When Rachel Ford received the devastating news that she had cancer and would undergo chemotherapy, the then 15-year-old’s mind immediately turned to one thing. “Typical teen, I thought, ‘Oh no, I’m going to lose my hair,’” Rachel says. Coming from a medical family, she was aware of the process of chemotherapy and the treatment she would undergo. “It’s one thing to know what’s going to happen, but actually going through chemo — that’s something for which you’re never prepared,” says Rachel, now a University of South Carolina student majoring in visual communication. Aside from hair loss, Rachel also experienced nausea, severe headaches and anemia. “If you survive chemo, you do feel like you can survive anything.”
With over a million new cases of cancer diagnosed each year in the United States, chances are most Americans will directly or indirectly be affected by the disease in their lifetime. An estimated 1,665,540 new cancer cases will be diagnosed nationwide in 2014, according to a report by the American Cancer Society. And in South Carolina, where more than 26,000 new cases are expected this year, cancer continues to be one of the leading chronic diseases in the Palmetto State.
Among the most widely used cancer treatments is chemotherapy, defined as the use of medications to treat or control diseases like cancer. Chemo can be aimed at curing the cancer, keeping the cancer from spreading, slowing the growth of the disease, killing cancer cells that have spread or relieving symptoms caused by cancer. The most common or well-known symptoms of chemo are hair loss and mild to severe nausea. But lesser known long- and short-term symptoms include: appetite changes, fatigue, memory changes, chronic pain, fertility issues and heart problems to name a few. “The thought of having chemotherapy frightens many people,” officials with the American Cancer Society write in their publication Understanding Chemotherapy: A Guide for Patients and Families. “But knowing what chemotherapy is, how it works and what to expect can often help calm your fears. It can also give you a better sense of control over your cancer treatment.”
More than 100 chemo drugs exist and are used in any number of combinations. Chemotherapy treatment can range from a single drug to multiple drugs used in a certain order or combinations called combination chemotherapy. Medical experts often use multiple drugs that have different actions, working together to kill cancer cells and lessen the likelihood of the cancer becoming resistant to any one chemo drug.
Chemotherapy has been quite effective for treating many forms of cancer, including more than 80 percent of childhood cancers. But when it comes to considering chemotherapy as a treatment option, one size does not fit all, medical experts say.
“There are protocols that we share in the field,” says Dr. Ron Neuberg, medical director of the Children’s Cancer and Blood Disorders Center at Palmetto Health.
“Advances in the field are made using protocols that are devised by experts and made available through clinical cooperative trials. Often this involves local control with either surgery or radiation therapy or both, and systemic treatment with chemotherapy that gets all over the body. Not every cancer requires chemotherapy. It depends on the disease, and it depends on the stage of the disease.”
There’s also no way to predict what side effects will affect any patient. “I remind patients and families multiple times in our discussions that the worst side effect of your child’s disease is the disease,” Dr. Ron continues. “Although most of the side effects are temporary, there is the potential for permanent organ damage. So, you give medications that have a risk associated with them for the potential benefit of curing a life threatening disease. Years ago, we didn’t have to worry about long term effects because, unfortunately, there was no long term. Now that we can cure patients, we strive to minimize short term and long term unwanted effects,” Dr. Ron says.
At Lexington Oncology at Lexington Medical Center, physicians like Dr. Steven Madden treat a wide range of cancers including: brain, breast, colon, gastrointestinal, head and neck, lung and prostate cancer. Consultation with new patients often includes discussion about the side effects and benefits of treatment, he says.
“I think all of us would rather not subject patients to any medications that have side effects,” Dr. Madden says. “But on the other hand, prevention of recurrence or treating cancer that has spread while giving the patients a high quality of life and longer survival are all tremendously important. So, we try to weigh all that out, as best we can, patient to patient.”
Claire & Amee’s Stories
Claire Bristow counts herself blessed. Undergoing chemotherapy this past summer, it took just 16 rounds to treat her aggressive Stage II triple negative breast cancer found during a mammogram.
“After the first or second chemo treatment, the tumor started shrinking immediately,” says Claire, who experienced few side effects during chemotherapy. “Dr. Robert Smith was my oncologist, and when he gave me the news, I jumped up and hugged him. The South Carolina Oncology Association had the best staff. Everyone was so encouraging and made me feel they were on my side. I was so grateful for a chemo that would cure me.”
For Claire, fatigue and some forgetfulness were her main symptoms. So, she felt pangs of guilt when reacting to hair loss — just 10 days into treatment.
“It was traumatic the week I lost my hair, a really difficult time,” Claire remembers. “It made the cancer a harsh reality. That was when I realized I was sick. It made me feel bad to care about losing my hair because I didn’t want to focus on vanity. But when I looked in the mirror, and saw I had no hair, no eyelashes and no eyebrows, it felt weird to see myself like that.”
Like many patients, Claire had strong support from family, friends and her medical providers and credits her faith to helping her through cancer and chemo.
“On a walk one day, I saw this beautiful butterfly on the ground, and I saw that butterfly as a special gift. God was at work in my life with people reaching out to me and bringing cooked meals for me to feed my family,” she says. “Because I’ve been through the fire, I’m a different person. I’m so much stronger, spiritually and emotionally. I have greater clarity in my life, and all of my relationships are stronger than ever.”
The same is true for Amee White. Today a busy wife and mother, Amee remembers the day that traumatically changed her life.
“I had a wonderful husband, a beautiful son, and we had just moved into a new house. All the things that I had wanted all my life had come together and had come true. Life was grand,” Amee says. “Then on July 27, 2007 came the news that I had breast cancer.”
In addition to surgery and radiation, Amee’s treatment included chemo. Tiredness, painful joints, weight loss, hair loss, nausea, memory loss and loss of taste buds were just a few of her symptoms. But the most difficult part of chemo for Amee was not her own side effects, rather the affects the treatment had on those around her.
“The most difficult part was witnessing so many people going through the same journey that I was going through — people from all walks of life. I never knew how many people were dealing with cancer until I was diagnosed,” Amee says. “There was also my family. I had a small child that was only 13 months old and needed his mommy. I didn’t feel normal, like I had something foreign in my body.”
Amee says during her treatment and throughout her survivorship, she has found strength in the experiences of others and her faith.
“I don’t feel invincible, but I also know that there is a light at the end of every tunnel. No one is immune from the storms of life, and I have come to realize that how we choose to respond to life’s challenges is what can make us stronger or weaker,” Amee says. “I know that as long as I have my faith in God and the support of my family, anything that I may go through will make me stronger.”
Advancements in Chemo
Within the oncology community, there’s hope for the future of chemotherapy. New combinations of medicines, new drugs and new drug delivery systems are helping doctors cure or control cancers. And new uses of chemotherapy and other treatments hold promise, medical experts say. “We are headed in the right direction, especially with newer targeted drugs that tend to only affect the cancer cells and with fewer side effects. That’s going to be the wave of the future,” Dr. Madden says. “The more we can develop those types of drugs the less we have to worry about some of these other side effects that have been present with chemotherapy in the past.”
The American Cancer Society reports that among the advances in chemotherapy include: chemoprotective agents to protect against specific side effects of certain chemotherapy drugs, other approaches to targeting drugs more specifically at the cancer cells and new agents to help overcome drug resistance.
At Palmetto Health Children’s Hospital, where there are around 40 to 50 new cases of children with cancer seen annually, Dr. Ron has seen a combination of improvements, from better drugs to better strategies for fighting the disease. “The typical chemotherapy drugs that we’ve used for most of my career have been what I call nuclear warheads; they kill normal dividing cells as well as the cancer dividing cells,” says Dr. Ron, who has worked at the hospital for 30 years. “We are now beginning to develop smart bombs as opposed to nuclear warheads, and that is very promising for our patients. These agents target the cancer cells with much less effect on the normal cells, therefore less side effects. Our goal is to find therapy that is 100 percent successful with zero percent side effects. Clinical trials are the only way to determine the optimal treatment.”