Coping with Chemotherapy | Patient Education

Before Starting Chemotherapy

Before starting chemotherapy we suggest that you take care of some of your basic health needs. If time permits, have your teeth cleaned before rather than while you are having chemotherapy. If you need major dental work, try to postpone it until after chemotherapy. If you need your teeth cleaned while receiving chemotherapy, please let your doctor or nurse know beforehand and discuss any concerns.

Emotional Support

You can have a family member, friend or support person accompany you to your chemotherapy sessions. We recognize that cancer has an impact on you as a whole person and also on your family and loved ones.

To varying degrees, all people with cancer struggle with the challenges of coping and adjusting to these life changes. At the Cancer Center, we have a number of programs to support you through the process, such as the Peer Support Program, support groups and individual counseling, that are available to all cancer patients.

Fever and Infection

Chemotherapy lowers the number of white blood cells (WBCs) your body makes. White blood cells are made in the bone marrow and help fight against infection. Neutrophils are one type of WBC that fights infection. Often your neutrophil count will determine whether or not you will receive chemotherapy on schedule.

A fever of 101° Fahrenheit (38.3° Celsius) or above, or chills with or without a fever, can be a serious sign of infection. You must call your cancer specialist if you experience these symptoms, even if it’s at night or on the weekend.

An infection is most likely to occur when your neutrophil count is low. You are most susceptible to a bacterial infection about seven to 12 days after your chemotherapy infusion. Most bacterial infections result from your body’s inability to fight off normal bacteria present in your gastrointestinal tract or skin. Bacterial infections
do not commonly result from being in a crowded place. So, if you are feeling well, we encourage you to continue to go out to the movies or out for a meal.

However, viral infections such as colds and flu are common and are transmitted easily from other people. To reduce your chance of infection, wash your hands frequently and avoid close contact with anyone who is ill during this time.

Practical Hints Regarding Fever and Infection

• If you have a fever of 101° Fahrenheit (38.3° Celsius) or above, with or without chills, call your doctor or nurse immediately. If you cannot reach your cancer specialist, go to an emergency room.
• Keep a thermometer in your home and know how to take your temperature. Do not eat, drink or smoke for 10 minutes before taking your temperature. Leave the thermometer under your tongue for three minutes. If you are still unsure of how to take your temperature, ask your doctor or nurse.
• Call your doctor or nurse as soon as possible if you develop a cough, sore throat, pain or burning when you urinate.
• Wash hands frequently with soap and water to prevent infection.
• Avoid rectal intercourse, tampons, douches, enemas and rectal thermometers.
• Do not eat raw foods such as sushi and sashimi, Caesar salad or milk shakes made with raw eggs, until you complete chemotherapy and your blood counts have returned to adequate levels. Raw foods may carry bacteria that can lead to infection. Make sure to thoroughly wash fruits and vegetables.
• Wash hands and cutting boards well after food preparation.
• Always tell your doctor before going to the dentist.

The table below will help you understand your temperature in both Fahrenheit and Centigrade:

Remember, always call your doctor if you have a temperature of 101° Fahrenheit (38. 3° Centigrade) or higher.

Flu-Like Symptoms

Around the third day following a chemotherapy treatment, some people may experience flu-like symptoms such as muscle aches and pains. If you experience these aches, you can take over-the-counter medications such as Tylenol or Advil. If necessary, contact your doctor for stronger medication.

Nausea

Medications called antiemetics or anti-nausea drugs are used to prevent and treat nausea and vomiting due to chemotherapy. Not all chemotherapy drugs cause nausea. Many anti-nausea drugs are available, and your doctor or nurse will recommend what is expected to work best for you.

If possible, have your prescriptions filled before your treatment day. Please call your doctor or nurse if your medications do not give you adequate relief or if you experience side effects with the anti-nausea medication.

Practical Hints for Nausea

• Eat a small, light meal before your chemotherapy appointment. Most people do better if they have something in their stomach.
• Eat what sounds good to you. In general, starches such as rice, bread, potatoes, hot cereals and puddings are well tolerated.
• Try not to skip meals. An empty stomach will worsen all symptoms. If you don’t feel like sitting down to a meal, try nibbling on something that appeals to you.
• Drink plenty of fluids. Herbal teas, water, sports drinks and diluted juices are recommended more than soda.
• Avoid unappealing smells.
• Freeze meals so you don’t have to cook. Ask your family and friends to help with meals, especially following chemotherapy when you are most likely to feel nauseated.

For more practical tips on dealing with nausea, schedule a free appointment with the dietitian by contacting the Patient and Family Cancer Support Center.

Fatigue

Chemotherapy can make you feel tired. This fatigue may or may not worsen as you are treated with more cycles of chemotherapy.

Most people have to make some adjustments in work and family responsibilities; the degree of change is very individual. Try to balance activity and rest. As much as possible, try to maintain your everyday activities. It can be very beneficial to both your physical and emotional recovery. The fatigue will go away after you recover from chemotherapy.

The Patient and Family Cancer Support Center also hosts monthly fatigue management workshops to address these concerns.

Practical Hints for Fatigue

• Plan your activities, such as grocery shopping, for a time when you feel the best.
• If you have children, rest when they are napping. When you feel most tired, consider hiring a babysitter for a few hours so that you can relax or take a nap.
• Take naps early in the day so you do not disturb your sleep pattern at night.
• Consider exercising every day or several times a week. Good forms of exercise include swimming, walking and yoga. Contact the Patient and Family Cancer Support Center for information on free exercise classes.

Hair Loss

Many people feel that hair loss is one of the most difficult aspects of chemotherapy treatment. Not all chemotherapy drugs cause hair loss, so talk to your physician or nurse about what to expect.

Most often, hair loss begins about two to three weeks after starting chemotherapy. Some people will lose relatively little hair, while others may lose the hair on their head, eyelashes and eyebrows, as well as other body hair. You may want to cover your head with a wig, scarf, hat or turban, or you may not want to cover your head at all. Do what makes you most comfortable. Many people choose different head coverings for different situations.

We have many resources to assist you during this time, including the Friend to Friend Gift Shop and the Look Good… Feel Better! program. Please visit the Patient and Family Cancer Support Center for additional referrals and resources for wig and head covering boutiques.

If you decide to buy a wig, try to buy one while you still have your own hair so you can better match color and style. You may want to ask your doctor for a prescription for a “cranial prosthesis” (i. e., a wig), as some insurance companies will only pay for a wig with a prescription for a cranial prosthesis.

Your hair will begin to grow back after you stop chemotherapy. It usually takes from two to three months to see the change from no hair to some hair. Your new hair may be slightly different in color and texture than your old hair. Often, the new hair will be baby soft and curly, but will generally return to its original texture after some time.

Practical Hints for Hair Loss

• It is not always necessary to buy a real wig. Synthetic wigs can look as good and are less expensive, easier to care for, lighter in weight and may be more comfortable to wear.
• Before possible hair loss, some people like to cut their hair short. The hair loss won’t be quite so shocking if there is less hair to lose.
• Put a towel over your pillow so that clean up in the morning will be easier while you are shedding your hair.
• Buy a drain catch for your shower. Other people choose to shave their head hair when hair loss begins.
• Refer to our wig information sheet for places to shop near you.
• Refer to the Friend to Friend Gift Shop or the Cancer Resource Center for more information.
• When buying a wig, take a friend for emotional support and maybe even a laugh!

Appetite and Taste Changes

During chemotherapy, you may experience taste and appetite changes and a heightened sensitivity to odors. Don’t worry if you don’t have an appetite the first few days or a week following chemotherapy; it is not unusual. As you feel better, your appetite will improve.

Reflux – when food backs up into your esophagus – burping, or a burning sensation may worsen nausea. Please report these symptoms to your physician or nurse so that they can be treated. You may find that you can only tolerate certain foods. We encourage you to eat what appeals to you during this time, and to drink enough fluids: eight to 10 eight-ounce glasses per day, more if you have a fever or diarrhea.

Recommendations for healthy nutrition include a diet low in fat (less than 20 percent fat) and high in whole grains, fruits and vegetables, and plant-based proteins. Some people want to begin dietary changes during active therapy; others prefer to wait until chemotherapy is completed. Some people prefer small, slow changes, while others benefit from a “major overhaul.” We encourage you to become informed and make healthy dietary and lifestyle changes.

Many people gain weight while on chemotherapy for reasons that are not well understood. Again, if you have concerns about nutrition, please consult our staff dietitian.

Practical Hints for Taste and Appetite Changes

• Eat what appeals to you during this time.
• Eat foods that are warm rather than hot.
• Avoid places where food is being cooked, such as the kitchen at dinnertime.
• Avoid unappealing smells.
• Try to drink eight to 10 glasses of fluid a day.

Diarrhea or Constipation

Some chemotherapy drugs can cause diarrhea. If you have more than three or four watery stools in 24 hours or blood in your stool, call your doctor or nurse. Do NOT use over the counter anti-diarrhea medications like Imodium unless advised to do so by your physician or nurse.

Some chemotherapy and anti-nausea drugs can cause constipation. Also, you may be more prone to constipation because your activity level and diet have changed. If you experience constipation, contact your doctor or nurse the same day.

Practical Hints for Constipation

• To help prevent constipation, drink eight to 10 glasses of fluid a day.
• Take a stool softener (not a laxative) such as ducosate sodium, also known as Colace, one tablet once or twice a day. Senekot or Senekot-S also may be suggested. Ask your doctor or nurse for a recommendation.
• Stay as active as you can. Consistent regular exercise can reduce constipation.
• If you can tolerate them, try high-fiber foods such as prunes, bran, fruits and vegetables.

Practical Hints for Diarrhea

• To replenish lost fluids, drink eight to 10 eight-ounce glasses of non-caffeinated fluids per day.
• If your rectum is sore, use soft toilet paper and A&D ointment (used for diaper rash in infants) or Anusol, which can help numb the rectum and soothe soreness.

Mouth Sores

Another side effect of chemotherapy can be mouth sores and discomfort when swallowing. Mouth sores occur because chemotherapy not only destroys cancer cells, but also rapidly dividing cells, such as those that line your mouth and esophagus. Please call your practitioner should you develop painful mouth sores or have difficulty swallowing. A special mouth rinse may be prescribed.

Practical Hints for Mouth Sores

• Brush your teeth with a soft toothbrush three times daily.
• Rinse your mouth with a solution of one teaspoon baking soda and one teaspoon of salt, diluted in a glass of lukewarm water, three or four times daily.
• Most commercial mouthwashes contain alcohol. Ask your health care provider about mouthwashes that are not irritating to your mouth.
• Ulcer-ease is a commercial product that may provide temporary relief from sores.

Neuropathy

Neuropathy, which means disease or dysfunction of the nerves, can happen to some people. Some of the most common symptoms of the type of neuropathy caused by chemotherapy include tingling and burning, numbness or pain in the affected areas, loss of your sense of position – knowing where a body part is
without looking at it – and loss of balance. The most commonly affected areas are the tips of fingers and toes, although other areas are sometimes affected as well.

Tell your doctor about any symptoms that you experience. Early detection and treatment are the best way to control your symptoms and prevent further nerve damage.

Practical Hints Regarding Neuropathy

• Tight shoes and socks can worsen pain and tingling, and may lead to sores that won’t heal. Wear soft, loose cotton socks and padded shoes.
• If you have burning pain, cool your feet or hands in cold, but not icy, water for 15 minutes twice a day.
• Massage your hands and feet, or have someone massage them for you, to improve circulation, stimulate nerves and temporarily relieve pain.

Menopause

For women, chemotherapy may temporarily stop your periods or result in permanent menopause. The effects depend on the type of chemotherapy administered, your age and how close you are to naturally occurring menopause.

With menopause, you may experience symptoms such as hot flashes, decreased libido, vaginal dryness, mood changes and sleeping disturbances. If you experience any of these symptoms, talk to your doctor or nurse to get information and treatment for the symptoms.

If your periods continue during treatment, they are likely to change in duration, flow and regularity. The changes may be temporary, lasting only while on chemotherapy, or the changes may lead to menopause.

Practical Hints for Menopausal Symptoms

• If you have breast cancer, we DON’T recommend hormone replacement therapy.
• Eat soy products or take vitamin E (400 units only) to reduce hot flashes.
• Your doctor may recommend prescription medications for hot flashes.
• Wear light cotton pajamas to help prevent overheating when sleeping.
• Use vaginal moisturizers on a regular basis or other water-based lubricants as needed, especially during and before sexual activity. These products will help with vaginal dryness and irritation.
• Try an opened vitamin E capsule or olive oil spread on the vagina to increase lubrication.
• There are prescription medications that give a local dose of estrogen to the tissues in the vagina to treat vaginal dryness.

Questions and Concerns

If you have a question or concern, staff will take your message and your nurse or physician will call you back. Please allow two days notice for medication refills.

If your call is urgent, please tell us immediately when you call.

If you are calling at night, on a weekend or a holiday, please call the same clinic number. You will speak with a staff member of the answering service who will take your name and number. A physician will be paged and will call you back. Please be prepared to tell the answering service:

• Your name and doctor
• Your type of cancer
• The type of chemotherapy and the date you last received treatment
• The names of any other medications you are taking
• Your pharmacy’s phone number

Please remember that we are here to make this time less difficult for you and call us with any questions or concerns.

What to Expect When Having Chemotherapy

It is normal to feel worried or overwhelmed when you find out that you need chemotherapy. However, learning more about this type of cancer treatment may help you feel more prepared and less anxious. The information in this article can help you get ready for your first treatment.

Who is on my chemotherapy team?

A highly trained medical team will work together to give you the best possible care. Your team may include these health care professionals:

Medical oncologist. This type of doctor specializes in treating cancer with medication. Your medical oncologist works closely with other team members to create your overall cancer treatment plan. They also lead your chemotherapy treatments.

Advanced providers, like oncology nurse practitioners (NPs) and oncology physician assistants (PAs). These providers meet with patients and collaborate with a supervising medical oncologist. Their responsibilities can include:

• Giving physical examinations

• Ordering and interpreting laboratory and diagnostic test results

• Prescribing and administering medications and other therapies, including chemotherapy

• Providing education and counseling for patients and families

Oncology nurse. An oncology nurse specializes in cancer care. This includes giving chemotherapy. Oncology nurses can also:

• Answer questions about treatment

• Monitor your health during treatment

• Help you manage side effects of treatment

Other health care professionals. Other team members may help care for your physical, emotional, and social needs during chemotherapy. These professionals include:

Learn more about the oncology team.

What happens before chemotherapy?

Each chemotherapy treatment plan is created to meet a patient’s unique needs. But before treatment starts, you can expect to take these general steps.

Meet with your oncologist. The doctor will look over your medical records and do a physical exam. You will also have tests done to help plan treatment. Your exact treatment depends on the type, size, and location of the cancer. Your doctor will also consider your age, your general health, and other factors, such as previous cancer treatments.

Learn about your chemotherapy treatment schedule. Your health care team will explain when and how often you need chemotherapy. Most chemotherapy treatments are given in repeating cycles. The length of a cycle depends on the drug(s) you receive. Most cycles range from 2 to 6 weeks. The number of treatment doses scheduled within each cycle also depends on the prescribed chemotherapy.

For example, each cycle may contain only 1 dose on the first day. Or, a cycle may contain more than 1 dose given each week or each day. Often, your doctor will check if the treatment is working after you finish 2 cycles. Most people have several cycles of chemotherapy. Sometimes, chemotherapy treatment is ongoing as a maintenance therapy.

Give permission for chemotherapy. Your doctor will talk with you about the possible risks and benefits of chemotherapy. This discussion will include potential short-term side effects and late effects of the chemotherapy. This is a great time for you to ask questions and share any concerns. Once you decide to move forward, your health care team will ask you to sign an informed consent form.

Signing this form means:

• Your team gave you information on your treatment options.

• You choose to have chemotherapy.

• You give permission for health care professionals to deliver the treatment.

• You understand that the treatment is not guaranteed to give the intended results.

• You understand that there are possible risks, like side effects, that may happen due to the treatment.

Learn how food and medicine can affect chemotherapy. Your health care team will tell you if there are restrictions or suggestions about what to eat and drink on chemotherapy days. This will help your treatment work best. Always tell your chemotherapy team about any prescription and non-prescription medicines you take. Include vitamins and other supplements, such as herbs. This is to avoid drug interactions and other unwanted side effects. Your doctor will tell you if you should not take them during chemotherapy.

How should I plan for chemotherapy treatments?

There are steps you can take before treatment begins to help you cope.

Prepare for side effects. Your team will work with you to plan for side effects common to your specific treatment. These may include nausea and vomiting, fatigue, and other side effects. This can include recommendations about eating well and getting regular exercise.

Relieving physical and emotional side effects is an important part of your overall cancer treatment. This type of care is called palliative care or supportive care. Talk with your health care team about the side effects you experience and ways to manage and treat them. Learn more about the side effects of chemotherapy.

Make a caregiving plan. People receiving chemotherapy may need extra help during treatment with transportation, household chores, and other tasks. Family and friends can provide valuable support during this time, called caregiving. Ask your team what type of caregiving at home you may need during and after treatment.

Get help with finances. Cancer treatment can be costly. Before chemotherapy starts, talk with your team about the financial considerations of your treatment, including specific insurance coverage. You may want to contact organizations that can provide financial support. This could be important if your health insurance does not cover the whole cost of treatment.

Get help at work. As you learn about your treatment schedule and side effects, you may be concerned about how this could affect your work schedule. Talk with your employer about possible adjustments to your work schedule or other arrangements during treatment and your recovery.

What happens during chemotherapy treatment?

There are different ways you can receive chemotherapy. The most common way that chemotherapy drugs are given is through a needle into a vein. This is called intravenous or IV chemotherapy. Chemotherapy can also be taken as a pill, capsule, or liquid by mouth, as an injection or shot, or as a cream that is put directly on your skin. Learn more about the different kinds of chemotherapy.

During your first IV chemotherapy appointment, you should bring a friend or family member. They can support you and help you remember information. Sometimes you will be given medication before your chemotherapy treatment that can make you tired, so you may need someone who can drive you home.

You may also bring items that make your treatment time easier. For instance, considering bringing your phone, a tablet, books, or a blanket.

Before your treatment starts, you will:

• Have a blood sample taken

• Meet with your oncologist so they can check your health and blood test results

• Meet the nurse or other health professionals who will give your treatment

• Have your blood pressure, pulse, breathing, and temperature taken before starting treatment

• Have your height and weight measured to find the right dose of chemotherapy

• May have an IV tube, also called a catheter, put in your arm

Some people receive chemotherapy through a port. Instead of putting the IV directly into your arm, the catheter will go into a round metal or plastic disk. With a port, your nurse does not need to find a vein to put the IV in for each treatment. If you need a port, you will need a minor surgery before your first chemotherapy appointment to put the port in. Learn more about catheters and ports.

The length of your treatment session will depend on many factors. Some chemotherapy treatments take minutes or hours. Others are given over several days or weeks. This is called continuous infusion chemotherapy. You do not need to stay at the hospital or clinic for continuous infusion. Instead, drugs are delivered through a small pump you wear or carry.

To get the full benefit of chemotherapy, it is important to follow the schedule of treatments recommended by your doctor and manage other medications you’re taking.

What happens after IV chemotherapy ends?

After your treatment session ends, the nurse or another health care team member will take out your IV. If you have a port, it will stay in until you finish all of your treatments. The nurse will check your blood pressure, pulse, breathing, and temperature again.

Your oncologist or nurse will talk with you about what to expect with side effects. They will give you medication, tell you how to manage common side effects, and offer information such as:

• Avoid people with colds or other infections. Chemotherapy weakens your body’s immune system. Your immune system helps fight infections.

• Drink lots of fluids for 48 hours after chemotherapy. This helps move the drugs through your body.

• Whether there are activities to do or avoid doing on future treatment days.

Before you leave your first treatment, be sure to ask who you should call with any questions or concerns and how to contact them, including after hours or weekends.

Questions to ask the health care team

• Who is creating my chemotherapy treatment plan? How often will the plan be reviewed?

• Which health care professionals will I see at every treatment session?

• How will I receive chemotherapy treatments? Will I need a port?

• Will I need any tests or scans before this treatment begins?

• Can you describe what my first treatment will be like?

• How long will each treatment session take?

• Will I need someone to drive me home after each session?

• How often will I have chemotherapy? For how long?

• What are the common side effects of the chemotherapy I will receive?

• Who should I talk with about any side effects I experience?

• Should I track the side effects I experience at home?

• Are there side effects I should let you know about right away?

• Who can I talk with if I’m feeling anxious about having this treatment?

• What type of caregiving could I need at home?

• How will we know if the chemotherapy is working?

• What follow-up care will I need after chemotherapy?

Related Resources

Making Decisions About Cancer Treatment

Prehabilitation Helps Patients Prepare for Cancer Treatment

When to Call the Doctor During Cancer Treatment

Physical, Emotional, and Social Effects of Cancer

More Information

Chemocare. com: Preparing for Chemo Treatments

National Cancer Institute: Chemotherapy to Treat Cancer

What every patient should know about chemotherapy

Chemotherapy is scary and unbearable. The media space tells us about this, and it is not surprising that due to such hyperbolization, many patients are afraid of it almost more than the disease itself. However, not a single film or novel tells what it is, how it works, and how justified the fear of drug treatment is. Together with the chemotherapist of the Luch clinic and the researcher of the St. Petersburg Clinical Center for Secondary Health Care, Maria Stepanova, we compiled an instruction for patients and figured out what drug therapy is and what the treatment regimen depends on.

What is drug treatment

Drug therapy is one of the options for treating cancer. Its capabilities and effectiveness depend on the type of malignant formation. There are four types of drug therapy: chemotherapy, the most studied type of therapy; hormone therapy; targeted therapy (eng. target “target”) and immunotherapy, the youngest and little studied type of treatment. To understand why a doctor chooses one or another type of therapy, let’s look at each of them in more detail.

Chemotherapy (CT)

Some still mistakenly believe that drug therapy is limited to chemotherapy. Indeed, for a long time, drug treatment of malignant tumors was given to cytostatics, antitumor drugs, the principle of which is the destruction of rapidly dividing cells. including malignant ones.

There are three types of chemotherapy regimens: high emetogenic (i.e. “nauseating”), moderate and low. To understand what type this or that combination of drugs belongs to, the chemist uses special schemes and tables. Since healthy cells are also affected by cytostatics along with the tumor, CT entails pronounced side effects: decreased production of blood cells (myelosuppression), inflammation of the oral mucosa (mucositis), hair loss, nausea, and vomiting. Such a list can scare anyone, and Maria reassures:

– For a patient who is concerned about the severity of nausea, it is important to know which drugs are included in his particular treatment regimen. I always talk about it and, if necessary, prescribe drugs to reduce side effects. Most often, this is a combination of intravenous and tablet versions of antiemetic drugs. However, poor health can catch up with the patient already at home, and then I discuss this and prescribe drugs that he can take without the supervision of a doctor.

— It turns out, as it happens rarely in films?

– Extremely rare! Of course, it will stir up, and many compare this feeling with toxicosis during pregnancy. In such cases, I recommend drinking ginger tea, chewing gum, sour-flavored caramel, salty and sour foods.

Chemotherapy uses a variety of drugs with different mechanisms of action, oriented to different characteristics of the tumor. Therefore, doctors use either monotherapy (one drug) or combination treatment (two or more drugs). This makes it possible to enhance the antitumor effect and reduce the likelihood of developing tumor resistance to treatment.

There are also chemotherapy-sensitive tumors (eg, germ cell tumors, choriocarcinomas, lymphomas) and chemotherapy-insensitive tumors (melanoma, some types of sarcomas). In order to find the best treatment options to increase life expectancy, clinical trials are now underway on the possibility of combining this type of therapy with immunotherapy.

Hormone therapy (HT)

Hormone therapy uses drugs that suppress the body’s production of natural hormones or their interaction with receptors. The most common type of tumor where this treatment option is used is breast cancer (BC). When an immunohistochemical (IHC) study is performed and estrogen and/or progesterone receptor positives are present, hormonal therapy is the optimal treatment option. With its help, you can stop tumor growth and even achieve complete or partial disappearance of the tumor.

– The peculiarity of the use of these drugs is that they are overwhelmingly in tablet form and have acceptable toxicity compared to chemotherapy. This allows patients to combine treatment with work, hobbies and travel.

Targeted therapy (TT)

Unlike chemotherapy, targeted (targeted) drugs attack only tumor cells. A tumor for TT is a kind of target, the destruction of which means the cessation of cell replication (reproduction) and metastasis.

It all started with the fact that doctors noted the insufficient effect of cytostatics and began to introduce immunohistochemical parameters. Immunohistochemical study (IHC) reveals proteins in a tissue sample that are specific to a particular type of cell. This makes it possible to distinguish one type of tumor from another and to identify markers that are responsible for the drug sensitivity of the tumor tissue.

“Targeted therapy begins with non-small cell lung cancer: in a rush of clinical research, doctors developed a drug that began to be used in clinical trials. The widespread use of Iressa in clinical practice was accompanied mainly by disappointments associated with the rarity of the manifestation of a therapeutic effect. The mystery was quickly resolved: analysis of the nucleotide sequence of the EGFR gene, carried out by three independent research teams, found that lung tumors that are sensitive to Iressa or Tarceva contain a mutated form of this receptor. So since 2009Iressa was introduced into clinical practice for patients with a mutation in the EGFR gene. A feature of the mechanism of action of TT is to block the mutation, as a result of which the tumor cannot divide, – explains Maria.

Side effects with targeted therapy are less pronounced and the patient most often does not need to stay in the hospital. Some targeted drugs are used in tablet form, while taking them, the patient’s quality of life does not significantly suffer, and patients can lead a normal life.

Immunotherapy (IT)

Immunotherapy is the youngest branch of drug treatment. There are several groups of immunodrugs with different mechanisms of action. Some act on the formation of blood vessels in the tumor and block their development (after which the tumor ceases to receive nutrition and dies), while others activate and direct the body’s immune forces to fight the tumor. takes a lot of time, has its own range of side effects, and also requires the attention of doctors and a thorough assessment of the dynamics of the patient’s condition.

– In theory, we use the introduction of drugs to train the immune system to recognize tumor cells and destroy them. It’s like installing an antivirus,” Maria explains.

Targets and evaluation of drug treatment

There are three types of drug therapy: preoperative (neoadjuvant), prophylactic (adjuvant), and palliative (maintenance).

How is each case treated?

Let’s start with preoperative drug therapy. For example, a patient with a diagnosis of stomach cancer enters the department. CT results show that there are no distant metastatic foci, however, due to the spread of the primary tumor, surgery at the first stage is impossible. In this case, the treatment looks like this: four courses of therapy, then surgery, and after it, four more courses of adjuvant therapy. Why else? Formally, the tumor was removed, but there is a risk of the formation returning, and adjuvant therapy helps to delay it.

The doctor chooses palliative care when surgical methods are powerless (for example, with distant metastases to the lungs, liver, lymph nodes, etc.). Then the treatment, first of all, is aimed at maintaining the quality of life of the patient and controlling the disease, and the duration of treatment depends on its effect. In chemotherapy, doctors use RECIST 1.1, a system of criteria for assessing the response of a tumor to therapy, and in immunotherapy, irRECIST.

— Let me explain how it works, using the example of a patient with a tumor of the colon and with multiple metastases in the liver and lungs. To assess the severity of the situation, we conduct an examination, identify the most measurable lesions and give two to three cycles of chemotherapy. Most of the CT courses are the administration of the drug. Between the first injection and the second – 14-21 days – and this time period is called a cycle.

Then we look and compare. If the tumor has decreased by more than 30%, this is a partial response, and therapy should be continued up to six courses. If she left, this is a complete regression, and we also add four courses to consolidate the result. If the tumor has increased or decreased by 20%, this is stabilization, we do two more courses and look again: if the situation has not changed, the patient goes on a chemotherapy vacation until the disease progresses, and then the scheme is repeated.

But if the tumor has grown by more than 20% during treatment, we are dealing with progression, most likely, this tells us about the aggressiveness of the tumor. In this case, I explain to the patient what is happening to him and why we are changing the treatment.

How to convince a patient for treatment?

– Everyone needs an individual approach. I always say: “Chemistry can worsen your condition, but you should not be afraid of this – we will try to find the optimal symptomatic therapy that will reduce adverse events. ” If after that during treatment there is evidence of poor tolerance, we will consider reducing the dose of the cytostatic. There are times when I literally persuade a patient to go to therapy and explain to him what we are fighting for. And I explain this, regardless of the severity of the case – if a person with an aggressive tumor is determined to fight to the last, it is my duty to give him this opportunity.

Interviewed by Daria Semeina

“It is absolutely impossible to lie down and lie down!” / LLC “ROSOGSH”

School of Patients: Joint project of the portal “Mercy.ru” and the regional patient organization “Cancer is treated”.
Venue: St. Petersburg Clinical Scientific and Practical Center for Specialized Types of Medical Care (oncological).
Participants: patients with various cancer diagnoses.
Idea: journalist and patient Veronika Sevostyanova .
Subject: chemotherapy

In this issue we have an oncologist of the highest qualification category, a member of the Russian Society of Chemotherapists, a member of the European Society of Oncologists (ESMO), Ph.D. Natalya Valerievna Levchenko

Red nausea

9 0009 Natalya Valerievna Levchenko

– Why are chemotherapy colors different? They say that the “red” is the most terrible? I had a red one, and the red color still makes me feel nauseous, for example, I can’t drink fruit drinks.

– What, what, and color has nothing to do with the effectiveness of chemotherapy and indications. The color of the drug depends solely on its chemical formula. We have preparations in blue, yellow, red. And the color in no way affects the choice of treatment tactics. The choice of treatment tactics is influenced by the diagnosis, the biological characteristics of the tumor and the patient’s condition.

And that’s why when patients ask with fear “Will I have red chemo?”, for some reason they tune in that this is the worst thing that can be in chemotherapy. But someone tolerates one chemotherapy well, someone else, and it depends, I repeat once again, on the prevalence of the process and on the patient’s condition. The same treatment can be tolerated differently by two patients, despite the fact that the accompanying therapy will be carried out in exactly the same way.

We have patients who run to give a lecture after a drip, and there are those who need accompanying therapy for several hours or even days. You don’t have to listen to anyone. You need to set yourself up for good, this is fifty percent of the key to success.

– I came to the School to find out how to recover after chemo. I think everyone is interested, everyone is bad from chemistry.

– It happens differently for everyone. And the toxicity of drugs is different. Therefore, one has weakness, another has diarrhea, a third has nausea, a fourth has a flu-like syndrome. Depending on this, the doctor makes recommendations.

– Then the question is specific. What to do if you feel sick?

– Now there are drugs that can almost completely eliminate nausea and vomiting. Another thing is that there is the concept of “delayed vomiting”, which occurs after five days. Or, here, neurogenic vomiting, when a person sees a red color and feels sick. There are patients who were treated two years ago, and they pass by the institution where they received chemotherapy and they spontaneously vomit, reflexively.

Well, you all know that there are such drugs as Zofran, Ondansetron, who received chemotherapy, or doctors will definitely tell you about them. What else can you do to help yourself besides medication?

First, chemotherapy is usually accompanied by some taste perversions. It becomes tasteless, what used to be tasty. For example, I used to like salty, now I can’t look at it, or vice versa. So, you need to understand what causes nausea and try not to eat it. And if the smells call for nausea, try not to cook your own food, but come to the meal.

Eat a piece of ice cream lemon or a cranberry before meals. If you do not have stomatitis, if everything is fine in your mouth. Pickled cucumbers and tomatoes also reduce nausea.

– Why frozen?

– Ice blocks receptors: cold blocking of receptors occurs, which is responsible for nausea. And plus sour. Then the gag reflex is suppressed.

Try to eat often, in small portions. There is food that is very high in calories, so that by eating a small amount, you get the necessary trace elements, proteins, carbohydrates and fats.

It happens that someone is more sick in the morning, someone in the evening. So you need to plan your diet in such a way that the main food load falls at a time when you feel less sick.

Many more patients put crackers and lollipops in their pockets and in the morning near the bed. Again, if there are no problems in the oral cavity. Plus, of course, try to eat food that is more homogenized, that is easier to digest. Yoghurts, broths, purees, cereals, etc.

Let’s move on to diarrhea?

. Again, with regard to drug therapy, your doctor will tell you about it. Well, the first drug you all know is loperamide or imodium. It is very important to apply it correctly. If you have diarrhea, the doctor will write you a scheme for how to use this drug. Taking it once a day, four days in a row does not make any sense. That is, if there are indications for loperamide, it must be drunk according to a certain scheme. And this scheme must be coordinated with your doctor. Everything related to medications must be coordinated with your doctor. Today I will talk more about how you can help yourself in everyday life.

So, diarrhea. The first is diet. We must reduce the amount of dietary fiber that stimulates the gastrointestinal tract as much as possible. This is black bread, this is raw fruits, vegetables, canned food, fatty, fried, spicy – we exclude all this from the diet. Again, we eat homogenized food so that it is easier to digest.

We eat food that does not have a stimulating effect on the gastrointestinal tract. These are cereals (oatmeal, rice), this is milk, cream, low-fat broths.

Meat products only if the diarrhea is mild; and preferably in a homogenized form, that is, either beat with a blender, or, well, at least minced meat. Fruits and vegetables can be processed. Ideally, it is steamed or baked in the oven.

I’m certainly not talking about the severity of diarrhea that requires hospitalization, infusion therapy.

And one more thing. Very misleadingly, many patients believe that if they have diarrhea, then they need to limit the amount of fluid. In no case! On the contrary, the amount of liquid should be more. If we say that, on average, a patient should drink two liters of liquid – and I will specifically emphasize that this does not take into account broths, soups, jelly, compotes – we are talking only about pure water. Then when the patient has diarrhea, the amount of fluid you drink should be increased.

Of course, if there are no contraindications from the cardiovascular system.

– And my roommates told me that it is necessary to eat green apples during chemo, because it is green that purifies the blood well and red: pomegranates, beets. Is the folk experience correct?

– I will say again in this case that the color does not matter. Green apple or red, there really are no fundamental differences. And pumpkin is no less useful than a tomato. Just because it’s orange doesn’t mean it shouldn’t be eaten. Another thing, here again, apples. I know patients who have never eaten raw apples before, because they immediately get flatulence and diarrhea. And there are many such patients. It is better to eat a baked apple. This is the perfect fruit. 9No decision to make 1

– After each course of chemotherapy, blood counts deteriorate very much, because chemistry has a bad effect on the liver . Can I somehow improve the blood, at least support it?

– Of course, chemotherapy is a toxic treatment, and whenever a patient comes for chemotherapy for the first time, we absolutely sincerely say that the treatment is tough, that the treatment is serious, associated with a huge number of complications, both objective and subjective. Those who have already undergone chemotherapy know that no doctor will hospitalize you for another course of treatment until he looks at the blood tests. Both chemical and biochemical. For what? In order to understand – there is toxicity from the treatment, no? And if so, how pronounced is it and are there any contraindications for continuing treatment.

In fact, if you start prescribing prophylactic drugs to protect everything that you can expect as side effects, then this will be polypharmacy. After all, you will have to prescribe fifteen to twenty drugs.

Drugs are prescribed for comorbidity, when there is a risk that a chronic disease will flare up, or when the initial manifestations of drug toxicity begin.

Yes, there are a large number of drugs that we can administer and at the same time we know for sure that the patient will come with absolutely normal blood counts. But! Every medal has two sides. For these drugs, too, there are certain indications.

Therefore, in my opinion, the most important thing for a patient to do between cycles of chemotherapy is to report their ailments either to their doctor or to their local internist; to lead a proper lifestyle – this is nutrition and, if possible, the absence of stress and, of course, the physical activity that the patient can afford.

In no case should you make a decision: “I am sick, I have chemotherapy, I close myself under a hood, I don’t go to work, I don’t communicate with children, I don’t cook, I don’t iron, I don’t clean, I’m sick. ”

You must do whatever your condition allows.

Sometimes such passivity is also promoted by relatives who unnecessarily protect their mothers, husbands, wives, sisters and say “don’t go here, don’t do this”, and as a result the patient falls into depression. So no way! Everything that you can afford according to your physical condition, be sure to do it.

And once again about nutrition. Must have herbs. Spinach, cilantro, parsley, dill. Olive oil and sesame seeds are also very useful. And they often ask about wine.

I can’t say that we recommend you drink red or white wine every day, no. But, in principle, if there are no contraindications, and you are planning a festive feast, you can definitely afford to drink a glass of wine. It is not prohibited.

Juices, herbs, vitamins: to drink or not to drink

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– What about juices?

– Juices? I honestly adhere to the fact that everything should be in moderation. We have seen completely yellow patients drinking carrot juice. And patients with perforated ulcers because they drank lemon-beetroot juice on an empty stomach. Therefore, whenever you want to do something folk or unconventional, you still need to consult a doctor, no matter how harmless this or that appointment may seem to you.

And I am absolutely not against herbs.

– You mean which one to brew?

– Decoctions, yes. Milk thistle, flax seed. But you should definitely consult with your doctor. Because there are herbs that have a very good effect on the liver, but at the same time, if there are stones in the gallbladder, they can provoke an attack of cholecystitis.

And again, I repeat that the main thing is the right psychological attitude. I can give a huge number of examples when you look at a patient and objectively understand that everything will not be very good for him. And he has such a positive, such a thirst for life that he overcomes everything. And it happens vice versa. When everything should be good, but the lack of faith in success, pessimism, giving up worsen the condition.

– What about vitamin C? And other vitamins. How do you feel about them?

– Just ten or fifteen years ago, all cancer patients were strictly warned: “no vitamins.” But today it is treated completely differently. We give our patients vitamin B12 when they have anemia. We prescribe folic acid. We drip vitamin C. But! Again, you need to understand for yourself that there should be a measure in everything. There must be a middle ground. And it is not necessary to drink handfuls of vitamins. You can eat normally, something we have already talked about. And if you have a balanced diet, then you will receive all those vitamins and microelements that the body needs with food.

But if, for example, diarrhea occurs, then vitamins can and should be taken. We very often prescribe neuromultivit for neuropathy to our patients. That is, in principle, I sum up, you can drink vitamins.

“I’m a big sun lover”

– My stoma is out , treatment by a chemotherapy I begin only tomorrow. And I am a very big fan of the sun, sunbathing, I spend all summer in the country. How should I proceed now?

– Actually a very good question, because very often they even reach the point of absurdity. What should we understand? That any overheating is contraindicated for patients with oncological diseases. This applies to everything – baths, saunas, exposure to sunlight, work in hot shops.

But again, my good ones, you are being treated and we are treating you so that you can live. Live quality! This does not mean that in the summer you should stay at home and not go out. This does not mean that you cannot go to the sea. But! If you went to the country and you need to do something in the garden, do it from seven to ten, when there is no scorching sun. Or in the evening. Do not go out into the sun in the sun. And if you need to pick up the children on a hot day from somewhere, from some circle, well, put on a hat.

– That is, if we sit by the sea under an umbrella, then the road to the sea will not kill us?

– No way. But it is in the process of chemotherapy, during the course of treatment, that I do not recommend you go to the sea. And not because of the sun, but because these are flights, moving, that’s what’s harmful.

I say again, we treat you so that you can live. And in recent years, in all clinical studies, in addition to the effectiveness of treatment, in addition to side effects, such a thing as quality of life is always evaluated. It is very important!

And you must understand that now, at the level at which oncology is, a lot of our diseases are becoming chronic. When people live five, seven, fifteen, twenty years. treated periodically. And all this is done so that you enjoy life, so that you can do everything that people who do not have a diagnosis do.

How to live now?

– Tell me, but I know that in Germany there are such sanatoriums to which they are sent immediately after chemotherapy, and they are immediately brought to their senses there in a month. What do we have?

– No, we do not have such specialized institutions. The fact that our patients are not contraindicated in sanatorium treatment is unambiguous. But there are no specialized, namely oncological sanatoriums, dispensaries or boarding houses. And what you’re talking about is called rehabilitation. And basically, it means restoring blood counts.

But let’s think about what happens to the blood? Why does chemotherapy affect the blood, why does diarrhea and other side effects occur?

A tumor cell differs from a healthy one in that it divides very quickly. And the principle of operation of classical cytostatics, chemotherapy drugs is based on the fact that it affects the cell, which is rapidly dividing, by various mechanisms.

Why does hair fall out? Because the cells of the hair follicle are rapidly dividing. Why haematological toxicity? Because blood cells are rapidly dividing and often renewed. Why diarrhea, stomatitis? Because the cells of the lining of the gastrointestinal tract are also quickly updated. And therefore, even if you don’t go anywhere, if your bone marrow is healthy, your blood will still be restored. For this, in principle, no special therapy is needed.

Another thing is that, as a rule, patients need psychological rehabilitation. It is very difficult to understand, especially when there is a long treatment, when you have been treated for a year and a half, when all this will end. Or maybe the opposite is the problem. When a person stopped going to the doctors every three weeks and he does not understand how to live on without medical supervision. Or a person is so tired that he also does not understand how to live on.

That, in my opinion, is where psychological rehabilitation is needed. How about restoring the blood? The blood will regenerate itself.

– And it also happens that they do chemotherapy every three weeks, it’s time for the next cycle, but the blood has not recovered. Well, yes, the doctors are starting to restore it with something, but at the same time they are postponing the next course. For example, for a week. Is this critical?

– The optimal duration of chemotherapy, if, as you say, about a three-week treatment interval, is three to four weeks.

– That is, this week of the pass, is it not critical?

– Not critical. But there are different treatment regimens. There is a scheme when the drug is administered on the first, eighth, fifteenth day. There is a weekly There is when the pills are drunk for two weeks, a week break. There are six weeks when the pills are drunk. That is, the treatment regimens are completely different.

Beware of biostimulants

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– Does the patient have a choice? When the patient himself decides that it will be easier for him one way or another? Or is it clear?

– I would always proceed from the consideration of what is most effective. Although very rare, there are situations when someone says, “Unfortunately, I won’t be able to stay in the hospital. I have a paralyzed wife or husband and me in general, it’s just not possible.” Well, then we are trying to look for some alternative schemes. But first of all, it is necessary to build on the expected effectiveness of treatment.

– And when the treatment is over, how can you support yourself? Well, food, of course. Or maybe some other antitumor supplements?

– Regarding supplements. In fact, how much I work, this delicate question arises so much. After all, there is not a single supplement that has been tested in parallel with anticancer treatment. Therefore, I personally am not a supporter of bioadditives. Because, as a rule, the goal of supplements is to make the patient feel better. But as scientific medicine knows, what you can quickly drink and from which you quickly feel good, these are all so-called biostimulants.

Well, for example, patients often say that they can practically fly when they drink bee products. Five balls are placed under the tongue and fly. Why? Because biostimulator. What is a biostimulant? This is a drug that stimulates. Including, it will also perfectly stimulate the growth of tumor cells. This is my personal opinion. I am against supplements.

– How do you feel about recovery probiotics? Can I take them between chemos? After all, the chemistry itself kills.

– This is definitely possible, and most likely your doctor told you about it. Especially if you have a tendency to diarrhea. This is the group of drugs that we prescribe both prophylactically and in case of developed complications. And preferably, if you drink eubiotics, then you need to drink different ones. Drink in cycles of two weeks. That is good.

Gradually need to return to sports

– May I ask you another question about physical activity? You said not to heat up. And I, for example, when I go skiing, I sweat more than after a bath. Is that also banned now?

– It is absolutely impossible to lie down and lie down, we have already talked about this. But, if due to treatment, for example, due to surgery, you had to temporarily interrupt your physical activities – whatever it may be – swimming, skiing, skating, running, tennis – you need to slowly return to sports. If earlier you, for example, skied five kilometers, now you may realize that two is not enough, and three is already hard. And it means that from two to two and a half is now your norm.

– What about sweat? Do you work out so much that you sweat a lot? Is this sweat as harmful as sweat after a bath?

– No. You do not overheat like in a bath. You still do not heat your body up to a hundred degrees, well, or up to eighty as in a bath. So if you go in for sports for one and a half to two hours and sweat at the same time, then this is nothing to worry about.

The main thing is that your heart does not suffer, that is, the load should still be dosed. Or, if this is after the operation, then, for example, a limb that cannot be loaded would not suffer. In this sense, everything should be very dosed and well-chosen.

– How effective is it to use a chemotherapy port? This is a system that is sewn under the skin.

– Do you want to ask when it is worth talking about the installation of a port-catheter system?

Yes. I have four rounds of chemo, each in three weeks.

– If you have normal access to the peripheral veins, then it does not make sense to put a port on four cycles.

– And I have a very small question. Is it possible to induce beauty during chemotherapy? Well, do hyaluronic acid? Or there, increase the lips? Peeling?

– Look, during chemotherapy, it is undesirable to do manipulations associated with a violation of the integrity of the skin. Why? Because if you’re on chemotherapy, usually two-thirds of the time you still have haematological toxicity. And we tell patients to “try not to scratch.” Try to keep your nails in order, without burrs, try not to cut the cuticle so that there is no entrance gate for infection. Therefore, it is better to wait with such procedures for now.

– And then?

– Then you can, of course. This is not contraindicated. That is, it is not Botox itself that is contraindicated during treatment (although it can be treated differently), not hyaluronic acid itself, but precisely manipulations associated with violation of the skin.

Do I need to warn all doctors now that I have a cancer diagnosis?

– I’ve already finished my treatment.