Chemotherapy

Overview: What is chemotherapy?

Chemotherapy is a very important treatment option for people with cancer. It helps with various types of cancer, such as breast, colon or pancreatic cancer. Cancer patients are given various cytotoxins, so-called cytostatics. In most cases, doctors combine several chemotherapeutic agents to increase the effectiveness of cancer treatment.

As a rule, cancer patients receive several cycles of chemotherapy at specific intervals. The body can recover in the breaks in between. There are different chemotherapy regimens – depending on the type, spread and aggressiveness of the cancer.

The drugs act throughout the body (systemically) and target different Achilles heels of cancer cells. They prevent their division and reproduction or kill them. Cytostatic drugs attack cells that divide and multiply rapidly. These include cancer cells, but also healthy cells, such as those of the hair or oral mucosa. This is also the reason for the hair loss that many cancer patients suffer under chemotherapy. Other side effects such as inflammation of the mouth are therefore not uncommon. Today, however, we are able to greatly reduce the side effects.

Chemotherapy: adjuvant, neoadjuvant, palliative

Chemotherapy can be differentiated according to further criteria:

• Adjuvant chemotherapy – as support for other cancer treatments to reduce the risk of relapse
• Neoadjuvant chemotherapy – before surgery, to shrink the tumor and make it more operable
• Palliative chemotherapy – the goal is not to cure cancer, but to stop or slow progression or relieve symptoms.

Which chemotherapy for whom?

There is no “one” chemotherapy that helps all cancer patients equally. The cytostatic drugs that oncologists choose and the frequency with which they administer them depend on various factors, for example:

• Type of cancer, size, spread and aggressiveness of the tumor, special characteristics of the cancer cells.
• The patient’s age, general state of health, existing underlying diseases and personal wishes and expectations all play a role. For example, younger and healthy people usually tolerate chemotherapy better than older people who still suffer from other diseases.

Oncology specialists use these criteria to determine the course of chemotherapy. They consider which cytostatic drugs to use, in which combination and dosage. Body weight and height, age and general condition are important points to calculate the appropriate dose of medication.

Chemotherapy procedure

Be well informed about the process and side effects of chemotherapy. Then you are better prepared for the upcoming therapy and know what to expect. Not everyone develops side effects to the same extent. The individual cycles can also be different with regard to side effects.

The course of chemotherapy can be described like this:

• You can have chemotherapy performed on an outpatient basis in a specialized oncology clinic. Then you go home again afterwards (usually after a few hours) and recover there. Sometimes inpatient chemotherapy is necessary, for example, if it is very intensive and scheduled at short intervals. However, an inpatient stay for chemotherapy may also be necessary for older people or those in poor health.
• Chemotherapy is administered by oncologists in cycles. Accordingly, there are days when you receive medication and therapy-free phases. Many different schemes are known – depending on the type of cancer. Examples: Six cycles of chemotherapy with a three-week break in between each cycle to allow the body’s healthy cells to recover. Dose-dense regimens, on the other hand, mean that you go to chemotherapy once a week for 18 weeks, for example.
• Before cytostatic drugs are administered, blood levels are checked during each chemotherapy cycle. Among other things, the number of leukocytes (white blood cells), erythrocytes (red blood cells) and thrombocytes (blood platelets) is important. Many cytotoxins also impair blood formation and dampen the immune system.
• In addition, on the day of chemotherapy before the cytostatic drugs, you will receive anti-nausea medications called antiemetics. They are very effective and act, for example, on the vomiting center in the brain.
• You usually get chemotherapy as an infusion – that is, as a liquid into the vein. They can quickly distribute cytostatic drugs throughout the body via the bloodstream and attack cancer cells. Chemotherapy always acts throughout the body, i.e. “systemically” (as opposed to locally = on the spot). There are also chemotherapies in the form of tablets that are used for certain types of cancer, such as colorectal cancer.
• During chemotherapy, you usually sit comfortably in an armchair that can be adjusted. You can sleep, read, listen to relaxing music, work on the computer or talk to other patients.
• The duration of chemotherapy can range from minutes to several hours. The infusion usually enters the body slowly and drop by drop. In addition, sometimes several infusion bags with cytostatic drugs are administered one after the other – depending on the type of chemotherapy. In addition, preparation and follow-up take time.
• Afterwards you can go back home and relax. If possible, walk a few steps in the fresh air, because exercise does some people good afterwards.

Preparation: tips for the time before chemotherapy

Before starting chemotherapy, there are still some points that are important, for example:

• The start of chemotherapy is often preceded by the implantation of a so-called “port“. It is usually implanted near the collarbone, sometimes on the arm. The port catheter allows direct access to the vein. The port remains in place throughout chemotherapy. Some time after the end of the treatment, you can have it removed again during a minor surgery.
• Have your teeth and gums checked and, if necessary, rehabilitated by your dentist’s office before chemotherapy. There should be no caries or foci of inflammation. Be sure to maintain good oral and dental hygiene during chemotherapy as well.
• Chemotherapy can affect fertility. This is especially important for young women and men who have not yet started or completed their family planning. Get professional advice. It is now possible to have eggs and sperm frozen in advance.
• Talk to your doctor about which vaccinations, if any, are necessary (e.g., flu virus, Corona virus, etc.).
• Consider how you will get to the doctor’s office or clinic. Be sure to organize this beforehand. Cancer patients are better off not driving a vehicle themselves, but letting themselves be driven. There is also the possibility of ambulance transport.
• Before chemotherapy, think about how you want to deal with hair loss. Find out about alternatives, such as caps, hats, scarves or a wig. There are specialized stores for this. Our nurse practitioners can assist you with this.
• Also for falling out eyelashes or eyebrow hairs there are good solutions today, for example, strong make-up and eyebrow tattoos Let yourself be advised beforehand also here.

Aftercare: Tips for the time after chemotherapy

Immediately after chemotherapy, the following tips may be helpful:

• Let us pick you up. Some, however, find it soothing to walk home. Exercise is not only good for the body, but also for the mind and soul. It depends on your well-being and health status whether this is advisable. Check with your doctor beforehand to be sure.
• Be sure to maintain good hygiene because you are more susceptible to infection after chemotherapy. In times of the coronavirus pandemic, most people have internalized appropriate hygiene measures and distance rules anyway. Stay away from people who are ill. If possible, avoid rooms and places where it is particularly crowded, such as public transportation. Wash your hands often and regularly with soap. Wearing a mask also stops pathogens and reduces the risk of infection. Family members and circle of friends should also pay attention to good hygiene.
• Do not smoke and abstain from alcohol, because you put additional strain on your body. He already has enough to do with the cellular toxins. If this is not possible for you, the following applies: seek advice from doctors and nursing professionals.
• Make sure you get enough relaxation and don’t overexert yourself.
• You can be physically active and play sports as appropriate, however.
• If you do not feel physically fit, ask for help with household chores. You may be looking for suitable home help beforehand for the time during and after chemotherapy.

Aftercare after chemotherapy

During follow-up, it is possible to check whether the chemotherapy was successful. In addition, doctors look for the signs of a relapse (recurrence) and ask you about symptoms, possible side effects and long-term consequences of treatment. This refers not only to the physical but also to the mental and spiritual state.

Physical examination, blood tests and imaging techniques, e.g. ultrasound, are also used. This can be used, for example, to detect liver metastases. If cancer settling is suspected, medical experts also use computed tomography (CT), magnetic resonance imaging (MRI = magnetic resonance imaging) and positron emission tomography (PET).

Follow-up care is provided at specific intervals that doctors determine with you. Initially, the follow-up intervals are shorter, but later they become longer and longer. You can continue follow-up care at the same place where you received chemotherapy, i.e., in a clinic or specialized medical practice. The family doctor’s office or other specialist practices can also be involved in follow-up care – if necessary.

The University Hospital of Zurich offers holistic care

At the Comprehensive Cancer Center Zurich (CCCZ), people with cancer not only receive the medical expertise of a university, but also holistic care. The CCCZ is a joint oncology center of excellence of the University Hospital Zurich and the University of Zurich involving Balgrist University Hospital and the University Children’s Hospital Zurich.

This includes cancer diagnostics as well as individual treatment concepts with surgery, chemotherapy, radiation, targeted therapies and immunotherapies. These are tailored to the particular type of cancer and individually to the cancer patients.

It is known today that cancer affects not only the body, but also the psyche, the entire everyday life and profession. In most cases, the relatives also suffer. Special counseling and treatment services offer holistic support that addresses physical, emotional and psychosocial factors. In addition, there is the possibility to participate in clinical studies. This enables them to benefit from the latest scientific findings and new therapeutic approaches.