How is Chemotherapy planned?
Chemotherapy planning is a challenging task. Two women of the same age, same stage of breast cancer, can get two different chemotherapy protocols depending on many other factors. Hence, this planning needs to be meticulous and reviewed regularly. Here is how a Medical Oncologist goes about:
Patient Assessment: At the first consultation, the Medical Oncologist assess the paitent in detail -
Any associated problems like Diabetes / Hypertension / Asthma / Heart / Kidney etc.
All latest Blood Tests as also the ECG and 2D Echo profile
The Histopathology Report of the tumour, the stage of cancer, the type (based on ER PR HER2), the aggressiveness etc.
Many other points are noted. After that, the Medical Oncologist comes to a fair idea of how much will be the benefit of chemotherapy - Is it just 1 or 2 percent, or is it in the range of 4 to 6 or 8 ot 10 percent. He discusses all the pros and cons of chemo. In some patients, a 'Genetic Profiling Test' may be useful and he may recommend it. And finally, he will counsel the patient whether chemo will benefit or not. If beneficial, and patient is agreeable, he goes to next step of 'planning'
Chemotherapy Planning: Depending on the various factors above, the Medical Oncologist will select a protocol which he thinks is most suitable for patient. A protocol will contain a few drugs (maybe two, maybe three), and they may be a different times (for example, 4 cycles of two drugs first followed by 12 weekly cycles of one drug). He will plan the dose of those drugs according to the weight and height of the patient. For those who do not have a Chemoport inserted, he may counsel them about the benefits of the same and send across to the Surgical Oncologist, for the same, before starting chemo. He will fix up a date for the first chemo, usually within a few days of this consultation.
The First Chemo: For most patients of breast cancer, chemotherapy is usually a 4 to 6 hour affair (day care). At the center, the medical Oncologist will assess once more, and the associate doctors will secure needle into Chemoport and start the chemotherapy. The staff at the centre re trained to watch out for any issues developing. In the vast majority, no problem happens, and the patient goes home peacefully, with much of problems. During discharge, most Medical Oncologists prescribe some medicines to prevent side effects from developing. Patients are also counselled on what to do if certain symptoms develop, and when to report. The next visit is now around 7th or 8th day of first chemo.
The 7th Day blood tests and visit: This 7th day visit is not necessary for all, but for most, the Medical Oncologist may ask for a CBC and maybe the liver and kidney profile (as per the drug in the protocol) to check how is the body responding. Occasionally, if the tests are not in a satisfactory range, he may reduce the dose of chemo. Once this test is done, and we get a rough idea of how the body is responding, the dose of chemo is now fixed (after a change if needed), and is changed only if the patient develops certain problems. So now the next chemo will be after another 14 days (in a 21 day cycle; some patients have a 14 days cycle, some have 7 days cycle as well)
Rest of Chemotherapy cycles: Now the 7th day visit after every chemo is not needed, and the rest of chemo will go ahead as per the decided cycle days. Of course, in case of a problem, the patient can always visit the Medical Oncologist or his team