Coping with chemo side effects
Thai dermatologist is conducting research into the often- overlooked side effects of chemotherapy
Like many other medical aids, chemotherapy is a double-edged sword. On the one hand, it helps fight cancer. On the other, it has a lot of side effects. Epidermal growth factor receptor inhibitors or EGFRI are a type of chemotherapy essential for advanced-stage cancers, especially for cancer of the lungs, colon, larynx and pancreas. Although commonly prescribed by oncologists, EGFRI come with skin-related side effects such as an acne-like rash on the face and upper body, dry and itchy skin, hair loss as well as inflammation around the fingernails.
Realising the physical and emotional burden of such chemotherapy-induced, skin-related complications, which in many cases are so severe that they bar patients from having a social life, Assoc Prof Dr Pawinee Rerknimitr of the Division of Dermatology, Faculty of Medicine under Chulalongkorn University, is conducting research to help patients cope with these side effects.
Her speciality in medical dermatology, Dr Pawinee’s responsibility usually involves treating skin diseases, especially those triggered by immune abnormality. So far, her research shows that around 70 to 80% of the cancer patients she analysed and who received EGFRI developed skin-related complications.
“Interestingly, the more side effects patients develop, the better their body responds to chemotherapy. But unfortunately, not everybody can stand those side effects. In some cases, they are so serious to the point that [chemotherapy] dosage has to be adjusted and reduced, lessening their chance of survival. And we are talking about cancer here, a disease that can be deadly,” said Dr Pawinee.
At Chulalongkorn University’s Division of Dermatology, Dr Pawinee has so far followed up with 40 EGFRI patients who developed said side effects. She aims to increase her sample size to 100 patients before attempting publication. This, she said, can be years from now.
Cancer cells contain receptors, which also occur on human skin. EGFRI works by blocking these receptors, disabling the cancer cells to grow. But in doing so, the receptors on the skin are attacked as well, whereby exfoliation of dead skin, hair and nails cannot function properly.
“The research examines these patients prior to their chemotherapy up to the end of their treatment course which could be a year or two. We study how the side effects progress, factors that make them worse or better and medication that can help alleviate the side effects so that patients can have a better life without the need to reduce chemotherapy dosage,” explained Dr Pawinee, also Assistant Dean for Research Affairs at Chulalongkorn University’s Faculty of Medicine.
In the end, Dr Pawinee found that the best protocol to help patients suffering chemotherapy-induced skin-related side effects is to give them time and counselling. The more patients are informed about what to expect, the more they can cope with the consequences.
“Acne-like rashes that we are talking about here can be small ones which can be just irritating or they can cause a lot of pain which affects patients’ ability to sleep. Also, because these rashes usually develop on the face and upper body, patients’ confidence in having a social life is affected.
“So apart from telling them what to prepare for, it is a must to advise preventive measures, too. For example, patients with dry and sensitive skin are more prone to having a rash, so applying moisturiser is paramount. They should also be told to avoid sunlight, which triggers the rash or use sunblock when going outside. Oral medication might be prescribed in some cases.”
Understanding and support from various branches of specialists including dermatologists, oncologists and radiologists as well as, more importantly, counselling nurses, is key, said Dr Pawinee, because if patients are not informed and kept in touch with, many of them might find the skin-related side effects unbearable.
“For these patients, moral support and encouragement plays a significant part,” said the dermatologist.
Although the research is still under way, Dr Pawinee is certain that the complete findings will soon be able to help provide better quality of life for a lot of cancer patients who struggle with chemotherapy-induced side effects.
“Above all, it can potentially be adapted and used as a guideline for treating these patients across the country,” she concluded.
SIDE EFFECTS CAN BE SO SERIOUS CHEMOTHERAPY DOSAGE HAS TO BE REDUCED, LESSENING PATIENTS’ CHANCE OF SURVIVAL