Side Effects

5.0  Overview

The most common side effects of chemotherapy include nausea, hair loss and fatigue. Furthermore, there is an increased chance of bleeding, getting an infection or developing anemia. Sterility is also an issue with some treatments.

5.1  Hair loss

Hair loss (alopecia) is a common side effect, but does not necessarily happen. When hair loss occurs, the hair may become thinner or may fall out entirely. Hair loss seldom happens right away; more often it begins after a few treatments. At that point, hair may fall out gradually or in clumps. In this case I recommend to have your hair cut short or shaved. It will make it easier to manage hair loss and looks better. Use a sun screen, sun block, hat or scarf to protect your scalp from the sun if you loose a lot of hair on your head. Hair loss can occur on all parts of the body, not just the head. Facial hair, arm and leg hair, underarm hair, and pubic hair all may be affected. The hair usually grows back about 2-3 months after the treatments are over. In some cases, hair may grow back in a different color or texture. Some experienced to have even more and thicker hair after the treatments.

5.2  Infection

Chemotherapy makes you more likely to get infections. This happens because most anticancer drugs affect the bone marrow and decrease its ability to produce white blood cells. There are different ways to prevent infections, such as


• Immunization with Hemophilus influenza, meningococcal and/or pneumococcal vaccines at least 1 week before treatment starts
  
  
• Addition of colony stimulating factors to keep your blood count from getting too far below normal
  
  
• Taking antibiotics for prevention
  
  
Your onc may also postpone your next treatment or give you a lower dose of certain drugs for a while.

5.3  Nausea

5.4  Eating and drinking

It still remains: celery and peanut butter happen to be unhealthy. ... snip ... At least get the peanut butter from the supermarket as the quantity of AFLATOXIN is regulated by the FDA. (It cannot exceed a certain concentration). In the health food store it isn't and amount of aflatoxin is sky-high because of lack of fungicides on the peanuts. However, if one is struggling with one's immune system and has low counts, don't you think that getting rid of all unneeded toxins is likely to be only helpful? You must, albeit, reluctantly, grant me that. The properties of these "foods" are well documented. The fact that it doesn't seem to have reached popular press fails to degrade the truth. Peanut products grown on this planet are all contaminated with aflatoxin. Less so when antifungals are used but always present. This is not alternative nutrition but well known toxicology. Check it out and you will be quite surprised. ... snip ... If anyone doesn't believe me do a search on either one and mutagenesis. I was just trying to promote good clean health. -- Asher <med007@ix.netcom.com>

For more information see http://www.maff.gov.uk/food/infsheet/1994/no37/37ethnic.htm.

procarbazine & food

Question for those of you on MOPP: When they say "no aged cheese", does that include things like american cheese, mozzarella cheese, ricotta cheese or cream cheese? How they expect anyone on chemo to survive without "cheese" is beyond me!

The "bad guy" is a chemical called tyramine. I am not an expert on which foods contain tyramine, but a web search turned up lots of sites including http://www.essiactea.com/diet.html This site says DO NOT EAT cheeses such as cheddar, blue cheese, provolone, brick, brie, camembert, mozzarella. All grated cheeses (parmesan,romano, locatelli). Sliced cheeses (Swiss, Munster,American-white or yellow). Anything that contains cheese such as salad dressing, crackers, chips, etc.

It says you MAY EAT Fresh Cheeses such as ricotta, cottage cheese, cream cheese and fresh mozzarella. -- Robert Glen Martin <rgmartin@cyberramp.net>

Can I drink alcoholic beverages?

Small amounts of alcohol can help you relax and increase your appetite. On the other hand, alcohol may interact with some drugs to reduce their effectiveness or worsen their side effects. Be sure to ask your onc if it's okay for you to drink beer, wine or other alcoholic beverages. -- Gallus Roemer <romerg@ch.sibt.com>

Should I take vitamin or mineral supplements?

There is no single answer to this question, but one thing is clear: No diet or nutritional plan can "cure" cancer, and taking vitamin and mineral supplements should never be considered a substitute for medical care. You should not take any supplements without your oncologist's knowledge and consent. -- Gallus Roemer <romerg@ch.sibt.com>

5.5  Mouth sores and jaw pain

jaw pain

Jaw pain can be caused by Velban (vinblastine) and is a relatively rare side effect, according to my onc. Lucky me, I got it the first time around with ABVD, but never again, and several other people have had the same experience of intense jaw pain after the first treatment, but it never came back. Every treatment can be different, never know what to expect. -- Krista Kamer <kristak@ucla.edu>

5.6  Fertility

Men:

Chemotherapy drugs lower the number of sperm cells, reduce their ability to move, or cause other abnormalities. These changes can result in temporary or permanent infertility. Because permanent sterility may occur, it is important to discuss this issue with your doctor before you begin chemotherapy. You might consider sperm banking, a procedure that freezes sperm for future use. Men undergoing chemotherapy should use an effective means of birth control during treatment and for a certain time after because of the harmful effects on chromosomes.

Women:

Anticancer drugs can damage the ovaries and reduce the amount of hormones they produce. As a result, some women find their menstrual periods become irregular or stop completely. Damage to the ovaries may result in infertility, sometimes temporary, in other cases it may be permanent. That depends mainly on the type of drug, the dosage given, and the women's age. The hormonal effects often cause menopause-like symptoms such as hot flushes and itching, burning or dryness of vaginal tissues. This tissue changes can make intercourse uncomfortable, but the symptoms often can be often relieved by using a water-based vaginal lubricant. The tissue changes also can make a women more likely to get vaginal infections. The risk of infertility might be reduced by taking additional hormones during the treatments. Ask your doctor about this.

5.7  Chemo and pregnancy

5.8  Growth factors (Neupogen / G-CSF / Epogen)

5.9  Long term effects

What are the long term effects of spleen removal?

It's vitally important to note that those of us who were splenectomized as part of the staging laparotomy - and possibly those who had radiation to the splenic pedicle (if you had abdominal radiation, this could apply - ask your dr to be sure) - present special situations in terms of antibiotic therapy for "bugs."

Echoing Thomas, a virus will just giggle at an antibiotic. It can prevent secondary infection, which may be important depending on the situation, but is usually unwarranted. However, in those who are currently on/recently off treatment, empiric antibiotic therapy is usually prescribed because of the risks - when someone's neutropenic, you can't just wait around and see what happens because it can become a life-threatening situation rather quickly. With those who are surgically or functionally asplenic, even years in remission & off treatment, antibiotics are almost always prescribed because of the risk of overwhelming post-splenectomy sepsis. Here's the story:

Basically, splenectomized patients have a defect in humoral (B-cell) immunity, particularly to encapsulated bacteria such as pneumococcus, hemophilus influenza type B, and meningococcus. The spleen serves as a sort of filtering center and phagocytizes bacteria so that the white cells can grab on and devour them. Without the spleen, encapsulated capsules, sliding right off the white cells that are trying to bind and "eat" them. Consequently, patients can develop what's known as overwhelming post-splenectomy infection (OPSI), or sepsis. This is an extremely dangerous condition in which you end up becoming hemodynamically unstable. . .and you can die from it. The rapid onset is part of the danger, since an individual can develop symptoms suddenly and be dead within less than 24 hours of feeling fine. Granted, this doesn't happen to the majority, but since there's no way to predict this with certainty, it's important to stay on top of this. It's not something that requires a huge amount of attention in daily life, so it's comparatively easy to adjust to.

With no good way to prevent OPSI in splenectomized people, physicians generally do the following for HD survivors, who are at particular risk (a) during treatment, when they're severely immunosuppressed from therapy, (b) even off treatment, esp w/prior chemo which, esp when combined with radiation, seems to make things a bit worse still, even years later:



• Vaccinations - Most drs recommend the Pneumovax; some also give the HiB and meningococcal vaccines. I've had all three. How well your body produces antibodies without a spleen is debatable, but most agree that any attempt at protection is better than none.

• Antibiotics - Most physicians adopt one of two approaches for splenectomized HD survivors: prophylactic penicillin V, 250 mg twice daily, or Augmentin (or a similar antibiotic) carried with the person so that s/he can initiate empiric treatment at the first sign of infection, which really does speed things up in terms of getting some antibacterials into your system. The penicillin prophylaxis approach is mostly used in children and teens (once daily in children); there is considerable debate about the necessity of lifelong prophylaxis, particularly in light of the emergence of resistant strains. My hematologist did the penicillin thing with me, but when I moved here and switched to the hematologist that even he recommended, this one discussed d/c'ing the penicillin and carrying Augmentin. It seems to work well; I haven't been sick any more frequently than when I was taking penicillin daily, in general. . .and since I work in a clinical environment in an area with a high prevalence of penicillin-resistant pneumococci it's probably better this way.

If you've had a splenectomy, I strongly urge you to talk with your dr about any vaccinations and antibiotic coverage you might need, and make certain you know how to reach him/her quickly. I've seen sepsis - no post-splenectomy so far, though - and knowing about it makes me extra vigilant in keeping tabs on my health. I don't call for a little fatigue or two sneezes, but I know when things are starting downhill and I do call my dr.

In reading, you will find that HD is peculiar in that patients and survivors - even those years post-therapy and apparently "cured" - display a specific immunologic defect. The defect is one of cellular mycobacterial (i.e., tuberculosis, MAI), and viral infections. This usually doesn't cause a real problem until late-stage disease; however, the defect itself doesn't indicate recurrence or anything like that. Anecdotally, most HD survivors I know report increased problems with infections - all the little colds & flu & other bugs. However, at this point I think it's chiefly anecdotal. -- Kimbra Wilder <Kimbra.Wilder@mcmail.vanderbilt.edu>

Possible Infection after Splenectomy

You will find a "Factsheet on Splenectomy and Infection" at http://www.leukaemia.demon.co.uk/spleen.htm

From the factsheet: "If you are without a functioning spleen, you should consult a doctor if signs of infection appear. The main sign of infection is fever. A severe sore throat, unexpected cough, severe abdominal pain, a headache with drowsiness, or a rash, are other indications to seek medical advice."

..."The commonest type of infection is by a bacterium, Streptococcus pneumoniae...a cause of pneumonia amongst other diseases."

..."The risk to a person without a functioning spleen varies from eight times higher... [adult]... to fifty times higher... [children] ... than the general population." -- Bill Azevedo <AZEVEDO.WILLIAM_E+@TUCSON.VA.GOV>

peripheral neuropathy

Side effects of chemotherapy - a common side effect from Vinblastine (used in ABVD) and possibly Stanford V (vinblastine and vincristine) is peripheral neuropathy. This manifests itself as tingling ("pins and needles") in the hands and feet. Other places might include the arms and face. Good reference pages:


http://www.alumni.caltech.edu/~mike/lymphoma/pn.html

http://www.alumni.caltech.edu/~mike/therapy/vinblastine.html

http://www.alumni.caltech.edu/~mike/therapy/vincristine.html


-- Mike Barela <mbarela@pp.htv.fi>