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Feb 13, 2008

Chemotherapy 101

Too many myths surround chemotherapy. It’s time for the facts, and only the facts.

I AM losing my hair and it is not because I am receiving chemotherapy for cancer. It is because I pull out my hair each time a patient tells me, “I don’t want to undertake chemotherapy because chemotherapy kills the good cells as well as the bad cells.”

This is told to me in all its Hokkien and Cantonese variants. Can someone try to translate this statement to Bahasa Melayu? I hear this unfounded statement several times a day!.

We ascribe human attributes to rocks, trees and mountains and infuse them with a spirit. Is there a word for this? I think it is paganism. It seems now that the cells in our body can also take on human characteristics.

There is no such thing as “good cells”. Even if we were to use “good cells” to mean normal tissues (as opposed to “bad” or cancerous cells), chemotherapy does not kill good cells. Not in the sense of annihilate, decimate or exterminate. Not with any finality.

Chemotherapy is used a lot in nations which have emerged from the pre-scientific era: North and South America, Europe, Australasia, most of Asia that is not at war, north of the Sahara and South Africa.

An example of a chemoport through which chemotherapy drugs can be delivered. This one is inserted into the abdomen.

Almost all patients with lung, breast and colorectal cancer will need chemotherapy in both the early and advanced settings. Patients with nasopharyngeal cancer (NPC) and cervical cancer will need chemotherapy given at the same time with radiotherapy. The list of cancers treated with chemotherapy goes on and on.

It is true that chemotherapy suppresses bone marrow function. The three kinds of blood cells produced by the marrow that concern us here are red blood cells (RBCs), white blood cells (WBCs) and platelets.

This important side effect is not such a problem these days. A lowering of RBCs (anaemia) can be easily treated with a combination of a good diet (lots of red meat, please), iron pills, blood transfusion and a drug called epoetin-alpha.

We oncologists always ensure the patient’s RBCs are adequate during chemotherapy to prevent tiredness, fatigue and a poor quality of life.

A lowering of WBCs makes a patient more prone to fever and infection. Again, this is not a problem. We have a drug called filgrastim (and its long-acting sister, pegylated filgrastim) which is given to prevent WBCs from becoming dangerously low.

Nausea, retching and vomiting are dreaded side effects of chemotherapy. This is much better managed today.

At your first chemotherapy session, your oncologist will prescribe an anti-emetic i.e. an anti-vomiting drug. If you still vomit badly despite the anti-emetic given, make sure your oncologist formulates a more effective cocktail at your second and subsequent chemotherapy courses.

I give you a checklist of the drugs you may need either singly or in combination to prevent vomiting: metoclopramide, dexamethasone, ondansetron/granisetron/tropisetron (one of these three will do) and aprepitant.

The problems of diarrhoea and its converse, constipation, plague some patients undergoing chemotherapy. If there is diarrhoea, avoid a high fibre diet. There are also many effective anti-diarrhoeals e.g. loperamide, diphenoxylate, dihydrocodeine.

If you are all bunged up, a laxative will help. There is no point in loading up on fibre, bran, fruit and vegetable to combat constipation. It is too much hard work. Also, your intestines will not tolerate such a load (99% of which is destined for the loo the next day anyway) during chemotherapy.

“Burnt”, “scalded”, inflamed veins are a thing of the past with the introduction of the chemoport. This is a device implanted beneath the skin below the collar bone. It allows chemotherapy, drugs and intravenous fluids to be given with ease. Blood can also be taken for examination from the chemoport.

Certain chemotherapy drugs (adriamycin, trastuzumab, lapatinib) may cause damage to the heart. It is imperative to measure the cardiac function before such drugs are given and thereafter every three months. With this precaution, hardly any patient will suffer from chemotherapy-induced heart disease.

Sadly, there is no effective way of preventing hair loss induced by chemotherapy. But, hey, this is the time to be creative. Hair scarfs, bandanna and tudung come in all shapes, fabrics and colours. Hair pieces can give you a new vibrant look.

Also, to some, a shaven head is a fashion statement (think of sexy Yul Brynner or even sexier Persis Khambatta).

Of course, not all chemotherapy drugs cause alopecia (medical term for baldness). Gemcitabine, pemetrexed, vinorelbine, oxaliplatin and liposomal doxorubicin are some drugs that do not cause significant hair loss. However, these drugs may not be suitable in your case. Remember, cancer is 1,000 disease entities.

The other phrase that makes me pull out my hair is “This herb and this health supplement will boost my immune system during chemotherapy.” I shall discuss this in another article.

And so, like the ancient mariner, I shall stoppeth one of three or maybe even one of two to tell my tale again and again. The tale about chemotherapy curing cancer and prolonging good quality life. About how to overcome chemotherapy-induced side effects. About how almost all chemotherapy-induced side effects are temporary, reversible and manageable.

I have to persevere in my quest in educating the credulous public and the unfortunate cancer patients. I have to keep on dispelling the fears and misconceptions about cancer and cancer treatment. I have to re-educate people about “good versus bad cells” and “boost the immune system”.

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