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Side Effects

Preparing for and Managing Side Effects from Chemotherapy and Radiation

Going into chemotherapy and/or radiation can be a frightening, nerve-wracking experience. As with many things in life, it’s the fear of the unknown that scares us the most, so we’ve put together a list of common side effects. This is not a comprehensive list, but deals specifically with our area of specialty—the skin, hair and nails. You may experience some of these symptoms, or none of them. They may be severe, or very mild. It depends on your particular type of treatment, as well as on your body chemistry. According to the American Cancer Society, “Every person doesn’t get every side effect, and some people get few, if any.”

We hope that by giving you this information, we can help you prepare for what may occur. Once you know what to expect, you can begin conscientious self-care by stocking up on non-toxic personal-care products, adjusting your habits to accommodate the changes your body will experience, and above all, taking the time to truly nurture and express compassion for yourself.

(Note: There are over 90 different chemotherapy drugs.  We have listed some below that may be responsible for certain side effects, but be sure to ask  your doctor or specialist nurse about specific side effects of your own treatment.)

ACNE (rash-like)

  • Some common chemotherapy drugs can increase the activity of oil glands in the skin and lead to increased acne
  • Skin can form pimples that are papular and pus-filled
  • It is important to not treat it with harsh acne medications as it can burn or damage the skin since it is so sensitive
  • Do not squeeze the pimples as it can spread bacteria
  • Speak to your dermatologist regarding options
  • This can also be confused with what may be a rash (see below under ‘Rash’)

DRUGS THAT CAUSE IT: steroids (prednisone, dexamethasone or decadron), Cetuximab (Erbitux),more drugs under ‘Rash’

DRY EYES

  • Excessive tearing
  • Eyes feel overly dry, gritty, or itchy
  • Sensitivity to light
  • Difficulty wearing contact lenses
  • Blurred vision
  • Need to blink constantly
  • Hard to open eyes after sleeping
  • Wear sunglasses to protect your eyes from environmental factors and the wind
  • Read our post on How to Bring some Comfort Back to your Dry Eyes During Treatment

DRUGS THAT CAUSE IT: Some medications like isotretinoin and tretinoin, cytarabine, fluorouracil (Adrucil, 5-FU, 5-Fluorouracil, Efudex), and medications to reduce side effects

DRY LIPS

DRUGS THAT CAUSE IT: fluorouracil (Adrucil, 5-FU, 5-Fluorouracil, Efudex), many others

DRY MOUTH (Xerostomia)

  • Occurs when the salivary glands don’t produce enough saliva
  • Can be caused by radiation when salivary glands are exposed
  • Dryness and elevated acidity in the mouth; may lead to tooth decay
  • Thick or stringy saliva
  • Change in your ability to speak clearly
  • Drink plenty of water and avoid beverages that are dehydrating like caffeine
  • Read our post on Dry Mouth and Tips to Bring Some Relief

DRUGS THAT CAUSE IT: radiation (to exposed salivary glands); chemo drugs include Accutane, Acrylin, Ala-cort, Alkeran, Amifostine, Arimidex, Azacitadine, Kidrolase, Lanacort, Lapnitib, Lenalidomide, Leustatin, Mercaptopurin, Mylocel, Octreotide, Oxaliplatin, Proleukin, Retinoic Acid, Streptoizocin, Toxal, Thioguanine, Vectibix, Xeloda, Zanosar, Zevalin, Zolina Zorneta

HAND AND FOOT SYNDROME (Palmar Plantar Erythrodysesthesia or PPE)

DRUGS THAT CAUSE IT: Can occur with several types of chemotherapy or biologic therapy drugs used to treat cancer; examples include bleomycin (Blenoxane), capecitabine (Xeloda®), dactinomcin (Actinomycin D, Cosmegen, Act D), daunorubicin (Cerubidine, Daunomycin, Rubidomycin, DNR), continuous-infusion doxorubicin, docetaxel (Taxotere), epirubicin (Ellence), etoposide (VePesid, VP-16, Etophophos), 5-Flurouracil (5FU), idarubicin (Idamycin), high-dose Interleukin-2, irinotecan (Camptosar), mitoxantrone (Novantrone, DHAD, DHAP), oxaliplatin, paciltaxel (Taxol), plicamycin (Mithracin), procarbazine (Matulane), topotecan (Hycamtin), valrubcin (Valstar), vinblastine (Velban), vincristine (Oncovin), vinorelbine (Navelbine)

HAIR LOSS OR THINNING (Alopecia)

DRUGS THAT CAUSE IT: All chemotherapy drugs have the potential to cause at least some hair loss; drugs known to cause the most extensive include cytoxan, taxol, taxotere, and adriamycin; also the regimens AC (Adriamycin and Cytoxan) and ACT (Adriamycin, Cytoxan, and Taxol)

INFECTION (increased risk)

DRUGS THAT CAUSE IT: 2-Cholrodeoxyadenosine (2-CDA; Cladribine, Leustatin), CCNU (Lomustine), cis-platinum (Platinol), fludarabine(Fludara), hydroxyurea (Hydrea), irinotecan (CPT-11), methotrexate (MTX), semustine (Methyl-CCNU), topotecan (Hycamtin), vinblastine (Velban)

MOUTH FISSURES OR ULCERATIONS (Oral Mucositis or Stomatitus)

  • Particularly common with patients who have head and neck cancers
  • Fissures may appear at the corner of the mouth
  • Ulcers (painful swellings with white centers) may appear anywhere inside the mouth including gums
  • Pain can make it difficult to eat, chew, and swallow
  • Read our post on How to Care for Mouth Fissures and Ulcerations

DRUGS THAT CAUSE IT:bevacizumab (Avastin), busulfan (Myleran), bleomycin, bortezomib (Velcade), busulfan (Myleran), capecitabine (Xeloda), carboplatin (Paraplatin), cetuximab (ERBITUX), chlorambucil (Leukeran), cyclophosphamid, cytarabine, daunorubicin, doxorubicin (Adriamycin), erlotinib (TARCEVA), etoposide (Etopophos, VePesid), fluorouracil (Adrucil), geftinib (IRESSA), idarubicin, ifosfamide, imatinib (Gleevac), melphalan (L-PAM; Alkeran; L-Sarcolysin), mechlorethamine (Nitgrogen Mustard), methotrexate, oxaliplatin (Eloxatin), paclitaxel (Taxol), panitumumab (Vectibix), sunitinib (Sutent), streptozocin (Zanosar), temozolomide (Temodal), thiotepa (Thioplex), vinblastine (Velban)

NAIL CHANGES

DRUGS THAT CAUSE IT: bleomycin, busulfan (Myleran), carboplatin (Paraplatin), chlorambucil (Leukeran), cisplatin (Platinol), cyclophosphamide (Cytoxan), daunorubicin, decarbazine (DTIC), doxorubicin, fluorouracil, ifosfamide (Ifex; Isophosphamide), mechlorethamine (Nitgrogen Mustard), melphalan (L-PAM; Alkeran; L-Sarcolysin), methyl CCNU (Semustine), oxaliplatin (Eloxatin), streptozocin (Zanosar), temozolomide (Temodal), thiotepa (Thioplex)

PHOTOSENSITIVITY

DRUGS THAT CAUSE IT: capecitabine (Xeloda), cladribine (Leustatin), clofarabine (Clolar), cytarabine(ara-C, cytosar-U), floxuridine (FUDR), fludarabine(Fludara, 2-fluora-ara-AMP), fluorouracil (Adrucil, 5-FU, 5-Fluorouracil, Efudex), gemcitabine (Gemzar), hydroxyurea (Hydrea), mercaptopurine (6-MP, Purinethol), methotrexate (Amethopterin, Folex, Folex PFS, Mexate, Mexate-AQ, MTX, Abitrexate, Rheumatrex), nelarabine (Arranon), pemetrexed (Alimta), pentostatin (Nipent), thioguanine (6-TG, 6-Thioguanine, Tabloid), vinblastine (Velban)

RADIATION BURNS

RASH (Tarceva Rash or other)

  • Occurs within the first few weeks of treatment
  • Develops in the face, neck, chest, back, and scalp
  • Looks like pimples or red bumps; redness
  • Can be like a sunburn-red and hot/flushing
  • Itchy, dry skin that flakes
  • Sores
  • Tender, irritated skin
  • Read our post on Tarceva Rash During Treatment

DRUGS THAT CAUSE IT: aminoglutethimide (Cytrdren, Elitpen), bevacizuman (Avastin), bleomycin Blenoxane), bortezomib (Velcade), cetuximab (ERBITUX), cisplatin (rare—Platinol, Platinol-AQ), cytarabine (Ara-C), dactinomcin (Actinomycin D, Cosmegen, Act D), daunorubicin (Cerubidine, Daunomycin, Rubidomycin, DNR), docetaxel, epirubicin (Ellence), erlotinib (TARCEVA), erbitux, fluorouracil (Adrucil, 5-FU, 5-Fluorouracil, Efudex), geftinib (IRESSA), idarubicin (Idamycin),  imatinib (Gleevac), L-Asparaginase, methotrexate (Folex, Folex PFS, Mexate, Mexate-AQ, Abitrexate, Rheumatrex), mitoxantrone (Novantrone, DHAD, DHAQ), paclitaxel, panitumumab (Vectibix), plicamycin (Mithracin), sorafenib (Nexavar), sunitinib (Sutent), tamoxifen (Nolvadex, taxomifen citrate), valrubcin (Valstar), 2-Cholrodeoxyadenosine (2-CDA; Cladribine, Leustatin)

SCARRING (from radiation or surgery)

  • Scar tissue remains on damaged tissue after it heals
  • The amount of scar tissue depends on the size, depth, and location of the wound
  • Surgery can leave scars at the incision points
  • Chemotherapy and radiation can leave scars in the skin from wounds, burns, and acne and/or skin rashes
  • Radiation can also leave hardened, stiff tissue known as radiation fibrosis
  • Read our post on How to Take Care of  Scars after Treatments and Surgery Are Over

SKIN TENDERNESS/DRY SKIN/ITCHY SKIN

DRUGS THAT CAUSE IT: Most of them

SKIN TONE CHANGES

DRUGS THAT CAUSE IT: bleomycin, busulfan, cyclophosphamide, cisplatin, docetaxel, etoposide, hydroxyurea (Hydrea), ifosfamide, methotrexate (MTX), prednisone (Apo-Prednisone, Orasone, Deltasone, Predisone), thiotepa

LOSS OF TASTE (Dysguesia)

  • Sometimes described as “metal mouth”
  • Bitter taste, or loss of taste
  • Decreased ability to taste sweet foods; lower tolerance for bitter foods
  • Can interfere with you getting the nutrition you need
  • Starts a week or two after the beginning of treatment
  • It’s estimated that about 50% of patients getting chemotherapy experience taste changes
  • Read our post on The Miracle Fruit and Reviving Taste Buds During Chemotherapy

DRUGS THAT CAUSE IT: bleomycin (occasionally), cyclophosphamide (Cytoxan, Neosar, Endoxan), paclitaxel (Taxol, Abraxane), rituxin (Rituximap), sunitinib (Sutent), vincristine (Oncovin, Vincasar PFS, leurocristine)

For more information on side effects, click on any of the resources below.

 Cancer Help, Chemocare, Caring, Oncology Channel, Care First Stay Well Solutions Online, Candlelighters

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