Side effects of chemotherapy

Chemo Induced Nausea and Vomiting (CINV)
Nausea and vomiting are two side-effects of cancer treatment that people often worry about the most.
About 50% of people who undergo chemotherapy for bowel cancer suffer from nausea and vomiting, which might also cause dehydration, fatigue, loss of appetite and difficulty concentrating.
Some patients are more vulnerable to CINV than others.  These include women (even more so if they experienced these symptoms during pregnancy), young people under age 50, and patients who have received previous chemotherapy treatments.
Other risks include a personal history of motion sickness, or problems with anxiety.
Many new medications are available to control CINV and it can now be prevented in the majority of people by carefully assessing your risk of developing these side-effects before you start treatment.
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How can I help manage chemotherapy induced nausea and vomiting?

  • Avoid eating solid foods immediately before and after treatment
  • Avoid caffeine and alcoholic drinks
  • Drink clear liquids such as sports drinks, ginger ale, lemon-lime sodas, or dilute, unsweetened fruit juices
  • Start with bland foods such as dry toast or crackers, then gradually increase to small, frequent meals throughout the day
  • Avoid spicy or greasy foods
  • Avoid favourite foods on days you are sick so they don't become nausea triggers
  • Avoid strong smells that may upset your stomach such as cooking odours, smoke, or perfume
  • Avoid lying flat for at least 2 hours following meals
  • Contact your specialist team if vomiting is severe or if you cannot keep anything down
  • Try doing some relaxing activities such as reading, puzzles, yoga, watching TV, or listening to music
  • Alternative therapies such as selfhypnosis, guided imagery, progressive muscle relaxation or acupuncture

Increased risk of infection and neutropaenic sepsis
Infection at any time during your bowel cancer treatment can have a significant effect on how well you tolerate your treatment and can slow down your recovery times.
Neutropaenic sepsis – or febrile neutropaenia – means that you have a fever caused by infection linked to low levels of neutrophils (white blood cells) in the blood. This is a serious condition, and one of the potential side-effects of chemotherapy for cancer. Chemotherapy for bowel cancer carries a moderate risk of neutropaenia.

Infection as a result of side-effects of chemotherapy – when the body is already compromised – is considered to be a medical emergency which often results in hospital admission for treatment with antibiotic intravenous (IV) infusions.
It is possible to assess your personal risk of developing this side effect before starting a new treatment.
You can manage your personal risk actively by careful attention to personal hygiene and limiting contact with other potential sources of infection: other people, pets, food and washing hands after touching hard surfaces (especially in busy, communal areas).
Who is most at risk?
The people most at risk of developing this serious problem are often older patients (over 65 years) who also have poor general health and other underlying health issues with heart, kidney or other problems with major organs.
Other factors known to increase risk of infection include a low baseline blood cell count as a result of previous chemotherapy treatments, along with current chemotherapy regimes that are being given in high doses.
That is why you will have your blood levels checked before each new cycle of treatment.  Your pretreatment assessment should also include checking your temperature and blood pressure as these can also help to identify potential problems ahead, as will picking up undiagnosed, underlying respiratory infections, and other local infections at the site of IV ports, for example.
Your chemotherapy team should give you a special card with the signs and symptoms to look out for, and an emergency contact number to call if you notice any problems or have any concerns.
Where the personal risk is considered to be high, specialised medications can be prescribed to increase the production of these white cells where necessary, supporting the body and helping it to recover more quickly from the chemotherapy treatments.