No matter what type of treatment a patient decides on, there are short- and long-term consequences.
The story of a Connecticut girl fighting for the right to choose how to treat her cancer has filled the headlines. Cassandra C's case centers on her refusal of chemotherapy. Chemotherapy is one of the more common treatments for cancer.
Dr. Adam Boruchovis an oncologist at St. Francis Hospital in Hartford. He explained that chemotherapy is used when cancer is widespread in a person's body, because the chemicals can go into the blood system and travel throughout the entire body.
These therapies kill actively dividing cells in the body, like cancer cells, Boruchov said. "It's kind of like when you put a pizza in a room with a bunch of hungry people," he said. "If the pizza has poison, the hungrier people who eat the most pizza are going to get the most poison."
That's how chemotherapy works, Boruchov said. "If you put it in the body, the cells most actively dividing are going to take up the most chemotherapy, and be destroyed."
But chemotherapy also produces side effects, Boruchov said, because there are other cells in our bodies that also rapidly divide. "Normal cells such as the immune system, or the skin, or the gastro-intestinal tract, can also take up some of the toxin, and therefore the cells there can die," he said. "We can get side effects such as suppression of the immune system, or nausea, vomiting, diarrhea, or even the hair falling out."
Boruchov specializes in treating leukemia and lymphoma, or blood cancers. He said treatment options for those are different from solid organ cancers like lung and breast. When talking about chance of survival with his patients, he said he discusses how and when to treat cancer.
"What we always talk about is Risk Benefit Ratio, because sometimes we can treat and make cancer go away but we don’t necessarily have to and the side effects that would be brought on aren’t necessarily worth it. So why expose someone to needless side effects if you’re not going to cure them of the disease?" Boruchov said. "On the other hand, there are certain types of aggressive lymphomas and leukemias [which], if not treated, are lethal. In that setting, if we do nothing, we know that alternative is death, and that is clearly unacceptable, so we offer chemotherapy options."
No matter what type of treatment a patient decides on, there are short- and long-term consequences, from nausea to organ damage, to a chance for new cancer later in life. Boruchov stressed that in medicine, particularly in oncology, "nothing is for free; nothing is without its side effects."
Below is more from our conversation with Boruchov:
WNPR's Lucy Nalpathanchil: What are the short-term and long-term side effects for someone going through chemotherapy?
Dr. Adam Boruchov: One of the most common side effects of most chemotherapies is lowering of the blood counts, and lowering of the red blood cells, which can make people tired and anemic. There are some therapies we can do for that.
One of the simplest is a blood transfusion. Lowering of the platelets can make patients have easy bleeding or bruising, and we can give them platelet transfusions. Lowering of the white blood cells is the most dangerous, because that sets people up for life-threatening infections.
So one of the newer developments in recent years are some of the supportive therapies that we have to manage these side effects. For example, there's a white blood cell growth factor we deliver right after chemotherapy to help rescue the white blood cells, to minimize the time that patients have low white blood cell counts to minimize their chance of infections.
And long-term side effects?
The most bizarre side effect to talk about with a patient is not a very common side effect. Many chemotherapies can cause a secondary leukemia, or another blood cancer.
So you are getting rid of one blood cancer, and can get another blood cancer, but that is rare. I'm always up front with patients [that] that can happen.
Some other side effects of chemo and radiation, in combination, are long-term damage to the heart. Or a patient can get a side effect in the short term that is long-lasting, such as neuropathy, which is damage to the nerve tissue.
There are other times that chemotherapy can cause damage in the short term that is long lasting. For example, some chemotherapies can cause damage to organs, such as the liver, or the kidney, or as I said before, the heart, or even the lung, and those can be life-long damage.
How do you talk about chance of survival with a patient?
Oncologists read about data in terms of percentages and overall survival, or median survival, at five years. These are ways to look at previous studies with patients. It’s an important way to frame it, but in the end, there’s no such thing as 20 percent survival. You're either surviving, or not.
For any given patient, it’s either going to work or not work. Those numbers are really used when looking at thousands of patients. It's very misleading to use those averages or median survival. Because when you are sitting in a room one-on-one with a patient, it's just one patient. They were not 1,000 patients on those previous studies. What I do, is I say: is there a chance for a cure? Yes or no. If there is: how big of a chance; is it worth going through?
How do you compare cancer treatments 30 years ago to today?
There's been great developments not only in chemotherapies, but in the different types of surgeries we do. Even radiation therapies have changed. There's new chemotherapies; there's immune therapies; there's vaccine therapies; there's a whole host of therapies. Even supportive therapies -- the medicines to treat or prevent nausea -- are amazing; 2015 is a new time in oncology. There's a lot of reasons to look forward to the future.
