Some chemo drugs cause long-term side effects, like heart or nerve . Last Medical Review: February 11, Last Revised: February It is also important to know that normal cells, as well as cancer cells, are affected by chemotherapy, and the cause of unpleasant side effects is toxicity of the. Chemotherapy is associated with a range of adverse effects (e.g., Symptomatic management of associated side effects is recommended to improve tolerance. . For specific indications see table under “Overview” above.
of Chemotherapy Effects Overview Side
Berberine has been reported to have a wide range of pharmacological effects, including interaction with DNA to form complexes, inhibition of DNA and protein synthesis, an arresting effect on cell cycle progress, an inhibition of tumour cell proliferation, and an anticancer effect. Berberine exerts an antitumor effect via inhibition of cell proliferation and induction of apoptosis in ovarian cancer cells[ ]. Antroquinonol, a ubiquinone derivative isolated from mycelia and the fruiting bodies of A.
Recent studies have reported that Antroquinonol induces apoptosis and autophagy of pancreatic cancer cells [ ]. Chemotherapy has shown some benefit when used alone in patients with stage IV of the disease, as well as in combination with radiotherapy in patients with locally advanced disease and in the preoperative setting in those with early stages of NSCLC. Platinum drugs are still considered of crucial interest based on clinical studies and the results of meta-analyses, with their inconvenience being their observed toxicity and the inherent resistance.
The poor efficacy and considerable toxicity of chemotherapy has caused great pessimism for many years regarding this approach, as only a small positive impact on survival rates was observed. Meanwhile, natural compounds have been used to treat various diseases and are becoming a significant research area for drug discovery.
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Evaluation of the cytotoxic activity of gemcitabine in primary cultures of tumor cells from patients with hematologic or solid tumors. Vistogard is an oral medication that blocks cell damage and cell death caused by chemotherapy. It should be taken as soon as possible after overdose even if symptoms are not present or toxic reaction that occurs within 4 days early-onset , according to the FDA.
It is not used to treat non-emergency reactions to fluorouracil or capecitabine because it can reduce the effectiveness of these chemotherapy drugs. Side effects include nausea, vomiting, and diarrhea. Interferon and interleukin-2 are commonly used biological agents. Interferon has been shown to improve survival in non-Hodgkins lymphoma patients, as well as in melanoma patients, renal cell cancer patients, and others.
It is also used in patients who have hepatitis C. Other side effects include water retention and water leakage often seen with interleukin , shortness of breath, cardiac arrhythmias irregular heart rates , and skin rashes. In some cases, neurological changes e. As with most side effects of chemotherapy, these effects are temporary and reverse with discontinuation of the medication. Most side effects of this treatment are constitutional, such as fever, chills, muscle aches, and lack of energy.
By presenting cumulative incidence these results give an insight into the pattern of side effects over the course of chemotherapy. The large proportion of people with mild side effects such as constipation, diarrhoea, mucositis and vomiting throughout the follow-up period is notable, as is the particularly large proportion of people reporting serious fatigue.
Although the incidence of side effects associated with chemotherapy is often reported in clinical trials of new treatments, there are few examinations of chemotherapy side effects in a community or routine care setting. Consistent with other observational studies of chemotherapy side effects which have examined specific chemotherapy regimens, cancer types or side effects, our results suggest that side effects are more common in standard practice than reported in clinical trials [ 23 , 24 ].
However, it can be difficult to compare incidence rates of specific side effects with these previous studies, as the duration of follow-up differs between studies. For example, a study of chemotherapy-induced nausea and vomiting in a community setting found that The higher rates of side effects observed over time in this study may indicate that many patients experience ongoing side effects during chemotherapy, and that for some individuals these side effects present after the first few months of treatment.
For a small proportion of individuals the side effects are serious, highlighting the importance of monitoring side effects throughout treatment. The apparent jumps in cumulative incidence seen in Fig 2 are a function of the smaller numbers of participants who had the full six months of follow-up, and care should be taken with interpretation of figures in later months.
The differences in the incidence of side effects in this study compared to previous literature may also be due to the method of collecting self-reported side effects. While there is evidence that patient self-reports of side effects are consistent with clinician assessments [ 16 ], there is also evidence that different timing of and approaches to collecting side effect data can influence results [ 30 ].
Oncologists and research nurses often collect information about side effects through open ended questioning, which may result in unintended underreporting of the number and type of side effects a patient is experiencing [ 16 , 31 ]. In this study, participants were provided with examples of each side effect by grade which may have encouraged them to report both a greater variety of and less severe side effects than if they had been asked open ended questions.
While it is difficult to compare directly, the apparently higher rates of side effects seen in clinical practice compared to clinical trial reports may be explained by the strict inclusion and exclusion criteria applied in trials. Trial participants are generally younger and fitter than a typical patient seen in clinical practice [ 12 ], and it is often suggested that they may be better able to cope physically with chemotherapy and therefore less likely to experience side effects.
In addition, the typical clinical trial is conducted in a large high-quality teaching hospital, where best-practice management of side effects and trial specific monitoring and follow-up are likely to reduce both the incidence and severity of any side effects [ 12 ]. However, this was not reflected in the results of this study, which suggest that younger patients were more likely to experience side effects.
This may indicate that in clinical practice older patients are more likely to receive lower doses of chemotherapy, thus minimising side effects [ 21 ], although possibly also reducing treatment efficacy [ 8 — 11 ].
These results highlight that side effects are common during chemotherapy, and that patient reported outcomes may identify symptoms which might not otherwise be identified. Identifying frequent side effects in patients undergoing chemotherapy in clinical practice highlights a challenge for clinicians, economic modellers and health policy makers. Oncologists and research nurses need to integrate patient-reported outcomes for symptomatic adverse events into clinical care.
In addition, our results show that monitoring for side effects should continue for the duration of treatment and follow-up. As financial pressure on the health care system mounts there is increasing demand for interventions to demonstrate cost effectiveness.
Many chemotherapy cost effectiveness models are built on the basis of clinical trial data. If trial data underestimates side effects, this could have important impacts on models of cost effectiveness, as side effects may reduce patient compliance and treatment effectiveness, and increase health care costs meaning cost effectiveness would be overestimated.
Future models could use our estimates of side effect frequency and prevalence as part of sensitivity analyses to test the impact of assumptions around side effect rates taken from the clinical trial literature. In addition, policy makers are usually making decisions for the general population. While this study is too small to inform national policies directly, it points to the value of observational data because of its improved accuracy compared to administrative data [ 33 ], and greater external validity compared to clinical trials [ 17 ].
Collecting observational data is time and resource intensive [ 34 ]. While it is not feasible for an observational study to be conducted for every economic evaluation, the conduct of large, well-designed, prospective observational studies with the needs of modellers and decision makers in mind could provide valuable input to both economic models and health policy decisions.
This was a relatively large, prospectively designed, observational study of a cohort of individuals with cancer in New South Wales, Australia. We examined the experience of side effects across multiple cancers, rather than looking at specific chemotherapy regimens as done in the existing literature. However, our sample is limited by the small proportion of individuals with non-small cell lung cancer, who may have had different experiences of side effects to those with breast and colorectal cancer.
We are also unable to differentiate those participants who are enrolled in a palliative care program. Similarly, those with other cancer types may also have different chemotherapy experiences which are not captured in this study. Without a non-cancer control group i. For example, some symptoms of the cancer itself may have been mistaken for side effects of chemotherapy. Fatigue [ 35 ] and constipation [ 36 ] are also both more common among older people, and may therefore be unrelated to treatment.
An additional limitation is that the response of the treating clinicians to the reported side effects is unknown. Some of the reported side effects may have been treated, while others may have gone unnoticed. These variations could have resulted in differences in the ongoing experience of the side effect which are not captured in the current study. It is also possible that the retrospective self-reporting of side effects at monthly intervals may have introduced recall bias into participant responses.
In the future larger, national, prospective, observational studies of individuals with a broader range of cancers and testing alternative mechanisms of side effect reporting would be valuable. This paper adds to the literature an estimate of the incidence of side effects experienced by patients undergoing chemotherapy in a routine care setting, rather than in the context of a clinical trial.
It has the additional advantage over previous studies of looking across a range of cancers and treatment regimens.
Many patients experienced mild side effects continuously throughout the period of treatment captured in the study. This information is useful for both clinicians and policy makers, who typically make treatment and funding decisions for standard practice, but often on the basis of potentially unrealistic clinical trials.
This work also confirms the need for side effects to be collected using patient-reported methods, to be monitored throughout chemotherapy treatment, and highlights the importance of observational data in providing information for decision-makers that is relevant to the clinical practice setting.
Preliminary results were presented in a rapid-fire session at the World Cancer Congress No funding organisation had any role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.
National Center for Biotechnology Information , U. Published online Oct Apar Kishor Ganti, Editor. Author information Article notes Copyright and License information Disclaimer. The authors have declared that no competing interests exist. Received Feb 5; Accepted Aug This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
This article has been cited by other articles in PMC. Abstract Aim Chemotherapy side effects are often reported in clinical trials; however, there is little evidence about their incidence in routine clinical care. Methods We conducted a prospective cohort study of individuals with breast, lung or colorectal cancer undergoing chemotherapy.
Results Side effect data were available for eligible individuals, who had a median follow-up of 5. Conclusion This research has produced the first Australian estimates of self-reported incidence of chemotherapy side effects in routine clinical care. Introduction Chemotherapy is an important component of treatment for many cancers, and new anti-cancer drugs represent one of the largest areas of pharmaceutical development [ 1 , 2 ].
Materials and methods The Elements of Cancer Care study The Elements of Cancer Care EOCC study design has been reported elsewhere [ 26 ], but in summary the study prospectively tracked patients undergoing chemotherapy for breast, colorectal and non-small cell lung cancer NSCLC , and utilised information from medical and chemotherapy charts, interviews and linked administrative data. Analysis Analysis was conducted for the full sample, and by cancer type.
Results Demographics and clinical characteristics There were eligible individuals recruited to the EOCC study, whose full demographic, cancer and chemotherapy details have previously been published [ 26 ]. Table 1 Demographic and clinical characteristics of the Elements of Cancer Care cohort.
Chemotherapy Side Effects
This article provides a basic introduction to chemotherapy, how it any changes in how you are feeling or any new side effects you are having. There are many different side effects of chemotherapy. But it's unlikely you'll experience them all, and there are ways to cope with them. Chemotherapy: About this Treatment. Overview It is important to discuss the side effects of any new treatment with your care team in a timely manner.