Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, February 4, 1992 TAG: 9202040136
SECTION: EXTRA PAGE: E-3 EDITION: METRO
SOURCE:
DATELINE: LENGTH: Long
TRICKS TO EASE THE SIDE EFFECTS OF CANCER DRUGS
The side effects of chemotherapy have become a fact of life for millions of Americans as cancer researchers continue to demonstrate the life-saving potential of an ever-growing list of cell-killing drugs.For many cancer patients who feel relatively well at the time their disease is discovered, the nausea and vomiting, hair loss, fatigue, and other debilitating symptoms often associated with chemotherapy can make the treatment seem far worse than the disease, at least in cancer's early stages.
For some, the side effects of cancer-fighting drugs are so distressing that they abandon the therapy and, in doing so, often sacrifice their only chance for a lasting cure.
It is important for patients to know and for doctors to explain that in more than 90 percent of patients, the side effects of chemotherapy can be significantly reduced or avoided.
Because they are unaware of the many tricks of the trade now available for minimizing the side effects of established chemotherapeutic drugs, patients may be lured to fringe therapists, many of whom are neither doctors nor experts on the complexities of cancer.
Some patients may seek out unproven "alternative" therapies that are said to be free of chemotherapy's toxic effects, like special diets and supplements, "cleansing" enemas, mental gymnastics, or cell therapies said to increase the body's ability to fight off the cancer.
And while many patients shun chemotherapy because they overestimate its debilitating effects, others are prompted to quit the drug treatments because they had not expected the side effects and did not realize they could be ameliorated.
Some oncologists, concerned about unduly frightening prospective chemotherapy patients, do not tell them enough about the potential complications of treatment.
But even when doctors are forthcoming, studies show that many patients fail to hear, comprehend or remember what they are told about side effects because of their emotional state.
Why chemotherapy?
A generation ago, chemotherapy was used only as a last-ditch effort when other primary cancer treatments, namely surgery or radiation, failed to produce a cure. The treatments often made patients even sicker than they already were, and because their cancers were usually well-advanced when the drugs were given, most patients died anyway. The effect was to give chemotherapy a bad name in the minds of most of the people who could now benefit from it.
For several cancers, for example the leukemias and testicular cancer, chemotherapy is now recognized as the most effective - and sometimes the only - route to cure. For other cancers, chemotherapy is an adjunct, given either as an essential part of the primary therapy or as the cleanup hitter after primary therapy.
Today chemotherapy is playing an ever-larger role as the mop for cancer cells that may escape the surgeon's knife or the radiologist's beam and lurk in hidden regions of the body where they could seed a recurrence months or years later.
For example, chemotherapy is now widely recommended for many women with breast cancer even when surgery seems to have removed the entire cancer and there has been no spread to the lymph nodes. Such women treated for at least six months with a combination of anti-cancer drugs are more likely to remain alive and free of cancer for a decade or more than are women treated with surgery alone.
All drugs capable of killing cancer cells can also attack normal cells, and this accounts for much of chemotherapy's unpleasant side effects.
The strategy in administering anti-cancer drugs is to maximize the effect on the cancer while minimizing the attack on normal tissue, often by using combinations.
One drug, for example, may be toxic to nerve cells, another to heart muscle, another to bone marrow. A second approach is to schedule treatments or adjust the dosage so that normal tissue, but not the cancer, is able to recover from one drug assault before the next round is begun.
A third method is to try to protect normal tissue from attack or to apply further treatment to ameliorate the unwanted effects.
Many patients think incorrectly that the side effects of chemotherapy must be endured if the drugs are going to cure their disease. As a result, they fail to inform their oncologists about discomforts that might be reduced or eliminated.
The following are some common side effects of cancer chemotherapy and ways to combat them:
Nausea and vomiting. Depending on the cancer, from 40 to 80 percent of chemotherapy patients experience either or both. Nausea often quickly becomes a conditioned response to therapy such that patients' stomachs flip-flop as soon as they enter the clinic.
This side effect can often be reduced or eliminated by anti-emetic drugs (including marijuana and ondansetron, or Zofran), "desensitization" therapy involving deep relaxation, acupuncture, and dietary manipulation. While chemotherapy is exacting its harshest toll, nutritionists recommend a diet high in protein and carbohydrates consumed in small amounts as often as possible and plenty of fluids between meals.
Mouth sores. These can be reduced by rinsing the mouth often with a solution of warm water, salt and baking soda and by using a soft toothbrush to keep the mouth and gums as clean as possible.
Hair loss. The good news is that about 70 percent of chemotherapy recipients lose little or no hair. Although only temporary (hair grows back normally after treatment stops), this side effect is often the most devastating to cancer patients.
Damage to hair follicles can often be reduced by chilling the scalp before and during treatments. People who will be taking drugs that can cause hair loss are often fitted for wigs that mimic their normal hair even before the first dose is administered. Others may choose to wear a hat or scarf. Still others experience only thinning of the hair and never become totally bald.
Fatigue. Few chemotherapy recipients are prepared for the extreme fatigue many experience as a result of the treatments, not the disease. Here the best weapon is to avoid exacerbating the side effect.
Patients should learn to pace themselves, set priorities and do the most important things first. They also should delegate household responsibilities, get assistants if necessary to help at home or at work, schedule rest periods during the day, and engage in regular physical exercise to reduce tension-causing fatigue.
Numbness and tingling. When chemotherapy's effects reach out to the fingers and toes, patients should protect their feet by wearing shoes or slippers at all times, and their hands by wearing mitts when cooking and gloves when gardening or washing dishes. They also should wear heavy socks when going out in the cold.
Jane Brody writes about health issues for The New York Times.