Identifying And Managing The Side Effects Of Chemotherapy To Cancer Patients

The principle behind chemotherapy

Discuss about the Side Effects Of Chemotherapy In Cancer Patients.

‘Cancer’ can be defined as a condition that arises due to the abnormal division of the cell which is predominantly referred to a condition known as ‘metastasis’ (Loven et al.,2013). The cell division rate is accelerated due to the failure of the check points regulating the cell division and it ultimately leads to proliferation of the cells that invade the normal tissues and continue to divide at an unstoppable rate. The unchecked cell division gives rise to accumulation of cell mass that forms ‘tumors’. Based on the origin of the tumor, cancer is classified into many subtypes and the terminology of the cancer also depends upon the same. Interventions for the treatment of cancer include a number of therapies such as chemotherapy and hematopoietic stem cell transplantation but the course of intervention depends on the identified stage of cancer (Aslam et al.,2014). This essay revolves around the identification and the discussion of the side-effects of monitoring chemotherapy to cancer patients and the further sections of the essay would also highlight the  nursing interventions that are undertaken in order to combat the side-effects.

It is extremely important to diagnose the patient suffering from cancer and identify which stage of cancer the patient is presently staged at. After the identification of the stage of cancer, interventions are devised by physical experts. Chemotherapy is the most widely used therapy to treat cancer worldwide and statistics suggest that it in more than 80% of the cancer cases, doctors widely recommend chemotherapy (Colagiuri et al.,2013). It is important to understand the existing principle operating behind the administration of chemotherapy. Chemotherapy is basically a medication that targets the rapidly growing cells in the body which are supposed to be the cancerous cells on account of their accelerated growth property (Hirsch et al.,2013). However, it should be critically noted that chemotherapy does not work by targeting specific cancerous cells, rather it focus on the targeted killing of the rapidly growing cells which sometimes also include other normal cells that possess the capability of diving at a very fast rate (Iwamoto,2013). Examples of such cells include the cells of the gastro-intestinal tract, the hair follicular cells and the cells of the bone marrow (Kanti et al.,2014). Hence, chemotherapy in most of the cases leads to the targeted killing of the cancerous cells in association with the normal cells and this counts as the major side-effect of using chemotherapy as an intervention to treat cancer patients.

Ways in which chemotherapy controls cancer

Chemotherapy works in a number of ways to combat cancer. Scientific studies reveal three ways in which chemotherapy controls cancer (Meacham & Morrison, 2013). The first process includes the targeted killing of the abnormally dividing cancerous cells so much so that there are no traces left to be detected in near future, the second process checks the spreading of the tumor cells to other healthy tissues or de-accelerates the growth of cancer and the third process is used to treat severe patients who are placed at the terminal stages and the process is directed towards the killing of the most painful tumors of the body which possess the capability to regenerate themselves (Loven et al.,2013). In most of the cases chemotherapy and radiation interventions are coupled together and administered to the patient.

It should be critically noted here that the side-effects associated with chemotherapy is not prevalent at all times and in most of the cases, the side-effects experienced are not too severe but can be managed with the administration of oral medicines that help in reducing the intensity of the side-effect.  Nursing interventions for the remedial treatment of the side-effects include accessing the degree of adversity faced by the patients both in terms of physical impairment and mental stress associated with the severe side-effects (Patel et al.,2013). Interventions to improve the mental status pertaining to depression linked with the side-effects incorporate the self-assessment of the distress-scale by the cancer patients. However, it should be noted that the nurses can also adopt better intervention strategies in close association with the oncologists as the oncologists help in understanding the severity of the chemo-induced side-effects (Paus et al.,2013). The most commonly reported side-effect has been identified to be the onset of ‘Alopecia’ which refers to excessive amount of hair fall from the body not necessarily the scalp hair but also body hair (Polovich et al.,2014). As explained earlier, chemotherapy is highly-non-specific and affects the cancerous as well as the non-cancerous cells to a great extent. A single hair shaft has roots that are aided with thorough and quick blood-supply that makes it much prone for the uptake of chemotherapy and as a result the roots are weakened and fall off resulting in acute hair-loss. Alopecia has a diverse range of effect in both the sexes, such that, the loss of facial hair from a male patient results in the display of a much younger look, whereas loss of scalp hair in both men and women leads to acute manifestation of baldness (Rugo et al.,2017). Chemotherapy also makes the patient sterile and as a result it can be concluded that, though hair loss due to the application of chemo-therapy does not count as a life-threatening incidence, but it leads to severe lowering of the morale and self-esteem of the patients. Patients are unable to accept baldness as a part of them that would now continue to be there as long as they exist. It affects the confidence level of both men and women drastically and men also suffer similar confidence-loss as compared to women who are more concerned about beauty and maintenance. Baldness creates a deep psychological effect on the patients which makes them feel unacceptable in terms of the social standards. In these critical cases, most of the times the patients are recommended to use wigs that are available from the National Health Service (Sui et al.,2013). A brochure is provided to the patients that is designed on the basis of the choice of wig and the care procedure after the regrowth of the hair. The brochure also contains information pertaining to hair loss and the medications that could be undertaken to minimize the same. Medications in the form of organic hair follicle regrow oil and gels are widely available at the dispensaries that is mostly prescribed to the patients.

Side effects of chemotherapy

Nursing interventions also include psychological counseling sessions where in the  nursing professionals interact freely with the patients and provide important tips on the factors that could be kept in mind to regrow the hair at a faster rate (Iwamoto,2013). Also. It is strictly made sure that any discussion pertaining to the permanent loss of hair and the inability of the follicles to ever regrow one strand of hair is avoided so that the patients do not feel de-motivated and discouraged. Interactions involve discussing about all the physiological changes that the patients tend to face and recording a patient history on the basis of it. Studies reveal that in many cases, patients do not feel comfortable discussing about the physiological ambiguities they experience after undertaking chemotherapy because they fear that it might to permanent stopping of the chemotherapy session and that might lead to the occurrence of death much sooner (Paus et al.,2013). Hence, the very initial process of clinical nursing intervention elucidates the development of the emotional crisis that the cancer patient is undergoing and providing emotional assistance accordingly at each and every step of the cancer treatment. Other side-effects that are most commonly reported according to the data gathered through various scientific discussion panels and journals includes issues related to ‘stomatitis’ which is basically identifies as a condition when there is an acute inflammation in the oral cavity, complete distortion of immunological responsiveness, chemotherapy induced diarrhea, nausea and vomiting, onset of hypersensitivity and complete damage of nerve tissues so much so that there is no responsiveness to external stimulus (Hirsch et al.,2013). Research papers have revealed two drugs, namely, Oxaliplatin and Taxanes to cause peripheral nerve damage in cancer patients who underwent chemo-therapy (Loven et al.,2013). Patients experiencing this problem have reported the feelings of numbness and blurred vision. Chemo-therapy has been reported to have destroyed the nerve endings permanently that are responsible for the conduction of the external stimulus to the brain.

Hence, from the clinical experiences that I have gathered so far, I can say that cancer in itself is an extremely negative word that bring back memories of suffering patients with intense pain, especially if the patients are little kids, the painful wails of the suffering patients cause a heart-wrenching experience from within. However, clinical aid incorporates the use of the best set of facility available in order to treat the patients and in most of the cases, chemotherapy due to its extensive successful rate has been recommended by oncologists and there have been many instances when the patients have not experienced any side-effects at all. Hence, it is a false notion that prevails that every chemo-therapy is coupled with a number of nasty side-effects. In most of the cases, oncologists and primary care physicians recommend pharmaceutical drugs in association with the chemo-therapy in order to minimize the possibility of side-effects but recommendations of the drugs involves the analysis of the identification of the degree to which a patient is affected and accordingly the interventions are designed. The most common concern that also counts majorly as a psychological concern includes the issue of ‘Alopecia’ and in that case, various interventions that could be undertaken to regrow the hair at a faster rate is discussed with the patient. Every attempt is undertaken to keep the spirit of the patient high and infest the patient with positive hopes towards life. Certain therapies include, hair-grafting, use of herbal hair-regrow oil and in some cases use of wigs. Counselling of the family members of the cancer patients is also done in order to make them strong such that they can offer moral support to the patient and in many instances supportive family members such as parents or spouse shave their head off in order to provide encouragement to the suffering Patient. In some of the worst cases, such as terminal stage when absolutely no hopes are left clinical trials also go an extra mile to fulfill small desires of the patient to instil a temporary feeling of happiness.

References:

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Colagiuri, B., Dhillon, H., Butow, P. N., Jansen, J., Cox, K., & Jacquet, J. (2013). Does assessing patients' expectancies about chemotherapy side effects influence their occurrence?. Journal of pain and symptom management, 46(2), 275-281.

Hirsch, H. A., Iliopoulos, D., & Struhl, K. (2013). Metformin inhibits the inflammatory response associated with cellular transformation and cancer stem cell growth. Proceedings of the National Academy of Sciences, 110(3), 972-977.

Iwamoto, T. (2013). Clinical application of drug delivery systems in cancer chemotherapy: review of the efficacy and side effects of approved drugs. Biological and Pharmaceutical Bulletin, 36(5), 715-718.

Kanti, V., Nuwayhid, R., Lindner, J., Hillmann, K., Stroux, A., Bangemann, N., ... & Garcia Bartels, N. (2014). Analysis of quantitative changes in hair growth during treatment with chemotherapy or tamoxifen in patients with breast cancer: a cohort study. British Journal of Dermatology, 170(3), 643-650.

Loven, D., Hasnis, E., Bertolini, F., & Shaked, Y. (2013). Low-dose metronomic chemotherapy: from past experience to new paradigms in the treatment of cancer. Drug discovery today, 18(3-4), 193-201.

Meacham, C. E., & Morrison, S. J. (2013). Tumour heterogeneity and cancer cell plasticity. Nature, 501(7467), 328.

Patel, M., Harrison, S., & Sinclair, R. (2013). Drugs and hair loss. Dermatologic clinics, 31(1), 67-73.

Paus, R., Haslam, I. S., Sharov, A. A., & Botchkarev, V. A. (2013). Pathobiology of chemotherapy-induced hair loss. The Lancet Oncology, 14(2), e50-e59.

Polovich, M., Whitford, J. M., & Olsen, M. M. (Eds.). (2014). Chemotherapy and biotherapy guidelines and recommendations for practice. Pittsburgh, PA: Oncology Nursing Society.

Rugo, H. S., Klein, P., Melin, S. A., Hurvitz, S. A., Melisko, M. E., Moore, A., ... & Ver Hoeve, E. S. (2017). Association between use of a scalp cooling device and alopecia after chemotherapy for breast cancer. Jama, 317(6), 606-614.

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