Chemotherapeutic drugs work throughout the whole body by disrupting cancer cells’ growth. The drugs can be given intravenously (most common), intra-muscularly, and by mouth. Chemotherapy for the treatment of head and neck cancers is usually given at the same time as radiation therapy and is known as chemoradiation. It can be given as adjuvant chemotherapy or as neoadjuvant chemotherapy.
Adjuvant chemotherapy is used for treatment after surgery to reduce the risk of cancer returning, and to kill cells that may have spread.
Neoadjuvant chemotherapy is administered before surgery to shrink the size of the tumor thus making it easier to remove.
Chemotherapy administered prior to chemoradiation treatment is known as induction chemotherapy.
Chemotherapy can, however, cause several temporary and long term side effects. Although these may be worse with combined radiation therapy, they generally disappear gradually after the treatment has ended.
The more common side effects are nausea, vomiting, taste alteration, diarrhea, sores (mucositis) in the mouth (resulting in problems swallowing and sensitivity in the mouth and throat), increased susceptibility to infection, anemia, hair loss, general fatigue, numbness in the hands and feet (neuropathy), hearing loss, kidney damage, radiation recall dermatitis, bleeding problems, malaise, and balance problem. Some side effects (e.g., nausea, mucositis) are generally more pronounced in those who receive radiation in combination with chemotherapy. An oncologist and other medical specialist watch for and treat these side effects.
Bruising or bleeding
A variety of renal disease can be caused by many chemotherapeutic agents. These agents can affect the glomerulus, tubules, and the interstitium of the kidney. Individuals can exhibit a variety of clinical manifestations ranging from an asymptomatic increase of their serum creatinine to acute renal failure requiring dialysis.
Chemoradiation therapy can cause progressive hearing impairment especially in those receiving the chemotherapy intravenously, with a modest deterioration of 5 decibel 4.5 years after treatment.
The cytotoxic agents most often associated with oral, pharyngeal, and esophageal symptoms of swallowing difficulty (dysphagia) are the antimetabolites such as methotrexate and fluorouracil. The radiosensitizer chemotherapies, designed to heighten the effects of radiation therapy, also increase the side effects of the radiation mucositis.
Nausea and vomiting can be treated by anti-nausea (anti-emetic) drugs. Regular mouthwashes can also help. These side effects can impact swallowing and nutrition. Accordingly, it is important to supplement one’s diet with nutritious drinks or soups. A dietitian's advice may be helpful to maintain adequate nutrition. Mucositis can lead to nutritional deficiency. Those who experience significant weight loss or recurrent episodes of dehydration may require feeding through a gastrostomy feeding tube.
Management includes meticulous oral hygiene, dietary modification, and topical anesthetics combined with an antacid and antifungal suspension ("cocktail"). Spicy, acidic, sharp, or hot food as well as alcohol should be avoided. Secondary bacterial, viral (i.e., Herpes), and fungal (i.e., Candida) infections are possible. Control of the pain (using opiates or gabapentin) may be needed.
Prevention and treatment of thrush can be found in the Preventive Care Section.
- Choosing foods that smell and taste good, even if the food is not familiar.
- Eliminating cooking smells by using an exhaust fan, cooking on an outdoor grill, or buying precooked foods. Cold or room-temperature foods also smell less.
- Eating cold or frozen food, which may taste better than hot foods. This is not the case in those receiving oxaliplatin (Eloxatin), which makes it difficult to ingest anything cold.
- Using plastic utensils and glass cookware to lessen a metallic taste.
- Trying sugar-free, mint gum or hard candies (with flavors such as mint, lemon, or orange) to mask a bitter or metallic taste in the mouth.
- Trying other protein sources (such as poultry, eggs, fish, peanut butter, beans, or dairy products) if red meats don't taste good.
- Marinating meats in fruit juices, sweet wines, salad dressings, or other sauces.
- Flavoring foods with herbs, spices, sugar, lemon, or sauces.
- Not eating one to two hours before and up to three hours after chemotherapy to prevent food aversions caused by nausea and vomiting. Additionally, avoiding favorite foods before chemotherapy helps prevent aversions to those foods.
- Rinsing with a salt and baking soda solution (½ teaspoon of salt and ½ teaspoon of baking soda in 1 cup of warm water) before meals, which may help neutralize bad tastes in the mouth.
- Keeping a clean and healthy mouth by brushing frequently and flossing daily.
- Considering zinc sulfate supplements, which may help improve taste in some people. However, one should consult with their physician before taking any dietary supplements, especially during active treatment.
Nausea and vomiting
Chemotherapy-induced nausea and vomiting (CINV) may be very distressing. CINV is a common problem with all chemotherapeutic agents. It can be acute (beginning within 1-2 hours of chemotherapy, peaking in 4-6 hours); delayed (beginning within 24 hours); chronic and anticipatory (occurring prior to treatment).
There are available therapeutic modalities that include medications andf accupuncture aimed at the prevention and treatment of CINV. Acupuncture can be used to help relieve nausea) caused by chemotherapy or other cancer drugs. Seabands (acubands) are bracelets that apply pressure to acupuncture points on the wrist and can help to reduce sickness due to chemotherapy or following surgery.
Radiation recall dermatitis
Disorders of peripheral nerves are frequent complications of chemotherapy. Chemotherapy can cause degeneration of peripheral sensory and motor nerves and cause patients to present with sensory disturbances, balance problems or weakness.
For some individuals, CIPN is just a little bothersome and they learn to deal with it. In others, however, it can be so severe that it can lead to stoppages or reduced dosages of chemotherapy. Patients experiencing any of these symptoms, are encouraged to talk with their physicians or another member of their health care team so that they can get help managing these symptoms.
- Keeping all rooms, hallways, and stairways well lit.
- Installing handrails on both sides of stairways.
- Removing small area rugs and any other clutter that could cause one to trip or slip.
- Installing grab bars in the shower or hand-grips in the tub, and laying down skid-free mats.
- Using a thermometer to check that any water used is below 110 0 F, or setting the water heater accordingly.
- Cleaning up any spilled water or liquids immediately.
- Using non-breakable dishes.
- Using potholders while cooking and rubber gloves when washing dishes.
- If driving, making sure that one can fully feel the gas and brake pedals and the steering wheel and that one can quickly move their foot from the gas pedal to the brake pedal.
- If prescribed, using a cane or walker when moving from one room to the other.
- Trouble concentrating, focusing, or paying attention
- Mental fog or disorientation
- Difficulty with spatial orientation
- Memory loss or difficulty remembering things, especially names, dates, or phone numbers
- Problems with understanding
- Difficulties with judgment and reasoning
- Impaired math, organizational, and language skills. This includes tasks such as not being able to organize thoughts, find the right word, or balance a checkbook.
- Problems multitasking
- Processing information slower
- Behavioral and emotional changes, such as irrational behavior, mood swings, inappropriate anger or crying, and socially inappropriate behavior
- Severe confusion
- Medications, including stimulants, cognition-enhancing drugs, antidepressants, and drugs that block the actions of narcotics
- Occupational therapy and vocational rehabilitation, to help people with the activities of daily living and job-related skills
- Cognitive rehabilitation and cognitive training, to help patients improve their cognitive skills and find ways to cope with these issues.
- Keeping a checklist of daily reminders
- Doing one task at a time without distractions
- Carry around a small pad and a pen or pencil to easily write down notes and reminders. Or, download a note-making app on your smartphone and tablet.
- Using a calendar and a notebook with questions and a to-do list.
- Letting friends, family, work place, and health-care team about one’s memory loss
- Getting counseling and other resources to improve memory.
- Placing sticky notes around the house and workplace to remind about important tasks.
- Use word play, such as rhyming, to help you remember things.
- Get plenty of rest.
- Keeping physically activity to increase mental alertness.
- Conduct brain-strengthening mental activities (i.e. hobbies, solving puzzles, and painting)
- Prepare for the next day by setting out the things you will need the night before.
- Color code or label certain cabinets or drawers where you store things around your home.
- Eliminating clutter, and placing things back in the same place
The following strategies can reduce fatigue and improved quality of life:
- Assess and document the level of fatigue daily by using a diary or worksheet to monitor fatigue daily. The fatigue level assessment includes monitoring its severity (none, minor, moderate, advanced) over the times the day.
- Perform regular daily tasks and activities especially during the time of day when feeling less fatigue. (based upon one’s diary or worksheet)
- Dring plenty of fluids and eat as nutritous as possible.
- avoid caffeine which dries the mouth and can disrup sleep.
- Maintain a daily exercise program.
- Allow plenty of time for sleep each night.
- Consult a social worker or psychologist, and seek support from family and friends.
- Seek evaluation and treatment of underlying medical and psychological conditions (i.e., anemia, hypothyroidism).
- Try to maintain a positive outlook.
Accupuncture may be helpful in relieving the tiredness.