Chemotherapy : Protocol, drugs and side effects

Chemotherapy

Chemotherapy is one of the treatments for cancer. It uses drugs that are often injected intravenously.

There are several types of chemotherapy (adjuvant, palliative...) What is the difference with radiotherapy? What are the side effects of the drugs administered? How does the protocol work? What should one eat during treatment?

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Definition: What is chemotherapy?

Chemotherapy is the treatment of cancer with chemicals.

Therefore, it is based on the administration of drugs, which in most cases are associated with each other according to the location and stage of the cancer. This is called "combination chemotherapy.

"Chemotherapy is adapted to each patient according to the type of cancer in order to propose the appropriate treatment," explains Dr. Jean-Baptiste Méric, oncologist and director of the public health and care pole at the National Cancer Institute.

The goal is to eliminate the cancer cells or prevent them from proliferating, wherever they are in the body.

It can be used alone in combination with radiation therapy.

Types of chemotherapy: adjuvant, palliative...

There are different chemotherapies:

• Neoadjuvant chemotherapy: offered prior to surgery to reduce the size of the tumor, facilitate the operation and reduce the risk of recurrence.
• Adjuvant Chemotherapy: often proposed after surgery, it destroys the remaining cancer cells and reduces the risk of recurrence and metastasis.
• Palliative (i.e., non-curative) chemotherapy: is performed in the metastatic phase, when cancer cells have spread throughout the body. It treats cancer cells throughout the body.

Difference between chemotherapy and radiation therapy

Radiation therapy consists of sending ionizing radiation to the tumor to destroy the cancer cells.

"Unlike chemotherapy, radiotherapy is a locoregional treatment that aims to destroy cancer cells and preserve as much as possible the healthy tissues and surrounding organs, since it only targets small areas," explains our interviewee.

Protocol: how is it going?

The drug can be administered orally, that is, it is a medicine in the form of capsules or tablets to be ingested. But most often the drug product is injected intravenously.

The product is placed in a bag, connected to a catheter placed in the patient's vein. Injections can be made:

• In the hospital as an outpatient: the patient enters in the morning and leaves at the end of the day, once the infusion has been completed When chemotherapy is performed
• at home: a nurse goes to the patient's home to make an infusion.

"The duration of the infusion varies from one patient to another and can last from 30 minutes to a few days," says Dr. Meric. he number of sessions is prescribed by the physician.

Their number and pace vary from one to several dozen sessions, spaced from a few days to a few weeks apart.

The rest periods between each cycle allow the body to recover from the toxicity of the treatment.

Drug Vademecum

"There are dozens of chemotherapy drugs, all different in their effectiveness, side effects and indications.

They can be combined with each other or with drugs called targeted therapies or immunotherapies," the oncologist says. For example, this can be: cyclophosphamide, docetaxel, epirubicin...

Efficiency

"When chemotherapy is carried out as an adjuvant treatment, that is, as an adjunct to surgery, its long-term effectiveness is measured by the absence of recurrence.

It is not possible, at the time of chemotherapy, to know if it has played its role in preventing relapse.

The decision to perform chemotherapy is made based on the results already observed in patients with the same disease," says Dr. Méric.

When chemotherapy is palliative (in a situation where chemotherapy cannot produce a cure), the effects of the treatment can be evaluated by measuring the metastases that the chemotherapy is intended to reduce or even eliminate.

These measurements are made regularly, at intervals of a few weeks or months, using imaging techniques (CT scan, MRI).

Depending on the results, the chemotherapy is either continued, adapted or stopped.

Maximum duration

The duration of chemotherapy varies greatly. It can last from 2 to 3 months to several years.

Side effects

Chemotherapy can cause many side effects:

• A drop in white blood cells that leads to a decrease in the immune system. This can be complicated by an infection, diagnosed by a fever over 38 degrees. This requires antibiotics urgently. Fortunately, this serious side effect is rare.
• Nausea and vomiting
• The presence of mouth ulcers and/or inflammation of the mouth
• Diarrhea or Constipation
• Hair loss
• Abnormal and intense fatigue

While these effects are common, they are not systematic. Doctors have therapeutic solutions to limit or even avoid them. Do not hesitate to talk to the medical team that follows you.

Diet and Chemotherapy

During the chemotherapy treatment period, a diet as balanced as possible is recommended to limit the side effects of the treatment (traffic disorders, reduced immunity, fatigue...).

• Add fruits and vegetables, cereals and especially proteins to your menu, as sometimes appetite is lacking during treatment. This nutrient, found in eggs, dairy products, fish, meat, cereals and legumes, will help you maintain your muscle mass.
• Divide food intake to avoid nausea or vomiting.
• Encourage foods with a neutral taste (dairy, fertilizer, pasta, rice...) and avoid foods that are too acidic or require excessive chewing, if you have difficulty swallowing, which can happen after chemotherapy.
• Eat lightly to reduce the risk of nausea and vomiting, especially on the eve of chemotherapy.
• Avoid fasting, which "can lead to a worsening of malnutrition in cancer patients. Patients who wish to follow a restrictive diet are strongly recommended to talk to the medical team," Dr. Méric recommends.

Thanks to Dr. Jean-Baptiste Méric, oncologist and director of the Division of Public Health and Healthcare at the National Cancer Institute.

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