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Here is something to consider, when deciding what treatment to take, there is a "better way"
WHAT IS CHEMOTHERAPY? from NEWS BBC UK.
Powerful drugs can kill cancer cells
Chemotherapy is drug treatment which is used to try and kill cancer cells or stop them spreading.
Different cancer cells respond to different drugs, so not all chemotherapy is the same.
Sometimes as many as eight different drugs is employed to get the best effect, and doctors are constantly trying out new combinations to improve treatment.
Chemotherapy is often associated with debilitating side effects, but many types of modern chemotherapy cause only mild problems.
WHO GETS CHEMOTHERAPY?
Because chemotherapy drugs are usually injected into the blood, they travel around the body and can attack cancer cells regardless of where they find them.
For this reason, doctors will use them when they think there might be cancer cells in more than one part of the body.
If some cancers have been growing for a while undetected, bits of them can break away from the main tumour and travel to either nearby tissue, or to more distant organs like the liver and lungs - and start growing there.
A surgeon can only cut out the main cancer tumour, and nearby tissues which may be involved.
Radiotherapy, which uses radiation to destroy cancer cells, can only be given to small areas of the body or it will cause damage to too many healthy cells.
Often, after an operation to remove cancer, chemotherapy will be given to "mop up" any remaining cells.
Some cancers, such as leukaemia, need chemotherapy because they involve cells which are found throughout the body.
Chemotherapy can be given to shrink a tumour to make it easier for the surgeon to remove.
It can also ease the symptoms of patients whose cancer is not curable.
HOW DOES IT WORK?
Chemotherapy, in its traditional sense, is a chemical which is poisonous to cancer cells and kills them.
This is called a cytotoxic chemical - one very early chemotherapy was produced from mustard gas, which was used as chemical weaponry during the First World War.
However, anything which is poisonous to cancer cells may also be poisonous to the body's healthy cells, which it needs to survive.
The trick with chemotherapy is to find a chemical which kills as many cancer cells as possible, and as few healthy cells.
Doctors have been getting increasingly successful at developing such chemicals, by spotting the differences between the cancer cells and neighbouring normal cells, and exploiting them.
The principle difference between many cancer cells and normal cells is the speed at which they reproduce, or divide.
Cancers tend to be dividing and growing faster than other cells in the body - which is why lumps or tumours sometimes appear.
Other cancer cells may become more or less active in response to natural chemicals called hormones produced by the body.
Some chemotherapy harnesses this reaction to control the growth of the cancer cells, so rather than poisoning the cells, they starve them of something they need to grow and multiply.
Some chemotherapies try to programme the immune system to see the cancer cells as foreign so they can be attacked and destroyed.
HOW IS IT GIVEN?
Often, chemotherapy is delivered by injection into a blood vein.
In many cases a saline drip will be set up to dilute the drug as it enters the body. This stops it harming the vein because it is so concentrated.
If the patient needs frequent doses of different drugs, to avoid the discomfort of having to have separate injections every time by having a tube kept in the vein which attaches to the syringe. This line is often left in a vein in the chest - one type is called a "Hickman line".
Sometimes, a concentrated dose of chemotherapy is needed on a particular part of the body, and side effects can be lessened by injecting it directly onto the cancerous area.
For example, for some bladder cancers, the drug can be pumped into the bladder so it works directly on the tissue involved.
How long chemotherapy courses last varies between different cancer types, with some being given intensively over a fortnight, normally in hospital, and some over a period of months.
WHAT ABOUT SIDE-EFFECTS?
Because some chemotherapy targets fast-growing, or fast-dividing cells, it is more likely to harm similar cells in the body.
These include the cells in the hair follicles, which is why cancer treatment is often associated with hair loss, although hair does regrow once treatment has ended.
Other fast-dividing cells can be found in the stomach and bowel lining, which leads to nausea and diarrhoea.
There are, however, drugs which help control this, and timing meals to avoid having a full stomach when the drugs take effect can also help in some cases.
Other types of normal cell that can suffer are the blood cells.
Red cells are important to carry oxygen to keep other cells alive. Other blood cells help stave off infection.
As a result, chemotherapy patients may be more prone to infections, and find them harder to fight off.
Hospitals will take regular blood tests to monitor the levels of different cells. This is called a full blood count.
Generally, patients on chemotherapy can be expected to have less energy than usual, or perhaps even feel extreme fatigue.
Chemotherapy can also affect the fertility of both men and women, and both can now freeze their sperm and eggs with the hope of using them to produce a test-tube baby.
The thawing of eggs is a relatively new technique which has only just been approved in the UK.
WHAT IS RADIOTHERAPY?
Radiotherapy destroys tumours with radiation
It has long been known that radiation can damage human cells - and radiotherapy harnesses that power to treat cancers.
Ionizing radiation - similar to x-rays - can penetrate tissue, and alter the part of the cell which regulates its growth and reproduction.
Healthy cells can recover from this damage, while cancer cells cannot.
There are two types of radiotherapy - delivered from outside the body by a machine, and using radioactive implants placed inside the body.
Researchers are working to increase the effectiveness of radiotherapy by targeting the beam of energy more precisely, and making the cancer cells more sensitive to it.
WHO GETS RADIOTHERAPY?
The principal use of radiotherapy is to tackle solid tumours found in just one location, for example skin, brain, breast or uterine cancers.
Sometimes doctors will use the treatment to shrink a tumour so that a subsequent operation will be more effective.
In some cases, for example in invasive bladder cancer, radiotherapy is considered as the first option, as an alternative to surgery that would have permanent effects on the lifestyle of the patient.
But although radiotherapy alone can cure many cancers, in other cases the radiotherapy is given after surgery over the surrounding area to "mop up" any remaining cells which have spread from the original cancer site.
If there is a suspicion or firm evidence that cells could have spread further afield, then chemotherapy may be the preferred option.
WHAT FORM DOES TREATMENT TAKE?
If the radiotherapy is delivered by a machine, then the patient will normally be given repeated treatments over a brief period.
Although treatment timing varies depending on the type of cancer, its location, size, and the dose chosen by the doctors, it is not unusual to be given treatments every day for a few weeks.
If the therapy involves inserting a radioactive implant near a tumour, then a brief hospital stay is normally needed.
WHAT ABOUT SIDE-EFFECTS?
Although the treatment itself is painless at the time, the culmulative effect of many sessions does produce side effects.
The radiation can produce a sunburn-like effect on the skin as it passes through. The extent of this depends on the number and intensity of treatments.
There can be hair loss in the area being treated - which is usually temporary.
The treatment can also leave the patient feeling fatigued and generally lethargic.
ARE THERE LONG-TERM RISKS?
Ionizing radiation produces changes within the genetic structure of the body's cells, and there is a small risk that an increased radiation dose leads to changes in healthy cells which can cause cancer.
New equipment and techniques help to reduce the risk of side effects by targeting doses more accurately on the cancer, thus lowering the dose received by critical organs and tissue around the treatment area, while allowing the malignant tissue itself to be zapped by higher doses than before.
Older radiotherapy equipment tended to target a larger area, so healthy tissue as well as cancerous tissue would be irradiated, increasing the risk of side effects.
The UK government is now investing in the latest machines.
WHAT'S LIKELY TO HAPPEN IN THE FUTURE?
Researchers are fine-tuning radiotherapy to improve the outcomes for patients.
The main efforts focus on delivering a more powerful radiotherapy beam accurately to smaller and smaller targets.
Some drugs seem to make cancer cells more vulnerable to radiation, which means less powerful radiotherapy, or fewer sessions, are needed.
Another field of research is looking at heating cells in a specific area to make them more sensitive to radiotherapy. p>Oncologists are also fighting despair. Because they administer most cancer drugs intravenously, the docs usually buy the drugs themselves and bill their patients at a razor-thin markup. "I am in an incredible bind," says Dr. Barbara L. McAneny, Thornton's doctor. She would like to give patients state-of-the-art treatment every time, "but you have to live in the real world. When the patient says 'I can't afford it,' I start to think about what is second-best." .
HERE IS SOME INFORMATION SUPPLIED TO PATIENTS ON JUST ONE DRUG, TAXOL.
BE AWARE DRUGS ARE OFTEN MIXED.
Paclitaxel (Taxol®)
Paclitaxel (pronounced pak-li-tax-el) is a chemotherapy drug that is given as a treatment for some types of cancer. It is commonly known as Taxol. It is most commonly used to treat ovarian, breast and non-small cell lung cancer.
This information describes paclitaxel, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your cancer, which give further information and advice.
If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.
HOW IT IS GIVEN
Taxol may be given as a drip (infusion) through a fine tube (cannula) inserted into the vein through a central line, which is inserted under the skin into a vein near the collarbone, or into a PICC line, which is inserted into a vein in the crook of the arm.
POSSIBLE SIDE EFFECTS
Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is given Taxol, and may be different if you are having more than one chemotherapy drug.
We have outlined the most common and less common side effects, so that you can be aware of them if they occur.
However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you do notice any effects which you think may be due to the drug, but which are not listed in this information, please discuss these with your doctor or chemotherapy nurse.
Lowered resistance to infection Taxol can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given and your resistance to infection usually reaches its lowest point 10-14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.
CONTACT YOUR DOCTOR OR THE HOSPITAL STRAIGHTAWAY IF:
Your temperature goes above 38ºC (100.5ºF) You suddenly feel unwell (even with a normal temperature).You will have a blood test before having more chemotherapy, to make sure that your cells have recovered.
Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.
Bruising or bleeding Taxol can reduce the production of platelets (which help the blood to clot).
Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.
Anaemia (low number of red blood cells) While having treatment with Taxol you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these are a problem.
Sore mouth and ulcers Your mouth may become sore, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening.
Tell your nurse or doctor if you have any of these problems, as special mouthwashes and medicines to prevent or clear any mouth infection can be prescribed.
Taste changes You may notice that your food tastes different.
Normal taste will usually come back after the treatment finishes.
Diarrhoea This can usually be easily controlled with medicine but let your doctor know if it is severe or if it continues. It is important to drink plenty of fluids if you do have diarrhoea.
Tiredness and feeling weak You may feel very tired. It is important to allow yourself plenty of time to rest.
Hair loss This usually starts 2-3 weeks after the first dose of paclitaxel, although it may happen earlier. Hair is usually lost completely but may just thin. You may also have thinning and loss of eyelashes, eyebrows and other body hair.
Hair loss is temporary and your hair will regrow once the treatment is finished. To help reduce hair loss, scalp cooling may be suitable for some people.
Aching or pain in joints and muscles This may occur a few days after paclitaxel is given. It does not usually last long and your doctor may prescribe painkillers or anti-inflammatory drugs to help.
Skin changes Taxol can cause a rash, which may be itchy. Your doctor can prescribe medicine to help with this.
Numbness or tingling in hands or feet. This is due to the effect of Taxol on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or similar fiddly tasks. Tell your doctor if you notice any numbness or tingling in your hands or feet. This usually improves slowly a few months after the treatment is finished.
Headaches Some people find that Taxol causes headaches. Let your doctor know if you have headaches while having treatment.
Allergic reaction Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, redness of the face, a feeling of dizziness, headache, breathlessness, anxiety and a desire to pass urine. You will be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse if you have any of these signs.
You will be given steroid tablets (usually dexamethasone) to take before the Taxol to reduce the chance of an allergic reaction.
If you are given any of these tablets before treatment it is important to take them as directed and to tell your doctor or nurse if you forget.
Nausea (feeling sick) and vomiting If you do feel sick it may begin soon after the treatment is given and last for a few days.
Your doctor can now prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness is not controlled or continues, tell your doctor, who can prescribe other anti-sickness drugs that may be more effective.
LESS COMMON SIDE EFFECTS
Low blood pressure Your blood pressure will be checked regularly during treatment. Let your doctor know if you feel faint or dizzy.
Changes in heart rate Taxol can sometimes cause a temporary slowing of the heart rate known as bradycardia. This usually does not cause any harm.
Your liver may be temporarily affected Taxol may cause changes in the way that your liver works, though your liver will return to normal when the treatment is finished.
This is very unlikely to cause you any harm, but your doctor will monitor this carefully. Samples of your blood will be taken from time to time to check your liver is working properly.
Abdominal pain This may start a few days after finishing the chemotherapy and may last for a few days. Your doctor can prescribe regular painkillers if it does happen.
ADDITIONAL INFORMATION
While Taxol is being given, it can cause pain at the place where the injection is given, or along the vein. If you feel pain, tell your doctor or nurse. They can slow the drip down to reduce the feeling.
Other medicines Some medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.
Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.
Contraception It is not advisable to become pregnant or father a child while taking paclitaxel, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor. --------------------------------------------------------------------------------------------------------------------
INFORMATION RE. CHEMICAL HANDLING PRECAUTIONS
Personal Protection Against Chemotherapy and Other Hazardous Hospital Chemical Agents .
Chemical agents used to treat cancer are referred to as cytotoxic agents, chemotherapy agents, or antineoplastic agents. These agents are toxic to all living cells, but are especially selective against rapidly growing cancer cells. The chemical composition of these chemical agents varies extensively as well as to the degree and type of toxicity exhibited on living cells.
These chemicals are classified as acute and chronic toxics and may cause cancer (carcinogenic), mutations (mutagenic), birth defects (teratogenic), orcause reproductive effects in parts per million exposures.
Healthcare professionals preparing or administering chemotherapy agents must be protected against exposure when handling any amount at any concentration of these drugs.
Although primary exposure would come through the hands during preparation or administration, full body protection (i.e., torso and arms) is also mandatory by OSHA to ensure exposures are minimized or prevented (1).
Chemotherapy drugs are handled in two areas of the hospital where exposures could occur: Pharmacy and Oncology Nursing.
The Pharmacy is the primary site where the drugs are prepared for patient use. These drugs are prepared within the confines of a laminar flow safety cabinet which protects both the product (e.g., the drug) and the person preparing the drug.
The pharmacist or technician is further protected through the use of a gloves and a gown to minimize or prevent direct exposure to the hands and to the body. Gown coverage should be to the full torso, arms, and legs to prevent exposure in the event of a spill or splash. Oncology Nursing is the site where drugs are administered to the patient.
Although the primary function of Oncology Nursing is to administer the drugs, in some instances drugs may also be prepared at this site. Patient drug administration requires the same personal protective wear as used by Pharmacy in the event of a spill or other unplanned release. Most drugs are given to the patient through an IV drip, but some drugs are "pushed" via syringe.
In either case, drug administration poses a risk to the nurse from a spill or release from the IV bag or through a pressured release during the drug "push".
In both the Pharmacy and Oncology Nursing, gowns are also required for clean-up in the event of a spill or release of the drug or from patient vomiting or excreta
Gowns, once worn, are disposed of immediately if known to be contaminated or, if not overtly contaminated, may be allowed for re-use until the end of the day with discard at shift's end. To protect individuals handling chemotherapy agents requires that the personal protective wear prohibit agents from reaching the skin or clothes. Migration of chemical agents can occur via chemical permeation through the material or through material adulteration due to chemical reaction of the agent with the protective material.
For years it had been assumed that vinyl or latex gloves were equally protective against chemotherapy agents. Testing revealed, however, that for the majority of gloves either vinyl or latex provided adequate protection but not interchangeably. And with some drugs, neither material provided any protection.
Unfortunately, methodologies to evaluate the ability of personal protective gowns to prevent skin contact from chemotherapy drugs have not been standardized.
However in the few studies that have been conducted, both total barrier protection and chemical resistance to material adulteration have been found necessary to prohibit chemotherapy drug penetration from the wide spectrum of chemical agents used to combat cancer.
Chemotherapy drugs represent a variety of chemical classes, molecular sizes, and solubility properties that must be taken into account in material selection.
Although most are water soluble, some drugs are available only in an organic solvent base.
This broad spectrum of properties requires a gown material to be universal in its application since selecting specific gowns for individual drug application would be difficult if not impossible to achieve. With the extreme toxicity exhibited by chemotherapy agents, the gown must be able to prevent drug penetration to provide the protection required for the healthcare professional handling or administering chemotherapy drugs.
Both parameters of barrier protection and material resistance to chemical-physical interaction must be satisfied to provide the assurance that no chemotherapy agent will come in contact with clothes or skin.
Breathable Versus Total Barrier Protection
Although chemotherapy drug exposure is more likely to be through hand contact, gown provide essential protection to the body and arms in the event of a spill or a splash.
However, little attention by healthcare or safety professionals has been given to the effectiveness of the gown in providing protection from slash protection or chemical permeation.
As such, gowns specifically marketed for chemotherapy protection have been and continue to be sold that have a pronounced permeability to chemotherapy agents as demonstrated in independent studies (3,4).
Selecting the appropriate gown for a specific application requires a cursory knowledge of the spectrum of gown materials currently used and the limitations and attributes each have in providing the protection required of the application.
To generalize, gown material can be initially classified as (1) "breathable" or as (2) "barrier" by its physical properties.
Materials such as Tyvek or spunbond are classified as "breathable", having micro-porosity characteristics to allow the transfer of air to and/or from the body to provide comfort to the wearer over extended periods of time. This attribute, however, allows direct physical permeation of chemotherapy drugs in either a gaseous or liquid phase through the material to the wearer.
To counter drug penetration through these materials, a coating (e.g., polyethylene) or lamination (e.g., Saranex, a co-extruded thermoplastic film of Saran between layers of polyethylene) to the outer layer of the base material (e.g., Tyvek or spunbonded) has been applied with mixed success. Independent tests have shown that polyethylene-coated spunbond and Tyvek have varying results in drug permeability dependent on the drug tested and variance between lot number and manufacturer (2, 3). It is speculated that imperfections in the polyethylene coating cause microscopic holes that can directly lead to permeation.
Only Saranex-laminated Tyvek, a multi-layered laminate, was found to be impermeable to all drugs tested at four hours contact. This garment is an industrial gown that is heavy, uncomfortable and unsuited for hospital or clinic use. It should be further noted that with the addition of the polyethylene coating or Sananex lamination, these materials are no longer breathable
BUSINESSWEEK (US) January 2006 NEWS: ANALYSIS & COMMENTARY
THE COST OF MEDICAL TREATMENT
Rising prices for cancer treatments are making patients -- and doctors -- balk
Avastin is one of the most important cancer treatments to come along in a decade. Developed by Genentech Inc. (DNA ) and approved in the U.S. two years ago, it can add months to the lives of the sickest patients with colon, lung, and breast cancer, a triple crown no other recent cancer drug can claim.
Still, Genentech announced this month that Avastin's recent sales are running about 10% lower than many Wall Street analysts had expected.
The reason isn't hard to figure out.
Avastin costs anywhere from $4,400 to $8,800 a month.
The drug has Food & Drug Administration approval only for the treatment of colon cancer, so many insurers are refusing to pay for its use against breast and lung cancer. "It is naive to think that a patient's ability to pay wouldn't affect the practice of medicine," says Dr. Neal J. Meropol of Fox Chase Cancer Center in Philadelphia.
Cancer has always been an expensive disease, but the stratospheric prices of the newest drugs are injecting cost into treatment decisions to a degree rarely seen before.
As a result, some doctors, patients, and even whole nations are beginning to reject the latest treatments, no matter how effective.
Drug companies argue that the high prices are necessary to offset development costs of these complex drugs. They also note that the newer products are more effective and safer. Before these were available, "the patients died quickly, so their treatment didn't impact the cost of health care," says Ian T. Clark, head of Genentech's commercial operations.
"SOMETHING HAS TO GIVE"
Now the impact is obvious. Most of the newest treatments are taken along with older chemotherapies, and some are even taken in combination with one another, adding pricey drug on top of pricey drug. Dr. Leonard Saltz of Memorial Sloan-Kettering Cancer Center in New York says that 10 years ago the drugs used to treat colon cancer cost about $500. Today, the tab is $250,000.
Over the same 10-year period, the average life expectancy for colon cancer patients increased from 11 months to a little more than two years. "We're excited about these drugs," he says, "but not everyone can get them. Something has to give."
Avastin is far from the only cancer drug raising such concerns. ImClone Systems Inc.'s (IMCL ) Erbitux costs $30,000 for eight weeks of treatment. Gleevec, a Novartis (NVS ) drug, costs $2,200 a month and can be taken indefinitely. Herceptin, a Genentech drug for breast cancer, runs $3,200 a month.
And antinausea drugs to relieve side effects can cost $100 a pill.
Insurers are watching this trend with alarm. Most drugs are only prescribed for FDA-approved uses, but oncologists routinely administer cancer drugs for unapproved, or off-label, uses if supported by clinical trial data. Medicare is required to pay for most off-label cancer treatments, and private insurers used to follow suit, but recently they have started to balk.Morgan Stanley (MWD ) surveyed 100 U.S. oncologists in December and found that their off-label use of Avastin for breast and lung cancer was very low, even though clinical data showed the drug could improve survival for those diseases.
The doctors said they expect to step up their use of Avastin once they are assured of reimbursement. "We're finally beginning to see some pushback on off-label uses,"says Dr. Steven Harr, a Morgan Stanley analyst.
Even so, drug companies have little incentive to lower prices.
New cancer drugs have patent protection, there are virtually no me-too drugs, and desperate patients have been known to mortgage their homes to pay for treatment. Plus, Medicare is forbidden from negotiating prices with drug companies.
"You might see some pressure in three to five years to moderate prices, but there are no forces at work now," says Eric Schmidt, analyst with S.G. Cowen & Co.
That leaves oncologists and patients with tough choices.
Doctors say many breast cancer patients routinely refuse a new class of drugs known as aromatase inhibitors, which prevent the disease from recurring, because they can't afford them. Herceptin is also effective at preventing recurrence, but a Belgian study released last month calculated that Herceptin would cost European governments $42,000 per patient if used for that purpose. "It is possible that present budgets will not be able to bear the extra expense," the authors warned.
In America, even patients with generous insurance policies are struggling with the expense. H. Wayne Thornton of Albuquerque, a supervisor with the U.S. Forest Service, was shocked when he was diagnosed with breast cancer in 1996. The 59-year-old has gone through surgery and numerous rounds of chemo.
He is now trying to survive on a combination of Herceptin, Avastin, and Abraxane, a new chemotherapy from American Pharmaceutical Partners Inc. (APPX ) -- at a cost of about $25,000 a month.
Thornton pays a premium of $388 per month to cover his wife, Betty, and himself. Still, his co-pays total hundreds of dollars each month for these three drugs. He also has co-pays for pain killers, antinausea medication, and doctors' bills. "I try to stay focused on my health, but it's easy to slide into depression," he says.
IF YOU HAVE GOT THIS FAR, CONGRATULATIONS. . . .YOU ARE WELL INFORMED OF WHAT NOT TO DO. . SO CALL NOW AND LEARN ABOUT THE BETTER WAY TO A HEALTHY AND SATISFYING LIFE.
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