•Advise the patient to sleep through the times when there is high risk of nausea and vomiting, which varies depending on age

•Should antiemetic drug administration at home be necessary: take 2 h before commencement of therapy

•Side effects of antiemetic drugs: headache, fatigue, constipation, or diarrhea

19.2.2Hair Loss

Depending on the treatment scheme, general condition, and hair condition before treatment, hair may become sparse (partial loss of hair) or fall out all together. The hair of the scalp is particularly affected; however, eyebrows, eyelashes, chest hair, axillary hair, pubic hair, and hair on the legs and arms may disappear temporarily.

19.2.2.1Causes

•Chemotherapeutic drugs also affect normal hair follicles that have high celldivision activity

•Chemotherapeutic drugs can cause a complete atrophy of the hair follicle, leading to hair loss. What happens more frequently, caused by partial atrophy of the hair follicle, is that the hair shaft is rendered weak and constricted

•The severity of alopecia is primarily dependent on the type of chemotherapy

•External influences such as washing hair and combing easily lead to fracture of the already weakened hair

The following factors can influence the extent of hair loss:

•Application mode, dose, and general treatment scheme

•Age of patient

•General condition of patient

•Condition of hair before beginning of therapy

•Severe concurrent illness

19.2.2.2Symptoms

•Loss of hair shows great individual variability, and onset is normally 2–4 weeks after start of treatment. Several days before commencement of hair loss, the scalp may be specially sensitive or itchy

•Renewed hair growth in individual cases may start during low-dose continuation therapy; although it usually starts 2–4 weeks after completion of treatment

•Newly grown hair may differ from the original type of hair in color and texture. It is commonly softer and denser than before

•With chemotherapy, loss of hair is always only temporary. Hair grows again after the end of therapy

•Chemotherapeutic agents are closely associated with alopecia: doxorubicin, daunorubicin, cyclophosphamide, ifosfamide, etoposide