Systemic chemotherapy is prescribed for some patients with PMP and related cancers, either before surgery to reduce the tumor load, after treatment to prevent recurrence, or to enhance quality of life.
There are a variety of drugs that can be prescribed; the oncologist will choose the most appropriate ones for the patient’s individual situation. While the different drugs have their own side effects, it’s important to realize that they don’t affect all patients equally. While one patient may experience a variety of side effects, others may have very few. It’s essential to keep the oncologist informed of side effects, especially if they are intense, so that appropriate medicines can be added to reduce them or modifications to the treatment regimen can be made.
A list of chemotherapy drugs and their common side effects is found at the bottom of this article.
PMP Pals has been working with patients taking chemotherapy for many years, and several patients have shared their tips for coping with side effects.
Nausea or decrease in appetite are among the most common side effects of chemotherapy, but not everyone experiences them. Don’t automatically assume that you will be badly bothered by nausea. You may not, or it may be mild. There are several drugs that will calm nausea. If what your doctor prescribes doesn’t provide relief, be sure to contact him/her so that a substitution can be made. Always keep your nausea medication with you and be sure to take it when the nausea begins. Drink plenty of fluids; hydration is important. Eating small meals or snacks of bland foods frequently throughout the day can be helpful as well. Being outside in the fresh air can be beneficial, because some patients have a heightened sense of smell during chemotherapy and certain odors can bring on nausea. Some patients find benefit from a heating pad on the stomach. Antacids may be helpful, but check with your oncologist and do not exceed the maximum dosage. Medications prescribed to treat nausea associated with chemotherapy include Dexamethasone (Decadron), Avitan (Lorazepam), Zofran (Ondansetron), Compazine (Prochlorperazine), and Emend. Gravol (Dimenhydrinate), a motion sickness tablet available over the counter, may also be useful. Always check over the counter medications with your oncologist.
Fatigue often occurs the first few days following chemotherapy sessions, but usually improves by the end of a week. Take naps or get plenty of rest these first few days. If you must continue to work your regular schedule, try to schedule your chemotherapy sessions late in the week, so you can rest over the weekend. Rest is your recuperative mechanism.
Neuropathy is tingling, numbness or pain in your fingers or toes. if you experience this, report it and its intensity to your oncologist. If it’s severe, the chemotherapy dose or schedule may be adjusted. Sometimes neuropathy is temporary and abates several months after finishing chemotherapy treatments. Some have found that IV or oral supplementation with minerals (calcium and magnesium) can minimize neuropathy. Alpha-Lipoic acid is another supplement that benefits some patients. Acupuncture can be helpful. Ask your oncologist about these treatments if you encounter neuropathy.
Hand and Foot Syndrome is heightened sensitivity, drying and cracking of the skin on hands and feet. If this is mild, Working Hands Cream may be sufficient. If not, the doctor may prescribe a cream containing urea. Many patients find that applying cream and then wearing socks on both the hands and feet to bed at night is helpful with these symptoms.
Some of the chemotherapy regimens result in sensitivity to cold, even to touching cold objects. Consider wearing a hat and gloves, especially if you go outside in cold weather.
If you receive an injection for low white blood counts due to chemotherapy, there is an oral over-the-counter antihistamine called Claritin that, if taken before the injection, can often prevent the flu-like side effects.
Nosebleeds can occur in patients taking Avastin. Sit up straight and apply pressure below the nose if this occurs. If this is a common or severe problem, the oncologist should be made aware of it.
Some patients produce a lot of mucous in the nose and mouth on some regimens. If you experience this, be sure to always have tissues available; in your car, home, pocket or purse.
Hair loss, while temporary, can be very distressing. There is a product called Cold Cap that can reduce or eliminate hair loss. The cap is only available to patients who use a chemotherapy clinic that has special freezers for storing them. Ordinary freezer temperatures are not cold enough to be effective. Information and a list of facilities that have the equipment can be found at http://www.rapunzelproject.org/coldcaps.aspx
In order to avoid those “scorcher days” in the hottest summer months, schedule your chemo for early in the mornings so that you can return home before the hottest parts of the day. It is especially important to drink plenty of fluids when the weather is hot. Hydration is essential. Wearing loose clothing and nibbling on popsicles, snow cones and ice chips can also help to “keep your cool”. Avoid going outdoors in the middle of the day, whenever possible. If there is hair loss, a loose headscarf can be cooler for women than wearing a wig when at home.
Many patients have stated that attitude is everything. Distraction for the first few days following chemotherapy treatments is very helpful. Watch movies, make plans for a vacation when you feel better, email friends and family, etc. Remind yourself in those dark hours that this is temporary and the chemotherapy is poisoning the cancer. Rest when you are fatigued, eat when you are hungry, and engage in enjoyable activities when you feel able.
Table of Chemotherapies for PMP
|Brand Name||Generic Name||For||Administration||Mechanism||Common Side Effects|
|Mutamycin||Mitomycin-C||PMP||HIPEC||DNA crosslinker effectively kills bacteria||nausea, vomiting, loss of appetite or weight, sores in mouth and throat, headache, fainting, blurred vision, hair loss, loss of strength and energy, rash|
|Adrucil||5-FU||colon cancer||intravenous||interrupts DNA replication||nausea, vomiting, diarrhea, mucositis, headache, myelosuppression, alopecia, photosensitivity, hand-foot syndrome, maculopapular eruption, itech, cardiotoxicity, persisitent hiccups, mood disorders|
|Xeloda||Capecitabine||colon cancer||pill||metabolizes to 5-FU and interrupts DNA replication||nausea, vomiting, diarrhea, mucositis, headache, myelosuppression, alopecia, photosensitivity, hand-foot syndrome, maculopapular eruption, itech, cardiotoxicity, persisitent hiccups, mood disorders|
|Leucovorin||Folinic acid||enhancing 5-FU toxicity||pill, intravenous||provides a source of reduced folinates which stabilizes 5-FU|
|Eloxatin||Oxaliplatin||colon cancer||intravenous||inhibits DNA synthesis causing cell death||peripheral neuropathy, fatigue, nausea, vomiting, diarrhea, neutropenia, ototoxicity, extravastion, Hypokalemia, persistent hiccups|
|Camptosar||Irinotecan||colon cancer||intravenous||inhibits DNA replication and transcription||diarrhea, immunosuppression|
|Avastin||Bevacizumab||colon cancer||intravenous||inhibits growth of new blood vessels||hypertension, heightenend risk of bleeding, bowel perforation|
|Erbitux||Cetuximab||colon cancer||intravenous||epidermal growth factor receptor inhibitor||rash, fevers, chills, rigors, urticaria, pruritis, hypotension, bronchospasm, dyspnea, wheezing, angioedema, dizziness, ahaphylaxis, cardiac arrest|
|Vectibix||Panitumumab||colon cancer||intravenous||epidermal growth factor receptor inhibitor||skin rash, fatigue, nausea, diarrhea, decreased magnesium levels|
|Removab||Catumaxomab||ascites||intraperitoneal||binds to EpCAM-positive tumors to enlist immune system response||fever, nausea, vomiting|
|Lonsurf||trifluridine + tipiracil||colon cancer||pill||incorporates into DNA during synthesis and inhibits tumor growth||anemia, neutropenia, fatigue, nausea, throbocytopenia, decreased appetite, diarrhea, vomiting, abdominal pain, pyrexia|
Contributors to this article include Elaine, Paul, Karen, Joanne, Mark, Robert, Andy, Warren, Sandra, Misty, and Gabriella Graham.