Chemotherapy is a type of treatment used to control or prevent the proliferation of cancerous cells. It is also used to improve quality of life and prolong life. Chemotherapy is not a type of treatment that targets specific areas like radiotherapy and radiosurgery but a systemic treatment method that works on all body cells. The lexical meaning of chemotherapy is drug therapy, in which cancer drugs are administered intravenously to prevent proliferation of damaged cells and kill cancer cells.

How does chemotherapy work?

Chemotherapy is used to treat the disease depending on the type and stage of cancer. The first goal is to prevent metastasis, that is, to prevent the cancer from spreading beyond the place where it started to other areas of the body. Chemotherapy prevents the growth of damaged cells and slows down irregular cell division. Chemotherapy is also used to shrink tumors before surgery. It can also be used after surgery as a precaution against the risk of tumor recurrence. Chemotherapy may be used in combination with other treatment modalities at the discretion of a specialist physician, taking into account the patient's health condition.

How is chemotherapy administered?

Chemotherapy is a serious treatment that should be administered in the medical oncology department of a full-fledged hospital under the supervision of a specialist physician. Chemotherapy drugs are mixed into serum and administered intravenously. Some chemotherapy treatments can take longer to administer, meaning that you may need to stay in hospital to have your treatment. Patients receiving long-term chemotherapy may need a catheter or port,  which allow healthcare providers to draw blood and give treatments directly to a large vein — including chemotherapy drugs — without a needle stick. Depending on the type and stage of cancer, oral chemotherapy at home in the form of pills or tablets can also be an option. Your specialist will give you detailed information on how and when to take these medicines. Oral chemotherapy pills taken at home are as important as intravenous drugs administrated in hospital, and if used incorrectly, they can adversely affect treatment outcomes and pose a risk to life. Along with the foregoing, chemotherapy can also be administered into cavities of the body, such as the abdominal cavity, the lung lining or the bladder.

What is the duration and frequency of chemotherapy?

The duration and frequency of chemotherapy depends on the type and stage of cancer, as well as the drugs used. The length of time for chemotherapy regimens can range from a few minutes to several hours or even a couple of days. It can also depend on the number of drugs administered during a session. Depending on the decision of your specialist, chemotherapy may consist of a single drug or a combination of drugs. Total duration of treatment varies from person to person and can range from 4 sessions (3 months) up to 1-2 years depending on your treatment protocol.

What are the types of chemotherapy?

There are several types of chemotherapy and each one treats cancer differently. The type chosen depends on the location, spread and type of tumor as well as the cancer drugs and cancer drug combinations used in treatment. Types of chemotherapy include:

●       Palliative Chemotherapy: The goal of palliative chemotherapy, also known as supportive care, is to improve quality of life in cancer patients by relieving or managing symptoms caused by the cancer itself or cancer treatments. It is used to ease complaints such as pain, nausea, vomiting, diarrhea and edema in severe and/or progressive cancer cases, thus improving patients’ mood.

●       Adjuvant Chemotherapy: The goal of adjuvant chemotherapy is to clear any remaining cancerous cells after surgical tumor removal in order to reduce the risk of recurrence. It is also known as preventive care.

●       Neoadjuvant Chemotherapy: The goal of neoadjuvant chemotherapy is to shrink the tumor and thus make the patient ready for surgery. Also known as induction chemotherapy, this type of chemotherapy also helps to distinguish cancerous tissue from healthy tissue. It is mostly used to treat regional but advanced cancer types such as breast, colon and rectum cancers for 1 to 4 cycles.

What are the side effects of chemotherapy?

Patients may experience several side effects after chemotherapy, the most common being nausea and vomiting. These side effects occur when the vomiting center in the brain and stomach movements are affected by the drugs used in chemotherapy, and they can usually be managed with pre-chemotherapy medications. Another common side effect is unexplained fatigue. To manage cancer-related fatigue, patients should continue their usual daily activities as before. Mild exercise is essential to keep the body vigorous. Plenty of fluid intake is recommended as it speeds up metabolism. Chemotherapy may also cause sores and redness in the mouth. Therefore, patients should have their teeth and gums treated before chemotherapy, if necessary. Some chemotherapy drugs used in high doses can reduce the number of platelets that help the body form clots to stop bleeding and, although not very common, cause increased bleeding tendency. Other side effects include dry mouth, loss of appetite, difficulty breathing, sore throat, diarrhea, constipation, anemia, hair loss, structural changes in the skin and nails, bruising in various parts of the body, fever, infection, sexual reluctance and weight loss.

What are the do and don’t during chemotherapy?

The immunity of a patient receiving chemotherapy is considerably lower than that of a healthy person. Therefore, patients receiving chemotherapy should first be protected against the risk of infection. They should avoid crowded environments as much as possible. Pet owners receiving chemotherapy should exercise caution when caring for their pets during treatment. It is important to have a digital thermometer at home. Men should take care not to cut themselves while shaving as the blood of a person receiving chemotherapy takes longer to form clots than that of a healthy person, leading to more blood loss in case of a possible injury. Live vaccines should be avoided during chemotherapy. Daily showering is advisable to maintain good personal hygiene. The best diet for patients receiving chemotherapy is the Mediterranean diet, which means consuming vegetable oils instead of solid fats, consuming plenty of fruits and vegetables in season, limiting red meat consumption and preferring white meat instead, consuming milk and dairy products, cereals and oily seeds and nuts such as hazelnuts, peanuts and almonds. This diet also recommends consuming whole fruits instead of juices. Plenty of water intake during chemotherapy is important to protect the kidneys. If you have complaints such as pain or burning sensation during urination, frequent urination, cough, sputum, redness and swelling around the nails, mouth and/or throat pain, vaginal discharge, pain and redness around the catheter, if any, you should consult a specialist right away.

What are the effects of chemotherapy on emotional and mental health?

There are many factors that can affect the emotional and mental health during cancer treatment. People receiving a cancer diagnosis can experience emotional and mental distress for various reasons including worries about the treatment, future concerns (financial and social), change of roles within the family, fear of being dependent on others, presence of cancer-related complaints such as pain, and the side effects of chemotherapy. Support from family and social environment plays a very important role in preventing and eliminating this distress. Maintaining the usual activities of daily living as much as possible during treatment has a positive effect on emotional and mental health. Professional psychological counseling is another tool that can help improve mental health and avoid the emergence of serious psychological problems.

If you are going through a difficult illness such as cancer and would like to learn more about the treatment of the disease, you are advised to make an appointment with a specialist physician at your nearest hospital.

References:

http://chd.cumhuriyet.edu.tr/tr/pub/issue/4322/57847

https://dergipark.org.tr/tr/download/article-file/522164