Research Assessment #5

Date:​ October 18, 2019

Subject:​ Oncology

MLA Citation:

“How Is Chemotherapy Used to Treat Cancer?” American Cancer Society, 16 Feb. 2016,

https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/chemother

apy/how-is-chemotherapy-used-to-treat-cancer.html.

Assessment:

Chemotherapy refers to the treatment of any disease using medicinal drugs. Most people

associate chemotherapy, often shortened to just chemo, with the treatment of cancer. The other

common treatment methods of cancer include radiation and surgery. All three of these techniques

work to reduce the size of the tumor by killing or removing the cancerous cells. While many

would be able to point out the most notable side effect of chemotherapy, losing hair, few people

know what chemotherapy is truly doing to cause this side effect in conjunction with a multitude

of other side effects, and how exactly it can treat cancer. In the article entitled “How Is

Chemotherapy Used to Treat Cancer?” the team at the American Cancer Society answers the

question about what exactly chemotherapy is and its effects.

The first piece of information I learned from this article is that there are three main goals

for chemotherapy: cure, control, and palliation. This information surprised me as I had before

this point never heard of the word palliation before. It refers to the relieving of something

(typically pain). The article, thereafter, dives into the first goal of chemotherapy, to cure. Within
this portion of the article, I learned that chemotherapy uses medicinal treatments to treat cancer

by destroying the cells of the body in an attempt to kill the cancer cells. It is because

chemotherapy indiscriminately kills both healthy and cancerous cells that patients experience the

side effects of losing hair and having an overall sickly appearance. Since this process is not

foolproof, doctors refer to this type of treatment as something of curative intent, which means it

can cure. This information surprised me as I have never heard of the term curative intent before.

The next main goal the article discusses is control, which chemotherapy does by preventing the

growth and spread of the tumor. The article notes, though, that the tumor may not go completely

away through chemotherapy treatment. It can even come back (relapse) and chemotherapy may

need to be administered again. The final main goal I learned more about is palliative care, which

is a treatment to ease the symptoms of cancer for patients, especially those who are in its

advanced stages. This is done to give the patients a better more painless quality of life.

The article then goes on to discuss the technicalities of chemotherapy. The first bit of

information I learned from this portion of the article is that chemotherapy often treats cancer

using more than one type of chemo drug in conjunction with others. I was surprised to learn this

as I was unaware that there was more than one type of chemo drug, and that you can combine

these different types of chemo drugs to create an overall more effective treatment. When

deciding what chemo drugs to use Oncologists take into consideration the following situations:

the type of cancer, the stage the cancer is currently in, how old the patient is, the patient’s current

level of health, other health issues of the patient, and any past cancer treatments the patient

already received. I also learned that there are specific terms used to refer to when chemotherapy

is used in conjunction with radiation or surgery for the treatment of cancer. According to the
article, when chemotherapy is used before it is called neoadjuvant therapy and when it is used

after it is referred to as adjuvant therapy. Additionally, I learned from the article how

chemotherapy treatment dosages are calculated. The dosage amount is determined by either the

patient’s body weight in kilograms or their body surface area. The dosage amount is also affected

by how old the patient is, their nutritional status, if they are obese or not, any other medicines

they have taken or are currently taking, if the patient has gone through radiation, the patient’s

blood counts, and if they are suffering from any other ailments such as kidney or liver disease.

The next piece of information I learned from this article is that chemotherapy cycles, which

refers to how often chemotherapy is administered, are dependent upon what type of chemo drugs

are being used. Cycles are determined to get the best results with as few side effects as possible.

These recommended cycle amounts are also based upon information collected from clinical trials

as well.

All in all, from this article that delved into the topic of chemotherapy, I learned that there

are three main goals that chemotherapy treatment is trying to achieve for cancer patients. The

first goal is to cure the patient of cancer by using medicine to destroy the cancer cells. It also has

an adverse effect of killing healthy cells which creates side effects such as hair loss. A second

goal is to control the cancer by limiting its spread and shrinking the overall size of the tumor.

The third and final goal is to offer palliative treatment to cancer patients to help relieve their pain

and give them an overall better quality of life. Also, I learned from the article that chemotherapy

treatment can use multiple types of chemo drugs that are determined by certain extenuating

factors about the patient. I also learned how Oncologists calculate the dosage amount from either

body weight or body surface area. Dosage is also affected by certain extenuating factors of the
patient as well. Finally, I learned that Oncologists determine how often chemotherapy treatments

are given to patients based upon what type of chemo drug they are receiving. All of the

information I gain from this article is important as it has informed me more about how the main

type of treatment I will be administering as an Oncologist, chemotherapy, works. The

information from this article was also important in the sense that it taught me how I will go about

determining which chemotherapy drug or drugs I will use, how I will calculate the dosage

amount, and how I will calculate the chemotherapy cycles. Furthermore, I will use the

information I learned in this article in the future when I am administering chemotherapy to my

patients to save their lives. I will use this information now during my ISM journey as it will be

vital for me to incorporate information about chemotherapy into my winter presentation and final

presentation to ensure that those who view my presentation better understand what my

profession entitles. In conclusion, I learned a plethora of important information about

chemotherapy from this article that will help me in the future as I administer this type of

treatment to my patients, and now during my ISM journey when I present information about my

profession to others.
Article: ​*Annotations are bold and italicized*

How Is Chemotherapy
Used to Treat Cancer?
Chemotherapy is the use of any drug to treat any disease. But to most people, the
word chemotherapy means drugs used for cancer treatment. It’s often shortened to
​ hat chemotherapy is.
“chemo.” W

Surgery and radiation therapy remove, kill, or damage cancer cells in a certain area,
but chemo can work throughout the whole body. This means chemo can kill cancer
cells that have spread (metastasized) to parts of the body far away from the original
(primary) tumor.

Goals of chemotherapy
treatment
If your doctor has recommended chemotherapy to treat your cancer, it’s important to
understand the goals of treatment when making treatment decisions. There are
three main goals for chemotherapy (chemo) in cancer treatment:

1. Cure
2. Control
 3. Palliation ​Goals of chemotherapy treatment.

Cure
If possible, chemo is used to cure cancer, meaning that the cancer is destroyed – it
goes away and doesn’t come back.

Most doctors don’t use the word “cure” except as a possibility or intention. So, when
giving treatment that has a chance of curing a person’s cancer, the doctor may
describe it as treatment with curative intent. ​Chemotherapy in relation to being a
cure.

There are no guarantees, and though cure may be the goal, it doesn’t always work
out that way. It often takes many years to know if a person’s cancer is really cured.

Control

If cure is not possible, the goal may be to control the disease. Chemo is used to
shrink tumors and/or stop the cancer from growing and spreading. This can help the
person with cancer feel better and live longer.​ A second goal of chemotherapy.

In many cases, the c​ ancer doesn’t completely go away,​ but is controlled and
managed as a chronic disease, much like heart disease or diabetes. In other cases,
the cancer may even seem to have gone away for a while, but it’s expected to come
back. Then chemo can be given again.
Palliation

Chemo can also be used to ease symptoms caused by the cancer. This is called
palliative chemotherapy or palliation.

When the cancer is at an ​advanced stage,​ meaning it’s not under control and has
spread from where it started to other parts of the body, the goal may be to improve
the quality of life or help the person feel better. For instance, chemo may be used to
help shrink a tumor that’s causing pain or pressure.​ What palliative care is.

It’s important to know that any treatment that’s used to

reduce symptoms or improve comfort is called
palliative care​. For example, anti-nausea
treatments or pain medicines are palliative, and can
be used at all stages of treatment. It can be
confusing when chemo is used as a palliative
treatment, because it’s most often used to try to
cure or control the cancer. But when it’s used with
the goal of comfort, chemo becomes palliative care.
Planning chemotherapy
treatments
You and your cancer doctor, called an oncologist, will decide what drug or
combination of drugs you will get. Your doctor will choose the doses, how the drugs
will be given, and how often and how long you’ll get treatment. All of these decisions
will depend on the type of cancer, where it is, how big it is, and how it affects your
normal body functions and overall health.

Cancer can be treated with a single chemo drug, but often several drugs are used in
a certain order or in certain combinations (called combination chemotherapy).
Different drugs that work in different ways can work together to kill more cancer
cells. This can also help lower the chance that the cancer may become resistant to
any one chemo drug.

Sometimes chemo is the only treatment you need. More often, chemo is used with
surgery or radiation therapy or both. Here’s why:

● Chemo may be used to shrink a tumor before surgery or radiation therapy.

Chemo used in this way is called neoadjuvant therapy.
● It may be used after surgery or radiation therapy to help kill any remaining
cancer cells. Chemo used in this way is called adjuvant therapy.
● It may be used with other treatments if your cancer comes back. ​Different
uses of chemotherapy.
Determining which chemotherapy
drugs to use
In some cases, the best choice of doses and schedules for each chemo drug is
clear, and most doctors would recommend the same treatment. In other cases, less
may be known about the single best way to treat people with certain types and
stages of cancer. In these cases, different doctors might choose different drug
combinations with different schedules.

Factors to consider when choosing which drugs to use include:

● The type of cancer

● The stage of the cancer (how far it has spread)
● The patient’s age
● The patient’s overall health
● Other serious health problems (such as heart, liver, or kidney diseases)
​ actors that affect what
● Types of cancer treatments given in the past F
chemotherapy drug is used.

Doctors take these factors into account, along with information published in medical
journals and textbooks describing the outcomes of similar patients treated with
chemo.

Determining chemotherapy doses

Most chemotherapy (chemo) drugs are strong medicines that have a fairly narrow
range for dose safety and effectiveness. Taking too little of a drug will not treat the
cancer well and taking too much may cause life-threatening side effects. For this
reason, doctors must calculate chemo doses very precisely.

Depending on the drug(s) to be given, there are different ways to determine chemo
doses. Most chemo drugs are measured in milligrams (mg).

​ ody weight in kilograms​ (1

The overall dose may be based on a person’s b
kilogram is 2.2 pounds). For instance, if the standard dose of a drug is 10 milligrams
per kilogram (10 mg/kg), a person weighing 110 pounds (50 kilograms) would get
500 mg (10 mg/kg x 50 kg).

​ ody surface area (BSA),​ which are

Some chemo doses are determined based on b
calculated using height and weight. BSA is expressed in meters squared (m2​ )​ . H
​ ow
chemotherapy doses are determined.

Because children’s bodies process drugs differently, dosages for children and adults
differ, even after BSA is taken into account. Children may have different levels of
sensitivity to the drugs, too. For the same reasons, dosages of some drugs may also
be adjusted for people who:

● Are elderly
● Have poor nutritional status
● Are obese
● Have already taken or are currently taking other medicines
● Have already had or are currently getting radiation therapy
● Have low blood cell counts
● Have liver or kidney diseases​ Factors that affect chemotherapy doses.
Determining a chemotherapy schedule (cycle)

Chemotherapy is commonly given at regular intervals called cycles. ​A cycle may be

a dose of one or more drugs followed by several days or weeks without treatment.
This gives normal cells time to recover from drug side effects. Sometimes, doses
may be given a certain number of days in a row, or every other day for several days,
followed by a period of rest. Some drugs work best when given continuously over a
set number of days. ​How chemotherapy cycles are determined.

Each drug is given on a schedule that makes the most of its anti-cancer actions and
minimizes side effects. If more than one drug is used, the treatment plan will say
how often and exactly when each drug should be given. The number of cycles given
may be decided before treatment starts, based on the type and stage of cancer. In
some cases, the number is flexible, and will take into account how the treatment
affects the cancer and the person’s overall health.

Changing chemotherapy doses and schedules

In most cases, the most effective doses and schedules of drugs to treat specific
cancers have been found by testing them in ​clinical trials​. ​ Clinical trials have
affected chemotherapy cycle determination. I​ t’s important, when possible, to get
the full course of chemo, the full dose, and keep the cycles on schedule. This gives
a person the best chance of getting the maximum benefit from treatment.

There may be times, though, when serious side effects require adjusting the chemo
plan (dose and/or schedule) to allow you time to recover. Sometimes, you might be
given supportive medicines to help your body recover more quickly. Again, the key is
to give enough chemo to kill the cancer cells without causing other serious
problems.