What to expect from chemotherapy

[00:00:00] Host Amber Smith: From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." You may have heard about chemotherapy as a treatment for cancer. Today, we'll delve deeper into what it is and how it works with Timothy Chang. He's a pharmacist at the Upstate Cancer Center. Thank you for being here, Mr. Chiang.

[00:00:19] Timothy Chiang, pharmacist: Thank you for having me today.

[00:00:21] Host Amber Smith: What is chemotherapy? Is there a standard definition?

[00:00:25] Timothy Chiang, pharmacist: So if we look at the definition of chemotherapy, it's any medications that are used to treat fast-growing cells in the body, and typically this is referring to cancer cells.

[00:00:38] Host Amber Smith: So by fast-growing, if there's other cells that are fast-growing, they might be affected as well.

[00:00:46] Timothy Chiang, pharmacist: Yes, they can be, which leads to some of the side effects that can happen with chemotherapy.

[00:00:51] Host Amber Smith: I see. Well, so it's not a particular medication or even a combination of medications.

[00:00:58] Timothy Chiang, pharmacist: No, it's referring to a just a group of medications that can do this particular thing of killing those fast-growing cells.

[00:01:06] Timothy Chiang, pharmacist: So it's just a general term.

[00:01:09] Host Amber Smith: How many different chemotherapy drugs are there?

[00:01:12] Timothy Chiang, pharmacist: Probably close to a couple of hundred medications available right now, and as time goes on this number keeps growing and growing.

[00:01:22] Host Amber Smith: So are some of the same drugs used for a variety of different cancers, or does every cancer have its own unique kind of chemotherapy?

[00:01:33] Timothy Chiang, pharmacist: Depending on the medication, there is some overlap with medication between the different types of cancers. It depends: A lot of this depends on the sensitivity of the tumor to these different types of chemotherapy and if they are sensitive, there is a potential for using these chemotherapies in those medications.

[00:01:52] Host Amber Smith: Well, can you tell us about the first chemotherapy drug? I mean, how many years ago was this developed?

[00:02:00] Timothy Chiang, pharmacist: So the first chemotherapy drug was available back in the 1940s, and development of it was actually fairly interesting. It was derived from mustard gas that was used in World War I by the Germans, and what ended up happening was, a doctor was looking at some of the autopsy results on, in some of the soldiers from the First World War, and they noticed that the bone marrow in those patients was significantly altered by the mustard gas. And then they looked at this and realized that they might be able to use this type of medication for cancer. And so, they did some modification to the mustard gas and made it into an injectable product at that point. So it was called nitrogen mustard, and now it's commonly known as a drug called mechlorethamine.

[00:02:53] Timothy Chiang, pharmacist: And they used it to treat the first lymphoma patient in the 1940s, and that patient had great results with it and ended up in remission at that time.

[00:03:02] Host Amber Smith: So sort of discovered by accident?

[00:03:05] Timothy Chiang, pharmacist: Yes.

[00:03:06] Host Amber Smith: Wow. So the patient in the '40s had lymphoma. What kind of cancer is that?

[00:03:12] Timothy Chiang, pharmacist: It's a blood type of cancer. A cell type in the lymph node starts growing uncontrollably.

[00:03:17] Timothy Chiang, pharmacist: And there are some more underlying things that can cause this, but that's the general definition.

[00:03:24] Host Amber Smith: Interesting. Well, can you walk us through how chemotherapy has evolved since then?

[00:03:31] Timothy Chiang, pharmacist: In the broadest terms, chemotherapy can affect all types of cells. As time's gone on, scientists are now looking at using more targeted approaches to try to minimize some of the toxicities to patients.

[00:03:43] Timothy Chiang, pharmacist: So as you look as time has gone on, the chemotherapy has become more and more targeted towards specific targets on the cancer cells. So a lot of the new oral medications that are out there, they're called molecular targets on the outside of the tumors, and they stop cell signaling, so a lot of the newer drugs are targeting this and some of the newer IV (intravenous) medications are looking at the same thing. They're targeting a specific module on the outside of that tumor and trying to minimize toxicity to our patients.

[00:04:11] Host Amber Smith: That's what I was going to wonder. Because if this started with mustard gas, toxic, the drugs have become less toxic over time?

[00:04:18] Timothy Chiang, pharmacist: So we hope they've become less toxic. Unfortunately, there are still a lot of side effects with some of these newer medications, they're just trying to focus it more, unfortunately by inhibiting a specific target, though. Sometimes those targets still affect some normal cell function as well. And that's what leads to some of these side effects.

[00:04:40] Host Amber Smith: So is the goal of chemotherapy always to kill the cancer cells?

[00:04:46] Timothy Chiang, pharmacist: It's either to kill the cancer cells or to slow down the growth of the cancer cells as well.

[00:04:53] Host Amber Smith: And then you use the term cell signaling that does that have to do with cell growth?

[00:04:58] Timothy Chiang, pharmacist: Yes. It can deal with cell growth. Yeah.

[00:05:02] Host Amber Smith: What about, are there other diseases other than cancer, for which chemotherapy may be prescribed?

[00:05:09] Timothy Chiang, pharmacist: Yes. There's some autoimmune type diseases that it can be used for. So things like rheumatoid arthritis, multiple sclerosis is starting to utilize some chemotherapy medications to try to slow down the course of the disease by stopping the immune system.

[00:05:26] Host Amber Smith: Interesting. You're listening to Upstate's "HealthLink on Air." I'm your host, Amber Smith, talking with pharmacist Timothy Chang from the Upstate Cancer Center, and our subject today is chemotherapy. Why are some chemotherapy medications oral and some intravenous, through a needle?

[00:05:46] Timothy Chiang, pharmacist: So it depends on how the medication can be absorbed. Some medications can be absorbed orally and then if when they go through the gut, they need to be converted by the liver, and some medications just aren't able to be absorbed that way, we can utilize the gut. Sometimes that is the best option. And also has to do with some of the toxicities available in the medications as well

[00:06:09] Host Amber Smith: Which works quicker, oral or intravenous?

[00:06:14] Timothy Chiang, pharmacist: Typically, IV has a faster onset of action, just because it's going straight into the bloodstream. The oral medications still work fairly quickly though, and so, I wouldn't say one's faster than the other necessarily.

[00:06:28] Host Amber Smith: And with other types of medications, I hear the term "time release," because they're meant to work over a course of hours or days, I guess.

[00:06:38] Host Amber Smith: Does that apply to chemotherapy drugs as well?

[00:06:40] Timothy Chiang, pharmacist: Certain chemotherapy medications, and sometimes that has to do with where in the GI (gastrointestinal) tract it needs to be absorbed from, so sometimes they'll say it's a time-release medication,though, so it has some protection for the medication. So it needs to get to a certain part of the gut in order for it to absorb properly.

[00:07:00] Host Amber Smith: Now if someone needs an infusion and needs the intravenous chemotherapy type through an infusion, what determines if that person is going to be hospitalized for that, or if they come and go home after the infusion?

[00:07:16] Timothy Chiang, pharmacist: So that's a great question. Sometimes it has to do with some certain risk factors for the patients.

[00:07:21] Timothy Chiang, pharmacist: So if they are at risk for having some type of reaction, they maybe could end up in the hospital. Depending on when they're diagnosed, too, unfortunately, some patients are then diagnosed right in the hospital, so they need to get treated right away. Also depending on the cancer type as well, so certain acute leukemias need to be treated in the hospital just because of the severity of his disease.

[00:07:44] Timothy Chiang, pharmacist: If it's not as severe, they can be treated on an outpatient basis if the medication allows for it to be like that, and also, depending, some patients need something called a continuous infusion, where they need to be hooked up to a pump. If we're able to, we'll send them home with something.

[00:07:58] Timothy Chiang, pharmacist: If not, they need to be admitted to the hospital just because of the time it takes for the infusion to go in.

[00:08:05] Host Amber Smith: In general, how would you tell a person to prepare for chemotherapy?

[00:08:11] Timothy Chiang, pharmacist: So the best thing to tell a patient is to get plenty of rest and keep up their nutrition. That is really the key factor to preparing themselves for this.

[00:08:24] Host Amber Smith: So be well rested, well hydrated, you know, good nutrition. Are there a set of side effects that are common with all chemotherapies, or is it very individualized to the drug?

[00:08:37] Timothy Chiang, pharmacist: It's individualized to the drug. Yeah, it's very individualized to the drug and to the patients, too. Some patients will not have any side effects from the medications and some patients will have some reactions to the medication.

[00:08:53] Host Amber Smith: I've heard about people losing their hair during treatment because of chemotherapy, is that as common today, as it used to be?

[00:09:02] Timothy Chiang, pharmacist: Again, it depends on the medication. So as we were talking about before, with some of the side effects, we had said that chemotherapy works on the fast-growing cells in the body, and one of the fastest growing cells in the body are the cells that produce the hair. And so, like I said, if the chemotherapy is targeting those rapidly growing cells, that's one of the first things that unfortunately can go, is the hair loss

[00:09:29] Host Amber Smith: Well, other than rest and nutrition, is there anything people can do, maybe during an infusion, even, that will help their body receive the medication?

[00:09:39] Timothy Chiang, pharmacist: Hydration and nutrition are probably the best things that they can do. And just making sure they have a good support system as well, to make sure those people around them that are able to help them during this tough time.

[00:09:51] Host Amber Smith: Are there medications or strategies that can be useful to offset any negative side effects, such as nausea or fatigue?

[00:10:01] Timothy Chiang, pharmacist: Yes. So as far as the nausea and vomiting go, and that is also one of the major side effects with a lot of these medications. And depending on the medication that's being given, there's a wide range of anti-nausea medications that would be given. One example is a medication called Zofran or ondansetron that seems to be the most commonly used one. And then depending on the combination of chemotherapy medications that are being given, certain combinations have a higher potential for patients to have nausea and vomiting. And in those groups of patients, we'll give a combination of anti-nausea medications to try to help calm that down.

[00:10:39] Timothy Chiang, pharmacist: And it's always important for the patients to remember, too, what we're going to give them, the most common anti-nausea medications, if they have nausea and vomiting still through that, though, it's important for the patients always let either the pharmacy or the nurse or the oncologist know, and then they can always find something a little bit stronger to help these patients through this tough time.

[00:11:02] Timothy Chiang, pharmacist: You don't want a patient to go home with that nausea and vomiting, have these poor outcomes because of that.

[00:11:09] Host Amber Smith: Do you have any advice for family members or loved ones for how they can help someone who's undergoing chemotherapy?

[00:11:16] Timothy Chiang, pharmacist: So the best thing to do is be an advocate for the patient. Do your research on the chemotherapy medication that the patient is going to be getting, be present for that education part of it and just keep an eye out for the patient.

[00:11:29] Timothy Chiang, pharmacist: Sometimes patients are too weak to say anything or too scared to mention anything. But if you can be an advocate for them, that really is the best thing. And the other thing to remember too, is, with some of these newer oral medications, it seems that if it's an oral medication, there won't be any side effects with these medications, but it's important to stay on schedule with those medications.

[00:11:48] Timothy Chiang, pharmacist: And also remember there are side effects that can happen and it's important to try to watch out for those side effects. And then if we can keep those under control, the patients can stay on those therapies for a longer period of time and hopefully have a better outcome and keep the disease in check.

[00:12:03] Host Amber Smith: Thank you to pharmacist Timothy Chang from the Upstate Cancer Center. I'm Amber Smith for Upstate's podcast and radio talk show, "HealthLink on Air."