The ups and downs of Prednisone during chemo

shouting man
Steroid Rage!

Chemo is hard on the mind and body. That almost goes without saying. But it isn’t just the chemo drugs that wreak havoc, some of the other drugs taken by chemo patients can have some major side-effects. In this post I will write about one of those drugs: Prednisone.

 

I am on a chemo regiment called R-CHOP. The “P” in R-CHOP stands for Prednisone, a type of steroid typically used for its anti-inflammatory properties. As part of R-CHOP Prednisone is actually used because it can “stimulate programmed cell death” in some cancer cell types. During the beginning of each three-week chemo cycle I take 100mg of Prednisone each day for five days. Since it is not an actual chemo drug, I really didn’t think it had any side-effects I would have to watch out for. Boy was I wrong.

When I first began chemo I noted Prednisone made me very hungry. This is still very much true. Unlike many chemo patients I have not lost any weight since starting treatment. Actually I am almost twenty pounds up since I first began chemo. The constant hunger during the week I am on Prednisone is basically insatiable. I won’t really complain about this side-effect too much. Recently I have found through smart diet and getting exercise I can counter-act the weight gain. After I’m done with chemo (and Prednisone) I’ll worry about losing those pounds I gained.

A side-effect of Prednisone I will complain about however is the mood swings. One moment I will be watching a movie and almost in tears because a character in said movie died, and the next moment I will feel great rage because my boys are fighting about nothing again. When I feel that great rage I have been trying to walk away. The boys are brothers, and they are going to fight. My yelling at them in a steroid rage is not going to do any good at all. It is hard to walk away though. When I get this great rage it feels like I have to let it out. Shortly thereafter I will find myself going to the boys and apologizing. They don’t know why I’m apologizing, other than the fact I’ve told them some of the drugs I am on for chemo can make me act strange. The wife and kids have been great about putting up with the mood swings during chemo week. Hopefully they will continue to understand and be patient for the next couple of treatment cycles.

While the mood swings from being on Prednisone is bad, it’s the withdrawals from the steroid that really gets to me. On Sunday of this week I finished my fourth cycle of Prednisone. During the days I am on Prednisone I actually feel pretty dang good (except for the mood swings). However the couple of days after no longer taking Prednisone I crash hard. The day after I start to feel weak with aches and pains cropping up all over my body. This gets worse for about two days. Yesterday, Tuesday, I felt so weak and sore that all I wanted to do was curl up in a ball and ignore the world. I don’t know if these symptoms are truly from withdrawal. It could be that the anti-inflammatory properties of Prednisone hide the aches and pains while I am taking the drug. Either way I feel like I’ve been hit by a truck for a couple of days after I’m done with the Prednisone.

I’ve spoken with other chemo patients who have similar experiences after coming off Prednisone. One person I spoke with had their oncologist prescribe something to taper down the withdrawal. I don’t really think this is necessary for me. Hopefully I only have two cycles of chemo left and feel I can cope with these symptoms now that I know about them.

One of the chemo patients I’ve spoken with also noted she experiences depression for a couple of days after coming down from Prednisone. I don’t think I experienced depression, but its hard to know. I definitely feel emotionally “down” after coming off Prednisone. If that counts as depression it is hard to say. This down feeling goes away after a couple of days. In fact today, Wednesday, I feel pretty upbeat and the emotional side-effects of Prednisone appear to be gone.

With only a couple of rounds of chemo left I won’t worry too much about the side-effects of Prednisone. I mostly shared my Prednisone experience in this post so other chemo patients suffering side-effects from the steroid know they are not alone. It is also my hope that friends and family of chemo patients suffering side-effects from Prednisone will get an understanding of what those patients are going through.

R-CHOP, the chemo regiment I’m on

21746916A follower of this blog noticed I’ve mentioned R-CHOP often as being the chemotherapy regiment I’m on. She asked if I could briefly explain what this means as she is about to start R-CHOP chemo herself. The doctor did give her information about R-CHOP, but it was basically just a sheet explaining the many side-effects which are possible. In this post I will try to briefly explain what R-CHOP is.

What is R-CHOP

R-CHOP is a chemotherapy used specifically to treat non-Hodgkin lymphoma. R-CHOP actually is actually an acronym for the five drugs that are used together to best battle the lymphoma. Combinations of drugs are often used in chemo. The five drugs which make up R-CHOP are as follows:

  • Rituximab
  • Cyclophosphamide
  • Doxorubicin (Hydroxydaunomycin)
  • Vincristine (Oncovin)
  • Prednisone

Explanation of each drug in R-CHOP

Only three of these drugs are actually chemo therapies. One is a targeted therapy drug and another is a steroid. Here is a further breakdown of these five drugs.

Rituximab

Rituximab is not actually considered a chemo drug. Instead it is a type of targeted therapy drug known as a monoclonal antibody. Here is what cancer research UK has to say about this drug:

Monoclonal antibodies target proteins on the surface of cells. Rituximab targets a protein known as CD20. CD20 is found on white blood cells called B cells. It is the B cells that are cancerous in the most common type of non-Hodgkin lymphoma.

Rituximab attaches itself to the B cells and marks them. The cells of the immune system recognize the marked cells and kill them.

It is a pretty cool idea to use the body’s own immune system to fight cancer. Rituximab is given via IV just like the chemo drugs. It is also the drug that makes the first round of chemo last seemingly forever. This drug has a lot of potentially nasty side-effects and the first IV has to be done very slowly to determine if the drug can be safely used for a patient.

Cyclophosphamide

Cyclophosphamide is one of the three chemo drugs. It is classified as a “cytotoxic agent” due to it being toxic to both bad and good cells. This drug is given through the IV.

Doxorubicin (Hydroxydaunomycin)

Doxorubicin is also a chemo drug. This may be prescribed as Adriamycin. It is given through an IV. Cancer patents often know this drug as the “red devil”. I have to agree with this name. The drug is deep red. It looks like a poison to me, but I’ve heard other say it looks very cool. It is also very dangerous if it leaks on the skin or out of a vein. But it is also a very effective chemo drug, so I find the risk worth it.

Vincristine (Oncovin)

Vincristine is the third and final chemo drug in the R-CHOP regiment. It is also given through an IV.

Prednisone

This is actually a steroid, and not a chemo drug at all. Some patients have Prednisolone instead of Prednisone during their R-CHOP treatment. This is taken as a pill instead of through the IV. In fact I take this the day of chemo, and the four days following. While prednisone has anti-inflammatory properties, it is used in this chemo regiment because it can “stimulate programmed cell deaths“.

How often is R-CHOP given

R-CHOP is typically given every three weeks. Each three-week period is called a cycle. I’ve read about two-week cycles, but honestly I can’t imagine being so aggressive with R-CHOP unless it was absolutely necessary. R-CHOP can last up to 8 cycles. In my case I was told I would likely be on R-CHOP for 6 to 8 cycles. As I write this post I am actually preparing for my fourth cycle. Today I should either be half way done or two-thirds of the way done with my chemo treatment. The results of my PET scan will help determine that.

Other thoughts on R-CHOP

I’ve heard of R-CHOP being referred to as a “shotgun approach” due to the mixture of drugs. I don’t think this is an unfair assessment of R-CHOP as a treatment. One of the problems with certain blood cancers, such as some types of non-Hodgkin lymphoma (NHL), is that they are not curable and can only be pushed into remission. NHL patients often have to wait for their symptoms to be bad enough for treatment. When they finally get that treatment they want it to be as potent as possible to help prevent the need for further treatments any time soon. Personally I am thankful R-CHOP treatment exists. At the same time though I hope new treatment options are created in the future which aren’t so hard on the body. And yes, R-CHOP is very hard on the body.