Monday, September 28, 2015

Avoid Chemotherapy and Radiation! (Part 3)

The Side Effects of Chemotherapy on the Body (see chart)
Cancer cells divide more quickly than healthy cells, and chemotherapy drugs effectively target those cells. Unfortunately, fast-growing cells that are healthy can be damaged too. There are many different chemotherapy drugs with the potential for many different side effects. These effects vary from person to person and from treatment to treatment. Factors that play a role in side effects include other ongoing treatments, previous health issues, age, and lifestyle. Some patients experience few side effects while others feel quite ill. Although most side effects clear up shortly after treatment ends, some may continue well after chemotherapy has ended, and some may never go away. Chemotherapy drugs are most likely to affect cells in the digestive tract, hair follicles, bone marrow, mouth, and reproductive system. However, cells in any part of the body may be damaged.
Circulatory and Immune Systems
Routine blood count monitoring is a crucial part of chemotherapy. That’s because the drugs can harm cells in the bone marrow, where blood is produced. This can result in several problems. Red blood cells carry oxygen to tissues. Anemia occurs when your body doesn’t produce enough red blood cells, making you feel extremely fatigued. Other symptoms of anemia include: lightheadedness, pale skin, difficulty thinking, feeling cold, general weakness. Chemo can lower your white blood cell count, which results in neutropenia. White blood cells play an important role in the immune system: they help fight infection and ward off illness. Symptoms aren’t always obvious, but a low white blood cell count raises the risk of infection and illness. People with an immune system weakened by chemotherapy must take precautions to avoid exposure to viruses, bacteria, and other germs. Cells called platelets help the blood clot. A low platelet count, called thrombocytopenia, means you’re likely to bruise and bleed easily. Symptoms include nosebleeds, blood in vomit or stools, and heavier-than-normal menstruation. Some chemo drugs can weaken the heart muscle, resulting in cardiomyopathy, or disturb the heart rhythm, causing arrhythmia. This can affect the heart’s ability to pump blood effectively. Some chemo drugs can increase the risk of heart attack. These problems are less likely to occur if your heart is strong and healthy at the start of chemotherapy.
Nervous and Muscular Systems
The central nervous system controls emotions, thought patterns, and coordination. Chemotherapy drugs may cause problems with memory, or make it difficult to concentrate or think clearly. This symptom sometimes is called “chemo fog,” or “chemo brain.” This mild cognitive impairment may go away following treatment, or may linger for years. Severe cases can add to anxiety and stress. Some chemo drugs can cause pain, weakness, numbness, or tingling in the hands and feet (peripheral neuropathy). Muscles may feel tired, achy, or shaky. Reflexes and small motor skills may be slowed. It’s not unusual to experience problems with balance and coordination.
Digestive System
Some of the most common side effects of chemotherapy involve the digestive tract. Mouth sores and dry mouth can make it difficult to chew and swallow. Sores also may form on the tongue, lips, gums, or in the throat. Mouth sores can make you more susceptible to bleeding and infection. Many patients complain of a metallic taste in the mouth, or a yellow or white coating on the tongue. Food may taste unusual or unpleasant. These powerful drugs can harm cells along the gastrointestinal tract. Nausea is a common symptom, and may result in bouts of vomiting. However, anti-nausea medications given in conjunction with chemotherapy drugs can help alleviate this symptom. Other digestive issues include loose stools or diarrhea. In some people, hard stools and constipation can be a problem. This may be accompanied by pressure, bloating, and gas. Take care to avoid dehydration by drinking plenty of water throughout the day. Side effects involving the digestive system can contribute to loss of appetite and feeling full even though you haven’t eaten much. Weight loss and general weakness are common. Despite all this, it’s important to continue eating healthy foods.
Hair, Skin, and Nails (Integumentary System)
Many chemotherapy drugs affect the hair follicles and can cause hair loss (alopecia) within a few weeks of the first treatment. Hair loss can occur on the head, eyebrows, eyelashes, and body. As troubling as it can be, hair loss is temporary. New hair growth usually begins several weeks after the final treatment. Some patients experience minor skin irritations like dryness, itchiness, and rash. You may develop sensitivity to the sun, making it easier to burn. Your doctor can recommend topical ointments to soothe irritated skin. Fingernails and toenails may turn brown or yellow, and become ridged or brittle. Nail growth may slow down, and nails may crack or break easily. In severe cases, they can actually separate from the nail bed. It’s important to take good care of your nails to avoid infection.
Sexual and Reproductive System
Chemotherapy drugs can have an effect on your hormones. In women, hormonal changes can bring on hot flashes, irregular periods, or sudden onset of menopause. They may become temporarily or permanently infertile. Women on chemotherapy may experience dryness of vaginal tissues that can make intercourse uncomfortable or painful. The chance of developing vaginal infections is increased. Chemotherapy drugs given during pregnancy can cause birth defects. In men, some chemo drugs can harm sperm or lower sperm count, and temporary or permanent infertility is possible. Symptoms like fatigue, anxiety, and hormonal fluctuations may interfere with sex drive in both men and women. So can worrying about loss of hair and other changes in appearance. However, many people on chemotherapy continue to enjoy an intimate relationship and an active sex life.
Kidneys and Bladder (Excretory System)
The kidneys work to excrete the powerful chemotherapy drugs as they move through your body. In the process, some kidney and bladder cells can become irritated or damaged. Symptoms of kidney damage include decreased urination, swelling of the hands and feet (edema), and headache. Symptoms of bladder irritation include a feeling of burning when urinating and increased urinary frequency. You’ll be advised to drink plenty of fluids to flush the medication from your system and to keep your system functioning properly. Note: Some medications cause urine to turn red or orange for a few days. This isn’t cause for concern.
Skeletal System
Most people—and especially women—lose some bone mass as they age. Some chemotherapy drugs can cause calcium levels to drop and contribute to bone loss. This can lead to cancer-related osteoporosis, especially in post-menopausal women and those whose menopause was brought on suddenly due to chemotherapy. According to the National Institutes of Health (NIH), women who have been treated for breast cancer are at increased risk for osteoporosis and bone fracture. This is due to the combination of the drugs and the drop in estrogen levels. Osteoporosis increases the risk of bone fractures and breaks. The most common areas of the body to suffer breaks are the spine and pelvis, hips, and wrists.
Psychological and Emotional Toll
Living with cancer and dealing with chemotherapy can exact an emotional toll. You may feel fearful, stressed, or anxious about your appearance and your health. Some people may suffer from depression. Juggling work, financial, and family responsibilities while undergoing cancer treatment can become overwhelming. Many cancer patents turn to complementary therapies like massage and meditation for relaxation and relief. If you have trouble coping, mention it to your doctor. They may be able to suggest a local cancer support group where you can speak with others who are undergoing cancer treatment. If feelings of depression persist, professional counseling may be necessary.
Multi-gene test enables some breast cancer patients to safely avoid chemotherapy
Date: September 28, 2015
Source: Loyola University Health System
The best evidence to date has been provided that suggests that a 21-gene test done on the tumor can identify breast cancer patients who can safely avoid chemotherapy.
A major study published in the New England Journal of Medicine is providing the best evidence to date that a 21-gene test done on the tumor can identify breast cancer patients who can safely avoid chemotherapy.
Oncologist Kathy Albain, MD, FACP, FASCO of Loyola University Medical Center and Loyola University Chicago Stritch School of Medicine is among the main co-authors of the international multicenter trial. Dr. Albain also is a member of the trial's steering committee.
The test examines 21 genes from a tumor sample to determine how active the genes are. The tumor then is assigned a score between 0 and 100; the lower the score, the lower the chance the cancer will recur in distant organs if treated with only a pill such as tamoxifen. In previous studies involving fewer patients, a low score also suggested that chemotherapy does not work well and does not add to the survival benefit of tamoxifen.
The clinical trial enrolled 10,253 women, including 41 at Loyola, who had a certain type of breast cancer (hormone-receptor positive, HER2 negative) that had not spread to lymph nodes. Although the lymph nodes were not involved, the tumors had other features that indicated chemotherapy should be given, followed by tamoxifen or other endocrine therapy pills.
In the trial, women whose tumors scored 10 or lower on the 21-gene test received standard hormone therapy such as tamoxifen, but did not undergo chemotherapy. After five years of being followed closely, there was a less than a 2 percent risk the cancer had spread to nearby or distant sites. The five-year overall patient survival was 98 percent.
These findings, researchers concluded, provide the highest level of evidence that the multigene test can spare the use of chemotherapy in women with low-scoring tumors who otherwise would receive chemotherapy. "This should provide a lot of reassurance to women and their physicians," Dr. Albain said. "In women whose breast cancer scored low on the multigene test, there was outstanding survival with endocrine therapy alone. The test provides us with greater certainty of who can safely avoid chemotherapy."
In the trial, 15.9 percent of the women had a multigene test score of 10 or lower. An additional 68 percent had a mid-range score of 11 to 25. These women were randomly assigned to receive either hormone therapy plus chemotherapy or hormone therapy alone. Continued follow-up still will be needed to determine whether any women in this larger group, with tumors in the intermediate-score range, can safely forgo chemotherapy.

Story Source:
The above post is reprinted from materials provided by Loyola University Health System. Note: Materials may be edited for content and length.

Journal Reference:
  1. Joseph A. Sparano, Robert J. Gray, Della F. Makower, Kathleen I. Pritchard, Kathy S. Albain, Daniel F. Hayes, Charles E. Geyer, Elizabeth C. Dees, Edith A. Perez, John A. Olson, JoAnne Zujewski, Tracy Lively, Sunil S. Badve, Thomas J. Saphner, Lynne I. Wagner, Timothy J. Whelan, Matthew J. Ellis, Soonmyung Paik, William C. Wood, Peter Ravdin, Maccon M. Keane, Henry L. Gomez Moreno, Pavan S. Reddy, Timothy F. Goggins, Ingrid A. Mayer, Adam M. Brufsky, Deborah L. Toppmeyer, Virginia G. Kaklamani, James N. Atkins, Jeffrey L. Berenberg, George W. Sledge. Prospective Validation of a 21-Gene Expression Assay in Breast Cancer. New England Journal of Medicine, 2015; 150927220039001 DOI: 10.1056/NEJMoa1510764
Most Doctors who were terminally ill would AVOID aggressive treatments such as chemotherapy - despite recommending it to their patients
  • 88% of doctors would choose 'do not resuscitate' orders for themselves
  • However, most pursue aggressive, life-prolonging treatments for patients
  • This could be because the medical system rewards doctors for taking action
  • The researchers say there is a 'tipping point' where the high-intensity treatment becomes more of a burden than the disease itself

Most doctors would turn down aggressive treatment if they were terminally ill, new research has found. Dr Kate Granger (pictured), who has terminal cancer, has talked about choosing to stop having chemotherapy
Most doctors would turn down the option of aggressive treatment if they were terminally ill, a study has found.
They say they would opt for a 'do not resuscitate’ approach should they find themselves on the receiving end of medical treatment.
Yet they tend to pursue aggressive, life-prolonging treatment for patients facing the same prognosis, Stanford University School of Medicine found.
However, studies found many patients would prefer to die at home without life-prolonging interventions but are often ignored.
The study, published in the journal PLOS ONE, found 88.3 per cent of doctors would choose ‘do not resuscitate’ orders for themselves and argued the reason behind this disparity and how patients are treated needed to be better understood.
Clinical associate professor of medicine Dr VJ Periyakoil said: ‘Why do we physicians choose to pursue such aggressive treatment for our patients when we wouldn't choose it for ourselves? The reasons likely are multifaceted and complex.’
As a geriatrics doctor she understands the difference between the type of care doctors want for themselves at the end of life and what they actually do for their patients.
She argued it was not down to doctors trying to make more money or because they are intentionally insensitive to their patients' desires.
At the core of the problem, she believes, is a medical system that rewards doctors for taking action, not for talking with their patients.
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The end of chemotherapy?
Elizabeth Payne, Ottawa Citizen
Published on: May 22, 2014
After she was diagnosed with breast cancer, Terry Smith kept working — and except for two weeks of sick leave she stayed in relatively good health. One reason the Ottawa woman did so well, despite surgery and radiation treatments, is that she was able to avoid chemotherapy and its side-effects.
“It was wonderful,” she said. “It would have really affected everything, including my health and my job.”
Her story is becoming more common as new research and diagnostic tools improve doctors’ understanding of what works and what doesn’t when it comes to treating cancer. Often that means patients who would have had chemotherapy in the past can now avoid it.
Is this the beginning of the end of chemotherapy? Oncologists say there will always be a role for the treatment, but for many cancer patients, the answer is yes.
The ability to get the same outcomes with less chemotherapy is the biggest recent development in breast cancer treatment, says medical oncologist Dr. Mark Clemons, a clinical investigator of cancer therapeutics at The Ottawa Hospital Research Institute. The trend is being cheered by doctors and patients.
“The vast majority of women, when they see they are going to get minimal benefit from chemo, say, ‘No thanks,’ and I don’t blame them at all,” he said. “Giving chemotherapy is terrible.”
While so-called personalized medicine is still in the early stages, some treatment can be tailored to individual patients rather than being a one-size-fits-all model that, for decades, relied heavily on chemotherapy.
This less-is-more movement regarding chemotherapy is also informing research and treatment guidelines. National American guidelines now call for doctors to monitor older men with slow-growing prostate cancer, rather than administering chemotherapy. A 2011 study in the journal Therapeutic Advances Medical Oncology looking at chemotherapy and colorectal cancer noted: “We treat many patients without benefit, either because their cancer does not respond or because it has already been cured surgically.”
There is no question chemotherapy has saved and extended countless lives since it came into standard use and is a major reason survival rates have improved so dramatically for many cancers. But it takes a huge toll on patients.


Designed to kill fast-growing cancer cells, chemotherapy also attacks other cells, and the hair. Baldness is the most visible side-effect, but it is just one of them. It also kills cells in the lining of the intestines, for example, and cells in patients’ ovaries, rendering them infertile, which can magnify an already traumatic experience.
The treatment has also often been used with no real benefit. One estimate suggests that as many as 85 per cent of patients with the most common form of breast cancer — estrogen-positive and lymph node-negative — received unnecessary chemotherapy over the years.
Now, doctors are getting better at determining whether chemotherapy will actually benefit a patient and by how much, which helps patients decide whether it is worth it.
Dr. Angel Arnaout, a surgical oncologist at The Ottawa Hospital and a clinical investigator of cancer therapeutics at The Ottawa Hospital Research Institute, is studying the early use of hormone-blocking agents and more targeted treatments for breast cancer.
There is still a certain amount of estimation, using factors such as a patient’s age and the size of their tumour, when it comes to determining how effective chemotherapy would be. Arnaout’s research aims to take some of the guesswork out of that.
It involves administering anti-estrogen medication to breast cancer patients whose tumours are hormone sensitive (fed by hormones), immediately after diagnosis. The majority of breast cancer tumours fit this category. Traditionally, patients would be given this treatment in addition to chemotherapy, radiation and surgery. Arnaout’s research should help doctors better figure out whether the anti-estrogen therapy alone is sufficient so that chemotherapy can potentially be avoided.
“It makes sense that if you want to subject someone to six months of really difficult treatment, a lot of which has side-effects, you should at least figure out whether it will truly work and that there is no other less toxic alternative treatment, such as anti-hormonal therapy,” said Arnaout.
Clemons said mathematical modelling is helping more patients make informed decisions about chemotherapy but Arnaout’s work is “taking this to the next level. I think this is where the future really lies.”
“Being diagnosed with cancer is terrifying,” he said. “Sitting with a patient in my clinic who is convinced she is going to need chemotherapy, and I am saying to her the benefits are so small it’s not worth it, then when I see her smile and this relief come across her face … you know you are doing your job well.”
Smith was involved in Arnaout’s initial trial, which administered hormone blockers to patients as soon as they were diagnosed. Her findings were positive — in 49 per cent of patients, tumours were significantly suppressed or stopped growing within weeks, which suggests those patients would not need chemotherapy. Arnaout is due to begin a bigger trial later this year comparing patients who receive chemotherapy and hormone blocking therapy with those who simply received hormone blocking therapy.
Not only are the implications for avoiding chemotherapy positive, but, Arnaout said, patients were happy to begin any treatment immediately rather than waiting weeks.
“It was really good to feel that you were doing something in those three weeks (before surgery),” said Smith.
Arnaout said that in the future she hopes oncologists will have enough information about the genetic makeup of individual tumours and how they respond to hormone blockers that they will not even offer chemotherapy as an option.
“I think it is unfair to ask the patients to choose when they are in an anxious and confused state,” she said.
The medical world is already getting far better at using chemotherapy only when needed, says Clemons.
“Nobody in their right mind would want to do chemotherapy, but when you see the benefits are very real it makes the toxicity far more palatable.”
In 1990, Clemons said, a guideline went out in the United States saying that “there is no group of patients who do not benefit from chemotherapy.”
Over the years, he said, many oncologists “cursed that guideline because it probably led to such wide use of chemotherapy and probably many people were hurt.”
Arnaout calls the use of chemotherapy without knowing whether it is doing any good “the old way of doing things.
“The problem is that chemotherapy is not innocent. It is toxic and hard on the patients for a very long time.”
Chemo by the numbers
85: Percentage of breast cancer patients who were treated with traditional chemotherapy a decade ago, according to Ottawa medical oncologist Dr. Mark Clemons
50: Percentage of breast cancer patients who are treated with traditional chemotherapy today
80: Percentage of patients with estrogen-positive, lymph-node negative breast cancer — the most common type — believed to have received unnecessary chemotherapy treatments over the past 20 years
0: The number of cancer patients a 1990 U.S. directive said would not benefit from chemotherapy.
49: Percentage of patients in a trial conducted by Ottawa cancer researcher Dr. Angel Arnaout whose tumours responded so well to anti-hormonal therapy that they did not require chemotherapy
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