Most often prescribed after surgery, so-called adjuvant chemotherapy aims to prevent cancer cells from spreading at a distance if there is a risk of recurrence. Recommended before an operation, so-called neoadjuvant chemotherapy can reduce the size of the tumor and sometimes prevent the total removal of the breast, while preventing the extension of tumor cells.
Anti-breast cancer drugs are numerous and classified by families (anthracyclines, taxanes, etc.). All of them are responsible for destroying cancer cells by mostly targeting their division cycle.
A toxic effect on healthy cells
But the counterpart is their toxic effect on healthy cells of the organism with rapid multiplication such as hair, blood (especially white blood cells, but also red blood cells and platelets) or the digestive tract …
Hence the dreaded hair loss, an increased risk of infection, nausea, vomiting … which make this treatment painful.
Several drugs are associated in chemotherapy
Chemotherapy is the job of a medical oncologist who has the hard job of explaining its effects. “My patients arrive in great shape, and my treatments make them sick,” says Dr Marc Espié. The choice of protocol is based on prognostic factors studied with precision. Thus the size and the scalability (or grade) of the tumor, the invasion of the lymph nodes, the presence of hormonal receptors or cancer cells in the vessels, the age of the patient, the expression of the HER2 protein, etc. direct to a particular drug combination.
Sometimes a single molecule is prescribed, but the most widely used protocols often combine drugs from different families. This is to increase their effectiveness while reducing their harmful effects. In general, these treatments are scheduled at a rate of six to eight courses over an average duration of six months. They are often three weeks apart, but this is not a rule.
Before chemotherapy treatment
The installation of the housing
Most often administered by the venous route, these drugs damage the veins, hence the almost systematic installation of an implantable “chamber” or casing to spare those of the arm, which are more fragile.
A small incision in the chest wall is made in the operating room by an experienced anesthetist to slide the casing (covered with a membrane) under the skin. A small, very fine tube (catheter) is then placed in a vein in the neck to lead it to the box through which the injections will be made. The case will bulge a little under the skin, but makes the infusions more comfortable.
A cardiac scintigraphy is requested before taking drugs of the anthracycline family.
Silicon based varnish
Silicon-based varnish is applied to prevent toxic effects on the fingernails and toenails the day before chemo with taxanes. These drugs also require taking corticosteroids to avoid the risk of allergy.
The care takes place in the hospital or in the clinic, often on an outpatient basis. The first time, it is better to come accompanied.
The patient is greeted upon arrival by a nurse who, depending on availability, takes her to a room or to a common room. A doctor also inquired about his condition.
In practice, it is installed on a reclining chair or a bed. A cooling helmet is available to limit hair loss.
After preparing the drugs listed in the protocol, the nurse injects the products through the implantable box. Unless there is an exceptional allergy, the effects are not immediate. Anti-emetics (against vomiting) are always injected in the first infusion. Once the last product has been administered, the infusion is disconnected and the skin facing the box is disinfected.
The interest of the cooling helmet
Applied to the hair, the cold has a vasoconstrictor (closing) effect on the vessels of the scalp, which limits the diffusion of the product. The effect is not always guaranteed. Nevertheless, 65% of patients benefiting from conventional protocols keep enough hair to do without a wig.
Ideally, the helmet (which comes out of the freezer) is placed before the chemo session and changed every 20 minutes.
The patient can go home on her own, ask for a taxi or a light medical vehicle (covered by Medicare). A prescription is given before discharge to prevent the adverse effects of the treatment.