WebMD Health - Ovarian Cancer

Jun 4, 2010 3:54 PM

Chemotherapy for Ovarian Cancer: Managing Side Effects

Chemotherapy drugs aren't discriminating. While they're busy killing cancer cells, they can also wreak havoc on the healthy cells your body needs.

The reason chemotherapy is so damaging is that it targets all kinds of fast growing cells. "Cancer cells are fast growing cells, but other cells in the body are also fast growing. One of them is hair," says Kathleen Schmeler, MD, assistant professor in the department of gynecologic oncology at the University of Texas M.D. Anderson Cancer Center in Houston. When healthy cells get damaged, they trigger the side effects women experience during their chemotherapy treatment.

Some chemotherapy side effects, such as fatigue, nausea, and numbness or tingling in the fingers and toes (neuropathy), are physical. Others, like hair loss, are more emotional because they can take a big hit on your self-esteem. "Women usually lose their hair two to three weeks after their first treatment. Usually they lose it all. They also lose their eyebrow hair, pubic hair --everything comes out," Schmeler says.

Every woman is different. Some women sail through chemotherapy with hardly a problem, while others struggle just to function. "I have patients who are able to continue to work full-time," says Deborah Armstrong, MD, associate professor of oncology, gynecology and obstetrics at the Johns Hopkins Kimmel Cancer Center in Baltimore. "I have [other] patients who can't work and can't even cook a meal." She says it's hard to predict which women will be hardest hit by their chemotherapy treatment.

Although chemotherapy affects every woman differently, overall it's a much better experience than it was a couple of decades ago because now doctors have more drugs available to relieve or even prevent side effects.

Chemotherapy Side Effects: How Your Doctor Can Help

Most of your side effects should eventually go away once your treatment ends. In the meantime, your doctor and the other members of your treatment team can help manage whatever side effects you experience.

Doctors take a proactive approach to dealing with chemotherapy side effects. Preventive drugs taken before your treatment can help ward off symptoms before they start. For example, nausea used to be one of the most debilitating side effects of chemotherapy. Today it's less of an issue because your doctor can give you anti-nausea medicines (anti-emetics) through an IV before your chemotherapy, as well as anti-nausea pills afterward.

Doctors can prevent side effects using other methods, too. For example:

  • Chemotherapy can attack your white blood cells, leaving you more vulnerable to infection. Your doctor will check your white blood cell counts regularly and may give you growth factors to stimulate your bone marrow to produce more blood cells.
  • Chemotherapy also attacks the red blood cells that carry oxygen to your body, which can lead to anemia. Your doctor might prescribe a drug to treat chemotherapy-induced anemia.
  • Abdominal pain is a side effect of intraperitoneal (IP) chemotherapy, which is delivered directly into the abdominal cavity (unlike IV chemotherapy, which is delivered into a vein). Your doctor will give you pain medications to relieve this symptom.
  • An infection in the catheter or port is another possible side effect of IP chemotherapy. Your doctor should monitor you carefully for an infection. If you get an infection, you'll be treated with antibiotics.

Your chemotherapy regimen isn't set in stone. If you find that your treatment is making you sick, your doctor can always make changes. "I think every cycle is its own kind of story and the story hasn't been written," explains Ursula A. Matulonis, MD, director and program leader of Medical Gynecologic Oncology at the Dana-Farber Cancer Institute and assistant professor of medicine at Harvard Medical School. "When somebody comes back in to see me after cycle one and she's having side effects, we make adjustments."

"We can either change the drug or we can decrease the dose of the drug," says Schmeler. That might mean switching you from IP to intravenous (IV) chemotherapy if you can't tolerate the more significant side effects of IP chemotherapy.

Whatever changes your doctor makes to your treatment regimen, she needs to balance concerns over your side effects with the need to combat your cancer. "It's a fine line between controlling symptoms and giving them the most aggressive chemotherapy we can," Schmeler says.

Chemotherapy Side Effects: What You Can Do

Your doctor will do everything possible to prevent or lessen your side effects. You can also do your part at home by adjusting your schedule and lifestyle to make things easier on yourself while you're undergoing treatment.

One way to do that is to plan your chemotherapy so that it has the least impact on your life. "One of the things my patients like to do is to get their chemotherapy on a Thursday or Friday so they have the weekends to recover," Schmeler says.

If you're feeling up to it, try to exercise, which will not only give you more energy, but can also help you take off any extra weight you gain from your treatment. Although it might seem like women would lose weight from chemotherapy, many women actually gain an average of five to 10 pounds during treatment, says Matulonis. The weight gain may be due to the drugs themselves, or to food cravings that can sometimes develop.

You might find that your tastes change while you're on chemotherapy. Discovering that you suddenly have an aversion to foods you used to love or a craving for unhealthy foods can make it hard to eat a well-balanced diet. Still, make every effort to keep your diet as healthy as possible. "We try to encourage people to eat less processed foods, more fruits and vegetables, and a variety of protein sources," Armstrong says.

Some other techniques you can try at home to help you feel better:

  • Give yourself time to take it easy on days you know you're going to be tired from the chemotherapy. Take naps or breaks whenever you need them to combat fatigue.
  • Eat several small meals throughout the day instead of three big meals, and drink plenty of water to prevent nausea.
  • Ask your family or friends for help with housework, childcare, and other activities that tire you out.
  • Ask your doctor whether you should take a multivitamin or other vitamin supplement. Vitamin B6 in particular can be helpful for neuropathy.
  • Wear a wig, scarf, or hat to cover your hair loss if it bothers you.

It can also help to keep a journal of your symptoms. At your medical visits, you can go back through your journal and tell your doctor exactly how you felt on a particular day, says Matulonis.

Chemotherapy Side Effects: When to Call Your Doctor

Although you can handle minor side effects like nausea and fatigue on your own, call your doctor if you experience any of these more serious symptoms:

  • Fever
  • Significant nausea or vomiting
  • Signs of infection (redness, warmth)
  • Abdominal pain or other pain
  • Not passing gas or having bowel movements
  • Diarrhea
  • Headaches

"People don't need to call us for every little thing, but if there's something that's new and very different for them, and lasts for more than a few hours we do ask them to call the clinic so we can check it out," Armstrong says.

Coping With the Stress of Ovarian Cancer

Dealing with a cancer diagnosis can be emotionally draining. Add to that the concerns over your treatment, and the stress can really take its toll on you. "What we see anecdotally is that stress negatively impacts people's well-being while they're going through cancer treatment, but it may also impact their cancer," says Schmeler.

Every woman deals with the stress of her cancer differently, Armstrong says. While some become activists, joining ovarian cancer groups, and fighting back against their disease, others would rather not dwell on their illness.

How you relieve your stress is also a matter of personal preference. "I always tell people to do what makes them feel better," Schmeler says. Try whatever stress-relieving techniques work best for you, whether that's massage, acupuncture, yoga, meditation, or just talking to someone.

No matter how you deal with your disease, don't make cancer the only focus of your life. "I tell people, 'Go ahead and live your life and do what you want to do,'" Armstrong says. If you've been planning a Caribbean cruise or trip to Europe, don't cancel it. Talk to your doctor about working your trip into your treatment plan. Then go and enjoy yourself.

Finally, if you're feeling depressed (i.e., sad, lack of interest in things you once enjoyed, decreased ability to concentrate), get help from a mental health expert.

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