The Next Fight

Nausea and vomiting made the already scary experience of chemotherapy even rougher for Lynn Lindstrom. But when the Inver Grove Heights woman started taking Emend capsules before her chemotherapy sessions for breast cancer, her symptoms suddenly subsided.

“They were phenomenal,” says Lindstrom, an elementary education teaching assistant who was diagnosed in June 2005. “I’m glad there are people out there researching this stuff, because I got a lot of relief.”

Surgery, chemotherapy, radiation, and adjuvant therapy can mean a long, healthy life for women with breast cancer, but they also carry a host of potentially incapacitating side effects. Fortunately, medicine has evolved to the point that it is able to lessen some—but not all—of these adverse effects.

Tackling the Side Effects of Chemotherapy
Of all the breast cancer therapies, chemotherapy presents the biggest burden to patients. Nausea and vomiting, hair loss, fatigue, cracking of the fingernails and toenails, and cognitive difficulties are common, though the occurrence and severity of these symptoms depend on the drug and dosage used, as well as on the individual patient. There’s good news, though.

“The toxicity of chemo-therapy has become more manageable and the duration of treatment has become shorter (eight to sixteen weeks rather than six to twelve months),” says Gail Bender, MD, a medical oncologist at Ridgeview Medical Center in Waconia. “Patients should not be deterred from seeking chemotherapy because of the side effects; there are also side effects to letting the cancer progress.”

Nausea and vomiting may occur as a response to chemotherapy through two mechanisms. The first is the injury of stomach cells that start the process of nausea and vomiting. The second is  activation of the area of the brain responsible for producing these symptoms. Chemotherapy drugs typically cause such reactions within a few hours of treatment, and some also cause another period of these symptoms a day later.

Some anti-nausea drugs, such as Emend, are taken before chemotherapy to prevent nausea and vomiting, and others, such as the serotonin antagonist Granisetron, may be administered during the session, says Tom Flynn, MD, a medical oncologist and president of MN Oncology Hematology in Minneapolis. “Certainly, compared to ten or fifteen years ago, we have much better drugs,” he says. “There are better drugs—and more choices—to treat nausea.”

It’s also important to remember that some drugs work better than others in some people. “Every patient is different,” Bender says. “Some people need stronger drugs, and some people need three drugs.”

Chemotherapy can wipe out a woman and can also lead to a risk of infection if it causes a patient’s white blood cell count to dip. To combat fatigue, rest, regular exercise, and adequate sleep are essential.

“We are all overbusy these days,” Bender says. “Chemotherapy patients need to realize that there is going to be a period of time when they just won’t be able to do as much.”

If fatigue is due to anemia, Flynn says, Erythropoietin can be used to boost hemoglobin and replenish energy. Likewise, if a woman’s white blood cell count drops precipitously, drugs called colony-stimulating factors are available to produce a more rapid recovery of white blood cells.

Chemotherapy also tends to harm the nails, one more reminder of the toxic effects of the treatment. “The chemotherapy can cause the nails to become dry and crack,” says Amy Spomer, MD, chair of oncology services at Park Nicollet Clinic in St. Louis Park.

Doctors have found that wrapping a patient’s hands in cold packs or plunging them into an ice bath during chemotherapy prevents the drugs from getting to the nails by restricting the blood flow to that area.

Unfortunately, despite many advances, doctors are currently not able to ameliorate the memory loss, concentration problems, and other cognitive difficulties collectively called “chemobrain” that can arise from chemotherapy treatment.