Chemotherapy, unpleasant but necessary

Tantri Yuliandini, The Jakarta Post, Jakarta

When someone finds out they have to undergo chemotherapy treatment, they are often overcome with dread, immediately visualizing loss of hair, frequent vomiting and drastic loss of body weight -- not unlike Campbell Scott's portrayal of a leukemia patient in the 1991 movie Dying Young.

This was one of the reasons why chemotherapy treatment remains an unpopular cancer treatment here, said specialist Nugroho Prayogo of Dharmais Cancer Hospital in Central Jakarta.

In fact, chemotherapy is often needed to complement surgery to destroy cancer cells that are too small to be surgically removed. Some types of cancer can even be treated with chemotherapy alone.

Besides surgery, chemotherapy can also be used together with other types of treatments like radiotherapy and immunotherapy.

Chemotherapy is the use of anti-cancer or cytotoxic drugs to destroy cancer cells. In the process, the drugs interfere with the ability of a cancer cell to divide and reproduce itself so they will eventually die. There are over 50 different chemotherapy drugs, some are given on their own, while others may be combined to produce a more effective treatment.

The type of treatment prescribed depends on the patient's general health, the type of cancer, parts in the body where it started, what the cancer cells look like under the microscope, and how far they have spread.

It may be given before an operation, known as neo-adjuvant therapy, to shrink a tumor and make it easier to remove; after an operation, known as adjuvant therapy, to destroy cancer cells too small to remove surgically; and the palliative therapy to shrink some types of cancer and prolong life.

"When a cure is not possible, chemotherapy may be given to shrink and control a cancer, and try to prolong a good quality of life," Nugroho explained.

The drugs can be administered by injection into a vein or intravenously, some are given as tablets or capsules, injected just under the skin (subcutaneous injection), and some are injected into the fluid around the spine (intrathecal injection).

"It is very rare that chemotherapy is injected into a muscle or intramuscular injection," Nugroho said.

But it is true chemotherapy drugs can also temporarily effect some of the normal cells in the body, and can cause unpleasant side effects.

Different chemotherapy drugs cause different side effects to different people, and some people may have very few.

The main areas they may be affected by chemotherapy treatment are those where normal cells rapidly divide and grow, such as the lining of the mouth, the digestive system, the skin, hair, and bone marrow.

Chemotherapy may reduce the number of blood cells produced by the bone marrow, the spongy material that fills the bone containing stem cells that normally develop into white blood cells, the red blood cells and platelets.

The reduction of these blood cells may make a patient become very tired and lethargic, bruise more easily, suffer nose bleeds, and become more vulnerable to infections.

Chemotherapy treatment drugs can cause feelings of nausea, vomiting and loss of appetite. The drugs can also effect the lining of the digestive system and cause diarrhea for a few days.

Mouth ulcers may break out from the effects of some drugs, usually happening about five to 10 days after the drugs are given, and will clear up within three to four weeks.

Hair loss is one of the most well known side effects of chemotherapy. The amount of hair lost, if any, depends on the type of drug or the combination of drugs used, the dose given, and the person's individual reaction to the drug.

If hair loss happens it usually starts within a few weeks of beginning treatment.

"But many of the side effects of chemotherapy, such as nausea and loss of appetite, can be easily countered using various drugs," Nugroho said.

Chemotherapy treatment may also cause infertility, whether temporary or permanently depending on the type of treatment, he said, explaining that in case of infertility it was sometimes necessary for male patients to bank some of their sperm.

Because of the effects of chemotherapy to the body, it is imperative the treatment is carefully planned. An initial health check should be done by an oncologist, including a complete blood test, kidney function test, and liver function test, Nugroho said.

"Don't be alarmed when the oncologist takes a blood test every week," he warned.

Although the side effects of chemotherapy can be unpleasant, they must however be weighed against the benefits of the treatment, Nugroho said, adding that it must be remembered that most of the side effects will gradually disappear once treatment is over.

Tips on coping with common chemotherapy side effects

Infection: Tell your doctor at once if you develop a temperature over 38 degrees Celsius, you need intravenous antibiotics. Keep clean, always wash your hands thoroughly before preparing food.

Nausea: Your doctor may prescribe anti-sickness (anti-emetics) drugs which usually work well. Low doses of steroids can also be helpful in reducing nausea and vomiting. Avoid eating or preparing food when you feel sick.

Avoid fried foods, fatty foods, or foods with a strong smell. Eat cold or warm food if the smell of hot food makes you feel sick, and eat several small snacks and meals each day.

Have a small meal a few hours before treatment, not just before treatment. Drink plenty of liquids slowly but avoid filling your stomach with fluid before eating.

Diarrhea and constipation: If you have diarrhea, eat less fiber and avoid cereals, raw fruits, and vegetables. Drink up to two liters of fluids a day.

If you are constipated, eat more fiber, raw fruits, cereals, and vegetables. Have prune juice and hot drinks.

Mouth ulcers: Eat fresh pineapple chunks to keep your mouth fresh and moist. Clean teeth or dentures gently every morning, evening, and after each meal using a soft-bristled or child's toothbrush. Gently use dental tape or floss daily.

If your toothpaste stings or brushing your teeth makes you feel sick, try using a mouthwash.

Avoid liquor, tobacco, hot spices, garlic, onions, vinegar and salty food.

Hair loss: If your drugs are likely to cause hair loss, it can help to have your hair cut quite short before treatment. The weight of long hair pulls on the scalp and may make hair fall out faster. Use a soft baby brush to brush your hair. Avoid using hair dryers, curling tongs, and curlers. Pat your hair dry gently after washing it.

If it is likely that you may lose your hair, ask your doctor about wigs early on, so that the wig can be as close a match as possible to your normal hair.