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.

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. 

Surgery and Hospital Care

Many cancer cases require surgery to remove portions of the tumor.  In instances of more advanced or aggressive forms of the disease, the affected organ may also need to be removed in whole or in part (e.g. mastectomy in breast cancer cases, excision of an affected testicle).  The removal of affected tissue and the potential loss of the functionality of the organ can have a severe effect on the patient’s outlook.  In their minds, they have literally lost a part of themselves.  Also, the physical scarring, the extended hospital stays and additional tests that are part of the surgical process can have a negative impact on the patient’s emotional state. 

One study published in the Journal of Surgical Oncology reveals what some experts consider an unexpected result: 

“Although often acknowledged, the impact of the surgical treatment of cancer on the spouse of the adult cancer patient is a largely unexplored area…The results (of the study) indicated that at both the presurgical and postsurgical period, spouses were exhibiting significantly greater distress than patients. Surprisingly, spouses’ levels of distress remained fairly constant across the presurgery to postsurgery period, while the patients distress decreased…Spouses of cancer patients undergoing surgical treatment appear to be an underacknowledged population at risk.” 

Before surgery, patients and their families are best served by educating themselves on the specific procedure as well as a time frame for recovery.  After the procedure, patients can learn more about what limitations they will have and how long such restrictions will be in place.  Family and friends can make the patient as comfortable as possible during both the inpatient and outpatient phases of surgical recovery.     

Internet Research and Telling the Family

Of course, many patients will begin their search for more information via the Internet.  Most hospitals, research clinics and treatment providers offer news and resources through their web sites.  Also, organizations such as the American Cancer Society and the National Cancer Institute give visitors access to a wealth of information on how to manage the various aspects of their treatment.   

One aspect of Internet research of which patients should be aware is the prevalence of misinformation, lies and outright scams that some unscrupulous people can perpetrate on someone desperate for a “miracle cure”.  Many websites that promote themselves as resources for cancer patients often contain misleading information, either as a result of incomplete or inaccurate research or as an attempt to sell their product.  These books, pills and diet plans, in the best cases, are as effective as placebos or, in the worst instances, can cause great harm to a cancer patient’s sensitive metabolism. 

Telling the Family 

After patients receive their diagnosis and their treatment information, the next step often involves telling their spouses and families.  For many patients, this step may be as emotionally difficult as when they first heard the news themselves.  Spouses may often feel the same sense of helplessness as patients; they may feel that this disease will take away their partner and that they can do nothing to stop it.  Young children may not entirely comprehend all of the physical ramifications of what could happen to their parent, but they will pick up on the emotional distress and become depressed, sad or angry.   

Most experts agree that the best way to combat these feelings is to keep the lines of communication open throughout the treatment schedule.  The patient should answer any questions, especially from younger children, as openly and honestly as possible.  One of the best ways to combat the feelings of helplessness that family members may experience is to include them in the therapeutic process.  Simple actions, such as organizing task lists and completing simple chores, can both alleviate the mental stress and add to the family’s feelings of contribution to the patient’s well being.   

The patient’s relationship with their spouse will undergo many of the more serious changes during treatment.  The patient may experience both physical and mental exhaustion during this time, so the spouse may have to take care of their normal household duties (taking out the trash, cooking dinner, dressing the children for school).  In addition, the nature of the couple’s physical relationship will also change.  Along with the lack of energy, the patient may have either lost their desire for sex or may be physically unable to perform.  These changes could cause resentment and anger to disrupt the relationship and add more stress onto their situation.  The spouse may then feel a measure of guilt for harboring these feelings against their ill partner.

Many psychologists, counselors and mental health professionals specialize in therapy for cancer patients and their families.  Even with the technology available to modern medicine, the idea of cancer is still very traumatic for both the patient and their loved ones.  These specialists can offer outlets for all the members of the family affected by the disease, the treatment and the consequences.  With the opportunities to alleviate much of the emotional stress caused by the illness, the patient and the family can focus on the other aspects of cancer therapy and potential recovery. 

Fertility or reproductive health may be an issue with patients and their spouses during treatment, especially if the reproductive organs are the ones affected by the cancer.  Doctors can give information on potential risks and outline options for couples that still hope to have children either during or after treatment.  Some techniques include protection of the reproductive organs during radiation treatment, tissue preservation of the organs for later reimplantation, hormone therapy and sperm/egg banking. 

Coping with Cancer

“You have cancer.”

No patient is ever prepared to hear these words from their doctor. The diagnosis can lead the patient to feel overwhelmed with anxieties, worries and fear. In years past, these words were the equivalent of a death sentence. However, with numerous advances in detection, drugs and other treatment options, many patients can experience a full life while undergoing therapy for the disease. While modern technology has helped in the treatment of many forms of cancer, the road to recovery is still long, often painful and very expensive. During this process, patients will encounter many serious issues that reach beyond the oncologist’s office and into every facet of their lives.

Knowledge Is Power

One of the best ways the patient can deal with the emotional shock of the initial diagnosis is to ask as many questions as possible. Patients should understand that they are the most important participants in their own recovery process. Doctors should encourage questions from patients and allow them to take an active role during the course of the treatment schedule. According to the American Society of Clinical Oncology, some of these questions should include:

  • What is the exact type and name of the cancer I have?
  • How was it diagnosed?
  • What tests were taken and what did they show?
  • Will I need additional tests?
  • What stage is the cancer and what does that mean?
  • What are my treatment options?
  • What clinical trials are open to me?
  • What are the possible side effects of this treatment option, both in the short term and the long term?
  • What is my prognosis? What will my quality of life be?
  • What are the next steps?

Such a frank exchange of information will help patients take control of their emotions and give them a course of action to follow, rather than allow them to be carried away by feelings of helplessness and despair. Doctors also benefit from these sessions; the more feedback they receive from the patient, the better they can tailor the treatment regimen to that specific patient’s needs.

Some patients may also be well served in obtaining a second opinion on their diagnosis. In many cases, doctors may recommend that patients see other specialists in order to gather more information on the specific form of cancer as well as to learn about the latest data on other treatment options. Patients may also benefit from the perspective of another professional opinion and incorporate that into their approach during the healing process.

 

Sarcomatoid Mesothelioma Treatment

Sarcomatoid mesothelioma is the least common histological type of mesothelioma, but it is the most aggressive.

http://www.ncbi.nlm.nih.gov/pubmed/20081811?dopt=Abstract

Even more than epithelial mesothelioma, the sarcomatoid form is difficult to diagnose and to distinguish from other diseases. Just looking at the cells under a microscope is not enough, and doctors employ immunohistological tests to distinguish Sarcomatoid mesothelioma from true sarcoma and pulmonary sarcomatoid carcinoma.

 

http://www.ncbi.nlm.nih.gov/pubmed/18199156?dopt=Abstract

The general treatment plan for sarcomatoid mesothelioma focuses on:

  • Managing pleural effusions
  • Administering radiotherapy to intervention sites
  • Evaluating suitability for radical surgery
  • Evaluating suitability for chemotherapy and clinical trial entry

Lung Cancer Patients Get Unequal Treatment

A new study from the MD Anderson Cancer Center in Houston found that patients who go to public hospitals for lung cancer care get less effective treatments than those who go to expensive cancer-oriented hospitals. The study also showed that patients who receive their care from public hospitals were nine times more likely to have severe symptoms when they check in for treatment than those who attend cancer centers such as MD Anderson.

The study examined the care in two Houston public hospitals, one Miami public hospital, and MD Anderson, one of the most respected cancer care centers in the world. Dr. Charles Cleeland, the study’s author, said that the disparity of care between public hospitals and cancer centers has existed “for the last couple of decades”. He also noted that lung cancer care “is less well managed” for patients who are poor, unemployed, members of minority groups or those that have little to no health insurance.

The number of public hospital patients experiencing symptoms before admitting themselves for care was nearly double that of cancer center patients. The study, which followed the patients’ progress for two months, showed major differences in the quality of care between the cancer center and the public hospitals. Dr. Cleeland said that patients in public hospitals that were displaying symptoms were “not being corrected”.

Dr. Cleeland also noted that the reasons for the differences in care between public hospitals and well-known cancer centers are “very complex”. “I don’t think it’s the intention of those caring for those folks,” he said. However, he did cite that the lack of access to technical resources or cancer specialists for those underserved patients might be some of the reasons behind the disparity.

A similar study conducted at the University of North Carolina found that African Americans are less likely than Caucasian patients to opt for surgery to remove lung tumors. Surgical tumor removal is often the most effective treatment in the early stages of the disease. Dr. Samuel Cykert, the UNC study’s author, attributed the differences to “unintended biases in physicians”. Dr. Cykert mentioned that doctors who work with underserved patients “would be less apt to recommend surgery” than they would for patients who could afford the procedure.

“Advocating for oneself is very important,” Dr. Cykert said. “Being passive is bad.”

The two doctors do agree on treating symptoms early, rather than allowing them to worsen before seeking help. Dr. Cleeland stressed that doctors, nurses and other health care professionals need to help patients with the symptoms of their lung cancer as much as with treating the cancer itself.

“I think we need to strategize about how to help them (underserved patients)”, he said. “This (study) is characterizing their experience.”

According to public health officials, 62 out of every 100,000 adults will be diagnosed with lung cancer each year. Underserved patients are more likely to engage in cigarette smoking, the primary cause of lung cancer in America, and are also more likely to die from lung cancer.

Sources:
http://www.reuters.com/article/2011/06/20/us-lung-cancer-patients-idUSTRE75J6Y320110620

Nanoparticles Communicate to Deliver Chemotherapy Drugs

Teams of researchers at opposite ends of the country have recently developed an improved system to deliver chemotherapy drugs to attack malignant cells. Scientists at both the Massachusetts Institute of Technology and the University of California at Sand Diego have devised a method involving microscopic machines known as nanoparticles. Although cancer researchers have used nanoparticles for several years to deliver chemotherapy treatments, this new method employs an added layer of accuracy.

While some cancer-fighting efforts with nanoparticles involve a single nanoparticle, the cooperative effort at MIT and UCSD involves a two-stage delivery system.  The first stage acts as a “scout”, locating the cancerous cells by tracking their protein emissions, which differ from those of health cells. Once the scout particle locates an area of malignant activity, it sends a signal to the second-stage nanoparticles. The second-stage particles deliver the chemotherapy drug and shrink the tumor.

Most methods that use nanoparticles to administer chemotherapy drugs are highly inefficient, with only one percent of the injected medication reaching the target. In tests on laboratory mice, the scientists found that the two-stage system delivered the drugs at 40 times the rate found in most single-stage methods. Geoffrey von Maltzahn, the lead author of the paper on this method, said that the dual-stage method “can improve the efficiency with which (nanoparticles) find and treat diseases like cancer.”

One of the keys to the success of the dual-stage system is that the “scout” particles are actually rod-shaped, microscopic gold particles. In addition to its connotations of wealth, gold is also highly conductive to both heat and electricity. When researchers shone a bright light on areas affected by the gold nanoparticles, the gold heated up and damaged the blood vessels around the tumor.

As the tumor began to bleed, the body sent a signal to its blood-clotting agents to create a protein known as fibrin. The second-stage nanoparticles also picked up on that signal and sent the drug to the bleeding tumor. The particles followed the signal deployed the drug to the tumor site. The blood clot closed around the malignant cells and sealed in the drug. This method improved both the accuracy and efficacy of the drug delivery system.

The method has shown great promise in the laboratory, as it improves the concentration of drugs delivered to the tumor site while greatly reducing the side effects associated with conventional chemotherapy treatments. However, much more research and effort will need to be done to see if it can be applied to human patients. One problem could be that the system could create blood clots in other areas of the body away from the tumor. Blood clots in the brain are often the source of strokes, and clots in the heart can cause pulmonary embolism and death.

“If you’re going to trigger coagulation, you want to be very selective, so that you don’t cause damage in other parts of the body,” said Dr. Anil Sood, an oncology specialist at the MD Anderson Cancer Center in Houston.

Related article

Sources:
http://www.popsci.com/science/article/2011-06/nanoparticle-teams-communicate-inside-body-target-tumors
http://blogs.discovermagazine.com/80beats/2011/06/21/two-types-of-nanoparticles-work-together-to-target-tumors/
http://bostinnovation.com/2011/06/21/mit-creates-new-nanoparticle-method-to-target-cancer-cells-more-effectively/
http://web.mit.edu/newsoffice/2011/swarming-nanoparticles-0620.html



Personalized Vaccines May Help Fight Cancer

Individualized vaccines created from a patient’s own cancer tumor may help boost the immune system’s response to the illness, according to a study conducted at Dartmouth-Hitchcock Medical Center. Early trials of the innovative new treatment option suggest that patient survival can be greatly improved through such vaccinations.

For the study, researchers (led by Richard Barth Jr, chief of general surgery at Dartmouth-Hitchcock) used dendritic cells culled from a patient’s blood to develop a personalized vaccine. Dendritic cells are an integral part of the immune system that seek out hostile antigens. By programming these dendritic cells to target a patient’s unique cancer cell manifestation, the result is an induced immune response to tumors.

As witnessed in the study, the injection of such a vaccine resulted in an effective anti-tumor response in a majority of patients.

The study included 26 patients who had tumors that had spread from the colon to the liver. All patients were surgically treated to remove the tumors. However, metastasized colon tumors are notorious for spawning regrowth following surgery. In an attempt to reduce the chances for the cancer to return, Barth and associates injected the vaccine into patients one month after surgery.

Study representatives report that 60 percent of all patients who received a vaccination displayed a favorable T-cell immune response to their tumors. Of those with a favorable response, 63 percent were alive and free of any signs of cancer after five years of treatment.

In comparison, only 18 percent of patients who did not respond to the immunization were alive and free of cancer during the same time period.

The study shows for the first time that dendritic vaccines may be useful in the treatment of cancer. Previous research efforts have attempted to show that such vaccines may be helpful in fighting larger tumor deposits. While previously unsuccessful, the vaccines may be used in conjunction with surgery to improve a patient’s chances for survival.

Additional studies are required before the efficacy and effectiveness of the treatment option can be validated. According to Barth, “This study isn’t definitive enough for us to say that everyone with colon cancer that spreads to the liver should get the vaccine. A next possible step would be to compare this vaccine with just dendritic cells which have not been pulsed with tumor antigens as a control.”

Findings of the study were published in the November issue of Clinical Cancer Research.

Sources:
http://www.smartplanet.com/business/blog/smart-takes/a-personalized-vaccine-to-combat-cancers-tumors/12609/
http://thedartmouth.com/2010/11/29/news/cancer