21.How can family members cooperate with patients during chemotherapy?
Since chemotherapy drugs have unique adverse effects, the cooperation of family members during chemotherapy plays an active role in the treatment and recovery of chemotherapy patients.
First of all, family members should understand the patient’s condition and psychological state, encourage the patient to overcome the disease, eliminate or reduce the patient’s nervousness, which is conducive to reducing the adverse effects of chemotherapy.
Second, family members should understand the common adverse reactions of chemotherapy drugs used. Many chemotherapeutic drugs can cause local redness and swelling when leaking outside the blood vessels during intravenous injection, and in serious cases, erosion, necrosis, and pain to the patient, especially NVB, HN, and ADM are the most obvious, so families should closely observe the site of infusion, find local swelling, leakage and other phenomena, and promptly respond to the medical staff. In addition, gastrointestinal reactions, such as anorexia, nausea, vomiting, diarrhea, etc., are common adverse reactions to chemotherapy. Families should observe the amount, color and frequency of vomiting and stool, pour out the vomit and excrement in time, and keep records. Families should also record the 24-hour urine volume of patients treated with cisplatin chemotherapy to prevent and treat renal damage from cisplatin. Bone marrow suppression is also the most common adverse effect of chemotherapy, especially the decrease in white blood cell count is common. At this time, family members should keep the room clean; irradiate the room with ultraviolet light regularly, and cover the patient’s eyes with a handkerchief when irradiating; keep the patient’s bed sheets and clothes clean and dry; and trim the patient’s nails frequently. Wen Bingji, Department of Medical Oncology, 113th Hospital of the Chinese People’s Liberation Army, should also help the family in life, such as making a diversified diet with good color, aroma and taste to induce the patient to eat. Long-term use of hormone can make patients have osteoporosis, so family members should pay attention to avoid fractures caused by their falls.
22.How do tumor patients treat the disease correctly?
Most tumor patients do not want to think that they are suffering from cancer, and hope that it is benign rather than malignant, and their psychological state is complicated and changeable, which makes the diagnosis and treatment difficult. Therefore, after being diagnosed, tumor patients need to face the reality, build up confidence to overcome the disease and actively cooperate with the treatment. We encourage patients to vent or communicate their bad emotions to relieve their internal pressure, and to understand the adverse effects of chemotherapy drugs used to relieve their tension. In terms of treatment, patients should not seek treatment indiscriminately, believe in the so-called “ancestral secret recipes” and various advertisements, but actively treat in regular hospitals and reflect their feelings during treatment in a timely manner, so that doctors can grasp the changes in the condition and adjust the treatment plan and dosage of drugs in time to receive the best results. Life, re-establish the routine of life, to develop good habits.
23.What should the patient do before chemotherapy?
Chemotherapy is one of the main means to treat tumor. Before chemotherapy, patients should prepare.
(1) Understand the adverse effects and characteristics of the chemotherapy drugs to be used, eliminate or reduce the tension, and accept chemotherapy psychologically.
(2) Improve various examinations, such as the determination of blood phase, liver and kidney function, and heart and lung function, etc.
(3) Keep the body and oral cavity clean.
(4) Give a high-calorie, high-protein, easy-to-digest diet.
(5) Get good rest and sleep before chemotherapy and be well prepared mentally.
24.How can chemotherapy patients observe whether their treatment is effective or not?
As a chronic disease, tumor will show certain symptoms or signs, which provides favorable conditions for chemotherapy patients to observe the efficacy of treatment.
The main methods are.
(l) The original discomfort symptoms caused by tumor are reduced or disappeared after chemotherapy. For example, the improvement of chest tightness and shortness of breath, the reduction of bone pain and the disappearance of poor feeding are the signs of effective chemotherapy.
(2) The tumor that can be touched on the body surface shrinks more than 50% after chemotherapy and is maintained for 4 weeks, which is the objective standard for the efficacy of chemotherapy and the indicator for patients to observe the efficacy of chemotherapy.
(3) The existing uncomfortable symptoms and palpable tumor changes are not obvious, which means that the tumor has not progressed significantly, and chemotherapy has controlled the process of tumor to a certain extent, which brings hope for long-term survival of those with tumor.
25.How to arrange life and living after chemotherapy?
It is very important to arrange life and living after chemotherapy. Active and regular life itself is a magic weapon to control cancer by eliminating tension and pessimism. Regular life refers to the arrangement of daily living and patient’s activities, including the treatment activities received, should be regular. The recommendations are as follows.
(1) Regularity of daily life Bedtime and waking up should be on time and regular. The most unacceptable thing is watching TV and playing mahjong all night, which affects sleep and health recovery.
(2) Diet regular meals, varied recipes, avoid overeating.
(3) clean and hygienic, bathe regularly, change clothes regularly, pay attention to the neatness of the instrument, do not give up on yourself because of the disease. Neat and tidy grooming is good for building your confidence.
(4) Insist on exercise As long as mental and physical strength allows, we should take time to participate in exercise. Of course, we must do it according to our ability and in a gradual manner.
(5) maintain emotional stability to be optimistic, trying to avoid pessimism, irritability and other negative emotions.
(6) Quit bad habits Smoking is a big taboo for cancer, so you should quit it first. Intoxication in alcohol is also not conducive to recovery and should be avoided.
26.What are the effects of chemotherapy drugs on pregnancy?
Chemotherapy drugs affect the growth and development of the fetus through the placenta, thus causing malformations, which is a major issue in human society. The mechanism of action, first of all, is that chemotherapeutic drugs pass through the placenta and cross the cell membrane for simple diffusion. The size of the diffusion ability of chemotherapeutic drugs is determined by the size of drug molecules, the degree of polarization, and the level of lipolytic properties. However most chemotherapeutic drugs are applied to the mother and enter the blood stream, and there is always a certain amount of chemotherapeutic drug input to the fetus. The teratogenicity of chemotherapeutic drugs is related to the stage of fetal growth and development, and the application of teratogenic drugs in early gestation can cause abnormalities and defects in organ structure. Later on, teratogenic drugs affect fetal growth, development and complete organ structure, especially brain development, for example, antimetabolites can cause fetal developmental malformations, and combined chemotherapy has a greater impact on the fetus than single drug chemotherapy. Therefore, we advocate abortion in early pregnancy and induction of labor in middle and late pregnancy for chemotherapy oncology patients to avoid the fetus receiving chemotherapy drugs, which may lead to adverse consequences.
27.Do chemotherapy drugs have any effect on fertility and the health of children in the future?
Chemotherapy drugs have an effect on fertility. Germ cells divide faster, so they are easily affected by anticancer drugs, especially alkylating agents, which may cause testicular atrophy and sperm reduction in men, as well as impaired ovarian function, low endometrial proliferation and infertility and infertility in female patients. A considerable number of anticancer drugs can also affect chromosomes and cause malformations or miscarriages. Some young patients may recover their reproductive function at least 2 years after the cessation of chemotherapy, so patients receiving chemotherapy drugs should not have children too early for their own and children’s health.
28.Why should we pay attention to the dosage intensity of drugs?
Hryniuk proposed the concept of dose intensity in the 1980s, that is, regardless of the route and method of administration, the dose of the drug given per unit time during the course of treatment is expressed in mg/m2/week. mg represents the dose of chemotherapy drug, m2 represents the body surface area calculated from the patient’s height and weight, and week represents the concept of unit time. Relative dose intensity (RDI) refers to the ratio of the actual dose intensity administered to an artificial standard dose intensity. In case of combination chemotherapy, the dose intensity of several drugs and the average relative dose intensity can be calculated. Since the dose intensity is the average weekly dose received during the whole course of treatment, the dose intensity will be reduced if the dose is reduced or the interval between doses is extended in chemotherapy. As seen in animal experiments, reducing the dose intensity of therapeutic drugs often significantly reduces the complete remission rate and cure rate. In clinical cancer chemotherapy, there are also many data proving that the dose intensity of chemotherapy is significantly correlated with the therapeutic effect. If the dose intensity of antineoplastic drugs is increased and the interval time is shortened according to the schedule, the efficiency and cure rate of treatment will be significantly improved, which has been confirmed in the treatment of breast cancer, ovarian cancer and lymphoma. There is another point why we should pay attention to the dose intensity of drugs, that is, considering the resistance of chemotherapeutic drugs. If the dose intensity is not enough, it will not only fail to kill cancer cells, but also cause the cancer cells to reduce the uptake of anti-cancer drugs or increase the repair ability of damaged cells, which will result in resistance, while the delay of chemotherapy regimen will lead to the re-proliferation of tumor cells, making chemotherapy more difficult and causing unsatisfactory treatment results. Many clinical data also show that the main reason for the treatment failure of some diseases that can be cured by chemotherapy is often due to insufficient dose rather than drug resistance. Therefore, in the treatment of patients with curative potential, chemotherapy at the maximum tolerable dose intensity should be used as much as possible to ensure efficacy. In recent years, the application of granulocyte colony-stimulating factor (G-CSF), granulocyte macrophage colony-stimulating factor (GM-CSF), autologous bone marrow transplantation (ABMT) and autologous peripheral blood to cell transplantation (PBSCT) has made it possible to increase the dose intensity of chemotherapy, and has attracted increasing attention.
29.What is a reasonable chemotherapy regimen?
Every tumor patient hopes to receive the best treatment and achieve the best efficacy, but each tumor has its own characteristics and the patients’ physical conditions are different, and there are more than 50 effective anti-tumor drugs and new anti-cancer drugs are constantly being developed. This reasonable plan includes the timing of drug administration, drug selection and combination, dose, and treatment interval. Many clinical protocols have been summarized from a large number of case studies. Generally speaking, the following principles should be followed to develop a reasonable chemotherapy regimen.
(1) Fully understand the patient’s situation
The patient’s diagnosis should first be clarified, and a histological or pathological diagnosis should usually be obtained. Because chemotherapy drugs usually have more obvious adverse effects, including the potential for teratogenicity, mutagenicity, and carcinogenicity, it is appropriate to consider chemotherapy only after conclusive pathological or histological confirmation. The so-called “experimental chemotherapy” is inappropriate. The purpose of histological diagnosis is not only to confirm the diagnosis, but sometimes the histological staging is decisive in determining the choice of drugs, predicting the outcome of treatment, and formulating the overall treatment plan. For example, small cell lung cancer and non-small cell lung cancer are completely different in terms of biology and the choice of treatment plan; secondly, the extent of tumor invasion should be understood, which is decisive in deciding whether chemotherapy is necessary after surgery and radiotherapy and the intensity of the drugs chosen. In addition, the general health condition of the patient must be understood. The patient’s body condition varies, so the chemotherapy regimen should not be uniform. The selection of drugs and dose arrangement should take into account the patient’s specific physical condition and important organ function.
(2) Understanding the patient’s previous treatment status
For patients who have not used chemotherapy in the past, they are often more sensitive to chemotherapy drugs and can be expected to achieve better results, so first-line or standard chemotherapy regimens should be used at this time.
(3) Determine the goal of treatment
Whether to do radical chemotherapy or palliative chemotherapy, whether to do postoperative chemotherapy (adjuvant chemotherapy) or preoperative chemotherapy (neoadjuvant chemotherapy), in short, the purpose of treatment should be clear.
(4) Sensitivity and individualization of drugs for tumor chemotherapy
When formulating chemotherapy regimens, combination chemotherapy with multiple drugs should be used as much as possible, which can help improve the sensitivity of chemotherapy and thus enhance its efficacy. The following aspects should be considered in the composition of combination chemotherapy: (1) the drugs that constitute the combination chemotherapy should be those that have been proven to be effective for the tumor alone; (2) drugs with different mechanisms of action and temporal phases of action should be used as much as possible to form the combination chemotherapy regimen in order to better play their synergistic effects; (3) drugs with different types of toxicity should be used as much as possible to avoid their toxicity from being added together, making it difficult for patients to tolerate; (4) the designed combination chemotherapy regimen should be proven in rigorous clinical trials. The designed combination chemotherapy regimen should be proved by rigorous clinical trials and its use value.
In conclusion, the development of chemotherapy regimen should be based on the patient’s own situation, varying from person to person, and the type and dose of drugs selected should be individualized, taking into account their effectiveness, adverse reactions and other aspects, and on this premise should try to use the standard effective regimen that has been confirmed by a large number of cases, and finally also take into account the patient’s affordability and many other factors.
30.What foods and drugs should be used during chemotherapy for leukocyte and thrombocytopenia to help them recover?
Chemotherapy drugs, except endocrine drugs, have different degrees of inhibitory effects on the bone marrow, which can lead to a decrease in leukocytes and platelets, resulting in a decrease in the patient’s immunity, a decrease in the ability to fight infections and secondary infections, as well as possible internal bleeding, making treatment more difficult. Therefore, it is necessary to choose appropriate blood-raising drugs when myelosuppression occurs during chemotherapy; (1) commonly used ones are leucovorin, spironolactone, shark’s liver alcohol, leucovorin, nucleic acid, etc.; (2) according to traditional Chinese medicine, cancer patients are mostly suffering from deficiency of yin and yang qi and blood, and weakness of positive qi. Therefore, the use of Chinese herbal medicines to support the essence, tonify the middle and benefit the qi, invigorate the blood to resolve the silt, and benefit the kidney to nourish the yin is very beneficial to enhance the patient’s constitution to restore the blood image to normal. (4) Colony-stimulating factors such as granulocyte macrophage colony-stimulating factor (GM-CSF) or granulocyte colony-stimulating factor (G-CSF) can promote the differentiation of bone marrow stem cells and the proliferation of granulocytes, reduce the degree of granulocyte reduction caused by chemotherapy and shorten the duration of granulocyte reduction, and promote the early recovery of white blood cells. It is the most widely used and effective leukocyte-raising drug in clinical practice; ⑤ Recent studies have identified cytokines that promote platelet production, such as thrombopoietin (TPO), interleukin-3 (IL-3) and interleukin-11 (IL-11). Preliminary clinical trials have shown the ability to reduce chemotherapy-induced thrombocytopenia and promote platelet recovery.
It is very important to choose a diet that is easy to digest and nutritious. Patients should pay attention to increase nutrition, eat more chicken, duck, fish, meat, milk, soy products, etc. They can also choose foods containing more iron such as animal liver, kidney, heart, lean meat, egg yolk, vegetables such as spinach, celery, clover, fruits such as apricot, peach, plum, raisins, red dates, pineapple, figs, etc. You can also use stewed black chicken, peanuts and other blood to nourish the right energy.
31.Why should liver and kidney function, blood routine and electrocardiogram be checked regularly during chemotherapy?
We all know that liver is a detoxification organ, and many anti-tumor drugs are metabolized and converted in the liver, resulting in different degrees of liver damage. Most of the liver damage is mainly due to the increase of ALT (SGPT), which is usually transient and occurs 7 to 14 days after chemotherapy, but recover quickly after stopping the drug and giving liver-protective treatment. Therefore, liver function tests should be done regularly before, during and after chemotherapy. Patients with abnormal liver function should be cautiously used or prohibited from using drugs with large liver damage, and the dose of drugs should be adjusted according to the damage situation.
Many antitumor drugs and their metabolites are eliminated from the body by the kidneys, so the kidneys are vulnerable to damage, which can be clinically manifested as symptomatic elevated serum creatinine or mild proteinuria, or even anuria and acute renal failure. During high-dose MTX treatment, renal damage is caused by the deposition of metabolites in the renal tubules, so renal function should be checked regularly during chemotherapy, and if renal damage is found, protective measures such as hydration diuresis or discontinuation of the drug should be given.
The vast majority of anti-swelling pain drugs have different degrees of bone marrow suppression. There is often a decrease in leukocytes, thrombocytopenia, and hematocrit. The main consequence of leukocytopenia is an increased risk of serious infections, and if leukocytes remain below 1000/microliter for 7-10 days, the chance of serious bacterial infections increases significantly. Patients with thrombocytopenia often have a tendency to bleed. When platelets are below 30.000/microliter, the risk of bleeding is great, and when platelets are below 10.000/microliter, life-threatening central nervous system bleeding, gastrointestinal hemorrhage and respiratory bleeding are likely to occur. In order to ensure the smooth implementation of chemotherapy, reduce and avoid secondary infections and bleeding, blood routine should be checked regularly, once or twice a week, and the drug dose should be reduced when the white blood cells are lower than 4,000/microliter and platelets are lower than 80.000/microliter, such as lower than 3,000/microliter or lower than 60.000/microliter, the drug should be discontinued, blood-raising drugs should be given and nutrition should be enhanced.
Some chemotherapeutic drugs have cardiotoxicity, the most common being anthracyclines, especially adriamycin (ADM) with erythromycin (DNR), which can lead to cardiomyopathy with congestive heart failure, ECG changes, arrhythmias, pericarditis, myocardial ischemia and myocardial infarction. To prevent serious cardiotoxicity, in addition to minimizing or avoiding the use of anthracyclines for elderly patients, those with a history of heart disease and those who have undergone cardiac radiotherapy, ECG should be checked regularly during chemotherapy to detect serious cardiotoxicity in time to stop or change the drug.
32.Will the hair loss caused by chemotherapy grow again?
The normal human hair includes two parts, one is located above the surface of the scalp called the hair stem, and the other is located within the scalp called the hair root. The lower end of the hair silver expansion is called the hair follicle, the hair follicle is the part of hair growth, development and nutrition. Normal human hair is in a cycle of growth and stopping growth. The growth period is 3 to 4 years, during which the hair grows out of the follicle, grows and receives nutrition from it. After that, the hair naturally falls out after a cessation of growth period of about 3 months. Only all the human hair or hair adjacent to each other are not in the same growth cycle, so human hair sheds and grows at any time, but the amount of hair shed is not much, which is a physiological phenomenon.
Most chemotherapy drugs, while treating tumors, often have a damaging effect on the hair follicle cells within the scalp, which manifests itself in patients with different degrees of hair loss. The World Health Organization stipulates that the lightest hair loss is only a small amount of hair loss; the heavy hair loss refers to the total loss of hair, and the hair will grow back after stopping chemotherapy for a certain period of time; the moderate hair loss is between the above two; the severe hair loss refers to the total loss of hair, and the hair cannot grow back after stopping chemotherapy, which is rarely seen in the process of chemotherapy. It can be seen that hair loss caused by chemotherapy drugs usually grows back in 1 to 3 months after stopping chemotherapy. Sometimes the hair that grows back is darker or curlier than the original hair. Not all chemotherapy drugs cause hair loss, and the degree of hair loss is not always the same. The drugs that most often cause hair loss are adriamycin, epi-adriamycin, erythromycin, cyclophosphamide, isocyclophosphamide, nitrogen mustard, aminopterin, pedialyte glycosides, wyman, fluorouracil, vincristine, vincristine amide, mitomycin, etc. These drugs can often cause partial or total hair loss. The next drugs are cisplatin, vincristine, vincristine, bleomycin, and mercaptopurine, which can cause small or partial hair loss. The degree of hair loss due to chemotherapy drugs is not only related to the type of drug, but also to the dose of the drug, the higher the dose given each time, the heavier the hair loss. Combination of several drugs chemotherapy is heavier than the hair loss treated with one drug alone. Hair loss due to chemotherapy drugs often starts 2 to 4 weeks after the administration of the drug and occurs first on the top of the head and gradually progresses to the periphery. In older patients, the original gray hair does not necessarily fall out. Usually the hair grows back completely in 1 to 3 months after the patient stops chemotherapy. In order to prevent hair loss, some people put ice caps on the patient’s head while injecting chemotherapy drugs to cool the scalp and reduce local vasoconstriction to reduce the drug reaching the hair follicles and reduce hair loss. However, the effect is not very obvious.
Hair loss due to chemotherapy drugs has no adverse effects on the patient’s body. The main problem is the change in one’s own image due to hair loss. This can be psychologically stressful and mentally taxing for patients who are concerned about their appearance. Therefore, patients who are about to receive chemotherapy or are undergoing chemotherapy must have a correct understanding of hair loss caused by chemotherapy drugs, avoid the fear brought about by insufficient understanding, and accept treatment with a frank and happy mind, which is conducive to disease recovery.
33.Is it right to say that the greater the adverse effects of chemotherapy, the better the curative effect?
As we all know, chemotherapy drugs are generally more toxic drugs. Clinicians apply chemotherapy drugs to treat cancer because they can kill or injure the fast-growing malignant cells. However, chemotherapeutic drugs are not strong in distinguishing normal cells from malignant cells, and they are also toxic to normal cells, which can cause obvious adverse reactions. Among the chemotherapy drugs, some drugs such as nitrogen mustard, cyclophosphamide, adriamycin, etc. with the increase of drug dose, the efficacy will also be improved, and there is a possibility to overcome the resistance of malignant cells to some extent. Of course, the dose of chemotherapy drugs increases, the adverse effects also increase, from this point of view, it seems that the greater the adverse effects, the better the chemotherapy effect has some justification. However, some chemotherapeutic drugs such as bleomycin, vincristine, pinyamycin, euflornithine, nurse fludine, etc., when beyond a certain dose range, the efficacy does not increase, and the toxic reactions increase significantly. In addition, with the advancement of adjuvant drugs for chemotherapy, the problems caused by side effects of drugs can be solved as much as possible, for example, peripheral blood leukopenia caused by chemotherapeutic drugs, by adding granulocyte colony-stimulating factor treatment after the application of chemotherapeutic drugs, such as gigafen, Wheal blood, granoxet, etc., the side effect of leukopenia is not obvious, and it also allows the dose of chemotherapeutic drugs to increase, making the efficacy improved. Another example is high-dose cisplatin chemotherapy due to the use of antiemetic drugs such as pivoxane, the side effect of vomiting is not strong, and the efficacy is significantly higher than that of low-dose cisplatin. Therefore, the statement that the greater the adverse effects of chemotherapy, the better the efficacy is not entirely correct. This should depend on the specific drug, the specific chemotherapy method, and whether the combination of adjuvant drugs is applied. The original goal should be to obtain the maximum efficacy through chemotherapy and to minimize the adverse effects of chemotherapy drugs. For the specific chemotherapy drugs to be applied, patients can discuss with experienced chemotherapists.