12 Sep, 2024
Several treatments are available for cancer. The most common of them are chemotherapy, surgery, and radiation therapy. Chemotherapy involves the administration of drugs that kill cancer cells. It is given in cycles for optimum efficacy and to recover from side effects. Treatment adherence is the key to positive outcomes. Therefore, patients should not skip or delay their chemotherapy cycles.
Patients undergo therapeutic chemotherapy in several cycles. The patients usually have 4-8 treatment cycles. The duration between one round of therapy and the start of the next is referred to as one cycle. Usually, in a 28-day treatment cycle, the oncologist administers chemotherapeutic drugs on the 1st, 2nd, and 3rd days, and there will be drug-free days from the 4th to the 28th day. The doctor plans the treatment during the chemotherapy cycles due to the following reasons:
When administered in cycles, therapeutic chemotherapy enhances treatment efficacy and improves outcomes. This is because not all cancer cells divide uncontrollably at a given point. Some are in the resting stage. Chemotherapy only kills those cells that divide rapidly. Thus, administering the drug in cycles helps kill all the cancer cells.
Chemotherapy has several side effects. These are nausea, vomiting, fatigue, and higher infection risk. Continuous administration of these drugs may cause severe side effects that the body cannot tolerate. The oncologists, depending upon the type of cancer and age of the patients, along with other factors, devise customized chemotherapy cycles for the patients. It provides time for the body to recover from the side effects.
Those undergoing chemotherapy may experience various side effects. These side effects may be mild to moderate. In some cases, however, these side effects can be severe and may need medical attention. Patients may reach out to their expert team for appropriate interventions in such cases. The following are the different side effects associated with chemotherapy:
Fatigue is the most common side effect of chemotherapy, and it can last for several weeks or even months after treatment ends. Patients need to rest often to tackle their tiredness effectively.
Chemotherapy drugs target rapidly dividing cells, including hair follicles, which can lead to partial or complete hair loss. Hair loss due to chemotherapy is usually temporary, with regrowth starting a few months after treatment ends.
In some patients, chemo treatment can cause pain in different parts of the body, such as the mouth, throat, and joints. This chemotherapy pain can be managed through medications.
Chemotherapy drugs can cause damage to cells in the mouth and throat, making them sore and tender, which may lead to swallowing difficulties. Doctors may recommend special mouthwashes and rinses to soothe mouth sores.
Some chemotherapy drugs irritate the lining of the digestive tract and may lead to diarrhea. Chemotherapy-induced diarrhea is temporary and can be managed with medication.
Certain chemotherapy drugs may affect the gut’s nerve supply and cause constipation. With the help of some lifestyle modifications and medications, it is possible to manage chemotherapy-induced constipation.
Certain chemotherapy drugs activate the chemoreceptor trigger zone (CTZ), and this may lead to nausea and vomiting in some patients. Both nausea and vomiting are temporary side effects of chemotherapy, and they can be managed effectively with medication.
Chemotherapy may affect the functioning of bone marrow in some cases and lead to reduced number of white blood cells, red blood cells, and platelets in the blood. This may make the patient susceptible to various blood disorders and infections.
Some patients experience challenges associated with thinking and memory while undergoing chemotherapy. These cognition issues are temporary and wear off once the treatment is over.
Patients undergoing chemotherapy may experience fertility issues, and it can also lead to changes in sexual desires and function. In such cases, patients may consider talking to their doctor about their concerns.
During chemotherapy, many patients experience loss of appetite. In such cases, patients may consider having food in small portions frequently. They may also consider consulting with an onco-dietician for nutritional counseling.
In some cases, doctors may recommend delaying chemo by two weeks or more, depending on individual case parameters. There are several reasons for skipping or delaying the chemotherapy cycles:
Some patients cannot tolerate the side effects of chemotherapy. It may lead to skipping or completely stopping the chemotherapy cycles. However, today, advanced chemotherapeutic drugs are available for certain types of cancer with fewer side effects. If the side effects are severe, the doctor may administer medications that can help manage them.
If the patient has an infection or a fever, the doctor may delay the chemotherapy cycle. The oncologists resume the chemotherapy once the patient recovers from the illness.
The patients may have low white blood cell count after the chemotherapy cycle. The doctor may delay the subsequent cycles if the patients have a very low white blood cell count after the chemotherapy cycle. Having a very low white blood cell count may increase the risk of infection.
Chemotherapy may cause severe fatigue and weakness. If the patients need hospitalization, the doctor may delay the chemotherapy cycle until they are fit to get chemotherapy.
Several other issues lead to the skipping or delaying of the chemotherapy cycle. These are financial constraints, family responsibilities, job requirements and depression and anxiety due to the disease.
Patients should not skip or delay their chemotherapy cycles. If there is any delay or skipping of the dose (especially the oral drugs), the patient should immediately inform the doctor. They should seek advice for a further course of treatment. Patients should not skip chemotherapy cycles due to the following reasons:
Skipping or delaying the chemotherapy cycles may offset the results obtained with the prior chemotherapy cycles. As already discussed, some cells are in the resting stage and may divide after completing the previous cycle. Therefore, the disease may reach the pre-treatment stage if these cells are not killed through the next treatment cycle.
It is essential to note that chemotherapy administration varies for each patient depending on the type and stage of cancer. When a patient skips the chemotherapy cycle, the disease may progress to the next stage, and the oncologists may have to change the complete course of treatment. Eventually, the patient may have to take medicine from the beginning. The patient may also require adjuvant therapy.
In fast-growing cancers, such as inflammatory breast cancer, skipping chemotherapy may cause the disease to quickly progress to an advanced stage. The oncologists may prescribe intensive chemotherapy treatment along with surgery or radiation therapy.
Cancer has a devastating effect on the lives of patients and their family members. Therefore, improving the patients' adherence to treatment is essential to improving survival and reducing mortality. Some of the ways to improve patients' adherence are:
The healthcare provider must provide clear information to patients with cancer. It includes the type of treatment and side effects. It will help the patient prepare for the treatment in advance.
Psychological support through counselling is required for both the patients and their family members. Studies have found that people with a higher degree of support have a higher adherence rate.
Several NGOs collect funds for the treatment of cancer patients. Further, the Central and State governments have several schemes to assist cancer patients financially. Therefore, there is a need to create public awareness about such schemes.
The doctor may alter the treatment when the patients cannot tolerate the current chemotherapy cycles. It may include lowering the dose of the drugs. It will reduce the side effects and allow the patients to complete the chemotherapy cycles.
Chemotherapy works well when patients stick to the scheduled chemotherapy cycles. Unless in emergency conditions, patients should complete their chemotherapy cycles. Further, healthcare professionals should also look into the reasons that force patients to skip treatment. Psychological support and counseling, if considered, are found to have a positive impact on treatment adherence and completion.