Side effects o' chemo'

Some notes for prescribers and receivers!!

Using Gemcitabine and Cisplatinum

These are comments and notes that I have made solely from personal experience and the information available from the macmillan website -

I have been on a three weekly regime of cisplatinum and gemcitabine (Gem CisPlat) given intravenously on days 1 and 8 in a 28 day cycle along with a very effective antisickness regime that starts intravenously in hospital and continues from days 1-3 at home with tablets

Chemotherapy regime - Cisplatin and gemcitabine (GemCisPlat) days 1 and 8 in a 21 day cycle

The Anti nausea regime with granisetron, dexamethasone and domperidone has been very effective!

I understand that side effects may increase with the number of cycle completed, but they have not been a major problem for me after 4 cycles (started in October 2009)

- this information is drawn from personal experience, advice I have been given and reading information from the useful pages on gemcisplat on the macmillan cancer support website.

The medication damages liver cells during treatment and makes them inflammed and swollen so you may be jaundiced and look and feel worsea before getting better.

If you are receiving treatment as a day patient, the regiome is complicated and takes time so allow at least Five and a half hour infusion time in total for intravenous treatment. This allows time for you to receive extra fluids to help your kidneys, the anti sickness treatment and then chemotherapy itself.

Below are some of the side effects that have occurred for me – none have been serious

1. Painful vein during the infusion – This does not happen every time.

If it does occur, tell someone - a warm cushion gives great relief and allows the infusion to continue more slowly and painlessly.

2. Slight dizziness - during the intravenous antisickness treatment with IV dexamethasone - it passes
3. Tiredness on day 1 evening - comes on suddenly after 3-5 hours – lasts until the next morning and intermittently at times for 2-3 days
   
4. Liver pain on day 1 evening - aches at sites of the liver tumours – a sign of “let battle commence!” It continues intermittently for a few days, is eased by usual analgesia

5. Swollen ankles - on day 2 and 3 only, painless and slight

6. Dry Skin - From day 2 onwards to day 15 – helped by aqueous cream as soap and emollient

7. Skin hacks - On fingers and heels helped by cortisone cream and emollients

8. Temperature rise - In my first two cycles on day 5 – stopped by antibiotic cover
9. Constipation - starts on day 2 and increases over 4 days - managed with movicol sachetts and roughage
10. Dark urine - despite drinking lots of fluids by day and night, urine colour changes a lot between days 2-15. My blood tests have been OK so presumably the changes reflect the powerful effects of the chemotherapy on the liver and cancer cells.
11. Taste - An odd dry metallic taste before meals is associated with the need for a bowel movement - it is often eased by passing wind or stool - useful for taste improvement before a meal...! It is also helped by diluted lime juice and by Benzydamine (Difflam) mouthwash at night. It seems to be to do with the vagus nerve and its effects on bowel activity alongside its role in taste sensation in the mouth and rear part of the tongue.
    
12. Hair - It almost stopped growing after the first treatment dose and is still very slow.

13. Hearing - It is slightly diminished though I had some tinnitus before treatment started.

So, for me at least, the benfits have far outweighed the harms of the treatment. The ill effects have been inconveniences and the benefits have been slowed (if not stopped) tumour growth along with control of symptoms of pain and extended life span. If you are in the situation I am in, stick with it - it is worth it.

The treatment is based on the results of the Advanced Biliary Cancer Trial 02 carried out in the UK and published in 2009.