Treatments

Chemotherapy can be the only treatment modality for a certain cancer, or it is given BEFORE surgery or radiation to shrink the size of the tumour (neoadjuvant therapy). It is also used AFTER surgery or radiation to kill remnant cancer cells in the body (adjuvant therapy). It is also used with other treatment methodologies in case of cancer recurrence.

Most cancers needing chemotherapy have set drug treatment protocols (based on clinical trials), and sometimes, in case of cancer variants, new drugs maybe added or deleted from these protocols.  Other considerations while selecting the right chemo treatment regimen are the patient age, general health, type of cancer, staging, co-morbidities, and previous cancer treatment (if any).

Usually, chemo drug doses are measured based on the body weight or the body surface area of the patient.  Dosages differ in children and adults and this is also adjusted based on older age group, nutritional status, other medications being taken, other adjuvant treatment, White Blood Cell counts, any other end organs affected viz. kidney and liver, etc.  Chemo is given in cycles of combination drugs and the number of cycles depends on the type and severity of the cancer. The duration between the cycles is given to ensure the recovery of the normal cells in the body from the toxic effect, as well as to minimise side effects.

Chemotherapy side effects

Chemotherapy also damages fast multiplying normal cells (viz. blood forming bone marrow cells, hair follicles, cells in the digestive tract and reproductive system) throughout the body, causing side effects and post treatment sequelae.  Chemo can also affect the heart, kidneys, bladder, lungs, and nervous system.

The common side effects are:

• Severe tiredness
• Hair loss
• Bruising, bleeding
• Infection (low white cell counts)
• Anaemia (low red blood cell counts)
• Nausea and vomiting
• Loss of or increasing appetite
• Constipation/ Diarrhoea
• Ulcers in the mouth and throat and pain while swallowing
• Nerve and muscle problems such as numbness, tingling, and pain
• Dry skin and nail color changes
• Urine, bladder and kidney problems
• Weight changes
• Chemo brain, which can affect concentration and focus
• Mood changes
• Changes in sexual function, reduced fertility

Every person does not react to chemotherapy in the same way, and drugs are routinely administered during chemo to avoid these side effects, and there are other treatments like acupuncture, acupressure, natural remedies, homeopathy, etc that can alleviate the symptoms.

Chemotherapy drug interactions

Chemotherapy drugs can interact with routine medication being taken for co-morbidities, multi vitamins, as well as nutritional supplements.   Some common examples

• Chemo lowers platelet counts and taking aspirin or related blood thinners can lead to serious bleeding problems.
• Vitamins A, C and E are considered anti-oxidants, so also the new gen anti-oxidants on the market.  It is believed that these can lessen the effects of chemotherapeutic drugs and should be taken only if prescribed during the treatment by the treating doctor.

What symptoms to look out for?

If the patient gets high fever, sudden bruising or bleeding, rash or allergic itches or throat swelling, rigors, pain in injection site, blood in urine, shortness of breath, or vomiting and diarrhoea, then the treating doctor should be contacted immediately for advice and treatment.