our patients undergoing chemotherapy.  We have drugs that can keep white blood cell counts up so that patients don’t suffer from significant infection that can be life threatening or can delay chemotherapy.  We now have evidence that there are particular drugs that can decrease cancer cocesia (ph.) or weakness from cancer. 

We know that that good nutrition is important.  We’ve certainly learned a lot about anti-nausea drugs.  And sure there are multiple avenues in which we’ve made progress. Part of the progress in cancer has been refining our treatment strategies, but it also reflects the advances we’ve made in supportive care over the past several decades.

Where to Get More Information

Dr. Patel: In my practice we give information to our patients at the first visit.  But I ask them to do their homework too.  I send them to Cancer.Net. They look at information, come back with questions and we can have dialogue over time about what side effects they expect, implications for cancer care, treatment ideas over time.  And it can be extraordinarily helpful.

[Closing and Credits]

Cancer.Net®: Doctor-Approved Patient Information from ASCO®

ASCO's patient education programs are supported by Conquer Cancer Foundation of the American Society of Clinical  

Special Thanks:

Dr. Mary Wilkinson, Dr. Raymund Cuevo, and the staff at Medical Oncology & Hematology Associates of Northern Virginia

Carolyn B. Hendricks, MD, The Cancer for Breast Health

Hasbro Children’s Hospital

Helen F. Graham Cancer Center at Christiana Care Health System

The Adele R. Decof Comprehensive Cancer Center at The Miriam Hospital. The Miriam Hospital is a teaching hospital of The Warren Alpert Medical School of Brown University

Video Footage and photography courtesy of:

St. Jude Children’s Research Hospital Biomedical Communications

Moffitt Cancer Center

University Hospitals Case Medical Center Seidman Cancer Center

The opinions expressed in the video do not necessarily reflect the views of ASCO or the Conquer Cancer Foundation.

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