How do you get through a round of chemotherapy unscathed?

Chemotherapy is inevitable for most lung cancer patients, and those who have not experienced it are often fearful of, or even very resistant to, the adverse effects it may bring.

Here’s a look at a complete round of chemotherapy and what we need to be aware of.

The process of a complete round of chemotherapy

Chemotherapy often involves four steps: pre-chemotherapy examination, pre-chemotherapy preparation, formal chemotherapy, and chemotherapy monitoring.

1. Exclusion of contraindications

First, a thorough examination is required before chemotherapy. The doctor will initiate treatment only after various contraindications have been ruled out.

Patients generally have difficulty tolerating chemotherapy in the following conditions: poor health, old and frail, body condition score less than 40 (Carlsbad score); poor bone marrow function, severe anemia, white blood cells and platelets below normal range; abnormal liver and kidney function, severe cardiovascular and pulmonary dysfunction.

And such as pregnancy (first 3 months), sepsis, coma, etc. would be absolute contraindications to chemotherapy.

2. Pre-chemotherapy dosing

After the pre-chemotherapy workup has been met, the patient enters pre-chemotherapy preparation. The specific preparations are often related to the chemotherapy regimen.

For example, paclitaxel analogs often require advance administration of hormones to avoid allergic reactions;

Cisplatin analogs are often given in advance with adequate hydration (intravenous administration or more water) to reduce the damage to liver and kidney function from tumor lysis;

Vincristine analogs are often intravenously placed to avoid phlebitis.

In addition, many patients experience anxiety and other emotions before chemotherapy, sometimes with insomnia, especially if it is their first time, or if they have had an adverse reaction to previous chemotherapy. This can affect the subsequent chemotherapy, and anti-anxiety medications can be taken under medical supervision.

3. Formal chemotherapy

After the initial preparation is complete, the “official” chemotherapy begins. Most chemotherapy drugs are administered intravenously and are often indistinguishable from normal saline. There may be some adverse effects during chemotherapy, such as:

Allergic reactions may occur with paclitaxel, and you may experience sudden chest tightness and shortness of breath; abdominal pain and sweating may occur with irinotecan.

Don’t panic if you feel unwell, and always inform your healthcare provider. Most of the adverse reactions are frequently encountered during chemotherapy, and doctors have certain expectations to be able to manage them symptomatically.

4. Chemotherapy monitoring

For some specific drugs, the physician will closely monitor some vital signs during chemotherapy.

For example, with anti-angiogenic drugs, changes in blood pressure need to be monitored closely; with recombinant human vascular endothelial inhibitor, changes in heart rate need to be noted, and so on.

For some regimens, there is a certain amount of time after the end of chemotherapy that needs to be closely monitored. For example, cisplatin needs to be observed for 3 to 5 days after administration to clarify the presence of delayed reactions; irinotecan needs to be closely monitored for the development of acute and delayed diarrhea after administration.

Discontinuation or a change in regimen should be considered during chemotherapy if:

Progression of disease after 2 cycles of treatment, or worsening during a break in the chemotherapy cycle, should be discontinued and an alternative chemotherapy regimen or treatment modality should be used as appropriate

When serious adverse reactions occur and there is a clear threat to the patient’s life.

How long does chemotherapy take?

This varies widely from regimen to regimen.

For most chemotherapy regimens, it can be over in 1 day and repeated every 21 days, whereas the EP regimen for small cell lung cancer (etoposide + cisplatin) requires 3 consecutive days and is repeated every 21 days, and IP (irinotecan + cisplatin) requires treatment on days 1, 8, and 15 and is repeated every 28 days.

In addition, chemotherapy drugs often make up only a small part of the overall regimen, and most patients will have additional antiemetic, gastric protection, and tube flushing drugs added to the regimen to reduce discomfort during chemotherapy, prevent adverse effects, and help smooth the chemotherapy process.

Summary:

Any treatment often has both efficacy and side effects, and chemotherapy is no exception. With the upgrade of adjuvant medications, doctors have ways to manage most of the adverse effects caused by chemotherapy. Most patients will go through these special years without the pain of “life and death”.

It is worth noting that chemotherapy is not “seamless” and that there is an “interval” to allow patients to “recuperate” and that doctors are very strict about the indications for chemotherapy. The first thing you need to do is to take a break from chemotherapy.