The Ups and Downs of Chemo

Posted by Shannon Hough at Tuesday, February 02, 2010

In therapeutics, we learned that we can treat cancers with chemotherapeutic agents. However, they are accompanied by toxic side effects. This month, I had a chance to see first-hand how these drugs affect our patients. This was a lesson in side-effect profiles I will never forget.

Lesson 1: Myelosuppression (decreased blood counts)
Many of the patients that we saw this month were receiving some form of 3+7 (3 days of an anthracycline and 7 days of cytarabine) for a leukemia diagnosis. These patients often became neutropenic (low white blood cells), anemic (low red blood cells), and/or thrombocytopenic (low platelets). Patients who are neutropenic can be at risk for infection, and were monitored very closely for fevers or other symptoms. Patients who have low red blood cells often had very low energy levels that improved when we gave them a blood transfusion. And patients with low platelets often experienced more bruising or bleeding, including nosebleeds. Many times, these effects can be delayed, and the patient can feel great during chemo, and even a few days afterward. It was almost predictive, that when we saw the patient’s blood counts decreasing, their spunk would decline as well. One of my favorite times to see patients was when their counts were recovering and they were excited at the prospect that they had had a successful treatment and would soon be able to go home.

Lesson 2: Cold-Induced Neuropathy
In this case, a patient with colorectal cancer was receiving FOLFOX, a chemotherapy regimen containing oxaliplatin. Certain patients can experience sudden pain when exposed to cold temperatures when receiving oxaliplatin. This can even be triggered by drinking a cold beverage or holding something cold. This is an important side effect to discuss with our patients as this pain can certainly be avoided with adequate education.

Sometimes studying drug side effects can be difficult. There are so many drugs and so many side effects. But as we continue to work as students, we can collect experiences to help our memories along the way.