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February 2003 Volume 5, Issue 5:
Ask the Expert: Staying Well During Chemotherapy
By Edith Mitchell, MD

This issue of Myeloma Today is sponsored in part by an unrestricted educational grant from Novartis Pharmaceuticals.

When analyzing the challenges of multiple myeloma and the effects of this disease on the lifestyles of patients, it is important to consider all of the surrounding implications of the illness. Not only can multiple myeloma disrupt life with its many emotional, physical, and psychological burdens, but the most common treatments likely will cause a variety of unpleasant side effects. There are strategies, however, that you can adopt in order to help you deal with these side effects.

Chemotherapy is the most widely used treatment for multiple myeloma. Designed to target and destroy cancer cells over a period of time, chemotherapy drugs also often destroy healthy cells. Normal cells that divide the fastest have the highest risk of damage; these are found primarily in hair follicles and the digestive tract. The resulting ill effects such as nausea, vomiting, and hair loss typically are discussed in the doctor’s office. But anemia, a frequent and debilitating side effect, often goes unmentioned, even though the majority of patients suffering from myeloma will experience this condition.

Anemia is the lack of an adequate supply of red blood cells. These cells contain hemoglobin, which is used by our bodies to transport oxygen to muscles, tissue and other organs. When our organs do not receive enough oxygen, we feel weakened and exhausted. When chemotherapy destroys red blood cells, the result is extreme fatigue. This type of fatigue is different from exhaustion brought about by activity or stress, which often is relieved by rest or sleep.

Anemia is actually one of the presenting features in multiple myeloma; as the abnormal myeloma cells crowd out the normal cells in the bone marrow, red blood cell production is interrupted. Chemotherapy drugs intended to treat the symptoms of multiple myeloma may also reduce the bone marrow’s ability to create red blood cells, leading to a significant drop in hemoglobin levels over time, and increasing the risk of anemia. Together, these two circumstances cause more than 70% of multiple myeloma patients to suffer from anemia.

Strategies for Combating Treatment Side Effects in Multiple Myeloma Patients

Fatigue caused by chemotherapy-related anemia cannot be alleviated through behavioral changes and is constant, making even the smallest daily tasks exceedingly difficult. Extreme fatigue also will prevent you from enjoying life-affirming activities that contribute to your overall sense of well-being and optimism, both very necessary in the battle against multiple myeloma.

Fortunately, chemotherapy-related anemia is often treatable. Your doctor may prescribe a medication to achieve a timely and significant increase in hemoglobin, allowing red blood cells to carry more oxygen and helping restore energy. As the ill effects of anemia subside, you should be able to do many of your daily activities again.

Aside from anemia, there are other serious complications of multiple myeloma that can affect patients. Bone damage and the ensuing pain, renal dysfunction, an inability to fight infection, and hypercalcemia are all possible. Although chemotherapy and radiation often help to control some pain from certain problems, you may need additional supportive care to be comfortable and maintain your quality of life. Pain control medication, relaxation techniques, and positive imagery exercises all are recommended, as is undertaking appropriate physical exercise to stop loss of calcium in the bones, and improve mental outlook. In many cases, a doctor may suggest some changes in diet. A balanced diet provides the vitamins and minerals required to maintain strength and stay active. Good nutrition may actually help in fighting cancer. Food is a great natural source of the energy that your body needs to heal itself.

Along with nutritional balance, emotional wellness will aid in the fight against the devastation of multiple myeloma, chemotherapy and anemia. Participating in pleasurable and relaxing activities such as painting, drawing, and listening to music may reduce stress and offset some of the anxiety caused by living with cancer. Explore all of the ways you can enhance your health and happiness. Even taking a walk or simply spending time with loved ones can contribute to your sense of peace and confidence.

Restoring your energy with the right combination of medication, behavior and activity, can enrich your life and better prepare and motivate you to face the challenges that multiple myeloma presents. There are many ways to feel better. Do not hesitate to ask your physician and other healthcare providers about solutions to the discomfort and fear that you may feel. They are your partners in wellness.

Dr. Edith Peterson Mitchell is a Clinical Professor of Medicine at Jefferson Medical College of Thomas Jefferson University in Philadelphia, and Program Leader of gastrointestinal oncology at Thomas Jefferson University Hospital and Jefferson’s Kimmel Cancer Center.

In addition to her clinical responsibilities, Dr. Mitchell is on the board of directors for the International Myeloma Foundation and the Colorectal Cancer Coalition. She is co-leader of Guardcare, a program that provides free physical examinations to inner city individuals. Most recently, she was involved in developing a state-funded, award-winning video about breast cancer, aimed at African-American women. Dr. Mitchell is also a member of a variety of professional associations including the American Society of Clinical Oncology and the American Medical Association.

Dr. Mitchell has been involved in various federally funded research programs. Since 1997, she has been Director of Special Populations for the Eastern Oncology Group, a National Cancer Institute (NCI)-sponsored organization that conducts cancer-related clinical trials. She currently is funded as part of an NCI-sponsored program project grant at Jefferson University Hospital to study genetic changes involved in colon and rectal cancer.

In 2001, Dr. Mitchell became the first African-American to achieve the rank of brigadier general in the Missouri Air National Guard. She is the first female physician to be promoted to this rank in the United States Air Force. Dr. Mitchell received her Bachelor of Science degree in Biochemistry from Tennessee State University in 1969 and her M.D. from the Medical College of Virginia in 1974. She completed her internal medicine residency at Meharry Medical College and her medical oncology fellowship at Georgetown University in 1977 and 1981, respectively

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