Family Cancer Center

Sarah had always been a practical woman.

During her fifty years, she had been careful to follow all medical advice. She got her checkups on time and scheduled her annual mammograms without fail. So, when Sarah found what she thought was a lump in her left breast one morning, she didn’t panic. She called her doctor who sent her for a diagnostic mammogram.
The news wasn’t what she wanted to hear – the lump was suspicious.

She was eventually scheduled for a mammotone biopsy and Sarah remembers laying face down on a table thinking, “this is just ridiculous.”

When the report came back, however, the diagnosis revealed cancer. Still, Sarah stayed the same, practical, no-nonsense woman she had always been. It was a small lump - less than an inch wide - and was caught very early. She promptly made an appointment with a surgeon who was recommended by her doctor.

She liked the surgeon very much and appreciated her calm and reassuring presence.

She was very much like Sarah. Her surgeon gave Sarah a few options - lumpectomy with lymph node biopsy, the removal of only the lesion and immediately surrounding tissue, or mastectomy, the removal of the breast and lymph nodes. With the full mastectomy, Sarah would likely not need radiation, which would have required numerous trips to a radiation oncologist and lots of time away from work.

After consideration, Sarah decided mastectomy was the most practical solution. Unfortunately, things didn’t go exactly as Sarah had planned. The lump was small, but cancer was found in a lymph node.

Chemotherapy was needed after all, something Sarah didn’t want and really feared. As she sat in the waiting room at the medical oncologist’s office all the unusual questions were in her mind: Would she lose her hair? Would she throw up after the treatments? Would she be weak and unable to work?

Sarah’s concerns are not unusual. Just the word “chemotherapy” can scare almost anyone.

Chemotherapy (or “chemo”) has been around for almost fifty years. In its early days, back in the 1960’s, only a handful of drugs were available for treatment. The first successful regimens were developed for lymphoma and Hodgkin’s disease. The initial therapies for other diseases were modeled on these. Consequently, nearly all early treatment protocols were very similar, with similar schedules and side effects. Virtually all patients were admitted to the hospital for treatment. They all lost their hair. They could count the hours of retching and vomiting in the hospital, followed by hours of “quiet time” hanging over the toilet bowl when they got home. Fatigue took on a whole new meaning. I remember one patient telling me she had to rest between applying eyeshadow to her right and left eyelids.

Science has progressed, and we have reached the twenty-first century. This is not your mother’s chemotherapy. Starting in the 1970s the pharmaceutical industry began to believe in drug therapy for cancer. What was once considered “experimental” was now considered mainstream. Research continues in earnest. The number of chemotherapy drugs available exploded and methods of delivery also expanded.
In the past, most chemotherapy regimens involved an intravenous (literally, “through the vein”) treatment every three or four weeks. Today, about 90 percent of such chemotherapy is given on an outpatient basis, as the patient sits in a large cushy chair in an office, clinic or occasionally a hospital outpatient facility. For those who take their chemotherapy as an outpatient will follow newer, lower-dose regimens that are much easier on them than the drugs of the past.

While IV chemo is still common, some patients now take their chemo drugs orally. Patients visit their local pharmacy, and fill the prescription for chemotherapy as with any other drug. Then, they can take their treatment at home as directed by their doctor with periodic checkups in the office. They can schedule treatment around life, instead of life around chemo.

Some patients still experience temporary hair loss, but many drugs will leave patients with a full head of hair (assuming they had hair to begin with). The constant retching of chemo’s early days has been addressed. New anti-nausea drugs, not available years ago, have made toilet-hugging a sport of the past.

Erythropoietic agents (drugs that stimulate production of red blood cells) have eased fatigue involved with many treatments. Other bone marrow stimulating drugs reduce the risk of dangerous immune suppression and life-threatening infection. Many chemo patients are able to keep working while taking treatment.

Mothers can continue to drive their kids to school, birthday parties, and soccer practice. Dads still coach T-ball and basketball, and may even be able to sneak in a round or two of golf. And, while the chemo is getting easier, the drugs are getting better. Patients are living longer, better quality lives.

Modern chemotherapy is not without side effects, stresses, strains, inconveniences and risks. For those who do find their chemo to be more of a burden than they anticipated, options exist. Many patients find massage useful. Others are helped by visualization techniques, hypnosis and other therapies. Those needing more can find support groups and other organizations willing to lend a hand. Cancer patients are brave people.

Sarah, like many cancer patients, experiences good and bad days, but she can take comfort in knowing her treatments have come a long way since yesterday.

By Margaret Gore, M.D. – Margaret Gore, M.D. has practiced with the Family Cancer Center since 2005. A graduate of Duke University Medical School, Gore completed her advance training at the University of Alabama. Board Certified in Internal Medicine, Medical Oncology, and Hematology, Gore is particularly interested in innovative drug technologies.