Side Effects of Chemotherapy (Physical and Mental)

The Side effects of chemotherapy Short and long term can be physical and mental: hair loss, loss of appetite, changes in the nervous system, loss of concentration and memory...

The enormous increase in life expectancy and survival of cancer patients due to the great technical, surgical and pharmacological advances, as well as the development and improvement of the early diagnosis, has led to a growing interest in the study of its adverse / adverse effects.

Side effects of chemotherapy

The effects of physical order have been widely investigated, since in the short term, many of them may pose a risk to the life of these patients. However, other side effects related to the cognitive functions, denominated with the concept of Chemobrain , Have been less investigated (Chiclana et al., 2014).

Currently, the medical and scientific community has become more aware of the effects that oncological treatments can exert on cognitive, emotional and behavioral processes (Quintero-Gallego and Ciscenos, 2013).

Physical Side Effects

As we have pointed out above, the effects of chemotherapy will depend on the health situation of each patient and the time of drug treatment that will be received. Many of the side effects are going to be temporary and go away when the treatment is finished. However, permanent effects may occur ( National Cancer Institute, 2015).

In the short term, the US National Cancer Institute (2015) offers an extensive list of symptoms and side effects that may appear as a result of chemotherapy treatment, including:

- Anemia : Chemotherapy hampers the production of red blood cells by the bone marrow and there will be a decrease in oxygen that transports the blood. The heart will work at an accelerated rate so it may give rise to feelings of shortness of breath, fast heartbeat, weakness, dizziness, or tiredness.

- Hair loss ( alopecia ): Many types of chemotherapy damage the cells responsible for hair growth. Normally, the hair begins to fall about 2 or 3 weeks after starting the treatment. The fall can happen on any part of the body: head, face, arms, legs, armpits, pubic area. Normally, the hair regrows about two or three months after the end of treatment.

- Changes in appetite : Due to nausea, or problems in the mouth, tiredness or drugs in itself, there will be a loss of appetite that can last from a few weeks to months. Because of this you could experience an obvious loss of weight, weakness and fatigue.

- Changes in the nervous system : Many of the consequences that occur on the SN may be temporary or may last a lifetime. These include: tingling sensation, burning, weakness and numbness of the limbs and hands; Pain in walking, muscle weakness, feeling of imbalance, tremors, hearing loss, fatigue , Confusion, memory problems, dizziness and even the development of some psychiatric pathology.

- Changes in the mouth and throat : Chemotherapy specifically damages rapidly reproducing cells such as those found inside the mouth, throat, or lips. Therefore, lesions in the mouth, sensitivity to food temperature, infections inside the mouth, changes in taste, or dry mouth sensations may occur.

- Skin and nail changes : The treatment will affect the rapidly growing cells of the skin and nails. The following symptoms may appear on the skin: rashes, dryness, redness, darker veins, sensitivity to the sun. And in the case of the nails, they can become fragile, breaking and taking a yellow color, even falling.

- Sexual changes : In women, treatment may produce changes in hormone levels that regulate sexual appetite. In addition, problems of vaginal dryness or early menopause will appear. In men, hormonal changes, reduced blood flow and damage to the nerves that control the penis will also appear. erectile dysfunction .

- Urinary changes : The cells of the kidneys and the bladder may be affected. You will see burning or pain when you urinate or after, frequent urination, inability to urinate, incontinence, blood in the urine, urine with a different color (orange, red, green or dark yellow) or with a strong drug smell.

- Pain : Sensations of burning, numbness, tingling, stabbing can appear. Further, headache And the derivative of the appearance of other lesions like the buccal ones.

- Fatigue : Fatigue caused by treatment can range from a mild or extreme level: weakness, tiredness, exhaustion, heaviness, slowness.

- Infection : The treatment can hinder the production of White blood cells (They help the body fight external infectious agents). The patient may present a Neutropenia , When it has a low level of neutrophils (white blood cell type), and therefore have a high probability of contracting some type of infection.

- Infertility : In women, treatments can affect the production of hormones by the ovaries and consequently, an early menopause may occur. In the case of men, treatments can affect sperm cells (reducing number or reducing mobility).

- Nausea and vomiting : Due to the impact that the drug causes on the organism, these two events can occur during treatment, just after or several hours and days later.

- Bleeding : Chemotherapy makes it difficult for bone marrow Produce platelets (cells that clot the blood). When the platelet level drops, thrombocytopenia may occur ( Bruises , Bleeding from the nose and mouth, or rash).

Cognitive side effects (chemobrain)

In addition to the symptoms characterized above, many cancer patients complain of concentration Y memory When treatment is being administered (Chiclana et al., 2014)

Although the effects of treatment on different Cognitive functions , There is increasing experimental evidence that there are side effects on the brain and cognitive functioning of the individual (Chiclana et al., 2014).

Adverse effects on the cognitive function of individuals with cancer and having undergone cancer treatment are called"chemobrain"and on other occasions the term"chemofog"is used.

The concept of chemobrain includes attention, concentration and memory problems that appear before and after treatment and are expressed by oncological patients (López-Santiago et al., 2011).

Based on the observation of the patients' growing cognitive complaints, a body of research has been started in relation to these types of symptoms, whose data show that there is a subgroup of patients who may suffer cognitive deterioration as a consequence Of the administration of chemotherapeutic treatment (López-Santiago et al., 2011).

Although in many cases they will be subtle and mild alterations, not reaching a serious status, they will significantly affect the daily life of the patient and their functional performance (Chiclana et al., 2014). In addition, when these alterations affect the child and adolescent population, in many cases they will be maintained throughout their life.

If these deficits occur early in life, they will affect normal development and affect later skill acquisition (Butler et al., 2008; Quintero-Gallego and Ciscenos, 2013).

In the study by G. Chiclana and collaborators (2014):" Evaluation of brain damage (chemobrain) associated with treatment of breast cancer" , Carried out in the University Hospital Gregorio Marañón Of the Community of Madrid, the results showed that in a period of observation of six months after the end of the chemotherapy treatment, it was observed:

  • On the one hand a decline in anxiety, depression, quality of life , dream.
  • On the other hand affectation of the cognitive domains, attention (ability to maintain, direct and alternate the attention focus), memory (Immediate recall, short and long term) and executive function (effective resolution of problems of daily life).

On the other hand, other studies such as the one by J. Vardy (2008), indicate that between 15% and 50% of the patients receiving chemo treatment could present the chemobrain phenomenon, with memory problems, learning , Concentration, reasoning, executive function, attention, and visuospatial ability (Argyriou et al., 2008, Quintero-Gallego and Ciscenos, 2013).

Many of the current studies have the collaboration of women with breast cancer to study the side effects of chemotherapy treatment and show that there are some cognitive domains that are more likely to have a deficit (Quintero-Gallego and Ciscenos, 2013 ):

  • Wagner, Sweet, Butt, Beaumont, Havlin, Sabatino et al. (2006): attention, visuospatial ability and working memory.
  • Jansen, Dodd, Miaskowski, Dowling and Kramer (2008): j viso-spatial ability and total cognitive scores.
  • Ahles, Saykin McDonald, Li, Furstenberg, Hanscom et al. (2010): verbal ability, short-term damage measured by age and cognitive reserve.
  • Wefel, Saleeba, Buzdar and Meyers (2010): learning, memory, executive function and processing speed.

Although most studies are performed with Breast cancer , The side effects detected are not only restricted to this population, but also affect many other cancer patients.

What is chemo?

He National Cancer Institute United States (" National Cancer Institute at the National Institutes of Health ") Defines chemotherapy, commonly referred to as the"chemo", as a type of cancer treatment that employs drugs to stop or Slow down the growth of cancer cells.

Generally, it is used both for treatment and for the relief of cancer symptoms, with a curative and palliative purpose.

It can be administered in a variety of ways, the most common of which are: oral (through tablets, capsules, or in liquid form), intravenous, injection into fatty areas under the skin, intratectal (between layers of tissue covering the spinal cord And the brain), intraperitoneal (in the area containing the intestinal organs), intraarterial and topical (through the application of a cream on the skin) ( National Cancer Institute, 2015)

This pharmacological treatment is used to treat many types of Neoplastic diseases . In many cases, chemotherapy may be the only treatment that is used. However, it is more often used together with other types of treatments, depending on the place, magnitude and symptoms derived from it ( National Cancer Institute, 2015).

Chemotherapy Jobs

Chemotherapy can be used to:

  • Reducing the size of tumors before a surgical approach or the application of a treatment radiotherapy .
  • As adjuvant chemotherapy: to eliminate cancer cells that may exist after surgery or radiation therapy.
  • As a complement to other types of treatments to improve its effectiveness.
  • Control the reappearance of cancer cells or spread to other parts of the body.

Despite these obvious benefits, when we use a chemotherapy treatment to destroy cancerous cells, it will also affect healthy cells, destroying them or slowing their growth. The involvement of healthy cells can lead to numerous secondary symptoms ( National Cancer Institute, 2015).

However, the toxicity of chemotherapy will depend on different factors of the drug itself and the patient. Among the first, it is necessary to emphasize the dose, the routes of administration, elimination and synergism of the drug.

On the other hand, the most important factors related to the patient are the functional status, age, the presence of previous chemotherapy or radiotherapy treatments and associated pathologies (Ferreiro et al., 2003).

For example, different studies show that haematological and cardiological effects are more severe in patients over 65 years of age than in young individuals. In addition, the presence of some pathology, such as Bone metastasis Favors haematological toxicity (Ferreiro et al., 2003).

CONCLUSIONS

The detailed study of the physical and cognitive side effects of oncological treatments will allow the elaboration of specific intervention protocols with the objective of finding alternatives that allow the cancer patients to adapt to the new conditions of their organism and, ultimately, to provide a quality Of optimal life.

References

  1. Chiclana, G., Ferre Navarrete, F., López-Tarruella, S., Jerez, Y., Marquez-Rodas, I., Lizárraga Bonelli, S.,. . . Martín-Jiménez, M. (2014). Chemobrain: Can we talk about brain damage acquired through chemotherapy? Trauma Fund MAPFRE, 25 (3), 143-149.
  2. Ferreiro, J., García, J., Barceló, R., & Rubio, I. (2003). Chemotherapy: side effects. Gac Med Bilbao, 100 , 69-74.
  3. López-Santiago, S., Cruzado, J., & Feliú, J. (2011). Chemobrain: Review of studies evaluating the cognitive impairment of cancer survivors treated with chemotherapy. Psychooncology, 8 (2-3), 265-280.
  4. NHI National Cancer Institute. (2015). Retrieved from http://www.cancer.gov/.
  5. Quintero-Gallego, E., & Cisneros, E. (2013). New challenges for the neuropsychologist: his contribution in units of pediatric oncology. Journal CES Psychology, 6 (2), 149-169.


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