Major side effects and their management associated with specific chemotherapy drugs.

Most of the chemotherapy drugs have similar and manageable side effects when administered for the treatment of cancer. However, there are some specific side effects associated with some chemotherapeutic drugs.

The following are the side effects of some specific chemo drugs.

Hemorrhagic cystitis: bleeding from the urinary bladder:

This side effect (bleeding from the urinary bladder is associated with a chemo called CYCLOPHOSPHAMIDE.

Why does cyclophosphamide cause bleeding from the bladder?

The cyclophosphamide, when administered, is metabolized in the body, especially in the liver. After metabolism, the end product of this chemo called ACCROLINE moved to the bladder with urine to be excreted from the body. If this end product remains in the bladder for a longer period, it can cause irritation in the bladder. This causes the bladder to bleed from its lining.

How can bleeding from the bladder (hemorrhagic cystitis) be prevented?

The following are some tips to prevent complications.

• Patient education:

Educating patients on the side effects earlier than cyclophosphamide chemotherapy is crucial. The teaching includes the following.

Maintain good hydration:

Instruct the patient to drink lots of fluids orally before, during, and after the cyclophosphamide infusion.

Do not hold the urine:

 Secondly, it is important to teach the patient not to hold the urine. It is necessary to pass urine as soon as you feel it.

 What is the main precaution healthcare providers should take?

As a healthcare provider, one should be aware of the major side effects of the medications administered to the patient. And, one should also know the preventive measures. So, with cyclophosphamide, it is necessary to keep the patient well hydrated. There are two basic protocols with cyclophosphamide. One is to give an injection of mesna, known as the antidote to cyclophosphamide. Another one, hyperhydration. If injection mesna is not available, the patient should be given at least 3000 mL to 4000 mL. Moreover, good hydration could save the patient from complications like cystitis.

 What will happen if bleeding occurs?

If the hydration has been compromised, bleeding could occur. Once the bleeding occurs, the patient may experience the following signs and symptoms.

Burning while passing urine

Unable to initiate the urine

Urinary hesitancy

Pain while urinating

Blood in urine

What is the management of hemorrhagic cystitis?

The management of hemorrhagic cystitis includes the following steps.

Start hydration as soon as possible.

• Manage burning sensation by starting any neutralizing agent.
• Avoid medications that tend to form blood clots.
• Start with local painkillers to soothe the area.
• Also, can give systemic pain killers for pain relief.
• In case the bleeding worsens, a urinary catheter, called 3 3-way catheter, is in place to start irrigation of the bladder. This irrigation method flushes out the urine and blood continuously and prevents blood clotting.
• Furthermore, if it’s not settled with irrigation, a surgical cut is made in the suprapubic region to remove the clot.

  Hence, it is said that ‘prevention is better than cure’ if the patient is well hydrated earlier, then they can be saved from such major complications.

 (Mouth ulcers)

Mouth ulcers are formed when the chemotherapeutic drugs affect the lining, known as the mucosa, of the gastrointestinal tract. The ulcers could be specific only to the mouth area, or throat, or sometimes can extend to the lower GI tract, which includes the small and large intestines.

Hair fall:

Hair fall is known as alopecia in medical terms. This is the major fear of every patient when the doctor decides to start chemotherapy or radiation therapy. The first question 90 % of patients ask the healthcare provider/doctor is whether chemotherapy causes hair loss. However, the answer to this question is yes, no, or might be. Because not all the chemotherapeutic drugs cause hair loss. There are specific chemotherapy drugs in the patient treatment, specific to the disease.

Why do chemotherapy drugs cause hair loss?

As chemotherapeutic drugs are designed to kill fast-growing cells, the nature of cancer cells is to grow fast and cannot differentiate between normal cells and cancer cells, so. They start damaging all the fast-growing cells. In a normal human being, the cells of hair follicles and the gastrointestinal tract grow at a faster rate than other cells. So, the chemo drugs kill them at a faster rate. That’s why patients experience more nausea, vomiting, and hair loss.

How can you manage hair fall?

Hair fall could be a bad and fearful experience for patients. Therefore, it is essential to prepare the patient mentally for the situation before starting the chemo cycle. Healthcare providers must explain the side effects of the chemotherapeutic drugs, including nausea, vomiting, and hair loss. Also, teach the patient some tips to manage the side effects.

Patients should be taught to cut their hair short so that it can be easily kept clean and combed.

Secondly, if the hair fall starts, it would not be that traumatic for the patient. Thirdly, an option of a scarf or hat, or a wick could be suggested. So, if that patient could make proper arrangements before chemotherapy. Once the hair fall has completed, the patient should be instructed to limit direct sun exposure.

How long will it take to regrow my hair?

The second most common question patients usually ask the healthcare provider is ‘How long will it take my hair to regrow? After the chemotherapy treatment is completed, it takes around 4 to 6 months for hair to regrow. The texture of the hair this time will be better than the previous hair. And mostly the hair grows curly.

Extravasation (burn of veins and tissues):

This is another common side effect of chemotherapeutic drugs; not all chemo drugs cause burn in the vein, there are selective chemo drugs which are vesicants, have the capacity to cause burn.

How is the burn managed if it occurs during drug infusion?

If the drug leaks or causes swelling during the infusion time, the HealthCare provider should immediately stop the infusion, draw back the medicine from the cannula as much as possible, and press or squeeze the vein to remove the remaining blood, then follow the extravasation protocol according to the hospital policy.

How can you prevent extravasation?

 To avoid extravasation, the priority should be a central line; administering such toxic drugs through a peripheral vein should be discouraged. In case of using the peripheral line, a safe site, secondly, the vein should not be fragile or thin. Moreover, the cannula should be of a larger bore.

Furthermore, instruct the patient to minimize excessive movements of the hand or arm to avoid dislodgement of the line. Such a preventive measure could save the risk of extravasation.

As there are so many toxic effects of chemotherapeutic drugs, timely prevention and a proactive approach play an important role in managing these side effects.