Chemotherapy in practice

Cytostatic drugs are the most frequently administered in form of intravenous injections and per os, rarely intramuscular or subcutaneous injections are used. Intravenous drugs administration is performed by drip or central catheter inserted to vein localised within chest. Catheter enables to administer next cycles of drugs without necessity of intravenous insertion. More and more frequently cytostatic drugs are administered with the help of infusion pump, which can be used by patient in hospital or in home.

Taking antineoplastic drugs does not have to connect with long staying in hospital - repeatedly chemotherapy can be administered in conditions of daily staying in hospital that is few-hour visit.

Chemotherapy is used in the following courses, where each may last from few hours to few days. Patient obtains dose of drugs, afterwards a few-week period of break follows. This time of "rest" is to enable the regression or reduction of side effects of administered cytostatics and the precise evaluation of efficiency of treatment. Before the beginning of each course, patient undergoes tests (of blood, X-ray, ultrasonographic, isotope examination).

Duration for the whole course, number and frequency of the following courses of drugs administration depends on few factors: type of tumour, type of drugs and their effectiveness and grade of intensiveness of side effects. During the therapy doctor can change primary plan of treatment, if i.e. he decide, that earlier proposed drugs are not effective.

Effectiveness of treatment with cytostatic agents

Tumours show different sensitivity on treatment with chemotherapy. They can be divided into 3 groups:

• group 1 - tumours, in which the chemotherapy used independently or in combination with other methods brings significant improvement of treatment results, i.a.: breast cancer, cancer of large intestine, germinal tumours, trophoblastic disease, Kaposi sarcoma, small cell lung cancer, Hodgkin and non-Hodgkin lymphomas, osteosarcoma, ovarian cancer, acute lymphatic and non-lymphatic leukaemia, Ewing sarcoma, neuroblastoma (under 2nd life year), retinoblastoma, Wilms tumour;
• group 2 - tumours which chemotherapy does not lead to recovery, but only to improve the quality of life and its prolongation, i.a.: rectal cancer, bladder cancer, endometrial cancer, prostatic cancer, esophageal cancer, tumours of nasopharynx, head and neck tumours, soft tissues sarcomas, neuroblastoma (over 2nd life year), central nervous system tumours;
• group 3 - tumours, which chemotherapy has not influence on the course of disease, i.a.: renal cancer, non-small cell lung cancer, thyroid gland cancer.

Side effects of chemotherapy

For a several years ago the administration of cytostatic drugs was inseparably connected with occurrence of many side effects. New generations of drugs cause less side effects, and side effects of chemotherapy are not a rule anymore - some patients feel them in minimal degree. Majority of side effects is reversible - resolves after end of treatment or even during its duration.

Infertility

One of the most difficult to accept by patients the side effect is risk of infertility. Infertility, as a result of chemotherapy can be permanent or temporary. In 30% of women treated with cytostatics after the end of therapy function of ovaries and regular menstruation return. However some cytostatic drugs cause permanent destruction of ovaries. Women who take chemotherapy, in who blockage of egg cells production is not observed yet and partners of men with tumours treated pharmacologically, should use contraceptive agents. Cytostatic drugs may lead to foetus damage.

Administration of cytostatics in men frequently causes decreased number of sperm cells in semen. Similarly to women, infertility can be permanent or temporary. Before the beginning of chemotherapy it is worth to consider possibility of storing healthy semen in sperm bank.

In some women taking cytostatics, accelerated symptoms of menopause are observed - lack or irregularity of menstruation, hot flushes, dryness sensation in vagina, decrease of libido. In some cases these ailments can be alleviated by hormonal therapy.

Ailments of gastrointestinal track

Not all cytostatic drugs cause gastric ailments. However many patients complain about nausea and vomiting. Ailments appear from several minutes to few hours from the moment of drugs administration and last usually to few-several hours. They can be alleviated by antiemetic drugs.

Other symptom is lack of appetite, what results from taste disturbances and sometimes is a result of nausea. Because majority of cytostatic drugs has unfavourable influence on mucous of digestive track, one of the side effects can be diarrhoeas as well. Doctor should be informed about each symptom.

Changes in bone marrow

Bone marrow, which quickly reacts on chemotherapy, is responsible for formation of different types of blood cells. As a result of negative action of cytostatic drugs on bone marrow anaemia may occur that is a decrease of number of red blood cells in blood. Low level of haemoglobin is responsible for feeling of weakness, drowsiness, sometimes as a result of insufficient tissues oxygenation, dyspnoea too. Anaemia can be treated pharmacologically or by blood transfusion.

Other symptom can be a decrease of white blood cells, what causes higher susceptibility of patient to infections. Decrease of platelets may occur, what decreases blood coagulability. Bruises easily appear on skin; even small wounds may bleed abundantly. In case of small level of platelets, preparation containing platelets is transfused to patient.

During chemotherapy blood parameters are often monitored, so then doctor can quickly implement supportive treatment.

Hair loss and changes on skin

Hair loss is one of the most frequently observed side effects of chemotherapy. The result of using the majority of cytostatics is destruction and hair loss not only on head, but also on the whole body. Hopefully, hairs grow back after the end of the treatment almost in each case.

In some patients taking chemotherapy changes on skin are observed – skin may be exceedingly dry, small decolourations and hyperpigmentations appear. Skin becomes sensitive on sun rays, cosmetic preparations should be used for its protection.

Undesirable symptom can be a presence of spots on nails and slower pace of their growth.

Ailments of oral cavity

Taking of some cytostatic drugs may lead to occurrence of irritations and even ulcerations in oral cavity. These changes disappear after about 3 weeks from their administration.

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