Chemotherapy was introduced in the late 1940s and came into common use in the early 1960s, according to a review by Yale historians Vincent T. DeVita Jr., and Edward Chu published in the November 2008 issue of "Cancer Research." Medications have been developed to lessen the effects of chemotherapy on the heart, kidneys, bladder and blood cells, but it is still critical for patients to know the early warning signs of treatment complications.
Fever and Malaise
The problem no one receiving chemotherapy wants to face is an infection that occurs at the time when their white blood cells or leukocytes are at their lowest level. The most important leukocytes in the fight against bacterial and viral infections are the neutraphils, and when these are depleted, the patient develops neutropenia. The signs of this dangerous condition include a fever which is defined as having 3 oral temperatures greater than 38 degrees C, or 100.4 degrees F, in a 24-hour period, or 1 temperature greater than 38.5 degrees C, or 101.3 degrees F, according to the Cleveland Clinic Cancer Center. If the patient is approaching his NADIR, the date after chemotherapy at which physicians predict the patient will have his lowest cell counts, physicians are not likely to wait for a second elevated temperature before starting antibiotics.
Even before a fever begins, a feeling of malaise may occur in the patient who develops an infection because his leukocytes cannot fight effectively. This general feeling of illness can include fatigue and body aches.
Bleeding
Not only are white blood cells destroyed by chemotherapy, but so are platelets, the cells necessary for blood clotting. In thrombocytopenia, the state of having too few platelets, hemorrhage can occur. Nose bleeds, bleeding gums when the teeth are brushed, and bruising from blood that collects under the skin are early warnings of thrombocytopenia. More serious conditions occur when blood is lost in larger quantities, often internally, causing the vomiting of blood, blood in the stools and dizziness caused by bleeding in the brain. If the thrombocytopenia is serious enough, the next round of chemotherapy must be postponed. This makes the regimen less effective and reduces the opportunity to affect a cure or long-term remission. To combat this, oncologists prescribe the drug Neumega, known generically as oprevelkin, which is given before chemotherapy to increase the production of platelets.
Fatigue and Depression
Anemia is caused by chemotherapy as red blood cells are destroyed. This makes the patient feel tired, short of breath and unable to carry out her normal activities of daily living. Fatigue affects up to 90 percent of people undergoing cancer treatment, but 43 percent do not realize that there are effective treatments for this symptom. Depression is found in up to 53 percent of patients, according to the July-August 2008 issue of "Psychosomatics." When cancer cannot be treated or a person does not have access to treatment due to lack of insurance, these feelings may simply reflect reality. But for those under treatment, the depression can start with fatigue caused by anemia. Patients should be taught to view depression as a warning sign of anemia which can be treated by blood transfusions.
References
- "Cancer Research"; A History of Cancer Chemotherapy; Vincent T. DeVita Jr. and Edward Chu; November 2008
- ChemoCare: Fever, Neutropenia and Their Relationship to Chemotherapy
- Caring4Cancer: Thrombocytopnia
- "Psychosomatics"; Cancer Fatigue: A Neurobiological Review for Psychiatrists; M.R. Levy, M.D.; July-August 2008
