Medicines taking sting out of side effects

Author: David Rumbach

No wonder chemotherapy can be hard to take.

The very first chemical ever used to fight cancer was, believe it or not, mustard gas.

Since then, physicians have found ways to ease patients’ suffering from many, but not all, of the harsh side effects.

They have good medicines to prevent nausea and vomiting, said Dr. Rudolph Navari, director of the Walther Cancer Institute at the University of Notre Dame.

It used to be that nine of 10 people receiving chemotherapy suffered nausea; with new drugs, that’s down to only about one in five.

“It is a relatively rare case that someone has intractable nausea that can’t be controlled,‘’ said Dr. Chil Kang, an oncologist-hematologist in South Bend. "We can get people through this much better than even five years ago.’’

Other medicines are available to boost patients’ supply of white blood cells. A drop in white blood cell counts, a side effect of chemo, makes people vulnerable to infections.

Navari said that before the invention of "stimulating factors,’’ which spur production of white blood cells, about a third of patients wound up in the hospital with an infection during the course of their chemo.

“Now it’s about 5 percent,’’ Navari said.

But loss of appetite and the resulting rapid weight loss remain unsolved problems for many patients, Kang said. "People say food tastes like cardboard and they don’t have any motivation to eat because taste is not there.’’

No medicines are available that effectively stimulate appetite for patients undergoing chemo. To make food even less attractive, chemotherapy also may cause painful mouth sores, not only in oral cancer, but in all types of cancer.

“The most I can do is play cheerleader,’’ Kang said.

It’s an important issue, he said, because studies have shown that chemotherapy is less effective when people lose weight rapidly or become dehydrated during treatment.

The therapy also works less well if people string out the treatments, which are usually given every three weeks or so. Such delays give cancer cells a chance to develop resistance.

“Our goal is ‘planned therapy on time,’ ‘’ said Kim Woofter, a cancer nurse and administrator at Michiana Hematology-Oncology Inc. "That provides the best survival benefit.’’

Chemotherapy was invented during World War II when doctors noticed that some people accidentally exposed to mustard gas had very low counts of white blood cells.

According to the American Cancer Society, they reasoned that mustard gas might be effective against lymphoma, an overgrowth of certain white blood cells called lymphocytes. They gave it to lymphoma patients in an injectable form, and it worked, but only temporarily.

Today, more than 100 kinds of chemotherapy are used, according to the ACS, all of which work by killing cells that grow rapidly.

Those rapidly growing cells include not only cancer, but healthy cells in the body that also have the property of fast growth: hair cells and cells in the stomach lining and mouth. The destruction of those healthy cells is one reason people suffer side effects during chemotherapy.

Fortunately, continuing research holds promise of further improvements.

A recent study led by Navari at Notre Dame found that the addition of a psychiatric drug called Zyprexa made anti-nausea medicines work better.

Another study, not yet published, assessed the value of screening cancer patients for depression and providing treatment to those found to have symptoms.

“Guess what?‘’ Navari said. "More of those who were treated got through chemotherapy.’’

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