Chemotherapy Side Effects and Syndromes

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Original Editors -Alisha Dye & Monica Toole Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.

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Definition/Description

     Chemotherapy is the use of medicines or drugs to treat a disease, such as cancer. This treatment is often just called “chemo.” Two other medical terms used to describe cancer chemotherapy are antineoplastic (meaning anti-cancer) therapy and cytotoxic (cell-killing) therapy. Chemotherapy differs from surgery or radiation in that it’s almost always used
as a systemic treatment. This means the drugs travel throughout the body to reach cancer cells wherever they are. Chemo can kill cancer cells that have metastasized or spread to parts of the body far away from the primary (original) tumor.   

     The first drug used for cancer chemotherapy did not start out as a medicine. Mustard gas was used as a chemical warfare agent during World War I and was studied further during World War II. During a military operation in World War II, a group of people were accidentally exposed to mustard gas and were later found to have very low white blood cell counts. Doctors reasoned that something that damaged the rapidly growing white blood cells might have a similar effect on cancer. So, in the 1940s, several patients with advanced lymphomas (cancers of certain white blood cells) were given the drug by vein, rather than by breathing the irritating gas. Their improvement, although temporary, was remarkable. That experience led researchers to look for other substances that might have similar effects against cancer. As a result, many other drugs have been developed. 

     Depending on the type of cancer, its stage, and where you are in the treatment process, the goal of chemo is to: cure the cancer, keep the cancer from spreading, slow the cancer’s growth, kill cancer cells that may have spread to other parts of the body, and relieve symptoms caused by cancer.

Prevalence

File:Cancer map.jpg

 Systemic chemotherapy plays a major role in the management of the 60% of malignancies that are not curable by regional modalities.

Characteristics/Clinical Presentation

Anemia
What is anemia?
Anemia is when you have too few red blood cells, and your body tissues don’t get enough
oxygen to do their work. You may have these symptoms:
· Extreme tiredness (fatigue)
· Dizziness
· Paleness
· A tendency to feel cold
· Shortness of breath
· Weakness
· Racing heart
Things that may help with anemia:
Try the ideas listed in the section called “Fatigue” (see below) if your anemia is making
you feel very tired. Let your doctor or nurse know if you have any of the symptoms listed
above. Your doctor will check your blood cell count (also called a complete blood count
or CBC) often during your treatment. If your red blood cell count falls too low, you may
need a blood transfusion. Some people can be treated with a growth factor – a drug used
to boost the number of red blood cells the bone marrow makes.
You can get a lot more information in Anemia in People With Cancer. Call for a free
copy, or read it on our Web site.
Fatigue
What is fatigue?
Fatigue is one of the most common side effects of cancer treatment. It can range from
mild tiredness to feeling completely wiped out. It’s different from feeling tired after a
long day and doesn’t get better with rest or sleep. Fatigue tends to be the worst at the end
of a treatment cycle. Like most other side effects, it usually goes away after chemo ends.
Things that may help with fatigue:
· Get plenty of rest, and allow time during the day for rest periods.
· Talk with your doctor or nurse about a regular exercise program.
· Eat a well-balanced diet, and drink plenty of liquids.
· Limit your activities. Do only the things that are most important to you.
· Get help when you need it. Ask family, friends, and neighbors to pitch in with things
like child care, shopping, housework, or driving. For example, you might ask
neighbors to pick up some items for you at the grocery store while doing their own
shopping.
· Get up slowly to help prevent dizziness after sitting or lying down.
· Let your doctor know if you are having a hard time sleeping at night.
You can learn more in our document called Fatigue in People With Cancer, which you
can read on our Web site or call us to have a copy sent to you.
Hair loss
How do I deal with losing my hair?
Hair loss (alopecia) can be distressing. But not all chemo drugs will make you lose your
hair. Some people have mild thinning that only they notice. Your doctor will be able to
tell you if your chemo is likely to make you lose your hair.
If you do lose your hair, it will almost always grow back after the treatments are over.
But it might be a different color or texture.
You can lose hair on all parts of your body, not just your scalp. Eyelashes and eyebrows,
arm and leg hair, underarm hair, and pubic hair all may be affected. It usually doesn’t
happen right away. More often, hair loss begins after a few treatments. At that point, your
hair may fall out slowly or in clumps. Some people shave their heads when this happens.
Any hair that remains may become dull and dry.
Things that may help with hair loss:
· Use mild shampoos.
· Use soft-bristle hair brushes.
· Use low heat if you must use a hair dryer.
· Don’t use brush rollers to set your hair.
· Don’t dye your hair or get a perm.
· Have your hair cut short. A shorter style will make your hair look thicker and fuller. It
also will make hair loss easier to deal with if it does happen.
· Use a sunscreen, hat, scarf, or wig to protect your scalp from the sun.
· Use a satin pillowcase.
Sometimes, either during the regrowth of your hair or when you are bald, your scalp may
feel extra tender, dry, and itchy. It may help to keep your scalp clean by using a
moisturizing shampoo and conditioner. Also, use gentle creams or lotions on your scalp
as needed. Even a gentle scalp massage may make your scalp feel better.
After chemo, your hair’s texture and fullness may change. Hair dyes contain chemicals
like peroxide that can damage hair. There’s no research that supports hair dye doing more
damage to hair after chemo, but most doctors recommend patients do not use hair dyes
until hair returns to normal. This may be as long as 6 months after treatment.
Should I cover my head if I lose my hair?
Some people who lose all or most of their hair choose to wear turbans, scarves, caps,
wigs, or hairpieces. Others leave their heads uncovered. Still others switch back and
forth, depending on whether they are in public or at home with family and friends. Here
are tips to follow if you choose to cover your head with a wig or hairpiece:
· Shop for your wig or hairpiece before you lose a lot of hair so you can match your
natural color, texture, and style.
· You may be able to buy a wig or hairpiece at a specialty shop just for cancer patients.
· A sales person may be able to come to your home to help you.
· You can get more tips or even buy a wig or hairpiece through our “tlc” Tender
Loving Care® catalog. Call us for a copy or visit the “tlc”TM Web site at
www.tlcdirect.org.
· If you would prefer to borrow rather than buy a wig or hairpiece, call us or check with
the social work department at your treatment center.
If you need a hairpiece because of cancer treatment, it’s a tax-deductible expense. It may
also be at least partly covered by your health insurance. Be sure to check your policy, and
ask your doctor to write a prescription for a “hair prosthesis.”
Increased chance of bruising, bleeding, and infection
How will chemo affect my blood cell counts?
The bone marrow produces 3 important parts of your blood:
· Platelets, which help blood to clot and stop bleeding
· White blood cells, which fight infection
· Red blood cells, which carry oxygen to cells (see “Anemia” above)
Chemo destroys some of the bone marrow cells so fewer blood cells are produced. A
drop in the levels of any one of these cells leads to certain side effects.
Your doctor will check your blood cell count by doing a test called a complete blood
count or CBC. This will be done often during your treatment.
Bleeding or clotting problems
Chemo can affect the bone marrow’s ability to make platelets. These are the blood cells
that help stop bleeding by plugging up damaged blood vessels and helping your blood to
clot. If you don’t have enough platelets, you may bleed or bruise more easily than usual,
even from a minor injury. A shortage of platelets is called thrombocytopenia (throm-bosy-
toe-PEEN-ee-uh).
Report these signs of thrombocytopenia to your doctor:
· Unexpected bruising
· Small flat red spots under your skin
· Red or pink urine
· Black or bloody bowel movements
· Any bleeding from your gums or nose
· Bad headaches
· Dizziness
· Pain in joints and muscles
Your doctor will check your platelet count often during your treatment. If it falls too low,
you may need a platelet transfusion.
Things that may help you avoid problems if your platelet count is low:
· Don’t take any medicine without first checking with your doctor or nurse. This
includes aspirin and aspirin-free pain relievers, like acetaminophen (Tylenol®),
ibuprofen, and any other medicines you can buy without a prescription. Some of these
medicines can make bleeding problems worse.
· Don’t drink any alcohol (beer, wine, or liquor) unless your doctor says it’s OK.
· Use an extra-soft bristle toothbrush to clean your teeth, and talk to your doctor before
using dental floss.
· If you have a runny nose, blow gently into a soft tissue.
· Take care not to cut or nick yourself when using scissors, needles, knives, or tools.
· Be careful not to burn yourself when ironing or cooking. Use a padded glove rather
than a potholder when you reach into the oven.
· Avoid contact sports and other activities that might cause an injury.
· Drink plenty of fluids and eat enough fiber to reduce your chances of getting
constipated.
· Use an electric shaver instead of a razor.
· When bending over, keep your head above your heart.
Infection
Having a low white blood cell count decreases your body’s ability to fight infections.
One type of white blood cell, the neutrophil (new-trow-fill), is especially important in
fighting infections. A shortage of neutrophils is called neutropenia (new-trow-PEEN-eeuh).
Infections can begin in almost any part of your body and most often start in your mouth,
skin, lungs, urinary tract, and rectum.
If your white blood cell count drops too much, your doctor may hold treatment, give you
a lower dose of chemo, or give you a growth factor shot that makes your bone marrow
put out more white blood cells.
Things that may help you prevent infections:
· Wash your hands often during the day, especially before you eat and after you use the
bathroom.
· Stay away from crowds.
· Stay away from people who have diseases you can catch, such as colds, flu, measles,
or chicken pox.
· Do not get any immunization shots (vaccines) without first checking with your cancer
doctor (oncologist or hematologist).
· Stay away from people who have recently had an immunization, such as a vaccine for
chicken pox or small pox. Check with your doctor about which vaccines are
important and how long you should stay away from people who have had them.
· Clean your rectal area very well but gently after each bowel movement. Ask your
doctor or nurse for advice if the area becomes sore or if you have hemorrhoids. Also,
check with your doctor before using enemas or suppositories.
· Don’t cut, bite, or tear the cuticles of your nails.
· Be careful not to cut or nick yourself when using scissors, needles, or knives.
· Use an electric shaver instead of a razor to prevent breaks or cuts in your skin.
· Use an extra-soft bristle toothbrush that won’t hurt your gums, and talk to your doctor
before using dental floss.
· Don’t squeeze or scratch pimples.
· Take a warm (not hot) bath, shower, or sponge bath every day. Pat your skin dry
using a light touch. Don’t rub.
· Use lotion or oil to soften and heal your skin if it becomes dry and cracked.
· Clean cuts, scrapes, and broken skin right away with warm water and soap. Use an
antibiotic ointment and cover with a bandage.
· Wear waterproof gloves when gardening or cleaning up after animals and others,
especially small children. Wash your hands afterward, since gloves can have holes
that are too small to see.
Even if you are extra careful, your body may not be able to fight infections when your
white blood cell count is low. Look out for and check your body regularly for signs and
symptoms that you might have an infection. Pay special attention to your eyes, nose,
mouth, and genital and rectal areas. The symptoms of infection could be:
· Fever of 100.5°F or greater when your temperature is taken by mouth
· Chills
· Sweating
· Loose stools (This can also be a side effect of chemo.)
· A burning feeling when you urinate
· A bad cough or sore throat
· Unusual vaginal discharge or itching
· Redness, swelling, or tenderness, especially around a wound, sore, pimple, IV site, or
central venous catheter
· Abdominal (belly) pain
Report any signs of infection to your doctor right away. If you have a fever, don’t use
aspirin, acetaminophen (Tylenol), or any other medicine to bring your temperature down
without first checking with your doctor.
For much more detail on the immune system, infections and cancer, and how to prevent
them, please see Infections in People With Cancer. It can be read online, or call us for a
free copy.
Nausea and vomiting
What can I do about nausea and vomiting?
Nausea and vomiting are 2 of the most dreaded side effects of chemo. How often you
have these side effects and how bad they are depends on the drugs you are getting and
how they affect you.
Nausea and vomiting may start during treatment and last a few hours. Sometimes, but
less often, severe nausea and vomiting can last for a few days. Be sure to tell your doctor
or nurse if you are very nauseated, if you have been vomiting for more than a day, or if
the problem is so bad that you can’t keep liquids down.
Nausea and vomiting can almost always be lessened by a change in the way you eat and
with drugs that help relieve both symptoms (these drugs are called anti-emetics).
Different anti-emetics work for different people. You may need to try more than one
before you get relief. Don’t give up! Keep working with your doctor and nurse to find the
anti-emetics that work best for you.
Some people getting chemo feel queasy even before treatment begins. This is called
anticipatory nausea, and it’s very real. The best way to handle anticipatory nausea is by
taking anti-emetics to prevent vomiting, and by using relaxation techniques.
Things that may help with nausea and vomiting:
· Avoid big meals so your stomach won’t feel too full. Eat frequent, small meals
throughout the day instead of a few large meals.
· Drink liquids at least an hour before or after mealtime instead of with your meals.
· Eat and drink slowly.
· Stay away from sweet, fried, or fatty foods.
· Eat foods cold or at room temperature so you won’t be bothered by strong smells.
· Chew your food well for better digestion.
· If nausea is a problem in the morning, try eating dry foods, such as cereal, toast, or
crackers, before getting up. (Don’t try this if your mouth is too dry, or if you have
sores in your mouth or throat.)
· Drink cool, clear liquids, such as apple juice, tea, or ginger ale that has lost its fizz.
· Suck on ice cubes, mints, or tart candies. (Don’t eat tart candies if you have mouth or
throat sores.)
· Try to avoid odors that bother you, such as cooking smells, smoke, or perfume.
· Rest in a chair after eating, but don’t lie flat for at least 2 hours after you’ve finished
your meal.
· Wear loose-fitting clothes.
· Breathe deeply and slowly when you feel nauseated.
· Distract yourself by talking with friends or family members, listening to music, or
watching a movie or TV show.
· Use relaxation techniques.
Call us or go to our Web site to get more tips and details in our document called Nausea
and Vomiting.
Other chemo side effects and tips to manage them
Appetite changes
There may be days when you just can’t eat because of things like nausea, taste changes,
or mouth and throat problems. You also can lose your appetite if you feel depressed or
tired.
When you have a poor appetite, try these tips:
· Eat small meals or snacks whenever you want. You don’t have to eat 3 regular meals
each day.
· Vary your diet, and try new foods and recipes.
· Take a walk before meals whenever you can. This may help you feel hungrier.
· Change your mealtime routine. For example, eat by candlelight or in a different place.
· Eat with friends or family members. When eating alone, listen to the radio or watch
TV.
· If you live alone, you might want to arrange for Meals on Wheels or a program like
this to bring food to you. Ask your doctor, nurse, or local American Cancer Society
office about services in your area.
For more information, please see our booklet called Nutrition for the Person With Cancer
During Treatment: A Guide for Patients and Families or Nutrition for Children With
Cancer.
Constipation
Some people become constipated (have trouble passing bowel movements) from chemo.
Others may become constipated because they are less active, eat less than usual, have diet
changes, or because they are taking certain pain medicines. Tell your doctor if you
haven’t had a bowel movement in 2 or more days. You may need to take a laxative or
stool softener, but don’t use these unless you have checked with your doctor, especially if
your white blood cell count or platelet count is low.
Things that may help you deal with constipation:
· Drink plenty of fluids to help keep your stool soft. Warm and hot fluids often work
well.
· Eat a lot of high-fiber foods. High-fiber foods include bran, whole-wheat breads and
cereals, raw or cooked vegetables, fresh and dried fruit, nuts, and popcorn.
· Get some exercise. Just getting out for a walk can help, as can a planned exercise
program. Be sure to check with your doctor before increasing your physical activity.
Diarrhea
When chemo affects the cells lining the intestine, it can cause diarrhea. Diarrhea is most
often defined as 2 or more loose stools in 4 hours. If you have diarrhea that lasts for more
than 24 hours, or if you have pain and cramping along with it, call your doctor. In severe
cases, the doctor may have you take an anti-diarrheal medicine, but don’t take any overthe-
counter anti-diarrheal medicines without asking your doctor first. Some chemo drugs
are known to cause diarrhea. Your doctor will give instructions on what to do if you are
getting one of these drugs.
Things that may help control diarrhea:
· Eat smaller amounts of food, but eat more often.
· Avoid coffee, tea, alcohol, and sweets.
· Avoid high-fiber foods, which can lead to diarrhea and cramping. High-fiber foods
include whole-grain breads and cereals, raw vegetables, beans, nuts, seeds, popcorn,
and fresh and dried fruit.
· Eat low-fiber foods, such as white bread, white rice or noodles, creamed cereals, ripe
bananas, canned or cooked fruit without skins, cottage cheese, yogurt, eggs, mashed
or baked potatoes without the skin, pureed vegetables, chicken or turkey without the
skin, and fish.
· Stay away from fried, greasy, or spicy foods.
· Avoid milk and milk products if they make your diarrhea worse.
· Eat more potassium-rich foods, such as bananas, oranges, potatoes, and peach and
apricot nectars, unless your doctor has told you otherwise.
· Drink plenty of fluids to replace those you have lost through diarrhea. Mild, clear
liquids, such as apple juice, water, clear broth, or ginger ale, are best. Make sure they
are at room temperature, and drink them slowly. Let carbonated drinks lose their fizz
before you drink them.
If your diarrhea is severe (meaning that you have had 7 or 8 loose stools in 24 hours), tell
your doctor right away. Ask if you should try a clear-liquid diet to give your bowels time
to rest. Then, as you feel better, slowly add the low-fiber foods. A clear-liquid diet
doesn’t have all the nutrients you need, so don’t follow it for more than 3 or 4 days. If
your diarrhea doesn’t get better, you may need to get IV fluids to replace the water and
nutrients you have lost.
Mouth, gum, and throat problems
Good mouth care is important during cancer treatment. Chemo can cause sores in the
mouth and throat. It can make these areas dry and irritated or cause them to bleed. Mouth
sores are not only painful, but they can also become infected by the many germs that
normally live in your mouth. Infections can be hard to fight during chemo and can lead to
serious problems. It’s important to take every possible step to prevent them.
Ways to help keep your mouth, gums, and throat healthy:
· Have your teeth cleaned at least 2 weeks before you start chemo, and take care of any
cavities, abscesses, gum disease, or poorly fitting dentures. This will give you time to
heal from any procedures that are needed.
· Ask your dentist to show you the best ways to brush and floss your teeth during
chemo.
· Ask about a daily fluoride rinse or gel to help prevent decay because chemo can make
you more likely to get cavities.
· Brush your teeth and gums after every meal. Use an extra-soft bristle toothbrush and
a gentle touch – brushing too hard can damage soft mouth tissues.
· Ask your dentist to suggest a special type of toothbrush, floss or dental ribbon, and
toothpaste if your gums are very sensitive.
· Rinse your toothbrush well after each use, and store it in a dry place.
· Avoid commercial mouthwashes. They often contain irritants such as alcohol.
Instead, ask your doctor or nurse about a mild mouthwash to help prevent mouth
infections.
If you develop sores in your mouth (this is called stomatitis), tell your doctor or nurse
right away because you may need treatment. Be sure to let the doctor know if the sores
are painful or if they keep you from eating.
If the sores are painful or keep you from eating, try these tips:
· Ask your doctor if there is anything you can put right on the sores to treat them and if
there’s medicine you can take to ease the pain.
· Eat foods cold or at room temperature. Hot and warm foods can irritate a tender
mouth and throat.
· Choose soft, soothing foods, such as ice cream, milk shakes, baby food, soft fruits
(like bananas and applesauce), mashed potatoes, cooked cereals, soft-boiled or
scrambled eggs, cottage cheese, macaroni and cheese, custards, puddings, and gelatin.
You also can puree cooked foods in the blender to make them smoother and easier to
eat.
· Avoid irritating, acidic foods, such as tomatoes, citrus fruit, and citrus fruit juice
(orange, grapefruit, and lemon); spicy or salty foods; and rough, coarse, or dry foods
like raw vegetables, pretzels, granola, and toast.
If your mouth is dry and it bothers you or makes it hard for you to eat, try these
tips:
· Ask your doctor if you should use an artificial saliva product to moisten your mouth.
· Drink plenty of liquids.
· Suck on ice chips, Popsicles, or sugarless hard candy.
· Chew sugarless gum.
· Moisten dry foods with butter, margarine, gravy, sauces, or broth.
· Dunk crisp, dry foods in mild liquids.
· Eat soft and pureed foods.
· Use lip balm if your lips become dry.
Nerve and muscle problems
Certain chemo drugs can cause peripheral neuropathy, a nerve problem that causes
tingling, pins and needles, burning sensations, weakness, and/or numbness in your hands
and feet.
You may feel any of these nerve-related symptoms:
· Loss of balance
· Clumsiness
· Trouble picking up things and buttoning clothing
· Problems walking
· Jaw pain
· Hearing loss
· Vision changes
· Stomach pain
· Constipation
Along with affecting the nerves, certain chemo drugs can affect the muscles and make
them weak, tired, or sore.
Nerve and muscle effects are frustrating, yet in most cases they are not serious if caught
early. They are usually short term and will get better after treatment is done. Still, it’s
important to tell your doctor about any nerve or muscle symptoms right away. They can
get worse and become quite painful if left untreated. Your doctor might want to stop the
chemo for a while or offer you treatment to ease these symptoms.
Caution and common sense can help you deal with nerve and muscle problems.
Follow these tips:
· If your fingers become numb, be very careful when handling objects that are sharp,
hot, or otherwise dangerous.
· If your sense of balance is affected, move carefully, use handrails on stairs, and use a
bath mat in the tub or shower.
For more information see Peripheral Neuropathy Caused by Chemotherapy. Call us for a
free copy or read it on our Web site at www.cancer.org.
Skin and nail changes
You may have minor skin problems during treatment, including color changes, redness,
itching, peeling, dryness, rashes, and acne.
You can take care of most of these problems yourself using these tips:
· If you develop acne, try to keep your face clean and dry.
· To help avoid dryness, take quick, warm showers rather than long, hot baths.
· Apply creams or lotions after bathing, while your skin is still moist.
· Do not use perfume, cologne, or aftershave lotion. These products often contain
alcohol, which can make your skin dry.
· For itching, try cornstarch.
When given through an IV, certain chemo drugs may darken your skin along the vein.
This discoloration will usually fade over time after treatment ends.
Most skin problems are not serious, but a few need to be taken care of right away. For
example, certain drugs given through an IV can cause serious, long-term tissue damage if
they leak out of the vein. Tell your doctor or nurse right away if you notice swelling or
feel any burning or pain near your IV site when you are getting IV drugs. These
symptoms don’t always mean there’s a problem, but they should always be checked out
right away.
Let your doctor or nurse know right away if you develop sudden or severe itching, if your
skin breaks out in a rash or hives, or if you start wheezing or have any other trouble
breathing. These symptoms may mean you are having an allergic reaction that needs
attention right away.
Some chemo drugs may make your skin more sensitive to the sun. Check with your
doctor or nurse about using sunscreen. You may need to completely avoid direct sunlight.
Wear long-sleeved cotton shirts, pants, and wide-brimmed hats to block the sun.
Your nails may become darkened, brittle, or cracked, or they may develop vertical lines
or bands. Protect your nails by wearing gloves when washing dishes, gardening, or doing
other work around the house. Some over-the-counter products might strengthen your
nails, but these products may also cause irritation.
Get advice from your doctor if any skin and nail problems don’t respond to your efforts.
Be sure to let your doctor know if you have redness, pain, or changes around your
cuticles or any other skin problems that you’re worried about.
Urine changes and bladder and kidney problems
Some chemo drugs can irritate your bladder or cause short- or long-term kidney damage.
They may also cause your urine to change color (orange, red, green, or yellow) or take on
a strong or medicine-like odor. For a short time, the color and odor of semen may be
changed, too. (See the section for men under “Sex, fertility, and chemo.”)
Ask your doctor if your chemo may have these effects. And let your doctor know if you
have any symptoms that might be a sign of a problem. Watch for these signs and
symptoms:
· Pain or burning when you urinate
· Urinating a lot
· A feeling that you must urinate right away
· Reddish or bloody urine (Some chemo drugs will change the color of your urine. Tell
your doctor or nurse if this happens.)
· Fever
· Chills
Drink plenty of fluids to ensure good urine flow and help prevent problems. Water, juice,
coffee, tea, soup, soft drinks, broth, ice cream, Popsicles, and gelatin count as fluids.
Weight gain
Some people, usually women, put on weight during chemo. We aren’t sure why this
happens.
Whether you gain weight or not, good nutrition is very important during treatment.
People who eat well cope with side effects better and are better able to fight infection.
Their bodies can also rebuild healthy tissues faster.
Eating well during chemo means choosing a balanced diet that contains all the nutrients
your body needs. You should include foods from each of the following food groups:
fruits and vegetables; poultry, fish, and meat; cereals and breads; and dairy products. You
also should take in enough calories to keep your weight up and, most importantly, enough
protein to build and repair skin, hair, muscles, and organs.
You also may need to drink extra fluid to protect your bladder and kidneys during your
treatment.
To learn more, please see Nutrition for the Person With Cancer During Treatment: A
Guide for Patients and Families and Nutrition and Physical Activity During and After
Cancer Treatment: Answers to Common Questions. Both can be read online or call us for
free copies.

Associated Co-morbidities

     The most common per-existing condition observed in all patients with cancer is hypertension. Diabetes is the second most prevalent pre-existing condition in middle-aged patients, while a previous solid tumor is the second most common pre-existing condition in patients 74 years of age or older.

Other comorbidities that may occur with cancer include:

Obesity
Digestive system disease
Arthritis
Dementia
Thrombotic events and conditions
Depression and other psychiatric illnesses
Chronic obstructive pulmonary disease (COPD) and other pulmonary conditions
Osteoporosis

Medications

1. Alkylating agents: These directly damage DNA to prevent the cancer cell from reproducing. These agents work in all phases of the cell cycle. Alkylating agents are used to treat many different cancers, including leukemia, lymphoma, Hodgkin disease, multiple myeloma, and sarcoma, as well as cancers of the lung, breast, and ovary. Because these drugs damage DNA, they can cause long-term damage to the bone marrow. There are different classes of alkylating agents, including: Nitrogen mustards, Nitrosoureas, Alkyl sulfonates, Triazines, and Ethylenimines.

 2. Antimetabolites: A class of drugs that interfere with DNA and RNA growth by substituting for the normal building blocks of RNA and DNA. They are commonly used to treat leukemias, cancers of the breast, ovary, and the intestinal tract, as well as other types of cancer. Examples of antimetabolites include: 5-fluorouracil, 6-mercaptopurine, Capecitabine, Cladribine, Clofarabine, Cytarabine, Floxuridine, Fludarabine, Gemcitabine, Hydroxyurea, Methotrexate, Pemetrexed, Pentostatin, and Thioguanine.

3. Anthracyclines: There are anti-tumor antibiotics that interfere with enzymes involved in DNA replication. These drugs work in all phases of the cell cycle. They are widely used for a variety of cancers. A major consideration when giving these drugs is that they can permanently damage the heart if given in high doses. For this reason, lifetime dose limits are often placed on these drugs. Examples of anthracyclines include: Daunorubicin, Doxorubicin, Epirubicin and Idarubicin.

4. Mitoxantrone: This anti-tumor antibiotic is similar to doxorubicin in many ways, including the potential for damaging the heart. This drug also acts as a topoisomerase II inhibitor (see below), and can lead to treatment-related leukemia. Mitoxantrone is used to treat prostate cancer, breast cancer, lymphoma, and leukemia.

5. Topoisomerase inhibitors: These drugs interfere with enzymes called topoisomerases, which help separate the strands of DNA so they can be copied. They are used to treat certain leukemias, as well as lung, ovarian, gastrointestinal, and other cancers. Examples include topotecan, airinotecan, etoposide and teniposide.

6. Mitotic inhibitors: These are often plant alkaloids and other compounds derived from natural products. They can stop mitosis or inhibit enzymes from making proteins needed for cell reproduction. They are used to treat many different types of cancer including breast, lung, myelomas, lymphomas, and leukemias. These drugs are known for their potential to cause peripheral nerve damage, which can be a dose-limiting side effect. Examples of mitotic inhibitors include: Taxanes,Epothilones, Vinca alkaloids, and Estramustine.

7. Corticosteroids: Steroids are natural hormones and hormone-like drugs that are useful in treating some types of cancer (lymphoma, leukemias, and multiple myeloma), as well as other illnesses. When these drugs are used to kill cancer cells or slow their growth, they are considered chemotherapy drugs. Corticosteroids are also commonly used as anti-emetics to help prevent nausea and vomiting caused by chemotherapy. They are used before chemotherapy to help prevent severe allergic reactions (hypersensitivity reactions), too. When a corticosteroid is used to prevent vomiting or allergic reactions, it’s not considered chemotherapy. Examples include: prednisone, methylprednisolone, and dexamethasone.

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