Treatment side effects: Easing the burden
By Richard Saltus
Cancer treatments, to be effective, must kill or disrupt the lives of cancer cells. Unfortunately, this is rarely possible without damaging normal tissue at the same time. For this reason, many cancer therapies carry the risk of adverse side effects, such as nausea, hair loss, fatigue, changes in blood cells, infection, and neuropathy – pain and numbness caused by damage to the nerves.
Some newer drugs and experimental compounds are designed to attack molecular targets found exclusively in cancer cells, reducing toxic side effects. Patients with certain types of cancer are currently taking such "smart" drugs – Gleevec is the best-known example – and are pleasantly surprised at how few symptoms they feel.
Meanwhile, patients who continue to receive standard therapies – surgery, chemotherapy, and radiation, along with newer "biologic" agents such as hormone therapy and cancer vaccines – can be assured that caregivers have a large and improving arsenal of methods to predict, control, or even prevent side effects. For example, more-precise radiation therapy is less damaging to normal cells, some surgeries are done with minimal tissue removal, and patients can use a variety of drugs and salves to relieve discomfort.
Along with hair loss, nausea and vomiting are some of the most feared consequences of chemotherapy. Powerful antinausea drugs like Zofran, introduced about 15 years ago, can dramatically lessen stomach symptoms and prevent vomiting. Nurse Practitioner Karen Pollard Murphy, MSN, APRN, BC, of Dana-Farber's Women's Cancers Program, recalls the striking difference she saw in patients when Zofran became available. "People were sitting up in chairs watching TV instead of being sedated in bed," she says. "It was so exciting to see."
Dana-Farber Chief Nurse Patricia Reid Ponte, RN, DNSc, FAAN, says that compared to the past, "Chemotherapy is more targeted, and doses are less toxic. We can predict the effects of chemo and manage symptoms so much better, so that patients can continue working and leading productive lives."
No magic bullet has been found to stop hair loss, which results from damage to fast-growing hair follicle cells, but some newer drugs – such as Herceptin for certain patients with breast cancer – generally don't cause hair to fall out. The Friends Boutique at Dana-Farber offers a variety of practical and stylish wigs, hats, and scarves for when hair loss is unavoidable.
Regardless of the therapy they receive, most cancer patients feel weighed down by fatigue from both the disease and treatment. It's one of the most frustrating parts of having cancer, they often say, and there is no entirely effective remedy.
"It's hard to distinguish among the many possible causes of fatigue," comments Robert Mayer, MD, a Dana-Farber gastrointestinal cancer specialist. "They include low red blood cell counts, the overall tiredness related to cancer, depression, and the effects of any chronic illness." Injections of growth factors can combat anemia by bolstering blood counts while also lowering the risk of energy-sapping infections. Medications can help; sometimes patients get safe stimulant drugs or antidepressants to raise energy and mood.
One of the best remedies, caregivers advise, is physical activity; it gets patients moving and feeling more vital, reduces stress, and restores a measure of well-being while fighting cancer.
