Chemotherapy is the most widely used treatment for pediatric cancer. It involves combinations of drugs that target rapidly dividing cells. Common side effects include fatigue, anemia, inflammation of the mucous membranes, appetite loss, skin and nail changes, cognitive problems, decreased urination, brain fog, anxiety, depression, and temporary hair loss. These side effects can range from mild to debilitating and impact patients physically and emotionally as they undergo cancer treatment. Chemotherapy aims to destroy cancer cells but can also damage healthy cells, especially those in the bone marrow, digestive system, and skin. Managing side effects is an important part of cancer care.

1. Chemotherapy and its
side effects
Presented by DR Mehr Wali Shah
PGR ONCOLOGY WARD
CHC & ICH MULTAN

2. TREATMENT:
• Chemotherapy
• The most widely used modality in pediatric cancer therapy is chemotherapy
• Therapy nearly always involves combinations of drugs, such as VAC (vincristine,
dactinomycin [Actinomycin D] and cyclophosphamide) and CHOP
(cyclophosphamide, doxorubicin [hydroxydaunorubicin/Adriamycin], vincristine
[Oncovin], and prednisone.

3. • Because most antineoplastic agents are cell-cycle dependent, their adverse effects
usually are related to the proliferation kinetics of individual cell populations.
• Most susceptible are tissues or organs with high rates of cell turnover: bone marrow,
oral and intestinal mucosa, epidermis, liver, and spermatogonia.

4. • Sequential single-drug therapy rarely results in complete responses, and partial
responses usually are infrequent and transient and grow progressively shorter in
duration with each drug used.
• Combination chemotherapy is the standard when combinations of drugs with
different mechanisms of action and non-overlapping toxicities were first
demonstrated to be effective in childhood leukemia.
• Most of the cytotoxic drugs for childhood cancer are selected from several
classes of agents, including alkylating agents, antimetabolites, antibiotics,
hormones, plant alkaloids, and topoisomerase inhibitors.

5. SIDE EFFECTS OF
CHEMOTHERAPY
AFFECTING HUNDREDS OF PATIENTS
• It is very difficult to envisage the exact side effects of chemotherapy before
the treatment begins. Although there are some common signs of the
treatment, patients experience various symptoms depending on the severity
of their condition, the dose of medication and the location of cancer.
• As we know, chemotherapy is the ultimate resort to fight cancer cells
following which even the healthy cells in the body are destroyed.

6. • Only a small chunk of patients have mild or few side effects from chemotherapy, and
even fewer have no symptoms at all.
• At any given cancer treatment center in the world, you will find patients trying to cope
with the side effects of chemotherapy, which includes physically as well as emotionally
debilitating complications.

16. EXPERIENCING FATIGUE
• Fatigue is not one such symptom that you would
recognize unless it is too overpowering. In case of
patients undergoing chemotherapy, fatigue is not just a
general feeling; as a patient, one might experience sever
tiredness in doing some of the routine tasks.
• Light exercises might be helpful, but it is important to
remember that it should be very light.

17. ANEMIA OR LOW RED BLOOD CELL
COUNT
• Chemotherapy lowers the red blood cell count. Organs and tissues inside the
body get the required oxygen from red blood cells.
• If the count of red blood cell goes down extremely, the body will not get
adequate oxygen and anemia is the consequence.
• Anemic patients feel tired and that may have other symptoms like
palpitations, or irregular heartbeat.

18. • Chemotherapy induced anemia needs immediate treatment.
• Blood transfusion may be needed to improve red blood cell count.
• At a cancer treatment center, patients are given the necessary food and
treatment to improve the condition.

19. INFLAMMATION OF THE MUCOUS
MEMBRANE OR MUCOSITIS
• Chemotherapy attacks dividing cells like bone marrow
• cells, blood cells, and cells present in the mucous membranes
• lining the digestive system, including the
• esophagus, mouth, intestines, stomach and rectum to anus area.
• Chemotherapy is harsh enough to damage or destroy the cells in
• the mucous membrane.
• Some may experience pain while
• 1. Eating
• 2. Drinking
• 3. Talking.

20. APPETITE LOSS
• Loss of appetite becomes a common after effect of
• chemotherapy. Cancer cells affect the metabolism of the
• body, and it worsens after chemotherapy.
• If a patient loses appetite as a consequence of chemotherapy, it
• will improve as soon as the treatment is over, even though it
• might take some time.
• The effect of appetite loss and consequent loss of weight depend
• entirely on the chemotherapy treatment and the cancer type.

21. SKIN AND NAILS
• Chemotherapy sometimes
• affects the skin and nails. Nails
• become brittle and flaky.
• Skin may develop sensitivity
• and quickly affected by
• sunlight. Protection will be
• needed against sunlight

22. COGNITIVE PROBLEMS
• Approximately one fifth of the patients undergoing chemotherapy have reported some cognitive problem of
the other, which includes memory, thinking and attention.
• This can often lead to a severe impact on the mundane tasks.
• Symptoms could include:
• 1. Lack of concentration
• 2. Shorter span of attention
• 3. Memory problems
• 4. Comprehension problems
• 5. Judgment problems
• 6. Reasoning problems etc

23. Decreased Urination
• Less urination might indicate that chemotherapy is harming the
• kidneys.

24. Brain Fog
• Foggy thinking and memory problems are often referred to as
• having a ‘chemo brain’.
• This side effect can cause further anxiety and stress during the recovery time.

25. Anxiety and Depression
• Chemotherapy side effects add up to the stress in our daily lives and can
become overwhelming leading to anxiety or depression.

26. Hair Loss
• Chemotherapy damages the hair follicles and causes them to temporarily
stop hair regrowth.
• The side effect, however, is temporary.

27. NEUROCOGNITIVE:
• Neurocognitive deficits
• Functional deficits in:
• • Executive function
• • Sustained attention
• • Memory
• • Processing speed
• • Visual-motor integration
• Learning deficits
• Diminished IQ
• Behavioral change

28. THANK YOU