By Dr Lemma
The Greek word for drugs, ‘Pharmakos’ has several meanings one of which means poison. It is true that any drug if taken inappropriately and for the wrong reason can be a poison. This is particularly true for chemotherapy medications that are not usually selective in attacking cancer cells but also affect our healthy system.
There are some patients with cancer who refuse to take chemotherapy stating it is a poison. Indeed chemotherapy has serious side effects. However as the saying goes in my country, “sharp with a sharp” “Eshokin beshok”, it is also supposed to fight a serious illness. Technology is getting close to the point where we can selectively kill cancer cells with minimal side effect on the healthy body. There are several such medications collectively known as targeted therapeutic agents. However until that time comes fully, we still have to use conventional chemotherapy as long as the benefit outweighs the harm.
In general chemotherapeutic agents work by attacking rapidly dividing cancer cells. Thus the most aggressive cancers are the most responsive to chemotherapy. Unfortunately they also affect rapidly dividing cells in the body particularly the bone marrow (blood forming cells), the skin and the lining of the gut.
For ease of understanding we can classify chemotherapy related side effects in to two groups (this does not mean physicians are not concerned about their patients’ worries) :
I) Side effects most worrisome for the patient:
a) Hair loss: hair loss is one of the most feared complications of chemotherapy for cancer patients. This is partly associated with the stigma of hair loss and cancer in the society as well as the self-image and cosmetic importance of hair particularly for women. Not all chemotherapy results in hair loss and when it happens it usually happens within 2-3 weeks of chemotherapy. The good news, it comes back when chemotherapy is completed! As some oncologists joke, it comes back in the color and style you want! Thanks to the cosmetic industry as well, wigs also called cranial prosthesis could make a big difference. Innovative ways are also being tried to prevent hair loss with chemotherapy.
b) Nausea vomiting: this used to be the most dreaded complication of chemotherapy in the old days. Fortunately with the advent of effective anti-nausea medications, the situation has changed dramatically. If used appropriately, nausea and vomiting can now be effectively prevented and or treated in most chemotherapy regimens. However there are times when it could still be a challenge for some patients affecting their ability to nourish themselves and resulting in dehydration as well as damage to the kidneys that may require hospitalization.
c) Fatigue: fatigue is indeed a poorly understood but significant side effect that can adversely affect patient’s quality of life. It is difficult to measure, to find the exact cause as well as to treat fatigue. Several things can contribute to fatigue during chemotherapy including but not limited to the underlying cancer, the effect of chemotherapy, low blood counts particularly anemia, infections, anxiety/depression associated with cancer diagnosis as well as lack of sleep from pain, anxiety… A lot needs to be done to address the issue of fatigue not only in cancer but in other medical problems as well.
II) Side effects most worrisome for the treating physician:
a) Low blood counts: this usually happens within a week to 10 days following strong chemotherapy. The most feared complication from low blood counts is infection which can be serious and sometimes fatal. Patients and health professionals should be in watch for any signs and symptoms of infection which can be subtle initially but can progress to serious illness within short period of time. Any fever in a patient on chemotherapy should not be taken lightly and patients need to either call their health care providers immediately or go the nearest emergency room. Personal hygiene is also important in minimizing the risk of infection.
The other complication of low blood count is anemia which can contribute to fatigue and other symptoms. Patients on chemotherapy will have frequent blood count checks and will be given blood transfusion as needed. Another possible complication of low blood count is bleeding but fortunately uncommon. This too can be prevented by transfusion when blood counts reach certain level. The good newssis blood counts will come back to normal in most patients once chemotherapy is completed and even in between chemotherapy cycles.
b) Side effects specific to specific chemotherapy medications: There are side effects which are specific to individual medications that treating physicians anticipate and follow up. Some chemotherapy medications can affect the function of the heart, others can affect the function of the kidneys, the lung or the liver. It is beyond the scope of this article to discuss all these.
c) Long term damages from chemotherapy: unusual but serious toxicity from chemotherapy and radiation therapy is the possibility of developing another cancer several years down the line. This is especially true in curable cancers where patients survive for several years after their initial treatment. Fortunately this complication is relatively unusual. However it is of real concern for the treating physician as well as the patient.
In summary chemotherapy needs careful consideration of its potential risks and benefit. It can indeed be harmful when used in conditions where the risk outweighs the expected benefit. This has to be thoroughly discussed between the patient and the treating physician.
Finally, with targeted agents (drugs that can selectively kill cancer cells with minimal side effect) coming to the armamentarium against cancer, time will come when we will look back and say how barbaric we were to use conventional chemotherapy….but for now we fight with what we have. In my opinion, both those who treat cancer and the patients who fight the disease are brave enough to face an unrelenting enemy with whatever is available in their hands. It is also fair to say that significant achievements have been made and continue to be made just over the past few years, thanks to those who work day and night to bring about breakthrough!
Dr. Lemma is a cancer specialist.