Chemotherapy drugs aim to destroy rapidly dividing cells like cancer cells but also healthy cells that divide quickly, potentially causing side effects. While side effects vary, they may include nausea, vomiting, hair loss, and reductions in blood cell counts. Anxiety and a fear of chemotherapy can worsen side effects, so behavioral therapies help patients relax and reframe chemo as beneficial treatment rather than a poison. Therapists recommend decision involvement, skill-building, and reframing chemo as a "friend" to improve patients' experience.

1. Chemotherapy

2. • There are now over 90 different chemotherapy
drugs, some of which have many side effects and
some of which do not.
• Most chemo regimens are given in cycles: every
day for a week or two, then off for a week or two,
or some combination thereof.
• Hence, you may experience fatigue immediately
after a treatment but then experience an upsurge
of energy during your week off from chemo.
• These cycles of treatment can last up to 6 months
or longer.

3. Chemotherapy: What Is It and How
Does It Work?
• We now know what has to take place for cancer to
develop.
• First, an abnormal cell has to get past your immune
system and appear in your body.
• A malignant tumor is an abnormal cell that can survive
ANYWHERE in your body, hence making it more
dangerous.
• The malignant tumor continues to divide and subdivide
in rapid succession after it should have stopped.
• It can't "turn off."
• It is the malignant tumor, that chemotherapy drugs
have been designed to kill.

4. • Chemotherapy drugs "aim" to destroy rapidly dividing
cells. Unfortunately, this not only includes rapidly
dividing cancer cells, but other fast replicating cells as
well—especially your hair cells, blood cells and cells in
your digestive tract.
• These too are "hit" by the chemo.
• Because of this, all of the cancer chemotherapy drugs
have the potential (not a guarantee, and each person
reacts differently, but a potential) to cause one or more
side effects.
• In knowing this ahead of time, you can learn to
soulfully side step, in your dance with chemo, the more
problematic manifestations of these adverse drug
effects by being prepared and being "in the know."

5. • For example, such side effects could include a decrease
in white blood cells called neutropenia (normal white
blood cell count [WBC] is between 4,000-10,000) which
could cause infections; a decrease in red blood cells
called anemia (normal red blood cell count [RBC] is
between 4.0 and 6.0) which can lead to a lack of
energy; a decrease in blood platelets leading to
bruising (normal platelet counts are usually between
150,000 and 450,000); as well as nausea, vomiting,
tingling, numbness, mouth sores, loss of hair, skin rash,
dizziness, drowsiness, taste changes (such as a metallic
taste in your mouth), and blurred vision.

7. Strategies to Cope With Chemo
Anxiety and Side Effects
• Research has shown that if you have a history of
motion sickness or aversion to certain food odors, you
will tend to be more nauseas and experience more
vomiting before or after getting chemotherapy.
• Those of us who are highly anxious will also tend to
have more problems with chemotherapy.
• For example, one research study showed that highly
anxious chemotherapy patients suffered twice as much
(18.1%) "anticipatory nausea"—nausea from being
worried about getting chemo—than did mildly anxious
patients (9.8%).

8. • Psychologists believe that those of us who undergo chemotherapy
and appraise the process as "threatening," or who are unprepared
to cope with its demands, will be more likely to experience a
"negative outcome," than those of us who view chemo as a
challenge or an ally, as Randy Stein did.
• Between 25%-65% of us who undergo chemo will develop a phobiclike fear of it.
• The term phobia comes from the Greek term, phobos, which means
"flight," or "terror.“
• The most potent trigger for "anticipatory" anxiety is when the nurse
cleans our skin with rubbing alcohol just prior to giving us the
chemo.
• Just like Pavlov's dogs who learned to salivate to a tone that
preceded food, we cancer patients, after four or five chemo
treatments, begin to feel nauseas or dizzy in response to the
alcohol or the nurse's perfume.
• These reactions can be either "clinic specific," limited to the actual
chemo room, or "pervasive," occurring throughout the entire day
prior to receiving our chemo treatment.

9. Therapy for Chemo Phobia
• Behavior therapy, cognitive-behavioral therapy, hypnosis,
progressive muscle relaxation and biofeedback are the
most common ways that therapists like myself treat
anticipatory nausea or chemo-phobia.
• In behavior therapy, I would attempt to eliminate your fear
by modifying your behavior.
• With cognitive-behavioral therapy, I Larry would attempt to
challenge and modify your fear producing thoughts.
• My initial goal would be to get you to remain relaxed when
simply imagining that you are going to the chemo office.
• Then I'd gradually expose you to the actual chemotherapy
session that you fear, while helping you remain relaxed by
having you do some deep breathing from your lower
stomach and muscle relaxation exercises.

10. Many times, you will find yourself thinking in distorted
ways that help maintain your fear of chemotherapy.
There are four common ways to distort your thinking.
• All-or-nothing/black-and-white thinking: You see things in
extreme. ("Too feel good, I will avoid all treatment. If I go and get
chemo, I will be constantly throwing up and in pain.")
• Overgeneralization: You take one event and apply that experience
to all other like experiences ("My cousin's neighbor passed out,
threw up, and experienced repeated infections when she
underwent chemo. All chemo drugs are painful and dangerous to all
people with any kind of cancer.")
• Disqualifying the positive: You reject positive experiences by
insisting that they "don't count:" ("That one nice lady at the
hospital who said she never threw up or had pain with her chemo
must have been a fluke! Chemo is not like that.")
• And, Magnification and minimization: You exaggerate the
importance of negative characteristics while minimizing the
positive. ("Although Susan had energy to go places and could eat
small meals, look how much she naps. See, that's the sneaky way
chemo gets to you.")

11. Recommendations For Getting
Through Chemo
• For the counselor or therapist who is treating a cancer
patient with chemo phobia, I'd recommend that you
help your client reframe their situation from seeing
chemo as poison to viewing chemo as a "friend."
• Help your client be a part of the decision making
process regarding their treatment. And help your client
with "skill acquisition," (e.g., distraction, relaxation,
counter conditioning, calming and reassuring imagery
and so on), to help alleviate some of the undesirable
effects of the various treatments.

12. References
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• Perera FP (November 1997). "Environment and cancer:
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• Damayanthi Y, Lown JW (June 1998).
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