Chemotherapy – When is it Preferred, its Side Effects and Myths


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Evidence Based - Facts Checked

Chemotherapy is a technique in which a drug is used to kill fast-multiplying cancer cells in the body. Depending upon the case of cancer, a single drug or a combination of drugs shall be used to treat the patient.

Chemotherapy, How Does it Work?

Chemotherapy in isolation may not be effective in some cases, and therefore, your oncologist may decide to use it in combination with radiation, hormone therapy, or surgery.


Various Stage of Cancer Treatment in which Oncologists Prefer Chemotherapy

Following are the various stages in which chemotherapy shall be used to treat the cancer1Manjelievskaia, J., Brown, D., McGlynn, K. A., Anderson, W., Shriver, C. D., & Zhu, K. (2017, May 01). 'Chemotherapy Use and Survival Among Young and Middle-Aged Patients With Colon Cancer' Source:-

Adjuvant Chemotherapy

Adjuvant chemotherapy is a chemotherapy given in the case of early-stage cancer, after surgery for systemic control of disease, i.e., it prevents the tumor from coming back to the local site or anywhere else in the body.

Neoadjuvant Chemotherapy

Neoadjuvant Chemotherapy is a chemotherapy given in locally advanced cases before surgery to downstage the tumor and make it ready for operation. Also, it helps in providing systemic control of the disease.

Palliative Chemotherapy

Palliative Chemotherapy is a chemotherapy given in patients with stage IV cancer where the tumor has already spread to the body’s distant organs. The purpose is to reduce the tumor burden in the body and provide some symptomatic relief so that the pain and trouble due to cancer can ease out a bit. Also, chemotherapy in stage IV cancer helps in preventing further spread of the tumor in the body2Harrington, S. E., & Smith, T. J. (2008, June 11). The role of chemotherapy at the end of life: "when is enough, enough?" Source.


Side Effects of Chemotherapy


Chemotherapy side effects

The side effects of chemotherapy depend on the type of chemotherapy regimen used, the schedule (weekly vs. once every three weekly), dosage, and duration of treatment.

Some of the most common possible side effects include3Nurgali, K., Jagoe, R. T., & Abalo, R. (2018, March 22). 'Adverse Effects of Cancer Chemotherapy: Anything New to Improve Tolerance and Reduce Sequelae?' Source:-

Acute side effects

- Hair loss

- Mouth sores

- Loss of taste, loss of appetite, weight loss

- Nausea and vomiting

- Low blood cell counts

- Fatigue

- Increased susceptibility of infections

- Altered bowel habits i.e., constipation and diarrheas

- Tingling or numbness in hand and feet

- Skin changes in the form of dryness, pigmentation

Long term side effects

- cardiomyopathy

- acute leukemia

- neuropathy

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Myths & Questions about Chemotherapy 


Myth -  Chemotherapy Is Used Only In Last Stage of Cancer When Surgery Cannot Be Done?

No chemotherapy is indicated in all stages to control systemic disease unless contraindicated due to advanced age or multiple comorbidities4Manjelievskaia, J., Brown, D., McGlynn, K. A., Anderson, W., Shriver, C. D., & Zhu, K. (2017, May 01). 'Chemotherapy Use and Survival Among Young and Middle-Aged Patients With Colon CancerSource.

Myth -  Chemotherapy is a life-threatening treatment

Chemotherapy is not a life-threatening treatment. Like all other treatments, it has some effects and some side effects. Symptomatic medications and supportive therapy very well manage the side-effects of chemotherapy. The dose and the frequency of the chemotherapy cycle are customized based on the patient’s general health and body surface area. Most of the patients complete chemotherapy on time without much interruptions. However, the tolerance to chemotherapy varies from person to person, and some patients may develop severe side effects5Islam, K. M., Anggondowati, T., Deviany, P. E., Ryan, J. E., Fetrick, A., Bagenda, D., . . . Ganti, A. K. (2019, August 27). 'Patient preferences of chemotherapy treatment options and tolerance of chemotherapy side effects in advanced stage lung cancer' Source.

Question -  Why does chemotherapy lead to hair loss, mouth ulcer, diarrhea when the cancer is somewhere else in the body?

Chemotherapy is one of the treatment options for cancer, which act on rapidly dividing cancer cells with high mitotic activity. The normal cells of hair follicles, skin, oral mucosa, and gastrointestinal tract divide rapidly. Therefore, the chemotherapy drug acts on these cells, lead to hair loss, mouth ulcer, and diarrhea. These are temporary side effects that last only during chemotherapy6Hair loss in chemotherapy: Overview. (2019, September 12). Source,7PDQ Supportive and Palliative Care Editorial Board. (2019, April 26). Oral Complications of Chemotherapy and Head/Neck Radiation (PDQ®). Source.

Myth -  The side effects of cancer chemotherapy are deadly

No, with the advancement in the medical field and pharmacology, various new drugs have been developed to manage chemotherapy’s side effects.

 The incidence and severity of chemotherapy-induced side effects have drastically reduced8Falzone, L., Salomone, S., & Libra, M. (2018, November 13). 'Evolution of Cancer Pharmacological Treatments at the Turn of the Third Millennium' Source.


Myth -  Hair loss in chemotherapy is Permanent

No, the hair loss in chemotherapy is temporary. It begins 1-2 weeks after the start of chemotherapy however, most of the patients regain their hair after 1-2 month of the completion of the final chemotherapy regimen9PDQ Supportive and Palliative Care Editorial Board. (2019, April 26). Oral Complications of Chemotherapy and Head/Neck Radiation (PDQ®). Source.

Question-  During chemotherapy patients become immunocompromised?

Chemotherapy acts on rapidly dividing cells of the body like hair, skin, mucosa, and blood-forming cell. The blood-forming cells include red blood cells, white blood cells, and platelets.

When chemotherapy drugs act on red blood cells, the patient develops anemia, and if it turns out to be severe, the patient may require a blood transfusion.

When white blood cells are destroyed, it results in decreased immunity, i.e., the patient’s inability to fight against infection.

So yes, during chemotherapy, patients immunity gets compromised, but when chemotherapy treatment is complete , the white blood cell count increases and the immunity improves10Kang, D., Weaver, M. T., Park, N., Smith, B., McArdle, T., & Carpenter, J. (2009). 'Significant impairment in immune recovery after cancer treatment' Source

Question-  Chemotherapy patients cannot eat or go outside or meet people?

Yes, this is partially true. It is advised not to eat outside or meet people as during chemotherapy, the patient’s immunity is compromised, and therefore the chances of catching an infection is pretty much high.

References

  1. 1
    Manjelievskaia, J., Brown, D., McGlynn, K. A., Anderson, W., Shriver, C. D., & Zhu, K. (2017, May 01). Chemotherapy Use and Survival Among Young and Middle-Aged Patients With Colon Cancer.
    Retrieved November 13, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5806125/
  2. 2
    Harrington, S. E., & Smith, T. J. (2008, June 11).
    The role of chemotherapy at the end of life: "when is enough, enough?"
    Retrieved November 12, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099412/
  3. 3
    Nurgali, K., Jagoe, R. T., & Abalo, R. (2018, March 22).
    Editorial: Adverse Effects of Cancer Chemotherapy: Anything New to Improve Tolerance and Reduce Sequelae? 
    Retrieved November 13, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5874321/
  4. 4
    Islam, K. M., Anggondowati, T., Deviany, P. E., Ryan, J. E., Fetrick, A., Bagenda, D., . . . Ganti, A. K. (2019, August 27).
    Patient preferences of chemotherapy treatment options and tolerance of chemotherapy side effects in advanced stage lung cancer.
    Retrieved November 13, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6712837/
  5. 5
    Hair loss in chemotherapy: Overview. (2019, September 12).
    Retrieved November 13, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK547552
  6. 6
    PDQ Supportive and Palliative Care Editorial Board. (2019, April 26).
    Oral Complications of Chemotherapy and Head/Neck Radiation (PDQ®).
    Retrieved November 13, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK65725/
  7. 7
    Falzone, L., Salomone, S., & Libra, M. (2018, November 13).
    Evolution of Cancer Pharmacological Treatments at the Turn of the Third Millennium.
    Retrieved November 13, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6243123/
  8. 8
    Kang, D., Weaver, M. T., Park, N., Smith, B., McArdle, T., & Carpenter, J. (2009).
    Significant impairment in immune recovery after cancer treatment.
    Retrieved November 13, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2777669/

Dr. Isha Jaiswal


This content is medically reviewed by Dr. Umang Singal and written by Dr. Isha Jaiswal

Last Medical Review Date - 13th November 2020


Dr. Umang Singal


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This content is only for educational purpose and should not be considered as a substitute for your Physician's/Doctor's clinical judgement

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