What are the worst side effects?
Many people receiving chemotherapy believe that nausea is a sign that their treatment
is working. Though medications are available to help prevent nausea, they worry
that if they tell their healthcare team about feeling sick, they might have to receive
a less effective dose to fight the cancer.
If chemotherapy-induced nausea
and vomiting (CINV) is not properly prevented, about 70% to 80% of patients
receiving chemotherapy may experience it. This is concerning when you consider that,
over the years, patients with cancer have consistently ranked nausea and vomiting
among the most severe side effects of chemotherapy. In fact, 3 different surveys
over a 16-year period showed that nausea and vomiting were ranked highest among
chemotherapy side effects that patients want to avoid (Table 1).
The impact of CINV is highlighted in a study where patients with ovarian cancer
receiving chemotherapy were asked to rank side effects of treatment on a list including
perfect health and remission (ranked by patients at one end of the spectrum) and
death (ranked at the other end). In between, patients ranked symptoms such as hair
loss, fatigue, nausea, and vomiting (Figure 1).
It is not surprising that prevention of nausea and vomiting (shown as CINV 1) ranked
near perfect health but that poorly controlled acute and delayed nausea and vomiting
(shown as CINV 3, 4, 5, and 6) were ranked close to death.
Why is this good information to know? For one thing, it is important that patients
receiving chemotherapy realize that they don’t have to feel nauseous from treatment.
Living with CINV can make it hard to function from day to day and may cause uncertainty
or distress. As a result, patients with CINV may not feel like continuing their
therapy. For patients whose lives are impacted by nausea and vomiting, managing
CINV is a priority.
Second, patients at risk for CINV
can ask their healthcare provider about the treatment that is right for them, including
nausea medications and diet and lifestyle changes that can help prevent CINV. It
may also help to keep a daily calendar
or checklist of symptoms
to share during appointments.
Many healthcare providers do not
know their patients are becoming nauseous from their chemotherapy. That
is why it is important to keep track of how you feel and talk to your treatment
team for ways you can stay strong during your course of therapy.
(Table 1) Patient perceptions of the most severe side effects of cancer chemotherapy
| 1 |
Vomiting |
Nausea |
Nausea |
| 2 |
Nausea |
Loss of hair |
Loss of hair |
| 3 |
Loss of hair |
Vomiting |
Constantly tired |
| 4 |
Thought of coming for treatment |
Constantly tired |
Vomiting |
| 5 |
Length of time treatment takes |
Having to have an injection |
Changes in the way things taste |
(Figure 1) Ranking of CINV compared to other side effects4
References:
1. Coates A, Abraham S, Kaye SB, et al. On the receiving end—patient perception of the side-effects of cancer chemotherapy. Eur J Cancer Clin Oncol. 1983;19:203-208.
2. De Boer-Dennert M, de Wit R, Schmitz PI, et al. Patient perceptions of the side-effects of chemotherapy: the influence of 5HT3 antagonists. Br J Cancer. 1997;76:1055-1061.
3. Lindley C, McCune JS, Thomason TE, et al. Perception of chemotherapy side effects cancer versus noncancer patients. Cancer Pract. 1999;7:59-65.
4. Sun CC, Bodurka DC, Weaver CB, et al. Rankings and symptom assessments of side effects from chemotherapy: insights from experienced patients with ovarian cancer. Support Care Cancer. 2005;13:219-227.