Taken literally, any chemical treatment of cancer could be considered chemotherapy, even an antibiotic, but most often we use the term more narrowly to refer to the use of cytotoxic substances that interfere with the genes of fast-growing cells.

Chemotherapy sometimes cures cancer, sometimes slows or stops the spread of cancer to other parts of the body, sometimes prevents the recurrence of cancer that has been removed surgically, and sometimes lessens the pain and other symptoms of cancer in order to give a person a better quality of life.

One of the most exciting developments in recent years in cancer treatment is targeted chemotherapy. These are new chemo drugs that affect only specific types of cancer cells rather than all rapidly dividing cells indiscriminately. One of the benefits of their increased use is fewer side effects, as fewer cells are affected by the treatment.

Each of our cancer patients has their cells tested to see if they have anything that can function as a target for such specialized chemo drugs. For example, roughly 25% of breast cancers express something called HER2/neu, and there is now a monoclonal antibody that attacks specifically HER2/neu-positive cells. Some lymphoma cells express something called CD20. Rituxan® is an antibody that targets specifically CD20-positive cells.

Not all, or even close to all, cancers have such convenient targets for existing specialized chemo drugs. But this is a situation that is gradually improving as more research is done and more such drugs are developed.

A useful site to learn more about specific chemo drugs is www.chemocare.com. You might also wish to view a short introductory video about cancer and chemotherapy at www.careflash.com/video/chemotherapy.

Most chemotherapy is given intravenously, i.e., through an IV tube. Less often it is taken orally, as a shot, or even topically (spread directly on the body).

Over time this is changing however. It is estimated that in five to ten years, one-third of chemotherapy treatments will be given orally, and not long after that it will likely become the most common means of administering the drugs.

Sometimes there is a choice in how to take the chemo drugs, and sometimes there is not. Some drugs are available in both intravenous and oral form, and the patient is able to decide which they prefer based on their own criteria (frequency of treatment, duration of treatment, location of treatment, physical discomfort, etc.).

For other chemo drugs, the only option is to take them intravenously. Such a drug might, for example, not be properly absorbed by the gastrointestinal tract if taken orally, or might burn and damage the stomach lining.

Note that contrary to popular belief, intravenous drugs are not by nature stronger than oral drugs. Some of the strongest and most effective chemo drugs are administered intravenously, some are administered orally, some are administered in yet another way, and some are available (at the same level of strength and effectiveness) in multiple forms.

Typically when we administer intravenous chemo drugs here in the office, they are introduced into the body via a port (short for Port-A-Cath®, a brand name for a specific port, which derives from portal and catheter). A port is a small medical device inserted just under the skin, usually in the upper chest under the collarbone, that allows convenient IV access to a major vein.

The frequency and duration of intravenous chemo treatments vary considerably, depending on the precise facts of your case and which drug(s) you are getting.

Occasionally patients need only one treatment. At the opposite end, there are patients whose cancer has gone into remission that have chemo treatments regularly for the rest of their lives to prevent it coming back. In between are most patients, who receive chemo for several weeks to several months.

Treatment during these weeks or months may be as frequent as five days a week, or as infrequent as once or twice a month.

How long your treatment takes on each visit to the office can also vary. On a typical visit, the nurse will prepare you, you’ll receive some kind of anti-nausea medication and possibly other medications to head off side effects, you’ll receive your chemo drugs, and then the nurse will remove your port and get you ready to go. For the shortest treatments this whole process may be over in little more than a half hour. Usually, though, you can expect your visit to take at least an hour, and it can be several hours.

You should discuss all of this with your physician in advance. He or she can tell you how many times you’ll need to come in for treatment, and roughly how long those visits will take. It’s always best to know what to expect.

So why do some people receive chemo so much longer, more frequently, and/or in greater doses than others? It’s not necessarily because their cancer is more advanced or severe or difficult to beat. Generally it’s because some chemo drugs are harder on the body than others, and so to lessen the risk of damage we space the visits out more to give the body time to recover.

Also, some drugs have simply proven to be most effective with a short exposure, and some need to be delivered in such a way that they remain in the patient’s system longer.

There are several things you can do to make your experience getting treatment in the office more comfortable:

-Drink plenty of fluids in the 24 hours before treatment. This helps with kidney function and improves the condition of your veins.
-Eat a light meal prior to treatment, and/or eat a light lunch or snack during the treatment. (Yes, it’s usually fine to eat during your treatment, contrary to the widespread belief that chemo makes you miserable and nauseated.)
-Bring a book, music with earphones, writing journal, or something that will peacefully occupy your mind so you don’t become too bored or anxious during long treatment.
-Wear clothes in layers, as you may become either warm or cold during treatment. (We also have blankets available.)
-Wear a shirt or top that is loose or otherwise allows access to the chest under the collarbone, so that it does not need to be removed in order for us to attach the IV to the port.

Oncology drugs can be very expensive. Patients who are given prescriptions for oral chemotherapy, even though they may expect the drugs to be costly, frequently are still surprised when they discover how costly they truly are.

There are pharmacies that specialize in oncology drugs. Typically your prescriptions can be filled at the local Walgreens or CVS, but we prefer to direct you to the specialty pharmacies instead, as they provide certain advantages.

Specialty oncology pharmacies are far more likely to have the drugs you need in stock; conventional pharmacies are reluctant to keep drugs on the premises that may cost thousands of dollars for a small quantity. The specialty pharmacies have more experience dealing with insurance companies about oncology drugs, and are more likely, for instance, to know when a drug might be covered if it is classified as a chemotherapy benefit rather than a drug benefit. In general they’ll go the extra mile for a cancer patient, whereas a conventional pharmacy might or might not.

The oncology pharmacies we work with will typically deliver the drugs right to your door by courier or mail order.

We’ll work with you on an individual basis to be sure that you understand any prescriptions you receive, and that you understand the costs and how to deal with them. You may for some drugs, for instance, need to be registered with a drug company who will then communicate with your insurance company to make sure you are being covered for everything you should be. We also will typically give certain prescriptions well before you need to start taking the medication, to allow for any possible delay in obtaining them.

Chemotherapy introduces toxic substances into your body. Not as a byproduct or as a flaw, but intentionally. These killer substances attack cancer cells, but other of your cells are vulnerable to them as well. (Though as noted above, this situation is improving as more advanced chemo drugs that precisely target certain kinds of cancer cells are developed.)

Because the chemo drugs seek out and attack fast multiplying cells, the cells they can most damage (besides the cancer cells themselves) include those found in the hair follicles, bone marrow, gastrointestinal tract, and reproductive system, as these are the cells your body most rapidly generates. Chemotherapy’s side effects largely derive from the damage these cells sustain. These cells usually are replenished quickly, making the damage temporary, but in the short term, if countermeasures are not taken, your body may let you know in unpleasant ways that it’s under internal attack.

So a big part of administering chemotherapy is providing additional treatment to deal with all the potential adverse effects of introducing strong toxic chemicals into your system. Just as a bitter tasting medicine may be given a sweet coating to make it more palatable to a child, your chemo drugs may be combined with anti-nausea medication and other mitigating extras to make them easier for your system to handle.

There’s a standard regimen that goes with each chemo drug, but that’s just a starting point. How a patient’s body responds to treatment gives us vital information that can be used to tweak the procedure on subsequent occasions, to deviate as needed from the standard regimen.

Therefore if you do suffer side effects after receiving chemo, you won’t necessarily have to go through them again on the next treatment, as changes will be made in response to what you experienced.

If countermeasures are in order, as a rule you’re better off anticipating and dealing with a problem preventively rather than waiting until it manifests itself.

For example, often a pattern will be discernible when you are undergoing chemotherapy. You might, say, be getting chemo on Tuesdays, and you notice that by about Thursday evening you are nauseated or suffering some other side effect, that it gradually gets worse until bottoming out about Friday afternoon, and then it gradually lessens. If that’s the case, then rather than wait until your condition is intolerable to you, since you know it’s coming you can take whatever countermeasures you and your physician have decided on (prescription anti-nausea medication for instance) earlier in the day on Thursdays.

One of the questions we’re asked most frequently is how common side effects are. We’ll be looking at many possible side effects below; will a person getting chemotherapy really have to endure all of these?

In short, no. But as always, every case is different. It’s not possible to give precise probabilities, because the likelihood of your getting any specific side effect depends on what type of cancer you have, what chemo drugs we are treating you with, and the various biological facts about you as an individual and your body that determine how tolerant your system is of these particular toxic substances.

What we can say in very general terms is this: The one side effect that is common, that you will probably experience to at least some degree, is fatigue. When your body is having to adjust to the introduction of chemo drugs, not to mention battling cancer, chances are you’re not going to have all the energy you otherwise would.

As far as the other side effects though, chemotherapy has come a long, long way in recent years and decades. Most patients either suffer no other side effects, suffer only mild versions of any other side effects, or only suffer other side effects temporarily until adjustments are made in their chemotherapy regimen to eliminate them.

But any side effects that you do experience, we want to know. If something happens when you are not in the office, please contact us.

When you call our office to report a side effect, the call will be classified according to urgency. For the most important things, you may get a call back almost immediately, even if it means pulling one of our physicians temporarily away from his or her other duties. If it is not something of that level of urgency, it may be a few hours before you get a call back, perhaps at the end of the work day when the physicians have seen all the patients they’re going to see that day. But either way, we want you to keep us informed, and we want to communicate with you about the best course of action.

On rare occasions when you report a side effect you might not get a call back as soon as you should. We have an excellent team, but we’re still human and we still make mistakes. So if you haven’t heard back from us, and you’re concerned that you may be experiencing a side effect that requires immediate attention, don’t be shy about calling again. It may be that there was a miscommunication with the person you spoke to, and they classified your information as having a lower level of urgency than they should have. Don’t let an error like that adversely affect your treatment; speak up and let us know that you’re concerned your situation needs to be addressed more quickly.

Note that your calling earlier in the day gives us more options. The later you call, the more pharmacies and other businesses are closed, the more members of our team have gone home, etc. You will always get help any time any day, but it’s wise to call early if you’re experiencing a side effect.

As noted, any side effect you experience we want to know about, but if you experience certain of them specifically, you need to call us right away.

These are the side effects of greatest urgency:

-Numbness or tingling in your hands or feet.
-Trouble using your hands.
-Feeling unsteady on your feet.
-Changes in your skin.-
-A temperature higher than 100.4ºF (38ºC).
-Shaking chills.
-Significant changes in your vision.
-Severe diarrhea—three or more watery bowel movements per day for more than three days.
-Severe constipation—constipated for at least three days, with laxatives having failed to relieve it.
-Unusual bruising or bleeding.
-Pain at or around the injection site.
-Shortness of breath.
-Vomiting more than 24 hours after treatment.
-Sores or ulcers in your mouth, or a sore mouth or throat.

In addition, if you experience something not on this list that you’re not sure might or might not be significant enough for us to want to be informed right away, call us. It’s better that you err on the side of contacting us sooner than you needed to rather than later than you should have. So when in doubt, pick up the phone and let us know what’s happening with you.

The cells lining your mouth and throat are among those that can be affected by chemotherapy. You may experience oral mucositis (a painful inflammation and ulceration of the mucus membranes in the mouth), thrush (an overgrowth of yeast), or HSV (herpes simplex virus, i.e., cold sores). Your mouth may be more sensitive than usual, and more easily irritated by spicy, acidic, too hard, too hot, or too cold foods and beverages.

Treatments for these conditions vary. HSV, for instance, requires antiviral medication.

Some patients find that painting tender areas with Maalox® helps with mouth soreness. We also have prescription solutions that can provide relief. They are called Cool Solution #1 and #2. (They are also sometimes referred to as Larry’s Solution #1 and #2, after the Johns Hopkins pharmaceutical wizard who first concocted them long ago.) They use slightly different formulas, so if one isn’t doing the trick for you, we’ll try the other.

Standard mouthwash is probably not going to work for you, as most contain alcohol and/or menthol and will irritate sensitive mucous membranes.

You can ascertain through trial and error what, if any, foods and beverages are irritating your mouth, and then you can stay away from them. You might find, for instance, that hard bread and crackers cause you discomfort and that you need to stick to softer foods.

Should you develop a sore mouth or throat during your chemotherapy, be sure to contact our office. The more information you can provide, the better. Before you call, inspect your mouth and throat and note any sore spots or color changes.

Your bowel habits may be affected by your chemotherapy. Some chemo drugs are more likely to cause diarrhea, some constipation, and some can cause either. In addition, the accompanying pain medications you may be taking and/or the accompanying anti-nausea medications you may be taking can sometimes cause constipation.

For bowel health, you’ll want to keep your fluid intake high with water, fruit juices, herbal tea, and other beverages. (Caffeinated and alcoholic beverages are not hydrating.)

For treatment of diarrhea, we typically recommend an over-the-counter anti-diarrheal such as Immodium®. We can also talk to you about dietary changes that may help, including stopping dairy products.

You may be able to forestall constipation by altering your diet to include natural laxative fruits such as prunes, dates, papayas, and rhubarb, and foods high in fiber. If needed, Metamucil®-type laxatives can also be effective.

As with many other side effects, once experience with chemotherapy has revealed that you can expect diarrhea or constipation, you need not wait for them to happen but can use countermeasures preventively. If you know that you usually become constipated starting a few hours after each chemo session, for example, then it would be prudent to take a laxative in advance of the symptom becoming obvious.

Chemotherapy can affect your taste buds, changing how things taste to you, and how much you like or dislike certain tastes. Think of it as similar to the way your tastes as an adult differ from your tastes as a child, the way, for example, maybe you loved a super sweet cereal when you were 8, but now it seems overwhelming and rather sickening.

You might discover while undergoing chemotherapy that you like some foods you never used to, and dislike some foods that you’ve always liked.

The precise effects of course will differ from person to person. One common experience is that food tastes more bland. This leads some patients to prefer to add more spice than in the past to counteract that effect. Others, though, find spicy foods now unpleasant and prefer to stick to the more bland (especially if in addition to taste changes, they’re experiencing some mouth sensitivity).

The perception of sweetness seems to be especially likely to change. Sweet foods may have a less enjoyable taste to you, or at least a different taste.

Some chemo patients report that water has a sort of chemical or metallic taste to it. In that case, it can be helpful to add a squirt of lemon juice, or switch to a mildly fruit flavored bottled water.

Really it’s just a matter of experimenting. Find out how things taste to you, and what you like and don’t like. If your appetite is lessened, or you just don’t care to eat as much because the food doesn’t have the same taste to you, consider adding food replacement supplements like Ensure® instant breakfast or other protein powders to your diet.

With the possible exception of hair loss, no side effect is more closely associated with chemotherapy in most people’s minds than nausea and vomiting.

But the truth of the matter is, nowadays you’ll likely experience minor or no nausea when undergoing chemotherapy. The chemo drugs themselves have changed over the years, the accompanying anti-nausea drugs have become more sophisticated, and experience has enabled the medical profession to improve the chemotherapy procedure so as to minimize the risk of nausea.

Walk into a room full of people in our office receiving chemo and what you won’t see are sick, miserable folks throwing up and trying to endure terrible nausea. Instead, you’ll likely see a good number of the people contentedly eating lunch or munching on a snack.

Still, nausea and vomiting remain possible side effects of chemotherapy. This is because the cells in the lining of the stomach and intestines multiply rapidly, making them the type of cells non-targeted chemo drugs seek out and attack.

Patients are sometimes advised that shortly before and after treatment they should avoid spicy foods or foods that can cause indigestion or heartburn. Really though, like so much else with chemotherapy, it’s a matter of trial and error. We’d like you to eat whatever is comfort food for you when you’re coming in for treatment. If experience reveals that your body has more trouble handling the chemo when you do so, then yes, we’ll want you to avoid the foods that seem to be contributing to the problem. But if not, then eat what you want to eat, whether it’s carrot sticks or spicy fast food tacos.

Whatever you eat, be sure to stay well hydrated. This is important in lessening the likelihood of multiple side effects.

There are three types of nausea associated with chemotherapy. One is anticipatory nausea. This is a psychologically produced nausea that occurs before treatment or at the beginning of treatment because the patient is anxious and expects to be made sick. This has become far less common over the years, as by the time today’s patients commence chemotherapy they’ve been educated as to the improbability of nausea and so are less anxious than in the past.

A second type is immediate nausea, which occurs in fewer than 5% of our patients. In these cases, the body reacts immediately to the introduction of the chemo drug into it, making the person sick.

A third type is delayed nausea. This occurs after the chemo drug has had a chance to work its way fully into the patient’s system. This kind of nausea usually hits 48-72 hours after treatment.

We have many anti-nausea drugs available. We give all our chemotherapy patients one of them prior to their chemo on each visit. Other drugs we send home with them as rescue medicine if they should experience delayed nausea. If a patient is so nauseated that they can’t even swallow oral medication, we have anti-nausea drugs in the form of a patch or suppository.

If you have any trouble at all with nausea, we can try different anti-nausea drugs, tinker with the timing and dosage, etc. Remember, chemotherapy involves making various adjustments along the way to arrive at the procedure that will be most comfortable for you and avoid side effects.

For all the side effects related in any way to diet, we work with dieticians who will help you with your questions and make recommendations.

Blood cells have a short life span (red blood cells about 120 days, platelets about 10 days, and white blood cells about 1-2 days), and replacements are constantly being generated. This puts them among the innocent bystander cells that are most vulnerable to chemotherapy drugs.

Throughout your chemotherapy we constantly check your blood counts. If one or more of the three types of blood counts are low, we’ll even delay treatment until we get it back up.

A low red blood cell count is anemia. If you’re suffering from anemia, you may notice your energy level is low and you become fatigued unusually quickly. We have medication to boost the red blood cell count. Less often a transfusion may be necessary.

A low white blood cell count is neutropenia. The white blood cells are your infection fighters, so with neutropenia your system is at a disadvantage contending with invaders. When you are neutropenic, you need to monitor your body and take every infection or possible infection seriously. Inform us of a temperature of 100.4ºF or more, chills, sinus problems, coughing, urinary problems, or any injuries that develop redness or drainage or other signs they may be infected.

When a patient with neutropenia has a temperature at that level and/or the other noted symptoms, we err on the side of safety by assuming your body is contending with an infection until proven otherwise. We’ll direct you to go to the emergency room, and to inform the emergency room personnel upon your arrival that you are a cancer patient and are, or might be, neutropenic. That way they’ll know that your symptoms have a greater significance. Pack a bag, as with low blood counts there is a realistic chance you’ll be staying overnight or longer to be diagnosed and treated.

Take precautions to avoid infection if you are neutropenic. In the old days neutropenic people were told to avoid fresh fruits and vegetables and even most human contact because of the risk of germs. However, it’s not necessary to take things to that extreme. You don’t have to mimic Howard Hughes or a bubble boy just because your white blood cell count is low.

What we tell patients nowadays is to use common sense and be a little more careful than usual. Don’t avoid fresh fruits and vegetables, just be especially meticulous about thoroughly cleaning them (which really you should be doing anyway). Don’t avoid all human contact, just limit your time around people you know are sick, and be wary of confined areas where it’s hard to avoid breathing in other people’s germs, like crowded theaters, subways, planes, etc.

For the types of chemo drugs that put you most at risk of neutropenia, we give you an accompanying shot with your treatment designed to boost your white blood cell count.

A low platelet count is thrombocytopenia. The main concern when your platelets are low is that your blood will not clot as efficiently as usual. If you have thrombocytopenia, we need you to protect yourself from activities putting you at risk of breaking your skin or getting bruised. You may want to switch to an electric razor and a very soft toothbrush. Use gentle perirectal care and monitor stools for color changes or blood. Inform us of any bruising on your body, or red or blue discoloration of the skin.

There are at this time no effective medications for thrombocytopenia. Besides delaying your treatments until your platelet count is back up, there is the option of a transfusion if your platelet count is severely low.

As a chemotherapy patient, you may experience issues with your eyes. Most commonly you’ll notice that you’re not seeing things quite as crisply and clearly as you’re used to. This is temporary (so no need to change your prescription if you wear glasses or contact lenses), and generally not something to be concerned about.

On the other hand, occasionally more significant eye problems develop from chemotherapy. If you experience any of these, we’ll want to know about it immediately:

-Double vision.
-Loss of vision in one or both eyes.
-Deterioration in vision quality greater than the mild loss of clarity described above.
-Mucus in the eyes.
-Pain around the eyes.
-Swelling around the eyes.

Another possible side effect of chemotherapy is dry eye, which paradoxically may manifest itself as watery eyes. Cells in the tear ducts can be killed off by the chemo drugs, which creates scarring and lower quality tears, leading to dry eye. The eyes then constantly water in an effort to correct the dry eye.

When this happens, we recommend preservative-free Tears Naturale®. If the problem persists or worsens, we will refer you to our ophthalmology colleagues. They might prescribe stronger eye drops, and if that’s not enough, there’s actually a way to insert a tiny plug in the tear duct to keep tears in the eye longer.

Difficulty breathing is a rare but potentially serious consequence of cancer and chemotherapy, one that it’s especially important you notify us of right away if you experience.

Cancer itself puts you at higher risk for a blood clot, which can form in your leg or pelvis, break free, and go to your lung, where it becomes known as a pulmonary embolism. If this is what is causing your respiratory issues, pulmonary embolisms are easily treated, but if left untreated can be fatal.

Breathing problems can also be a sign of pneumonia, brought on by an infection made possible by losing too many white blood cells to the chemo drugs.

It’s also possible that what feels like shortness of breath is really not a respiratory issue at all, but a matter of fatigue. Often it is hard for a person to differentiate between being tired and drained of energy, versus being out of breath.

But if you feel your breathing is off, you’ve developed a cough, or you have pain in your chest, we need you to contact the office so you can be evaluated. If you have respiratory problems that become severe, report to the emergency room and they will notify us.

A certain amount of fatigue is a common, and largely unavoidable, side effect of chemotherapy. If you accept that you likely will have periods when you won’t have the level of energy you’re used to, and you make sensible adjustments, you should be fine.

Don’t try to force yourself to do as much as you usually do. Even if you’re one who typically takes care of others, give yourself permission to be selfish and let others take care of you. This is a time for calm and rest.

Often you’ll notice a pattern in your energy level relative to your chemotherapy treatments. For example, let’s say you’re receiving treatment once every two weeks. You might come to realize that you consistently feel the most fatigue from Day 4 to Day 6 of each fourteen day period. If so, then this is valuable information. You can plan your activities so as to take account of the fact that for those three days every two weeks you need to really slow down and take it easy.

Generally there’s not much we can do to eliminate fatigue caused directly by chemotherapy. But if it’s instead caused by some other factor related to your cancer, then that’s a different story. Are you tired because you’re anemic? Depressed? Experiencing a high level of anxiety? Getting insufficient sleep? There are effective medications for all these conditions.

So you might need to simply cope with some fatigue while you’re undergoing chemotherapy. But let’s first ascertain if there might be some other cause of your fatigue, in which case we may be able to alleviate it.

Chemotherapy—some chemo drugs more than others—can attack rapidly generating cells in the reproductive organs, and can cause fluctuations in hormonal levels. This can give rise to a number of symptoms.

For men, impotence and/or infertility are possible. These will likely be temporary, but are occasionally permanent. Medication such as Viagra® may be prescribed for impotence if needed. For a man wishing to have children in the future and concerned about infertility, it may be prudent to freeze some semen at a sperm bank.

For women, vaginal dryness may occur, which can be remedied with a water-soluble lubricant such as K-Y Jelly®, Astroglide®, or Replens®. The estrogen level may be affected in such a way as to induce menopausal symptoms, including hot flashes, erratic periods, mood swings, or weight gain. The closer one is to menopausal age, the more likely this side effect will be permanent menopause. For a younger woman, it will likely be a temporary, pseudo-menopause.

There are medications to treat hot flashes. Vigorous exercise has also been found to be beneficial.

For a woman intending to have children, an injection can put the ovaries to sleep during chemotherapy, increasing the chances they will avoid damage. It is also possible to harvest eggs before the treatment and freeze them, so that in vitro fertilization can later be attempted.

For both sexes there is a risk of decreased libido.

Neuropathy is a numbness or tingling in the hands and feet, which in severe cases can become painful. It may include reduced feeling and dexterity, making it harder to perform tasks such as gripping and picking up objects or buttoning a shirt. Balance may be affected.

Some chemo drugs can cause neuropathy by attacking the microtubules upon which nerves depend. Some can also make one more vulnerable to cold-induced neuropathy.

You’ll want to inform us if you’re having any neuropathy symptoms at all. There are treatments available to at least mitigate the condition, including medications, vitamins, physical therapy, acupuncture and massage. There is also the option of switching to different chemo drugs.

Neuropathy is an infrequent but important potential side effect of chemotherapy, in that it can significantly affect quality of life and can take six months to a year after treatment to go away completely. Occasionally it can even be permanent.

The cells in your hair follicles are among the most rapidly multiplying in your body, and thus among those most vulnerable to the chemo drugs. When enough of these cells are damaged, the result is hair loss, or alopecia. Chemotherapy can affect hair follicles not only on your head, but anywhere on your body where you have hair. Whether you suffer hair loss and to what degree is related to the type and dose of chemotherapy, and the length of treatment.

Hair loss typically begins 10-21 days from the start of your chemotherapy, and may be accompanied by tingling and sensitivity in your scalp.

To prepare for and deal with potential hair loss, you may want to cut your hair to an easy to manage style before treatment begins. If you choose to wear a wig, select one ahead of time to match the color of your hair. We have a list of wig stores, as well as the American Cancer Society’s catalog with many wig choices.

We can give you a prescription for a wig, which makes it a tax-deductible medical expense. Wigs are also sometimes covered by insurance.

Some patients prefer to wear a hat rather than a wig. You may want to experiment with different looks to see what you are most comfortable with.

Unlike the other chemotherapy side effects under discussion here, hair loss is almost entirely a cosmetic matter. It would be a mistake, though, to dismiss it as trivial for that reason. It can have a very real effect on a patient’s emotional well-being, in part by affecting how he or she is perceived by others.

So we treat it as a serious matter, and we offer another innovative way to deal with it. The Penguin Cold Cap® is a head covering worn while receiving chemotherapy. The cap is cold enough to freeze the hair follicles so that they will not be exposed to the chemo drugs working their way through your system, but not so cold as to risk frostbite or other injury.

We were the first oncology practice in Michigan to offer the Penguin Cold Cap®. It does not succeed in every case, but it certainly decreases the likelihood of hair loss, and many of our patients have been very happy with it.

It’s important to be aware of the downside of the Penguin Cold Cap® as well though. Most people would consider it pretty expensive at about $500 per month, and it is generally not covered by insurance. You have to have the cap on for about an hour before and an hour after receiving your chemo, significantly lengthening the treatment session. Most of our patients experience it as mildly to moderately uncomfortable—not terrible, but not pleasant to have on for several hours each time you come in for treatment.

Most importantly, there is a very small but nonzero chance that a cancer cell could be temporarily lodged in the scalp, avoid the chemo drugs due to the Penguin Cold Cap®, and then reemerge to reestablish the cancer when it might have otherwise been eradicated. This is more of a theoretical possibility—we have had no evidence that any of our patients have actually experienced this—but one worth considering.

You can learn more about the Penguin Cold Cap®, including an instructional video, at www.msc-worldwide.com.