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Chemotherapy: Better than it used to be, still a challenge for some patients

09/18/2014 06:36 EDT | Updated 06/16/2017 00:59 EDT
TORONTO - "He's going to have some rough days."

That was the assessment of Dr. Zane Cohen as he talked about Toronto Mayor Rob Ford's next step in his cancer journey, chemotherapy.

It's a word that strikes dread in most hearts. Most people either know someone who has soldiered through it, have seen it portrayed in a movie or worried about having to undergo it someday.

But what exactly is chemotherapy? Let us explain — with some help from Dr. Marianne Taylor of the B.C. Cancer Agency and the websites of Toronto's Princess Margaret Hospital — a cancer centre — and the Mayo Clinic.

Q: WHAT IS CHEMO?

A: The term itself means to treat disease with chemicals that are toxic to the micro-organisms, in the case of infections, or aberrant cells, in the case of cancer. For our purposes, we'll focus on the cancer application.

The drugs given to fight cancer target cells in the body that are fast growing, explains Taylor, who is the B.C. Cancer Agency's vice-president of systemic therapy. That's a hallmark of cancer — the cells grow faster than other cells in the body.

Q: SO KILLING FAST-GROWING CELLS IS A GOOD THING, RIGHT?

A: It is. It's a way to weed out cancer cells from the body. But there is a problem with chemotherapy that is similar to what happens when you take antibiotics. With antibiotics, the drugs zap bacteria broadly, killing the bad guys but taking out some of the healthy bacteria your body needs too. That sometimes leads to C. difficile diarrhea.

The same is true with chemotherapy. It doesn't just kill cancer cells. It also inflicts damage on other cells in the body, which is why people taking them develop side-effects.

Q: WHAT SIDE-EFFECTS ARE ASSOCIATED WITH CHEMO?

A: The most commonly known one is hair loss. Taylor says not all chemo regimens will trigger hair loss, but the ones that are used for breast cancer, for instance, generally do. An educational video on the Princess Margaret website says hair loss typically starts at about Day 15 in chemotherapy.

Why hair loss? The cells in hair follicles are fast-growing cells. And that doesn't just mean hair on the head. The Mayo Clinic website notes that people sometimes experience hair loss all over their body, including eyelashes, eyebrows and armpit hair. Most of the time this is temporary and the hair will grow back in three to 10 months after chemo ends.

Other side-effects include nausea, which can start early in a chemo regimen, and fatigue. The bone marrow, which produces blood, is also affected by chemotherapy. That can mean low red blood cell counts, which leads to anemia. Or it can lead to low white blood cell counts, which makes it difficult to fend off infections. Or on rare occasions it can lead to a low platelet count, which can affect the ability of the blood to clot, Taylor says.

The gastrointestinal tract is also sensitive to chemotherapy, so some people may develop sores in their mouths and-or diarrhea.

Q: THAT SOUNDS GRUESOME. HOW BAD IS IT?

A: Taylor says reactions vary depending on the drugs used and also by the people getting the drugs. But she says there have been advances made in chemotherapy regimes and the ones used now are much better than those used when she first started practising medicine 23 years ago.

"We're better at managing side-effects and ... in some cases of cancer we use totally different drugs than I used to use in the olden days," she says.

Still, chemo isn't a walk in the park.

"Some people have troubles with nausea and vomiting, despite the best drugs we have available. But that is an uncommon thing these days. The movies that I used to watch as a kid, you're in a hospital room and you're vomiting and you've got no hair. Some of that's still true. But I think for a lot of patients side-effects aren't that bad anymore," Taylor says.

Q: HOW IS IT GIVEN?

A: Some chemo drugs are given intravenously. Others are given in pill form. Some are given by injection and some, for some skin cancers, are applied in a cream.

Q: ARE PEOPLE ADMITTED TO HOSPITAL TO GET CHEMO?

A: Taylor says about 99 per cent of patients getting chemotherapy will have the treatment at an out-patient clinic and go home afterward. But with a few types of cancer, patients are admitted to hospital when they are given the drugs.

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