Chemotherapy is the medical treatment which is given to cancer patients to destroy fast multiplying cells in the body. The drugs are called as chemotherapeutic agents/drugs.
Targeted therapy is a form of treatment in which drugs act by targeting specific receptors on cancer cells. This form of therapy is less toxic, but it has side effects too. Broadly chemotherapy may be classified based on if given before surgery or after surgery or along with radiation therapy.
1. Combined modality chemotherapy Neo-adjuvant Chemotherapy – Chemotherapy which is given before surgery. It is given with an intent to reduce the size of the tumor to make it surgical resectable.
Adjuvant Chemotherapy – Chemotherapy which is given after surgery. It is given with an intent to kill the cancer cells present in the blood circulation in the body.
Concurrent Chemotherapy – Chemotherapy which is given when the patient receives radiation therapy. It is usually given once in a week, while the patient receives radiation therapy on a daily basis.
2. Curative Chemotherapy
Chemotherapy when given with a curative intent is called as curative chemotherapy. It is usually given in the early stages of cancer.
3. Palliative chemotherapy
It is a chemotherapy given to the patient, when the disease is in stage IV, with an intent to improve the symptoms & improve the quality of life. The other kinds of chemotherapy are induction, consolidation and maintenance chemotherapy (in leukemia).
Chemotherapy may be used in the following cases:
To cure cancer, as primary treatment
After other treatments, to kill any hidden or undetected cancer cells
To shrink the tumor size so that other treatments become more effective
Chemotherapy is also administered in bone marrow diseases and immune system disorders.
Depending on the chemotherapy will be administered, you might have to make certain preparations. In most cases, there is no special requirement to get chemotherapy. You may need to:
Require chemoport, If chemotherapy will be administered intravenously.
Undergo certain tests to ensure that the body is ready for chemotherapy.
Check dental infection, in rare cases.
You should eat and drink right during your chemotherapy sessions.
It is usually given in the form of Intravenous (blood administration), also given in the form of oral pills, intramuscular, spinal, peritoneal, directly into CSF.
A single chemotherapeutic agent may be used or a combination of many drugs may be used at the same time or at different times.
It can be given via intravenous line (through veins), or via Chemoport or PICC line (Peripherally Inserted Central Catheter). You may or may not be able to get admitted for chemotherapy. It is usually administered in day-care (where chemotherapy is administered for a few hours & then patient is discharged) under the supervision of paramedical staff. Chemotherapy may be administered over few seconds, or minutes or hours. It may be given over a period of few days also, depending on the treatment protocols, for which you may have to get admitted. Your doctor (medical oncologist) will decide which form of chemotherapy should be given to you based on age, cancer site, histological type, stage and other parameters.
Some International organizations, such as, NCCN (National Comprehensive Cancer Network), ASCO (American Society of Clinical Oncology), ESMO (European Society for Medical Oncology) publish guidelines & protocols specifying dosage, schedule, method of administration of chemotherapy, duration of administration of chemotherapy etc. based on evidence based medicine. You will receive chemotherapy according to the chemotherapy protocols.
You may receive chemotherapy daily, on alternate days, weekly, twice weekly, monthly or so on. It depends on the chemotherapy protocol (designed by the international organizations or personalized protocols).
Chemotherapy leads to a period of few days of low immunity (low white blood cell counts), when you should be careful about onset of fever.
Some patients feel much tried & weak after chemotherapy, the duration of which may vary.
You should consult your doctor about working hours & also, you can discuss your work schedule with your employer.
You can work during chemotherapy if you medically fit for the same.
Risk and Complications
Various types of chemotherapy agents have different side effects. The severity may vary from person to person. Few of the predictable side effects are:
Infections – especially during the phase of low white blood cell count
Changes in fertility These days, chemotherapy is not as scary as before. New drugs are available which are safe and more effective. Majority of side effects of chemotherapy are manageable with the help of supportive treatment. For example:
Neutropenia – Low white blood cell count – is managed with the injections (filgrastim/peg filgrastim), which boost the white blood cell count.
Anaemia – Low haemoglobin – is managed with the help of blood transfusion, erythropoiten stimulating agents & iron supplements, if required.
Nausea/Vomiting – is managed with the help of intravenous medications before chemotherapy (called as pre medication), & with the help of oral medications after chemotherapy is over. Various combination of medications are used in different dosages depending upon the type of chemotherapy and severity of nausea/vomiting.
Loose stools/constipation – can be managed with the help of supportive medications.
Hair Loss – Currently it can’t be managed with the help of medications. However, hair loss is not permanent. Hair start growing again after the chemotherapy is over.
Similarly, there are other side effects of chemotherapy, which may or may not be managed with the help of supportive treatment. Different types of chemotherapeutic agents have different types of side effects. Not everybody suffers from all side effects & severity of side effects may vary.
Chemoport, also called as Port-A-Cath, is an implantable device, which is used for venous access. It consists of the portal reservoir (with silicone bubble) & septum (for needle insertion) which is inserted under the skin. Portal is connected to the catheter which extends till the vein in the neck. It is inserted with a simple surgery of short duration. It makes the blood sampling & chemotherapy administration relatively easy. It can be kept in place for few years, but needs flushing with heparin at regular intervals (discuss with your doctor).
PICC line, Peripherally Inserted Central Catheter, is long, flexible tube, which is inserted through a large vein in the arm & the other end of it reaches the large vein in the neck. The insertion is a simple procedure (similar to the insertion of IV cannula) & needs flushing with heparin at regular interval (discuss with your doctor). Cost of chemotherapy is based on the type of chemotherapy, brand of the medicine used, dosage of the medicine (calculated according to the body weight) and chemotherapy protocol being used. It may vary from a few thousands to few lakh.
You should discuss the approximate cost of chemotherapy in the respective cancer centre. BSA, also called as Body Surface Area, is measured or calculated surface area of human body. It is a parameter used to calculate chemotherapy dosage. It is calculated with the help of various formulas, using two parameters, height & weight.
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