Chemotherapy

Stimulating the P6 point on the inner wrist, with needles, electrical stimulation or a pressure band, adds a small further reduction in chemotherapy vomiting on top of modern anti-sickness drugs. It is safe and cheap, and guidelines say it can be offered.

Numb, tingling or painful hands and feet after taxanes, platinum or bortezomib have no proven preventive treatment. Small trials suggest acupuncture may ease the symptoms, but they are too small and inconsistent to be sure, so it is an option to try inside a trial or with careful tracking rather than an established treatment.

Autologous stem cell transplant collects the patient's own blood-forming stem cells, gives melphalan or another chemotherapy at a dose that would otherwise destroy the marrow, then returns the cells to rebuild it. It is standard consolidation in myeloma and for relapsed lymphoma, though CAR-T has displaced it in early-relapsing large B-cell lymphoma.

Eyelashes and eyebrows often fall out with chemotherapy and can be slow to return. Bimatoprost, a glaucoma eye drop approved for thin lashes, applied along the lash line each night increased lash length and thickness in a randomised trial that included people after chemotherapy.

Two synthetic cannabinoid tablets, dronabinol and nabilone, have been approved for chemotherapy nausea since 1985 and can help when standard anti-sickness drugs fail. Modern antiemetics work better for most people, and evidence for herbal cannabis or vaped products is thin.

Giving the same drug at a different time of day, because the body clock changes how much damage it does and how well the immune system responds.

Sealed connectors that let a pharmacist or nurse draw up and give chemotherapy without any drug vapour or droplet escaping, protecting the staff who handle these drugs every day.

Several drugs have been put on the scalp to stop chemotherapy hair loss before it starts: minoxidil lotion, vitamin D analogues, and others. The trials were done and they did not work. Scalp cooling remains the only method cleared by a regulator to prevent it.

Cytotoxic chemotherapy drugs (platinums, antimetabolites, microtubule agents and topoisomerase inhibitors) kill rapidly dividing cells by damaging DNA or the mitotic spindle. They still cure testicular cancer, lymphoma and leukaemia, and they are the warhead inside antibody-drug conjugates, but a narrow margin between effective and toxic doses is their limitation.

A one-off blood test done before fluorouracil or capecitabine that finds the roughly one in twenty-five people who cannot break the drug down; halving their dose prevents severe and occasionally fatal toxicity without losing effect.

A pulse generator and needle electrodes that give a tumour a few brief electric shocks minutes after a small dose of chemotherapy, opening the cells so the drug floods in. Used mostly for cancer nodules in the skin, now also for tumours inside the body.

Moderate exercise while on chemotherapy is safe and reduces fatigue, helps people finish their planned doses, and may protect the heart and nerves.

Fasting-mimicking diets cut food intake for three days around each chemotherapy dose to lower glucose, insulin and IGF-1, which may shield normal cells and sensitise the tumour. The DIRECT trial in early breast cancer improved radiological response but fewer than 20% of patients kept to the diet, and it is unsafe in cachexia or without a dietitian.

Wearing frozen gloves and socks, or tight surgical gloves, during taxane infusions reduces nail damage and may reduce numbness in the hands and feet, by narrowing the blood vessels while the drug is at its peak. Trials are small but consistent, and it is cheap.

Keeping cheap, essential chemotherapy drugs like cisplatin available; shortages in 2023 forced rationing in US hospitals.

Cisplatin, carboplatin, methotrexate and most old chemotherapy drugs are cheap vials made by very few factories under sterile conditions. In 2023 one Indian plant stopped and American cancer centres ran short of both platinum drugs for months.

Ginger capsules taken alongside standard anti-sickness drugs reduced nausea in the largest randomised trial, but other trials found no effect and the doses and products vary. It is safe for most people, with a caution about bleeding for anyone on anticoagulants.

Oral glutamine, an amino acid that gut and mouth lining cells use for fuel, may reduce the severity of mouth ulcers during head and neck chemoradiation; mucositis guidelines suggest it for that use. Intravenous glutamine in transplant patients is not recommended, and evidence for preventing nerve damage is thin.

Every cancer drug plant works under Good Manufacturing Practice rules and is inspected. When inspectors find problems they write them up (a Form 483 in the United States), and if the answers are poor a public warning letter, an import ban or a court order can follow. Those actions protect patients, and they are also how shortages begin.

Hearing loss in a child still learning to speak and read costs more than the same loss in an adult. In the St Jude Lifetime Cohort, severe hearing impairment affected 34.9 per cent of platinum-treated survivors and 38.3 per cent of those irradiated at the cochlea, against 8.8 per cent of unexposed survivors, and tracked deficits in reasoning, fluency and mathematics.

Cisplatin kills the hair cells of the inner ear, starting at the high frequencies, and the loss does not come back. In children, sodium thiosulfate given six hours after each dose cut hearing loss from 63 to 33 per cent in one randomised trial and from 56.4 to 28.6 per cent in another. Nothing equivalent is licensed for adults.

Most heart damage from anthracycline chemotherapy appears within the first year after it finishes, and most of it improves at least partly when it is caught and treated. Heart muscle weakened by trastuzumab usually recovers when the drug is stopped. Radiotherapy to the chest raises the risk of coronary disease years later, in proportion to the dose the heart received.

Washing the abdominal cavity with heated chemotherapy during surgery to kill microscopic peritoneal deposits.

The pump and heater that circulate warm chemotherapy through the abdomen at the end of an operation for cancer that has spread across the abdominal lining, and the small nebuliser that sprays chemotherapy as an aerosol through keyhole ports when surgery is not possible.

A harmless molecule that turns into a poison only where there is no oxygen, which in the body means inside a tumour.

Infusion devices are the implanted ports, smart pumps, and take-home pumps that deliver chemotherapy safely, including 46-hour infusions patients carry home.

Removing an amino acid or nutrient that certain tumours cannot make for themselves, while normal cells can.

Most hair grows back after chemotherapy, but a minority, especially after docetaxel, are left with thin hair, and tamoxifen and aromatase inhibitors cause gradual thinning. Minoxidil lotion or low-dose tablets, the same treatment used for pattern hair loss, improved regrowth in most patients in dermatology series and shortened regrowth time in an early randomised trial.

Taxanes lift the nail from its bed, leave transverse ridges that mark each cycle, and discolour it. Reported rates across studies range from none to forty-four per cent. Cooling the hands during the infusion reduced nail damage in a pooled analysis, but the one properly randomised trial was negative and six in ten participants stopped because the cold was too uncomfortable.

Numbness, tingling and pain in the hands and feet are common on platinum, taxane, vinca and proteasome-inhibitor treatment, and most of it fades. In a meta-analysis of 4,179 patients it was present in 68 per cent in the first month, 60 per cent at three months and 30 per cent at six months or later. Only duloxetine has evidence for the pain, and no drug prevents it.

Robots and closed systems that prepare chemotherapy doses safely, protecting pharmacists from hazardous drugs and patients from errors.

Sucking ice chips for half an hour around a bolus dose of fluorouracil or high-dose melphalan roughly halves the risk of painful mouth ulcers. It costs nothing and is recommended in international mucositis guidelines.

Most targeted cancer drugs are tablets. Turning a powder into a tablet that dissolves the same way every time is its own craft, and when patents end the same craft lets generic makers sell the drug for a fraction of the price.

Whether periods return after chemotherapy depends mostly on age and on which drugs were given. In the one study that recorded bleeding daily, about two thirds of women who stopped bleeding for six months after an anthracycline regimen started again, usually within a year. Of those who went two years without a period, one in ten bled again and none regained regular cycles.

Scan after two cycles of chemotherapy; if the tumour has gone dark, give less treatment, and if not, give more. Hodgkin lymphoma pioneered this.

Testing a patient's inherited genes before certain chemotherapies to spot people who cannot break the drug down and would suffer severe, sometimes fatal, side effects.

Platinum agents such as cisplatin and carboplatin work by crosslinking DNA. They are curative in testicular cancer and central to lung, ovarian, bladder, head and neck, and TNBC treatment.

Probiotic supplements (Lactobacillus, Bifidobacterium) may reduce diarrhoea during pelvic radiotherapy for cervical, rectal and prostate cancer and some chemotherapy, but a 2018 Cochrane review rated the evidence low certainty and strains differ between trials. Patients in profound neutropenia or with a central line should not take them without advice, because bloodstream infections have occurred.

Dexrazoxane, given with the chemotherapy, cuts clinical heart failure in adults by about four fifths in pooled trials without reducing how well the chemotherapy works. Beta blockers and blood-pressure drugs given preventively protect the ejection fraction by a point or two during treatment, and in the one trial that followed patients for two years that difference had gone.

A bare scalp burns in sun it has never met, loses heat fast in cold, and is more easily irritated while treatment is going on. The measures are small and free, and they are the part of hair loss a person can act on from the first week.

A tightly fitted cap chilled to a few degrees above freezing, worn before, during and after each chemotherapy infusion, narrows the blood vessels of the scalp so less drug reaches the hair roots. In a randomised trial about half of women on taxane-based chemotherapy kept most of their hair, compared with none who went without.

Before a tablet or a vial exists, the active drug itself has to be made: many chemical steps in reactors, or extraction from a plant, at a handful of factories most patients never hear of. When one of those factories stops, whole cancer drugs disappear.

Tandem transplant gives two back-to-back rounds of marrow-destroying chemotherapy, each rescued with the child's own stored stem cells, for high-risk neuroblastoma in North America. It kept more children relapse-free than one transplant in a randomised trial, but adds organ toxicity and hearing loss.

For several treatments there is a published number above which lasting damage becomes much likelier: the total anthracycline dose and heart failure, the total cisplatin dose and hearing, the radiation dose to the parotid gland and dry mouth. Twenty-three thresholds are listed with their sources, because the total you have had is a question your team can answer.

Heart damage from childhood treatment appears quietly and decades later. When 1,853 adult survivors were examined rather than asked, 7.4 per cent had cardiomyopathy and 28 per cent had valve disease, and most of it was new at that visit: nearly all of them had no symptoms. High blood pressure multiplied the risk of heart failure nineteenfold, which makes it the most treatable thing on the page.

Trouble with memory, concentration and word-finding after chemotherapy is real and measurable, and what a person reports and what a test shows often do not match. Cognitive rehabilitation is the approach with the best trial evidence, exercise helps on some measures and not others, and every drug tried so far has failed, including a large trial of donepezil.

Topoisomerase-I inhibitors jam the enzyme that untangles DNA during copying, causing double-strand breaks. As free drugs (irinotecan, topotecan) they are modest, but their analogues SN-38 and deruxtecan are the dominant antibody-drug conjugate payload class of the 2020s, active after taxane failure; cross-resistance between these ADCs is a growing problem.

Before children and adults with acute lymphoblastic leukaemia start two years of daily mercaptopurine, two genes are checked; carriers of low-activity variants need a fraction of the standard dose or their bone marrow shuts down within weeks.

A catheter threaded into the artery feeding a liver tumour delivers chemotherapy and then blocks the vessel, starving the tumour from inside.

A gene test that finds people who clear irinotecan's active form slowly because of a common variant in the UGT1A1 enzyme, the same variant behind harmless Gilbert syndrome; they run a higher risk of severe diarrhoea and low white cells at full dose.

For each treatment and each lasting effect, whether recovery is usual, partial or unlikely, how long it takes and in what proportion of people, with the source for every answer. The grid is mostly empty, because for most pairs nobody has published a recovery figure, and the page says how empty it is rather than hiding it.