Chemotherapy

Types of Chemotherapy

 Chemotherapy can be administered in different ways. The variety of ways include oral pill,  IV or  injection. According to the needs, there are different moods of chemotherapy which are as under;

• Primary Chemotherapy: It is a chemotherapy treatment which is used in the sole anti-cancer treatment in highly sensitive tumor types. For example- CHOP for Non-Hodgkin’s lymphoma.
• Adjuvant chemotherapy: It is a chemotherapy treatment which is given after surgery to mop-up microscopic residual disease. For example – Adriamycin and cyclophosphamide for breast cancer.
• Neoadjuvant chemotherapy: It is a chemotherapy treatment which is given before surgery to shrink the tumor and increase the chance of successful resection. For example– Adriamycin and ifosfamide for osteosarcoma.

When Doctors recommend chemotherapy?

Chemotherapy is mostly needed in almost all the stages but mainly related to Stage 3 and Stage 4. Chemotherapy can be used in stage 1 and stage 2 after local treatments like surgery and radiation. In case of blood cancers chemotherapy is a main treatment but cancers like lung cancer, head and neck cancers radiation, surgery and then chemotherapy will be given. In stage 4 cancers mostly the treatment will be shifted to chemotherapy because first, we have to give the medicines which reach the other parts of the body through blood and also take care of the disease which is spreading everywhere.  In stage 4 chemotherapy is definitely the main treatment but in stage 1 and stage 2 the choice of treatment will be radiation and surgery and chemotherapy is along with the part of the treatment.

How chemotherapy is performed?

Chemotherapy is usually given in cycles, which means there is a treatment period and a rest period. For example, if you have a 28 day cycle you may have three weeks of treatment and then one week of rest. The cycles you receive depend on your diagnosis and as determined by your care team. Chemotherapy can be given alone or given in combination with other treatments such as surgery, radiation or immunotherapy. For the medications and blood samples a central line is inserted in your body by a nurse which is known as mediport or a PICC (Peripherally inserted central line) and at the end of your infusion it is removed by your healthcare provider .  

Each infusion visit consists of a lab draw and verification of your blood test results, after an assessment of the reports done by an infusion nurse, and verification of treatment orders signed by your doctor the pharmacy can begin preparation of the medications. It takes almost 30 minutes. During this process, you may receive hydration and other medications. Other medications that may be a part of your treatment are;

• Biological Therapy
• Monoclonal Therapy
• Targeted Therapy
• Hormonal Therapy

Chemotherapy drugs

Not all chemotherapy medications work in all types of cancer. Drugs may be given as a single medication or may be given in combination with other medications. Some IV chemotherapy requires placement of a port. A port is a device approximately the size of a quarter that is implanted under the skin by a surgeon. This device uses a special needle that the nurse can use for chemotherapy, blood draws and IV fluids.  A port which is used in chemotherapy stays in your body for a period of treatment and it would take a time of months or may be years. The types of chemotherapeutic drugs are as follows;

1. Alkylating agents
2. Antimetabolites
3. Mitotic spindle inhibitors
4. Topoisomerase inhibitors 
5. Antitumor antibiotics
6. Nitrosoureas
7. Corticosteroids

What are common side effects of chemotherapy?

As with most medications, chemotherapy drugs may have side effects. Side effects are the unintended actions that occur as a direct result of taking medication. Not all chemotherapy causes side effects. Different people may have different reactions. It is important to remember the severity of the side effect does not indicate the effectiveness of the treatment. Most side effects are temporary but there are some side effects that are more long term. The side effects of Chemotherapy are as under;

• Hair loss
• Nausea and vomiting
• Low blood cell counts
• Increase risk of infections
• Infertility
• Fever
• Weak Immunity
• Mouth sores, taste changes, dry mouth
• Diarrhea and dehydration
• Constipation
• Allergies and hypersensitivity
• Pain
• Chest discomfort 
• Trouble breathing
• Flushing
• Fatigue

Chemotherapy process time

It depends on which part of the body is being treated and how it affects the health of an individual. This is also going to depend on what kind of chemotherapy is being done. There are several cycles which are administered to the patient. The most common course is a 21-day chemo cycle while the complete course generally takes 6 months. During the 6 months course a patient may have their appointments every week which completely depends on the stages and severity of cancer.

Chemotherapy cost in Pakistan

The Chemotherapy cost in Pakistan varies for each person and depends on your treatment plan. Your care team will give you an overall idea of the duration and amount of treatment. The earlier the cancer is diagnosed the shorter the treatments that you are going to get or the more concise the treatment that you are going to get because you are going to be at an earlier stage. In private cancer hospitals, the cost of the treatment can be vary from as little as around PKR 400,000 to 500,000 for that woman who probably would just need surgery and a very short duration of chemotherapy and some hormonal therapy while to someone where the treatment can go up to PKR 2 million where you might need to use targeted agents as well. And so, it really depends on what kind of cancer that you have. In government cancer hospitals the cost of treatment is comparatively very low and this could be less than 200000 but here considering the stages and severity of cancer is very important because if the cancer is in its last stages the cost will definitely increase.