Chemotherapy
The intensity of acute adverse reactions to chemotherapy can be quite different from patient to patient. Nausea and vomiting occurring several hours after the administration of chemotherapeutic drugs can be considerably mitigated by antiemetic drugs. Loss of hair is an adverse reaction that affects most patients. However, it is usually a temporary problem, and permanent loss of hair is seen very rarely.
Blood
Chemotherapeutic drugs have a damaging effect on the bone marrow, which plays an important role in therapy. The bone marrow impairment causes changes in the blood count and should therefore be monitored at close intervals. If the number of white blood cells (leukocytes) decreases, this is associated with an increased risk for contracting infectious diseases, particularly oral, nasal or pharyngeal infections or pneumonia. New drugs, which are injected subcutaneously, may reduce the time during which the infection risk is increased. In very rare cases, spontaneous bleedings caused by a decrease in platelets (thrombocytes) have been observed. A decrease in red blood cells (erythrocytes) may cause symptoms like general weakness, fatigue and shortness of breath. A blood transfusion may be necessary, depending on the chemotherapeutic regimen used. Before the start of a new chemotherapy cycle, the blood parameters should have recovered.
Fertility and hormonal balance
Whether male patients become permanently infertile as a consequence of therapy seems to depend on the dose of some of the drugs used. The physician must inform male patients, particularly young patients, about these potential late effects and discuss the option to cryopreserve (freeze) sperm before the start of treatment if the patient wants to have children after treatment.
Female patients have to be informed about a premature onset of the menopause. Whether the ovaries recover and the patient is able to conceive again after treatment depends on the patient’s age and the dose of the administered cytostatic drugs. Even one year after end of treatment a spontaneous return of menstruation is possible. However, to reduce the risk of a premature onset of osteoporosis (reduction in bone density), a female hormone (estrogen) deficiency should be balanced (temporarily or permanently) if corresponding complaints occur. After end of treatment it is recommended to consult a gynecologist and/or endocrinologist regarding these problems.
Before start of treatment a detailed menstruation history and a hormonal analysis should be performed. In this context, the so-called anti-Müllerian hormone is subject to recent research activities. This hormone seems to be a marker for the ovarian reserve (the number of oocytes able to mature).
Oral contraceptives (the “Pill”) or so-called GnRH analogues may protect the ovaries, and administration should be considered. Both influence the ovarian cycle and inhibit the maturation of oocytes, through which damage to ovaries and oocytes may possibly be prevented. In addition, it is possible to remove mature oocytes and to freeze (cryopreserve) them either fertilized or unfertilized. Cryopreservation of ovarian tissue may also be an option.
Heart and lung function
Certain drugs contained in chemotherapy regimens can affect heart and lung function. An impairment of the heart function is usually dose-dependent and is also influenced by other individual factors. It may affect the pump function of the heart, cardiac rhythm and blood circulation in the coronary vessels. Acute symptoms are reversible in almost all cases. However, cardiac symptoms occurring after end of treatment are often persistent. The lung function may be impaired by inflammation or changes of the lung tissue. The severity of a lung function impairment usually also depends on the dose. Acute inflammations of the pulmonary alveoli occur quite rarely and are not necessarily dose-dependent. Because of the potential adverse effects mentioned above, heart and lung function should be examined at the beginning of therapy and within the scope of follow-up care.
Nervous system
During the cause of chemotherapy, sensation disorders that usually present as tingling sensations or a numb/furry feeling in hands and feet may occur. Depending on the severity of these symptoms, the causative drug can be replaced or its administration can be discontinued.