Chemotherapy helps in treating cancer as it aims to destroy rapidly multiplying cancer cells. In the process, some healthy cells are also destroyed, leading to a plethora of negative impacts. To preempt these negative impacts, oncologists offer other medications, also known as premedications, which are given prior to chemotherapy. These premedications improve the comfort of patients during treatment with utmost efficacy. 

Why Does Chemotherapy Cause Side Effects Like Nausea, Hair Fall, and More?

Chemotherapy helps in treating cancer as it aims to destroy rapidly multiplying cancer cells. However, it does not do a perfect job at differentiating cancerous cells and non-cancerous cells. For this reason, some of these non-cancerous cells get destroyed leading to common side effects. 

Let us elaborate this further.

1. Nausea and Vomiting  

Vomiting center in the brain as well as the lining of the gastrointestinal organ are rather vulnerable to impacts caused by chemotherapy. Numerous drugs used in chemotherapy, for instance, induce the vomiting center via the release of certain chemicals such as Serotonin. This gives rise to the nausea feeling, which in few instances results in repeated excessive vomiting. This necessitates the use of antiemetics before chemotherapy sessions to mitigate these impacts.

2. Hair Loss (Alopecia)

The most prevalent side effect of chemotherapy is alopecia or hair loss, as all termed. This is on account that the majority of body hair follicles undergo rapid mitotic division and during the treatment, the chemotherapy targets and destroys these. Chemotherapy has a detrimental effect on cells, hair follicles are not spared, leading to thinning or loss of hair. The extent to which hair is lost varies patient to patient, but the form of chemotherapy chosen does impact the side effect significantly pushes it towards distressing. Thunderous applause is on cue though because the hair does resume regrowth almost invariably post-treatment.    

3. Fatigue

We all know that cancer is a highly deadly disease; however, underestimating the fatigue is a problem. Chemo works wonders for tumor growth, usually putting a check to it in terminal cancer, but life when enduring the chemo becomes extremely deficient of energy. This tends to occur as their is damage inflicted to red blood cells, which leads to oxygen deficiency in the body. The fatigue emerges at an extreme low level of erythrocytes, commonly termed anemia. Fatigue calm breaches primal energy levels of a human further resulting in bouts of sleep, making chemotherapy feel like a curse rather than a treatment. The immune system works ceaselessly during the treatment trying to repair any damage while controlling inflammation. Chemo might bite back suppressing the body, yet in sheer contrast pumping in non tow energy.  

4. Mouth Sores and Digestive Issues

Chemotherapy does bore a set of unique unique identifiers or side effects that differ from treatment to treatment. One such sore flank, or hallmark if you may, that is rather cruel is mouth ulcer or sore. The mouth and gut like many other parts in the body host a lining composed of cells prone to rapid cell division and so chemotherapy has a profound ability to damage it. Chemo directly weakens these tissues leading to extremely painful mouth sores, intense pain while swallowing, and strange digestion patterns such as diarrhea, or acute constipation. Steps in mouth hygiene like following meal plans greatly assist in soothing these symptoms and restoring some form of functioning.

5. Decreased White Blood Cells

The immune system is more vulnerable to infections from microscopic organisms such as bacteria or viruses because of the low immune white blood cell count caused by chemotherapy. This can be further complicated by infections that are otherwise non-threatening. During treatment, supportive medications known as growth factors are, at times, used to stimulate the body to generate more white blood cells.

6. Skin and Nail Changes

Other patients may report having dry skin and nails that could easily splinter, along with darkening skin and nail beds. Such side effects are believed to be reversible and diminish following the conclusion of the treatment.

7. Psychological Side Effects

The body undergoing the physical trauma of chemotherapy, like hair loss or chronic fatigue, can take an emotional hit. Patients dealing with anxiety, low mood, and body image concerns is relatively common, and a majority of patients tend to use counseling or support groups during this phase.

Understanding Premedications in Chemotherapy

In the context of chemotherapy, premedications refer to an adjunct prophylactic strategy designed to mitigate or avoid chemotherapy side effects like nausea, vomiting, allergic reactions, and infection, and in some cases, include other associated problems. These are possibly tailored to the patient's regimen and treatment health history. 

1. Antiemetics: Prevention of Nausea and Vomiting

Chemotherapy, as it is known, is a widely known therapeutic procedure, which in turn has its own array of associated effects, two of the most troubling being frequent nausea and vomiting. To tackle these, antiemetic drugs are prescribed before treatment:

• 5-HT3 Receptor Antagonists: Ondansetron (Zofran) and other medications are classified as 5-HT3 receptor antagonists which block serotonin receptors to allevate chremotherapy associated nausea and vomiting. These drugs are generally supplied through intravenous means prior to the chemotherapy sessions. 
• NK1 Receptor Antagonists: Aprepitant (Emend) and its intravenous form, fosaprepitant (Ivemend) are preferred medications for neulokun Payak neurokinin receptor antagonists with secondary action emesis which lends them property to retarding vomiting. More than one known theory exists. Thus, they are frequently administered with other antiemetics. 
• Dopamine Antagonists: Available as metoclopramide and even haloperidol, these can be utilized where there is no sufficient application of various antiemetics as some of them nadir applied act upon dopamine receptors and decrease emesis. 

2. Corticosteroids 

Dexamethasone, a strong corticosteroid, increases inflammation and therefore the anti emetic effect  is enhanced. Because of these inflammation antagonists, other antiemetrics cannot counter gouterswelling or allergic reactions. 

3. Antihistamines: Mitigating the effects of an allergic reaction

In order to prevent possible allergic reactions to chemotherapy medications, antihistamines are prescribed:  

• H1 Histamine Receptor Blockers: Allergic reactions can be avoided through the use of diphenhydramine (Benadryl).  
• H2 Histamine Receptor Blockers: In order to relieve gastrointestinal discomfort, ranitidine or famotidine may be prescribed to reduce stomach acid.  

4. Acetaminophen: Fever and Mild Pain Relief  

Certain chemotherapy agents are associated with fever and mild pain which can be prevented by the use of acetaminophen (Tylenol).  

5. Benzodiazepines: Reducing Anxiety and Anticipatory Nausea  

Lorazepam (Ativan) is effective in reducing anxiety and is also useful in mitigating anticipatory nausea and vomiting, which refers to feelings of sickness before treatment, owing to the patient's conditioning.  

6. Colony Stimulating Factors: Increasing the Production of White Blood Cells  

Filgrastim (Neupogen) and pegfilgrastim (Neulasta) are administered to increase the production of blood cells in the bone marrow in order to prevent neutropenia, which can lead to severe infection due to low white blood cells.  

7. Protective Agents: Prevention of Certain Organ Damage  

Restricting hemorrhagic cystitis of the bladder by mesna when used with ifosfamide or cyclophosphamide and the prevention of cardiovascular damage from doxorubicin by dexrazoxane are examples of protective agents needed in some chemotherapeutic agents.  

8. Managing Hydration and Electrolytes  

There are fewer side effects relating to the kidneys and other toxins when adequate hydration is maintained before, during and after chemotherapy.

Final Thoughts

Premedications are recommended for patients undergoing chemotherapy for exess mitigations for side effects to occur post therapy.** Knowing the medications and their purpose allows patients to self motivate engage in active participation in their treatment plans. Discussing premedications freely with the physician assists in smoothing the execution of effective chemotherapy. 

Dr. Pooja Babbar is without a doubt one of the most highly skilled and dedicated medical oncologist for oncology patients. Dr. Babbar, with over a decade in practice, is an expert in developing personalized treatment plans for managing cancer using chemotherapy, immunotherapy, and targeted therapy. Her relentless focus on patient centered care ensures that she meets all patient needs and has enabled patients successfully overcome cancer.