Chemotherapy

Question 1

What is chemotherapy, and how is it commonly administered?

Answer 1

Chemotherapy is the use of drugs and chemical agents to fight cancer. It is often administered systemically, meaning it circulates through the bloodstream to affect the whole body.

Question 2

What is the primary goal of chemotherapy in cancer treatment?

Answer 2

The main goal of chemotherapy is to disable cancer cells, especially by damaging them genetically so they cannot reproduce. This approach minimizes its negative impact on normal body tissues.

Question 3

How does chemotherapy target cancer cells compared to normal cells?

Answer 3

Chemotherapy agents impair cell replication or attack cells that are actively reproducing. Cancer cells are targeted more often because they replicate constantly, whereas normal cells can usually recover.

Question 4

When is chemotherapy typically used in cancer treatment?

Answer 4

Chemotherapy is primarily used to treat metastatic cancer. If a cancer can be addressed locally, surgery and/or radiation are preferred. Chemotherapy is employed when metastasis is identified or statistically likely.

Question 5

Why is systemic chemotherapy statistically less successful?

Answer 5

Systemic chemotherapy often tackles cases with a poorer prognosis and is highly toxic, making it difficult for the body’s organs and systems to handle. It can also disable the immune response temporarily, posing additional risks.

Question 6

What is the death rate associated with chemotherapy protocols, and what factors influence it?

Answer 6

The death rate in chemotherapy protocols ranges from 1-27%, depending on factors like cancer type, stage, the agents used, and the patient’s overall health. It can be higher in certain circumstances.

Question 7

How does systemic chemotherapy impact the immune system, and why is this a concern?

Answer 7

Systemic chemotherapy can temporarily disable the immune system, making it a riskier treatment choice. This impact varies by cancer type, and targeted therapies are preferred to minimize broad-spectrum chemo use.

Question 8

What are some newer categories of chemotherapeutic agents, and how do they work?

Answer 8

Newer chemotherapy agents include:

• Targeted molecules that exploit specific cancer cell vulnerabilities, sparing normal cells.
• Hormones that affect the growth success of certain cancers.
• Biologics that enhance the body’s natural anti-tumor defenses.

Question 9

What does “antisense” mean in the context of DNA and RNA?

Answer 9

“Antisense” refers to a sequence of DNA or RNA that is complementary to a specific messenger RNA (mRNA). It pairs with this mRNA, blocking it from being translated into protein, thereby inhibiting gene function.

Question 10

What is the primary function of cell cycle inhibitors in cancer treatment?

Answer 10

Cell cycle inhibitors work by slowing or stopping the progression of the cell cycle. They can induce cell cycle arrest at various stages, reducing the rate of cell division and decreasing the number of actively cycling cells.

Question 11

How do angiogenesis inhibitors help fight cancer?

Answer 11

Angiogenesis inhibitors combat cancer by blocking the growth of blood vessels that support tumors, rather than directly targeting the tumor cells.

Question 12

What is “adjuvant” chemotherapy, and what is its purpose?

Answer 12

Adjuvant chemotherapy is used as a supplemental treatment after surgery and/or radiation therapy. Its purpose is to attack micrometastases in a “clean up” role to reduce the risk of cancer recurrence.

Question 13

What is “neoadjuvant” chemotherapy, and when is it administered?

Answer 13

Neoadjuvant chemotherapy is given before surgery with the goal of shrinking the tumor, making it easier to remove.

Question 14

What is the purpose of “maintenance” chemotherapy, and how is it typically administered?

Answer 14

Maintenance chemotherapy is usually a lower-dose regimen used to prolong remission, keep an inoperable cancer from thriving, or restrain cancer activity. It aims to give the person more time by keeping the cancer under control.

Question 15

What is the role of “palliative” chemotherapy in cancer treatment?

Answer 15

Palliative chemotherapy is used to reduce suffering and improve quality of life for the patient, especially when curative treatment is not an option.

Question 16

What are the limitations of chemotherapy when used in maintenance and palliative roles?

Answer 16

The use of chemotherapy in maintenance and palliative roles is limited by factors such as patient tolerance and the balance of risks versus rewards.

Question 17

Is oral medication a common method for delivering chemotherapy?

Answer 17

No, oral medication is not a common method for delivering conventional chemotherapy. However, some agents, especially newer targeted therapies and maintenance chemotherapy, are available in capsule, tablet, or liquid form.

Question 18

How are oral chemotherapy agents absorbed, and what considerations are there for safety?

Answer 18

Oral chemotherapy agents may be swallowed and absorbed through the GI tract, or dissolved in the mouth to cross the oral mucosa. Despite being taken orally, these agents are not always safer or have fewer side effects and often require careful handling.

Question 19

Why might doctors be reluctant to prescribe oral chemotherapy agents?

Answer 19

Doctors may be hesitant to prescribe oral chemotherapy if they are concerned that the patient may not adhere strictly to the dosage and timing required for effective treatment.

Question 20

What is the most common method of chemotherapy delivery, and what are its variations?

Answer 20

Intravenous (IV) delivery is the most common method for administering chemotherapy. For shorter-term or less toxic treatments, standard IV methods are used. For prolonged protocols or when agents can damage blood vessels, more complex IV delivery methods are employed.

Question 21

What is the purpose of tubing “lines” in intravenous chemotherapy?

Answer 21

Tubing “lines” allow for easier administration of intravenous chemotherapy by placing a catheter into a major vein, typically leading towards the heart. This setup enables prolonged use without needing repeated insertions.

Question 22

Which veins are commonly used for chemo line placements?

Answer 22

Common veins for chemo line placements include the right subclavian vein, basilic vein, and brachial vein. In some cases, the femoral vein may be used.

Question 23

Describe the Central Line, also known as the Hickman Line.

Answer 23

The Central Line, or Hickman Line, is inserted into the anterior chest and tunneled under the skin to the right subclavian vein. From there, the catheter runs through the superior vena cava to the right atrium. Needleless connectors (access ports) are attached for easy injection or infusion of chemotherapy.

Question 24

What is a PICC Line, and where is it inserted?

Answer 24

A PICC Line (peripherally inserted central catheter) is placed in the basilic or brachial vein. It is threaded through the right subclavian vein to the superior vena cava and into the right atrium, allowing central access for chemotherapy.

Question 25

How does the femoral option for a Central Line work?

Answer 25

In the femoral option, the line is inserted into the femoral vein and threaded up through the inferior vena cava to reach the right atrium. This approach is less common but used when other veins are unsuitable.

Question 26

What are the primary hygienic precautions Registered Massage Therapists (RMTs) should take with patients who have chemo lines?

Answer 26

RMTs should follow standard hygienic precautions for skin openings, which include keeping dressings dry and clean, and ensuring no tugging forces are applied to the lines.

Question 27

Why should RMTs be cautious about lines directly under the skin?

Answer 27

RMTs should be cautious of lines under the skin to avoid pressure or accidental pulling, which could dislodge or damage the lines, posing risks to the patient.

Question 28

What is a chemo port, and why is it commonly used in long-term chemotherapy protocols?

Answer 28

A chemo port is an intravenous device with a surgically placed reservoir under the skin, reducing infection risk once healed. It connects via a line threaded into a vein leading to the right atrium and can stay in place for months.

Question 29

After a chemo port incision heals, what should RMTs keep in mind during treatment?

Answer 29

Once the skin around the port is healed, RMTs should avoid pressing on the line under the skin but do not need additional hygienic precautions near the port.

Question 30

How is medication administered through a chemo port?

Answer 30

A needle penetrates the port’s top, resealing material, and a butterfly clip injection set locks in place. The chemo agent then drips into the reservoir and flows through the line into the bloodstream.

Question 31

What should RMTs consider if massaging a patient during a chemo session with a chemo port?

Answer 31

RMTs should take hygienic precautions due to a short-term skin opening at the port site and avoid creating tugging forces on any external tubing.

Question 32

Describe the intrathecal method of chemotherapy delivery.

Answer 32

Intrathecal chemotherapy involves injecting or dripping the chemo agent into the cerebrospinal fluid (CSF) around the brain or spinal cord, often using an Ommaya reservoir placed under the scalp for brain treatments.

Question 33

What is the intra-arterial method of chemotherapy delivery?

Answer 33

Intra-arterial chemotherapy involves injecting or dripping the chemo agent into an artery with direct blood flow to the area with cancer, though this method is less common.

Question 34

How might chemotherapy agents be administered aside from ports and intravenous methods?

Answer 34

Chemo agents can be injected directly into a muscle, subcutaneous tissue, the peritoneal cavity, or topically on the skin for treating precancerous or cancerous lesions.

Question 35

What are RMT considerations for treating patients using topical chemotherapy?

Answer 35

RMTs should research or consult about appropriate adjustments to treatment, as certain topical chemo agents may have risks or require specific handling precautions.

Question 36

Is there a risk for RMTs when treating chemo patients due to skin-based chemo metabolite elimination?

Answer 36

There may be a risk if toxic metabolites are excreted through the skin. RMTs should investigate each chemo agent's potential for skin absorption, effects of lubricants, contact time, glove use, and other factors to assess risk and adjust practices accordingly.

Question 37

What common-sense precautions can RMTs take when treating patients who are eliminating chemo metabolites through the skin?

Answer 37

Precautions include treating through clothing, wearing gloves, asking patients to wash or shower, waiting a few days post-chemo, and being aware of symptoms or risks associated with specific chemo agents.

Question 38

What factors influence chemotherapy protocols for a patient?

Answer 38

Chemotherapy protocols vary greatly depending on the agents used and the specific purpose of the treatment for each case.

Question 39

How often do patients typically receive intravenous infusion chemotherapy for systemic agents?

Answer 39

Patients typically receive chemotherapy every 3-4 weeks, with each session being administered in a clinic or hospital day patient room.

Question 40

How many chemotherapy sessions are typically prescribed by an oncologist?

Answer 40

Most patients are prescribed 6-9 sessions, though the number may be adjusted based on progress markers.

Question 41

What is the usual cycle that patients experience with chemotherapy sessions?

Answer 41

Patients typically go through a cycle of illness and recovery with each chemotherapy session. As the protocol advances, the patient’s health usually declines, and the rebound period may take longer.

Question 42

Why might a chemotherapy patient bring a "chemo buddy" to their treatment?

Answer 42

A patient may bring a "chemo buddy" for support and assistance during their chemotherapy day.

Question 43

When is a patient more likely to be admitted to the hospital as an inpatient for chemotherapy?

Answer 43

Patients may be admitted as inpatients if the chemotherapy is especially aggressive or hard to tolerate, requiring more intensive monitoring or care.

Question 44

Why do side effects of chemotherapy vary between patients?

Answer 44

The side effects of chemotherapy vary due to the range of chemotherapy types, delivery methods, and individual patient responses.

Question 45

What are some common side effects of chemotherapy?

Answer 45

Common side effects include fatigue, nausea, vomiting, diarrhea, constipation, fast-turnover tissue issues, toxicity/irritation issues, "chemo brain," mood disturbance, sleep disturbance, neuropathies, dyspnea, and hormonal symptoms.

Question 46

How does fatigue typically cycle during chemotherapy?

Answer 46

Fatigue is often debilitating and cycles with the chemo protocol, usually being worse for several days after treatment, but improving afterward. People may experience "good days" and "bad days," but the fatigue is not always predictable.

Question 47

What gastrointestinal symptoms might chemotherapy patients experience?

Answer 47

Patients may experience nausea, vomiting, diarrhea, constipation, GI upset, pain/cramping, anorexia, food intolerances, and changes in taste.

Question 48

Which tissues are most affected by chemotherapy, and what are the resulting symptoms?

Answer 48

Fast-turnover tissues (those with rapid replication rates) are most affected, leading to hair loss, easy bruising and bleeding, dryness and sores in mucosa (oral, respiratory, GI tract, vaginal), dry, thin skin, thin, dry nails, dysphagia, and pain while chewing or swallowing.

Question 49

What are common toxicity/irritation issues associated with chemotherapy?

Answer 49

Common toxicity/irritation issues include headaches, skin rashes, heartburn, joint effusion, and joint pain.

Question 50

What is "chemo brain"?

Answer 50

"Chemo brain" refers to mental fog, memory issues, and cognitive problems like difficulty concentrating, decision-making, and focus during chemotherapy.

Question 51

How might chemotherapy affect mood?

Answer 51

Chemotherapy can cause mood disturbances such as anxiety, depression, and mood dysphoria, both as primary and secondary effects. Patients may need warmth, nurturance, and emotional support.

Question 52

What types of sleep disturbances may occur during chemotherapy?

Answer 52

Sleep disturbances can occur due to a range of primary and secondary causes, affecting the patient's ability to rest.

Question 53

What are the common types of neuropathies caused by chemotherapy, and where do they occur?

Answer 53

Chemotherapy-induced neuropathies (CIPN) are common in the feet and hands, causing hypaesthesia, paraesthesia, or dysesthesia. Motor issues like grip strength problems and an increased fall risk can also occur.

Question 54

How does massage therapy help chemotherapy patients?

Answer 54

Studies have shown that massage therapy can help manage and improve chemotherapy-induced peripheral neuropathy (CIPN).

Question 55

What are some causes of dyspnea during chemotherapy?

Answer 55

Dyspnea can result from loss or irritation of respiratory lining membranes, changes in lung tissue, hydrothorax, hydropericardium, anemia, heart weakness, or overstress.

Question 56

What hormonal symptoms might chemotherapy patients experience?

Answer 56

Hormonal symptoms can include loss of libido, erectile dysfunction, irregular menstruation, onset of perimenopausal changes, and changes in secondary sex characteristics, especially when hormonal agents are used.

Question 57

Why are low blood cell counts a serious concern in chemotherapy?

Answer 57

Low blood cell counts are a serious concern because chemotherapy targets replicating cells, which includes blood cells. This leads to problems with platelets, red blood cells, and white blood cells over the course of the protocol.

Question 58

What is the turnover rate for different blood cells?

Answer 58

Platelet turnover is about 10 days, red blood cells take about 120 days, and white blood cells have varying turnover, ranging from 60 days to up to a year for some types.

Question 59

What problems does a low platelet count cause in chemotherapy patients?

Answer 59

A low platelet count (thrombocytopenia) causes issues with coagulation, leading to an increased risk of uncontrolled bleeding. It also contributes to tissue and blood vessel fragility, increasing the tendency for bleeding.

Question 60

How is low platelet count managed in chemotherapy patients?

Answer 60

Platelet counts are regularly monitored, and platelet infusions are commonly administered to manage thrombocytopenia.

Question 61

What effects does red blood cell loss (anemia) have during chemotherapy?

Answer 61

Red blood cell loss causes anemia, leading to symptoms such as fatigue, weakness, dyspnea, light-headedness, low blood pressure, orthostatic hypotension, low body temperature, tachycardia, and palpitations. It also contributes to tissue fragility and inhibits tissue repair and recovery.

Question 62

How does low red blood cell count affect organ function?

Answer 62

Low red blood cell count hampers the ability of organs and glands to perform their functions, as there is reduced oxygen supply to tissues.

Question 63

What impact does a decrease in white blood cells have on the body?

Answer 63

A decrease in white blood cells weakens the immune system, increasing the risk of infections and impairing phagocytosis and tissue repair.

Question 64

What role do neutrophils play in the immune system?

Answer 64

Neutrophils (55-70% of the body’s white blood cell population) are the primary fighters of infection, especially bacterial infections.

Question 65

What happens when neutrophils drop in chemotherapy patients?

Answer 65

A drop in neutrophils (neutropenia) leads to fevers, increased susceptibility to infections, and symptoms such as cough, sore throat, painful urination, diarrhea, and rashes.

Question 66

What complications can arise from neutropenia in chemotherapy patients?

Answer 66

Neutropenia can cause pain, redness, swelling, and oozing around ports and lines. Infections may be harder to fight off, and prolonged use of antibiotics can have adverse effects. Neutropenic sepsis is life-threatening.

Question 67

How does neutropenia impact chemotherapy treatment?

Answer 67

Chemotherapy patients with neutropenia are at a high risk for infection and must be cautious about exposure. If infections occur, they are harder to eliminate, and dangerously low red or white blood cell counts may cause delays in the chemotherapy protocol.

Question 68

How is neutropenia managed in chemotherapy patients?

Answer 68

Various treatments, such as growth factors or other interventions, are added to chemotherapy protocols to boost cell production and resilience to offset the adverse effects of low white blood cell counts.

Question 69

Why might chemotherapy cycles be delayed?

Answer 69

Delays in chemotherapy cycles may occur if there are dangerous drops in red or white blood cell counts. Although delays are not ideal for the effectiveness of the protocol, they can be necessary to prevent serious complications.

Question 70

How does chemotherapy stress vital organs?

Answer 70

Chemotherapy stresses vital organs by increasing their workload in terms of perfusion, toxicity, and potential damage from chemotherapy agents or infection.

Question 71

What symptoms should chemotherapy patients seek immediate medical care for?

Answer 71

Chemotherapy patients should seek immediate care for: • High fever (over 101°F / 38.5°C) • Intense chills • Unusual bleeding or bruising • Allergic reaction symptoms • Pain at port/catheter sites • Intense headache or unusual pain • Persistent vomiting/diarrhea • Blood in urine or stool • Difficulty breathing

Question 72

Which tissues tend to rebound quickly after chemotherapy?

Answer 72

High cell turnover tissues like skin, hair, blood vessels, and endothelial lining membranes tend to rebound quickly, usually within a couple of months, though individual variation exists.

Question 73

How long can blood cell restoration take after chemotherapy?

Answer 73

Blood cell restoration can take several months, which means anemia and impaired immune response may persist during this time.

Question 74

What lingering sensory issues may occur after chemotherapy?

Answer 74

Sensory issues such as numbness, paraesthesia, temperature sensitivity, dysesthesia, and neuropathic pain may persist. These symptoms can slowly fade or potentially become permanent.

Question 75

What bone-related issues are common after chemotherapy?

Answer 75

Osteoarthritis in multiple joints is common, and bone thinning/osteopenia/osteoporosis may become clinically significant, especially if the person has other risk factors.

Question 76

How can chemotherapy affect vital organs long-term?

Answer 76

• The CNS and heart may have persistent issues depending on the damage sustained. • The liver usually restores itself over time. • Lung impairments may persist, influenced by factors like age and comorbidities.

Question 77

What hormonal issues may occur after chemotherapy?

Answer 77

Ongoing hormonal issues can include fertility problems, menstruation issues, premature menopause, and difficulty with libido restoration.

Question 78

How long can fatigue persist after chemotherapy?

Answer 78

Fatigue may persist for as much as a year after chemotherapy.

Question 79

What sleep-related issues might chemotherapy patients face?

Answer 79

Sleep dysfunction can be an ongoing challenge for chemotherapy patients and may require sleep rehabilitation.

Question 80

How does chemotherapy impact emotional and mental health?

Answer 80

Emotional and mental health concerns after chemotherapy may include feelings of trauma, grief, and difficulty adapting to a changed body. Some may not have received the personal support needed, leading to issues like relationship breakups.