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By Dr. Andrew Odhiambo
Consultant Physician & Medical Oncologist

Dear Cancer Patient/Caregiver,

Cancers are generally treated in 4 main ways Surgery, Radiotherapy, Chemotherapy, and Targeted therapy/Immunotherapy. This write up mainly focuses on chemotherapy to help you understand more about it, demystify the rumors and make your treatment journey as smooth as possible.

What is Chemotherapy ?

  • These are simply drugs we use to treat cancer. Most are given through the vein.
  • Unlike simple antibiotics chemo is a process/journey. A lot goes into preparation before the infusion as well as afterwards.

Is all chemotherapy the same?

  • No. There are over 100 different types of chemotherapy drugs. Different cancers are treated using different types chemotherapy.
  • We often combine 2 or more types of chemo to get better results. These are chosen in accordance with international guidelines meaning treatment is standardized all over the world for most common cancers e.g Chemotherapy for colon cancer in Kenya is the same as in India, America, Europe etc.
  • Most drugs have shared side effects but some have unique effects related to a specific drug.
  • It is important to know which one(s) you are receiving and learn their potential effects and how to overcome them. Patients & caregivers are encouraged to own the chemotherapy process as well.
  • Every patient has a unique dose calculated using her/his weight & height.

Who is a Medical Oncologist?

  • This is an Internal Medicine Specialist/Physician trained in treating cancers using chemotherapy, targeted therapy and immunotherapy. She/he is usually the main coordinator and oversees a patients entire treatment journey.

Why do I need chemotherapy?

  • Chemotherapy may be used for any one or more of the following reasons
    1. To reduce the size if a tumor/cancer so that the surgeon can perform a successful surgery also known as “neoadjuvant chemotherapy”
    2. To eliminate microscopic cancer cells that may linger in the body after successful cancer surgery also known as “adjuvant chemotherapy”
    3. To make radiotherapy more effective in killing cancer cells also known as “concurrent chemoradiation”
    4. To induce remission/cure for blood systems cancer by eliminating all circulating cancer cells e.g Leukaemia & Lymphoma “Induction chemotherapy”.
    5. To prolong life and improve its quality by reducing cancer related symptoms in stage 4 cancers “Palliative chemotherapy”

How is chemotherapy given?
Chemotherapy is not a one-time thing like taking anti-malarial drugs, it’s a journey. It begins the day your oncologist recommends this treatment for you. He/she will explain why it’s needed, the combination of drugs to be used and the anticipated side effects. You will then sign a consent form similar to that you would sign before a surgical operation. Chemo usually takes place in an infusion centre, and in most cases as a day-case procedure meaning you will not be admitted to the in-patient wards. There are some chemos that require you to be admitted to hospital for a few days due to the nature the infusion.

Prior to the date scheduled, you will be required to do blood tests to assess your bone marrow, liver, kidney function. In most cases (not all), these are done prior to each session. Your doctor or nurse will review your results and you will only proceed if they are satisfactory. Your doctor/chemo nurse or pharmacist can determine this. The chemo nurse will then fix an IV canula on your hand which will be used to deliver the treatment. Some patients who require longer drips will use chemo-ports that are usually implanted under the skin below the collar bone prior to chemotherapy. Make sure you tell your chemo nurse if the drip IV cannula is painful swollen or burning so as to minimize chances of leakage. The line should flow with ease and without pain.

On the day start chemo (call it Day 1), your trained pharmacist will carefully reconstitute and prepare your chemotherapy drugs following the detailed instructions from your oncologist. Think of it like a chef following instructions from a food recipe. A recipe that is specifically written for by your oncologist. Your chemo nurse will then take over and begin the infusion process. The nurse is like your personal waitress. She/he will oversee the delivery. The whole team has to work together. First, you will receive what we call premedication which consists of a cocktail of drugs to counteract the effects of chemotherapy particularly nausea, vomiting and allergic reactions. This is like starter soup to warm you taste buds. After the first infusion you and receive the chemotherapy (main meal) which looks pretty much like any IV drug. Don’t be spooked if you find it covered with black bags. This is to protect it from UV light. You can eat before, during and after the drip. It is not painful. The nurse will monitor you. If you feel like itching, scratching, or chest tightness please alert your nurse immediately. This may be an allergic reaction. Most are mild and are treated easily allowing you to continue with the drip Once the drip is over you will receive some IV fluids (desert) to flush the system and then you'll be unplugged and you can go home. You will carry home tablets to swallow usually to counteract nausea and other acute reactions. Sometimes your doctor may prescribe for you immune boosting injections which you may receive for several days after chemotherapy.

Please make sure you note the date of the next cycle/session (usually 21 days later, may be shorter or longer). Please take note of all instructions given to you by your chemo nurse. You will be given a lab test form for the same blood tests to carry out before the second cycle/session. It is important to communicate to your doctor/nurse any side effects the fact you may experience so that they may be managed quickly as they appear and this is why Chemotherapy is more of a relationship more than a one-time procedure.

Why does chemo cause side effects?
Cancer cells are fast growing and that’s why we use chemotherapy to kill them. Because chemotherapy circulates throughout the whole body, it tends to harm other body cells that also grow quickly. These include hair, mucous membranes in the mouth and blood cells in the bone marrow. These effects are not universal and should not make you worry so much. Some chemotherapy drugs may affect cells of major organs like heart kidney, bladder and lungs . These are rare and tend to occur with very high doses. Your doctor will mention these to you in case it is relevant and take all necessary precautions.

What do you need to remember about chemo side effects?

  • Not all patients experience chemotherapy side effects.
  • Some patients are sensitive and experience more effects than others.
  • Effects will vary with type of drugs and dose used.
  • Always report any effects to your doctor/nurse so that it can be treated before it worsens. We often adjust the dose of chemo.
  • Your doctor will give you additional medication to counteract majority of these effects if they occur.
  • Some drugs cause effects many years later. Your doctor will also arrange for regular checkups incase these are expected.
  • Be sure to talk to your doctor to elaborate which affects you are most likely to experience with your chemotherapy, when to expect them, how long they will last, how bad it may get and how to prevent or overcome them

Many times, you may have heard about a neighbor or relative who “suffered” throughout chemotherapy and experienced “very bad” side effects. Most of the time, this occurs because the treatment is not being monitored closely. Most patients’ usually “suffer” because of the cancer itself and not the chemotherapy. Constant communication with your doctor is key. Think of it as a relationship rather than just a one-time treatment. As much as it is okay to worry, you doctor is always there to allay your anxiety and explain what is happening. Fear of the unknown usually breeds stigma.

What are common side effects of chemotherapy?
Here are some of the more common side effects caused by chemotherapy. These are not listed in any particular order:

  • Hair loss (some types DO NOT cause hair loss)
  • Mouth sores
  • Infections
  • Blood clots
  • Low appetite
  • Body weakness
  • Skin & nail changes – darkening or peeling
  • Diarrhea or constipation
  • Easy bruising or bleeding
  • Forgetfulness & mood swings
  • Numbness & tingling
  • Headaches
  • Low sex drive or libido

Can I take vitamins & supplements with chemotherapy?
It is important to mention all the drugs you may be taking for other reasons like blood pressure & diabetes tablets, vitamin supplements, herbal remedies etc. Some drugs may interact with the chemotherapy and it is important for your doctor to know so that necessary adjustments are made. These interactions may make side effects worse and affect how well chemo drugs work. General vitamins and mineral supplements are allowed especially if your feeding is poor. But remember to seek clearance frim you doctor.

Can I use medical marijuana during chemotherapy?
No. As much as it is purported to have benefits in symptom management, medical marijuana is NOT LEGAL in Kenya so my advice is NOT to use it.

Can I have SEX during chemotherapy?
Yes, you can but there are certain precautions that need to be taken. These vary with cancer type and type of chemo. Always consult your doctor before you engage in any type of sexual activity.

What are the danger signs to look out for during chemotherapy?
Call you doctor/nurse or right away if you have any of the following symptoms during chemo treatment:

  • A fever > 38°C
  • Shortness of breath
  • Allergy itchiness, swelling of mouth throat
  • Bleeding , blood in stool or urine
  • Whole body rash
  • Mouth ulcers
  • Diarrhea more than 4 times a day
  • Pain or soreness at chemotherapy injection site or chemo-port
  • Severe headache
  • Severe nausea & vomiting
  • Fainting episode
  • Swelling of feet/legs

What are some tips to manage and cope some mild side effects in case I experience any & and do you have any general recommendations for someone undergoing chemo?
Remember to always report you side effects to your doctor. Here are some tips you can use to counter the effects as well as general recommendations during chemotherapy:

  • Talk to your doctor/nurse, family member or chemo buddy often to allay anxiety
  • Hydrate well up to 3L of liquids per day
  • Eat a healthy diet – well balanced
  • Avoid street snacks and undercooked foods
  • Keep away from the sick and overcrowded areas
  • Take an effort to look good and sexy, wear some makeup and get a wig or hat
  • Moisturize your skin
  • Eat small-sized meals more frequently
  • Avoid tobacco and alcohol
  • Use plastic cutlery
  • Try sugar free mints, gums. Licking lemons also helps with taste buds..
  • Use different flavors for you food like BBQ, mustard, rosemary, mayo, ketchup to increase your appetite.
  • Rinse your mouth with a baking soda, salt, and water mouthwash before eating to help foods taste better. (Mix 1 teaspoon salt and 1 teaspoon baking soda in 4 cups of water. Shake well before swishing and spitting.)
  • Try frozen fruits, smoothies or yoghurt
  • Eat fresh veggies and marinate your meats to make the tastier an tender. Yes meat !!, I said meat coz its allowed in moderation.

This guide is not exhaustive and may be missing some information. It only serves as a bridge to help you with your journey. For any clarification please consult your doctor as your situation maybe be different from another patients.

I hope this has helped make you your cancer journey easier. If you have any further questions you can message me (on my website www.drandrewodhiambo.com) or tweet me @odhis1.

Yours truly,

Dr. Andrew Odhiambo
Email: drandrewoncology@gmail.com
Twitter: @odhis1
FB Page: Dr. Andrew Odhiambo
Website: www.drandrewodhiambo.com


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