Changes in Chemo

The Changes in Chemotherapy.

By Sue Leonard.

Published in The Irish Independent, 16^th march 2009.

The word ‘cancer’ spells terror. We know that the Big C is no longer, automatically, a killer. We know that many people now survive, but we fear the treatment too. We’ve heard the horror stories. We think of the vomiting; the constant illness, and wonder how we would ever find the strength to cope.

Cancer is still a serious illness. People still, do, die, but the treatment, in the past twenty years, has improved beyond recognition. The treatment, of course varies hugely for every type of cancer; and indeed, for each individual.

Take breast cancer. There are many different types of breast cancer, and different treatments, but the news, in general, is good.

“The treatment for breast cancer is dramatically better,” says Dr John Kennedy, Consultant Medical Oncologist at St James’s Hospital.

“Back in the eighties there were, maybe, two or three drugs available to treat breast cancer. The drugs had just a modest impact on the risk of reoccurrence in early stage cancer, and just a modest benefit for those with advanced disease. There have been huge advances in both those areas.”

We now have well organised expert centres, so it’s easier to treat patients. Chemotherapy can be prescribed specifically for each patient.

“The chemo drugs are better, and medications to prevent sickness and reduce the risk of infections have improved too,” says Dr Kennedy.

There are better hormonal therapies; and better ways of managing patients who have more advanced breast cancer.

“We now use bisphosphomates; drugs that are also used for osteoporosis to help when breast cancer has reached the bone. These substantially reduce pain, and the risk of fracture.”

Patients don’t feel as bad as they once did, either.

“These days vomiting is unusual; most patient’s don’t ever vomit. 20 years ago, they all would. This is because there’s now a range of effective drugs to treat it.

“The newer chemotherapy therapies tend not to cause low blood counts or sickness, but they can cause tiredness.

“The majority of patients say that the chemotherapy treatment was not as bad as they thought it would be,” says Dr Kennedy. “They say it was over quicker than they expected it to be. For most people it takes six months of therapy; and getting back on their feet takes a year.

“It is routine for me to see patients in my clinic who were diagnosed seven or eight years ago with a very high risk breast cancer, who are now well. I am convinced that 20 years ago, those women would not be around.”

Naomi Fitzgibbon, breast cancer information nurse with the Irish Cancer Society, says that patients are generally terrified before they attend treatment.

“They have to go through this whole learning curve, with all these technical new words. They have heard all these stories, and have no idea what the first treatment will be like.

“It can be disconcerting, too, that the lady beside her, who also has breast cancer, might be on a completely different set of drugs. They may have their treatments in a different order. Some women have chemotherapy after surgery, and some before. It depends on the type of cancer that they have, and on the stage it is at.

“It’s not ‘one size fits all.’ The treatment is now very much tailored to suit the woman. And, now that we know how the drugs work we cab pre-empt the side effects before they happen.

“But the really good thing, is that we now have such good communication,” she says. “Nurses work closely with the women, so they can describe how they are feeling, and get interventions when they need them; maybe a dermatologist, dietician or psychologist. Women can get all the support that they need.”

When Geraldine Jennings was diagnosed with a rare, and acute form of breast cancer, she was devastated.

“I had inflammatory breast cancer; there was pain, and a lot of swelling,” she says. “It was a terrible shock. I cried; then got drunk, then cried again.”

When she’d got over the shock, though, Geraldine became more positive.

“I thought, ‘at least it’s me, and not my children,’ she says. “The consultant at Beaumont said I had a large fibrous tumour. He said I’d need chemotherapy, surgery and radiotherapy. But he said, ‘you will live through this.’

“He said I’d have the chemotherapy first, and it would be a strong dose. But I knew it was going to save my life. I said ‘throw everything at me.’ I wanted to get on with it.”

Geraldine was diagnosed at the end of April 2007, and she started her chemotherapy on 4^th May.

“I remember walking in that first day,” she says. “I didn’t know what to expect, and there all these people sitting around. The room felt welcoming. It was as if I was the new girl in school. They knew how I felt. They had been there. There was nothing intimidating about it at all.”

Geraldine was prescribed FEC Chemotherapy- and it was given four times, three weeks apart.

“It was injected over an hour and a half, and the effects are immediate. But I felt ok afterwards. I went out to Chapter One restaurant, and on to the gate Theatre as planned.

“Those first weeks I continued to work,” she says. “I’m a business consultant, and I was working with a client. But I was gradually slowing down, and closing off accounts.”

After the second dose, Geraldine’s hair began to fall out.

“I’ve always been identified by my hair. It was long and luxurious. I wasn’t sure how I would feel about losing it. My children, who were then 22 and 21, came up for a hair cutting day. I didn’t want to find wads of hair in my bed. We opened some champagne, and they shaved it off. I was surprised. Being bald didn’t look too bad.

“My eyebrows and eyelashes thinned, but I never lost them completely. I tried to keep feminine, and I always wore make up. There was a ‘beauty day’ at Beaumont. They gave us makeup, and showed us how to pencil in our eyebrows and use blusher. That was fun, and very helpful.”

Although she sometimes felt nauseous, Geraldine never vomited. But she did feel unwell, and extremely tired.

“I was surprised by that. I am an active, positive woman, but I was floored. I kept hearing of people who worked right through chemotherapy. I had to remind myself that this was not a competition; and that everyone has a ‘different’ breast cancer, and different treatment.

“At the start I kept wondering why someone like Linda McCartney died. Why would she, as the richest, healthiest person die, if I was not going to? But I realised I knew nothing about her cancer, or what stage she’d been at. I only knew about me.

“I did a lot of reading, and the stats for my cancer weren’t too good. My breast care nurse told me that the drugs that were keeping me alive were not available five years ago.”

Geraldine didn’t lose her appetite; she didn’t get mouth ulcers either, but she did lose a certain amount of taste. And, at around fifty, she went into the menopause too; there’d been no sign of it before. For all this, she found the support of the team in Beaumont second to none.

“The nurses became my new best friends. I could ring them anytime. They told me that if I felt unwell I should always tell them. Because I shouldn’t. And If I did, they could modify the drugs.

“I was living alone for most of the time. My daughter had moved out, and my son was in college. I had to learn to ask for help. A couple of times I rang a friend and said, ‘I’m too tired to cook, and I’m just snacking all the time. Would you cook me dinner?’ And she did. People were so kind.

“The tiredness is accumulative. When it was bad, I’d set targets for myself. I had bad reflux, and needed to get to the chemist for an over the counter treatment. I knew I could ask a friend, but I thought, ‘I will just get out of bed. I will ring then if I need to.’ I got dressed, and finally did make it to the shops.”

The holistic care at Beaumont was second to none. Geraldine had psychological support, and says that that, too, helped to get her through. And she attended the Gary Kelly Cancer Support Centre.

“It was wonderful to meet all the women who had been through treatment and were going through it. They were all such strong amazing women. If someone was having a bad day they’d get a hug.

“We’d discuss things like ‘chemo brain.’ I once asked for a yoghurt maker in a computer store; another woman put her mobile into the fridge and put a pound of butter in her bag.”

After the chemo, Geraldine had a total left lateral mastectomy.

“They took a lot of lymph nodes as well,” she says. “It wasn’t pretty, but there are worse things. I may go for reconstruction eventually.”

Next was a course of radiotherapy; and after that, Geraldine had a second course of chemotherapy.

“I thought, ‘here we go again,’ but it wasn’t such a strong dose,” she says. “I didn’t feel as sick. I drove myself there and back, but it affected me in different ways. I had pins and needles, but it didn’t worry me. I was still able to sew and do embroidery; something I found essential for all the hours of waiting around.”

A year and a quarter on, it’s all become a memory.

“You do forget,” she says. “It’s like childbirth.” Work, in the recession, is difficult. But Geraldine keeps herself busy running a theatre group, and painting. “I’ve got hens now, and also two dogs. They keep me occupied,” she says.

“There are positive things about cancer. I never knew what love was. It’s being able to ring the niece and say, ‘bring over dinner.’ It’s the little things.”

Has she advice for anyone who is now going through chemotherapy?

“Ask questions. Get to know as much as you want to. Believe your doctors. And don’t compare yourself to anyone else.

“Once you are diagnosed you are in the safest hands. You are with a team and the support is wonderful. They know, exactly what you are going through. They understand you.”

FACT FILE.

• Breast cancer accounts for 28pc of all cancers in women in Ireland. 1726 women are diagnosed each year.
• The death rate is improving by 2pc each year. This is due to better treatment.

FOR MORE INFORMATION.

1800 30 90 40.

1800 200 700.

© Sue leonard. 2009.