The term chemotherapy indicates any treatment consisting of substances of chemical origin. In common usage, however, this word is used to indicate drugs for the treatment of cancer (Video). Biological drugs or immunotherapy drugs are not part of chemotherapy.
Chemotherapy works by killing cells during their reproduction (replication) process and, due to this characteristic, it is also called cytotoxic or antiblastic therapy. The faster the growth of the cancer cells, the more intense the toxic effect of the drug on them will be. By targeting the cells in active multiplication, however, it also affects the healthy cells of the organism such as, for example, those of the skin. , of the hair bulbs, mucous membranes or bone marrow, generating the well-known and important undesirable effects that occur with the use of chemotherapy.
The choice of whether or not to use chemotherapy must be made by the doctor based on the type of tumor, the site where it is located, its sensitivity to chemotherapy, the stage of the disease and the general state of health of the patient. Generally, it is indicated in cases where a tumor has spread throughout the body (metastatic) or there is a high probability that it will spread.
There are different types of chemotherapy and the treating doctor will decide on a case-by-case basis which one to use, how many cycles to prescribe and if it should be used alone or in combination with other therapies, surgery, radiotherapy.
The main purposes of chemotherapy are:
- eliminate the disease (curative chemotherapy)
- make other treatments more effective, chemotherapy, for example, can be combined with radiotherapy (a treatment that uses radiation to kill cancer cells)
- reduce the volume of the tumor before surgery (so-called neo-adjuvant chemotherapy)
- reduce the risk of the tumor returning (relapse) after radiotherapy or surgery (precautionary or adjuvant chemotherapy)
- relieve symptoms and slow the course of the disease when it is not possible to eliminate the tumor with surgery or radiotherapy because it is too advanced (palliative chemotherapy)
Chemotherapy drugs can be used alone or in combination following a treatment plan established by the treating physician.
Undesirable effects (side effects)
Chemotherapy is effective in treating cancer or in alleviating the symptoms of the disease but, unfortunately, it causes undesirable effects which, in some cases, can be very serious. Chemotherapy drugs, in fact, exert their action not only on cancer cells but also on the cells of the organism in rapid growth, such as the cells of the blood, skin, marrow, hair bulbs and mucous membranes of the mouth, stomach and intestine. The extent of undesirable effects varies from individual to individual but, in general, adapting to it can be challenging. It is important to consider, however, that most, if not all, side effects will disappear once the treatment is over.Furthermore, their negative impact on the well-being and quality of life of the patient has changed a lot today thanks to the increasing attention paid by doctors to minimize it.
In which cases it is indicated
Chemotherapy is potentially a life-saving cure and, as such, is usually recommended in those people with cancer who can benefit from it even if their health conditions are not optimal.
In some specific cases, however, chemotherapy treatment is contraindicated or it is advisable to wait before starting it. They include:
- first three months of pregnancy, the risk that chemotherapy can cause serious defects in the growing embryo is high
- lower than normal amount of blood cells, the use of chemotherapy could make the patient particularly vulnerable to infections, since it further reduces the number of circulating cells
- severe kidney or liver disease, they could get worse because most chemotherapy drugs are processed in the liver and eliminated through the kidneys
- recent surgeries, before starting chemotherapy the wounds must be healed because it could compromise their healing
- ongoing infections, chemotherapy, by lowering the body's defenses, could increase the risk of developing serious complications
The treatment path
There are different types of chemotherapy and different methods of administration that determine effects that vary from person to person. In most cases, thanks also to supportive measures and care that reduce unwanted (side) effects, chemotherapy is compatible with a good quality of life.
The medical staff
Generally, the patient during the period in which he undergoes chemotherapy is followed by a team of medical specialists which includes:
- oncologist, a specialist in the non-surgical treatment of cancer who is responsible for identifying the most suitable chemotherapy for each patient
- pathologist, a specialist who deals with the characterization of tissues affected by the disease
- hematologist doctor, a specialist who studies blood and its diseases
- psychologist, a professional who helps the patient to manage the psychological and emotional impact of chemotherapy
- specialized nurse professional who follows the patient during the administration of the therapy
Deciding which treatment is best suited to each patient is a delicate step. The team of doctors has the task of proposing the therapy that it deems most suitable but the final decision rests with the patient. For this, it is important that he has information available that allows him to choose between the possible possibilities available and to be aware of the treatments he will be subjected to and their purposes. For example, he will have to know:
- efficacy of the type of chemotherapy proposed and what likelihood of success it will have in curing or slowing the disease
- side effects which he will encounter and how to alleviate them
- existence of alternative treatments to the proposed chemotherapy
The decision to subject the patient to chemotherapy is usually preceded by the execution of a series of analyzes that allow to evaluate the patient's general state of health and to ensure that he can deal with any unwanted (collateral) effects that may occur. treatment path further analyzes will be performed to evaluate the progress of the disease and the effectiveness of the treatment.
Before starting chemotherapy, the team of doctors will ask the patient to undergo some tests to check the values of blood cells (red, white blood cells, platelets) and the functionality of some organs that could be damaged by the treatment (liver, kidneys , heart, lung).The analyzes will subsequently be repeated before each chemotherapy cycle. If the results show altered values from the norm, the doctor will evaluate whether to postpone the administration of the drugs or modify the composition of the treatment until the values have normalized. The tests to be performed vary according to the state of health of the patient, the type of treatment and cancer.
Radiodiagnostic examinations can be performed in order to establish the best type of treatment to carry out and to evaluate its effectiveness over time. The main tests are:
- computed tomography (CT)
- magnetic resonance imaging (MRI)
The treatment plan
The team of doctors draws up a specific treatment plan for each patient that includes the choice of drugs and their combination, the doses, the duration of each course of therapy, the number of cycles required and the length of the pause between one cycle and the 'other. The plan of care is also known as chemotherapy protocol and can vary depending on the type of cancer and the stage of the disease.
Types of chemotherapy
Chemotherapy is usually given in two ways: by mouth (orally) or through a needle inserted into a vein (intravenously). There are also other types of administration such as, for example, intrathecal injection through the spine or intramuscular or subcutaneous administration, as appropriate.
Some medications are given by mouth in the form of tablets or capsules. If the patient is in good health, he can take the medicines directly at home. However, he will have to go to the hospital periodically to undergo the checks required by the doctors. When taking drugs it is important to follow the times specified in the chemotherapy protocol.In case you forget to take a tablet or feel unwell after taking it, contact the medical staff quickly.
This type of chemotherapy is slowly injected into a vein over a set amount of time which can range from a few hours to several days. In some circumstances, continuous treatment with low doses of the drug may be required for several weeks or months. In these cases, a small portable infusion pump may be made available to the patient. The intravenous infusion can be done through a peripheral venous catheter or needle cannula, a small tube inserted into a vein on the back of the hand or forearm, or through a central venous catheter, a thin tube that is inserted into the chest and connected to one of the veins near the heart. The tube can be left in place for several weeks or months, allowing intermittent or continuous infusion of medications and nutritional therapies, saving the patient from repeated injections and damage to peripheral veins. It can also be used to draw blood.
The undesirable effects (side effects) of chemotherapy are very varied and it is difficult to predict exactly which types will develop in different people and at what intensity. They can cause serious discomfort for the patient, putting him to a severe test from both a physical and psychological point of view. It will be the doctors' responsibility to provide him with all the assistance and support necessary to deal with the difficulties that will arise during therapy. Although some effects can manifest themselves in a rather serious way, it should be emphasized that they do not represent, in most cases, a serious threat to health and that will regress once the treatment is finished.
Some complaints (symptoms), of particular concern, should be reported to the doctor immediately:
- fever at 38 ° C or higher
- respiratory difficulties
- chest pain
- flu symptoms, such as muscle aches or general malaise
- bleeding from the gums or nose
- bleeding from other parts of the body which does not stop even after applying pressure to the part for 10 minutes
- mouth ulcers which prevent eating and drinking
- He retched continuous, despite taking specific medications
- 4 or more episodes of diarrhea
More frequent side effects
Feeling fatigued is very common during chemotherapy. Almost everyone who is treated with chemotherapy experiences a sense of general exhaustion or a lack of strength after performing normal daily acts. During the treatment, therefore, it is important to allow yourself ample rest and avoid carrying out activities that you do not feel up to. Rather, it is advisable to engage in light physical exercises, such as walking or practicing yoga, activities that can restore an adequate level. of energy without requiring excessive effort from your body. You should contact your doctor if you suddenly feel much more tired than usual and feel short of breath. These disorders (symptoms), in fact, could be the sign of an anemia.
Nausea and vomit
Feeling nauseated and vomiting are common side effects of chemotherapy. About half of sufferers suffer from these disorders. In the event that they occur, the doctor may prescribe so-called anti-emetic drugs that can be administered together with chemotherapy in a vein, by mouth (oral route) or injected into the muscle (intramuscular route).
Hair loss does not always occur but is one of the most typical undesirable (side) effects of chemotherapy.It can be difficult to accept from a psychological point of view: it affects one's image and denounces the state of illness to the outside world. However, it is good to remember that this is a transitory phenomenon and the hair will grow back once the treatment is finished. Many people wear scarves, hats or wigs to combat the sense of discomfort. In some cases this phenomenon can be prevented by wearing an ice cap during drug administration: this determines a low blood supply to the scalp and therefore also a low local release of the drug, reducing its effects. However, this procedure is not always applicable. Some chemotherapy drugs also have an effect on the skin, making it dry and sore as well as on the nails which can be brittle and chipped.
Infections, anemia, bleeding
Chemotherapy interferes with the normal renewal process of blood cells, and can have a number of consequences, sometimes even serious ones. For example, the decrease in the number of white blood cells leads to a reduction in the body's defenses (immune defenses) putting the patient at risk of contracting infections.
The lowering of the number of red blood cells, on the other hand, causes anemia, a condition easily recognizable by the state of fatigue and lack of air that the patient feels during the treatment. Platelets, blood cells necessary for clotting, can also suffer a reduction. Their deficiency can lead to bleeding and bruising.
If these disorders occur, they must be reported to the medical staff to be eliminated or managed adequately.
Disorders of the digestive system
Chemotherapy can cause various disorders to the digestive system, such as the formation of ulcers on the inner lining of the mouth (mucosa) that make it difficult to eat, drink and speak; the onset of diarrhea or constipation, manageable with some specific drugs but also with a diet In these cases, you need to drink a lot to avoid dehydration.
Other common undesirable effects (side effects) of chemotherapy are related to the sleep-wake cycle and include difficulty falling asleep, waking up during night sleep and the inability to go back to sleep.
Sexuality and fertility
Feeling tired, worried about your health can affect your interest in sex life during chemotherapy. However, this is a temporary situation. Some drugs can also affect fertility, compromising the ability to conceive and mature. This condition is also generally temporary but, in any case, it is advisable to talk about it with doctors to evaluate the possibility of freezing the spermatozoa or eggs in the perspective of medically assisted procreation (PMA) interventions.
Living with the effects of chemotherapy can be frustrating, stressful and traumatic. It is often a source of anxiety and worry, especially in relation to the uncertainty that is generated about the success of the therapy. The continuous discussion with the treating doctors and with a psychologist can help a lot to mitigate these effects.
Italian Association for Cancer Research (AIRC). Chemotherapy
Italian Association of Cancer Patients, Relatives and Friends (AIMaC). Chemotherapy