Coping With Chemotherapy Side Effects
- In gastric cancer, surgery is often the most critical part of the treatment process — and in some early stage patients, it could be curative. But for many others, chemotherapy will also be part of the treatment plan.
- Chemotherapy can be given before surgery (neoadjuvant) in an attempt to shrink the tumor or after surgery (adjuvant) to get rid of any residual cancer cells that may have been left behind and reduce the risk of recurrence.
- For gastric cancer, typically two or three different drugs are combined, sometimes with the addition of a targeted therapy. The treatment path depends on factors like the cancer’s stage, the patient’s overall health, and whether chemotherapy is paired with radiation.
- Nausea, decreased appetite, hair loss, and digestive issues, among others, are common side effects, but these can often be managed with your medical team.
The term chemotherapy encompasses a wide range of drugs. Depending on the specific medication, chemo may be administered intravenously (through an IV) or orally. How frequently a person needs to get chemo treatments depends on their disease, how they tolerate the treatment, and several other factors.
Read MoreChemotherapy for Gastric Cancer
In some cases, chemotherapy is given before surgery — this is known as neoadjuvant therapy. Chemotherapy can also be administered after surgery, in what is called adjuvant therapy, with the purpose of eliminating any residual cancer cells that may have been left behind and reducing the risk of recurrence.Despite all the benefits, this treatment comes along with some degree of adverse effects, and ultimately can impact patient’s daily life.
“When I meet patients with early-stage gastric cancer, I often tell them that while surgery may be enough, many will need chemotherapy to reduce the chance of cancer coming back. With chemotherapy, especially around surgery, patients often worry about how it will affect their daily lives,” Dr. Nicholas Hornstein, a Medical Oncologist at Northwell Cancer Institute in Manhattan, tells SurvivorNet.
A variety of chemotherapy drugs can be used to treat gastric cancer, including:
- 5-FU (fluorouracil), often paired with leucovorin (folinic acid)
- Capecitabine
- Carboplatin
- Cisplatin
- Docetaxel
- Epirubicin
- Irinotecan
- Oxaliplatin
- Paclitaxel
- Trifluridine and tipiracil (Lonsurf) (a combination oral medication)
Typically, two or three of these drugs are combined, sometimes with the addition of a targeted therapy, depending on factors like the cancer’s stage, the patient’s overall health, and whether chemotherapy is paired with radiation.
Combinations involving three drugs generally have a higher risk of side effects, so they are usually recommended for patients in excellent health who can be closely monitored by their healthcare team.
Common chemotherapy combinations used before and/or after surgery include:
- FOLFOX: Oxaliplatin plus 5-FU/leucovorin
- CAPOX: Oxaliplatin plus capecitabine
- FLOT: 5-FU/leucovorin, oxaliplatin, and docetaxel
- Docetaxel or paclitaxel with either 5-FU or capecitabine
- Cisplatin with either 5-FU or capecitabine
- Paclitaxel and carboplatin
When chemotherapy is combined with radiation therapy following surgery, a single agent such as 5-FU or capecitabine is often used to minimize toxicity while effectively targeting residual cancer cells.
“The chemotherapy regimen called FLOT is commonly used. It involves a combination of four drugs and can have side effects. But with new medicines, we’ve been able to manage issues like nausea and vomiting much better. Side effects such as hair loss, numbness or tingling in the hands and feet, called neuropathy, and general fatigue are what we watch for closely,” Dr. Hornstein explains.
Coping With Side Effects
Chemotherapy drugs target rapidly dividing cells in the body, which can lead to various side effects. The specific side effects and their severity depend on the type, dosage, and duration of treatment.
Dr. Hornstein notes that some patients are able to continue working and living normally during chemotherapy, while others may need to scale back a bit.
“It really depends on the individual’s age, other medical conditions, and how they respond to the first cycle of treatment. I usually tell my patients that the first cycle of chemo is a good indicator of how they’ll feel during the rest of the treatment. Over time, they become better at managing symptoms like fatigue, and we work together to adjust their lifestyle to fit their treatment,” he explains.
Common side effects include:
- Nausea and vomiting
- Decreased appetite
- Hair loss
- Digestive issues like diarrhea or constipation
- Mouth sores
- Increased susceptibility to infections (due to reduced white blood cells)
- Easy bruising or bleeding (due to low platelet counts)
- Fatigue and shortness of breath (due to reduced red blood cells)
Most of these side effects improve once chemotherapy ends. For instance, hair typically grows back after treatment. It’s important to communicate any side effects to your healthcare team, as there are often medications or strategies available to help manage them, such as anti-nausea drugs.
During treatment, “Many of my patients continue to work but may need to modify their schedule,” Dr. Hornstein adds. “Perhaps working from home or getting more breaks. We always try to ensure that treatment doesn’t stop them from living their life as fully as possible.”
Maintaining a Healthy Lifestyle
There are other ways to help maintain your lifestyle while on a chemotherapy regimen, such as doing your best to keep up with strong nutritional habits.
A proper diet that may include vitamin supplements can go a long way towards feeling better. Exercise has also been shown to improve tolerability of chemotherapy.
Addressing mental health by seeking support is an important aspect in maintaining quality of life during chemotherapy.
Certain chemotherapy drugs can cause specific side effects patients should also be aware of, including:
- Nerve damage (neuropathy): Medications like cisplatin, oxaliplatin, docetaxel, and paclitaxel can affect nerves, often causing symptoms such as pain, tingling, or sensitivity in the hands and feet. This side effect typically resolves after stopping treatment, but in some cases, it may persist. Oxaliplatin can also cause throat nerve sensitivity, making it painful to swallow cold foods or drinks.
- Heart damage: Drugs like epirubicin, if used in high doses or for extended periods, can impact heart function. To minimize this risk, doctors monitor heart health with tests like echocardiograms or MUGA scans and adjust doses as needed.
- Hand-foot syndrome: This can occur with capecitabine or 5-FU (especially when administered through an infusion). Early symptoms include redness and sensitivity in the palms and soles, which can progress to pain, blisters, or peeling skin if not managed promptly. Reporting symptoms early can help prevent worsening.
- Diarrhea: Many chemotherapy drugs may cause diarrhea, but it is especially common with irinotecan. It is important to manage this immediately to prevent dehydration. If your treatment includes a drug prone to cause diarrhea, your doctor will likely provide guidance on how to control this side effect.
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