Cancer patients and chemotherapy
Patients with cancer feel devastated at the time of diagnosis, not only because of fear of death, but also due to fear of undergoing treatment especially chemotherapy. This is mainly because of the misbelieves spreading among general population about cancer treatment. In contrary to the popular misbelief, most of the cancers can be cured and an ample amount of cancers can be controlled.
Treatment of cancers include several modalities including surgery, radiotherapy and chemotherapy. The tumor can be removed from the body by surgery which is usually done by Cancer Surgeons. Radiotherapy is another mode of treatment which can be used before or after surgery or as the only definitive treatment. In addition, Chemotherapy is also used to cure or control the cancer process. In this article, I would like to briefly discuss chemotherapy and how a patient should be prepared before and during chemotherapy to get the maximum benefit of the treatment. Although patients are worried about getting chemotherapy, they will sail through this journey easily and safely, if they follow the medical advice properly.
Cancer patients are treated with chemotherapy in the following instances. • As neoadjuvant treatment which means chemotherapy is used to reduce the bulk of disease prior to the definitive treatment which surgery or radiotherapy. • As part of the definitive treatment- For example in leukemia it is the main modality of treatment. • 3 As an adjuvant treatment which means chemotherapy will be used to prevent future recurrences after completing the definitive treatment. • As a palliative treatment modality which means chemotherapy is used for symptomatic control and to improve quality of life in patients with metastatic disease or incurable conditions. The main fear of patients and their relatives about chemotherapy is due to the side effects of chemotherapy. These effects can be minimized by preparing the patients properly prior to chemotherapy and by strictly following the medical advices. The side effects of chemotherapy can be categorized as acute and late side effects. • Acute effects- Undesired effects that come within 7 days of treatment • Late effects- undesired effects that appear after 3 months of treatment One of the commonest side effects which is very uncomfortable for the cancer patients is vomiting. Hair loss is a striking side effect which affects the physical image of a person. Chemotherapy also disturb the immunity, which result in severe infections that can be Life threatening sometimes.
Patients can feel fatigue during chemotherapy which can also last for a longer duration even after completion of chemotherapy. The side effects of chemotherapy depend on the drug or combination of drugs which are prescribed to treat cancer. How the patients tolerate chemotherapy differs from person to person, so the experience of each patient can be different. Common side effects of chemotherapy can be summarized as follows with how to manage or minimize them. 1. Fatigue- Fatigue is feeling tired or exhausted even if you get enough sleep. It is the most common side effect of chemotherapy. This can be minimized by doing exercises like walking during chemotherapy cycles, having short naps and rest breaks, having good nutrition and plenty of liquids. 2. Vomiting- taking the prescribed antiemetics before and after chemotherapy prevents chemotherapy induced vomiting. There are medications to prevent anticipatory vomiting which happens due to fear of vomiting patients are having even before getting chemotherapy. Eating several small meals, avoiding greasy or spicy food, keeping head elevated for one hour after the meal helps minimising this dreadful side effect. 3. Hair loss - Some types of chemotherapy, but not all, cause hair loss. Hair loss usually starts after the first few weeks of chemotherapy. It tends to increase 1 to 2 months into chemotherapy. Your doctor can predict the risk of hair loss based on the drugs and doses you are receiving. Hair loss can be minimized by cooling caps 4. Mouth Ulcers and Sore throat. Chemotherapy can damage the cells inside the mouth and throat. This causes painful sores in these areas, a condition called mucositis. Mouth sores usually happen 5 to 14 days after a treatment. It is also important to watch for infection in these sores. Oral mucositis / mouth sores can be minimized by good mouth care, mouth washes, avoiding eating hard food practices and using soft tooth brush. these sores. 5. Change in bowel habits are more common side effects Diarrhea. Some chemotherapy causes loose or watery bowel movements. Preventing diarrhea or treating it early helps keep you from getting dehydrated Constipation. Chemotherapy can cause constipation. This means not having a bowel movement often enough or having difficult bowel movements. 6. Infections- These can be prevented by following good hygienic practices advised by your doctor like proper hand washing, consuming freshly cooked food (only home cooked), avoiding crowded places etc. If you get an infection, you should be vigilant enough to identify even a slightest evidence of infection and seek medical advice urgently. Although these are the commonest side effects of chemotherapy there are several others which are specific to each chemotherapy drug. Therefore you must discuss with the treating physician about all relevant side effects to your chemotherapy schedule, and follow the medical advices strictly.
Dr Daminda Rajapaksha (MBBS MD)
Consultant Clinical Oncologist (Act) TH Ratnapura
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