May cause ondansetron cancer

Side effects of cytotoxic drugs

Hardly any other drug treatment scares patients as much as chemotherapy with cytostatics. Not without good reason: side effects occur 100%. They are uncomfortable and sometimes dangerous. But: It is now possible to significantly reduce the worst side effects.

Nausea, vomiting. The most feared side effects include nausea and vomiting. Today, preventive drugs are given as early as the first cycle of therapy, the selection of which depends on both the cytostatic drugs administered and the patient's individual risk. A combination of active ingredients almost always minimizes nausea and prevents vomiting. They are very effective Setrons (such as Ondansetron, e.g. Zofran®, Granisetron, e.g. Kevatril®, Tropisetron, e.g. Navoban®) together with cortisone (especially dexamethasone, e.g. Fortecortin®). In addition to chemical anti-vomiting agents, ginger capsules can be taken to reduce nausea during chemotherapy. The patient takes the ginger capsules at a dose of 0.5 to 1 g daily, from the 3rd day before the start to the 3rd day after the end of chemotherapy.

Loss of appetite. To stimulate the appetite, are suitable Galangal or Calamus rootstockbecause they contain a lot of bitter substances. They are available as tinctures and can be taken dissolved in water before meals. If a tincture loses its effect on the patient, a switch to the other active plant ingredient is indicated.

Digestive problems. Combination preparations such as Iberogast®, Carvomin® Digestion Drops, Carminativum Hetterich® or Lomatol® Drops have proven themselves as herbal prokinetics - drugs that improve digestion. Of the monopreparations, curcumen capsules, Curcu-Truw® or Harongan® drops are suitable. Since it is not possible to predict which herbal remedies will work best, a 14-day attempt at therapy is recommended.

Hand-foot syndrome. Certain cytotoxic drugs temporarily cause skin changes on the palms of the hands and the soles of the feet. They manifest as swelling, painful redness, blistering, peeling skin and feelings of numbness. This also changes the finger lines and identification by fingerprint is temporarily not possible. However, within two weeks of the end of therapy, the skin changes recede completely.

Inflammation of the mucous membranes. Certain chemotherapeutic agents can cause inflammation of the mucous membrane (mucositis), especially of the oral mucosa. An example of this is mouth rot caused by herpes viruses. The intestinal mucosa can also be affected, which manifests itself in the form of diarrhea. Depending on the severity of the inflammation, the symptoms of an inflammation of the oral mucous membrane range from a slight burning sensation to severe pain and disruption of food intake. A visit to the dentist before the start of chemotherapy is advisable in order to have "weak points" on teeth, gums and, if necessary, dentures repaired and to reduce the risk of inflammation. During chemotherapy, oral care should be careful, but at the same time gentle, as oral mucous membrane ulcers, e.g. B. bleeding easily from a toothbrush that is too hard and can become a source of infection due to the simultaneous reduction in immune cells. So after every meal, brush your teeth with a soft toothbrush, if it is still too hard, switch to an oral irrigator and use dental care chewing gum if necessary. Amifostin® is available as a drug to protect the mucous membrane, but its use is very limited due to the risk of severe skin symptoms, drop in blood pressure and nausea. For treatment, it is advisable to drink plenty of fluids, only lightly season food, avoid vinegar or other spicy supplements, and rinse the mouth with chlorhexidine and sage several times a day. Hard, sharp-edged and acidic foods should be avoided. If this is not enough, the doctor will prescribe “soft” food with toast, noodles, rice (not whole grain rice) and pudding or even mashed foods such as soups or porridge (e.g. pureed vegetables). Sage, chamomile and marigold tea can be used both for mouthwashes and to make ice cubes or lollipops. Sucking ice cubes relieves pain. In the worst case, it has to be fed artificially through a gastric tube or vein.

Smoking and alcohol are two of the few taboos. The body is already heavily stressed during chemotherapy, and other poisons (alcohol, nicotine) should be avoided at all costs. In addition, intolerance symptoms can occur with some chemotherapeutic agents when alcohol is consumed at the same time.

Common cytostatic side effects include painful irritation and inflammation of the veins through which cytostatic drugs have been infused. If the inflamed vein sections are directly under the skin, they are visible as red-violet strands.
Georg Thieme Verlag, Stuttgart

Vein irritation. In the course of treatment, venous irritation and inflammation, including venous blockage (vein obliteration) due to the cytostatic infusions, increase, making it increasingly difficult to find a suitable vein for blood draws or infusions. Therefore, patients who are likely to have several chemotherapy cycles are usually offered the option of planting one Port systems at. A small box with a fluid chamber (comparable in size to a pacemaker) is implanted under the skin in the collarbone area and connected to a large vein in the chest using a thin tube. Before the start of the therapy cycle, all that is left to do is to puncture the chamber through the skin (which can be easily hit) and to connect special utensils through which all infusions can then be given. At the end of the cycle, the cutlery is removed so that the person concerned z. B. can shower without any problems. Provided that it is used correctly, a port lasts longer than a year and saves those affected from the increasingly difficult procedure of searching for veins.

Port systems make it easier for both patient and doctor to administer medication. The diagram above explains how a modern port system works. The photo below shows a port in front of the implantation on the right and the associated puncture needle on the left.
GTVE

Hair loss. Hair loss, which is caused by damage to the hair root cells, is often unavoidable. Depending on the type of cytostatics used, but also individually, it affects not only the scalp hair, but also eyebrows, eyelashes and pubic hair. A few weeks after the end of chemotherapy, the hair begins to grow back, but it may look a little different than before, e.g. B. curly. It is advisable to have a wig made in good time (the cost of synthetic hair is covered by the health insurance), as long as your own hair is still available as a "sample", regardless of whether the wig will be mostly worn later or not. Because those affected perceive hair loss very differently: While some need to look as "normal" as possible for their well-being, so put make-up on their eyebrows and wear a wig at home, others find a soft headscarf more comfortable or prefer to go "topless" because they perceive everything else as “not belonging to themselves”. Fortunately, dealing with treatment-related hair loss is much more open today than it used to be. When it comes to the question “wig, headscarf or nothing at all”, you should primarily focus on yourself! Headgear is only really necessary for protection in strong sunlight or in the cold.

Lack of blood cells. Initially not noticed by the patient, the side effects of chemotherapy on the blood cells are medically relevant. Most significant is the drop in white blood cells (leukocytes), which leads to an increased risk of infection. How strong it is depends on the cytostatic drug and the dose administered. With a slight drop, Leukocytopenia (leukopenia for short), it is usually sufficient to stay away from people with a visible infectious disease and to avoid crowds. In addition, the growth of white blood cells can now be stimulated with G-CSF (Neupogen®, Granocyte®) if necessary. A sharp drop in white blood cells (agranulocytosis), on the other hand, is life-threatening, but rarely with normal dosed chemotherapy. The number of blood platelets responsible for blood clotting also falls - one of the reasons for careful oral care to avoid excessive bleeding from the gums. The anemia caused by the cytostatic treatment is usually the least problem and can be managed with the transfusion of red cell concentrates.

Impairment of memory. Many cancer patients struggle with memory problems and impaired fine motor skills after chemotherapy. Doctors also speak of a "chemo-brain", in German "chemo brain". Until now, many doctors assumed that patients would recover quickly from it. However, this does not apply to all, as studies have shown.

Psyche. The patient's psychological well-being also suffers from chemotherapy: Who would like to have concentrated cytotoxins infused! On the other hand: Those who can trust their doctors and nurses, know their relatives and consciously say “yes” to life after chemotherapy, also tolerate the infusions better and have proven to have fewer side effects. Knowledge and understanding of cancer and its treatment, a positive attitude towards therapy and good support from professional helpers and relatives definitely have a positive effect.

In order to get through chemotherapy well, it helps to create a pleasant atmosphere as often as possible (e.g. listening to music, reading books) and to relax, e.g. B. using relaxation techniques. In addition, it makes sense to eat many small meals and choose the dishes according to appetite and tolerance. Chewing gum, sucking candy or inhaling aromas are also worth a try.

Late side effects and permanent consequences

Fertility. Basically, cytostatics impair fertility up to complete infertility. Whether these changes are temporary or permanent depends on the type, dose, and duration of chemotherapy. For this reason, young men are recommended to have a sperm donation frozen (cryopreservation). In women, the ovaries can be “shut down” with medication for the duration of chemotherapy, thereby protecting them. The deep-freeze storage of ovarian tissue or egg cells is (still) in the experimental stage. Permanent hormone deficiency symptoms in the sense of artificially induced menopause occur especially in women and can make hormone administration necessary. Cytostatics also damage the unborn child. Both women and men must therefore use a safe method of contraception during and for the first two years after chemotherapy.

Organ damage. Like all drugs, cytostatics can damage certain organs such as the heart. In order to avoid this damage as much as possible, the endangered organs are regularly examined before and during the treatment, if necessary the cytostatic agent is changed or the dose is reduced.

Secondary tumors. Due to their possible genome-altering effect, cytostatics also increase the risk of developing secondary tumors, especially acute leukemia. The risk increases further when chemotherapy and radiation therapy are combined.

Authors

Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 13:38