• Marcio Alvarez-Silva, PhD

Chemotherapy in cancer treatment: what to expect?


Undoubtedly, chemotherapy is one of the pillars of cancer treatment. Even with all the benefits of chemotherapy in cancer treatment, many patients do not know what to expect when they start treatment. There are doubts and uncertainties and many myths.

Chemotherapy is one of the main therapeutic methods for cancer. It can be used as the sole treatment or in combination with other procedures such as surgery, radiotherapy, immunotherapy, and hormone therapy, increasing its benefits. The doctor usually requests many tests to determine the best approach to establish the treatment for the patient. The delay in starting the chemotherapy can bring some uncertainties, thinking that the doctor is taking too long to start treatment. However, it is essential to guide the best choices of medicines and procedures. The treatment chosen needs to be as accurate as possible.

Chemotherapy has made many advances, minimizing much of the discomfort it has caused in the past. I have cited in a previous article the improvements of new drugs for the treatment of cancer. Chemotherapy should not be seen as a treatment that will always cause discomfort to patients. Many of the medications used do not cause any unpleasant side effects, such as nausea and vomiting. In cases where such effects occur, the patient is treated with supportive medications to avoid side effects.

Side effects depend on the medicines used in chemotherapy protocol. We currently have hundreds of drugs that are used in chemotherapy. Therefore, it is not easy to define a specific side effect. Doctors prescribe a combination involving two or more medications that are considered more useful for the patient. This combination of drugs, period, and interval of administration, we call the chemotherapy protocol. Each drug of chemotherapy protocol is chosen by the doctor, based on the type of tumor and its stage. A series of previous tests for the prescription of the most appropriate drugs to treat cancer more efficiently is essential. It can vary enormously from patient to patient.

The chemotherapy protocol defined by the oncologist considers several parameters: the dosage of the drugs used, the type of cancer, anatomical location of the tumor, stage of the disease, presence of metastases, the general health and physiology of the patient, the presence of pre-existing chronic conditions, the frequency and duration of treatment, age of the patient, previous treatment of other diseases or cancer. Finally, the doctor considers many factors to define the best chemotherapy protocol for the patient. It is a personalized protocol, minimizing side effects, and increasing treatment efficiency. Therefore, it is complicated to predict what side effects a patient can develop since each patient has a physiology of its own and responds differently to the chemotherapy protocol developed for him.

Patients who have the same type of cancer, as in prostate cancer, may receive different chemotherapy protocols. It may confuse patients who share their histories, reporting that they had different experiences with treatment. A patient's protocol at a more advanced stage of the disease will be different from that prescribed for a patient at the earlier stage of cancer. Older patients tend to have other health problems like hypertension or diabetes. It may modify the medications and dosage used in the protocols. It is not possible to compare the side effects of cancer treatment between different patients. Some patients report that they do very well, while others say they have had some discomfort in their chemotherapy protocol. It isn't easy to compare the effects of chemotherapy on different people.

I attended a woman who started her chemotherapy to treat breast cancer. She was very anxious, expecting many side effects followed by significant discomfort. At the end of a few chemotherapy cycles, she told me happy that he passed very well during his chemotherapy and that his hair did not fall out. I argued that this does not happen to all patients. It will depend on the protocol used. It had become clear to me that this is another of the myths that distress patients: there will always be discomfort and hair loss. It is a source of much anxiety when starting the chemotherapy protocol, producing a negative feeling. In many cases, we deal with patients with concern and pessimistic expectations about their treatment.

Some chemotherapy protocols can bring discomfort. However, most patients handle treatment very well without side effects, such as total hair loss, nausea, and vomiting. Even in more advanced cases, with more aggressive chemotherapy protocol, these effects may not be observed.

The most important thing during chemotherapy is to have an optimistic attitude. The patient and the clinical staff work for the cure, and having a positive posture dramatically influences the treatment. If the patient has depression or discouragement, it is necessary to seek psychological support to overcome this and reverse the pessimism. It can give the patient strength for coping with cancer.

Family support during chemotherapy is essential. Care and understanding are crucial pillars that help the patient to overcome the disease. A peaceful and neutral environment at home can make a difference. Conducting cancer treatment in a patient living in a conflicting and aggressive environment has a negative influence. The family environment has a more significant impact than one might imagine in cancer treatment.

During chemotherapy, the patient does not need to modify his/her entire routine. People can work and have an everyday family life during chemotherapy. It is necessary to have some precautions: 1) regular repose; 2) avoid stress; 3) communicate to the doctor if you need to use any medication, even a simple analgesic; 4) avoid smoking; 5) avoid alcoholic beverages; 6) prevent any medical or dental procedure during chemotherapy; 7) avoid high-impact sports and risk of injury. It is essential to eat healthily, consuming fruits and vegetables during treatment. People may have light and regular physical activity. It helps a lot, but if there is tiredness, the patient should rest to recover the energy.

Positive attitudes and understanding that chemotherapy is essential in your cancer treatment can be determinant for success. Patients and their families must overcome anxiety and have confidence in chemotherapy to get better results in the treatment of cancer.

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