1. Cognitive change
of chemotherapy
In the past, chemotherapy was often seen as a terrible treatment. When it comes to chemotherapy, people often associate it with nausea, vomiting, hair loss and other serious adverse reactions, and even think that chemotherapy is a “poison” that will make patients worse than death. However, with the continuous progress and development of medicine, people’s views on chemotherapy are gradually changing.
Nowadays, more and more people are beginning to realize that chemotherapy is not terrible. On the one hand, with the development of drugs, a variety of leukocyte-increasing injections and antiemetics, such as aprepitant and Tannen, have appeared in clinic, which can alleviate vomiting symptoms well. The application of leukocyte-increasing drugs can also prevent low white blood cells and reduce bone marrow suppression. On the other hand, doctors will formulate an individualized treatment plan according to each patient’s physical condition. Reasonable diet, regular sleep, good mentality, and active participation in the doctor’s treatment will be very beneficial to the condition. From the last century to the present, the principle of action of chemotherapy drugs has been developing. From the initial treatment of malignant lymphoma with nitrogen mustard, to the clinical use of fluorouracil, cyclophosphamide, cisplatin, carboplatin, doxorubicin and other drugs, to the gradual marketing of taxanes and other drugs after the 1990s, the efficacy of chemotherapy drugs has become better and better, and the side effects have become lighter and lighter.
Although chemotherapy may bring some adverse reactions, these adverse reactions can be effectively controlled with the careful treatment of doctors and the active cooperation of patients. People’s understanding of chemotherapy is changing from fear in the past to rational view, and they realize that chemotherapy is an effective cancer treatment.
2. Why
Chemotherapy Is Not Terrible
(1) With the rapid development of medical technology, there are more safeguards for cancer chemotherapy. Individualized treatment plan has become a trend, doctors will tailor the most suitable chemotherapy plan for patients according to their tumor type, stage, physical condition and other factors. For example, for some patients with specific gene mutations, targeted drugs targeting the gene mutations can be used in combination with chemotherapy drugs to improve the therapeutic effect while reducing side effects.
New drugs continue to emerge, bringing new hope for chemotherapy. For example, immune checkpoint inhibitors can activate the patient’s own immune system and enhance the ability to attack tumor cells. At the same time, some new chemotherapy drugs not only improve the efficacy, but also reduce the side effects of traditional chemotherapy drugs. For example, pemetrexed and carboplatin chemotherapy regimens have shown good efficacy in the treatment of non-small cell lung cancer, breast cancer, ovarian cancer and other tumors, with relatively small side effects. It is well tolerated by patients and brings more treatment options for patients.
(2) Good attitude and active cooperation
It is very important for
patients to maintain a good state of mind for the smooth progress of chemotherapy. A positive attitude can regulate the body’s potential, increase its own immune function, and fight against the double blow of disease and drugs. During chemotherapy, patients should maintain an optimistic and stable mood, full of spirit and open-minded attitude. Reasonable diet is also the key, cancer and chemotherapy can cause loss of appetite, good nutritional conditioning is very important. Patients should choose light and nutritious foods, such as high-quality protein, fresh fruits and vegetables. At the same time, we should pay attention to controlling the amount of food, avoid overeating, and take the way of eating less and more meals.
Regular sleep can help patients recover their physical strength and enhance their body’s resistance. Patients should maintain a regular rhythm of life, adjust their mental state and enhance their confidence in overcoming the disease. In addition, patients should actively participate in the treatment, follow the doctor’s advice, take medicine on time and review regularly. In the course of treatment, patients can also take part in some indoor and outdoor activities and recreational activities to cultivate life interest and maintain physical and mental health.
3. Side effects
of chemotherapy
(1) Common side effects
There are many common adverse reactions of
chemotherapy. The first is gastrointestinal reactions, which include vomiting, nausea, loss of appetite, diarrhea and constipation.
Myelosuppression is also one of the common side effects, mainly manifested by the decrease of white blood cells, platelets and red blood cells. Leukopenia can reduce the body’s resistance and easily infect pathogens; thrombocytopenia is prone to skin and mucosal bleeding; erythrocytopenia is prone to anemia, fatigue, pale and other symptoms.
Alopecia is an adverse reaction of all chemotherapy drugs, which can bring psychological pressure to patients. In addition, chemotherapy may also cause damage to liver and kidney function, manifested as impaired liver function, abnormal kidney function and so on.
(II) Response measures
For different side effects, there are corresponding coping methods. For gastrointestinal reactions, drug treatment can be taken according to the specific conditions of patients, such as severe vomiting can be properly combined with antiemetic drugs and antiemetic treatment. For patients who have no appetite, they can eat less and more meals, use appropriate drugs to increase appetite, give patients food that is easy to digest and rich in vitamins and high protein, regulate the electrolyte balance of patients, and give nutrition from the intestinal tract or outside the intestinal tract when necessary. Diarrhea patients can eat high-protein, low-cellulose food and timely replenishment of water, give antidiarrheal drugs, if necessary, intravenous fluid and electrolytes. Constipation patients should drink more water, exercise more, eat high cellulose food, give appropriate laxatives to soften stool, and reduce chemotherapy drugs according to the situation.
For bone marrow suppression, when leukopenia occurs, if the number of white blood cells is 2000-4000/UL, patients are generally advised to take oral leukocyte-increasing drugs to promote the recovery of white blood cells. If the level of white blood cells is less than 2000/UL, or even the absolute value of neutrophil is less than 1000/UL, the patient will be advised to use colony stimulating factor. For patients with decreased red blood cells and mild anemia, special treatment is generally not needed. Patients with severe anemia accompanied by palpitation and shortness of breath after activity should be treated with red blood cell transfusion. When platelets decline, patients with mild decline can generally be given interleukin 11 or thrombopoietin to promote platelet recovery. If the patient’s platelets are less than 50000/UL or even less than 30000/UL, and accompanied by obvious bleeding tendency, especially skin and mucosa bleeding, the patient should be given platelet transfusion.
For hair loss, patients can adjust their psychological mood reasonably and realize that hair will grow back after chemotherapy. At the same time, you can also wear wigs to reduce the trouble caused by hair loss.
Liver and kidney function damage can be treated with liver-protecting and enzyme-lowering drugs. During chemotherapy, patients should also pay attention to light diet, regular blood routine, liver and kidney function tests, in order to find problems in time and take appropriate measures.
IV. Progress
of Chemotherapy Technology
(1) Diversification
of chemotherapy regimens
Nowadays, chemotherapy regimens are more diverse. In the treatment of breast cancer, the commonly used chemotherapy regimens include CAF regimen (C: cyclophosphamide, A: doxorubicin; F: fluorouracil), AC regimen (T: docetaxel, A: doxorubicin, C: cyclophosphamide), anthracycline and taxane sequential regimen (AC-T), CMF regimen (cyclophosphamide, methotrexate, fluorouracil), etc. These options are selected according to the patient’s specific physical condition, tumor pathology, disease progression and other factors, providing a variety of treatment options for breast cancer patients. There are also many options for chemotherapy for lung cancer. EP regimen (etoposide plus cisplatin) is the first-line treatment for small cell lung cancer, and irinotecan plus oxaliplatin is the second-line treatment. GP regimen (gemcitabine plus cisplatin) and TP regimen (paclitaxel plus cisplatin) can be selected as first-line chemotherapy regimens for non-small cell lung cancer, while docetaxel plus oxaliplatin and pemetrexed plus oxaliplatin can be selected as second-line chemotherapy regimens.
For colorectal cancer, commonly used chemotherapy regimens include FOLFOX (fluorouracil + oxaliplatin + leucovorin) and FOLFIRI (fluorouracil + irinotecan + leucovorin), which can be used to eliminate micrometastases and palliative chemotherapy for advanced colorectal cancer.
(2) Research and development of
new drugs Innovative drugs
targeting specific targets of tumor cells continue to emerge, providing new options for chemotherapy. For example, immune checkpoint inhibitors can activate the patient’s own immune system and enhance the ability to attack tumor cells.
At the same time, some new chemotherapy drugs not only improve the efficacy, but also reduce the side effects of traditional chemotherapy drugs. For example, pemetrexed and carboplatin chemotherapy has shown good efficacy in the treatment of non-small cell lung cancer, breast cancer, ovarian cancer and other tumors, and the side effects are relatively small. It is well tolerated by patients and brings more treatment options for patients.
(3) Precision medical practice
With advances in genomics and precision medicine, individual-specific treatment regimens are developed to improve efficacy and reduce side effects based on a patient’s genetic variation, molecular markers, and pathophysiological characteristics.
Through in-depth study of the genome, epigenome, transcriptome and proteome of patients, molecular markers related to the occurrence, development, drug resistance and prognosis of cancer can be found. Based on these markers, chemotherapy drugs and doses suitable for specific patients can be screened out to achieve personalized treatment.
(4) Feasibility
of hyperthermic perfusion chemotherapy
1. Theoretical basis: Hyperthermic perfusion chemotherapy is a new therapy that combines hyperthermia and chemotherapy to treat tumors. It uses the temperature tolerance difference between tumor tissue cells and normal tissue cells. The maximum tolerance of normal tissue cells is 47 C, while that of cancer cells is about 43 C. Constant temperature perfusion above the maximum tolerance temperature of cancer cells can increase the effect of anticancer drugs and increase the killing rate of tumors.
2. Clinical application: Hyperthermic perfusion chemotherapy can be used to treat peritoneal metastasis of advanced gastric cancer, colorectal cancer, radical oophorectomy, advanced cholangiocarcinoma, radical pancreatic cancer and other abdominal tumors. For example, in the treatment of patients with advanced ovarian cancer, hyperthermic peritoneal perfusion of paclitaxel after cytoreductive surgery (CRS) combined with intravenous chemotherapy of oxaliplatin and docetaxel can improve the control of ascites, KPS score and progression-free survival (PFS), without significantly increasing the incidence of complications and adverse reactions.
3. Prospect: With the continuous progress of technology, hyperthermic perfusion chemotherapy is expected to play a greater role in the treatment of cancer. For example, new drugs targeting specific cancer types are being developed, which may target cancer cells more precisely and reduce damage to normal cells. At the same time, the importance of clinical trials has become increasingly prominent. Through clinical trials, doctors can understand the effects of new drugs, side effects and interactions with other drugs, so as to provide patients with the best treatment plan.
Future outlook
Chemotherapy still plays an important role in cancer treatment
today. Although chemotherapy may bring some adverse reactions, with the continuous progress of medical technology, chemotherapy programs are more diversified, new drugs are emerging, and precision medical practice has brought more accurate and effective treatment programs for cancer patients. At the same time, the emergence of new therapies such as hyperthermic perfusion chemotherapy also provides more choices for cancer treatment. Although chemotherapy still faces some challenges, it has great potential and is worth looking forward to better serving patients in the future.
