Criticism of Chemotherapy

When members of the general public imagines a future cure for cancer, they probably imagine a medicine, ideally a pill.  For some reason the other forms of treatment don’t occur to people thinking about a “cure”. This is ironic considering surgery and radiation are more effective tools in oncology today.

According to an article in The Economist, experts estimate chemotherapy drive about 11% of successful cancer remissions.  Of course it is difficult to extract what positive results derive from surgery, what from radiotherapy, and what from chemotherapy as combinations of treatments are so common and adjuvant chemotherapy is routinely given after surgery.  But those in the know think chemotherapy is a number three in the list of treatment modalities.

Another criticism is that chemotherapy is a “blunt tool” that clobbers cells in general, not just diseased ones.  The newer targeted therapies partially address this criticism, but those drugs are arguable still too general and less specific than ideal.  Cancer is not a single disease; it is over a hundred – maybe 200 – diseases. Yet the same chemotherapy agents are used to treat multiple types of cancer.  A counter argument is that the if one drug can be effective against more than one disease, we might as well use it.

Why does chemotherapy fail?

  • Innate resistance – the tumor is not sensitive or sensitive enough to selected treatment
  • Acquired resistance – the tumor evolves the ability to survive treatment which may have had some efficacy.

Side Effects

One thing we’ve learned while running a chemotherapy website – people are forever asking about side effects.  This is a big concern for patients about to start chemotherapy and for their family members. Oncology nurses also know it is one of the elements that negatively affects quality of life for people in treatment.  As chemotherapy has become more widely used, methods to deal with the side effects have also evolved. Nausea is a common side effect and antiemetic therapies can lessen the impact. Medical professionals know chemotherapy is hard on the body and take a patient’s overall status into account before prescribing it.

Chemoprotective drugs may be co-administered to keep side effects under control and many afterwards medicines can help ease nausea, etc.  Brain training has been found to help people with the cognitive impairment known as “chemo brain”.

ALL drugs produce side effects for some patients in some situations.  There is no drug without side effects. Cancer chemotherapy side effects are worse than those of many drugs.  It is difficult to separate the side effects from the symptoms of the cancer sometimes.

Side effects include psychological ones, including anxiety over receiving treatment, fear of needles, and the bother of the lengthy time chemotherapy takes.

In many cases the side effects of chemotherapy are similar to the symptoms of cancer, so it is difficult to say whether a symptom is caused by the disease or the medicine.

Can I avoid side effects if I have treatment confined to surgery and radiation?

No.  Surgery and radiation both produce side effects aside from pain and discomfort at the time of treatment.  Lymphedema of the arm is a side effect of breast cancer surgery and radiation therapy Other long-term local effects of surgery and radiation therapy include numbness, tingling, or tightness in the chest wall, arms, or shoulders.

Radiation therapy interferes with the DNA to create a problem the cancer cell cannot repair, leading to cell death.  Radiation is non-specific, both in terms of the cancers they treat and the cells the act upon. This means that healthy cells may also pay the price of treatment.

Does it matter if chemotherapy isn’t a cure for cancer?

Just because chemotherapy doesn’t cure cancer, does that mean it’s useless?

No.  There are some forms of cancer where chemotherapy is considered curative – leukemia, lymphoma, testicular cancer – but for other cancers chemotherapy by itself usually is not the cure.  It can be part of the cure however, when combined with radiation and/or surgery. And chemo has other benefits even when it is not a cure. It can reduce the size and scope of cancer, and can lessen pain and symptoms.