New chemo drugs ease cancer patients’ treatment burden

Some cancer patients dread or refuse chemotherapy, reason: people often undergo unpleasant experience during the treatment with bouts of nausea and vomiting, diarrhoea, fatigue, numbness, falling hair and darkening of skin and nails.

But doctors say with new chemo drugs in the Kenyan market, not all patients feel wiped out.

“We now have newer treatments that help reduce side effects. In fact, some patients resume normal duties just days after undergoing chemo and others even gain weight,” said Dr Sitna Mwanzi, an oncologist at the Aga Khan University Hospital, adding that doing some light exercises can help ease the fatigue.

For a disease that kills 76 Kenyans every day, it means we all may know of someone battling cancer and understanding the treatment options plays a crucial role in helping patients navigate through the disease.

Surgery, chemotherapy and radiation are the main treatments for cancer. Dr Mwanzi said of the three treatments, chemotherapy is the most misunderstood.

“Surgery involves removing part or all of the tumour, radiation uses special high-energy rays to kill the cancer cells while chemotherapy uses drugs to kill the cancer,” she said.

Chemotherapy is a primary treatment for blood cancers and lymphomas (those that start from the lymphatic system), but it is a complementary to either surgery or radiation when treating other cancers especially those with solid tumours.

Chemo can be given before surgery and radiation to reduce the size of the tumour or after in cases where there is a likelihood of the cancer spreading or recurring.

Palliative chemotherapy is given to prolong the life of patients with advanced cancers and to alleviate symptoms rather than reduce the size of the tumour.

One of the common myths about chemo, Dr Manzi said, is that the treatment involves one particular drug and works in a specific way to kill the cancerous cells.

“There are many types of chemotherapy drugs which are administered differently either orally or intravenously where they are injected into the patients’ blood stream,” she said.

For many years, chemo drugs have been injectables, but tablets are now available which patients can take from home. Most patients take a combination of more than one chemo drug.

“In some rare instances we give one drug, other cases you give a combination of two drugs together and you can also give two drugs in one cycle and a third in the following cycle,” she said.

With more than 50 different chemotherapy medicines there are a variety of drug combinations that can be given to patients in multiple cycles of either three or four weeks dependent on the dosage.

“Cancer drugs are very potent so if you give them in high doses only once instead of multiple cycles, the chance of damaging other  normal tissues without recovery is very high,” said Dr Manzi.

“What is given with the multiple drug combinations is enough to kill the cancer cells without much damage to the body then give another cycle so that the cancer does not become resistant to treatment.’’

Multiple drugs are prescribed as lower doses to tackle the cancerous tumour while trying to reduce the side effects.

The schedule of chemo cycles or how long a patient undergoes treatment is dependent the type of cancer, how advanced the tumour is and whether or not it has presented characteristics that it is likely to spread to other parts of the body.

“Just because a patient has a similar cancer to another person does not guarantee they will be given the same chemo drugs or take them in a similar number of cycles. The regimens are not fixed,” she said.

When used together with radiation, patients undergoing chemo are likely to suffer localised side effects on the part of body that is exposed to the rays.

In cases where the side effects are severe, doctors can opt to halt the treatment, switch drugs or reduce the dosage.

There are instances, the oncologist explains, when the tumour becomes resistant to drugs either by mutating and changing their DNA not to ‘absorb’ them or ensuring that they eject the drugs as soon as they are ‘absorbed’.

“Clever cancer cells can become resistant to chemotherapy which you notice when there is no longer a reduction in size of the tumour despite undergoing a few treatment cycles,” Dr Mwanzi said.

She said the myth that patients undergoing chemo treatment are restricted to a particular diet is false as patients, especially those who may lose taste sensations, are encouraged to eat what they want provided it is a balanced diet and they stay hydrated.

Pregnancy risks

While undergoing treatment, it is advisable that couples postpone conception. If a woman conceives while on treatment, doctors might advise termination of the pregnancy depending on the kind of cancer one has, its advancement and the prescribed medication.

“As much as chemotherapy kills cancer cells it also targets rapidly dividing cells which is what happens in the first 8-12 weeks as the major organs of the baby are formed, which increases the chances of losing the pregnancy or having a baby with abnormalities,” she said, adding that in lesser life-threatening situations, a woman may carry the pregnancy to term.

The waiting period depends on whether it is the man or woman who has undergone chemo and if the cancer is hormone-dependent.

“Those who have suffered hormone-dependent tumours like breast cancer are advised to wait up to two years before trying to get pregnant while those with lymphomas can be advised to wait a year to help the body recover,” she said.

If a woman is diagnosed with cancer and put on treatment shortly after delivery, she needs to stop breastfeeding as the chemo drugs can be excreted through breast milk.

There are also targeted therapies that have been launched in private hospitals that have helped advance the treatment of cancer.

For instance, there are drugs that take advantage of the difference between normal and cancerous cells which have altered DNA and inhibit the characteristics that help the tumours grow.

Chemotherapy is costly and sometimes beyond the reach of many. The cost of treatment varies depending on the kind of drugs prescribed. Some drug combinations might go for about Sh20,000 per cycle while others cost more than Sh500,000.

“Cancer treatments are available in Kenya more so in the private sector, but they may not be accessible and affordable to the larger population.

“We need to have more public hospitals involved in offering care as well as leverage on bulk purchases to make the drugs more affordable,” she said.