My visit to Aga Khan Hospital's cancer ward

Most cancer patients are scared of chemotherapy more than the cancer; care and support is vital for their survival.

“The cells found are malignant and you are likely to have cancer.”

On a visit to Aga Khan University Hospital (AKUH), a 43-year-old woman suffering from lymphoma cancer, told me that her first thoughts upon hearing these words were about chemotherapy.

This was not surprising. Most cancer patients fear chemotherapy more than the disease itself. In fact, cancer patients absolutely dread the days scheduled for their chemo sessions.

Chemotherapy and the will to survive

The simplest and crudest definition of chemotherapy is poisoning an individual’s body with drugs that wipe out the malignant cancer cells while simultaneously re-producing healthy cells in the procedure. The after-effects are usually awful including emotional stress, physical pain, demoralising and despairing physical changes.

The diagnosis itself can be a traumatic experience for patients. The biggest blessing in such a condition is a good doctor who can motivate the patient and help keep dismal feelings at bay. After all, it is the patient who has to endure the pain and if he/she gives up hope and the will to survive, it becomes very difficult to initiate and continue cancer treatment.

Hence, after diagnosis the patient either wants to fight back or loses hope. In cases of despair, negative reactions can range from mild to extreme, like an ovarian cancer patient admitted,

“I was in a state of shock and reacted with revulsion against my oncologist.”

Hence, it is really important for the oncologist to engage in friendly conversation with the patient. During 15-20 minute sessions, doctors should try to gain the patient’s confidence. If the doctor seems hurried, it may be impossible to gain the patient’s trust which can greatly hamper chances of recovery.

Fighting cancer with emotional support

Cancer is truly a devastating disease in which abnormal cells divide and multiply. To make matters worse, diseased cells are able to invade other tissues through the blood and lymph cells. So patients often end up fighting not just one disease but a combination of many.

Cancerous cells can grow, divide, break and spread abnormally all over the body. The process of cancer spreading in the body is called metastasis. There are more than a hundred types of cancers and most cancers are named after the organ or cell from which they originate; for instance, cancer that begins in the colon is called colon cancer but breast cancer that has spread to the liver is called metastatic breast cancer and not liver cancer.

The behaviour, growth rate and treatment of cancer cells depends on the type of cancer it is. The stage at which cancer is diagnosed determines the intensity level of the treatment needed and can be a predictor of how successful treatment might be. Although the treatment of any disease is not easy, cancer’s treatment itself adds to the complex nature of the disease since the patient has to bear not just the pain of the disease but also the trauma of radiation and/or chemotherapy.

The question is how does one deal with such pain and hopelessness? How can caregivers encourage patients to keep their hopes up and fight to stay alive and regain health?

There are some patients who do have a positive approach like one who declared,

“I am looking forward to being a cancer survivor!”

Undoubtedly, the desire to fight is a definite factor in winning this battle. However, the fear of relapse can cause despair and certain events can trigger fears after the treatment such as follow-up visits to the doctor or the anniversary of the cancer diagnosis. 

Moreover, the diagnosis of cancer concerns the entire family. The chances of survival and cure are definitely better when patients have the support of family and friends. However, this battle can be emotionally draining for those around the patient.

Inside the chemo ward

The first thing that hits you upon entering a chemotherapy ward is the weariness on every face. There are women who have had their breast(s) removed, others who have lost their hair, and some who are going through blood transfusions to increase their white cell count. Visiting the children’s chemo ward is an even more traumatising experience because they are so young. These little angels are just at the onset of life when they are told that they’ll have to fight for it.

My heart broke to see a four-year-old receiving chemotherapy in the children’s ward. She was diagnosed with leukaemia at the age of two. Her mother told me,

“It is a painful task to bring her here for a session. She is always scared before coming here, because she knows her squeals can’t stop the treatment. The mental torment starts as soon as she smells the alcohol swabs. It seems like a never ending process, but honestly, I don’t want to stop no matter how long and how hard it is.”

As difficult as it is for children, adults don’t go through chemotherapy easily either. An adult described the aftermath of chemo in the following words:

“The nausea sets in after a day making me feel gross and feeble, that is the time when I count how many more to go.”

The hospital staff also plays an extremely important role because every patient is not accompanied by family and attendants have to fill that gap. They have to be gentle and supportive and often patients get attached to them which helps them recover faster, like a staff nurse said,

“Loss of hope weakens the immune system, affecting the patient physically as well as spiritually. We always tell the patients not to be pessimistic.”

Physical changes caused by chemotherapy can include loss of hair, darkening or paleness of skin, dryness and flakiness of skin, discolouration of nails and weight loss if the patient has trouble eating. On the other hand, many patients gain weight during or after chemo. Although these changes are very upsetting, they can usually be reversed after the treatment is over by establishing a good lifestyle.

Improvements in cancer treatment

New drugs and therapies in recent years have given new hope to cancer patients.  Monoclonal antibodies are a relatively new innovation: they’re laboratory produced molecules that are carefully engineered to attach to specific defects in cancer cells and work by making the cancer cell more visible to the immune system.

Rituximab (rituxan) helps the immune system to attack the cancer cells and Avastin is a monoclonal antibody that can treat a number of cancers except breast cancer. It intercepts the tumour signals and stops them from connecting their targets. Many other antibodies drugs like Zevalin, Erbitux and Hereceptin are available to treat various types of cancer.

Researchers have made major advances in finding drugs which target cancer cells. In targeted therapy, drugs actually attack the surface of cells and control the switches of growth or control blood supply to the cancer cells. This is an amazing treatment to help cancer patients live longer and control the disease. In order to know if a cancer patient is eligible for targeted therapy, the doctor advises a special test of tumour, called a molecular test, by taking a sample or performing a biopsy of the tumour.

Molecular therapy can be very effective and has fewer side effects. Since only the pathways of cancer cells are targeted, only those cells are affected without damaging other parts of the body. Moreover, the side effects of molecular therapy are very mild as compared to chemotherapy. Traditional chemo can cause nausea and hair loss, but its most serious side effect is low blood count. On the other hand, side effects of molecular therapy hardly ever go beyond diarrhoea, fatigue and skin rashes.

Targeted therapy can be done in isolation or along with traditional chemotherapy. Herceptin, Avastin, Rituxan, and Tarceva are the first wave towards safer and more effective therapies and they help block the blood vessels feeding the tumour. However, the major hurdle in targeted therapy is the cost involved and naturally, the pressing concern in our country is that the treatment isn't affordable for everyone.

Dr Nehal Masood, head of the Department of Haematology/Oncology at AKUH told me,

“Targeted therapy drugs are very effective with few traditional side effects; so not all chemo is toxic and today there are many patient-friendly drugs in the market. A lot of patients undergoing chemo at AKUH are receiving these new drugs.”

After the diagnosis

Needless to say, cancer is like an unwelcome house guest. Amidst all the turmoil, sometimes the one thing that we can control is who to tell and when. Although people keep the news of a cancer diagnosis to themselves for valid reasons, family and friends can feel offended upon finding out at a later stage. A leukaemia patient at AKUH told me,

“I didn't want to tell my immediate family until I could better understand what was happening.”

Also, many people assume that talking about the disease has nothing to do with its cure. All things considered, talking positively about it can be the one thing that keeps optimism alive. Support of relatives, friends, doctors and nurses can literally mean ‘life’ for cancer patients. A 23-year-old cancer patient at AKUH admitted,

“The condition was disclosed to me by the doctor in such way that I took it as a challenge rather than a disease. Therefore, I have no fear and I am determined to fight for my life.”