Table of Contents
Introduction
The bone marrow produces three types of blood cells: white blood cells to help fight infection, red blood cells to carry oxygen, and platelets to help clot the blood. Normally these cells grow and divide in a regular and controlled way. Cancer cells are abnormal; they form and continue to grow without control. Chemotherapy destroys cancer cells and thereby preventing their growth and spread. Unfortunately, chemotherapy also destroys healthy cells. It is the damage to the rapidly growing healthy cells that can result in the side effects that people experience.
How Does Chemotherapy Work?
Chemotherapy treatments are given in a hospital ward or day treatment area and are usually given through the veins (intravenous) or in tablet form. Occasionally it is given under the skin as an injection. The patient is then asked to wait for a short period after the chemotherapy has been delivered to monitor their health.
How Is Chemotherapy Used?
There are several ways in which chemotherapy is used, which include-
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Induction Chemotherapy- In this type, drugs are used to shrink cancer cells.
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Adjuvant Chemotherapy- Chemotherapy is given after other treatments to shrink the remaining cancer cells.
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Consolidation Chemotherapy- In this type, drugs are given after induction therapy to kill the remaining cancer cells.
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Neoadjuvant Therapy- Chemotherapy used to reduce cancer size before surgery.
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Combination Therapy- Drugs combined with one or more other treatments as the primary therapy.
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Maintenance Therapy- Drugs are given after other therapies to prevent cancer relapse or to slow the growth of advanced cancer.
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Palliative Therapy- It is used to extend life and increase overall wellness in those patients with cancers that are considered incurable.
How Is the Type of Therapy Decided?
The drugs, dose, and treatment depend on several factors, such as-
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The type of cancer.
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The tumor size, its location, and stage of cancer.
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Patient’s age and general health.
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Patient’s body weight.
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Patient’s tolerance to certain side effects.
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Any other medical condition of the patient.
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Previous cancer treatments.
What to Expect in Chemotherapy?
Healthy cells in certain parts of the body are sensitive to chemotherapy. Each person reacts differently to chemotherapy. Some patients may experience a variety of symptoms, while others may have very few side effects or none at all. Some of the side effects are mentioned below-
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Nausea and vomiting.
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Mood changes, also known as chemo brain.
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Alopecia (loss of hair).
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Mouth ulcers.
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Diarrhea or constipation.
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Chemotherapy agents can cause changes in the skin and nails.
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Some chemotherapy agents can acutely cause nerve side effects, causing peripheral neuropathy.
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Long-term chemotherapy can cause premature menopause in males and it can affect sperm production.
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Fatigue is very common during chemotherapy; five % of people will develop long-term fatigue.
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Even though it is uncommon, some people can get a bloodstream infection during chemotherapy.
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Chemotherapy can damage the production of neutrophils which could lead to bacterial infections.
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It is, although rare, that the liver will not recover from chemotherapy.
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There are some rare complications, such as irritation of the lungs and irritation of the pancreas, through different medications.
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Some people may have an increased risk of blood clots.
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There can be pelvis or leg pain.
What Are the Complications of Chemotherapy in Older People?
Chemotherapy can be challenging among older patients due to several reasons, such as
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Elderly patients do not tolerate the treatment well as compared to young people due to their age.
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Due to decreasing organ function in old age, the pharmacokinetics of several chemotherapeutic agents can be affected.
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The comorbidities that elderly patients are often associated with might increase the risk of toxicity in their bodies.
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The drugs used to treat the comorbidities in older patients may interact with the chemotherapeutic drugs.
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Malnutrition in older patients increases the risk of chemotherapy intolerance.
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Cognitive problems in elderly patients can hinder multiple aspects of oncology, such as the inability to understand and recall complex tasks given to the patients.
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Social isolation and decreased survival instincts in older patients become a challenge while treating them with chemotherapy.
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Older patients with frailty are more vulnerable to accidental falls and death during hospitalization.
How to Manage the Side Effects?
Since chemotherapy reduces the ability of bone marrow to produce healthy cells and its usual capacity, the patient will need regular blood tests to monitor the number of red blood cells, white blood cells, and platelets; this is called checking the blood count. After each chemotherapy treatment, the healthy cells will typically reduce and then recover before the next treatment is due, and until the cells recover, there are several side effects that patients will experience, such as:
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Side Effects- Reduction in the white blood cells can cause symptoms such as a temperature above 38 degrees Celsius, cough with yellow or green sputum, pain or burning sensation after urinating, abdominal cramps, and flu-like symptoms.
Management- Check temperature every day, and report immediately to the doctor if it is above 38 degrees Celsius. To minimize the risk, avoid unwell people and wash hands thoroughly and maintain hygiene.
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Side Effects- A reduction in red blood cells can result in anemia and tiredness. Tiredness is a very common side effect that tends to be worst at the start of the chemotherapy and generally lasts for about ten days. Some people also feel out of breath when anemic.
Management- Report any tiredness to the doctor. Planning activities with a rest period. Exercises also help to improve the symptom of fatigue.
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Side Effects- Reduction in platelets can make the patient more susceptible to bleeding. It causes bruising, nose bleeds and gum bleeds.
Management- Report immediately to the doctor. If the doctor is concerned about blood levels, chemotherapy may be delayed, or the dose can be reduced.
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Side Effect- Nausea.
Management- It can be managed by taking anti-sickness medications. Take small amounts rather than three large meals. If there is significant weight loss, it should be reported to the doctor.
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Side Effect- Mouth ulcers.
Management- Use mouthwash twice daily after meals and before bed. Use a soft toothbrush. Avoid flossing if gums are bleeding.
- Side Effects- Diarrhea or constipation.
Management- Medications, eating a high-fiber diet, drinking plenty of fluids, and maintaining physical health.
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Side Effects- Skin changes.
Management- Skin dryness can be managed by using a skin lotion regularly. Sun rashes should be reported to the doctor. Sunburns should be avoided by using sunscreen, wearing a hat outdoors, and avoiding midday sun exposure.
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Side Effects- Hair loss.
Management- Use pH-neutral shampoo, soft hair brush, and cool setting in hair dryers. Do not use chemicals, electric curlers, and hair straighteners.
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Side Effects- Peripheral neuropathy is when the patient may experience a burning and shooting sensation or loss of feeling in the hands and feet.
Management- Report it to the doctor. Take extra care while touching hot or cold surfaces or objects.
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Side Effects- Allergies such as facial flushing, shortness of breath, chest tightness, facial or body heat, itching, rash, sudden body pain, or discomfort, and early menopause.
Management- Report it to the doctor. Patients can be prescribed antihistamine medication.
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Side Effects- Early menopause.
Management- Consult the doctor for fertility options before starting chemotherapy.
Conclusion-
Although geriatric patients are a less tolerant population among chemotherapy patients, they should not be denied the right to treat their cancer. It is often considered that since older patients might not live much longer, they should avoid undergoing chemotherapy, which is ethically wrong. Cancer is a tough condition to deal with, and it might be difficult for an elderly person to go through the cancer treatment process but not receiving the care and treatment will be more difficult. With advanced technologies and newer developments, it is now possible to treat an older individual effectively.
