Table of Contents
- Overview
- Need For Chemotherapy Cycles
- What are the Side Effects of Chemotherapy Cycles?
- Why Do People Skip Chemotherapy Cycles?
- Why Should You Not Skip Chemotherapy Cycles?
- How to Improve the Patients’ Adherence to Chemotherapy?
- Conclusion
- Frequently Asked Questions
Overview
Several treatments are available for cancer. The most common of them are chemotherapy, surgery, and radiation therapy. Chemotherapy involves the administration of drugs that kill cancer cells. It is given in cycles for optimum efficacy and to recover from side effects. Treatment adherence is the key to positive outcomes. Therefore, patients should not skip or delay their chemotherapy cycles.
Need For Chemotherapy Cycles
Patients undergo therapeutic chemotherapy in several cycles. The patients usually have 4-8 treatment cycles. The duration between one round of therapy and the start of the next is referred to as one cycle. Usually, in a 28-day treatment cycle, the oncologist administers chemotherapeutic drugs on the 1st, 2nd, and 3rd days, and there will be drug-free days from the 4th to the 28th day. The doctor plans the treatment during the chemotherapy cycles due to the following reasons:
Therapeutic efficacy
When administered in cycles, therapeutic chemotherapy enhances treatment efficacy and improves outcomes. This is because not all cancer cells divide uncontrollably at a given point. Some are in the resting stage. Chemotherapy only kills those cells that divide rapidly. Thus, administering the drug in cycles helps kill all the cancer cells.
Body recovery
Chemotherapy has several side effects. These are nausea, vomiting, fatigue, and higher infection risk. Continuous administration of these drugs may cause severe side effects that the body cannot tolerate. The oncologists, depending upon the type of cancer and age of the patients, along with other factors, devise customized chemotherapy cycles for the patients. It provides time for the body to recover from the side effects.
What are the Side Effects of Chemotherapy Cycles?
Those undergoing chemotherapy may experience various side effects. These side effects may be mild to moderate. In some cases, however, these side effects can be severe and may need medical attention. Patients may reach out to their expert team for appropriate interventions in such cases. The following are the different side effects associated with chemotherapy:
Fatigue
Fatigue is the most common side effect of chemotherapy, and it can last for several weeks or even months after treatment ends. Patients need to rest often to tackle their tiredness effectively.
Hair Loss
Chemotherapy drugs target rapidly dividing cells, including hair follicles, which can lead to partial or complete hair loss. Hair loss due to chemotherapy is usually temporary, with regrowth starting a few months after treatment ends.
Pain
In some patients, chemo treatment can cause pain in different parts of the body, such as the mouth, throat, and joints. This chemotherapy pain can be managed through medications.
Mouth and Throat Sores
Chemotherapy drugs can cause damage to cells in the mouth and throat, making them sore and tender, which may lead to swallowing difficulties. Doctors may recommend special mouthwashes and rinses to soothe mouth sores.
Diarrhea
Some chemotherapy drugs irritate the lining of the digestive tract and may lead to diarrhea. Chemotherapy-induced diarrhea is temporary and can be managed with medication.
Constipation
Certain chemotherapy drugs may affect the gut’s nerve supply and cause constipation. With the help of some lifestyle modifications and medications, it is possible to manage chemotherapy-induced constipation.
Nausea and Vomiting
Certain chemotherapy drugs activate the chemoreceptor trigger zone (CTZ), and this may lead to nausea and vomiting in some patients. Both nausea and vomiting are temporary side effects of chemotherapy, and they can be managed effectively with medication.
Blood Disorders
Chemotherapy may affect the functioning of bone marrow in some cases and lead to reduced number of white blood cells, red blood cells, and platelets in the blood. This may make the patient susceptible to various blood disorders and infections.
Changes in Thinking and Memory
Some patients experience challenges associated with thinking and memory while undergoing chemotherapy. These cognition issues are temporary and wear off once the treatment is over.
Sexual and Reproductive Issues
Patients undergoing chemotherapy may experience fertility issues, and it can also lead to changes in sexual desires and function. In such cases, patients may consider talking to their doctor about their concerns.
Appetite Loss
During chemotherapy, many patients experience loss of appetite. In such cases, patients may consider having food in small portions frequently. They may also consider consulting with an onco-dietician for nutritional counseling.
Why Do People Skip Chemotherapy Cycles?
In some cases, doctors may recommend delaying chemo by two weeks or more, depending on individual case parameters. There are several reasons for skipping or delaying the chemotherapy cycles:
Side Effects
Some patients cannot tolerate the side effects of chemotherapy. It may lead to skipping or completely stopping the chemotherapy cycles. However, today, advanced chemotherapeutic drugs are available for certain types of cancer with fewer side effects. If the side effects are severe, the doctor may administer medications that can help manage them.
Infection
If the patient has an infection or a fever, the doctor may delay the chemotherapy cycle. The oncologists resume the chemotherapy once the patient recovers from the illness.
Low White Blood Cell Count
The patients may have low white blood cell count after the chemotherapy cycle. The doctor may delay the subsequent cycles if the patients have a very low white blood cell count after the chemotherapy cycle. Having a very low white blood cell count may increase the risk of infection.
Hospitalizations
Chemotherapy may cause severe fatigue and weakness. If the patients need hospitalization, the doctor may delay the chemotherapy cycle until they are fit to get chemotherapy.
Other Issues
Several other issues lead to the skipping or delaying of the chemotherapy cycle. These are financial constraints, family responsibilities, job requirements and depression and anxiety due to the disease.
Why Should You Not Skip Chemotherapy Cycles?
Patients should not skip or delay their chemotherapy cycles. If there is any delay or skipping of the dose (especially the oral drugs), the patient should immediately inform the doctor. They should seek advice for a further course of treatment. Patients should not skip chemotherapy cycles due to the following reasons:
Neutralize the Effect of Prior Cycles
Skipping or delaying the chemotherapy cycles may offset the results obtained with the prior chemotherapy cycles. As already discussed, some cells are in the resting stage and may divide after completing the previous cycle. Therefore, the disease may reach the pre-treatment stage if these cells are not killed through the next treatment cycle.
Need for Change of Treatment
It is essential to note that chemotherapy administration varies for each patient depending on the type and stage of cancer. When a patient skips the chemotherapy cycle, the disease may progress to the next stage, and the oncologists may have to change the complete course of treatment. Eventually, the patient may have to take medicine from the beginning. The patient may also require adjuvant therapy.
Progression of Cancer to Advanced State
In fast-growing cancers, such as inflammatory breast cancer, skipping chemotherapy may cause the disease to quickly progress to an advanced stage. The oncologists may prescribe intensive chemotherapy treatment along with surgery or radiation therapy.
How to Improve the Patients’ Adherence to Chemotherapy?
Cancer has a devastating effect on the lives of patients and their family members. Therefore, improving the patients' adherence to treatment is essential to improving survival and reducing mortality. Some of the ways to improve patients' adherence are:
Detailed Information
The healthcare provider must provide clear information to patients with cancer. It includes the type of treatment and side effects. It will help the patient prepare for the treatment in advance.
Greater Level of Psychological Support
Psychological support through counselling is required for both the patients and their family members. Studies have found that people with a higher degree of support have a higher adherence rate.
Financial Support
Several NGOs collect funds for the treatment of cancer patients. Further, the Central and State governments have several schemes to assist cancer patients financially. Therefore, there is a need to create public awareness about such schemes.
Strategic Alteration in Therapy
The doctor may alter the treatment when the patients cannot tolerate the current chemotherapy cycles. It may include lowering the dose of the drugs. It will reduce the side effects and allow the patients to complete the chemotherapy cycles.
Conclusion
Chemotherapy works well when patients stick to the scheduled chemotherapy cycles. Unless in emergency conditions, patients should complete their chemotherapy cycles. Further, healthcare professionals should also look into the reasons that force patients to skip treatment. Psychological support and counseling, if considered, are found to have a positive impact on treatment adherence and completion.
Frequently Asked Questions
- How many rounds of chemo is normal?
The number of chemotherapy cycles recommended may vary from one patient to another, and it depends on various other individual case parameters, such as the type of cancer, its stage, the goal of the treatment, the treatment plan recommended, and the patient’s overall health.
Often, chemotherapy may be recommended along with other cancer treatments, such as surgery and radiation therapy. Also, it may be recommended before surgery to shrink the tumor or after the surgery to destroy the residual cancer cells.
- What is the 7-day rule in chemotherapy?
The 7-day rule in chemotherapy is more of a guideline for scheduling chemo cycles. The goal of this rule is to balance the killing of cancer cells with giving the body sufficient rest. The 7-day rule of chemotherapy involves:
- Treatment days followed by rest days Chemotherapy cycles may be planned in such a way that there will be 5 days of chemo with 2 days of rest, all within 7 days (roughly).
- Maintaining drug levels: 7-day rule helps ensure that there is enough chemo in the body to fight cancer.
- Minimizing side effects: Rest days allow the patient to recover from chemo's harsh effects.
- Neutropenia management: Chemotherapy often leads to neutropenia, which is a decrease in infection-fighting neutrophils. The 7-day rule helps in the careful scheduling of the treatment and reduces the risk of neutropenia.
- When to stop chemo for pancreatic cancer?
The medical oncologists will know better when to stop chemotherapy treatment for pancreatic cancer. Generally, any cancer treatment, including chemotherapy, is stopped when the treatment response is poor, i.e., the tumor continues to grow and spread to different parts.
In such cases, the doctor may recommend other treatments. Once the patient exhausts all their treatment options, they may be recommended to enrol in clinical trials for pancreatic cancer management.
It is important to note that pancreatic cancer is aggressive, and after a certain stage, this disease can only be delayed and survival can be prolonged.
- Is chemotherapy necessary after surgery?
For early-stage cancers, surgery is the first line of treatment, and it is alone enough to treat cancer in some cases. However, in most cases, surgery is accompanied by other treatments like chemotherapy and radiation therapy.
Combining chemotherapy with surgery improves the overall treatment effectiveness and supports a better recovery. When administered after the surgery, chemotherapy kills the cancer cells that may be left behind.
That said, your doctor will know what the best course of treatment for your case is, and if they include chemotherapy in your treatment plan, then it is advised that you adhere to it.
- What are the best foods to eat after chemotherapy?
Chemotherapy is associated with various nutrition-related side effects, such as mouth sores, changes in the sense of smell and taste, loss of appetite, mouth sores, nausea, vomiting, constipation, and diarrhea. These side effects can make it challenging for chemotherapy patients to consume food. Therefore, it is important for patients to consider talking to an onco-dietician for appropriate nutritional guidance.
Chemotherapy patients are advised to consume foods that are bland, lukewarm to cold, and rich in calories and nutrients. Some of the best foods that you can consume after chemotherapy include oatmeal, bread toast, plain pasta, rice, fruits and vegetables, etc. It is also necessary to optimize your fluid intake to avoid dehydration.
- How long do chemo side effects last?
Most of the side effects associated with chemotherapy may wear off sometime after the treatment. However, it is important to note that the side effects associated with chemotherapy may vary from patient to patient, and therefore, the duration they last may also be different.
Before the treatment, the patients and their caregivers will be informed about the possible side effects, how long they last, and how to manage them. If patients are having a hard time managing their side effects, they must talk to their expert team for appropriate intervention.
- How long is the chemo session?
The duration of the chemotherapy session depends on the type of chemotherapy administered. Oral chemotherapy may take a few seconds, whereas other modes of chemotherapy administration, such as intravenous, intramuscular, intraperitoneal, etc., may take several minutes to a few hours.
- How many different types of chemotherapy are there?
Chemotherapy is classified into various types based on the class of chemotherapy drugs and mode of administration. Based on their mode of action, chemotherapy drugs are classified into alkylating agents, antimetabolites, topoisomerase inhibitors, anti-tumor inhibitors, nitrosoureas, anthracyclines, and plant alkaloids.
The different types of chemotherapy depending on the mode of administration include oral chemotherapy, topical chemotherapy, intravenous chemotherapy, intramuscular chemotherapy, intraperitoneal chemotherapy (stomach cavity), intravesical chemotherapy (bladder cavity), intrapleural chemotherapy (chest cavity), intrathecal cavity (brain and CNS), and HIPEC.
- Does chemo kill cancer?
Yes, chemotherapy drugs are anti-cancerous in nature and therefore can kill cancer cells. /p>
- Is chemo painful?
Yes, pain after chemotherapy may be seen in some patients. 2-3 days after chemotherapy, patients may experience pain in joints and muscles. This pain can be managed with medication.
