What you need to know about:

Chemotherapy

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Recovery Period:

6 to 12 months

Permanence:

Depends on patient condition

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Overview of

Chemotherapy

in Thailand

Chemotherapy refers to the administration of drugs to destroy or halt the development of cancer cells. Selecting the correct chemotherapy, including the type, quantity and duration it must be taken, is very important for the efficiency of the treatment of cancer. Since chemotherapy drugs are considered dangerous, excessive amounts of it can cause severe side effects. But if too little is given, it may not destroy the cancer cells. In choose the formula for chemotherapy the oncologist will consider a number of factors, such as the type of cancer, the stage of cancer, the health of the patient, any other illnesses they may be suffering from, past cancer treatments (if any), side effects, and the reactions between chemotherapy drugs used together. Patients may receive just one drug at a time or multiple drugs. Using multiple drugs is more effective than using one drug at a time.

Goals of

Chemotherapy

The objectives of chemotherapy treatment are: -Curing the cancer and prevent recurrence. -Manage the disease by decreasing the size of the tumors or preventing them from growing and metastasizing to other parts of the body. -Alleviating symptoms of patients whose cancer has spread to other parts of the body to improve quality of life. However, because chemotherapy does not only affect cancer cells, but also impacts normal cells of the body and the functions of other organs, there are side effects to this type of treatment. These include nausea, vomiting, mouth sores, loss of appetite, compromised immune system, diarrhea, and hair loss. These side effects may be mild or severe, depending on the type of drugs administered, the patient’s health, and the patient’s emotional readiness.

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Chemotherapy

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Pros and cons of

Chemotherapy

Pros

-The ability to kill many cancer cells throughout the entire body (including cancer cells in the main tumor, and other tumors in the body)

-Synergize together with radiation therapy in order to kill more cells together than either therapy could do alone

-Ability to kill microscopic disease at the edge of the main tumor that may not be seen grossly by the surgeon

-Tailoring of the systemic treatment for each patient (e.g. specific hormonal therapies for breast cancers; targeted therapies for lung cancers)

-Preservation of an organ (e.g. not removing a breast, larynx, or part of the gastrointestinal tract, which would have significant negative impact on a patients quality of life)

Cons

-Inability to kill a tumor alone (in most cases, chemotherapy is used with either surgery or radiation therapy)

-Inability to deliver chemotherapy therapy if the patient is on certain medications (e.g. blood thinners), or around the time of surgery, or has certain medical conditions (e.g. kidney failure, liver failure, heart disease)

-Systemic toxicities (since the drugs go through the entire body and may affect all normal tissues) The side-effects are therapy-dependent and can be different for different drugs.

-Inability to get to the tumor (e.g. crossing the blood-brain barrier; going to a limb where there is poor circulation)

-Relative inconvenience (e.g. some forms of chemotherapy must be delivered daily, 5 days per week, for weeks; or they must be taken orally for years).

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How it works:

Chemotherapy

Chemotherapy drugs can be introduced into a patient’s body in many different ways, including: -Oral chemotherapy – some chemotherapy drugs cannot be taken orally as the digestive system is not able to efficiently absorb the drug or it may be too irritating to the digestive system, causing nausea, vomiting and/or diarrhea. -Intravenous chemotherapy – this is the most popular method of administering drugs as it allows it to spread through the body most quickly. -Intramuscular chemotherapy – this is not a popular method as the drugs can irritate and destroy the skin and muscles. A patient may receive chemotherapy drugs through a combination of methods and may have to do so for one day or several days consecutively or once a week. The oncologist will select the formula and schedule for chemotherapy that is most appropriate for the type of cancer and the patient’s overall health. The length of treatment depends on the type of cancer, the stage of the disease and responsiveness to the drugs. Normally chemotherapy drugs are administered as a cycle, using one to five days per cycle, and each cycle is administered three to four weeks apart. A patient may, on average, receive six to eight cycles of chemotherapy (depending on the oncologist’s treatment plan). It is recommended that the patient keep every chemotherapy appointment that is scheduled for the most effective treatment.

Preparation before

Chemotherapy

Pre - treatment

How you prepare for chemotherapy depends on which drugs you'll receive and how they'll be administered. Your doctor will give you specific instructions to prepare for your chemotherapy treatments. You may need to: 1. Undergo tests and procedures to make sure your body is ready to receive chemotherapy. Blood tests to check kidney and liver functions and heart tests to check for heart health can determine whether your body is ready to begin chemotherapy. If there's a problem, your doctor may delay your treatment or select a different chemotherapy drug and dosage that's safer for you. 2.Plan ahead for side effects. Ask your doctor what side effects to expect during and after chemotherapy and make appropriate arrangements. For instance, if your chemotherapy treatment will cause infertility, you may wish to consider your options for preserving your sperm or eggs for future use. If your chemotherapy will cause hair loss, consider planning for a head covering. 3. Make arrangements for help at home and at work. Most chemotherapy treatments are given in an outpatient clinic, which means most people are able to continue working and doing their usual activities during chemotherapy. Your doctor can tell you in general how much the chemotherapy will affect your usual activities, but it's difficult to predict exactly how you'll feel.Ask your doctor if you'll need time off work or help around your home after treatment. Ask your doctor for the details of your chemotherapy treatments so that you can make arrangements for work, children, pets or other commitments. 4. Prepare for your first treatment. Ask your doctor or chemotherapy nurses how to prepare for chemotherapy. It may be helpful to arrive for your first chemotherapy treatment well rested. You might wish to eat a light meal beforehand in case your chemotherapy medications cause nausea.Have a friend or family member drive you to your first treatment. Most people can drive themselves to and from chemotherapy sessions. But the first time you may find that the medications make you sleepy or cause other side effects that make driving difficult. 5. Looking well after your self: -Eat foods from all five food groups. -Get enough rest and take one- to two-hour long after naps. -Prepare mentally and emotionally for the treatment by reducing stress and anxiety.

Recovery after

Chemotherapy

Post - treatment

You'll meet with your cancer doctor (oncologist) regularly during chemotherapy treatment. Your oncologist will ask about any side effects you're experiencing, since many can be controlled. Depending on your situation, you may also undergo scans and other tests to monitor your cancer during chemotherapy treatment. These tests can give your doctor an idea of how your cancer is responding to treatment, and your treatment may be adjusted accordingly.

Risks & side effects

Side effects of chemotherapy drugs can be significant. Each drug has different side effects, and not every drug causes every side effect. Ask your doctor about the side effects of the particular drugs you'll receive. Common side effects of chemotherapy drugs include: -Nausea and vomiting -Diarrhea -Hair loss -Loss of appetite -Fatigue -Fever -Mouth sores -Pain -Constipation -Easy bruising and Bleeding Many of these side effects can be prevented or treated. Most side effects subside after treatment ends. Chemotherapy drugs can also cause side effects that don't become evident until months or years after treatment. Late side effects vary depending on the chemotherapy drug but can include: Long term side effects include: -Damage to lung tissue -Heart problems -Infertility -Kidney problems -Nerve damage (peripheral neuropathy) -Risk of a second cancer

FAQs:

Chemotherapy

What are the common side effects that I can expect to see after chemotherapy?

Chemotherapy works by killing rapidly dividing cancer cells. But as it wipes out cancer cells, chemotherapy can also destroy fast-growing healthy cells. This may cause you to experience side effects. The following are the kinds of symptoms that you may experience. Hair loss This might be the first thing that you notice during your chemotherapy sessions. Chemotherapy targets rapidly growing cells and that includes healthy cells in your hair. Hair loss happens most often on the scalp but your eyebrows and eyelashes may thin, too. Fortunately, hair loss is almost always temporary. If you're concerned about this side effect, ask your doctor about strategies to minimize hair loss, such as cooling caps. Low blood cell production -Anemia- You may not have enough healthy red blood cells to carry oxygen to your tissues, which can leave you feeling tired or short of breath. -Bleeding-You may not have enough platelets — a blood cell that plays an important role in forming blood clots — to help prevent bleeding when you're injured. -Infections-You may have fewer white blood cells to protect your body from infections Gastrointestinal symptoms -Diarrhea. Your body's ability to absorb nutrients from food and get rid of waste might be affected. -Nausea and vomiting. Damage to your stomach and intestinal lining can also cause nausea and vomiting. -Constipation. Though less common, constipation also can be a side effect of chemotherapy. Mouth sores. Damage to the cells in your mouth can create sores that make it difficult to eat and drink.

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How often will I need chemotherapy?

How often you take chemotherapy depends on the type of cancer and which drug or combination of drugs you receive. Different drugs work at varying times in the process of cancer cell growth. Your treatment schedule will take all of these factors into consideration. Chemotherapy is usually structured in cycles with rest periods between. Generally, treatments are given daily, weekly, every other week, every third week, or monthly. Your doctor will help you determine the most effective treatment schedule for you.

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How will chemotherapy be administered?

Your doctor will choose the chemotherapy method that will be most effective against your particular type of cancer and cause the fewest side effects. You may receive chemotherapy drugs in one or more of the following ways: -Pill (also referred to as “oral” or PO medication) -Shot (injection) -Intravenous (IV) – delivering liquid medicine through a tube into a vein) -Intraarterial (IA) -The drugs go directly into the artery that is feeding the cancer, through a needle, or soft, thin tube (catheter). -Intraperitoneal (IP): The drugs are delivered to the peritoneal cavity, which contains organs such as your liver, intestines, stomach, and ovaries. It is done during surgery or through a tube with a special port that is put in by your doctor. -Topical - You rub the drugs in a cream form onto your skin Some types of chemotherapy can be given at home. Through instruction, you and your family members can learn how to administer chemotherapy in pill form or by injection with a small syringe and needle similar to those people with diabetes use to administer insulin. In some cases, a nurse will administer chemotherapy in our clinic. In other situations, it may be necessary to go to the hospital to receive treatment.

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