by Paromita Pain
Susan Mai did not want to die. When she was diagnosed with breast cancer and her doctor prescribed a course of chemotherapy, she knew it was the most that could be done. The very words “cancer” and “chemotherapy” evoke images of sufferers with empty eyes staring out of hollowed faces marked by the havoc of the illness haunt. Yet the experience caused Susan to become a stronger individual. “Of course it’s scary,” Mai says, “but there’s more to it than hair loss or the fact that you can emerge looking very different from the way you went in.”
For me, like most women of my generation, the word cancer is synonymous with chemotherapy. While I feverishly research ways to detect and prevent cancer, I have rarely explored the idea of chemotherapy. The idea of prevention is so strong that it overpowers our understanding of treatment options. It was while working on my previous story on inflammatory breast cancer that chemotherapy as a treatment option took on a whole new meaning.
Historically, the term chemotherapy literally means “treating by chemicals.” Developed during the 1940s, enemy combatants were gassed with the earliest developed drugs, which killed by dangerously reducing white blood cells in the bodies of the exposed victims. They were later used effectively in treating lymphoma – cancer in the lymphatic cells of the immune system. Today the development of cancer drugs is a billion dollar industry.
Chemotherapy involves combinations of drugs – taxol and carboplatin among the most common – that are effective poisons against cancer cells. “Chemo” is also used to increase the efficiency of radiotherapy or surgery.
It is hard to understand how a poison can “cure” and increase the efficacy of treatment, but Dr. Pollack, Director of Medical Oncology at CTCA at Southwestern Regional Medical Center, puts it in perspective. “Chemo in the classic sense kills all cells whether cancerous or otherwise indiscriminately and administered intravenously goes wherever blood in the body goes,” he explains. This means chemo can reach the liver, the lungs, kidneys, and even the most remotely accessible parts of the body with ease. Chemo can even go through the bone to destroy the tiniest clusters of cancer colonies, which can go undetected by tests. Its reach within the body gives it an undeniable edge over surgery and radiation. But as doctors like Pollack, who has been in the field nearly 30 years, say, while the benefits of chemotherapy are many, the side effects can be harsh.
Meeting Nona Walia (54) really brought home just how harsh the side effects can be. Walking into her room at the MD Anderson Cancer Center, where she was being treated, I could hardly believe that the frail woman, who was almost as white as the sheet under her chin, was able to speak. She reassured me that she was happy I had come. Nona’s chemo treatment for breast cancer left her with a severely compromised immune system. Her road to recovery meant battling pneumonia and racking coughs. “I woke up one day with blood on my sheets,” she says. “I cannot explain how scared I was.” Her doctor stopped her chemo for a while in order to treat her pneumonia, then resumed her sessions.
The second time around, Nona was able to deal with it much better. “Make sure people, especially women, understand that while chemo may seem the most awful thing ever, it actually strengthens the body to fight better,” she said, her grip on my hand strong and steady.
Explaining chemo’s effect on Nona, Dr. Pollack says, “Chemotherapy hurts the immune system by lowering the number of white blood cells produced in the body, which is essential in preventing and fighting infections. Chemo tends to lower the number of these cells because it destroys any cell in the body that grows quickly. These include cancer cells, as well as the rapidly growing healthy cells in hair, the digestive system, and bone marrow – where blood cells are produced.”
The longer chemo is administered, the more white blood cells die, leaving patients susceptible to various infections, ranging from coughs and colds to pneumonia. As Dr. Sramila Aithal says, “Chemo dosages are an important aspect of treatment. Too little might prove ineffective. Too much might compromise a patient’s immune system beyond repair. Treatment is highly individualized here.”
That is why doctors insist that patients monitor their conditions. Even a 101 degree fever can be a sign of danger. “If a patient wakes up with bruises…after chemo then it’s an obvious sign that platelets that help blood clot have gone down to dangerous levels,” says Dr. Pollack.
Chemo can be fatal, and there is a very fine line between its therapeutic benefits and its dangers. This was an idea I found hard to understand. After all isn’t all treatment meant to cure? Dr. Aithal corrected this idea. “Patients might not die from chemo directly but the side effects and diseases the body becomes susceptible to after being given chemo can certainly cause death,” she said.
But depending on the dosage and types of drugs used, the side effects might be more manageable. Dr. Pollack says, “Certain chemo drugs like Rituxan have very few side effects and are very effective in killing abnormal cells. Rituxan is very effective in breast cancer treatment and has little consequences like hair loss and nausea. New drugs like Bendamustine or old ones like Treanda are effective and cause very little nausea or vomiting.”
Considering the fallouts of chemo treatment, future research will work to reduce dependence on traditional chemo for at least some forms of cancer. Sara Sukumar, co-director of the Breast Cancer Program at the Sidney Kimmel Comprehensive Cancer Center, John Hopkins, is refining a biomarker-based test that she hopes will someday help the nearly 25,000 women diagnosed with estrogen receptor–negative breast cancer each year. Estrogen receptor–negative cancers do not respond well to traditional chemotherapy.
“The goal is to identify patients who can try out new modalities as a first-line therapy instead of going through treatment that will never help them,” says Dr. Sukumar. New modalities involve treatments like photodynamic therapy – using complex compounds of chemicals and light – and more refined surgery procedures that help remove all cancerous cells without chemo and radiation procedures.
For now, some hospitals use naturopathic physicians as an integral part of treatment to help patients cope better. A certain maitake mushroom, sold under the brand name "Maitake,” helps some patients to produce white cells and platelets in place of drugs that cost thousands of dollars. But as Dr. Pollack warns, “Often patients by mistake make choices that actually assist in cancer growth. For example, folic acid in unregulated doses in people with predisposition to cancer can promote the growth of tumors.”
As a woman, I had questions about the effects chemo might have on our complex systems. Dr. Pollack says, “Chemo doesn’t make women infertile. Women may enter temporary menopause due to chemo but they may also come out of it years later.”
But chemo’s complexities do not just end with its action in the body. Financing a chemo treatment can be complicated, Sheetal Desai, an expert in managed-care health care plans and Director of Clinical Authorization Center at USC Norris Cancer Hospital, tells me. “Call your insurance provider to understand if cancer is covered and how comprehensively,” Desai recommends. “Often, insurance companies deny payment because they feel that the chemo drug being administered isn’t effective.”
I discovered that understanding the concept of chemo can be empowering. Dr. Pollack seconded my thoughts and summed it up well: “It’s true that cancer affects more than a million people in the United States every year. The numbers don’t lie. But more people make it alive and well than not. Can you really tell by looking at people whether they have had radiation or chemo? Even the woman across from you in the grocery aisle might be a survivor. You are more in control than you know. Read, learn, and ask questions. Seek knowledge. Stay strong.”
You can read Paromita's previous article on Inflammatory Breast Cancer here.
About the author: Paromita Pain has been a senior reporter and writer for The Hindu National Newspaper, India, and has worked with several other media projects specializing in health, development and social journalism as well as writing for young people. A recent graduate from the Annenberg School of Journalism at the University of Southern California, her reporting focuses on health, human rights, and prison systems in the United States.