No thanks to movies and televisions, cancer is often dramatised; and chemotherapy (chemo) and radiotherapy are always being portrayed as horrifying experiences, thus causing much fear, stigma and hopelessness for those who contracted the disease.
Despite the challenges that cancer brings, it is still possible to rebuild a really good life after cancer – even a healthier and better one than ever before, according to Dr Muhammad Azrif , an oncologist practising in Prince Court Medical Centre. Understanding and managing the effects of chemo and radiotherapy is one of the first steps towards a positive recovery.
Both chemo and radiotherapy are methods used to kill cancer cells. Chemo involves the infusion of certain drug(s) delivered intravenously into the body of the patientto reach cancer cells wherever they are. On the other hand, radiotherapy involves the use of X-rays targeting a specific part of the body.
“Chemotherapy is usually performed as a day treatment once a week or once every three weeks over a period of time according to the patient’s condition. There are 30 to 40 types of chemo drugs available and side effects vary according to the drug used. The more common ones are tiredness, nausea, constipation, indigestion or heartburn in the first week, and mouth ulcers, diarrhea and risk of infection in the second,”Dr Azrif said.
“To prevent nausea, patient will usually be given medication before chemo. After chemo, the patient should not eat too much food at a time especially during the first few days. Eatingsmall meals after three to four-hour intervals is better than consuming two or three big meals a day. Do not take any greasy or fatty food because they can increase bloating and nausea, as well as spicy food in case one has stomach ulcers or heartburn. Drink plenty of liquids especially if one is tired and having nausea. Taking ginger might also help alleviate nausea,” he advised.
To manage mouth ulcers, Dr Azrif recommended patients to brush their teeth with a soft toothbrush after meals to maintain oral hygiene. “When rinsing the mouth, use salt water instead of typical mouthwash which might be too strong. Ulcer medication can also be used on discreet ulcers. Usually, ulcers heal within one or two days.”
While chemo destroys cancer cells, it also reduces the number of white blood cells in the body. Hence, patients are particularly at risk of infections seven to 14 days after chemotherapy, when the level of white blood cells is at its lowest.
Infections can usually be effectively treated with antibiotics. To prevent an infection, Dr Azrif advised patients to avoid crowded and confined areas, like the LRT and cinemas. “Patients should wash their hands properly, especially when cooking food and after going to the bathroom. When outside of the house, they can carry with them a hand sanitizer. When gardening, they should wear gloves to avoid cuts or being pricked by thorns, and apply anti-septic creams if they cut their hand.
“In terms of diet, in order to prevent food poisoning, patients should cook their meat, eggs and seafood properly and avoid any half-cooked food. Fruits and vegetables, although don’t necessarily need to be cooked, should be cleaned thoroughly. Separate knives and cutting boards for meat and fruits should be used as not to transfer the germs from the meat to fruits which you don’t cook. Patients should also avoid sushi and sashimi,” he said.
Dr Azrif stated that none of these side effects lasts for weeks and weeks to come. “At most, they only last about two to three days. Usually by the third week, the patient’s immunity should bounce back. It is often the first week which is a bit rough mainly due to the tiredness and nausea. But things should be much better second week onwards. I even have patients who go back to work in the second week,” he explained.
“Some chemo drugs such as those which treat breasts cancer and leukemia can cause hair loss and numbness of the fingers, but these conditions always return to normal sooner or later. The hair will grow back within six months. In 12 years of my clinical practice, I have not come upon a single patient whose hair doesn’t grow back,” Dr Azrif assured.
The side effects of radiotherapy, on the other hand, are very specific and occurdepending on the areas of body treated.
“Radiotherapy is mainly prescribed for local control after surgery if there is a high risk of the cancer recurring at the area. Let’s take radiotherapy to the breast as example. The treatment area should always be kept clean and dry. A simple moisturing cream can be applied to minimise dryness. When bathing, patients should use a very gentle and moisturising soap such as baby wash because the typical soap might be too harsh and hence dry up the skin. If the skin is rather reddish, a steroid cream might be prescribed.”
Dr Azrif said that patients receiving radiotherapy to the breast will not develop diarrhea or nausea. Antibiotics will be given if the patient develops an infection.
He explained that whether or not a patient is required to undergo chemo or radiotherapy depends on the characteristics of the cancer. “If a cancer is mild, often patients do not need chemo. But whether they need radiotherapy or not depends on the kind of surgery done. For example, in breast cancer, if they just have the lump removed, the risk of the cancer coming back on the breasts is too high, so undergoing radiotherapy is advisable. But if patients have mastectomy (total removal of the breast), often they do not need radiotherapy. In oncology, we are dealing like 200 different kinds of cancer, so treatment is very much individualised. Patients could be treated differently even though they may be having the same stage of the same type of cancer.”
People used to worry about the side effects of chemotherapy but according to Dr Azrif, the medication available today are very good in managing the side effects. “Upon taking their medication, some patients don’t even experience any symptoms of nausea after chemo. If the patient develops a fever during the treatment period (which means that his white blood cells are low), we can give them a booster injection to boost the white blood cells count and keep the fever at bay.
“A lot of time is just doing the simple things well. None of them is very complicated. In fact, upon recovery, a lot of cancer patients tend to live healthier lives than the general people as they have learnt how to take care of their health properly,” he concluded.