Living with Prostate Cancer
Side Effects of Chemotherapy
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Each of the chemotherapy drugs available today works in a slightly different fashion, and it’s hard to predict what sorts of side effects any one person will experience. But there are a few rules of thumb when it comes to chemotherapy that should always be kept in mind.
- Ignore what others have said about their reactions to the different drugs—dosage, the combination of drugs, and the response to the drugs might be completely different. No two people are the same and no two cancers are the same, which means that no two people will react to the drugs in the same way. For example, the side effects of docetaxel as used to treat prostate cancer are VERY different and less severe than the side effects of docetaxel and cisplatin when used to treat lung cancer.
- Pay close attention to both expected and unexpected reactions to the different drugs. The doctors, nurses, and pharmacists will describe what to look out for in general, but it’s always possible to experience something that they didn’t anticipate. An unexplained side effect might be nothing, but it’s far better to be extra cautious than to ignore something that might be causing harm. Ask for a handout about the medication that is being given to you, and a treatment calendar so you know when to be in for therapy.
- Don’t be "macho." There are plenty of drugs available to help ward off or treat the different side effects, including nausea/vomiting, sleep problems, and general exhaustion. All treatments work best when the body is at its strongest.
- Relax. Chemotherapy drugs are powerful and can take a toll on the body. Focus on getting well by finding a way to relax—listening to music, doing yoga or stretching exercises, taking a walk in the woods or on the beach, or watching a movie marathon on television. Effectively relieving stress will help contribute to the ultimate goal of all cancer treatments—getting well.
The most common chemotherapy drug, docetaxel (Taxotere), is actually very well tolerated, and many men are pleasantly surprised to find that many disease-related symptoms (pain, fatigue, loss of energy) are improved after starting this therapy. However, docetaxel does have some side effects to be aware of. For example, about 3% of men will experience a fever with a low white blood cell count that will require medical attention. This can be prevented through the use of white blood cell growth factors (neulasta), but infection remains a slight but serious risk. About 50% of men will experience significant fatigue at some point in their therapy, usually for the first week of each cycle. About 1/3 of men will experience numbness or weakness in their toes or fingers that interferes with function (neuropathy). This is best handled by prevention, so letting your doctor know if you are experiencing this is vital; doses can be held or reduced to prevent this. Fortunately, neuropathy often improves slowly over time.
Other side effects of docetaxel include low platelets that can result in bleeding (1%), anemia (5%), reduced heart function (10%), hair loss (65%), diarrhea (32%), nail changes (30%), loss of appetite (20%), shortness of breath (15%), and fluid retention (10-20%). Many of these are mild and reversible and treatable and should not be a reason to avoid chemotherapy if you need it.
Cabazitaxel (Jevtana) chemotherapy can also affect the blood counts and is almost always given with neulasta to boost the infection-fighting cells. A blood transfusion is sometimes necessary to increase the oxygen-carrying red blood cells and to combat the fatigue related to low blood counts. The most common serious side effect seen with cabazitaxel is diarrhea – this is seen in almost half the patients treated with cabazitaxel but can often be effectively treated with anti-diarrheal medications such as imodium or lomotil. Other possible side effects include: fatigue (37%), neuropathy (13%), shortness of breath (12%), headache (8%), hair loss (10%), abdominal pain (17%), and low blood pressure (5%).
Regardless of the type of chemotherapy you are receiving, you will be monitored very closely by doctors, nurses, and pharmacists to make sure that all side effects are being addressed. Many of these side effects, especially fever and inability to keep food/drink down, need to be addressed right away – don’t wait until your next appointment to tell your provider