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Old 03-01-2010, 11:43 PM   #1
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Miscellaneous side effects

CA Cancer J Clin. 2011 Aug 19. doi: 10.3322/caac.20124. [Epub ahead of print]
Oncologic emergencies: Pathophysiology, presentation, diagnosis, and treatment.

Lewis MA, Hendrickson AW, Moynihan TJ.

Senior Hematology and Oncology Fellow, Division of Hematology, Department of Oncology, Mayo Clinic College of Medicine, Rochester, MN.

Free Article


Oncologic emergencies can occur at any time during the course of a malignancy, from the presenting symptom to end-stage disease. Although some of these conditions are related to cancer therapy, they are by no means confined to the period of initial diagnosis and active treatment. In the setting of recurrent malignancy, these events can occur years after the surveillance of a cancer patient has been appropriately transferred from a medical oncologist to a primary care provider. As such, awareness of a patient's cancer history and its possible complications forms an important part of any clinician's knowledge base. Prompt identification of and intervention in these emergencies can prolong survival and improve quality of life, even in the setting of terminal illness. This article reviews hypercalcemia, hyponatremia, hypoglycemia, tumor lysis syndrome, cardiac tamponade, superior vena cava syndrome, neutropenic fever, spinal cord compression, increased intracranial pressure, seizures, hyperviscosity syndrome, leukostasis, and airway obstruction in patients with malignancies. Chemotherapeutic emergencies are also addressed. CA Cancer J Clin 2011;. © 2011 American Cancer Society.
Copyright © 2011 American Cancer Society, Inc.

[PubMed - as supplied by publisher]

J Investig Allergol Clin Immunol. 2011;21(2):108-12.
A new rapid desensitization protocol for chemotherapy agents.

Gastaminza G, de la Borbolla JM, Goikoetxea MJ, Escudero R, Antón J, Espinós J, Lacasa C, Fernández-Benítez M, Sanz ML, Ferrer M.

Department of Allergology and Clinical Immunology, Clinica Universidad de Navarra, Pamplona, Spain. gastaminza@unav.es




Desensitization has been used for some decades to treat patients with the allergenic drug when an alternative drug with similar efficacy and safety is not available. We present the results from a series of oncology patients desensitized at our hospital during the last 2 years.

To assess the efficacy of a new desensitization protocol in patients allergic to chemotherapy drugs.

We performed an observational retrospective study of 11 women (6 breast cancer and 5 ovarian cancer) who underwent our desensitization protocol. Four patients had immediate reactions to carboplatin, 3 to docetaxel, 3 to paclitaxel, and 1 to both docetaxel and paclitaxel. Premedication was administered in all cases. A 5-step protocol based on 5 different dilutions of the drugs was used.

We performed 39 desensitization procedures: 14 to carboplatin, 3 to oxaliplatin, 16 to docetaxel, and 6 to paclitaxel. Eight patients tolerated the full dose in 36 procedures. One patient suffered an anaphylactic reaction to carboplatin that reverted with treatment. One patient had dyspnea after a paclitaxel cycle. One patient experienced dyspnea due to chronic pulmonary thromboembolism related to her disease.

Desensitization is a useful procedure in patients who are allergic to their chemotherapy agents.

[PubMed - in process]

At her side: Derm's solutions help wife through cancer treatment


Norman, Okla. — Dermatologist Joel Holloway, M.D., is accustomed to relying on his training as a pharmacist to come up with treatment solutions for his patients’ skin conditions. Little did he know that his expertise would also help his wife, Twyla J. Smith, M.D., when she experienced extreme treatment-induced side effects during her recent bout with breast cancer.
“She had every side effect known to man from the chemo,” Dr. Holloway says. “None of the people who were doing the treatment had any answers. They were sympathetic, and that was about it.”
He discovered that inflammatory responses from treatment, whether from radiation or chemotherapy, are almost always mediated by two mechanisms. One is the prostaglandin cascade; the other, singlet (free radical) oxygen reaction.
“If you can do something to interrupt those two things, you can usually do a lot to stop the inflammatory responses,” he says.
To address the burning sensation in Dr. Smith’s hands and feet, Dr. Holloway made a solution of aspirin and vitamin C powder. “Back in the mid '70s, there was a paper that came out on treating and preventing sunburn after UV exposure, with topical aspirin. I just took that information … and projected that onto what would happen in any inflammatory response,” he says.
“We would soak her feet and hands during the time of infusion. You may do it twice a day, every day … and it was pretty remarkable, the relief that she got.”
He used desonide ointment (Desonate, Intendis), applied four times a day on the eyelids and cheeks, to protect the skin from tear burns. The ointment stopped the burning almost immediately, according to the dermatologist.
Relieving mouth pain
Dr. Smith said her mouth hurt and burned during treatment, and she did not get relief from sucking on ice, which is what patients are often told to do. Instead, Dr. Holloway gave his wife chewable baby aspirin and vitamin C tablets to suck on during infusions.
“The aspirin inhibits the prostaglandin cascade and the vitamin C inhibits the singlet oxygen-induced inflammation,”
he says.
Dr. Holloway used a different approach to address Dr. Smith’s muscle pain, after serendipitously discovering that she had small, infected fissures. Using doxycycline twice a day to address the secondary infection, he was able to stop the muscle pain in less than an hour after the first dose.
“We know that doxycycline is the most anti-inflammatory of all the tetracycline antibiotic
, but I had no idea that it would work like that,” he says.
By the time Dr. Smith underwent radiation treatment, the couple anticipated the resulting burns and prevented them with wet soaks of aspirin and vitamin C powder every day — applied as soon as possible after radiation.
“Then, I made a formula [a lotion] that contains CQ10 and alpha lipoic acid — both strong antioxidants. You put that on the area,” Dr. Holloway says.
To address the very dry skin his wife experienced from treatment, Dr. Holloway used CeraVe creams and lotions (Coria Laboratories), applied four times a day.
Dr. Holloway and his wife now are reaching out to help other cancer patients, with a group they call Hope Oklahoma.

Sanofi's Latest Challenge: Women Who Say Its Chemotherapy (Taxotere) Left Them Permanently Bald

XELODA hand foot syndrome:

Basically, the Xeloda has a way of leaking into healthy tissues and goes to the extremities.
Things that seem to help:

Udder Cream (available at Wal-Mart) Note: apply liberally but GENTLY. Vigorous rubbing can aggravate things. Apply a few times throughout day. Good to goop it on at night and wear cotton socks or gloves to keep it there.

B6 supplement, 200mg/day
" The addition of pyridoxine (200 mg/day) for ameliorating the symptoms of CAP-induced HFS allows for the administration of higher doses of CAP"

Topical Henna, purchase here: www.castleart.com
discussed here: http://xelodasideeffects.blogspot.com/
Interesting anecdote: "Henna is a natural antiseptic and the chemical in henna fills the skin cell thus it can keep hands from cracking . Field workers in India would dig small recesses in the dirt fill with henna & water ans dip their hands & feet in the mix to help prevent the skin from cracking and keep other nasty bacteria away."

Generic neosporin from Walgreens helps for splits.

Staying off feet as much as possible until things calm down may help.

Some suggestion that 5FU/Xeloda may be better tolerated at night. could try taking most of the Xeloda before bed.

Try all the above before approaching docs since they may only offer dose reduction.

Lengthy article about 5FU (active component of Xeloda) which gives a great overview of where Xeloda came from and hints at newer variations on the way (S-1)


Cancer. 2010 Apr 28. [Epub ahead of print]
Acute and late onset cognitive dysfunction associated with chemotherapy in women with breast cancer.

Wefel JS, Saleeba AK, Buzdar AU, Meyers CA.
The University of Texas M. D. Anderson Cancer Center, Section of Neuropsychology, Department of Neuro-Oncology, Houston, Texas.

BACKGROUND:: Growing evidence supports cognitive dysfunction associated with standard dose chemotherapy in breast cancer survivors. We determined the incidence, nature, and chronicity of cognitive dysfunction in a prospective longitudinal randomized phase 3 treatment trial for patients with T1-3, N0-1, M0 breast cancer receiving 5-fluorouracil, doxorubicin, and cyclophosphamide with or without paclitaxel. METHODS:: Forty-two patients underwent a neuropsychological evaluation including measures of cognition, mood, and quality of life. Patients were scheduled to be assessed before chemotherapy, during and shortly after chemotherapy, and 1 year after completion of chemotherapy. RESULTS:: Before chemotherapy, 21% (9 of 42) evidenced cognitive dysfunction. In the acute interval, 65% (24 of 37) demonstrated cognitive decline. At the long-term evaluation, 61% (17 of 28) evidenced cognitive decline after cessation of treatment. Within this group of patients, 71% (12 of 17) evidenced continuous decline from the acute interval, and, notably, 29% (5 of 17) evidenced new delayed cognitive decline. Cognitive decline was most common in the domains of learning and memory, executive function, and processing speed. Cognitive decline was not associated with mood or other measured clinical or demographic characteristics, but late decline may be associated with baseline level of performance. CONCLUSIONS:: Standard dose systemic chemotherapy is associated with decline in cognitive function during and shortly after completion of chemotherapy. In addition, delayed cognitive dysfunction occurred in a large proportion of patients. These findings are consistent with a developing body of translational animal research demonstrating both acute and delayed structural brain changes as well as functional changes associated with common chemotherapeutic agents such as 5-flouorouracil. Cancer 2010. (c) 2010 American Cancer Society.

PMID: 20564075 [PubMed - as supplied by publisher]



CABOT P.O.L. CREAM was introduced in Europe in Long Term Care facilities for the care and prevention of pressure ulcers and to provide a moisture barrier for the incontinent.
Since its introduction in the United States, it has also been found to help protect skin at risk from diabetes and peripheral vascular disease (P.V.D.) and post radiation and laser treatments and in treating psoriasis, eczema, dermatitis and dry cracked fragile skin conditions.
Many nurses and patients have reported an improvement in the appearance of aging skin.
J Endod. 2010 Sep;36(9):1588-92. Epub 2010 Jul 4.
Cytotoxic chemotherapy-induced odontalgia: a differential diagnosis for dental pain.

Zadik Y, Vainstein V, Heling I, Neuman T, Drucker S, Elad S.
Department of Oral Medicine, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel. yzadik@gmail.com

INTRODUCTION: Peripheral neurotoxicity and neuropathic pain are well-known complications of several anti-cancer chemotherapeutic agents. Such pain might cause an impairment of the patient's quality of life and is a common limiting factor of anti-cancer chemotherapy. Neurotoxicity in orofacial structures has been previously described as diffuse jaw pain or numbness. Currently, localized pulpal pain is not listed as a possible complication of cytotoxic therapy. The aim of this report was to suggest cytotoxic-induced neurotoxicity as a differential diagnosis for toothache during anti-cancer therapy.
METHODS: We described the diagnostic process in a patient suffering from severe pulpal pain in apparently intact teeth during cytotoxic therapy. A non-Hodgkin's lymphoma patient complained of 2 episodes of excruciating dental pain evoked by mouth breathing, which caused nocturnal awakenings.
RESULTS: Both episodes developed immediately after administrations of cyclophosphamide as part of an anti-cancer chemotherapy protocol. Clinical parameters and radiographic characteristics eliminated other possible dental and facial etiologies. Pulp extirpation (pulpectomy) resulted in immediate pain relief. In both episodes, cytologic evaluation of the extirpated pulp tissue failed to show inflammation or an infiltration of lymphoma cells.
CONCLUSIONS: This case presented a circumstantial relation between the clinical presentation of dental pain, with associated significant impairment of the patient's quality of life, and the timing of administrations of high-dose cyclophosphamide. It suggests that chemotherapy-induced toxicity might manifest as pulpitis-like toothache, which might present a diagnostic challenge for the dental practitioner.

PMID: 20728733 [PubMed - in process]

Help for chemobrain?

Nutritional Supplement Boosts Cognition in Healthy Women

The investigators found that participants who received low- or high-dose citicoline showed improved attention, demonstrating fewer commission and omission errors on the CPT-II compared with the placebo group.
"Women receiving the supplement made fewer errors in response to nontarget stimuli over the course of the study," Dr. McGlade said.
"Interestingly, the 250 dose produced similar results to the larger dose. The improvement was quite noteworthy, with a P value equal to .02 for the 250-mg dose and a P value equal to .03 with the 500-mg dose, and this was just after 28 days, so the effect was relatively rapid as well," she said.
It is important to know that a supplement such as citicoline can affect attention without side effects, she added.

J Clin Sleep Med. 2009 Apr 15;5(2):132-6.
The relation of trouble sleeping, depressed mood, pain, and fatigue in patients with cancer.

Stepanski EJ, Walker MS, Schwartzberg LS, Blakely LJ, Ong JC, Houts AC.

Accelerated Community Oncology Research Network, 1770 Kirby Parkway, Suite 400, Memphis, TN 38138, USA. estepanski@sosacorn.com

Free PMC Article



To evaluate the relation among several symptoms that occur commonly in cancer patients: trouble sleeping, fatigue/sleepiness, depressed mood, and pain in a large cohort of cancer patients undergoing treatment in a community oncology practice.

Demographic, clinical, and patient reported outcomes data from 11,445 cancer patients undergoing treatment in a large community oncology practice were analyzed using structural equation modeling. The data were split so that a model was constructed using half of the patients; this model was then cross-validated on the remaining patients.

Fatigue was best represented as a latent variable, and significant direct effects were found for trouble sleeping, depressed mood, and pain. Also, there were significant indirect effects of these variables on fatigue. The effect of depressed mood on fatigue and pain was mediated by trouble sleeping, and the effect of trouble sleeping on fatigue was mediated by pain.

These results predict that interventions aimed at treatment of trouble sleeping, depressed mood, and pain will improve fatigue in patients with cancer. Further, these data predict that treatment of trouble sleeping will improve pain management in this population.

[PubMed - indexed for MEDLINE]

PMCID: PMC2670332

Managing the Side Effects of Aromatase Inhibitor Therapy

The incidence of musculoskeletal issues appears to be highest in patients who are in transition into menopause, including patients who experience a loss of ovarian function secondary to chemotherapy.[15] Musculoskeletal issues appear to be most significant during the initial period that patients take AIs; they then improve over time. A retrospective analysis of the ATAC trial suggested that the presence of joint symptoms may be associated with a decreased risk for recurrence,[16] although such an association was not confirmed in an analysis of the MA.27 trial.[17] The management of musculoskeletal issues is challenging and poorly defined to date. Anti-inflammatory agents may be helpful in some patients, while many other patients can function without intervention, particularly as symptoms improve over time. There is anecdotal evidence to suggest that changing to an alternative AI may ameliorate symptoms, but as stated above, there is no evidence to suggest that one agent is less likely to cause musculoskeletal issues than another. In some patients, switching to tamoxifen, which has a lower incidence of musculoskeletal issues, may be necessary. There is some evidence to suggest that vitamin D may play some role in musculoskeletal complaints associated with AIs. In one study,[18] patients with normal or high vitamin D levels were less likely than those with low levels to report arthralgias when taking AIs. With vitamin D deficiency having been reported in more than two thirds of patients with early-stage breast cancer,[19] it would seem appropriate to check vitamin D levels and replace as necessary in patients in whom AI therapy is planned.

From a non-med standpoint, there is this on yoga:

IMPLICATIONS FOR CANCER SURVIVORS: Results of this qualitative analysis indicate that interventions to support BCS with AIAA are warranted. Yoga appears to positively impact these side effects of hormonal therapies.
Phase III evaluation of American ginseng (panax quinquefolius) to improve cancer-related fatigue: NCCTG trial N07C2.

Symptom Management/Supportive Care/Palliative Care
Patient and Survivor Care
2012 ASCO Annual Meeting
Abstract No:
J Clin Oncol 30, 2012 (suppl; abstr 9001)

Author(s): Debra L. Barton, Heshan Liu, Shaker R. Dakhil, Breanna M. Linquist, Jeff A. Sloan, Craig R. Nichols, Travis W. McGinn, Ernie P. Balcueva, Grant R. Seeger, Charles L. Loprinzi; Mayo Clinic, Rochester, MN; Cancer Center of Kansas, Wichita, KS; Virginia Mason Medical Center, Seattle, WA; Spartanburg Regional Medical Center, Spartanburg, SC; Michigan Cancer Research Consortium, Ann Arbor, MI; Altru Cancer Center, Grand Forks, ND
Abstract Disclosures

Background: Ginseng is popularly used as a treatment for fatigue, one of the most common and disabling symptoms in people diagnosed with cancer. It is termed an “adaptogen”, thought to help the body combat negative effects of stress. This trial was to evaluate 2,000 mg American Ginseng versus placebo for cancer-related fatigue (CRF). Methods: Patients with cancer undergoing or having completed curative intent treatment and experiencing fatigue, rated at least 4 on a numeric analogue fatigue scale (1-10) for ≥1 month, were eligible. Exclusion criteria included CNS lymphoma, brain malignancies, or prior use of ginseng or chronic systemic steroids. Other etiologies for fatigue, such as pain and sleep, were also excluded. Patients were randomized to receive, in a double blind manner, 2,000 mg/d of American Ginseng or placebo in BID dosing for 8 weeks. The primary endpoint was change from baseline in the general subscale of the Multidimensional Fatigue Symptom Inventory (MFSI) at 4 weeks. Other MFSI subscales and the fatigue-inertia subscale of the Profile of Mood States (POMS) were also analyzed. Data were transformed to a 0-100 scale. Results: 364 patients were enrolled from 10/2008 to 07/2011. Data at 4 and 8 weeks are provided for several fatigue endpoints in the table below; higher numbers are better. Mental, emotional and vigor subscales of the MFSI were not significantly different between arms. There were no statistically significant differences in any grade of toxicity or self reported side effects between ginseng and placebo.
Conclusions: This trial provides data to support that American Ginseng reduces general and physical CRF over 8 weeks without side effects. The treatment did not provide significant reductions in fatigue at 4 weeks and did not impact mental, emotional, and vigor dimensions of fatigue.

NOTE: Varieties of Ginseng may have estrogenic properties.
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Old 03-02-2010, 06:12 PM   #2
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Join Date: May 2008
Location: Hershey, PA. Live The Sweet Life!
Posts: 1,986
Re: Miscellaneous side effects

The guy should market a line of lotions/potions for chemo side effects! He'd make a mint.

Smile On!

Dx'd w/multifocal DCIS/IDS 3/08
7mm invasive component
Partial mast. 5/08
Stage 1b, ER 80%, PR 90%, HER-2 6.9 on FISH
0/5 nodes
4 AC, 4 TH finished 9/08
Herceptin every 3 weeks. Finished 7/09
Tamoxifen 10/08. Switched to Femara 8/09
Bilat SPM w/reconstruction 10/08
Clinical Trial w/Clondronate 12/08
Stopped Clondronate--too hard on my gizzard!
Switched back to Tamoxifen due to tendon pain from Femara

11 Years NED
I think I just might hang around awhile....

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Old 08-31-2010, 11:18 PM   #3
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Re: Miscellaneous side effects

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