When Glory Sang learnt in 2012 that she had a rare form of soft tissue cancer known as synovial sarcoma, she thought that the worst she would experience during the subsequent chemotherapy was hair loss. But she was wrong.
She was scheduled to undergo three chemotherapy rounds as doctors tested what would work best for her.
“In the first cycle, I was admitted for six days where I did chemotherapy intravenously. I then took a break for two weeks and got readmitted for five to six days for the next cycle.”
And that is when the side effects kicked in.
“The biggest side effect was the extreme nausea. I also lost my sense of taste and satiety. I couldn’t tell if I was hungry or sated, and everything tasted like cardboard. I felt like I was on some hard drugs, floating in the air instead of walking.
Her appearance wasn’t spared either.
“My nails turned black. And while I eventually lost my arm, I didn’t have other severe long-term effects. I did not lose weight, unlike other patients – in fact, I gained a kilo or two. The only thing it might have affected permanently is my blood, because whenever I go for checkups there is a component that is usually low.”
Chemotherapy is so far the most effective way of treating cancer, but these kinds of adverse effects have been a mainstay of the treatment. “Cancer is abnormally multiplying cells and chemotherapy targets these rapidly multiplying cells, but because it is systemic, meaning it goes round the whole body and damages damages normal healthy cells,” says Dr Ahmed Komen, an oncologist at the Aga Khan University Hospital.
It almost seems like chemotherapy is about hoping the cancerous cells die before you do.
Damaged organs and cells
“The cells it can damage include those in the bone marrow, those aligned from the mouth through to the intestines and the hair follicles. Sometimes it also damages organs such as the heart, lungs, kidney and urinary bladder,” he says.
Because chemotherapy can also damage the bone marrow which manufactures blood, patients can lose their immunity, meaning they are susceptible to catching all manner of opportunistic diseases. However, newer forms of chemotherapy have been reducing the action in the bone marrow rather than destroying it, so the red blood cells, white blood cells and platelets become lower instead of getting obliterated. The patient may however still develop anaemia as a result.
In severe extremes, some chemo drugs may cause secondary cancers or other cancers 10 or 20 years later. This is the reason why the patient is constantly evaluated during chemo by checking their blood levels and kidney and liver function. If an abnormality is detected, it’s first corrected before chemo is re-administered.”
Infertility in women
Chemo drugs damage a woman’s eggs, making conception difficult later on. Also, a woman’s age, the dosage and particular drug used can determine how much a woman’s fertility is affected.
Infertility in men
Chemotherapy targets cells that multiply fast. Since sperm cells divide fast, they become an easy target. Permanent infertility can occur if the immature stem cells in the testicles are also damaged.
Mouth sores and nerve damage
“Chemotherapy can also cause mucositis. This is where the patient develops mouth sores and the cells around the stomach are damaged, which causes nausea, vomiting, diarrhoea and constipation,” says Dr Komen.
It can also:
· Damage the nerves and cause nerve pain
· Discolouration of skin where the patient becomes darker skinned
· Discolouration of nails where the patient’s nails darken
· Constant fatigue and dizzy spells
“It is important to stress that these general side effects may be felt more severely by one patient than by another. Some can experience almost all these side effects, while others experience only one or two of them,” says Dr Komen.
One may also experience ‘chemo brain’. This is brain fog that happens during chemotherapy that renders one unable to think clearly or struggles to do so. You can beat this by keeping to-do lists, noting down what you need to remember and trying to keep your brain active by doing brain training exercises such as reading and puzzles. Getting enough sleep and light exercise can also help.
WAYS TO MITIGATE THE EFFECTS
Doctors, having seen what chemotherapy can do to people, always take measures to mitigate these adverse effects. “As doctors we always ensure that first and foremost the disease can respond to treatment before needlessly subjecting the patient to such rigorous treatment,” says Dr Komen.
1. Anti-nausea drugs
They also make sure that the patient is fit enough to be able to take it and they do work ups and investigations to ensure the patient’s white blood cell counts are within normal range. “Before we initiate it we have to ensure the patient will be able to tolerate it, so people should not be scared of it. On the day of chemotherapy, we give the patient pre-medications, enough fluids and some common drugs that are anti-nausea.
2. Easy pace
A chemotherapy session for the day usually takes three hours. “We make sure it is done by very qualified personnel because if it is done too fast, patients can develop more side effects than necessary. We also ensure that after chemo, we give post-medication to help you not develop side effects.”
Patient initiated measures
1. Ginger and ginger tea
Consuming ginger helps with nausea and vomiting.
2. One should also take smaller meals, five or six throughout the day rather than three large ones.
3. Eat slowly to help with the nausea and to ease digestion.
4. The blander the food, the better. Sweet, strong-smelling, fried and fatty food can give you nausea during chemotherapy.
5. Avoid spicy and acidic foods, in order to protect the mouth and stomach lining from sores.
6. Drink fluids throughout the day, which should be one hour before or after you eat and not while eating.
7. Rest when you feel tired. However, if you are always abnormally tired, you should have your blood work done to check if there are components that are too low and get treatment for it.
WHAT IS IN THE CHEMOTHERAPY DRUGS?
The oncologic term for chemotherapy is cytotoxics. Chemotherapy drugs are toxic to both normal and abnormal cells. Some drugs are derived from nature, such as plants; others are synthetically manufactured. At present there more than 100 chemotherapy drugs used in treatment of cancer.
They can either be used alone or in combination with other drugs or treatments, each having very different chemical compositions, mode of administration, side effects and effectiveness. The drugs belong to different groups based on their chemical structure and relationships with other drugs.
“In most cancers, we use a combination of chemo drugs. Sometimes we can even combine four drugs. In such instances, such a patient is likely to experience more side effects than one on one or two drugs,” says Dr Mbogo.
“Every patient needs to ask their doctor what side effects to expect when they start chemo as the toxicities of the different drugs varies.”