From the India Today archives (2017) | A future without cancer?
What Is Chemotherapy?
Chemotherapy is a treatment that uses drugs to destroy cancer cells. Chemotherapy drugs can be given by mouth (orally), on the skin (topically), into a vein (intravenously), or through other routes. Healthcare providers recommend chemotherapy to treat or cure cancer in different areas of the body. However, this treatment usually affects cells in several areas of the body, and side effects are common.
An oncologist (a doctor who treats cancer) usually recommends a specific regimen of chemotherapy drugs based on your type of cancer and overall health. The treatment is usually administered by oncology nurses (nurses who specialize in cancer treatment).
The purpose of chemotherapy is to slow or stop the growth of cancer cells. Cancer cells tend to grow and divide quickly. Chemotherapy can also help shrink the size of a cancerous tumor, which can reduce painful symptoms.
Depending on your type of cancer and how advanced it is, the three goals of chemotherapy are to:
There are several types of chemotherapy, each of which can fight cancer in different ways. Many people with cancer receive more than one type of chemotherapy during their treatment. The types are usually grouped by how they work and their chemical structure. Most types of chemotherapy drugs work by altering the DNA inside of cancer cells.
When developing your chemotherapy treatment plan, your oncologist will consider your type of cancer, how advanced it is, where it has spread, your age, and overall health.
Alkylating AgentsAlkylating agents are chemotherapy drugs that work by keeping cancer cells from multiplying. These drugs damage the DNA of the cancer cells and prevent the cells from reproducing. This stops the spread of cancer throughout the body.
Most alkylating agents are used to treat leukemia, lymphoma, Hodgkin's disease, multiple myeloma, sarcoma, and cancers of the brain, lungs, breasts, and ovaries. However, they may damage the cells in the bone marrow and raise the risk of cancer over time.
Nitrosoureas are the only type of alkylating agent that can cross the blood-brain barrier and travel to the brain. They are used to treat brain cancer. Examples of alkylating agents include Temodar (temozolomide), Myleran (busulfan), and cyclophosphamide.
AntimetabolitesAntimetabolites are chemotherapy drugs that interfere with the DNA and RNA of cancer cells. This prevents the cells from reproducing and multiplying.
Antimetabolites are used to treat leukemia and cancers of the gastrointestinal tract (the passageway between your mouth and anus that helps with digestion), breasts, and ovaries. Examples of antimetabolites include 5-FU (5-fluorouracil), 6-MP (6-mercaptopurine), Xeloda (capecitabine), and gemcitabine.
Anti-Tumor AntibioticsAntitumor antibiotics treat cancer by changing the DNA inside of the cancer cells. By interfering with the enzymes (proteins) involved in copying DNA, they prevent cancer cells from reproducing.
Anti-tumor antibiotics are used to treat a variety of cancers. However, taking these drugs in high doses may cause long-term damage to the heart, so your healthcare provider will monitor you frequently while you take these medications. Examples of anti-tumor antibiotics include Cosmegen (dactinomycin), Blenoxane (bleomycin), Cerubidine (daunorubicin), and Adriamycin PFS (doxorubicin).
Topoisomerase InhibitorsTopoisomerase inhibitors are plant alkaloids (drugs that come from plants) that interfere with the DNA of cancer cells. These drugs alter enzymes called topoisomerases which are needed to separate strands of DNA so that it can be copied.
Topoisomerase inhibitors treat leukemia and cancers of the lungs, ovaries, and gastrointestinal tract. However, they may raise the risk of developing acute myeloid leukemia over time. Examples of topoisomerase inhibitors include etoposide, Camptosar (irinotecan), and Hycamtin (topotecan).
Mitotic InhibitorsLike topoisomerase inhibitors, mitotic inhibitors are also plant alkaloids that work by stopping cancer cells from dividing into new cells. Your healthcare provider can recommend this type of therapy to treat myeloma, lymphoma, leukemia, and cancers of the breasts and lungs.
Common miotic inhibitors include Taxotere (docetaxel), Halaven (eribulin), Ixempra (ixabepilone), Taxol (paclitaxel), and vinblastine. Keep in mind: mitotic inhibitors may cause painful nerve damage.
CorticosteroidsCorticosteroids are medications that reduce inflammation (swelling) in the body. When used to treat cancer, they are considered chemotherapy drugs. Examples of commonly-used corticosteroids include prednisone, methylprednisolone, and dexamethasone.
Your healthcare provider can administer chemotherapy in regular intervals known as rounds or cycles. You will likely receive treatment regularly for days or weeks and then have a break. This break time allows your healthy cells to recover from chemotherapy and your body to get rest.
Chemotherapy may be given with other cancer treatments too. If you require surgery to remove a tumor, your care team may recommend chemotherapy before or after surgery to shrink the tumor or kill any remaining cancer cells.
Before ChemotherapyIt takes some preparation to get ready for a chemotherapy appointment. If you are receiving chemotherapy in a hospital or outpatient clinic, your appointment could take several hours.
Before your first chemotherapy appointment, you will meet with your oncologist to discuss your individualized care plan. Your healthcare provider will perform a physical exam, take blood tests, and ask about any medications or supplements you are taking.
Ask your oncologist if there are any other medical procedures you should have before starting chemotherapy. For example, your care team will likely recommend a dental exam and teeth cleaning before cancer treatment starts. This is because the bacteria in the mouth can enter the bloodstream during dental procedures. Because chemotherapy weakens your body's ability to fight infection, it's best to have this done before chemotherapy starts.
Your oncologist may also recommend meeting with a cardiologist (a doctor who specializes in the heart) because some forms of chemotherapy can cause long-term damage to your heart. Finally, chemotherapy can affect your fertility. If you hope to become a parent in the future, ask your oncologist about your options for preserving your fertility.
During ChemotherapyOn the day of your chemotherapy appointment, consider asking a friend or family member to come with you. It might be nice to have some company during your long appointment. Make sure to ask your medical facility about any visitor restrictions first.
Keep in mind: you may experience side effects after a chemotherapy session. One of the most common side effects of chemotherapy is fatigue. You may be too tired to drive yourself home after the appointment, so arrange for a ride. It may also be helpful to get help with household chores like cleaning and food preparation, as well as babysitting if needed.
Before leaving for your appointment, eat a small, bland meal. Because the appointment is long, you'll want some food in your stomach. However, chemotherapy often causes nausea so opt for bland foods like rice or toast.
When you arrive at the hospital or clinic for your appointment, you will check in at the front desk. The healthcare team will check your vital signs including your heart rate, blood pressure, and temperature, as well as your height and weight.
Most people receive chemotherapy while sitting in a recliner-type chair. Your healthcare provider will likely place an IV in your arm to draw blood and give chemotherapy and fluids. They will then double-check your name, date of birth, medication, and dosage. If you need medications before chemotherapy, such as drugs to prevent an allergic reaction, you will receive them right away.
Once your chemotherapy starts, it may take several hours. During your appointment, the care team will monitor you for any signs of a drug reaction. They will also continue to check your vital signs throughout the appointment.
To pass the time, consider bringing relaxing activities like books, podcasts, audiobooks, knitting, or crossword puzzles. Some people feel cold while receiving chemotherapy, so bring layers of clothing and a blanket as well.
Ask your oncologist if it's ok for you to eat during your appointment and bring a large water bottle and bland snacks. After your appointment, continue to stick with bland foods that don't have a strong aroma. Cold or cool foods usually don't have much of a smell. However, hot foods with strong aromas could trigger nausea.
After ChemotherapyAfter chemotherapy, there are some important precautions to keep in mind. If you received treatment in an outpatient facility, you will go home after your appointment.
It takes your body about 48 to 72 hours to break down chemotherapy drugs. Any bodily fluids, such as urine and stool, will contain chemotherapy for the first few days after your appointment. If you live with others, it's important to protect them from any chemotherapy exposure.
You can protect others from exposure in the following ways. If you have an extra bathroom, consider using your own away from your family. Always flush the toilet twice and close the lid, and remember to wash your hands throughout the day. If you have someone helping you during the day, ask them to wear two pairs of disposable gloves to protect themselves.
In the days after chemotherapy, you will likely feel very tired. Engage in gentle exercise when you can but don't feel the need to push yourself too hard. The important thing is to get your rest and do what you comfortably can while you are receiving treatment.
There are several risks and potential side effects associated with chemotherapy. Chemotherapy works by targeting cells that divide and multiply rapidly, which helps attack cancer cells living in your body. Unfortunately, there are healthy cells in the body that also divide quickly. These include cells in the skin, hair, mouth, and digestive tract. If chemotherapy attacks these cells, serious side effects occur.
Common side effects of chemotherapy include:
Chemotherapy may also lead to long-term damage to the heart, kidneys, nerves, and reproductive system.
Walking into your first chemotherapy appointment is an overwhelming experience. Being well-prepared may help to ease some of the anxiety you are feeling. It's helpful to remember that there is no right or wrong way to feel as you begin cancer treatment. You will likely feel a wide range of emotions from hope for treatment success to worry about the future.
Here are some tips to keep in mind when preparing for chemotherapy:
Chemotherapy is a cancer treatment that uses drugs to slow and stop the growth of cancer cells. It is a common cancer treatment and is sometimes used in combination with other treatments like radiation therapy, surgery, immunotherapy, or targeted therapy.
Chemotherapy is usually prescribed by an oncologist—a doctor who specializes in the diagnosis and treatment of cancer. During your chemotherapy appointments, you can expect oncology nurses to administer the treatment. Chemotherapy may be given in the hospital, at an outpatient facility, or at home.
There are several different types of chemotherapy, and your oncologist will consider your type of cancer, how advanced it is, and your overall health when recommending chemotherapy. Before beginning treatment, talk to your provider about any concerns or questions you have. Living with cancer can be difficult and scary. Get all the information and support you need to make this journey as comfortable as possible for you.
Everything To Know About Chemotherapy For Lymphoma
Chemotherapy is a type of treatment for cancer. It is one of the most common treatments doctors use to manage the different types of lymphoma.
People can typically undergo chemotherapy as outpatients. Chemotherapy treatment usually consists of a combination of various chemotherapy medications that doctors administer to the patient over one or a few days. These medications typically come in the form of tablets or infusions.
After the treatment, a person waits for a few weeks to allow their body to recover from the treatment before receiving another cycle of chemotherapy. People usually undergo chemotherapy treatment for several months and have regular appointments to review how the cancer is reacting to the treatment.
This article will review chemotherapy for the different types of lymphoma, the side effects of chemotherapy, and the other treatment options for lymphomas.
Chemotherapy is the main type of treatment for non-Hodgkin lymphoma. This is because the chemotherapy that healthcare professionals administer into the bloodstream can reach most parts of the body. This makes it particularly effective in treating lymphoma.
How doctors administer itDoctors can give chemotherapy in the form of tablets or intravenously through a vein. If they suspect cancer may spread to the brain, they may also give chemotherapy injections straight into the cerebrospinal fluid.
Doctors may recommend chemotherapy as the sole treatment method for treating cancer. However, depending on the type of the disease, they may suggest this treatment alongside radiation therapy or targeted therapy.
Types of chemotherapyThere are different types of chemotherapy treatment for non-Hodgkin lymphoma, including:
Learn more about non-Hodgkin lymphoma.
The type of chemotherapy treatment doctors may recommend for treating Hodgkin lymphoma may vary depending on the stage, physical conditions, and symptoms that a person with this type of cancer may experience.
When doctors use itChemotherapy is the principal type of treatment for Hodgkin lymphoma. It typically consists of a combination of two or more chemotherapy medications.
Doctors use chemotherapy to destroy cancer cells and help prevent their growth and spread.
How doctors administer itDoctors typically give chemotherapy for Hodgkin lymphoma intravenously in the form of an infusion. The main three ways of giving chemotherapy include:
People with Hodgkin lymphoma typically receive a new cycle of chemotherapy every 3–4 weeks to allow their bodies to recover from the previous treatment.
Types of chemotherapyThe type of chemotherapy treatment for Hodgkin lymphoma may vary depending on the stage of cancer.
Doctors may administer the chemotherapy treatment for Hodgkin lymphoma alongside radiation therapy in its early stages. Chemotherapy treatment may include:
Doctors may recommend undergoing chemotherapy treatment for Hodgkin lymphoma and then involved-site radiation therapy in its later stages. The chemotherapy treatment may include:
Learn more about Hodgkin lymphoma.
Side effects of chemotherapy may vary from person to person. Some people may only experience a few of them. If a person undergoes chemotherapy, they may experience side effects, including:
Read more about the side effects of chemotherapy.
In some cases, doctors may use other types of treatment for treating people with lymphoma. This depends on the type of lymphoma, its stage, and other factors relating to the health of the person receiving treatment.
Other types of treatment for lymphoma may include:
Here are some common questions about chemotherapy for lymphoma.
How long is chemotherapy treatment for lymphoma?The duration of chemotherapy treatment for lymphoma usually lasts for several months. However, it may vary depending on the severity, stage of the cancer, and how it reacts to the treatment.
Is lymphoma curable with chemotherapy?Chemotherapy is typically effective in treating lymphoma. However, doctors may recommend a combination of different cancer treatments depending on various factors.
What happens after the first chemo treatment for lymphoma?After the first chemo treatment, people with lymphoma may have to wait between 3 and 4 weeks before receiving another cycle of therapy. This is to allow the body to recover from the side effects of the treatment.
Chemotherapy is one of the most common treatments for Hodgkin lymphoma and non-Hodgkin lymphoma. Doctors typically administer it in the form of infusions, but tablets may also be available.
Chemotherapy treatment for lymphoma typically lasts several months, and people with cancer usually receive a cycle of chemotherapy every 3–4 weeks. Chemotherapy drugs can help destroy cancer cells and prevent their growth. In some cases, healthcare professionals may administer chemotherapy alongside other cancer treatments, such as radiation therapy and targeted therapy.
Chemotherapy may cause some side effects, including nausea, diarrhea, and fatigue. However, its side effects can vary among individuals.
A Short Supply Of Cancer Drugs Has Doctors And Patients Worried: 'We're At A Critical Juncture'
Here's why cancer patients and doctors are worried about the drug shortage
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Sitting in an infusion center last Wednesday afternoon, Elizabeth Arnold wondered whether the cancer drug dripping into her vein would be enough to make a difference.
Arnold, 63, was recently diagnosed with advanced uterine cancer. Her surgeon said she needed chemotherapy to knock down the tumors before operating.
But with key medications in shortage, she was told she would get five bags of the drug carboplatin, not the usual six. The nurse at her hospital in Anchorage, Alaska, said they would likely run out completely before her next treatment in three weeks.
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"I'm terrified, quite frankly," said Arnold, a journalism professor at the University of Alaska and former reporter with National Public Radio.
She's caught up in a frightening and frustrating national shortage of essential drugs that experts say has put the lives of more than 100,000 cancer patients, particularly women, at risk.
"The last six months have been the worst in my career, including some of the shortages we had during the peak of COVID. It's just been incredibly challenging," said Julie Kennerly-Shah, associate director of pharmacy at the Ohio State University Comprehensive Cancer Center.
Fourteen cancer drugs have been in shortage in recent months, mostly because of supply chain issues. Those in the shortest supply include cisplatin and carboplatin, platinum-based drugs used to treat gynecologic, breast, testicular, bladder, head and neck, and non-small cell lung cancers.
The American Society of Clinical Oncology (ASCO) has been working to resolve the shortage and saw the first glimmers of hope last week after a national delivery of carboplatin, which has been in shortage for a month.
© Courtesy Elizabeth Arnold Elizabeth Arnold, with her newly shaved head, is keeping active to improve her chances against uterine cancer"I think we may very well have hit rock bottom and are starting to slowly see more release of drug," said Julie Gralow, the society's chief medical officer and executive vice president.
But it's not yet clear whether the crisis is ending or if supply will continue to ebb and flow.
"None of us knows yet what that means. Is it going to be adequate? Are we going to be practicing week to week?" said Dr. Amanda Nickles Fader, a professor of obstetrics and gynecology at Johns Hopkins Hospital and president-elect of the Society of Gynecologic Oncology. "We obviously need long-term solutions."
Fader's organization surveyed its members in late April and only a handful, mostly in rural or smaller hospitals, said they were near a crisis point. By last week, they'd heard from facilities in more than 40 states, including some major medical centers, that they were running short of at least one key cancer medication.
"We're at a critical juncture," Fader said. "If this crisis worsens, every hospital in the United States is going to be impacted."
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Alternative approachesDoctors can often give patients a different drug if one is in shortage, Fader said. But cisplatin, which has been limited since February, is often used as a substitute for carboplatin and visa versa ‒ so limited access to both creates problems.
New guidelines from ASCO encourage doctors to stick to the lowest recommended dose and the longest accepted interval between doses.
That's why Arnold got just five bags of carboplatin instead of six. It's within the recommended range based on clinical trials, but still, Arnold would have preferred to throw as much as possible at her cancer.
And though using the minimum should be enough for most people, Gralow said, "we're all worried about the risk to patients and that some patients might be getting inferior care."
On Thursday, Gralow received messages from a cancer treatment center in Florida and another in Tennessee who said they were about to start rationing care. She hopes the recent release of some carboplatin will enable them to avoid that.
If hospitals are forced to ration life-saving drugs, Arnold is worried she'll be far down on the list. Medications will go first to patients with the highest likelihood of being cured. Arnold's dangerous tumor type was down at No. 18 on a rationing list she was given by a Seattle doctor.
Providing too little chemotherapy might leave patients with terrible side effects but no benefit – or even worse, might make their tumor resistant to the drug, said Dr. Michelle Benoit, a gynecologic oncologist in Washington State who has consulted on Arnold's cancer.
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With the health care system already stretched incredibly thin, it can be challenging for doctors to identify an alternative course of therapy and then get an insurance company to cover it.
Fader's society is working with insurance companies to relax prior authorization requirements so patients can get nonstandard treatments.
Some substitute therapies are just as effective as original ones but might require a different dosing schedule or carry more side effects, Fader said.
Even the fact that some drugs take longer to deliver than others can cause problems, she said, with tightly run infusion centers lacking capacity to handle these longer schedules.
All these changes require "a lot of reworking of clinical pathways and workflows in order to get there," Fader said.
Why these cancer drugs are in shortage nowAlthough cisplatin and carboplatin are manufactured by five companies, all rely on a single supplier in India that was shuttered over the winter for safety reasons. Though some production has resumed, deliveries are behind schedule and supplies are low.
Drug shortages have been an issue in the United States for at least a decade, with problems exacerbated during the pandemic, said Bindiya Vakil, CEO of Resilinc, which provides global supply chain mapping and monitoring.
And demand, particularly for cancer drugs, keeps rising as patients live longer with their disease.
Globally, spending on cancer drugs reached nearly $200 billion in 2020, according to the IQVIA Institute for Human Data Science, and is expected to reach $375 billion by 2027.
The irony is that these absolutely essential platinum-based drugs are in shortage in large part because they're so inexpensive.
Cisplatin costs $15 a vial and carboplatin $25, said Matt Christian, director of supply chain insights at the U.S. Pharmacopeia, a nonprofit that sets standards for the pharmaceutical manufacturing industry.
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Because companies stand to make so little from these medications, they have little incentive to create backup plans in case raw material suppliers or manufacturers run into trouble, Christian said. "It's hard to incentivize redundancy if the price is $15 a vial."
The platinum-based drugs are also delivered by sterile injection, which makes them trickier to produce than a pill. That's why sterile injectables are three-times more likely to be in shortage than the average generic drug, he said.
Manufacturers have no incentive to improve their process or product safety.
Plus, with such a small profit margin and because companies don't want to reveal their competitive advantages, production is a closely guarded secret.
That means the American medical system doesn't know when a factory is shut down in India or a raw material shortage impacts the drug supply, so hospitals can't plan ahead or encourage other drug companies to pick up the slack.
How to fix the problemThe Food and Drug Administration is working to address the drug shortage, said spokesperson James McKinney.
"While the agency does not manufacturer drugs and cannot require a pharmaceutical company to make a drug, make more of a drug, or change the distribution of a drug, the public should rest assured the FDA is working closely with numerous manufacturers and others in the supply chain to understand, mitigate and prevent or reduce the impact of intermittent or reduced availability of certain products," he said via email. "The FDA understands that manufacturers expect availability to continue to increase in the near future."
But that's not enough, Gralow said.
Structural changes are needed. Congress should add regulations to require data-sharing, offer incentives to protect the drug supply, manufacture more medications in the U.S. And create a stockpile of essential drugs, she said.
Her organization, American Society of Clinical Oncology, has been lobbying both houses of Congress – and encouraging patients to ask their representatives – to improve the supply of critical medicines.
The U.S. Government should use its buying power to encourage multiple manufacturers to make essential drugs, rather than focusing on the cheapest source and a "race to the bottom," Gralow said. "It's a vulnerable system that needs to be strengthened."
The U.S. Pharmacopeia has been advocating for what Christian described as a "supply chain control tower." The goal would be to increase demand information to raw suppliers and manufacturers so they can better plan their production and to hospital pharmacies so they could better predict fluctuations in supply.
"Our goal ultimately is to inform people with insights and help them take mitigative actions," he said. "The patient impact is why we're fired up to do this work."
The state of cancer 1.95M people may be diagnosed with cancer in 2023
Helping people on the groundArnold just hopes that changes will come in time to help her live longer.
She was a healthy marathoner before headaches, a high blood pressure reading and a nagging anxiety led her doctor to conduct a pelvic ultrasound.
Diagnosed a month ago with an aggressive form of uterine cancer known as serous, it had already spread to her pelvis, stomach and colon. She was scheduled for a hysterectomy, but the surgeon said she wanted Arnold to get chemotherapy first to knock back the tumors.
Her first round of chemo and the first few days after her second have left her with a lot of abdominal pain, which she hopes is caused by cancer cells dying off. One marker of her disease improved dramatically after that first treatment, suggesting the medication is making a difference.
© Courtesy Elizabeth Arnold Elizabeth Arnold after placing second in her age category in a marathon last year.She's working out every day – running when she has the energy; walking when she doesn't – hoping to be among the one-third of people with her tumor type to survive more than five years after diagnosis.
At a time when she wants to be entirely focused on battling cancer, Arnold and her friends on "Team Betsy" have been trying to figure out how to ensure she gets the medication she needs.
She noted that President Biden has been working toward a "Cancer Moonshot," setting a goal of dramatically reducing cancer deaths. Arnold said she hopes the administration is also focusing "right here on the ground."
Medications like carboplatin are already proven to work. But only if people can get them, she said.
"They will save lives and prolong lives. Like mine."
Contact Karen Weintraub at kweintraub@usatoday.Com.
Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.
This article originally appeared on USA TODAY: A short supply of cancer drugs has doctors and patients worried: 'We're at a critical juncture'
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