A brief background about chemotherapy (chemo)

Mustard gas, a poison, was used in World War I (1914). The soldiers who had cancer and were exposed to the gas showed improvement in their cancers. These healing effects of mustard gas were discovered by accident and called chemotherapy.

Many changes have occurred in chemo:

• The types of drugs used
• How the drugs are given to the patient
  • Intravenous (IV, injected in a vein)
  • Orally (pills, by mouth)
  • Catheter (through a tube sewn into the body when the veins cannot handle the drugs or when the amount of drugs is very large)
  • The strength of the drugs (dosage)
  • The combinations of drugs
  • How often chemo is given (frequency)
  • How long the series of chemo treatments last (6 weeks, then a break for a few months) (duration)

• There are more than fifty different types of chemo drugs

• The drugs are used in different proportions or amounts

• The drugs are combined with other chemo drugs (chemo cocktail)

• The amount and type of chemo you receive is based on the
  • The type of cancer cells (histology)
  • The size of your tumor
  • Whether or not your cancer has spread (metastasized)

• How chemo works
  • Cancer cells grow and duplicate quickly.
  • Chemo uses drugs that kill cells or slow down their duplication.
  • In general, chemotherapy drugs affect the DNA of the cells by interfering with cell duplication.
  • Chemo drugs are poisons that breaks up the DNA so that it cannot make new cells

• Chemo is given to:
  • Shrink the size of a tumor before surgery or radiation
  • Kill or poison cancer cells when surgery is not an option (to destroy or slow the growth of cancer cells)
  • Kill or poison any remaining cancer cells that were not removed during surgery (to stop cancer from spreading)
  • Relieve cancer pain or other symptoms

"During the surgery of course they check your lymph nodes and I had one cancer cell out of seventeen so my doctor then recommended that I go through a six month course of chemotherapy and he really said it was up to me uh if I didn't really want to do the chemo that it was only one in seventeen so that it might be okay not to do it but he just really advised that I strongly consider it because it was kind of like added insurance and I have a cousin who's a medical doctor and he called and he said you've really gotta do it, it's really important, it's added insurance and it's not gonna be all that difficult to get through six months of chemo, so I decided well maybe I should do it. So I went in immediately and did the whole six months of chemotherapy as an outpatient ." to play Video Vignette - click

"I didn't even know what an oncologist was, so I was happy that when I did meet the oncologist. He took the time, he let me know how the chemotherapy would react when they introduced it into my blood system and how the process builds."

• Chemo drugs affect both the cancerous and the healthy cell DNA.
• The healthy cells that are particularly susceptible to chemo are by cells that multiply quickly:
  • The skin (including body, facial, and head hair)
  • The digestive system (gastrointestinal tract)
  • The bone marrow (that makes red and white blood cells)

"Chemo is not easy, because it really, uh, it really lowers your resistance to a considerable extent, because they are trying to kill off the cancer cells, a lot of other good cells are killed in the process so your immune system is really assaulted and I think the thing that probably bothered me more than anything during chemo was a lowered resistance and one really needs to be careful during that stage, that you're not in contact with people that have contagious diseases, that you're not around people who have a lot of colds and have the flu. You just gotta be a lot more cautious, and once you catch something like even a minor cold, that could be major and uh so you've really gotta take care of yourself." to play Video Vignette - click

• The most common reason is because your cancer is different from the patient sitting next to you (you have a different type of breast cancer)
• Another reason is that you may have had severe side effects and they are using a different combination of drugs (cocktail) to see if you react better to the treatment
• Another reason is that one of you may be on a clinical trial that is using a drug combination that may or may not be better than standard treatment for your type of cancer.
• Sometimes, we do not get the standard treatment because we do not have private insurance or our insurance is limited. This is not supposed to happen, but sometimes does.

"I kept seeing the same lady in the chemo room and we began to visit a lot during the chemo. It ended up that we both had the same type of cancer. You know, the same stage and everything. But she was getting different drugs than I was. When the nurse came in, I asked her why we were getting different treatments because we had the same cancer. She said, oh you have different doctors, but she kind of looked embarrassed. So, when I saw my doctor, I asked him. He gave me some really flaky answers and then finally said, you're here on IHS contracted services and they don't cover those other drugs. I was so mad. I went to the hospital director's office. I told him I was just as important as the white people and that he'd better find a way to get me the same drugs. Next time I went for chemo, I had the same drugs as my white friend."

• Most patients come to the hospital or clinic and receive the chemo drugs through an IV (intravenous) tube
  • You sit in a room alone or with other patients who are also getting chemo
  • Your family or friends can come sit with you while you receive the treatments
  • You may want to bring a blanket because if your treatment lasts for a few hours, you may get cold (the liquid in the IV is cold)
  • You may want to have a glass with some ice chips to suck on
  • You may want to drink a mild tea, like ginger tea to help reduce the upset stomach
  • If you are diabetic, you need to bring a healthy snack or drink so that your blood sugar doesnt get too low while you are in treatment.

"Nothing really happened except I got cold as this waters' cold you know it looks like plain water and stuff. So, I was reading in a book too, and it says, you know, drink warm, a lot of liquids, this is highly concentrated medication. So that's what I did, I drank hot water to warm myself up you know while they did it." to play Video Vignette - click

"I was in the room long enough when I had the chemo, the chemotherapy. I wouldn't wear a jacket or anything because it was Summertime. But I'd always ask for a blanket when I got there, and they'd cycle maybe two or three blankets for me, because I was there long enough, and what they'd do is they'd put them in the microwave, they had a microwave in the clinic and they were nice and warm, and I always got chemotherapy in the same arm, and I able to just lay my arm on the warm blanket and it kept this arm warm on the left side. It's important that you drink lots of water, and fluids or whatever." to play Video Vignette - click