Welcome to Mayo Clinic's podcast. Our topic today is the side effects of chemotherapy, what to expect. I'm your host, Rich Dietman.

In today's podcast we're talking about chemotherapy side effects. Over the past several decades, chemotherapy, which relies on a wide array of drugs to kill cancer cells, has become a standard in cancer treatment. But despite its success, chemotherapy still has negative connotations for many people. Here to talk about chemotherapy side effects is Mayo Clinic's Dr. Ed Creagan. Dr. Creagan is board certified in internal medicine, medical oncology, hospice medicine, and palliative care. He treats cancer patients in the division of medical oncology at Mayo Clinic, and he's also the author of a blog on stress management on MayoClinic.com. Dr. Creagan, thanks for being with us.

Dr. Ed Creagan: Thank you.

Rich Dietman: First of all, does everyone who has cancer need chemotherapy?

Dr. Creagan: The answer is no, Rich, because some individuals have relatively small cancers that are completely excised surgically where the cure rate is virtually 100 percent; so for that individual there would be no role for chemotherapy. However, for a larger cancer, for a cancer which has spread into regional lymph nodes, where the probability of recurrence is high, preventive chemotherapy is often recommended.

Rich Dietman: Dr. Creagan, going into chemotherapy, what's one of the most important questions that I should have on my mind to be asking my health care provider?

Dr. Creagan: Rich, the No. 1 question, the No. 1 inquiry that the patient should make is as follows. "Doctor, nurse, health care provider, what will I buy from chemotherapy? What's the payoff for me?" Now let me tell you where I'm coming from. There are some cancers for which the benefit of chemotherapy is 5 percent. That means it does not work in 95 percent of patients. Yet, if I take the chemotherapy, I'm going to have all of these side effects and my quality of life will deteriorate. Is it worth it? So as a patient, I need to know what's the probability of benefit, may I be cured, how long will that benefit last, and what kind of side effects should I be expecting from this engagement? Crucial questions that really need to be asked.

Rich Dietman: Chemotherapy's a very effective treatment. So why does the term prompt such an anxious response in so many people as opposed to say when you're talking about surgery or radiation therapy?

Dr. Creagan: Every patient, without exception, knows someone who has had chemotherapy; either directly or indirectly, and up until about 10 years ago the side-effects of chemotherapy were ferocious, and everyone has a horror story; nausea, vomiting, retching, bleeding and infection, and I think those complications have really tainted the reaction of many patients toward chemotherapy.

Rich Dietman: Does chemotherapy always cause side effects?

Dr. Creagan: Not necessarily. One of the real advances in the war on cancer in the past 10 years has been a revolution in predicting, anticipating and treating the side effects of chemotherapy; especially nausea and vomiting.

Rich Dietman: So nausea and vomiting are clearly two of the most prominent side effects from chemotherapy. What can be done? You talked about some targeted drugs or medications. Talk a little bit about those and what can be done to either reduce or eliminate …

Dr. Creagan: For example, we now know that medicines called cortisone or prednisone have a tremendously powerful role in turning off nausea and vomiting. There are medications called, for example, ondansetron (or Zofran) which specifically target parts of the brain involved with nausea and vomiting, so we're much more knowledgeable, and we also now have a holistic concept about nausea and vomiting. If you are anxious, if you are spiritually distressed, if there are issues in your personal life that need to be addressed, and if they are not addressed, this will magnify the side effects of chemotherapy, so we need to have a mind-body-spirit approach to this problem.

Rich Dietman: Another side effect that I think a lot of people associate with chemotherapy is hair loss. Is that a given?

Dr. Creagan: In many cases it is a given, and this can be devastating. We are all vain people. A few years ago, Ray Nitschke was the middle linebacker for a team in Wisconsin called the Packers — he was bald. Michael Jordon was a famous athlete obviously, in the 1980s and '90s and he was bald, and it was OK for men to be bald at that time, but in general the loss of hair can be devastating. However, with newer hairpieces, many times we never know which patient has a hairpiece and which patient has their natural hair, so again we're making inroads in addressing the importance of vanity for each of us.

Rich Dietman: And if I do lose my hair during chemotherapy, is there at least a rough estimate as to how long it will take before it grows back?

Dr. Creagan: About three months, so many times it comes back very different from the way it was initially. So you may wake up one day and you may look like Shirley Temple, so your hair may come back black and curly whereas it was blonde and straight before chemotherapy.

Rich Dietman: Another side effect is fatigue?

Dr. Creagan: Fatigue is one of the major issues that patients complain about. And we have treatments for that. We now measure their oxygen count in the blood, and if it's very low, blood transfusions may be appropriate. There are medications to increase the blood count, and these can be very, very successful. But equally important is to tell patients, look, chemotherapy and cancer is a full-time job. You can't be expected to work 60 hours a week, feed the hungry, take care of global warming, run a corporation and eliminate homelessness. You have to prioritize your energies.

Rich Dietman: So you have to adopt a different lifestyle?

Dr. Creagan: Absolutely. Make a list. Ask for help. Nobody does it alone.

Rich Dietman: So what are some of the other common side effects that we haven't talked about?

Dr. Creagan: A little bit depends on the specific kind of chemotherapy. For example, there is a chemotherapy called platinum, just like the metal — predictably most patients will have numbness and tingling of their hands and feet. Now for many individuals, this is a nuisance, but for some it could have career implications. For example, if you're a toll collector, if you are a seamstress, if you are a painter, if you are a musician, you need to know about these types of side effects.

Rich Dietman: Is there a way that doctors can tell me, as a cancer patient, ahead of time what side effects, if any, I'm going to have?

Dr. Creagan: The answer is yes. For example, if a patient is receiving a medicine called Adriamycin, or doxorubicin, we know that hair loss occurs in almost every patient. So we would say, there is some element of uncertainty; however, most patients will lose their hair. So if you think this will be an issue for you, now is the time to consider visiting with a specialist in providing a hairpiece. We know, for example, that your blood counts will go low getting a medicine called cyclophosphamide. So that means you're at risk for an infection, so that means you should wash your hands carefully, stay away from individuals with infections. So we can be proactive. We can be assertive. We can be involved in helping that patient get the best outcome.

Rich Dietman: So there are some things that I can do going into chemotherapy to prepare myself and to protect myself, it sounds like.

Dr. Creagan: Absolutely. This is not a roll of the dice, and we, as patients — and in effect we're all patients — we need to be assertive and take charge of ourselves because nobody has a greater stake in our health and wellness than we do.

Rich Dietman: And this is sort of a global question, that sort of keys off what you just said about preparing. What are the kinds of things that you tell a person going into chemotherapy as far as preparing — emotionally, physically, mentally?

Dr. Creagan: Without question, this is a composite assault on the mind, the body, the spirit. First, I think one needs a support group — positive friends, nurturing friends, who are with us during the good times and the bad times. Next is the importance of visiting with a registered dietitian, because we become what we eat. Most of us do not have adequate nutrition, and we need to understand the importance of nutrition as it relates to dealing with cancer. I think a spiritual dimension is crucial, whether this be a priest, a minister, a rabbi, some member of the clergy to walk with us during these difficult times, but it's equally important to prioritize your activities. What's important to you? What do you want to accomplish? We cannot do it alone; we cannot do everything.

Rich Dietman: Thanks very much, Dr. Creagan. We've been talking with Dr. Ed Creagan, cancer specialist in the division of medical oncology at Mayo Clinic. You've been listening to Mayo Clinic podcast. I'm Rich Dietman.