Part III Management of the Side Effects of Chemotherapy and Radiotherapy

Chapter 1

How to Cope with the Side Effects 

Dealing with Type 2 Side Effects

Anemia (lower levels of red blood cells)

As mentioned before, both chemotherapy and radiotherapy can lower RBC count and result in anemia. Generally, the RBC count for a healthy adult is about 5 x 10⁶/µL. Because chemotherapy or radiotherapy could damage bone marrow, which produces RBCs, RBCs are not replaced at the same rate as they are being destroyed. As a result, the RBC count becomes much lower than that in a healthy person, a situation referred to as anemia.

If patients become anemic due to cancer therapies, they will have reduced blood levels of RBCs, which carry oxygen from the lungs to the body’s muscles and other organs. As a result, patients can become tired more easily; patients may also feel dizzy or light-headed when they quickly stand up from a crouching position. Although a normal healthy body can replenish lower levels of RBCs, it does take time. In addition, multiple treatments of chemotherapy or radiotherapy can hamper the reproduction process of RBCs. During the cancer therapy, when the RBC count is significantly below acceptable levels, it could cause a physician to temporarily suspend the chemotherapy or radiotherapy. In more serious conditions, blood transfusion or treatment by a specific bone marrow stimulating drug(s) may become necessary. Some of these drugs will be briefly described in the following sections.

Otherwise, what can a patient do? First, a patient should watch the diet. For example, eat nutritious food including liver, red meat, and green vegetables (such as spinach) to supplement iron in blood, which is important for maintaining RBC levels. Most of the body's iron is bound to hemoglobin in RBCs. When red blood cells die, the released iron is carried by transferrin (iron-binding plasma glycoprotein) to the bone marrow, to make new RBCs.

Iron pills can be very useful for treating anemia, but they should be taken under the prescription of the physician because of the potential side effects. When too much iron is taken, it could slowly accumulate and could become toxic in different organs, including the liver and heart.

In addition to iron supplement, patients should take some other dietary supplements, such as vitamin C, which is important for iron absorption, and vitamin B₁₂, which is important in maintaining normal RBC formation. Furthermore, patients should rest often to conserve energy and not to conduct any vigorous exercises.

Leukopenia (low WBC count)

There are reports about a natural chemical, hesperidin, which may be helpful in increasing WBC count. Hesperidin is abundant in the peels of citrus fruit, including orange, lemon, and grapefruit. One can be creative in using the peel by blending the peel in juice or in food for easier consumption.    

Thrombocytopenia (low platelet count)

Although it does not happen for all chemotherapeutic agents, thrombocytopenia does happen to many patients. Thrombocytopenia is not uncommon for acute leukemia patients treated with radiotherapy; under serious condition, it could even be life-threatening. Similar to anemia and neutropenia, thrombocytopenia is usually temporary. When the platelet count is low (between 15,000 and 30,000 per µL), unexplained bruises may happen. When the platelet count is even lower (under 10,000 per µL), a patient may need a platelet transfusion.

As a patient, one must be careful in daily activities and try to avoid any injury because the bleeding might take much longer than normal to stop. In addition, patients need to be careful in conducting any physical activities to avoid cutting/bleeding. 

Hair Loss

Not all chemotherapy drugs cause hair loss. Some people may lose all the hair on their heads and other body hair, while others may not lose much hair. For many people, hair loss may be a difficult aspect to deal with. In this case, using a wig to cover the head could make a patient feel more comfortable. Several weeks after the therapy, the hair should begin to grow back; the new hair may be slightly different in color and texture. Usually, the new hair will be thin and soft, like baby’s hair, but will often return to its original color and texture after several months.

 

Diarrhea or Constipation

 

Crypt cells in the intestine are likely to be attacked by chemotherapy drugs and may result in diarrhea. Some chemotherapeutic drugs may cause constipation. Patients with constipation should consider taking a stool softener, such as Colace® or Senekot®. Also, drinking a lot of liquid may help prevent constipation.  If a patient has several watery stools or constipation, the patient may want to call his/her doctor or nurse.

Mouth Sores

Because epithelial cells in the mouth and esophagus are fast dividing, they are easily damaged by chemotherapy and radiotherapy. As a result, mouth sores occur often with chemotherapy and radiotherapy. For a patient to assuage that, rinse the mouth often with salty water. If a patient develops painful mouth sores and the situation is not relieved, one should call his/her physician or health practitioner and a special mouth rinse may be prescribed for the patient. If a commercial mouth wash is used, avoid those that may be irritating to the mouth.

© Jiajiu Shaw, 2022

Disclaimer: This blog is written solely for informational purposes. It does not constitute the practice of any medical, nursing or other medical professional health care advice, diagnosis, or treatment. All contents posted are extracted from the book, "SIDE EFFECTS OF CHEMOTHERAPY AND RADIOTHERAPY", prepared by Dr. Jiajiu Shaw, Dr. Frederick Valeriote, and Dr. Ben Chen.