By Jim Upchurch and Melinda Bachini
“Over 42 billion cancer ass kicking cells were just infused!! :) Let the games begin!”
This text from a friend and fellow paramedic was sent from her bed at the National Cancer Institute after her first experimental treatment in a cancer study. Despite prior surgery and chemotherapy, her tumors were growing. When the opportunity to participate in an experimental treatment program came up, she was ready, not only to help herself but to help others who may benefit when this treatment proves successful.
Historical perspective
Since the 1940s, persistent researchers and the countless number of cancer patients willing to be test subjects have produced many highly successful cancer therapies. This resulted in the first cancer cures from chemotherapy alone and increased cure rates in cancers that require surgery and/or radiation therapy. Where chemotherapy is not curative, it can help prolong survival for many types of cancer patients1.
Early in the development of cancer drugs, many physicians and health care/research administrators were unsupportive; they did not believe chemotherapy would work. They even identified this new branch of medicine as one dealing in poisons.
However, as the years passed, each cancer cure generated more interest and consequently, more research resources.
Today, the overall death rate from cancer has declined despite our growing and aging population thanks to the sustained effort to develop more effective cancer treatments, including chemotherapy1.
Lymphomas, certain leukemias, testicular cancer and small cell lung cancer all have a high rate of cure when chemotherapy is administered1.
So exactly what is chemotherapy?
Poisons
Chemotherapy is treating disease with chemicals whipped up in a laboratory. In the broadest sense of the term, this includes medication such as antibiotics or high blood pressure medicine. However, when most of us hear the term “chemotherapy,” we think cancer treatment.
Most cancer chemotherapy agents either kill cancer cells or stop them from reproducing. The problem is that they work the same way on normal cells.
Cancer cells tend to reproduce at a much faster rate than normal cells, so the trick is to kill off the cancer cells while leaving enough normal cells behind to maintain body function.
The normal cells in the body with higher rates of reproduction then suffer the most during chemotherapy. These cells are found in the gastrointestinal tract, blood (red and white blood cells) and hair. Thus the common side effects of chemotherapy include nausea, vomiting, anemia, infection and hair loss.
Side effects
Near the top of chemotherapy’s Most Miserable Symptom Index is nausea and vomiting, and I think the nausea ranks higher than the actual vomiting.
Fortunately, both medication and non-medication therapies can treat it. Anti-nausea/vomiting or anti-emetic medications include2:
- Anticholinergics: scopolamine
- Antihistamines: meclizine; diphenhydramine
- Cannabinoids: dronabinol; nabilone
- 5-HT3 receptor antagonists: dolasetron; granisetron; ondansetron; palonosetron
- Phenothiazines: chlorpromazine; prochlorperazine; promethazine
- Substituted benzamides: metoclopramide; trimethobenzamide
- Substance P/neurokinin 1 receptor antagonist: aprepitant
Effective agents for chemotherapy-induced nausea and vomiting include ondansetron plus all its cousins and aprepitant3. Not listed above are the benzodiazepines like lorazepam (Ativan), which decreases pre-treatment anxiety, thus blunting anticipatory nausea.
As for non-medication therapy, got a long, skinny needle? Acupuncture is effective in some patients with chemotherapy-induced nausea and vomiting... but out-of-hospital acupuncture has not come of age yet.
How about acupressure4? Whether you do it or your patient does it, may the force be with your patient.
P6 is the nausea and vomiting pressure point and you can find it with four simple steps:
1. Turn the arm with the palm facing upward, and lift the palm slightly to identify the wrist line that separates the hand from the arm.
2. Measure three fingers from the wrist line down the arm, and locate the two tendons in the middle (use the patient’s fingers unless yours are the same size).
3. The spot between the two tendons is the P6 pressure point.
4. Apply pressure for 30 seconds to several minutes.
Thanks to Katie for the use of her arm.
Press this spot firmly until the nausea decreases, until your finger or thumb cramps up and you can’t continue, or until the patient complains. It may not work all the time, but it’s worth a try. And just laying of hands may be soothing to the distressed patient.
Another anti-puke option is to sniff alcohol pads, even though that sounds illegal. This technique can relieve post-operative nausea5 and, in my personal experience, nausea from other causes. However, in the cancer chemotherapy patient, the smell of alcohol may backfire, causing anticipatory nausea if it triggers recall of their last nausea-inducing chemo session.
Conclusion
Sometimes it is as simple as human touch, sometimes more complicated. Either path to making someone’s existence a little easier or less discomforting can be a great gift, especially if the individual is fighting the battle for their life.
References
1. DeVita VT, Chu E. A History of Cancer Chemotherapy. Cancer Res 2008; 68:8643-8653
2. Monthly Prescribing Reference: Antiemetic Medication. Retrieved June 22, 2012 from http://www.empr.com/antiemetic-medications/article/125873/
3. War DG. Chemotherapy and Cancer Related Nausea and Vomiting. Current Oncology2008;15: Supplement 1.
4. Dibble SL, Luce J, Cooper, Israel J, Cohen A, Nussey B, Rugo H. Acupressure for Chemotherapy-Induced Nausea and Vomiting: A Randomized Clinical Trial. Oncology Nursing Forum 2007;34:813-820.
5. Winston AW, Rinehart RS, Riley GP, Vacchiano CA, Pettergrinin JE. Comparison of Inhaled Isopropyl Alcohol and Intravenous Ondansetron for Treatment of Postoperative Nausea. AANA Journal 2003;71: 127-133.
