Understanding Cancer Treatment Options: Chemotherapy

 How does chemotherapy work and why does it cause side effects? We answer these questions and more in this episode as we continue our series about cancer with a discussion about chemotherapy. https://bit.ly/42Hvhyk

In this Episode:

• 03:31 - Travel: Rhode Island and Clam Cakes
• 04:35 - Anna Quindlen - We Need to "Get a Life"
• 08:45 - Chemotherapy Overview: How it works, Cycles, Port
• 12:19 - Types of Chemotherapy Drugs
• 15:35 - Apoptosis and Chemo Success
• 17:04 - Side Effects of Chemotherapy
• 18:02 - Discussion - "How Long Has Chemo Been in Use?"
• 21:41 - Jeena R. Papaadi, "The Person in the Bed"
• 24:51 - Outro

Related Episodes:

• S6E4: Understanding Cancer Treatment Options: Immunotherapy
• S6E3: Understanding Cancer Treatment Options: Radiation Therapy
• S6E2: Understanding Cancer Treatment Options: Surgery
• S5E52: Cancer Gone Wild – Learn All About Metastasis
• S5E45: Why Does Cancer Exist? Empower Yourself With Understanding
• S5E46: “Why Do I Have Cancer?” Kismet, Chastisement or Coincidence?
• S5E47: MythBusters – Cancer Edition; Clarifying Common Cancer Myths & Misconceptions
• S5E48: How to Read a CT Scan Report – Learn the Sections Relevant to Your Diagnosis
• S5E49: Are there Miracle Cures for Cancer? With Dr. Jeanna Ford
• S5E50: What is Meant by Cancer Staging? Learn the Language of a Cancer Diagnosis

#cancer #cancertreatment #cancertreatmentoptions #chemotherapyeducation #palliativecare #cancereducation #cancerresources #sideeffects #everydayisagift #everyonedies

Chapters

• 0:00 Intro
• 3:31 Travel: Rhode Island and Clam Cakes
• 4:35 Anna Quindlen – We Need to “Get a Life”
• 8:45 Chemotherapy Overview: How it works, Cycles, Port
• 12:19 Types of Chemotherapy Drugs
• 15:35 Apoptosis and Chemo Success
• 17:04 Side Effects of Chemotherapy
• 18:02 Discussion – “How Long Has Chemo Been in Use?”
• 21:41 Jeena R. Papaadi, “The Person in the Bed”
• 24:51 Outro

Transcript

Hello, and welcome to Everyone Dies, the podcast where we talk about serious illness, dying, death, and bereavement. I'm Marianne Matzo, a nurse practitioner, and I use my experience from working as a nurse for 47 years to help answer your questions about what happens at the end of life. And I'm Charlene Navarrette, an actor in New York City, and here to offer an every-person viewpoint to our podcast.

We're both here because we believe that the more you know, the better prepared you are to make difficult end-of-life decisions. Also, this podcast does not provide medical nor legal advice. Please listen to the complete disclosure at the end of the recording.

Welcome to this week's show. We're so glad to have you join Charlie and me for the next hour as we continue with our series titled, Everything You Always Wanted to Know About Cancer, but didn't have anyone to ask with a conversation about chemotherapy. This podcast is a combination of education and entertainment—edutainment, if you will—delivered in three halves.

Our main topic is in the second half, so you can fast forward to that chitchat-free zone if you'd like. In the first half, Charlie has our recipe of the week and the final excerpt from Anna Quinlan's A Short Guide to a Happy Life. In the second half, I'm going to talk about how chemotherapy is used to treat cancer.

And in the third half, Charlie has a reflection about hospitalization and death. Charlie, what's new in your world? Ella Fitzgerald, the great Ella Fitzgerald. I was listening to the radio yesterday on fresh air, and they had a segment.

There was a concert she gave in 1967 in Los Angeles, and somebody just put all those songs together into an album. Marianne, oh my, geez. This woman and her voice, the control she has, it's just, you know, I always think, is it Sinatra or Ella? And I never, yeah, I can't.

There's not one over the other. See, I'd say Tony Bennett. But yes, I remember that.

Yeah, you really like Bennett. Yeah, I thought he had an incredible voice. But Ella, just something about her voice.

I saw her in concert, and she did the whole show barefoot. She had this gorgeous gown on and no shoes, and I thought, she's my woman. There we are.

In fact, she's Ella. She doesn't need shoes. Wow, that's great.

That's right. Oh, gosh, and I forgot the name of the damn album. It's just come out.

I was going to say, it's a new album then. Yeah, it's brand new. I'll look it up, and we'll throw it in the show notes.

Is that the Royal Wee? Wee Wee. Our first half travels this week. Take us to Rhode Island, the smallest state with the largest heart.

Aw. It is the sailing capital of the world, and Block Island is 12 miles off its shore. Block Island has its very own ghost ship, which has haunted islanders ever since a deadly wreck there in 1738.

Some say the passengers and crew seek revenge against locals who fail to help them as the boat went down. According to legend, a local mass grave contains their bodies. Rhode Island's Narragansett Bay is famous for its clams.

Quahogs are used for preparing many scrumptious dishes, such as clam chowder, clam stuffies, and clam cakes. Which brings us to this week's weekly recipe, Rhode Island clam cakes. Not to be confused with crab cakes.

These fried goodies go great with a bowl of clam chowder, but alone are a mighty compliment to your next funeral lunch. Bon appétit. And now for something completely different.

I have an excerpt from the book, A Short Guide to a Happy Life by Anna Quindlen, the best-selling novelist and columnist. In it, she reflects on what it takes to get a life, to live deeply every day and from your own unique self, rather than merely to exist through your days. I learned to live many years ago.

Something really bad happened to me. Something that changed my life in ways that, if I had had a choice, it would never have been changed at all. And what I learned from it is what today sometimes seems to be the hardest lesson of all.

I learned to love the journey, not the destination. I learned that this is not a dress rehearsal and that today is the only guarantee you get. I learned to look at all the good in the world and try to give some of it back, because I believed in it completely and utterly.

And I tried to do that in part by telling others what I had learned, even though so many people may have thought I sounded like a Pollyanna. By telling them this, consider the lilies of the field. Look at the fuzz on a baby's ear.

Read in the backyard with the sun in your face. Learn to be happy. And think of life as a terminal illness, because if you do, you will live it with joy and passion as it ought to be lived.

You just need to get a life, a real life, a full life, a professional life, yes, but another life too. School never ends. The classroom is everywhere.

The exam comes at the very end. No man ever said on his deathbed, I wish I'd spent more time at the office. I found one of my best teachers on the boardwalk at Coney Island many years ago.

It was December and I was doing a story about how the homeless suffer in the winter months. He and I sat on the edge of the wooden supports, dangling our feet over the side, and he told me about his schedule, hand handling the boulevard when the summer crowds were gone, sleeping in a church when the temperature went below freezing, hiding from the police amid the Tilt-A-Whirl and the Cyclone and some of the other seasonal rides. But he told me that most of the time he stayed on the boardwalk facing the water, just the way we were sitting now, even when it got cold and he had to wear his newspapers after he read them.

And I asked him why. Why didn't he go to one of the shelters? Why didn't he check himself into the hospital for detox? And he stared out at the ocean and said, look at the view, young lady, look at the view. And every day in some little way I tried to do what he said.

I tried to look at the view. That's all. Words of wisdom from a man with not a dime in his pocket.

No place to go, nowhere to be. I look at the view. Look at the view.

When I do what he said, I am never disappointed. Please go to our webpage for this week's recipe for Rhode Island Clam Cakes and additional resources for this program. Everyone Dies is offered at no cost but is not free to produce.

Can we count on you to contribute? Your tax-deductible gift will go directly to supporting our non-profit journalism so that we can remain accessible to everyone. You can also donate at www.everyonedies.org. That's every, the number one, dies.org. Or at our site on Patreon and search for Everyone Dies. Marianne.

Thank you, Charlie. You might find it helpful to go back to some of the other podcasts in the series about how cancer grows to set the stage for our topic today, which is chemotherapy. Chemotherapy is the administration of drugs to try to stop the growth of cancer or kill the cancer cells directly.

The first chemotherapeutic agent was a nitrogen mustard compound called meclorthoramine in the 1940s to treat Hodgkin's disease and other lymphomas. By the early 21st century, more than a hundred different drugs were being used to treat cancer. Unlike surgery or radiation therapy, which often cannot treat widespread metastasis, chemotherapy destroys cancer cells by preventing them from multiplying.

Chemotherapy drugs can move throughout the body in the bloodstream and attack tumor cells where they are growing. Chemotherapy is given in cycles and how long each cycle is depends on the type of cancer, the chemotherapy drug that will be used, and how the cancer ends up responding to the drug. A cycle of chemotherapy is the amount of time between the start of one round of chemotherapy to the start of the next.

While chemotherapy drugs kill cancer cells, they also kill fast-growing healthy cells in the body. So, receiving chemotherapy in cycles helps to kill off the cancerous cells while still allowing the person's body time to restock the healthy cells. A single course of chemotherapy will typically involve four to eight chemotherapy cycles.

For instance, a four-week cycle could involve someone taking medications on the first, second, and third days, then no further medication until the 29th day. The exact drug and the timing will be discussed with you by the oncologist so you can understand what's being planned. These drugs can be hard on your veins so they're not usually given through the arm, like where blood is drawn.

In most instances, before your first chemotherapy dose, a permanent line is placed with a port, which is a metal disc. A small cut in your skin is made and the port is placed under the skin, just under the collarbone. Attached to the port is a soft piece of plastic called a catheter that goes into one of the big veins.

The port has a soft top that a needle can go through. So, when you go to the infusion center, they'll access your port, that's what it's called. By putting a needle through your skin that goes into the rubber top of the port, they can then draw your blood from there, start IV fluids, and give the chemotherapy all through that one needle.

Now, that port can stay in for years, but usually we take it out about a year after you finish chemotherapy. When you go to the infusion center, you'll likely see the same nurses over time and they'll get to know you and you get to know them and whoever comes in with you. Often there are nurse practitioners who review your labs and order your chemotherapy based on the oncologist's plan.

So, chemotherapy drugs are classified by their structure and function. So, I'm just going to tell you their names and basically how they work on not to make it too confusing. So, the first type of chemotherapy drug is called alkylating agents.

These kinds of drugs damage the cancer cell's DNA to stop them from making copies of itself and reproducing. So, remember we talked about cancer is really sort of a misstep somewhere in the reproduction of a cell. So, these alkylating agents are going to go in and stop the cancer cell from reproducing.

The second type is called an anti-metabolite and these interfere with the DNA and RNA production to stop the cancer cells from reproducing. So, you see the theme here. We're trying to get that cancer cell to just stop and these chemotherapy drugs go about that in different ways.

So, the anti-metabolite is going to mess with the DNA and RNA to stop the cells from reproducing. The third type of drug is the anti-tumor antibiotics. Now, these bind with the cancer cell's DNA so that it cannot make copies of itself and reproduce.

The fourth type is the topoisomerase inhibitors. Enzymes called topoisomerases help separate DNA strands for replication. Topoisomerase inhibitors bind with the topoisomerases thereby stopping cancer cells from reproducing.

The last type that I'm going to tell you about are the mitotic inhibitors. Mitotic inhibitors prevent enzymes from making the proteins necessary for cell reproduction thereby shutting it off. Typically, more than one type of chemotherapy is given and we call this combination chemotherapy.

The specific drugs are given in a dose based on the body weight and is calculated by the healthcare practitioner after you arrive at the infusion center. Chemotherapy is not mixed in advance because the dose may change based on your weight. It may need to be held if your blood counts are low or they want to make sure that you're there for your infusion because these drugs are really expensive and if they mix it ahead of time and you don't make it in, they have to throw it away.

Now, not all chemotherapy is given through a port. There are oral chemotherapy drugs that you swallow according to a pre-arranged schedule. Some are applied to skin cancers in the form of gels, ointments, or creams.

Cancer cells can develop resistance to chemotherapy just as bacteria can become resistant to antibiotics. One explanation for the development of drug resistance and resistance to radiation as well is that some cancer cells resist apoptosis and apoptosis is what we're trying to achieve. So it's worthwhile to spend a minute to talk about this.

Apoptosis is programmed cell death. It is considered an important part of our body's cellular maintenance that includes normal cell turnover, proper development, and functioning of the immune system, hormone-dependent wasting, embryo development, and chemical-induced death. Both chemotherapy and radiation kill cells by bringing about apoptosis, essentially making the cell trigger the program of cell death rather than because they die from the chemical, the drug itself.

Another mechanism of resistance involves the ability of tumor cells to actively rid themselves of drug molecules that have reached the cell interior. So what do you want with chemotherapy? Apoptosis. And when do we want it? Well, you know the rest.

The side effect of chemotherapy differs greatly among individuals and between drug combinations. Side effects happen because many chemotherapeutic agents kill healthy cells as well as the cancer cells. Nausea, vomiting, diarrhea, hair loss, anemia, which are low red blood counts, loss of ability to fight infection, and an increased risk of bleeding may be caused by chemotherapy.

Your healthcare practitioner will order medications to lessen the intensity of the side effects or to limit how long they last. Some people wrongly believe that the worse the side effects are, the better the chemotherapy is working. It's not true.

There is no relationship between the effectiveness of a drug on a tumor and the presence or absence of side effects. Charlie, got any questions? How long has chemotherapy been around? Since the 1940s. Wow.

I mean, how did anyone come up with this idea? I just find it interesting. Somebody would think, oh yeah, here, let's throw radiation to people. I mean, any idea how that someone came up with that thought? No, I didn't research that, but Charlie, you could go to your World Book encyclopedias and probably look that up.

Thank you very much, yes. It's just like, how does anybody come up with anything? Maybe somebody had a mother or a child or somebody that had a cancer and they said, there must be a way that we could kill these cells. And through a theory in science, we call that a hypothesis.

We say, well, I think maybe if I bake it in the sun, maybe that would do it. That's true, yeah. To your point, maybe somebody was in the backyard, left an apple out there, the sun hit it and something popped into that person's head sort of thing, yeah.

I mean, I'm sure the story is there. I didn't make it up. I was just curious.

I'm always curious about how things begin. Well, and I've been on, when I worked at the Cancer Center, I was on the national research groups for gynecological cancers and was involved in different research studies and would go to their, I think they were twice a year, conferences. And you take really, here's one piece of info and the group of best minds get together and they say, well, what if we did this? Or what if we did that? And then you study it.

There's, you know, that's what the research process is. And sometimes something works tremendously well. And sometimes you say, well, that was a good theory.

This doesn't exactly work, but if we tweak this, and then that takes you to the next research study. And those studies, they involve a lot of people. They involve, you know, safety mechanisms for the people that are being studied.

They involve, you know, infrastructure to have the mice labs or whatever it is that they're doing. And all that takes money and time. And it's got to be supported in some way, either through the universities who, you know, depending on the university, either, you know, can support a lot of research or support their football teams, you know, depends on.

Yes, yes, yes. The bell rung around the country, yes. Well, you know, we decide what we're going to spend our money on.

And these things, the only way that you're able to, to figure out what's going to work and eventually save lives is through that research process. In our third half, a reflection about the experience of her mother's hospitalization and death, written by Gina R. Epati, who was the author of six books of fiction and poetry. She worked for Pallium India, which provides palliative care as manager of communications.

The person on the bed. Doctors, why are you in such a hurry? Yes, I know your time is valuable. You need to attend to everyone.

But take a moment. Take a breath. Please don't run away.

The old woman on the bed is waving to you to grab your attention. Her voice is low. She knows you won't hear while you're talking about her condition to your team and to everyone else.

Except to her. Pull a chair and sit by her if you can. Touch her hand.

Look at her. It'll only take a moment. Ask her how she's doing today.

Pretend if you must to care about her answer. This little act would brighten her day. Look around at the family.

Talk to them just as you talk to your team. Include them. Please make them feel they're important because they are.

Tell them what you have instructed your team to do. Let's try this. Let's give this medicine.

Let's do this test. Let's see if her condition improves. So that when the nurse comes in the middle of the night to give an injection, the family isn't startled.

They don't ask strange questions. They trust. If they are already told, it's as simple as that.

And when you realize the patient is passing or will pass away soon, don't be afraid to look the family in the eye. You see, more often than not, they know it too. They want to hear it from you.

Don't whisper among yourselves, young doctors. Don't exit the room quickly, awkwardly. Please don't run away.

The family knows it's tough on you too, but they need you at this moment. Give them that one moment. Be vulnerable.

It's okay. It's okay. Just stay a moment.

Be awkward. You don't need to don a mask all the time. Allow it to shed sometimes.

They know you're human too. The one thing that scares everyone is indifference. Allow them to see your vulnerability, your humanness, because it matters to them.

A fleeting moment to you, perhaps, a lifetime memory to them. Yes, that one moment you give would make a world of difference to the family members of the person on the bed. And this ends another episode of Everyone Dies.

Please stay tuned for the continuing saga, and thank you for listening. This is Charlie Navarrette, and from director and writer Woody Allen, dying is one of the few things that can be done as easily lying down. And I'm Marianne Matzo, and we'll see you next week.

Remember, every day is a gift. This podcast does not provide medical advice. All discussion on this podcast, such as treatments, dosages, outcomes, charts, patient profiles, advice, messages, and any other discussion are for informational purposes only, and are not a substitute for professional medical advice or treatment.

Always seek the advice of your primary care practitioner or other qualified health providers with any questions that you may have regarding your health. Never disregard professional medical advice or delay in seeking it because of something you have heard from this podcast. If you think you may have a medical emergency, call your doctor or 911 immediately.

Everyone Dies does not recommend or endorse any specific tests, practitioners, products, procedures, opinions, or other information that may be mentioned in this podcast. Reliance on any information provided in this podcast by persons appearing on this podcast at the invitation of Everyone Dies or by other members is solely at your own risk.