Other Complications and Side Effects
1. Cognitive Disorders and Delirium
Cognitive disorders and delirium are conditions in which the patient experiences a confused mental state and changes in behavior. People who have cognitive disorders or delirium may fall in and out of consciousness
and may have problems with the following: attention, memory, thinking, muscle control, awareness, sleeping and waking and emotion.
Delirium occurs frequently and suddenly and the patient’s symptoms may come and go during the day in cancer patients, especially in patients with advanced cancer.
TREATMENT OF THE CAUSES OF DELIRIUM
The standard approach to managing delirium is to find and treat the causes. Symptoms may be treated at the same time.
Treatment may include the following:
- Stopping or reducing medications that cause delirium.
- Giving fluids into the bloodstream to correct dehydration.
- Giving drugs to correct hypercalcemia (too much calcium in the blood).
- Giving antibiotics for infections.
2. Fever
The main causes of fever in cancer patients are
- Infections, a common cause of fever in cancer patients and can cause death.
- Tumor cells, which can produce various substances that can cause fever reactions.
- Graft-versus-host-disease, occurs when transplanted bone marrow or peripheral stem cells attack the patient’s tissue.
- Medications like chemotherapy drugs, biological response modifiers, and antibiotics, such as vancomycin and amphotericin.
GENERAL TREATMENTS TO RELIEVE FEVER
Along with treatment of the underlying cause of fever, comfort measures may also be helpful in relieving the discomfort that goes along with fever, chills, and sweats. During periods of fever, giving the patient plenty of liquids, removing excess clothing
and linens,and bathing or sponging the patient with lukewarm water may give relief. During periods of chills, replace wet blankets with warm, dry blankets, keep the patient away from drafts, and adjust the room temperature to improve patient comfort.
3. Gastrointestinal Complications
Gastrointestinal complications such as constipation, impaction, bowel obstruction, diarrhea, and radiation enteritis are common problems for cancer patients, with causes that include the cancer itself or treatment
of the cancer.
a) ConstipationIn persons with cancer, constipation may be a symptom of cancer, a result of a growing tumor, or a result of cancer treatment. Constipation may also be a side effect of medications for cancer or cancer pain and may be a result of other
changes in the body (organ failure, decreased ability to move, and depression). TREATMENT FOR CONSTIPATION Prevention is the best treatment for constipation through elimination of possible causes and limited use of laxatives. | | b) ImpactionPatients with impaction may have symptoms similar to patients with constipation, or they may have back pain or bladder problems. The patient’s abdomen may become distended causing difficulty in breathing, rapid heartbeat, dizziness,
and low blood pressure. TREATMENT OF IMPACTION - moistening and softening the stool with an enema
- manually removing stool from the rectum after it is softened
- use of glycerin suppositories
- Administering of Enemas and laxatives (To be administered carefully to avoid damage to the bowel instead).
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c) Bowel ObstructionThe most common cancers that cause bowel obstructions are cancers of the colon, stomach, and ovary. A bowel obstruction may be caused by a narrowing of the intestine from inflammation or damage to the bowel, tumors, scar tissue, hernias,
twisting of the bowel, or pressure on the bowel from outside the intestinal tract. It can also be caused by factors that interfere with the function of muscles, nerves, and blood flow to the bowel. |
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d) DiarrheaThe most common causes of diarrhea are - Cancer treatment (chemotherapy, radiation therapy, bone marrow transplantation, or surgery).
- Antibiotic therapy can cause inflammation of the lining of the bowel
- Infection may be caused by viruses, bacteria, fungi, or other harmful microorganisms.
- Stress and anxiety related to being diagnosed with cancer and undergoing cancer treatment
TREATMENT OF DIARRHEA Diarrhea is treated by identifying and treating the problems causing diarrhea. For example, diarrhea may be caused by stool impaction and medications to prevent constipation. The doctor may make changes in medications, diet (like having
small frequent meals or avoiding certain foods) and fluids. | | e) Radiation EnteritisRadiation therapy stops the growth of rapidly dividing cells, such as cancer cells. Since normal cells in the lining of the bowel also divide rapidly, radiation treatment can stop those cells from growing, making it difficult for bowel
tissue to repair itself. As bowel cells die and are not replaced, gastrointestinal problems develops. TREATMENT OF RADIATION ENTERITIS Treatment of enteritis includes treating the diarrhea, replacing fluid loss, improving poor bowel absorption, and relieving stomach or rectal pain. These symptoms usually get better with medications, changes in diet, and rest. If symptoms
become worse even with this treatment, then cancer treatment may have to be stopped, at least temporarily. |
4. Hypercalcaemia
Hypercalcaemia occurs in 10%-20% of people with cancer. The cancers most often associated with hypercalcaemia are cancers of the breast and lung, as well as certain cancers of the blood, particularly multiple myeloma.
Early diagnosis and treatment are not only lifesaving in the short term, but may also increase the patient’s ability to complete cancer therapy and improve the patient’s quality of life.
MANAGING HYPERCALCAEMIA
- Fluids are given to treat dehydration.
- Medication is given to stop the breakdown of bone.
The severity of the hypercalcaemia determines the amount of necessary treatment. Severe hypercalcaemia should be treated immediately and aggressively. Less severe hypercalcaemia should be treated according to the symptoms. Response to treatment is shown
by the disappearance of the symptoms of hypercalcaemia and a decrease in the level of calcium in the blood.
5. Nausea and Vomiting
Nausea is an unpleasant wavelike feeling in the back of the throat and/or stomach that may or may not result in vomiting. Vomiting is the forceful elimination of the contents of the stomach through the mouth. Although treatments
have improved, nausea and vomiting continue to be concerned side effects of cancer therapy.
TREATMENT OF ANTICIPATORY NAUSEA AND VOMITING
Treatment of anticipatory nausea and vomiting is more likely to be successful when symptoms are recognized and treated early. Although anti-nausea drugs do not seem to be effective, the following may reduce symptoms:
- Guided imagery.
- Hypnosis.
- Relaxation.
- Behavioral modification techniques.
- Distraction (such as playing video games).
TREATMENT OF ACUTE AND DELAYED NAUSEA
Acute and delayed nausea and vomiting are most commonly treated with anti-nausea drugs. Some drugs last only a short time in the body, and need to be given more often; others last somewhat longer and thus are given less frequently. Blood levels of the
drug(s) must be kept constant so that control of nausea and vomiting is effective.
The above mentioned side-effects and treatments are part of a more extensive and comprehensive booklet. To read more into the entire list of side – effects and their various treatments kindly obtain the full series of booklets on ‘Coping with
Cancer and its Side Effects from Parkway Cancer Centre.