What is chemotherapy & what are its possible side-effects?

.Chemotherapy is the treatment of cancer with drugs that can destroy cancer cells. Chemotherapy targets cells that divide quickly, including cancer cells that grow and multiply without control as well as healthy cells that divide rapidly. Adjuvant chemotherapy is chemotherapy that is used to destroy any cancer cells that may remain after surgery and/or radiation therapy have cleared the readily detected cancer cells.

Chemotherapy drugs may be given intravenously or orally on certain days of the week over a set number of weeks. For example, you may receive chemotherapy Monday, Wednesday and Friday on weeks 1, 4, 7 and 10.

Combination chemotherapy is when two or more drugs are given at the same time as they work better together than alone. There is no well-established combination chemotherapy for Merkel cell carcinoma. MCC has similarities to other neuroendocrine carcinomas, such as small cell lung cancer. For this reason, your medical oncologist may use drugs that have shown effectiveness against small cell lung cancer. Etoposide and carboplatin is one such regimen.

Information on treatment with chemotherapy (etoposide and carboplatin) comes from a study of 53 patients that demonstrated a 76% overall survival at 3 years in patients treated with both chemotherapy and radiotherapy . It is not possible to determine from this study whether adjuvant chemotherapy improves outcomes because 1) the survival was essentially unchanged from that expected for a group of similarly staged (IA, IB & II) MCC patients and 2) it was not randomized.

6 Reasons why it is not currently recommend adjuvant chemotherapy

('Adjuvant' chemotherapy is used to destroy any cancer cells that may remain AFTER surgery and/or radiation therapy have cleared all detectable cancer cells.)

• Mortality: there is a 4 to 7% acute death rate due to adjuvant chemotherapy in MCC partly due to the fact that these patients are often elderly (Voog 1999; Tai 2000).
• Morbidity: Neutropenia (low white blood count) occurs in 60% of patients with fever, and sepsis in 40% (Poulson 2001).
• Decreased quality of life: this is quite severe in this older population, including fatigue, hair loss, nausea and vomiting.
• Resistance to chemotherapy: Merkel cell carcinoma that recurs after chemotherapy is less responsive to later palliative chemotherapy.
• Immunity: chemotherapy suppresses immune function and this is known in general to be very important in preventing and controlling MCC.
• Apparent poorer outcomes: among patients with nodal disease, there was a 60% survival if chemotherapy was not given among 53 patients. In contrast, survival was only 40% among node positive MCC patients who did receive adjuvant chemotherapy (Allen 2005). While this is not a randomized trial and was not statistically significant, it certainly does not suggest a survival benefit for administering adjuvant chemotherapy.

Side effects of chemotherapy include nausea, fatigue and losing your hair as well as weight loss/gain.

Nausea
You are given a number of drugs to prevent nausea and vomiting. They are effective and will make the experience far less difficult. Remember that dehydration can occur and it’s important to take in enough fluids and stay hydrated.

Fatigue
When your blood cell count is down and you are producing fewer red blood cells (carriers of oxygen to the body) feeling tired and even dizzy is natural.

Remember to be kind to yourself and give yourself rest when you need it. You will probably have to take naps during the day and cut down on your usual schedule.

The fatigue is utterly debilitating. The only one who is going to lose out is you. Your body needs rest. Your bodies defences are under attack and you will need all of the stamina you have to recover.

Susceptibility to infection
Having a low white blood cell count makes you vulnerable to infection. When your white blood cell count is low avoid crowds and any sick people.

Remember to let you doctor know immediately if you are feeling sick (especially if you have a fever). Your immune system does not have the same ability to fight infection as it normally would & therefore something that seems insignificant can develop into something serious very quickly.

Because chemotherapy extends throughout the body, it also affects cells other than cancerous ones including:

• · bone marrow (reason for low white blood cells)
• · hair follicles (reason for hair loss)
• · mucous membranes in your mouth and intestines (reason for ulcers and stomach issues)

Side effects of chemotherapy vary greatly depending on a variety of factors including:

• · Type of drug
• · Dosage
• · Other medications you are taking
• · How long you’re on the drug
• · Current stage of treatment you are going through
• · Mental state and attitude
• · Your bodies physical state

Remember that going into treatment well prepared and knowing what to expect will help you cope better.

Reducing symptoms

There are certain measures that can assist in symptom reduction. These include:

• · Eating the correct foods (protein, green leafy vegetables)
• · Avoiding inflammatory foods (i.e. spicy, fatty, sweet or salty foods)
• · Eating small, bland meals & drinks at room temperature helps control nausea

Hair loss

Losing hair is probably the most upsetting side effect.

Most survivors recommend that you cut off your hair before it falls out so the experience is less traumatic. Although not immediately, your hair will grow back. It may grow back a different colour (often darker) and texture (often curlier) than before.

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