 |
|
|
|
|
|
|
Home |
Patients |
and Clinics |
Links |
Us |
Page |
Information |
|
|
|
|
|
|
|
Home |
Patients |
and Clinics |
Links |
Us |
Page |
Information |
 |
 |
 |
|
|
Probably the most serious side-effect of chemotherapy is its effect on the blood cells. There are three types of cells produced by the bone marrow: the red cells, which carry oxygen to the two issues, the white cells, which defend the body against infection, and the platelets, which make the blood clot and prevent bleeding when you are injured. When the red cells are low in numbers, this is called anaemia. It is a side-effect of chemotherapy, but is generally not serious. It can be treated by blood transfusions, or, occasionally, use of the growth factor erythropoeitin. Certain chemotherapy drugs lower the platelets also, and this is called thrombocytopenia. Generally, chemotherapy for breast cancer and melanoma really causes serious thrombocytopenia. The white cells are separated into several different types. One group are the neutrophils which defend the body against bacterial infection. Another are the lymphocytes, which are involved in the body's immune defences. The chemotherapy used for breast cancer and melanoma affect the neutrophils in particular. The condition of having to low neutrophils is called him neutropenia. The type of chemotherapy that you will be receiving for breast cancer or melanoma usually only causes very short-lived neutropenia. Typically, the neutrophils begin to fall about 9 or 10 days after each chemotherapy treatment. They are usually only low for one or two days after which they steeply recover and they are usually back to normal levels by about Day 14. Occasionally, however, some people have much more sensitive bone marrow to chemotherapy. Sometimes this is because of previous chemotherapy in the past, sometimes it is due to having large areas of bone marrow treated with radiotherapy. In still other cases there is no particular reason. Whatever, these patients may have a more protracted period of neutropenia, sometimes lasting seven days or more. No matter what the duration of neutropenia, it may happen by chance that some bacteria get into the bloodstream during the time that the neutrophils are low. Should this happen, the body has little defence against the bacteria in the bloodstream and infection can spread rapidly. The presence of many bacteria in the bloodstream is called septicaemia. Untreated, it can result in low blood pressure, and a state of shock. Clearly, we must all be on the alert to prevent this, and I am happy to say that not one of my patients has had life-threatening shock during chemotherapy for many years and I think that is because they follow carefully the instructions that follow.   How do I know that I have an infection?
In the vast majority of cases, patients are unaware when the neutrophils are low. However, should an infection occur, the cardinal sign is fever. You will need to have a thermometer at hand at home and be sure on how to use it. Thermometers can be purchased at any pharmacy. Generally, if infection occurs while you are neutropenic, you will feel unwell, often as you do when you have the early stages of influenza, perhaps with aches and pains, mild nausea, and perhaps a headache. Most importantly, you will often feel hot, or have episodes of shivering and shaking, called "rigors". This is because you are having a fever. The golden rule is, that if you feel at all unwell at any time during your chemotherapy treatment programme, you should take your temperature. If the reading is over 38 degrees centigrade then you must present yourself as soon as possible (within one or two hours) to the nearest accident and emergency department. Ideally, that will be at the hospital where you are receiving your chemotherapy. If you are a patient of Westmead Private Hospital, you should present to the chemotherapy suite during normal hours, but if your fever occurs out of normal hours you should press the Night Bell and present to the Night Supervisor who will know exactly what to do. At your first chemotherapy visit, the chemotherapy nurses will give you a card to show when you present to the emergency department or to the after-hours staff which will explain that you are on chemotherapy and that you may be suffering from what we call "febrile neutropenia". The clinic staff will check your temperature and blood pressure and will take some blood to see how low the neutrophils are. If it is confirmed that you are febrile and neutropenic they will commence intravenous antibiotics. Normally this is very effective in bringing the temperature down very quickly, and you should be out of hospital within a few days. The chances of a febrile neutropenic episode happening in women having chemotherapy for early breast cancer, for example, are around 10-15 per cent, so you have to be a little unlucky. The most important thing, is not to delay, particularly if the fever occurs in the middle of the night, or, as sods law would have it, in the middle of the weekend. The only patients of mine who have had any problem at all have been those who thought, "it is the middle of the night and I do not want to disturb the family. I will wait to see my own doctor in the morning." That is most certainly not a good idea! The short answer is probably very little. There is no evidence that the commonly mentioned methods (staying away from small children, avoiding public transport, avoiding swimming pools and spas, etc) have any impact at all on reducing the chances of infection. Usually, the bacteria arise from the large bowel, which as you know is a seething ocean of bacteria. There is absolutely nothing that you can or should do to reduce the bacterial content in the intestine. The use of Probiotics, like natural yoghurt, may help a little but there is not proof of its efficacy. It is not generally recommended that you take preventative antibiotics, except in particular circumstances where your doctor can predict that you may be neutropenic for prolonged periods. My own practice is to use preventative ciprofloxacin 500 mg twice daily on days 9-16 after the FEC regimens. On subsequent cycles the drug Neulasta may be used to prevent neutropenia (see below). Taking antibiotics may just cause selection of bacteria that are resistant to these agents when you really need them. My advice is to live your life completely normally, without altering your routine of work, travel, and leisure at all. However, you need to be watchful for the early signs of infection and have them promptly treated. There is a drug that reduces the risk of neutropenia which, in fact, was discovered in Australia by Dr Donald Metcalf. It is called granulocyte colony stimulating factor or G-CSF. It works by stimulating the bone marrow to produce more white blood cells. It has now been made into a long-acting form. The trade name is Neulasta. In Australia it is available on the Pharmaceutical Benefits Scheme for patients who have had one episode of severe febrile neutropenia and who are receiving chemotherapy for early breast cancer. This is because it is an expensive drug, and it would be completely unnecessary to give it to all women receiving adjuvant chemotherapy just on the off chance that you might be one of the 10 per cent or so who develop febrile neutropenia. Should Neulasta be indicated in your case, I will tell you about it and prescribe it for you. Generally, it is taken on day two after chemotherapy, as close as possible to 24 hrs after your chemotherapy. It is given as an injection under the skin from a pre-loaded syringe. The chemotherapy nurses will give you or your partner instruction in how to do this. It is no more difficult than the daily injections of insulin that diabetic patients give to themselves routinely. Some patients get a reaction to Neulasta consisting of fever, or bone pain. This may occur on Day 4 or 5 post-chemotherapy and may require paracetamol or, sometimes, stronger pain killers. Often this reaction does not re-occur with subsequent injections, but it may. There is no medical evidence that any herbal preparations or health food products prevent the neutropenia induced by chemotherapy. My advice to you is save your money! | Beating Nausea | Alopecia (Hair loss) | Low blood counts and Infection | Menstrual changes and Infertility | Bad taste 'Dysgeusia' | Mouth Soreness and Ulceration | Indigestion and Heartburn | Changes in Mental Function | Nose Bleeds | Bad smells | Diarrhoea | Anaemia | Fatigue | Depression | | What's New | FAQ Page | Living with chemotherapy | Dietary Advice | Exercise | The Flu Vaccine | Insomnia | Marijuana | Alternative Medicine | Managing Menopause | Advice to Carers | Breast Cancer | Pain | Useful Tips | Chemotherapy: The What and How | MRI Screening | | Your Cancer Information | | Return Home | New Patients | Services and Clinics | Useful Links | Contact Us | Download Page | Cancer Information | |
||
 |
 |