Neuropathy

Chemotherapy drug treatments can cause neuropathy, or injury to the peripheral nerves. These consist of motor nerves that help with movement and muscle tone and sensory nerves that help with temperature, pain and touch. The symptoms of neuropathy depend on the nerve type that is affected.  

Symptoms of motor nerve damage include muscle weakness, spasms, cramps, and possibly loss of balance and coordination. Sensory nerve damage can result in pain, numbness, tingling (burning, freezing sensation), and extreme sensitivity to touch. 

If peripheral neuropathy goes untreated, it can develop into permanent damage to nerves, tissues and muscles. Proper treatment can help reduce the risk of irreparable damage and other serious consequences. 

Drugs That Cause Neuropathy

Patients that receive vinca alkaloids (anticancer drugs that stop cancer cell growth by inhibiting cell division) are susceptible to develop neuropathy during their treatment. The condition may develop weeks, month or years even after treatments end. The symptoms may wane as the nerves heal.

Some chemotherapy drugs that are known to cause neuropathy are cisplatin, paclitaxel, oxaliplatin, vincristine, thalidomide and bortezomib. Patients that are already experience nerve damage by other conditions such as diabetes or excessive alcohol use are more prone to develop chemotherapy drug related neuropathy. 

Drug Treatments for Neuropathy

Physicians are investigating some drugs such as anticonvulsants (used in the treatment of epileptic seizures) and antidepressants to help treat the symptoms of neuropathy.

Doctors have found these drugs helpful in managing the condition even though the Food and Drug Administration has not given approval of these drugs for neuropathy treatment. 

Anticonvulsants such as Neurontin have been administered to patients with the condition. Doctors prescribe a low dose to begin and increase as time goes on to help manage pain.  

Some antidepressants used to manage neuropathy symptoms are nortriptyline and amitriptyline.  

Other Non-Drug Treatments for Neuropathy

Some of the following methods can be used in combination with drug treatment or alone to help manage symptoms of neuropathy: 

– massage 
– herbs 
– acupuncture 
– physical therapy to help strengthen muscles 
– occupational therapy to help with assistance of daily tasks 

Another technique is to use transcutaneous electrical nerve stimulation (TENS) to help stop pain signals from going to the brain by using painless electrical impulses by placing electrodes on the skin. TENS seems to be more effective with acute pain and less effective with chronic pain. 

Neutropenia in mesothelioma patients

Chemotherapy drug treatments reduce the number of neutrophils, also known as white bloods cells that protect the body against infection. This causes a condition known as neutropenia. Cancer patients that suffer from neutropenia have an increased risk of bacterial infections and could be fatal if left untreated. Some symptoms of neutropenia include body aches, fever and fatigue. Doctors normally find neutropenia when conducting a complete blood count (CBC) to determine the number of red and white blood cell counts.

Physicians determine the risk of neutropenia by calculating the neutrophil count, called the absolute
neutrophil count (ANC). The absolute neutrophil count is calculated by
multiplying the total white blood count by the percent of neutrophils.

The following scale shows the risk of infection based on the ANC:

Risk of Infection based on Absolute Neutrophil Count (ANC)

ANC greater than 1500: No increased risk of infection

ANC 1000-1500: Slight increase in risk of infection

ANC 500-1000: Moderate increase in risk of infection

ANC 100-500: High risk of infection  

ANC less than 100: Extremely high risk of infection 

Drugs That Cause Neutropenia 
 
Overall, most chemotherapy drugs can cause neutropenia because they tend to lower the number of neutrophils. They grow quickly but only survive three days.  
 
Drug Treatments for Neutropenia 
 
Physicians treat cancer patients that suffer from neutropenia with a drug called Neupogen (filgrastim). This substance recreates blood growth factors that boost the number of white blood cells. It is given by injection every five to seven days, but due to the inconvenience of this frequency, another type of drug called Neulasta (pedfilgrastim) was developed. It lasts longer and needs to be administered every 21 days. These drugs have side effects of their own that causes bone and joint pain.

Other Precautions to Reduce Risks of Infection

The following precautions should be taken by patients with neutropenia to reduce risk of infection:

  • Avoid people that might be sick with a cold, flu or infection
  • Keep skin moist to prevent dry, cracking skin
  • Don’t scratch sores and keep them clean with antiseptic and a bandage
  • Don’t eat raw foods
  • Keep mouth clean, brush regularly and use alcohol-free mouthwash

Fatigue as a side effect

Chemotherapy drug treatments can be effective, but they also seem to be linked to intense fatigue. Drugs that often cause cancer-related fatigue are vinblastine, cisplatin and vincristine.

The severity of fatigue may vary by individual, but almost 90 percent of cancer patients experience some level of fatigue related to cancer treatment at some time during therapy. It is also known that the symptoms from fatigue can last for months or years after cancer treatment.

Specifically, fatigue can be caused by cancer-related anemia or low thyroid function and can intensify with emotional distress or depression related to the cancer treatment. A patient with fatigue may feel weak, forgetful, have decreased energy level and an inability to concentrate.

Drug Treatments to Reduce Fatigue

Physicians treat cancer patients that suffer from fatigue in a similar way to patients with anemia. Doctors use drugs that produce hormone and stimulants such as Ritalin (methylphenidate) and Provigil (modafinil).

Other Treatments to Reduce Fatigue

None-drug treatments such as exercise, diet and conserving energy have been shown to reduce fatigue.

Exercise

Doctors put their patients on a low-intensity exercise regimen to avoid the loss of too much muscle mass that can lead to fatigue more easily than someone that does some sort of physical activity. Too much high-intensity exercise is not good for cancer patients since it can put the immune system at risk.

Diet

Cancer patients can monitor their diet to help reduce fatigue. If a patient doesn’t maintain the proper nutrition by eating the right foods, this will contribute to fatigue. It is recommended that a cancer patient gets at least 15 calories per pound of his or her body weight. Proper amounts of protein are also important to help rebuild and repair body tissue. The recommended amounts of protein are 0.5 to 0.6 grams for every pound of body weight. Patients should have a minimum of 64 ounces of fluids per day and limit their intake of alcoholic and caffeine beverages. It is recommended to supplement their diet with a multivitamin that gives them 100% of the recommended daily nutrients.

Conserve energy

Cancer patients should organize their tasks ahead of time and try to schedule rest periods to help save energy throughout their day. The following are some recommendations to conserve energy:

– Take time in the day to rest
– Take multiple short naps or breaks instead of one long break
– Save energy for important tasks
– Get help to delegate some tasks
– Moderate pace is better than rushing through tasks

Oral Mucositis – Sores in Mouth and Throat

Some chemotherapy drugs can cause sores in the mouth or throat because they inhibit the replacement of the healthy cells. The condition that causes sores in the mouth is known as stomatitis, and a comparable condition in the throat is known as pharyngitis.  

The lining of the mouth starts to become pale and dry. As time goes on, the mouth and throat may become red, sore and inflamed. The patient may have trouble eating, talking or swallowing. Eventually, the condition can lead to painful, bleeding ulcers and possibly infection. This condition normally develops approximately 5 to 14 days after chemotherapy treatment has taken place. These conditions eventually heal once chemotherapy treatment has ended. 
 
It has been determined that up to 75 percent of patients who receive high-does chemotherapy get oral mucositis and approximately 40 percent of patients that receive standard-dose chemotherapy experience this side effect. 

  
Drugs That Cause Oral Mucositis 
 
Some chemotherapy drugs such as methotrexate and 5-FU have shown to cause a higher incidence of oral mucositis than some others. If the patient is treated early, it can lessen the severity of the symptoms. 
 
Treatments to Reduce and Relieve Incidence of Oral Mucositis 
 
There are some common none-drug treatments to help reduce the severity of oral mucositis. 

Following are some steps that can be taken to help the healing process: 

– Keep the mouth clean and moist 
– Brush teeth with a soft toothbrush or swab 
– Stay away from mouthwashes; rinse with salt or baking soda solutions 
– Stay away from foods and juices that are acidic 

There are some medications that have been recommended and administered to cancer patients to help alleviate pain from oral mucositis. They include the following: 
 
– Tylenol liquid (acetaminophen) – helps relieve pain but doesn’t heal sores 
– Kepivance (palifermin) – this drug is used for severe cases of oral mucositis in patients with  
  blood cancers 
– Gelclair (hyaluronate)- relieves pain by creating a protective barrier and coating the oral  
  mucosa 
– Saforis (glutamine) – a new drug known to be effective in preventing and treating oral mucositis 

Anemia

Chemotherapy drug treatments can cause anemia, a condition that results in a low red blood cell count (RBCs). Symptoms such as fatigue, weakness, increased heart rate, dizziness and shortness of breath result because there aren’t enough red blood cells to carry nutrients and oxygen to the body tissues. These symptoms can also inhibit the intensity of the cancer treatment.  
 
Most patients treated with chemotherapy drugs are likely to get anemia. Patients with lymphoma, myeloma and leukemia are also susceptible to anemia because these diseases grow within the bone marrow and squeeze out more healthy red blood cells. Some patients may not get anemia because of cancer, but some may already have a tendency toward it such as premenopausal women.  
 
A doctor can determine whether or not a patient has anemia by evaluating the concentration of hemoglobin in the blood and the hematocrit levels. 
 
– Red blood cells contain a protein called hemoglobin that carries oxygen to the muscles and organs.  If the number of RBCs is low, the hemoglobin concentration is below the normal range. 

The normal range for women is 12 to 16 grams per deciliter and 14 to 18 grams per deciliter for men. 
 
– The percentage of total blood volume occupied by RBCs is known as hematocrit. The normal hematocrit levels should be between 37% and 52%. Usually, these percentages are higher in men than in women. 
 
Normal Adult Values-Male             Female 

RBC                          4.5 – 6.0 M/ul4.2 – 5.4 M/ul 

Hemoglobin (HgB)14 – 18 g/dL12 – 16 g/dL 

Hematocrit (Hct)40 – 52%37 – 47% 

  
 
Drugs That Cause Anemia 
 
Overall, most chemotherapy drugs can cause anemia because they tend to lower blood cell counts due to their toxic effects on bone marrow that is responsible for producing blood cells.  
 
Some cancers cause anemia due to blood loss. Cancers that have an impact on the genitourinary or gastrointestinal tracts may cause bleeding. Tumors are another cause of bleeding, they can bleed from within.  

 
Treatments to Reduce Anemia 
 
If a cancer patient shows signs of severe anemia, a blood transfusion can be given to return the RBC levels to a proper level. This option is normally only used in very severe cases because blood transfusions may present some risks. 
 
A more common approach taken to maintain the proper RBC levels is to use a drug called Procrit or Epogen (epoetin alfa). This substance acts like the body’s naturally-occurring substance, erythropoietin, by stimulating red blood cell production. Epogen is usually administered once a week by an injection to boost the hemoglobin levels.  
 
A more recent drug used to treat chemotherapy-induced anemia is Aranesp (darbepoetin alpha), approved for use in 2002, it has the same characteristics as the naturally-occurring erythropoietin. 

Nausea and vomiting and hair loss

Nausea and vomiting

Chemotherapy drugs can cause nausea and vomiting because they irritate the stomach lining and the duodenum. This results in activating the part of the brain that triggers vomiting. It can also be triggered through intestinal blockage and inflammation that are likely chemotherapy effects.

Drugs That Cause Nausea and Vomiting

The severity of nausea and vomiting side effects vary by patient. Some of the chemotherapy drugs that are most likely to cause nausea and vomiting are cisplatin, dacarbazine, mechlorethamine, melphalan, daunorubicin, carmustine, procarbazine, lomustine and others.

Treatments to Reduce Nausea and Vomiting

It is a common practice to control nausea and vomiting by administering some drugs before chemotherapy treatment begins. Some drugs are administered alone or in combination with others to prevent or reduce nausea and vomiting side effects. These drugs are known as anti-emetics and include the following: Ativan (lorazepam), Compazine (prochlorperazine), Reglan (metoclopramide), Zofran (ondansetron), Phenergan (promethazine), and Aloxi (palonosetron).

There are some non-drug treatments to help control nausea and vomiting such as:

– ginger ale or ginger tablets
– soothing music
– relaxation exercises

Hair Loss

Cells formed in hair follicles divide rapidly. It is this characteristic that makes hair loss, also known as alopecia, a common side effect during chemotherapy. The amount of hair loss varies among patients. The patient’s drug treatment schedule and drug dose can also determine the severity of hair loss. This side effect may start with a tingling sensation when the patient’s first strands of hair start to fall out. Hair loss can also occur on the patient’s legs, arm, face (eyebrows and eyelashes), and in the nose.

Drugs That Cause Hair Loss

The chemotherapy drugs that have shown to cause significant hair loss have been drugs such as Adriamycin (doxorubicin), Taxotere (docetaxel) and Taxol (paclitaxel). Other chemotherapy treatments that have shown to cause significantly less hair loss are drugs such as Oncovin (vincristine) and Gemzar (gemcitabine).

Treatments to Reduce Hair Loss

Recently, other treatments have been used that are referred to as “targeted agents” that do not cause hair loss since they are directed only at the existing cancer cells. These agents are Herceptin (trastuzumab) and Gleevec (imatinib).

In other cases where traditional chemotherapy drugs are used, the hair may start to grow back at its normal pace after the chemotherapy treatment has ended. Hair loss from chemotherapy is difficult to prevent with alternative methods; however, it is suggested to use mild hair products, soft brushes, and try to avoid harsh chemicals such as dying and perming products.

Patients can choose to use head coverings such as caps, scarves, hairpieces or wigs. The National Cancer Institute suggests that if a patient does choose to get a wig, it is advised to get it before the hair loss side effects so that it can be colored to match your natural hair color.  

Patients should check with their health insurance company to make sure whether or not the cost of the wig or hairpiece is covered. Some policies do cover them as part of cancer treatment.

Side Effects of Chemotherapy Drugs For Cancer Treatment

When a person is cancer-free and in good health, their cells grow, die and then divide and regenerate in a natural, controlled manner.  Cancer cells on the other hand, tend to divide at an uncontrolled rate and reproduce rapidly. Chemotherapy drugs are used to attack cancer cells and keep them from multiplying uncontrollably.  
 
The chemotherapy drugs are transported through the blood and eventually access the cancer cells. The problem with chemotherapy drugs is that when they attack cancer cells, they can also attack the healthy cells. In most cases, the healthy cells can survive, but sometimes the attack on the healthy cells results in side effects. For the most part, the side effects are only temporary and last as long as the length of the chemotherapy drug treatment. 
 
The type of chemotherapy side effects can vary based on the type of cancer the patient is diagnosed with, the type of chemotherapy drugs that are used for treatment, and how the patient’s body reacts to the drugs.

Religion and Spirituality

Some patients may take solace in their religious or spiritual beliefs after receiving their diagnosis.  Patients can often experience an outlet of their pent-up emotions through prayer and meditation.  Many studies have shown that patients who employ such practices have better psychological outlooks during treatment than those who do not.  Also, many clergymen have been trained in counseling techniques similar to those of mental health professionals.  For those patients with religious backgrounds, such spiritual guidance can be very helpful both to them and to their families.  

Also, activities such as meditation, reflection and journaling about the experience can alleviate much of the emotional turmoil in a patient’s mind.  Simple meditation can clear the mind of distracting or negative thoughts.  Slow, steady breathing can improve mental functions and regulate heart rate.  Reflection on one’s life and accomplishments can show the patient that their life is worthwhile and improve their outlook during the most stressful stages of therapy.  Writing a journal about the process can also help the patient work through their emotions in a constructive manner.  Each of these methods is useful in developing a strong mental attitude and aiding in physical healing.

Recovery and Recurrence 

Patients who complete their treatment regimen and receive a cancer-free prognosis may feel as if a massive burden has been lifted from their backs.  In the most literal sense, they have a new lease on life.  While the most arduous part of the recovery process may be over, the work to maintain their health truly begins.  The staff at the Mayo Clinic recommends that patients who have finished treatment continue to take part in all of the activities they started during their recovery.  These include staying with a healthy diet, regular exercise and other healthy habits such as avoiding tobacco and alcohol.

During follow-up exams, some cancers can show signs of recurring at or near the same location in the body where the first tumors appeared.  Many patients will feel the same type of distress and anxiety that they experienced during their initial diagnosis.  Others may start to believe that the time, effort and money spent on combating the initial cancer has been wasted; they may not feel strong enough to go through the same battle all over again. 

One of the advantages that patients who receive a diagnosis of a recurrence can use is that they are much more prepared than they were the first time.  They also have access to many more educational, emotional and social resources and understand the process much better than they did after their initial diagnosis.  Also, in most cases, the treatment schedule will be much easier; patients may experience less discomfort and doctors will be able to treat the patient more effectively and with less “trial and error”. 

A patient who experiences a cancer diagnosis understands it as a life-changing event, both for themselves and everyone in their life.  While the disease and treatment can affect every aspect of daily life, many tools exist today to help deal with the impact.  In order to cope with this trying situation, patients should start asking questions without fear and anxiety.  From there, they should take the information they’ve gathered to form plans and organize details to smooth out the long and arduous process.  Numerous health care professionals and cancer survivors understand that, when fear wins, the patient loses. 

Alternative Cancer Treatments

While many scams and get-rich-quick schemes involve “alternative cancer therapies”, many reputable hospitals and non-profit organizations are also researching non-traditional therapy methods that can offer many of the same benefits.  The study of Complimentary and Alternative Medicine (CAM), while still relatively new, has shown promise to patients who are looking for ways to gain the benefits of current modes of treatment while alleviating many of the painful side effects.  Some of these alternatives include: 

  • Acupuncture to manage pain  
  • Dietary supplements to maintain energy 
  • Yoga and other stretching exercises to keep up muscle strength and flexibility 
  • Therapeutic activities (e.g. art therapy) to combat depression and anxiety

Patients often find comfort in these methods for several reasons: 

  • The patient is taking an active approach to their treatment regimen.  This approach helps the patient to feel less like a “lab rat” or a “guinea pig” than in a clinical setting. 
  • The patient understands how these methods can add to the effectiveness clinical treatment sessions. 
  • Most CAM methods are administered in more welcoming and inviting environments.  These settings allow the patient to take a break from the cold, sterile surroundings of hospitals and doctor’s offices.

Patients should always check with their doctor or health care professional regarding CAM methods.  They should also attempt to do thorough research on the costs and benefits of different CAM treatments. 

Side Effects of Treatment

Another major issue that patients deal with on a consistent basis during treatment is the side effects of the various remedies. Radiation therapy can cause hair loss and digestive problems. Chemotherapy sessions can leave a patient feeling lethargic and depressed. Prescription medications can cause mood fluctuations and disruptions in sleep patterns. Some other side effects that patients could encounter include:

  • Constipation

  • Diarrhea

  • Fatigue

  • Incontinence

  • Low White Blood Cell Count/Weakened Immune System

  • Mouth Sores

  • Nail and Skin Discoloration

  • Nausea

  • Nerve Damage

  • Sexual Inability

  • Shortness of Breath

  • Vomiting

In fact, many patients may fear the treatment side effects more than the damage done by the disease itself. Such fears may make patients hesitant to accept traditional treatment methods. Doctors often prescribe additional medications for the purpose of managing these effects (e.g. opioids for pain, antidepressants for mood swings, antibiotics for infection)