Chemotherapy Combatting Cancer

Cancer is common in the United States. National Cancer Institute statistics compiled in 2020 from the latest available data estimated 1,806,590 new cases of cancer and 606,520 deaths that year.

The most common cancers, listed in descending order according to estimated new cases in 2020, were breast cancer, lung and bronchus cancer, prostate cancer, colon and rectum cancer, melanoma of the skin, bladder cancer, non-Hodgkin lymphoma, kidney and renal pelvis cancer, endometrial cancer, leukemia, pancreatic cancer, thyroid cancer, and liver cancer.

Prostate, lung, and colorectal cancers are the top 3 cancers diagnosed in men. For women, the three most common cancers are breast, lung, and colorectal, cancer.

The good news is that deaths have declined steadily over 30 years. One of the many reasons is treatment that often includes chemotherapy.

What is Chemotherapy

Chemotherapy is the use of strong drugs that specifically kill fast-growing cells and cell types like cancer. During World War II it was noticed that people exposed to nitrogen mustard gas had lower white blood cell counts. Pharmacologists at Yale began experiments using nitrogen mustard gas to treat lymphoma in mice. This led to the use in humans and the development over the past 80 years of a series of drugs – all designed to attack rapidly multiplying cancer cells in various cancers. Today, more than 100 different chemotherapeutic drugs are available to attack different steps in cell replication and different types of cancer cells. When chemotherapy is combined with another form of therapy it is often referred to as adjuvant therapy, meaning it is used in addition to other approaches such as surgery or radiation.

Why is Chemotherapy Used

Each type of cancer is different, and each patient is unique. Chemotherapy involves four general approaches for treating cancer.

Cure the cancer without other treatments.

Kill microscopic cancer cells that other treatments did not eliminate.

Prepare the patient for another type of approach, such as surgery and/or radiation.

Use as a palliative approach to reduce symptoms of persistent cancer.

The specific type of cancer, the stage at which it is diagnosed, and the patient’s overall medical condition are factors in determining determine which of the four uses chemotherapy fulfills.

The patient and a team of experts make this decision jointly. The team likely includes an oncologist, a surgeon, a radiation oncologist, pharmacist, nurse, and perhaps a social worker. The patient’s primary care physician, as well as other specialists who may have cared for the patient, are consulted. In other words, the treatment plan is specific to the patient.

Risk Benefit of Chemotherapy

Everything in medicine is approached from a risk benefit point of view. Simply put, the patient and the team analyze the risk of a particular treatment and its potential benefit. Because chemotherapeutic drugs affect normal cells as well as cancer cells, chemotherapy carries risks and side effects. Table 1 lists many of the more common adverse consequences of chemotherapy. The table includes page numbers from a very useful pamphlet published by the National Cancer Center and is available for free download at: cancer.gov/publications/patient-education. The page numbers describe the various reasons for the side effects, signs to watch out for, and the best ways to manage each side effect. I encourage readers who are undergoing or about to undergo chemotherapy to read this valuable resource.

In addition to side effects listed in the table, which tend to be short-lived and last only a few days to months, longer lasting or permanent consequences can develop in some patients. These tend to be organ specific and include damage to the lung, heart, kidney, or peripheral nerves. If a patient has disorders of these systems, drugs known to influence these organs are avoided. Still, damage may still occur since the drugs attack normal as well as cancer cells.

Undergoing Chemotherapy

Chemotherapy is usually provided on an outpatient basis by drug infusion or pills. During the infusion, a nurse and/or pharmacist may be present. A catheter is often placed in a major vein in the chest to facilitate repeated infusions. Other times a temporary catheter is placed at each infusion session. Patients must be informed by the oncologist regarding the choice of drugs, the schedule for the treatments, the monitoring during the time of therapy, such as blood tests and imaging scans, as well as anticipated side effects. The patient should have a record of:

1. Scheduled chemotherapy
2. List of expected side effects
3. List of any new symptoms and problems with general health
4. List of phone numbers including cell number of the responsible physician
5. Weight change
6. Dietary change
7. Stool/urination changes
8. Insurance documents

Because patients often feel tired and perhaps depressed, they should communicate with a spouse, relative, or trusted friend during therapy. Often people seek support from fellow cancer patients for support. It’s a mistake to try to go through chemotherapy alone. Others can and will assist the patient while going through the transitory period of treatment called “chemo.” As with all medical issues, patients must follow a healthy diet and exercise as much as they can tolerate.

Bottom Line

Chemotherapy is one reason why the number of cancer survivors is increasing every day. Treatments are still being developed and have proven effective as part of the overall treatment strategy for many cancers. Shared decision making and clear communication between the patient and the care team are essential to that strategy.

 

Common Side Effects from the chemotherapeutic drugs

	Side Effects	Pages in NCI pamphlet
1	anemia	14-15
2	appetite change	16-17
3	bleeding (thrombocytopenia)	18-19
4	constipation	20
5	diarrhea	21-22
6	fatigue	23-24
7	hair loss	25-26
8	infection (leukopenia)	27-29
9	infertility	30-31
10	mouth and throat sores	32-34
11	nausea and vomiting	35-36
12	nervous system change	37-38
13	pain	39-40
14	sexual changes	41-43
15	skin and nail changes	44-46
16	urinary, kidney, or bladder changes	47
17	other side effects	48

Table 1. Common Side Effects from the various chemotherapeutic drugs used to treat cancer. The page numbers refer to the National Cancer Institute publication entitled Chemotherapy and You. In the pamphlet are causes and treatment of the side effects.