Thursday, March 12, 2009

Adjuvant therapy

How is adjuvant therapy given? It can be either via oral pathway or by injection. Both routes allow the drugs to enter the body systemically, hitting cancer cells that may be spread throughout tissues and organs. Typically, chemotherapy must be administered on a schedule of treatment and then rest, during which the patient can recover from the effects. The schedule cycle occurs on the order of days, so for a few days the patient may rest, and take drug on one day, then continue to rest for a few more days.

The adjuvant therapy can be quite grueling due to the tremendous toll on the body from side-effects of chemotherapy damaging all the cells of the body not just the cancer cells. During this time, cancer patients may suffer from hair loss, anemia, weight loss, nausea and vomiting in addition to other side effects. Adjuvant treatment may last for several months until a positive outcome is observed. To deal with the effects of adjuvant therapy, some patients also fast every two days, a procedure that seems to counteract the debilitating side effects.

In addition to physical side effects, chemotherapy also seems to cause mental ones. Patients often experience a "cloud" effect on memory, with declining ability to remember episodes during treatment. Although there is no hard science to prove this effect, it is widespread enough that it has come to be known by a unique and somewhat macabre name: "chemobrain". Under chemobrain, patients have decreased ability to recall, focus, and do complex multitasking tasks. The unfortunate patient variable is that some patients have only short term memory problems while others never seem to fully recover from the mental damage done by adjuvant therapy drugs. This area is undergoing research, and some think it's related to the cancer itself. Further confounding the symptoms is the fact that some of the anti-nausea drugs may also interfere with thinking, or the fact that many patients tend to be older so are more likely to suffer some memory impairment. But basically if you're undergoing adjuvant therapy and you're noticing strange, small mental or psychological changes, it may very well be a real effect and not to be dismissed lightly. Plan your daily activities accordingly to reflect this state of mental alteration. Don't do important or complex tasks, but defer them to another day. Not only might you be too weak after treatment, but you may not be in the right frame of mind to deal with it. Take a proactive stance by using a data planner (electronic or book form) to meticulously schedule events and follow it. Use your spare time to exercise your mind, keeping it focused with active reading, and puzzle solving like crosswords or Sudoku.

According to American Cancer Society (ACS), the symptom of chemobrain seems to occur in 20-30% of patients, a rather high number, and irrespective of whether the patient is a man or woman.

Similarly, tamoxifen hormonal therapy targeting ER-positive breast cancers must be a systemic treatment. Clinical studies dictate that a five year period of tamoxifen provides protective effects against recuring cancers.

Another type of therapy for patients suffering from cancer is radiation therapy which involves using high power ionizing radiation focused on localized tumors to kill them. Radiation can penetrate skin, and if several beams are focused on one spot, there is minimal damage to the respective paths to tissue, but at the focused spot there is a lot of energy to kill cancer cells. It is not only the fact that cells succumb to radiation, but that radiation selectively targets cancer cells in the same way as chemotherapy selects out fast dividing cells. Radiation has the effect of damaging DNA, which for replicating cells like those in the tumor is vital. In other normal cells, damage to DNA is quickly repaired. But in cells that are dividing, the repair mechanism on top of the cell splitting into two makes it much easier for radiation to be damaging. There is also total body irradiation, which is used for destruction of bone marrow in preparation for a patient to receive bone marrow. The source of leukemic cells in patients with leukemia is bone marrow which produce malignant blood cancer cells, and therefore warrants its destruction via radiation. Ironically, radiation is also known to cause cancer to some low probability extent. In cases of cancer, the benefits completely outweigh the risks.

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