It is often said that there is a ‘can’ in cancer because we can beat it. Given my experience of over two decades in treating cancer, I can definitely vouch for this statement.
That said, even after decades of experience as an oncologist, it has never been easy for me to inform a patient about his/her cancer diagnosis. A moment that is delicate and difficult at the same time, letting someone know that they have cancer is always challenging. Inspiring confidence in the patient that cancer is indeed beatable while not denying the diagnosis is easier said than done — a predicament I recently faced, yet again.
At 36, Naina (name changed), a spirited working professional, was arguably living the best years of her life. She was happily married, a mother of two and was enjoying herself both personally and professionally considering she had an excellent support system too. With no family history, cancer had never crossed her mind and hence a mammogram was something she would not even give a fleeting thought.
But one fine day, she noticed a lump in her breast which prompted her to go in for a check-up. After days of agonising wait that involved many tests and reports, she discovered the ‘C’ word in her life. I did my best to break the news to her in the gentlest of ways while highlighting the positive fact that we had caught the condition in the early stage and that it was definitely curable.
Cancer treatment: anxiety and apprehension
As it is commonly seen, the very word cancer creates a fear; a fear of the treatment, its side effects and of becoming weak and vulnerable. As expected, Naina too was experiencing a roller coaster of emotions. Multiple questions were running through her mind.
- What will happen to her body when she is undergoing chemotherapy?
- What kind of pain will she have to endure?
- Is she mentally and emotionally prepared for chemotherapy?
- How will her loved ones cope with all of this?
The most common fears patients have when it comes to chemotherapy are the fear of losing hair, fear of chronic and common side effects like nausea, hair loss, constipation, anaemia, weight loss, fertility problems, kidney problems and the fear that chemotherapy is physically very painful. That said, it is key to note that every patient has different levels of side effects; some experience higher side effects than other patients. Also, some side effects can be prevented with the help of extra care and medication.
However, it is of critical importance to state that medical research and innovation have now made it possible for some women to avoid chemotherapy altogether. In India, 95 per cent of cancer patients choose to undergo chemotherapy, but a large percentage of them can avoid it too. Studies show that chemotherapy can be avoided in 70 per cent early stage HER2 positive breast cancer patients. Personalised treatment through the all-important recurrence prediction tests can help in avoiding unnecessary chemotherapy.
Chemotherapy-related adverse events
The side effects caused by breast cancer chemotherapy are immense and this includes emotional trauma, which may be augmented by a lack of proper professional support. Even though drugs and other approaches are used to overcome these side effects, they are not completely effective. Treatment of the side effects also adds to the physical, emotional and financial burden of the condition. According to a study conducted in the United States, chemotherapy-related side effects resulted in a large incremental expenditure of USD 1,271 per patient annually. All this can have a negative impact on the quality of life of the patient. The quality-of-life further declines if the patients have comorbidities like hypertension, diabetes and arthritis. The physical and emotional impact on the caregivers and loved ones cannot be undermined too.
Predicting cancer recurrence: A tool to avoid overtreatment
Breast cancer has four stages of which stage 1 and 2 are considered as an early stage and it currently accounts for 50 per cent of the newly diagnosed cases in India. In the early stages, the cancer is contained at the primary location and not spread to the other areas of the body. Once a patient is diagnosed with breast cancer, the tumour is surgically removed. Post-surgery, an oncologist creates a treatment plan based on the risk of recurrence. Chemotherapy is recommended only for those patients who have a ‘high risk’ of cancer recurrence. But it is common that several early-stage breast cancer patients undergo chemotherapy to avoid cancer recurrence. It is often the ‘fear’ of recurrence that prompts excessive chemotherapy and this often has a devastating effect on the patient’s health and quality of life.
Hence, it is of utmost importance that there is a clear understanding about the risk of cancer recurrence which helps in devising an optimum treatment plan. This will ensure that patients are not over treated which may lead to the above-mentioned toxic side effects. Breast cancer overtreatment can put the recipients at the receiving end of all the adverse events of cancer treatment. Therefore, every effort should be taken to prevent cancer overtreatment by identifying those patients in whom the administration of these treatment modalities can be safely avoided. And one of the ways to accurately predict whether a patient has high risk or low risk of breast cancer recurrence is through prognostic tests. Taking a balanced approach on a case-to-case basis is sure to boost the morale of the patients and improve their quality of life. After all, for every mountain, there is a miracle.
Dr Ajay Bapna is the director and HOD of medical oncology at Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur
2 Responses
Will anybody give a solution to peripheral neuropathy?
This was very insightful. Thank you