Restoring stomach function after chemotherapy

Chemotherapy is one of the main treatment methods in oncology. The mechanisms of action of chemotherapy drugs vary, but they all boil down to one principle: the drugs damage and destroy rapidly multiplying cancer cells.

Since chemotherapy drugs are most often administered intravenously, they spread throughout the body and attack not only tumor cells, but also healthy, actively dividing cells, in particular in hair follicles, red bone marrow, and mucous membranes (mouth, digestive tract, reproductive system). This causes side effects. Some chemotherapy drugs can damage cells of the heart, kidneys, bladder, nervous system, and lungs.

The consequences of chemotherapy are undesirable effects that are observed to one degree or another in every patient.

The side effects of chemotherapy can be managed, but require separate treatment. Euroonco specialists compile an individual list of recommendations and prescribe modern procedures that allow you to undergo treatment with the greatest possible comfort.

If you are about to undergo chemotherapy, you are likely worried about serious side effects. Here's what you need to know about it:

• There is no reliable way to predict how the body will respond to chemotherapy. Some patients have almost no side effects, while others have very severe side effects.
• There is a rule in oncology: the dose of chemotherapy should be high enough to effectively kill cancer cells, but low enough to cause minimal side effects. The doctor always looks for the “golden mean”.
• Over the past 20 years, doctors have learned to effectively prevent and treat many of the side effects of chemotherapy drugs.

Maintenance therapy helps you endure chemotherapy comfortably. This is important because reducing the dose or stopping chemotherapy reduces the chances of successful treatment and increases the risk of relapse. Doctors at Euroonco clinics know how to keep side effects under control.

Book a consultation around the clock +7+7+78

Main side effects of chemotherapy drugs

Use the quick links to find out about the side effect you are interested in:

• Hair loss
• Anemia
• Change in appetite
• Skin and nail changes
• Memory changes
• Constipation
• Weakness and fatigue
• Nausea and vomiting
• Effect on fertility in women
• Effect on fertility in men
• Mouth and throat
• Diarrhea
• Edema
• Nerves
• Urinary disorders
• Bleeding
• Infection

Using Probiotics |

• Several studies have shown that probiotics are effective in the treatment of diarrhea caused by chemotherapy: their use against the background of cytotoxic therapy prevents the development of gastrointestinal disorders, thereby preventing the development of diarrhea and vomiting.
• Also, lacto- and bifidobacteria help get rid of inflammatory bowel disease that occurs against the background of diarrhea after therapy.
• Probiotics benefit patients with ileal inflammation after colectomy and ulcerative colitis, but not Crohn's disease.
• There is strong evidence to support the use of probiotics to combat acute infectious diarrhea, which is a leading cause of gastroenteritis.
• Some studies indicate the benefit of probiotics in easing the symptoms of irritable bowel syndrome (often occurring after chemotherapy).

Hair loss (alopecia) due to chemotherapy

This side effect of chemotherapy is not harmful to health, but is often very distressing for many patients. Hair falls out because chemotherapy drugs damage the roots where cell division occurs. Alopecia does not occur in all patients. Sometimes the hair simply becomes thinner.

Hair loss usually begins a few weeks after starting chemotherapy. Sometimes they fall out quickly, in bunches, sometimes gradually. Most often, this side effect is temporary. Hair grows back 3-6 months after treatment is completed. Their color and appearance may vary slightly.

Euroonko uses Orbis cooling caps, which help prevent hair loss. When the scalp cools, the blood vessels constrict, reducing the flow of blood, which contains the chemotherapy drug, to the hair roots.

What to ask your doctor?

• Will my hair fall out during treatment?
• How to properly care for your hair?
• Is it possible to use a cooling cap to protect your hair?
• How quickly will hair grow back after chemotherapy?

Adverse reactions and complications of chemotherapy for tumor diseases

The use of antitumor chemotherapy is often accompanied by adverse reactions. Chemotherapy drugs primarily damage rapidly renewing cells of the digestive tract, bone marrow, hair follicles, etc. In addition, antitumor drugs can damage almost all normal tissues of the body.

There are 5 degrees of severity of side effects of chemotherapy drugs - from 0 to 4.

At grade 0, no changes are observed in the patient’s well-being and research data. With grade 1, there may be minor changes that do not affect the general activity of the patient and do not require medical intervention.

At grade 2, moderate changes are observed that disrupt the patient’s normal activity and vital functions; laboratory data have changed significantly and require correction.

At grade 3, there are severe disturbances that require active treatment, delay or cessation of chemotherapy.

Grade 4 is life-threatening and requires immediate discontinuation of chemotherapy.

The toxic effect of chemotherapy on hematopoiesis is the most common side effect of chemotherapy and is manifested by inhibition of all hematopoiesis. The progenitor cells of leukocytes and platelets are especially often damaged, and less often the cells responsible for the development of red blood cells.

Risk factors for the development of toxic effects of chemotherapy on the bone marrow include: previous chemotherapy and radiation therapy, age of patients over 60 years and under 1 year, general condition of the patient, exhaustion.

Inhibition of hematopoiesis is usually observed in the coming days after the administration of chemotherapy (on days 7-12). Some drugs cause delayed toxic effects.

A sharp and prolonged decrease in the number of leukocytes can lead to an increased incidence of infectious complications. In the last 20 years, there has been an increase in cases of fungal and viral infections.

With a significant decrease in the number of platelets, nosebleeds, gastrointestinal bleeding, cerebral hemorrhages, etc. may occur.

The toxic effect of chemotherapy on the gastrointestinal tract can lead to nausea, vomiting, stomatitis, enteritis and diarrhea (loose stools) as a result of damage to the mucous membranes of the oral cavity and intestines, and toxic damage to the liver.

Nausea and vomiting are not the most dangerous, but the most common and most painful manifestation of the toxic effect of chemotherapy drugs. In some cases, these reactions can even lead to refusal of treatment.

Toxic liver damage is more often detected in patients who have previously had hepatitis or have impaired liver function before the start of chemotherapy.

Cardiotoxicity (damage to the heart muscle) occurs mainly when using anthracyclines (adriamycin, rubomycin) and less often when using other drugs (cyclophosphamide, 5-fluorouracil, etoposide, etc.).

Early manifestations of cardiotoxicity include: decreased blood pressure, rapid heartbeat, rhythm disturbances, and pain in the heart area. Later symptoms of cardiotoxicity occur due to damage to the heart muscle and rhythm disturbances. Sometimes myocardial infarction may occur.

Signs of myocarditis (damage to the heart muscle) are: rapid heartbeat, shortness of breath, enlarged heart, poor circulation.

The development of cardiotoxicity is more often observed in people over 60 years of age, with heart disease, with irradiation of the lungs or mediastinum, with previous chemotherapy with drugs that have cardiotoxicity.

The toxic effect of chemotherapy drugs on lung function is rarely observed. When using bleomycin, the incidence of such a complication (pulmonitis) is 5-20%. The timing of the onset of pulmonitis varies: from several weeks when using bleomycin to 3-4 years when treating with cyclophosphmide and myelosan.

More often, this complication is detected in elderly patients, in patients with lung diseases and previously undergone chemotherapy or radiation.

Damage to the urinary system is due to the fact that most chemotherapy drugs are excreted by the kidneys. The degree of toxicity of drugs depends on their dose and concomitant kidney diseases, as well as on the age of the patient. Renal dysfunction during chemotherapy is most pronounced when using platinum.

Uric acid nephropathy. If the tumor is highly sensitive to chemotherapy, rapid tumor shrinkage (lysis syndrome) may be accompanied by an increase in the level of uric acid in the blood serum and the development of a serious kidney complication - uric acid nephropathy. The initial signs of this complication include: a decrease in the amount of urine, the appearance of a large number of uric acid crystals in the urine sediment, etc.

Allergic reactions can occur in 5-10% of patients when using various chemotherapy drugs. In patients receiving paclitaxel, docetaxel and L-asparaginase, allergic reactions are most common. When using L-asparaginase, allergic reactions are detected in 10-25% of cases.

Neurotoxicity can manifest itself in various parts of the nervous system. In most cases, it is mild, varied and is observed during treatment with many chemotherapy drugs (vincristine, etoposide, prospidine, natulan, platinum, taxol, etc.).

Symptoms of central neurotoxicity most often manifest themselves in the form of impaired attention, memory, emotional disorders, and decreased general tone. The appearance of hallucinations and agitation should be considered serious complications.

Peripheral neurotoxicity manifests itself as mild tingling in the fingers, impaired function of the upper and lower extremities, bloating, blurred vision and hearing.

Neurotoxicity can occur when chemotherapy drugs are injected into the spinal canal or when high doses are used. In this case, patients may experience headaches, dizziness, nausea, vomiting, disturbances in orientation and consciousness.

The toxic effect of chemotherapy on the skin can manifest itself in the form of redness, rash, itching, increased body temperature and decreased sensitivity.

Later, these phenomena can worsen and turn into persistent skin changes with the development of infection, hyperpigmentation of the skin, nails and mucous membranes.

Many skin and nail toxicities resolve on their own soon after chemotherapy is stopped.

Baldness (alopecia) occurs when certain chemotherapy drugs are used that damage the hair follicles. Alopecia is reversible, but is a severe mental trauma, especially for young patients and women. E

This complication often occurs during treatment with doxorubicin, epirubicin, etoposide, taxanes, and other drugs.

Complete hair restoration occurs 3-6 months after the end of chemotherapy.

Toxic fever is most often observed in 60-80% of patients receiving bleomycin. An increase in body temperature also occurs during treatment with L-asparaginase, cytosar, adriamycin, mitomycin C, fluorouracil, etoposide.

The temperature quickly returns to normal and, as a rule, does not cause chemotherapy to be discontinued.

Toxic phlebitis (inflammation of the veins) develops more often after several injections of drugs and is manifested by: severe pain along the veins during the administration of chemotherapy, thrombosis and blockage of the veins.

Most often, toxic phlebitis develops during treatment with embiquin, cytosar, vinblastine, dactinomycin, doxorubicin, rubomycin, epirubicin, dacarbazine, mitomycin C, taxanes, nevelbine and with repeated injections of drugs into the same vein.

The local toxic effect of chemotherapy drugs occurs when some of them (nitrosourea derivatives, doxorubicin, rubomycin, vincristine, vinblastine, mitomycin C, dactinomycin, etc.) get under the skin during intravenous administration. As a result, necrosis (death) of the skin and underlying tissues is possible. Late complications of chemotherapy are uncommon. They develop over a year or longer after chemotherapy.

The most dangerous complications of chemotherapy include: osteoporosis (bone loss), damage to the mucous membrane of the bladder and the emergence of new (second) malignant tumors.

In later stages, it is also possible to develop persistent suppression of the bone marrow, immune system, gonadal function, and damage to the heart and lungs.

In children treated with cyclophosamide, methotrexate, dactinomycin, adriamycin and hormones, growth and development disorders may occur

Anemia during chemotherapy

Oxygen is delivered to the tissues of the body by red blood cells - erythrocytes. Each of them lives only 3-4 months, so new ones must constantly form in the red bone marrow. Chemotherapy drugs attack red bone marrow cells, the content of red blood cells and hemoglobin in the blood decreases, and anemia develops.

Manifestations of anemia:

• weakness;
• dizziness;
• shortness of breath, feeling of lack of air;
• cardiopalmus.

Tell your doctor if you begin to experience these symptoms. Anemia requires immediate treatment. There are drugs that increase the activity of red bone marrow. In severe cases, red blood cell transfusion is indicated.

Why is the stomach damaged from exposure to cytostatics?

Chemotherapy drugs destroy any cells that are prone to rapid division, regardless of whether they are cancerous or not. These can also be healthy structures of the bone marrow, blood, gastrointestinal tract, and reproductive organs.

Cellular apoptosis, a regulated genetic process of cell death, is a natural program that is disrupted by the influence of chemistry. However, a healthy cell retains the ability to regenerate, but this requires timely and comprehensive assistance.

Changes in appetite during chemotherapy

Typically, chemotherapy causes two types of changes in appetite:

1. Decreased appetite, up to complete absence.
2. Changing the taste of foods.

It is important for cancer patients to continue to eat and drink enough fluids. Some tips will help with this:

• Train yourself to always eat at approximately the same time . Even if you are not hungry, take some food.
• Often 5-6 small meals throughout the day are better than 3 large ones.
• Try new dishes. If you don't feel like eating, eat socially with family and friends while watching TV.
• Seasonings can improve the taste of food . Ask your doctor which ones may be appropriate for you.
• Sometimes patients feel a metallic taste in the mouth. In this case, you can replace the spoon and fork with plastic ones.
• Food should be high in calories and rich in protein.
• Move more. Physical activity will help increase your appetite.
• Eat liquid foods (broths, cocktails) that are easy to swallow.
• Don't drink while eating.
• Keep a food diary , write down everything you eat, and note the time. This will help you and your doctor monitor how well you are eating.

High-calorie foods recommended during chemotherapy:

• Soups : bean, lentil, cream soups.
• Drinks : whole milk, fruit smoothies, milkshakes, drinking yoghurts.
• Snacks : beans (black and red), chicken, fish, eggs, grains, nuts, wheat germ.
• Desserts : muffins, ice cream, custard, yoghurt, puddings.
• Other products : margarine, sunflower and butter, soft cheese, sour cream, cottage cheese, milk powder, liquid meal replacements.

If you are losing weight, be sure to tell your doctor about it!

What to ask your doctor?

• What foods can you eat?
• Should I take vitamin complexes and protein shakes?
• How much fluid should you drink every day?
• What physical exercises can you do to increase your appetite?
• How to properly keep a food diary, what to write down there?
• In what cases do you need to urgently contact a doctor?

Diet and lifestyle recommendations

If you have irritable bowel syndrome, you should avoid foods that can negatively affect its walls. It is advisable to give preference to a gluten-free diet during the treatment period. The menu should be varied in order to enrich the body with proteins, micro- and macroelements, and vitamins.

Eat freshly prepared meals, eat them often and in small portions. Chew food thoroughly and slowly, avoid overeating. The diet consists of the following products:

• boiled lean meat;
• low-fat fish;
• kefir, cottage cheese, yogurt without sugar and fillers;
• jams, jelly or puree from fresh fruits;
• fresh, baked, stewed vegetables;
• vegetable oil and butter;
• egg omelet.

Complete refusal of the patient from coffee, alcoholic and carbonated drinks, and smoking. A healthy lifestyle, good sleep, mental and physical peace play a very important role. To strengthen the body's defenses, daily walks in the fresh air are necessary in any weather. Gentle types of hardening are suitable: walking in the park or along the shore of a reservoir, wiping with a wet sponge or towel.

Changes in skin and nails during chemotherapy

During chemotherapy courses you may experience: dryness, itching, redness, pain of the skin, increased sensitivity to sunlight. Hives may appear on the skin. Nails become brittle and brittle. All these symptoms should be reported to your doctor.

Skin care recommendations

• Take short showers and baths with warm water. Do not use hot water.
• When washing, do not rub the skin with a washcloth; gently stroke it.
• When using lotions and creams, ask your doctor or nurse how to use them correctly.
• The cream should be soft and gentle on the skin. Never use products that contain perfume or alcohol.
• Sometimes in the area of ​​​​skin folds (in the armpits, under the mammary glands, in the popliteal hollows) it is worth applying corn starch. This will help prevent irritation and itching.
• If shaving causes discomfort or irritation, then you should shave less often, or not shave at all.
• Protect your skin from sun rays. When leaving the house, wear long sleeves and long pants, use sunscreen and chapstick.
• Do not visit the solarium.

Nail care tips

• Keep your nails short.
• When washing dishes and cleaning, wear rubber gloves.

What should you ask your doctor?

• How to properly care for your skin and nails? What products are best to use?
• What soaps, shampoos and lotions should you not use?
• Which sunscreen and chapstick should you buy?
• What products should you use to treat your nails?
• Is it possible to get a manicure?
• What to do if your skin itches a lot?
• How to care for your skin and nails after treatment? How long will it take to do this?
• In what cases should you consult a doctor?

Changes in memory during chemotherapy

About one in five patients who receive chemotherapy experience problems with memory and thinking. They can be caused by two reasons:

1. side effects of chemotherapy drugs;
2. fatigue, anxiety, stress due to illness and treatment.

The doctor must understand the causes and prescribe treatment. Sometimes memory impairment is not severe and does not cause any special problems, in other cases it interferes with everyday activities.

Useful tips to help with memory loss:

• Plan ahead. Write them down in a diary or on colored sticky notes placed in a visible place.
• The most difficult tasks should be completed when you feel good and can concentrate as much as possible.
• Get more rest.
• , special boxes, and marks in a calendar or diary will help you take your medications on time and correctly
• Don't be shy to ask family and friends for help if you can't handle things on your own.
• Ask your family to remind you about taking medications and procedures.
• If you feel that your condition has worsened, your consciousness is confused, you need to call the doctor and ask that someone close to you be with you at all times.

What should you ask your doctor?

• Why did my memory deteriorate?
• What medications can improve it?
• What recommendations should you follow?
• How long will these violations last?
• In what cases should you urgently consult a doctor?

Prescribed treatment to restore stomach function after chemotherapy

Initially, the doctor must determine the cause of the deterioration. When it is confirmed that these are consequences of antitumor treatment, medications are prescribed to eliminate symptoms:

• Cerucal, Osetron, Zofran - antiemetics;
• Loperamide – antidiarrheal;
• Linex, Bifidumbacterin – probiotics;
• Regidron is a water-soluble powder for correcting electrolyte balance and preventing dehydration;
• Diosmectite, Polysorb - sorbents that remove harmful substances from the body;
• Guttalax, Bisacodyl, senna leaf are laxatives that stimulate peristalsis. Sometimes a cleansing enema is given or the patient is asked to take 1-2 tablespoons of castor oil. once a day.
• Our experts also recommend taking VIALIFE chlorophyll capsules, which will help minimize the side effects of toxic chemotherapy drugs in the shortest possible time, thanks to the properties of the maximum possible dosage of chlorophyll in the composition.

If tests reveal the infectious nature of diarrhea, antibiotics are prescribed.

When to see a doctor?

Tell your doctor if you are concerned about the following symptoms:

• There was no stool for more than 2 days.
• I'm worried about pain in my stomach.
• The belly has increased in size.
• Appetite has decreased, nausea and vomiting occur periodically.

How to deal with constipation?

These simple tips help many people:

• Drink enough liquid - at least 8 glasses a day. Plain water, compote, juices from fruits and vegetables, tea, coffee will do. Water will help soften the stool and make it easier to pass.
• Eat more foods rich in fiber : seeds, nuts, vegetables, fruits, whole grain bread.
• Move more. Physical activity helps strengthen intestinal motility. Walk or bike for 15-30 minutes every day. Ask your doctor what exercises may be appropriate for you.

What to ask your doctor?

• What medications will help relieve constipation?
• What's better to eat and drink?
• How much fluid should you drink daily?
• What physical exercises can you do?
• When do you need to see a doctor urgently?

How to treat diarrhea after chemotherapy

Sometimes people ask me how to treat diarrhea that occurs after or during chemotherapy for a malignant tumor. Let me remind you that chemotherapy

is the treatment of infectious, parasitic and oncological diseases with the help of drugs (chemicals).

Here is one of the questions sent in 2013:

My mother is 75 years old. She has throat cancer, took a course (30 days) of radiation, after which she underwent surgery - tracheostomy. Prescribed to take the drug Ftorafur

24 days. But due to the onset of diarrhea, I had to stop taking it for the last 6 days. And for a month now we have been struggling with my mother’s problem and almost unsuccessfully. The feces consist almost entirely of mucus, 5-6 times a day. She took Enterosgel, Linex, yogurt, Smecta, and activated charcoal. And everything is spontaneous, i.e. without a specific course. The longest break with more normal bowel movements was 1-2 days. He eats rice, semolina soup, mashed potatoes, crackers and tea. We kindly ask you to help. How to treat and what diet to follow.

Two Causes of Diarrhea During Chemotherapy

Some cancer medications are likely to cause diarrhea, but not all. Hormone therapy for cancer is not accompanied by diarrhea, but the use of cytostatics

may cause diarrhea with a 10-70% chance. The following cytostatics cause diarrhea most often:

• idarubicin
  (20-73%),
• tomudex
  (60%),
• 5-fluorouracil
  (12-57%; often in combination with
  calcium folinate
  ),
• topotecan
  (25-42%, including severe diarrhea in 5%),
• navelbine
  (18-38%),
• teniposide
  (33%),
• gemzar
  (8-31%),
• irinotecan
  (15-25% severe),
• oxaliplatin
  or
  eloxatin
  (12-25%, severe - 3-7%; in combination with
  5-fluorouracil
  and
  calcium folinate
  - 84%, including severe - 25%),
• cytarabine
  (especially in combination with
  doxorubicin
  ),
• dactinomycin
  and
  methotrexate
  (mostly taken orally).

Ftorafur

is a
5-fluorouracil
that often causes diarrhea.

Medicines used in chemotherapy are aimed at destroying uncontrollably dividing tumor cells, but indirectly damage healthy cells, which are normally characterized by rapid division. bone marrow cells are affected first

(especially leukocytes) and
the epithelium of the gastrointestinal tract
.
Ulcers may form in the intestines ( ulcerative enterocolitis
). Due to damage to the epithelium, absorption is impaired and the movement of intestinal contents is accelerated.

A second possible cause of diarrhea during chemotherapy is a low white blood cell count.

in the blood (
leukopenia
), caused by a decrease in the number of neutrophils (
neutropenia
). A low level of leukocytes contributes to the occurrence of infectious complications, including intestinal infections. An important sign of the development of infection is elevated temperature (38° C and above). Fortunately, not everyone experiences neutropenia, and effective but expensive medications are now available to prevent neutropenia. Read more: how to increase the level of neutrophils when treating tumors.

In what cases is hospitalization required?

Hospitalization

necessary in severe cases of diarrhea, especially when combined with fever:

• blood in stool
• severe dehydration (excretion of small volumes of concentrated urine, low blood pressure),
• inability to take fluids orally for any reason (impaired consciousness, vomiting),
• persistent lack of improvement with treatment at home.

The local doctor is responsible (legally responsible) for monitoring and treating the patient at home.

clinics.
Please keep him informed of the patient's situation and coordinate the desired appointments. If you are in doubt whether hospitalization is necessary, you can always call the ambulance service and get advice. A senior doctor
is on duty at the call center , who, from the perspective of his experience, will suggest the correct actions and, if necessary, dispatch an ambulance team.

Replacement of fluid losses (rehydration)

With diarrhea, there is a loss of not only fluid, but also important mineral salts.

, therefore, the larger the volume of fluid that has to be replaced, the closer the solution taken should be in composition to blood plasma.

For oral administration, ready-made pharmaceutical preparations

in bags that need to be dissolved in water. Currently sold in Russia:

• Regidron,
• Hydrovit,
• Hydrovit forte.

You can independently prepare a solution for rehydration (based on 1 liter of final solution):

• 3/4 or 1 teaspoon table salt (NaCl),
• 1 teaspoon baking soda (NaHCO3),
• 4 tablespoons granulated sugar,
• 1 glass of fruit juice (preferably apple, black currant or chokeberry).

Adding fruit juice is required to replace potassium

, which is abundant in vegetables and fruits.

Landmarks

during rehydration: normal blood pressure and (most importantly!)
a sufficient volume of urine per day
(not less than 1.5 liters, preferably 2 liters per day).

You need to drink often, but little by little. Food and drink should be warm or at room temperature (25-35° C); very hot or cold drinks are not allowed. Sour juices, fruit drinks, jellies, jelly made from the four “Cs” ( blueberries, black currants, chokeberries, bird cherry) are

), as well as weak sweet tea. Milk and coffee are prohibited. All liquid should be non-carbonated (carbon dioxide irritates the walls of the stomach).

Astringent plant extracts are also used for drinking: blueberries, chamomile, St. John's wort, oak bark, pomegranate bark, nutmeg

.

Diet for diarrhea

Nutrition for diarrhea after chemotherapy follows the same principles as for other types of diarrhea.

1. White bread, crackers, rice porridge, boiled eggs, low-fat cottage cheese, kefir, unsweetened yogurt, lean boiled meat and fish are allowed.
2. Eat only peeled fruits and vegetables, preferably boiled or baked. Bananas and boiled potatoes are ideal. Apples - first baked.
3. Limit or eliminate rough, fibrous foods and fiber (brown bread, whole grain bread, bran, etc.).
4. Avoid fatty, spicy foods and milk, alcohol, gas-forming foods (beans, peas, grapes, plums), sweets, nuts, and mushrooms.

Meals should be frequent and small.

Drug treatment of diarrhea after chemotherapy

Probiotics (Probifor or Bifidumbacterin Forte, Enterol), Loperamide, enterosorbents (Smecta or Enterosgel) are required. In addition to treatment, Nifuroxazide, Galavit, enzyme preparations (Creon 25000, etc.) can be added. More details below.

MANDATORY drugs will benefit almost all patients with diarrhea after chemotherapy

Probiotics

(beneficial bacteria)

The correct composition of intestinal microflora is necessary not only for proper digestion and intestinal function, but also for the competitive displacement of pathological pathogens. Probiotics are a must.

The best probiotic today is Probifor

, containing in each capsule or each sachet 500 million colony-forming units (CFU) of bifidobacteria. Clinical studies show that in acute infectious diarrhea, Probifor is not inferior to antibiotics. The good effect of Probifor is due to the large number of bifidobacteria sorbed on activated carbon particles, which ensure the rapid restoration of normal microflora. Probifor dosage regimen for adults: 2-3 sachets/capsules 2 times a day. The course of treatment is 7–10 days. Read the instructions before use.

How to replace Probifor

?
A complete replacement is possible only with 10-fold doses of the drug Bifidumbacterin Forte
. The composition of Bifidumbacterin Forte is similar, but 1 sachet/capsule contains only 50 million colony-forming units of bifidobacteria. Taking into account the required amount, treatment with Probifor will be cheaper.

For maintenance treatment with probiotics, you can use courses of Enterol, Linex, Bifiform, Bifilise, Acipol, Acylact, Hilak forte

and etc.

Loperamide

Loperamide

(
Imodium, Loperamide-Acri, Lopedium, Diara, Vero-Loperamide
) is not a drug, but acts on opiate receptors in the intestinal wall, producing a double antidiarrheal effect (slowing peristalsis + reducing fluid secretion into the intestinal lumen). Loperamide is taken orally. It is not a pain reliever and is available without a prescription. Loperamide is prohibited for children under 6 years of age and limited to children under 12 years of age due to high toxicity to the brain (there have been deaths).

Loperamide capsules 2 mg

are taken orally with water without chewing, and lingual tablets are taken on the tongue, after which they are swallowed with saliva without water. The initial dose is 2-4 mg, then 2 mg after each loose stool. The maximum daily dose is 16 mg. For chronic diarrhea (long-term use), 4 mg/day is recommended. If there is no stool for more than 12 hours, Loperamide should be discontinued.

Caution is needed in elderly patients and with impaired liver function (no more than 2 capsules per day).

Loperamide is an effective symptomatic

an antidiarrheal drug that reduces diarrhea regardless of its cause.
However, with infectious diarrhea, loperamide can worsen the condition ( weakness, high fever
) because pathogenic microbes are not removed during diarrhea, but remain in the intestines and poison the body from the inside. Loperamide is contraindicated for intestinal ulcers and infectious diarrhea. In case of diarrhea after chemotherapy, Loperamide should be used, because without it it is difficult to cope with diarrhea.

If loperamide is ineffective, after consultation with your doctor, octreotide

(
sandostatin
), which suppresses the secretion of regulatory hormones of the gastrointestinal tract and reduces blood flow in the abdominal organs. This is a replacement for Loperamide in desperate situations.

Enterosorbents

Enterosorbents

(
Smecta, Enterosgel
, etc.) is a well-known and popular remedy for the treatment of short-term infectious diarrhea and foodborne toxic infections. However, they are less suitable for long-term use because they absorb not only toxins, but also beneficial substances. With long-term or frequent use (longer than 1-2 weeks), a deficiency of individual nutrients cannot be ruled out.

If you have diarrhea after chemotherapy, you should not use activated charcoal.

, since there is evidence that it can mechanically irritate the intestinal villi.

It's better to use Smecta

, which additionally protects the intestinal mucosa. Smecta increases the thickness and viscosity of the protective mucous layer, which increases resistance to various irritants and toxic substances. It was found that the drug can affect the reproduction process of rotaviruses. Smecta also activates blood clotting factors, which is important for hemorrhages in the intestinal mucosa due to various harmful effects. Smecta is not absorbed in the intestine and is excreted unchanged. In the first 4-7 days, you can use Smecta 2-3 times a day, then continue 1 sachet per day. It is recommended to maintain an interval of 1–2 hours between taking Smecta and food/medicines.

A complete analogue of Smecta is Enterosgel

, but it costs 3 times more (proportional amount).

ADDITIONAL drugs are prescribed for additional indications

If you suspect an intestinal infection (fever), Nifuroxazide

and
Galavit
.

Nifuroxazide

(
Enterofuril, Ersefuril, Stopdiar
) refers to intestinal antiseptics, because
not absorbed from the gastrointestinal tract. Nifuroxazide is active against pathogenic gram-positive (staphylococci, streptococci) and some gram-negative ( salmonella, shigella, E. coli
) bacteria. Does not have cross-resistance with antibiotics and does not cause the emergence of resistant bacteria. It is stated that Nifuroxazide does not affect the normal microflora of the large intestine. Adults are prescribed 2 tablets (200 mg) 4 times a day every 6 hours for 5-6 days.

For serious intestinal infections, the use of Nifuroxazide is not enough - antibiotics

, since Nifuroxazide does not penetrate the intestinal wall and blood, but bacteria can penetrate. Antibiotics are also required when there is a combination of elevated temperature (for any unknown reason) and a low level of neutrophils in the blood (below 1500 granulocytes/mm3 of blood), and the patient must be hospitalized.

Galavit

- an anti-inflammatory immunomodulator, which shows the best effect in intestinal infections and toxic infections. For example, adding Galavit to the standard treatment of typhoid fever in children 10-14 years old speeds up recovery by 10-12 days (about half). Galavit is best used in tablets; it is 2 times cheaper than bottles or rectal suppositories. 2 tables are accepted. once, then 1 tablet. 3-4 times a day until symptoms of intoxication cease for 3-5 days.

Read on the topic: trials of Galavit in the treatment of intestinal infections at the Department of Infectious Diseases of the Russian Medical Academy of Postgraduate Education.

Enzymes

are needed if there is a suspicion of deterioration in the exocrine function of the pancreas.
With a lack of pancreatic enzymes, stool is infrequent (several times a day after meals), but of large volume, mushy, gray or light in color, fetid, “greasy” and poorly washed off the walls of the toilet. The drugs used are Creon 25000, Mezim, Panzinorm,
etc., which take 1/3 of the dose before meals, and 2/3 of the remainder during meals.

How it ended

The patient received duplicative drugs: enterosgel, smecta, activated carbon

.
You should have left Enterosgel
or
Smecta
.
Loperamide
was also added to the treatment .

After 2 weeks the answer came:

Thank you very much for your help! The ice has broken)) Everything has been restored, while, of course, my mother is sticking to her diet. I drank a little loperamide and smecta. Now he takes Lactobacterin and Linex. It’s strange, but the local doctor couldn’t prescribe anything significant...

Fatigue and weakness during chemotherapy

Increased fatigue can be associated with chemotherapy, anemia, stress and depression, insomnia, and chronic pain. Sometimes fatigue occurs only at certain times, other times it lasts all day. Be sure to tell your doctor if this makes it more difficult for you to cope with daily activities or if your fatigue does not go away even after resting.

Some tips will help improve your condition:

• Plan ahead. Do the most important ones first when you feel good.
• Ask your family for help if you can’t cope on your own.
• If you plan to continue working during treatment, take time off early and take fewer working hours .
• It is useful to keep a diary. Write down how you feel every day. This will help your doctor better monitor your condition and prescribe the best treatment.
• Eat well . Cook meals when you feel good and freeze for later.
• It is better to have 5-6 small meals during the day than 3-4 solid ones.
• Drink at least 8 glasses of liquid per day. You can take small sips throughout the day.
• Try to exercise for at least 15 minutes a day.
• Rest often . If you feel tired, don’t force yourself and continue working.
• Train yourself to nap during the day . It should last at least an hour.
• Always go to bed at the same time.
• Before going to bed, try to relax. For example, pleasant music helps.
• Your night's sleep should last at least 8 hours.

What should you ask your doctor?

• What medications will help cope with fatigue?
• What should I eat and drink?
• How much fluid should I drink every day?
• What physical exercises can make me feel better?
• How can I properly control my well-being? What information should you write down in your diary?
• In what cases should you urgently consult a doctor?

Nausea and vomiting during chemotherapy

Nausea and vomiting usually occur on days when chemotherapy is not administered. Medicines and some recommendations can help cope with these side effects:

• Limit spicy, sweet, salty, fried, fatty foods.
• If you can't stand the smell of raw food, ask your loved ones to cook it for you.
• Allow food to cool, do not eat it hot.
• Eat little, but more often. 5-6 small meals throughout the day are better than three “big” ones.
• If you find it difficult to drink a lot, take small sips of liquid throughout the day.
• During the administration of chemotherapy, you should try to relax and breathe deeply. Your loved ones can help and distract you.
• Find the best meal time for you. Some people feel fine if they eat a little before the procedure. Others are better off not eating anything.
• It is not recommended to eat or drink anything for at least an hour after the administration of chemotherapy drugs.
• Acupuncture helps some people cope with nausea.

Foods and drinks that will help improve your condition:

• Transparent broths: beef, chicken, vegetable.
• Grape or cranberry juice.
• Soda.
• Tea.
• Rehydron and other salt solutions for rehydration.
• Semolina.
• Skinless chicken, boiled or baked.
• Oatmeal.
• Cookies, crackers.
• Boiled potatoes.
• Pasta, noodles.
• Croutons (from white bread).
• White rice.
• Yogurts.
• Applesauce.
• Canned peaches and pears.
• Bananas.
• Sherbet.
• Fruit ice.
• Kissel.

What should you ask your doctor?

• What foods are recommended for me to eat?
• What foods should you limit?
• What foods should you completely avoid?
• How much fluid should you drink daily?
• Can physical therapy and acupuncture be helpful in my case? Where can you find specialists?
• Where can I find a nutritionist who can create an optimal diet?
• In what cases should you immediately consult a doctor?

Basic questions for patients regarding chemotherapy

E.B. SHAKHNOVICH, oncologist, Federal State Health Institution Central Medical Unit No. 119, FMBA of Russia Medical Unit No. 4

Despite all the advances in medicine, the diagnosis of malignant oncological disease, in common non-medical vocabulary - cancer, remains the most psychologically unacceptable diagnosis, causing a feeling of fear and hopelessness in the patient.

Treatment of oncological pathology includes a number of techniques, such as surgical treatment, radiation therapy, antitumor treatment and many others. As a rule, antitumor treatment in non-medical vocabulary is called chemotherapy, although this concept includes a number of different drugs, such as chemotherapy itself (the use of cytostatic drugs), hormone therapy, immunotherapy, targeted therapy, etc. Drugs of these groups can be used both in combination with radiation therapy, surgical treatment, and in combination with each other, which is called combined or complex treatment.

In this article we will try to answer the main questions that arise in almost all patients who are prescribed chemotherapy treatment.

How chemotherapy drugs confuse cells

The main goal of antitumor therapy is to stop the growth of the tumor, reduce its size, reduce the clinical manifestations of the disease, and in the most favorable case, lead to its complete destruction. Each type of tumor has its own set and combination of drugs, and each patient has its own individual sensitivity and development of complications during chemotherapy, so you should never rely on other patients receiving antitumor treatment.

The mechanism of cytostatic drugs is based on the fact that these substances are released by rapidly dividing body cells (tumor cells), are integrated into the life processes of tumor cells, most often during the division process, and lead to the death of malignant cells. As a rule, several cytotoxic drugs are prescribed to have different effects on the functioning of the tumor cell, which is called a treatment regimen. Each drug has its own mechanism of action and, as a result, different types of toxicity.

In the process of creating and studying treatment regimens, drugs with different mechanisms of action and toxicity are selected, i.e. Cross (same) toxicity is eliminated whenever possible, which increases the tolerability of the treatment regimen and efficiency.

A feature of chemotherapy treatment is its duration and frequency, depending on the mechanism of action of the drugs. During the break between courses, the patient is exposed to the drug; repeated administration serves to create an optimal concentration of the drug in the blood in order to maximize the effect on the tumor. Doses of chemotherapy drugs are strictly individual for each patient and are calculated taking into account the patient’s height and weight (body surface area).

But in the human body, in addition to rapidly dividing tumor cells, there are also normal cells with rapid division according to their function. These include cells of hair follicles, bone marrow (hematopoietic precursor cells), intestinal epithelium, reproductive cells, etc. Chemotherapy drugs “confuse” these cells with the cells of a malignant tumor, which leads to complications: hair loss (alopecia), decreased levels of leukocytes (leukopenia, neutropenia), nausea and vomiting, loose stools (diarrhea), stomatitis, etc.

The most difficult psychological factor

Alopecia (hair loss) is not the most important phenomenon for the patient’s health, but it raises the first question about complications during chemotherapy, because is a psychologically difficult factor, especially for young women. Not all chemotherapy drugs cause hair loss. But if the patient undergoes preventive treatment after removal of the mammary gland for cancer with the use of Doxorubicin, Adriamycin, total hair loss is expected.

As a rule, maximum hair loss begins 10-14 days after chemotherapy is administered. In this case, in order to maintain personal hygiene, it is recommended to remove hair (shave your head) at the first signs of hair loss. Alopecia is reversible, hair restoration begins after the end of chemotherapy in approximately 2-3 weeks. Hair growth is very fast and according to our observations, the growth density increases, color changes and the appearance of curly hair growth are possible.

Not the most dangerous, but a common manifestation

Nausea and vomiting are not the most dangerous, but the most common and most painful manifestation of the toxic effect of chemotherapy drugs. There are acute nausea and vomiting, delayed and waiting vomiting.

Acute nausea and vomiting develops within 24 hours of chemotherapy administration. Delayed nausea and vomiting occurs more than 24 hours after treatment and may last several days. Anticipatory vomiting usually occurs before a second course of chemotherapy during long-term chemotherapy treatment and is psychogenic in nature. Vomiting of anticipation can be caused by the very thought of the upcoming chemotherapy the day before, the appearance of the hospital, the treatment room, specific smells, etc.

The main mechanism for the occurrence of acute vomiting is the activation of 5-HT3 receptors, which are located in the brain, neurons of the gastrointestinal tract (GIT), and the vagus nerve under the influence of serotonin produced in the cells of the upper intestine. In order to relieve this complication, pharmacology offers a sufficient range of drugs both in the form of solutions and tablet forms and suppositories. In the practice of Russian doctors, the most common drugs are Zofran (Latran, Emiset) in the form of tablets, injections or suppositories, Navobane in the form of capsules and solutions, Kytril in the form of tablets and solutions (drugs are ranked according to their effectiveness).

In order to increase the antiemetic effect of these drugs, glucocorticoid hormones are additionally used, most often dexamethasone, which, in addition to its antiemetic (antiemetic) effect, has antiallergic functions during chemotherapy. The choice of antiemetic therapy depends on the type of chemotherapy drugs, which are divided into highly emetogenic, moderately emetogenic and low emetogenic.

The mechanism of cytostatic drugs is based on the fact that these substances are released by rapidly dividing body cells (tumor cells), are integrated into the life processes of tumor cells, most often during the division process, and lead to the death of malignant cells. As a rule, several cytotoxic drugs are prescribed to have different effects on the functioning of the tumor cell, which is called a treatment regimen. Each drug has its own mechanism of action and, as a result, different types of toxicity.

Psychogenic nausea and vomiting

Initially, the prescription of anti-emetic therapy is carried out solely on the basis of the doctor’s experience; then, when an individual reaction is established, anti-emetic therapy can be changed towards intensification if the effect is insufficient. The time of administration and method of administration of the drug are determined by the instructions for use. The effect of antiemetic drugs lasts on average 8-12 hours, the effectiveness ceases 48 hours after the administration of chemotherapy and is meaningless, therefore, in order to prevent and relieve delayed vomiting, we recommend the use of cerucal, and in case of severe nausea or vomiting, the administration of dexamethasone.

All drugs in the 5-HT3 antagonist group act on intestinal activity and can cause constipation and, less commonly, diarrhea. In order to reduce toxic reactions of antiemetics, it is necessary to strictly observe the intervals between doses and the maximum permitted doses. Antiemetics do not prevent preliminary nausea and vomiting, because it is psychogenic in nature, the main drugs used for preliminary nausea or vomiting are sedatives (sedatives), selected strictly individually. The main complication of vomiting is dehydration, which can lead to heart failure due to electrolyte imbalance and venous thrombosis. If this complication occurs, it is recommended to drink plenty of mineral salts. If severe vomiting occurs more than 4-5 times a day for more than 2 days, you should consult a doctor to restore electrolyte balance by intravenous administration of electrolytes.

There is an opinion among patients

The nutrition of patients during chemotherapy treatment does not require adherence to any diet and remains typical for the patient’s daily routine nutrition. However, it is necessary to follow the diet recommended for concomitant diseases, such as diabetes, stomach ulcers, cholecystitis, etc.

There is an opinion among patients that consuming foods containing glucose promotes tumor growth or that consuming milk and fermented milk products contributes to the spread of breast cancer. But these statements are not true.

When administering chemotherapy, severe pain and a burning sensation may occur at the injection site or along the vein, which is due to the adverse effects of chemotherapy on the vascular endothelium. If these sensations occur, you should additionally “rinse” the vessel with saline solution after completing chemotherapy.

Repeated administration of chemotherapy can cause the development of phlebitis and phlebosclerosis of the veins of the limb. In order to prevent these complications, it is necessary to comply with the rules for diluting drugs and the duration of their administration according to the instructions. As an additional treatment, it is necessary to use alcohol or semi-alcohol compresses on the injection area, ointments containing anticoagulants.

In case of insufficient development of the superficial peripheral veins of the upper extremities, long-term infusions of 5-fluorouracil, and expected long-term repeated chemotherapy, it is possible to install an intravenous port, which allows treatment without the use of peripheral veins of the extremities.

Injection of chemotherapy into the arm from the surgical removal of the mammary gland should be avoided, because this can increase the symptoms of lymphostasis; taking blood from this arm is quite acceptable.

Is it possible to have children after chemotherapy?

When administering chemotherapy, an iatrogenic complication is possible: necrosis of the subcutaneous tissue when the drug gets under the skin. The occurrence of these complications depends on the practical skills of the medical worker administering the drug. The resulting necrosis is characterized by rapid spread through the subcutaneous tissue and a long process of tissue regeneration.

Allergic reactions during treatment can occur in 5-10% of patients when using various chemotherapy drugs; the most dangerous in this case are taxanes, which require specific pre- and post-medication with the inclusion of large doses of glucocorticoids. The occurrence of an allergic reaction is possible at any stage of treatment, regardless of the number of previously administered similar courses of chemotherapy.

Quite often, patients are concerned about the effect of chemotherapy on sexual function. Potency may decrease during chemotherapy, but after it is completed, erectile function is fully restored.

Chemotherapy has a significant impact on the growth and development of the egg, which can be accompanied by menstrual irregularities up to aminorrhea. Women over 40 years of age may experience menopause during chemotherapy, which in some cases requires consultation with a gynecologist.

The possibility of having children during chemotherapy is excluded for both men and women. Germ cells are highly sensitive to chemotherapy, which can lead to the development of genetic defects and the birth of an underdeveloped child. Abroad, before chemotherapy, women of reproductive age undergo a preliminary pregnancy test and sign a special document on the prevention of complications during pregnancy during chemotherapy.

It is more difficult to answer the patient’s question about the possibility of having children after treatment. There remains a risk of damage to the genetic apparatus of the egg and the development of genetic defects in the child. A patient who decides to have a child under these conditions must consult an oncologist and undergo an examination by a geneticist.

The effect of chemotherapy on female fertility

Chemotherapy can lead to decreased levels of female sex hormones and premature menopause. Symptoms such as:

• Dryness, itching in the vagina, pain and discomfort during sexual intercourse.
• Hot flashes.
• Decreased sexual desire.
• Weakness, emotional instability, tendency to depression.
• Irregular periods or absence of them.
• Sweating at night.

Hormonal therapy, relaxation techniques, and artificial vaginal lubricants help to cope with these manifestations. If hot flashes are a concern, carry a fan with you. Wear light clothing under warm clothes so that they can be removed during high tide.

During chemotherapy, you need to use contraception because chemotherapy drugs damage the cells of the embryo and fetus. If you are planning to have a child in the future, you need to inform your oncologist in advance and consult with a reproductive health specialist.

The effect of chemotherapy on male fertility

Some chemotherapy drugs cause a decrease in testosterone levels in the body in men. This leads to some symptoms:

• Erectile dysfunction: difficulty getting and maintaining an erection.
• Decreased sexual desire.
• Increased fatigue.
• Irritability, tendency to depression.
• Sometimes - hot flashes, sweating.

Some medications help combat these disorders.

When a man is undergoing chemotherapy, he must use a condom during sexual intercourse, even if his partner uses other forms of contraception. Chemotherapy drugs can penetrate sperm and enter the woman’s body with it.

Oral cavity and throat

Cells in the mucous membrane of the mouth and digestive tract are constantly multiplying and renewing themselves, so chemotherapy drugs can damage them. In some patients, 7-10 days after the start of treatment, an inflammatory process occurs in the mouth - oral mucositis. The burning sensation is disturbing, like after a burn with boiling water, ulcers may appear.

Tell your doctor if you experience any of these symptoms:

• It became difficult to eat and swallow.
• Painful spots and ulcers appeared on the oral mucosa.
• Sores appeared on the inside of the lips and cheeks.
• You began to taste and smell food and objects differently.
• Saliva production has almost ceased, and my mouth is constantly dry.
• When you eat hot or cold food, pain occurs.

Recommendations from Euroonco doctors:

• Take care of your teeth regularly. Brush your teeth and tongue after every meal and before bed.
• Use a toothbrush with soft bristles or cotton swabs.
• Toothpaste should contain fluoride - it helps strengthen teeth.
• Rinse your mouth with a solution of baking soda (¼ teaspoon) and salt (1/8 teaspoon) diluted in a glass of water. After this, you need to rinse your mouth with plain water.
• Moisturize your lips with chapstick.
• Drink in small sips or through a straw.
• Choose soft foods that are easy to swallow.
• If you have pain in your mouth, you can eat scrambled eggs, porridge, and mashed potatoes.
• Broths , gravies, and sauces will help soak solid foods.
• Don't eat hot food , let it cool.
• Avoid drinking citrus and tomato juice.
• Don't drink alcoholic beverages.
• Don't drink sweet soda , limit foods that contain sugar.
• If you smoke, try to quit.

You should visit your dentist 2 weeks before starting chemotherapy. If you are having dental treatment, the treatment must be completed.

What should you ask your doctor?

• What foods and drinks should I consume?
• Can I rinse my mouth with a solution of salt and soda?
• How can you reduce pain when brushing your teeth?
• Which toothpaste is best to use?
• What medications can reduce my symptoms?
• In what cases should you urgently consult a doctor?

Life after "chemo"

Chemotherapy is one of the most effective forms of cancer treatment. It helps kill a dangerous and insidious enemy, but along with cancer, “chemistry” can also affect healthy tissues and organs.

Side effects of chemotherapy drugs affect all patients without exception. How to recover from toxic treatment and return to a full life?

The reaction is immediate, unfavorable

The main difference between malignant cells is their ability to grow rapidly. Chemotherapy drugs “find” rapidly dividing cells and attack them.

At the same time, they, alas, do not take into account that some healthy cells of the body can divide quite quickly, in particular, cells of hair follicles, blood, and epithelium of the digestive tract. They are the first to be hit by chemotherapy drugs.

By affecting the bone marrow, chemotherapy leads to a decrease in the level of leukocytes, platelets, and red blood cells. Clinically, this is manifested by fatigue, malaise, a tendency to bleed, and an increased risk of contracting various infections.

By damaging the cells of the mucous membrane of the digestive tract, “chemistry” causes the development of stomatitis and ulcers. They are accompanied by nausea, changes in taste, and loss of appetite. One of the most notorious side effects of chemo is damage to the hair follicles and subsequent hair loss.

The above list is far from complete: it includes dozens of adverse reactions affecting various organs and systems. They are united by one common property - temporary, transient nature.

Of course, during chemotherapy treatment, doctors monitor indicators and, if necessary, adjust the treatment regimen, introduce new drugs that help alleviate the condition, but the body carries out the main “restorative work” itself.

New hair growth begins within a few weeks after chemotherapy. Healthy bone marrow is restored and the number of blood cells returns to normal. Ulcerative formations in the oral cavity and digestive tract heal.

And yet, a person who has undergone chemotherapy needs long-term rehabilitation. To keep your quality of life high and the likelihood of relapse low, it is important to review your lifestyle and make adjustments if necessary.

What to change?

Physical activity

Regular exercise is an effective way to improve your condition after chemotherapy.

The American Cancer Society recommends that adults undergoing cancer treatment get at least 150 minutes of exercise per week, including strength training at least two days a week.

Some early research suggests that physical activity may help reduce the risk of cancer recurrence (1).

Important: Before starting an exercise program, you should consult with your doctor and agree on the level of exercise.

Diet

The menu after cancer treatment should be reviewed. It should be dominated by fruits, vegetables and whole grains.

For those who have undergone chemotherapy, it is recommended:

• At least 2.5 cups of fruits and vegetables every day. Cup - the amount of product that fits in the palm of your hand
• Healthy unsaturated fats found in vegetable oils, as well as omega-3 fatty acids. They are rich in fish and walnuts
• Proteins low in saturated fat, found in fish, vegetable oil, eggs, nuts, seeds, legumes
• Healthy carbohydrates - whole grains, legumes, fruits, vegetables.

Important: A complete, balanced diet ensures the supply of all necessary nutrients. But many experts are skeptical about taking vitamin supplements daily. Even if vitamins seem to be what you need, you should consult your doctor before you start taking them.

Body mass

During chemotherapy, many patients lose weight, and an important goal after treatment is to normalize it. The energy value of foods should be increased, given that high-calorie foods often contain a lot of saturated, unhealthy fats.

It is fundamentally wrong to try to increase body weight by increasing the content of fatty dairy and meat products.

Important: It is better to select a diet with a balanced benefit/harm ratio together with a nutritionist.

Rest mode

Difficulty getting proper rest and sleep is a common problem among those who have undergone chemotherapy. It is necessary to overcome them: adequate sleep helps ensure optimal functioning of organs and systems, increase cognitive capabilities, normalize hormonal levels and improve overall well-being.

To restore sleep, it is recommended:

• Avoid caffeinated drinks 8 hours before bedtime
• Stick to a daily routine
• Exercise no later than 2-3 hours before bedtime
• Avoid watching TV or working on the computer 1-2 hours before bedtime
• Provide comfortable sleeping conditions (dim the lights, eliminate loud sounds, etc.).

Important: You should not take sleeping pills without consulting your oncologist.

Stress management

All patients after chemotherapy need emotional rehabilitation. Using effective stress management strategies can improve quality of life and reduce the severity of symptoms of the underlying disease.

Diarrhea (loose stools) during chemotherapy

Chemotherapy drugs may cause your stool to become loose and frequent. During diarrhea, the body loses fluid, which can lead to serious complications. Some tips will help improve your condition and replenish fluid loss:

• Eat more often: 5-6 small meals a day instead of 3 large ones. Give preference to foods that are easy to digest.
• Drink more - 8-12 glasses of water a day.
• Clear broths, jelly, and Regidron solution help to replenish fluid loss.

Avoid foods that make diarrhea worse:

• Any alcoholic drinks.
• Caffeine, including in black and green tea.
• Fatty, spicy, fried foods.
• Dairy products. Instead, it is better to buy lactose-free products.
• Cabbage, broccoli and other foods that increase gas formation.
• Muesli, whole grain bread and other high fiber foods.
• Raw vegetables and fruits. It is better to eat canned ones instead.
• Some medications make diarrhea worse. Before taking any drug, consult your doctor.

When should you call a doctor?

If diarrhea is accompanied by some symptoms, this indicates serious problems. Contact your doctor if:

• Diarrhea and colic have been bothering me for more than a day.
• Stool frequency more than 6–7 times a day.
• My head is spinning.
• The temperature rose above 38°C.
• There was pain in the rectum, blood in the stool.

What to ask your doctor?

• What medications will help cope with loose stools?
• How much fluid should you drink daily?
• Should I take rehydration solutions?
• Where can I find a nutritionist who can recommend the optimal diet during chemotherapy?

Diarrhea during systemic treatment

Based on aggregate data, it is estimated that diarrhea occurs in 75% of those undergoing chemotherapy. Diarrhea is completely uncharacteristic of hormone therapy.

What chemotherapy drugs can cause diarrhea?

idarubicin (20-73%), raltitrexed (60%), 5-fluorouracil (12-57%; often in combination with calcium folinate), topotecan (25-42%), vinorelbine (18-38%), teniposide (33 %), gemcitabine (8-31%), irinotecan (15-25% severe), oxaliplatin or eloxatin (12-25%; in combination with 5-fluorouracil and calcium folinate - 84%), cytarabine (especially in combination with doxorubicin), dactinomycin and methotrexate (mostly taken orally), tegafur.

Diarrhea can be especially dangerous in the elderly - dehydration!

Diarrhea also occurs during radiation therapy to areas of the abdominal cavity, pelvis, and lumbar spine.

Main causes of diarrhea in cancer patients

Diarrhea can be caused by:

• damage to the intestine by tumor nodes;
• the consequences of removing part of the intestine with a tumor (short bowel syndrome), when the absorption surface is reduced and the transit time of food is reduced;
• complications of chemotherapy (direct toxic damage to rapidly dividing cells of the gastrointestinal tract by cytostatics);
• damage to the intestine due to radiation therapy, usually at a dose of over 40 Gray (its duration rarely exceeds 3 weeks after completion of the course);
• release of biologically active substances by neuroendocrine tumors (carcinoid syndrome); Along with diarrhea, patients are worried about hot flashes, bronchospasm, cyanosis, and skin lesions;
• power supply errors;
• infection, intestinal parasites, pathogenic fungi, etc. (in such cases there are characteristic general symptoms);
• renal failure (uremia) due to kidney cancer;
• diseases of other organs (gastrogenic, pancreatogenic, hepatogenic, metabolic);
• taking laxatives.

Why does diarrhea occur?

• accelerated movement of food gruel under the influence of increased intestinal contractions or, conversely, with weakened peristalsis;
• impaired absorption of fluid from altered intestinal mucosa;
• release of an inflammatory secretion into the intestinal lumen that irritates receptors, which leads to increased peristalsis and impaired absorption;
• for some neuroendocrine tumors;
• low level of white blood cells in the blood (leukopenia), caused by a decrease in the number of neutrophils (neutropenia). A low level of leukocytes contributes to the occurrence of infectious complications, including intestinal infections. An important sign of the development of infection is elevated temperature (38°C and above).

Severity of diarrhea

What foods contribute to diarrhea?

• fatty and fried foods;
• spicy and highly seasoned foods;
• caffeinated foods and drinks such as coffee, tea and chocolate;
• milk and milk-based drinks;
• chewing gum, as well as sugar-free candies that contain sorbitol or mannitol.

Diarrhea while taking irinotecan

Diarrhea is the limiting toxicity of irinotecan treatment: it may occur during or immediately after infusion (early diarrhea), which is associated with the development of a cholinergic syndrome. The effect can be controlled by administering atropine at a dose of 0.25-1.0 mg s.c. Late diarrhea, associated with the metabolism of the drug in the intestine, usually occurs 2-7 days after administration and is well controlled by taking loperamide.

If diarrhea does not stop, octreotide and various eubiotics can be used. Correct tactics not only make it easier for the patient to tolerate irinotecan, but also comply with the chemotherapy regimen without complications.

Diarrhea while taking capecitabine

If loose stools occur during treatment with capecitabine, the drug should be discontinued until the stool normalizes.

Capecitabine is not used in conjunction with antidiarrheal drugs. Diarrhea lasting more than 48 hours (especially against the background of rapid weight loss) requires fluid therapy to compensate for electrolyte disturbances and prevent hypovolemia and shock.

To normalize the water-electrolyte balance, it is possible to recommend ingesting solutions of water-electrolyte balance regulators. In the presence of pain, analgesics and antispasmodics are prescribed.

When is hospitalization required?

Hospitalization is necessary in severe cases of diarrhea, especially when combined with fever:

• blood in stool;
• severe dehydration (excretion of small volumes of concentrated urine, low blood pressure);
• inability to take fluids orally for any reason (impaired consciousness, vomiting);
• persistent lack of improvement with treatment at home.

Treatment of diarrhea

Diet correction. A low-fiber diet is prescribed because fiber stimulates intestinal motility.

Soluble fiber, found in some foods, absorbs liquid and can help relieve diarrhea. Foods High in Soluble Fiber:

• fruits: applesauce, bananas (ripe), canned fruits;
• vegetables: boiled potatoes;
• bread and pasta: oats, white rice, tapioca, pearl barley and white flour products.

During periods of severe diarrhea, it is recommended to follow the BRAT diet:

• bananas (B);
• white rice (rice, R);
• applesauce (A);
• toast (toast, T).

Drug treatment

Drug treatment is prescribed only by the attending physician.

PROBIOTICS

The correct composition of intestinal microflora is necessary not only for proper digestion and intestinal function, but also for the competitive displacement of pathological pathogens. Probiotics are a must.

LOPERAMIDE

Slows down peristalsis and reduces fluid secretion into the intestinal lumen. Loperamide is taken orally. It is not a pain reliever and is available without a prescription.

Loperamide is prohibited for children under 6 years of age and limited to children under 12 years of age due to high toxicity to the brain (there have been deaths).

If there is no bowel movement for more than 12 hours, loperamide should be discontinued. Caution is required in elderly patients and in cases of impaired liver function.

Loperamide is contraindicated for intestinal ulcers and infectious diarrhea. In case of diarrhea after chemotherapy, loperamide should be used, because without it it is difficult to cope with diarrhea.

If loperamide is ineffective, after consultation with the attending physician, octreotide is administered subcutaneously 3 times a day, which suppresses the secretion of regulatory hormones of the gastrointestinal tract and reduces blood flow in the abdominal organs. This is a replacement for loperamide in desperate situations.

ENTEROSORBENTS

They are less suitable for long-term use because they absorb not only toxins, but also beneficial substances. With long-term or frequent use (longer than 1-2 weeks), a deficiency of individual nutrients cannot be ruled out.

For diarrhea after chemotherapy, the use of activated charcoal is not recommended, as there is evidence that it can mechanically irritate the intestinal villi.

INTESTINAL ANTISEPTICS

This is a group of drugs that are effective against most pathogens of infectious diarrhea. The distinctive features of this pharmacological group are moderate systemic effects and a predominant antimicrobial effect in the cavity of the digestive canal.

ENZYME PREPARATIONS

Prescribed for suspected deterioration of pancreatic function.

With a lack of pancreatic enzymes, stool is infrequent (several times a day after meals), but of large volume, mushy, gray or light in color, fetid, “greasy” and poorly washed off the walls of the toilet.

https://chemocare.com/chemotherapy/side-effects/diarrhea-and-chemotherapy.aspx https://rassc.org/ru/recommendations/gastrointestinalnye-oslozhneniya https://www.macmillan.org.uk/information- and-support/coping/side-effects-and-symptoms/eating-problems/diarrhoea.html https://www.cancer.gov/about-cancer/treatment/side-effects/diarrhea

Swelling during chemotherapy

The occurrence of edema can be provoked by chemotherapy drugs, hormonal changes in the body, and general health (in particular, the cardiovascular system). Call your doctor immediately if you experience the following symptoms:

• Difficulty breathing.
• Feeling that the heart is not working properly.
• Rapidly, sharply occurring swelling that quickly increases.
• Unexplained weight gain - This may also be due to swelling.
• Very rare urination, a small amount of urine - this indicates that fluid is retained in the body.

Some recommendations will help improve your condition:

• Wear loose shoes.
• Try not to stand for long periods of time.
• When lying or sitting, try to raise your legs so that they are no lower than the level of your heart.
• Weigh yourself at the same time every day, keep a diary and record your results every day.
• Avoid adding salt and soy sauce to your food.
• Avoid foods that contain a lot of salt: ham, chips, sauerkraut, pickles.
• When you buy foods, be sure to read labels and check how much salt they contain.

What should you ask your doctor?

• How much salt can I consume per day?
• Should I wear compression garments?
• What kind of weight gain should you pay attention to?
• What foods should you not eat?
• How can you reduce swelling and improve the condition?

Read more about swelling due to cancer in a separate article.

Medicines and probiotics

In order for food to be better digested, you need digestive enzymes with plant enzymes and pepsin. Dietary supplements with probiotics and prebiotics will help restore microflora. You can add fermented foods, for example: lightly salted cucumbers, sauerkraut brine, kombucha infusion.

For healing the intestinal wall, mucous-enveloping decoctions of flax seeds, psyllium husks, and vegetable jelly are very useful.

We recommend taking VIALIFE capsules or VIALIFE solution, because they contain the highest possible concentration of chlorophyll, which:

• strengthens the immune system;
• enhances cell regeneration;
• saturates tissues with oxygen;
• has antioxidant, anti-inflammatory, detoxifying effects.

Restoring the intestine after chemotherapy requires long-term treatment, since it plays a significant role in the functioning of all organs and systems. Among the drugs usually used, in addition to vitamin complexes and products containing lacto- and bifidobacteria:

• antiemetics;
• painkillers and antipyretics;
• antidiarrheal;
• venotonics;
• hepatoprotectors to support the liver;
• to increase the level of platelets, leukocytes and neutrophils;
• Our experts also recommend taking VIALIFE chlorophyll capsules, which will help minimize the side effects of toxic chemotherapy drugs in the shortest possible time, thanks to the properties of the maximum possible dosage of chlorophyll in the composition.

Nervous system during chemotherapy

Chemotherapy can cause some nervous system side effects. If you notice them, you should immediately tell your doctor:

• Pain while walking.
• Rapid fatigue of the arms and legs, tingling, burning, numbness.
• Loss of balance, falling.
• Dizziness.
• Muscle spasms, cramps, pain.
• Deterioration in hand function: it has become more difficult to lift and hold objects.
• Hearing loss.
• Stomach ache.
• Constipation.

Helpful tips for people with neurological disorders:

• Remove or move carpets in your home to avoid tripping hazards.
• Screw on special grab bars in the bathroom.
• Place a non-slip mat in the bathroom.
• Wear comfortable shoes without high soles.
• Use a cane.
• Buy comfortable shoes for indoors.
• Wear rubber gloves when working in the kitchen or cleaning.
• Regularly examine your feet with a mirror, ask your loved ones for help.
• An ice pack will help reduce pain and discomfort.
• When doing chores around the house, take your time and don't overexert yourself.
• If you find it difficult to do some things, do not hesitate to ask your loved ones for help.

What should you ask your doctor?

• What medications can help treat neurological disorders?
• Should I see a chiropractor?
• What neurological problems might I have and when is it most likely to happen?
• How long will these side effects last?
• In what cases should you consult a doctor?

Urinary dysfunction during chemotherapy

Chemotherapy may change the color and smell of your urine. Ask your doctor what changes may occur. If some symptoms appear, you must inform your doctor about them:

• Chills, fever over 38°C.
• The urine turned red, orange, dark yellow, green, cloudy, and there was blood in it.
• Urination has become difficult, during which there is a burning sensation and pain.
• The urine began to smell sharp.

Some recommendations will help you:

• Drink enough liquid - at least 8 glasses daily. This can be water, juices (it is better to dilute them with water), fruit drinks, milkshakes, compotes, soups.
• Drink more water, even if you urinate a lot and often, this will help normalize your body's functioning.
• Avoid any drinks that contain alcohol or caffeine.

What should you ask your doctor?

• How much fluid should I drink daily?
• What drinks are best to drink?
• What drinks are undesirable?
• What drinks should you not take?
• In what cases should you urgently consult a doctor?

Symptoms of stomach damage

The sensitivity of the gastrointestinal tract to chemotherapy drugs is individual and selective, so it can manifest itself differently in each person. But most often it is accompanied by toxic reactions and side effects in the form of:

• painful spasms in the epigastric region;
• bowel disorders - diarrhea, which can lead to cramps due to dehydration;
• irregular, difficult bowel movements;
• decreased or lack of appetite;
• nausea, vomiting;
• changes in the concentration of hydrochloric acid in gastric juice down or up;
• heartburn;
• flatulence.

If symptoms are pronounced and continue for a long time, you should consult an oncologist.

Bleeding during chemotherapy

Chemotherapy suppresses platelet production in the red bone marrow, causing platelet levels in the blood to decrease and causing increased bleeding. Bleeding may begin due to minor tissue damage caused by everyday activities.

Recommendations for patients with increased bleeding:

• Don't go barefoot.
• Use a soft-bristled toothbrush.
• Don't blow your nose too much.
• Use only an electric razor.
• Before visiting the dentist, be sure to consult your doctor.
• Don't lift heavy objects.
• Don't drink alcohol.
• Avoid constipation, drink more fluids.
• Don't use enemas.

If there is heavy bleeding, consult a doctor immediately!

What should you ask your doctor?

• What medications will help reduce bleeding?
• What recommendations should you follow?
• May a platelet transfusion be required? In which cases?
• In what cases should you immediately consult a doctor?

Degrees of diarrhea

The severity of diarrhea is determined by the number of bowel movements per day above the baseline level. The baseline is the quantity and quality of bowel movements recorded under normal circumstances. However, individual baseline activity may vary depending on the patient's condition. For example, a person may have several bowel movements a day if:

• recently had surgery on the abdominal or pelvic area;
• diagnosed with cancer that has spread to the abdominal or pelvic area;
• other gastrointestinal diseases are present.

And the excrement can be soft, half-formed or even runny. An increase in the number of bowel movements to six loose stools per day, which is considered moderate in severity for one patient, may be only minor for another.

Diarrhea is classified by severity as follows:

• Grade I - an increase of less than 4 bowel movements per day compared to the baseline;
• II degree - an increase of 4-6 bowel movements per day compared to the baseline;
• III degree - Increase in more than 7 bowel movements per day compared to the baseline, urinary incontinence;
• Grade IV - life-threatening consequences, including extremely low blood pressure as a result of severe dehydration;
• V degree - death.

Infection during chemotherapy

Tell us immediately if you:

• Temperature 38⁰ C or higher. Ask your doctor how to take your temperature.
• You have chills.
• Cough or sore throat.
• Ear pain.
• Headache and pain in the maxillary and frontal sinuses.
• Pain or stiffness in the neck muscles.
• Skin rash.
• Ulcers, white coating on the tongue or inner cheeks.
• Redness or swelling anywhere. This is especially important if you have a catheter.
• Blood in the urine or cloudy urine.
• Pain or burning when urinating.

If you feel unwell or have symptoms that weren't there before, don't wait. Call your doctor immediately.

Follow these tips to reduce your chance of infection:

Always wash your hands:

• Before preparing and eating food,
• After the toilet,
• After being in public places. Wash your hands with warm water and soap.
• Ask your loved ones to wash their hands thoroughly as well.
• Consult your doctor about using hand sanitizer.

Follow the rules of hygiene:

• Brush your teeth after eating and before going to bed. Use a very soft toothbrush.
• If you have a catheter, try to keep the area dry and clean. Ask your nurse how to care for this area.

Try to avoid injury:

• Use an electric razor, not a regular razor.
• Wash yourself thoroughly and carefully after using the toilet. Tell your doctor if your rectal area hurts or bleeds.
• Do not touch or squeeze pimples.

Avoid contact with germs:

• Stay away from people who are contagious, especially those with a cold or flu. Avoid large crowds of people.
• Wash raw fruits and vegetables thoroughly.
• Wash your hands thoroughly after handling raw meat. Fry the meat thoroughly.
• Try to avoid people who have recently been vaccinated against measles, chickenpox, or polio.
• Have someone clean up after your pets.

Questions to ask your doctor:

1. In what cases should I call a doctor? 2. What else can I do to avoid infection? 3. How often should the temperature be measured? 4. In what cases should you call an ambulance?

Is it possible to die from chemotherapy?

In some cases, antitumor therapy can cause significant side effects, however, the death of the patient from chemotherapy is extremely unlikely. Such cases are described in the world literature, but there are very few of them, and first of all we are talking about patients with malignant tumors in the terminal stage and severe concomitant diseases. For example, there were situations when chemotherapy drugs led to a marked decrease in the level of leukocytes in the blood, immunodeficiency, and the patient developed an infection that the body could not cope with.

To ensure safety for the patient and conduct a course of chemotherapy with minimal risk of side effects, doctors at Euroonko clinics strictly adhere to the established rules:

• Before starting treatment, the patient’s condition is carefully assessed, all concomitant diseases are taken into account, and optimal drugs, dosages, and administration regimens are selected.
• In advanced stages of cancer, the question of the advisability of further treatment is always decided, and the potential benefits and risks are compared. If the disease is in a terminal stage, and chemotherapy drugs will only bring toxic effects with negligible benefits, we inform the patient about this and refer him to a hospice.
• We use the most modern, original anticancer drugs that are well tolerated by patients and have minimal risk of side effects.
• During the course of therapy, the patient's condition is carefully monitored, and regular examinations are carried out.
• Chemotherapy is carried out against the background of supportive, symptomatic therapy - they help prevent and control side effects.

Don't be afraid of chemotherapy - it helps preserve and prolong life. With the right treatment regimen, the risk of severe side effects is minimal.

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Are there effective alternatives to cytostatics?

Of course, it is available to absolutely everyone, except pregnant and lactating women, patients with severe liver and kidney failure. This unique technique, called Selective Chronophototherapy (SCPT), which is based on photodynamic therapy, is capable of activating a cascade of biochemical and cellular reactions to regulate the level of immune status indicators. A special substance is introduced into the body - chlorophyll (a natural photosensitizer of the latest generation), which accumulates in cancer cells. A laser beam is sent to the site of accumulation, capable of synchronizing with the patient’s rhythms, which makes it possible to reduce or increase the intensity of the effect. Penetrating to the required depth, it concentrates on pathological cells, destroying them, without touching healthy ones. – an organ-preserving method used instead of complex surgical operations for malignant and benign neoplasms, as well as before, after and during interventions. Compared to chemotherapy and radiation therapy, it does not produce devastating side effects and complications.

Its ability to find and destroy cancer even in the most inaccessible places is simply priceless. In this case, the surgical field does not bleed, and no scars remain on the surface of the skin.