Side Effects of the Treatment of Ovarian Cancer Can Have Great Impact on Activities of Daily Living

NEW YORK—Treatment of ovarian cancer can cause side effects that have a significant impact on patients’ everyday lives, including walking, according to Lois Almadrones, RN, MS, MPA, clinical nurse specialist, Gynecology Service, Memorial Sloan-Kettering Cancer Center in New York. Speaking at an industry-sponsored symposium held in conjunction with the Oncology Nursing Society annual meeting, she outlined approaches to improve the management of palmar-plantar erythrodysesthesia (PPE), peripheral neuropathy, and hypersensitivity to some chemotherapeutic agents.

Palmar-Plantar Erythrodysesthesia

PPE, which is often also associated with skin erythema at pressure points of the body, pain, swelling, peeling, and sometimes vulvovaginitis, is dose and cycle dependent, Ms. Almadrones reported. For several days after receiving pegylated liposomal doxorubicin, patients can help alleviate symptoms by wearing loosely fitting clothes and shoes, and avoiding sunlight, exercise, and pressure on their skins, she advised.

Ice packs and cool water soaks applied to affected areas help, as do cooling creams and vitamin B6 (100 mg daily). One inventive patient, Ms. Almadrones related, soothed her sore feet by placing them in bags of frozen peas.

Peripheral Neuropathy

Cisplatin (Platinol), paclitaxel (Taxol), and carboplatin (Paraplatin)—all "mainstay agents" in ovarian cancer treatment—can cause peripheral neuropathy, Ms. Almadrones continued. It can affect sensory, motor, and autonomic nerves, causing pain, weakness, and bowel, bladder, and sexual problems, among other symptoms. Walking is also often affected, and oncology nurses can frequently detect neuropathy by looking for changes in a patient’s gait, she noted.

Neuropathies often develop at the third or fourth treatment and can last up to 6 months before improving. "Patients are scared" if they don’t know that these problems are the known side effects of treatment and not indications that the cancer is worsening, she said.

In randomized, placebo-controlled trials, glutamine given before paclitaxel treatment has proven protective in lessening motor weakness and conserving gait and the ability to perform activities of daily living, both of which play an important role in preserving the patient’s independence, Ms. Almadrones said. Topical analgesics form the "first line of treatment," she added. The tricyclic antidepressant nortriptyline and the anticonvulsant gabapentin (Neurontin) can also be useful, she said, adding that information on peripheral neuropathies is available at www.neuropathy.com.

Hypersensitivity Reactions

Hypersensitivity reactions are important and potentially very dangerous side effects of carboplatin and paclitaxel, she continued. Reactions to carboplatin begin after several courses and cause varied symptoms that can include itching, rash, chest tightness, emesis, alteration in blood pressure, and swelling. These reactions can occur anywhere from minutes to days after infusion. Severity of symptoms determines whether treatment can be resumed, she noted.

Paclitaxel hypersensitivity occurs with the first or second course and produces a set of characteristic symptoms including tightness in the chest, back pain, dyspnea and changes in blood pressure. Reactions occur within minutes after the infusion begins.