Chemotherapy is the treatment of infectious diseases or malignancy with drugs that destroy microorganisms or cancer cells preferentially with minimal damage to host tissues
Chemotherapy refers to treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing
2. Definition
● Chemotherapy is the treatment of infectious diseases or
malignancy with drugs that destroy microorganisms or cancer cells
preferentially with minimal damage to host tissues
● Chemotherapy refers to treatment that uses drugs to stop the
growth of cancer cells, either by killing the cells or by stopping
them from dividing
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3. ● Chemotherapy may be given by mouth, injection, or infusion, or on
the skin, depending on the type and stage of the cancer being
treated.
● It is a systemic treatment.
● It may be given alone or with other treatments, such as surgery,
radiation therapy, or biologic therapy.
● Chemotherapy is associated with a range of adverse effects (e.g.,
nausea, vomiting, increased risk of infection, and impaired growth
of healthy cells), and with some agents, an increased risk of
secondary neoplasms
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4. Chemotherapy Induced Disorders
Chemotherapy damages rapidly growing tissues, but can also be neurotoxic and lead to
peripheral neuropathy.
1. Gastrointestinal mucosa:
● Mucositis - Inflammation of the mucous membranes lining the digestive tract from the
mouth to the anus. Mucositis is a common side effect of chemotherapy and of
radiotherapy that involves any part of the digestive tract.
● Mucositis affects the rapidly dividing mucosal cells that line the mouth, throat,
stomach, and intestines (all normally have a short lifespan). If a therapy destroys these
cells, they may not be replaced right away, resulting in mucositis.
● A person with mucositis may have raw sores (ulcers) in the mouth and throat and feel
like he or she has a sunburn in the throat.
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5. 2. Hematopoiesis (myelosuppression)
● Granulocytopenia and lymphocytopenia (increased risk of infection)
● Thrombocytopenia (increased bleeding risk)
● Anemia (fatigue)
3.Hair and Skin: Alopecia (loss of hair) is due to the damage to hair follicles.
Alopecia is usually reversible on stoppage of therapy. Dermatitis and skin rashes
can occur too.
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6. 4. Chemotherapy-induced peripheral neuropathy
● Pain, burning, tingling, and loss of sensation in the distal extremities
that spread from the hands and feet.
● Typically spreads in a “stocking-glove pattern”
● Causative agents include platinum-based medications (e.g., cisplatin),
taxanes (e.g., paclitaxel), and vinca alkaloids (e.g., vincristine)
5. GIT: Nausea and vomiting are due to central action (Chemoreceptor
Trigger Zone) and peripheral action in GI tract. Most of the cytotoxic drugs
cause vomiting
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7. 6. Gonads: Cytotoxic drugs also affect gonadal cells and cause
oligozoospermia and infertility in males, amenorrhoea and infertility in
females.
7. Fetus: Administration of Cytotoxic drugs during pregnancy usually
causes abortion or teratogenic effects.
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9. Chemotherapy Agents
1. Alkylating agents: These directly damage DNA to prevent the cancer cell
from reproducing. These agents work in all phases of the cell cycle. Alkylating
agents commonly treat leukemia, lymphoma, Hodgkin disease, multiple
myeloma, sarcoma, and cancers of the lung, breast, and ovary. Because these
drugs damage DNA, they can cause long-term damage to the bone marrow.
There are different classes of alkylating agents, including: Oxaliplatin,
Nitrogen mustards, Nitrosoureas, Alkyl Sulfonates, Triazines, and
Ethylenimines.
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10. 2. Antimetabolites: This is a class of drugs that interfere with DNA and RNA
growth by substituting for the normal building blocks of RNA and DNA. They are
commonly used to treat leukemias, breast and ovary cancers. Examples include:
Capecitabine, Cladribine, Clofarabine, Cytarabine, Floxuridine, Fludarabine,
Gemcitabine, Hydroxyurea, Methotrexate, Pemetrexed, Pentostatin, and
Thioguanine.
3. Anthracyclines: These anti-tumor antibiotics interfere with enzymes involved
in DNA replication and are used for a variety of cancers. These drugs work in all
phases of the cell cycle. A major consideration when giving these drugs is that
they can permanently damage the heart if given in high doses. Because of this,
lifetime dose limits are often placed on these drugs. Examples include:
Daunorubicin, Doxorubicin, Epirubicin and Idarubicin.
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11. 4. Mitoxantrone: This anti-tumor antibiotic also interferes with enzymes involved in DNA
replication. This drug also has potential for damaging the heart and can lead to treatment-
related leukemia. Mitoxantrone is used to treat prostate cancer, breast cancer, lymphoma,
and leukemia.
5. Topoisomerase inhibitors: These drugs interfere with enzymes called topoisomerases,
which help separate the strands of DNA so they can be copied. They are used to treat certain
leukemias, as well as lung, ovarian, gastrointestinal, and other cancers. Examples include:
Topotecan, Airinotecan, Etoposide and Teniposide.
6. Mitotic inhibitors: These medications are often plant alkaloids and other compounds
derived from natural products. They can stop mitosis or inhibit enzymes from making
proteins needed for cell reproduction. They are used for breast and lung cancer, myelomas,
lymphomas, and leukemias. These drugs are known for their potential to cause peripheral
nerve damage. Examples include: Taxanes, Epothilones, Vinca alkaloids, and Estramustine.
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12. 7. Corticosteroids: Steroids are hormone-like drugs that are useful in
treating cancer including lymphoma, leukemias, and multiple myeloma.
Corticosteroids are also commonly used as anti-emetics to help prevent
nausea and vomiting caused by chemotherapy. They are also used
before chemotherapy to help prevent severe allergic reactions. When a
corticosteroid is used to prevent vomiting or allergic reactions, it’s not
considered chemotherapy. Examples include: Prednisone,
Methylprednisolone, and Dexamethasone.
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13. Medications to Treat Chemotherapy-induced Side Effects
1. Chemoprotectants: Designed to reduce toxicity of chemotherapy drugs and repair
DNA while not reducing the effectiveness of the chemotherapy drug. Amofistine is
the most common medication.
2. Vitamins and Minerals:
● Vitamin E - Vitamin E is an antioxidant and is used to protect against several side
effects of cisplatin and cytotoxic drugs such as numbness, tingling, burning, or
pain. Research studies show Vitamin E decreases these neurotoxic symptoms.
● Calcium and Magnesium Infusions - Designed to prevent neurotoxicity side
effects associated with oxaliplatin. Studies have shown that they effectively
reduce pseudolaryngospasm, neuropathy and other neurotoxic symptoms.
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14. 3. Tricyclic Antidepressants: Have analgesic effects to treat chemotherapy related
pain. Mixed evidence that they may decrease paresthesias.
4. Anticonvulsants: Carbamazepine most common. Small studies have shown that it
decreases or eliminates CIPN.
5. Glutamine: Used to treat symptoms of paclitaxel. Research shows that glutamine
reduces side effects of chemotherapy, particularly dysesthesias in the fingers and toes,
weakness, and loss of vibratory sensation.
6. Glutathione: Used to treat symptoms of platinum compounds. Shown through
research to reduce CIPN. It has also been shown to improve mood and decrease
depression. However a side effect of glutathione is weight gain.
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15. 7. Capsaicin ointment: Found to significantly decrease hypoesthesia
from diabetic neuropathy. May cause allergic reaction in a small
percentage of people.
8. Chinese Herbal Medicines: Low level evidence that these
medicines reduce nausea and vomiting and improve leukopenia and
immune system function.
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16. Systemic Involvement
Respiratory System
● Patients receiving chemotherapy are at risk for developing infection, metastatic
disease, pulmonary embolism, or drug-induced pulmonary toxicity.
● Chemo drugs commonly cause pulmonary toxicity but many other drugs may
also have an association.
● Initial presentation can be hard to detect because the patient may be
asymptomatic and changes on chest X-ray may be minimal.
● However, patients may complain of a dry cough or increasing breathlessness
with exercise. Due to the immunosuppressant effects of chemotherapy drugs,
patients may also present with infections such as pneumonia.
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17. Cardiovascular System
● Cardiac toxicity due to chemotherapy is common and may be life threatening or
cause significant morbidities.
● Common symptoms include hypotension, hypertension, arrhythmias, myocardial
infarction, congestive cardiac failure, cardiomyopathy, myocarditis, and
pericarditis, leading to pericardial effusion and cardiac tamponade.
● Cardiac toxicity can be immediate or delayed after completion of the course of
chemotherapy.
● Chemotherapy drugs tend to damage myocytes, cardiac valves, vessels and the
pericardium.
● Risk factors for cardiotoxicity include pre-existing cardiac disease, the use of
concurrent chemotherapy agents, older than the age of 70, female, and current or
previous radiation therapy involving the mediastinum.
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18. Renal System
● Several chemotherapy drugs can cause acute or chronic renal failure.
● Common chemotherapy drugs are often a cause of renal tubular and glomerular damage.
Most commonly, these medications cause: proximal tubular abnormality, hemorrhagic
cystitis, microangiopathic hemolytic anemia and renal failure.
Nervous System
● Chemotherapy can damage any part of the nervous system. Chemotherapy agents can cause
neurotoxicity, peripheral neuropathy, muscle pain, cranial neuropathy, seizures or exacerbate
pre-existing neurological conditions.
● There are also effects on the autonomic nervous system, which can cause orthostatic
hypotension. In high-doses some drugs may induce acute encephalopathy, causing confusion,
seizures, hemiparesis, and coma. It is important that physical therapists conduct a full
neurological examination to detect any neurological damage. 18
19. Gastrointestinal
● Gastrointestinal toxicity is a common side effect of most
chemotherapy drugs.
● Signs and symptoms of gastrointestinal toxicity includes: nausea
and vomiting, mucositis, diarrhea and dehydration.
● It is important that fluid and electrolytes are replenished before and
after exercise.
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20. Medical Management
Cycle
Chemotherapy is generally given at regular intervals called cycles. A chemotherapy cycle may involve
a dose of one or more drugs followed by several days or weeks without treatment. This gives normal
cells time to recover from the drug’s side effects. Sometimes, doses may be given several days in a
row, or every other day for several days, followed by a period of rest. Some drugs work best when
given continuously over a set number of days.
Cycle considerations include:
● Minimizing side effects
● Number of drugs being used
● Type of cancer
● Stage of cancer
● Health status
● Goals of treatment. 20
21. Other Management Strategies
Behavioral Therapy: Systemic desensitization has been found to significantly decrease
anticipatory N&V before chemotherapy treatments.
Exercise: Exercise may help you manage signs and symptoms during and after cancer
treatment. Gentle exercise, such as walking or swimming, may help relieve fatigue and
stress and help you sleep better.
Massage therapy: Studies have found massage can be helpful in relieving pain in people
with cancer. It may also help relieve anxiety, fatigue and stress.
Meditation: Meditation may help people with cancer by relieving anxiety and stress.
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