What are the goals of chemotherapy?
The main goals of chemotherapy are to cure cancer, keep it from spreading, slow its growth, kill cancer cells that may have spread, and relieve symptoms caused by cancer. Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. But it can also harm healthy cells, causing side effects.
When chemotherapy is used as the main cancer treatment, the goal is to cure the cancer so it does not come back. Sometimes chemotherapy is used as the only cancer treatment. But more often, it’s used with surgery, radiation therapy, targeted therapy, or immunotherapy. This is called adjuvant therapy. The goal is to kill any cancer cells that may remain after surgery or radiation therapy to help keep the cancer from coming back.
Chemotherapy is also used as neoadjuvant therapy before surgery or radiation. The goal here is to shrink tumors so they are easier to remove with surgery. It also helps keep cancer from spreading.
In people with advanced cancer, chemotherapy can help shrink tumors so they cause fewer symptoms. And it can help control the cancer, improving survival. But it’s usually not meant to cure the cancer in this case.
So in summary, the main goals of chemo are:
– Cure cancer
– Keep cancer from spreading
– Slow cancer growth
– Kill cancer cells that have spread
– Relieve cancer symptoms
How is chemotherapy response measured?
Doctors use tests and exams to see how well chemotherapy is working. Tracking the response helps them determine if chemo should continue or if a change in treatment is needed. Ways response is measured include:
– **Physical exam:** The doctor checks for signs the tumors have shrunk, such as decreased size of a lump.
– **Imaging tests:** These include CT, MRI, PET, and ultrasound scans. They show the size and locations of tumors. Doctors compare scans done before and after chemo. Tumor shrinkage means chemo is working.
– **Blood tests:** Complete blood counts are done often during chemo. Increased white blood cells may mean chemo is working to kill cancer cells.
– **Tumor marker tests:** Levels of substances called tumor markers can be measured with blood tests. Decreased marker levels may indicate chemo is effective. Examples are PSA for prostate cancer or CA-125 for ovarian cancer.
– **Biopsies:** Samples of the tumor are removed and examined under a microscope. Fewer actively dividing cancer cells may mean chemo is working.
Doctors use the results of these tests to determine how well the chemo is working. Usually, more than one type of test is used. The response is categorized as a complete response, partial response, stable disease, or progressive disease:
– **Complete response:** All signs of cancer have disappeared.
– **Partial response:** The tumor has shrunk significantly, by at least 30%.
– **Stable disease:** The tumor has neither decreased nor increased in size.
– **Progressive disease:** The tumor has grown in size by at least 20%.
Knowing the response helps guide treatment decisions. If chemo results in a complete or partial response, this is a good indication it’s working. Treatment would continue. Stable disease may mean the chemo regime should be maintained or tried longer before changing medications. Progressive disease indicates the chemo is not effective, and a change is needed.
What does it mean if chemotherapy is not working?
If tests and scans show that the cancer is not responding to chemo or is continuing to grow, this means the chemotherapy is not working effectively. There are several potential reasons why this may occur:
– **The cancer is resistant to the chemotherapy drugs being used.** Cancer cells may have ways of resisting the drugs, such as by pumping the drugs out of the cells before they can act.
– **The chemotherapy regimen is not aggressive enough.** Higher doses or additional drugs may be needed to kill the cancer cells.
– **The type of chemotherapy is not appropriate for the specific cancer.** Different cancers respond better to certain chemo drugs. Using targeted therapy matched to the cancer can help.
– **The cancer is advanced or metastasized.** Chemotherapy is less effective with late-stage cancers that have already spread widely throughout the body.
– **The cancer cells have undergone genetic changes.** Mutations may make cancer cells better able to withstand chemotherapy.
– **The patient has other health issues.** Problems like diabetes, heart disease, and obesity can impact how well chemo works.
When chemo is not working, it does not mean there are no more options. However, it usually indicates a change in treatment is needed to achieve better results. The oncologist will consider altering the chemo drugs, increasing the doses, adding other therapies, or switching to a different treatment altogether.
What are the next steps when chemotherapy fails?
If chemotherapy is not working, the oncologist will discuss the next best steps for treatment. Options may include:
– **Change to different chemotherapy drugs**. A chemo regimen with different medications that work in other ways to kill cancer cells may be more effective.
– **Add targeted drugs or immunotherapy**. These newer tailored treatments can be combined with chemo meds to enhance anticancer effects.
– **Increase the chemotherapy dose**. Higher doses may overcome chemo resistance but also increase side effects.
– **Reduce intervals between treatments**. Shortening breaks between chemo cycles reduces opportunity for regrowth.
– **Enroll in a clinical trial**. New chemo drugs being researched may provide benefit.
– **Switch chemotherapy for radiation**. Radiation may better target and eliminate certain cancers.
– **Have surgery to remove tumors**. Surgery may be an option to try to remove resistant cancer.
– **Keep getting chemo**. If cancer growth is slow, continuing the same chemo longer may help.
– **Stop chemotherapy**. When chemo provides no benefits, the focus shifts to relief of symptoms.
The decision depends on the specific cancer, available treatments, and the person’s wishes. The goal is to provide the most effective treatment with acceptable side effects. If chemo is no longer working, the doctor will thoroughly discuss whether trying another type of treatment is recommended or continuing without chemo is the best option.
What if the cancer continues to progress through all chemotherapy options?
If the cancer keeps growing and spreading after trying multiple different chemotherapy regimens, this is referred to as refractory or resistant cancer. Unfortunately, this means the cancer has become unresponsive to chemo medications.
When this happens, chemotherapy is typically discontinued, as continuing would have significant side effects without providing benefit. Other options at this point may include:
– **Clinical trials** – Experimental new treatments may help overcome the resistance to standard chemotherapy.
– **Immunotherapy** – This enlists the body’s immune system to fight cancer. It works differently than chemo and may be effective.
– **Targeted therapy** – These drugs are designed to block specific characteristics of cancer cells. Genetic testing of the tumor can identify targets.
– **Hormone therapy** – Used for hormone-sensitive cancers, it blocks hormones driving cancer growth.
– **Radiation therapy** – High energy radiation can help shrink tumors and kill cancer cells.
– **Surgery** – If possible, surgery may be able to remove some resistant tumors.
– **Ablation or embolization** – These procedures destroy tumors without surgery.
– **Palliative care** – This focuses on quality of life and managing cancer symptoms.
The overall goal shifts from trying to cure the cancer to prolonging life and making the person comfortable. The doctor will thoroughly explain prognosis and guide palliative care choices aimed at reducing pain and improving daily living.
What is the life expectancy when chemotherapy stops working?
Life expectancy when chemo stops working varies substantially depending on the type and stage of cancer and other individual factors. So it’s not possible to provide a single estimate. However, some general guidelines include:
– **Early-stage cancers:** Stopping chemo usually indicates advanced, likely terminal disease. But life expectancy may still be over a year.
– **Advanced cancers:** Life expectancy is often measured in months but this depends heavily on the cancer. Pancreatic or lung cancer may progress quickly, while breast cancer may remain slow.
– **Primary cancer vs metastases:** Life expectancy is generally longer if chemo stops working on metastases versus the original tumor.
– **Person’s overall health:** Performance status greatly impacts prognosis. Those in good health typically live longer.
– **Available treatments:** Clinical trials and newer therapies may extend life compared to no further treatment.
Doctors determine life expectancy on a case-by-case basis using knowledge of the disease course and statistics on survival times. But they cannot make definitive predictions. With supportive care focusing on quality of life, some patients live longer than expected.
Can chemotherapy be tried again if it initially stops working?
In some cases, restarting chemotherapy after it has stopped being effective is an option. Cancer that initially responds to chemo but later starts growing again may respond again to the same regimen or a similar one. Reasons to try chemo again may include:
– **Cancer-free period after initial response** – If the cancer was in remission for many months or years, reusing the same chemo has a better chance of success.
– **Different mechanism of resistance** – Trying a similar but not identical regime can potentially overcome new resistance.
– **Patient pancreatic cancer** – This type of cancer often responds again when chemo is restarted after a break.
Factors arguing against restarting chemo include:
– **Short initial response** – Cancers that responded briefly are less likely to respond again.
– **Rapid regrowth** – Quick recurrence after initial chemo means highly resistant disease.
– **Many prior regimens** – Cancer that progressed through multiple regimes has lower chance of responding.
– **Patient frailty** – Individuals weakened by earlier chemo may not tolerate restarting it.
The risks and benefits must be carefully weighed when considering repeating chemotherapy. Performance status, extent of prior treatment, cancer genetics, and available alternative therapies all play a role. The physician will thoroughly review the likelihood of response compared to potential side effects before deciding to rechallenge with previous chemotherapy.
What are clinical trials and how can they help if chemotherapy fails?
Clinical trials are research studies that evaluate new medical treatments in human volunteers. They test the safety and effectiveness of promising new therapies. Clinical trials recruit people with specific diseases, like cancer that has stopped responding to chemotherapy. Participating provides access to cutting-edge treatments not yet available outside trials.
There are several types of cancer clinical trials:
– **Treatment trials** – Test new chemo drugs, combinations, doses, and delivery methods to overcome resistance
– **Prevention trials** – For people at high risk of cancer recurrence to prevent it coming back
– **Diagnostic trials** – Evaluate new imaging tests to detect recurrent cancer earlier
– **Screening trials** – Test new protocols to check for return of cancer after treatment
– **Quality of life trials** – Explore ways to improve comfort and well-being
Clinical trials have strict eligibility criteria and protocols. Risks include unknown side effects. But they may provide benefit when standard therapies have failed. Oncologists help patients consider if there is an appropriate clinical trial based on the specific situation.
Participating in a trial requires diligent follow-up. But it gives access to cutting-edge medicine not otherwise available. For recurrent cancer that chemotherapy cannot treat effectively, a clinical trial may offer hope of new, potentially more effective options.
What is palliative chemotherapy?
Palliative chemotherapy is treatment given to help control cancer symptoms and improve quality of life – not to try and cure the cancer. It is an option when:
– Cancer has spread too far to be eliminated by chemo
– Cancer has become resistant to multiple chemo drugs
– The patient has other serious health issues
– The side effects of intensive chemo outweigh benefits
Instead of aggressively attacking the cancer, the goals are maximizing comfort, function, and time. Palliative chemo uses:
– Lower drug doses to minimize side effects
– Oral medication rather than intravenous for convenience
– Less frequent treatments, like every few weeks rather than daily
This balances controlling cancer growth and managing symptoms without disrupting life. Candidates have incurable disease limited to one area, like the lungs or liver.
Palliative chemo often uses gentler drugs like cyclophosphamide, paclitaxel, or etoposide. The oncologist tailors the medications and schedule to the patient’s needs and goals.
The aim is not to cure or extend life but to relieve issues like pain, breathing problems, nausea, or fatigue. This can improve quality of life and time spent doing favored activities with family.
What are the emotional stages of stopping chemotherapy treatment?
Learning chemotherapy is no longer working can be devastating. Ending treatment prompts emotional reactions similar to the stages of grief:
– **Denial** – Difficulty accepting chemo has failed despite evidence of advancing cancer.
– **Anger** – Frustration that treatment options are exhausted and life goals disrupted.
– **Bargaining** – Trying to negotiate more chemo or access to unapproved treatments.
– **Depression** – Overwhelming sadness and loss from cessation of active treatment.
– **Acceptance** – Adjusting to the new reality and focusing on quality of life.
These feelings are normal when chemotherapy ends. The transition process varies emotionally from relief over side effects ending, to anxiety about the future, to loss of a sense of control.
It’s crucial for patients and family to process these emotions. Social worker and psychologist support can assist with grief counselling and coping strategies. Palliative care emphasizes hope and meaning derived from relationships and reducing suffering.
With time, most come to accept the limits of medical treatment and value time with loved ones over quantity. Focus shifts to reducing physical and emotional distress to make the most of each day.
What are some tips for coping when chemotherapy stops working?
Learning chemotherapy is no longer controlling cancer unleashes intense and complex emotions. Adjusting life perspectives is challenging. Some tips that may help:
– **Seek support.** Turn to family, friends, support groups to express feelings and gain understanding. Don’t isolate.
– **Take time.** Allow yourself to grieve the loss of treatment options. Adjustment takes time.
– **Focus on positives.** Appreciate the positives chemotherapy provided, even if limited. There was value.
– **Realign priorities.** Set new goals like time with loved ones, tasks to complete, memories to make.
– **Consider a counselor.** A professional therapist can help process difficult emotions and shifting outlook.
– **Address regrets.** Think about amends to be made and conflicts resolved. Don’t wait.
– **Practice gratitude.** Count blessings in mind and spirit rather than body. Give thanks.
– **Be present**. Make the most of each day rather than dwelling on the unknowable future.
– **Join a support group**. Connecting with others facing the same struggle can provide perspective.
– **Reflect on meaning.** Consider the purpose and meaning derived from relationships, activities, and values.
Though painful, with time and support, most adapt to limiting treatment and focus on quality time living life. What’s important is reshaped by the situation. With shifting perspective, coping becomes possible.
Conclusion
Learning chemotherapy is no longer controlling cancer can be extremely difficult news to receive. Unfortunately, sometimes cancers become resistant to treatment or patients cannot tolerate more aggressive regimes. When this happens, the goal of care shifts from cure to comfort.
Next steps may include alternative treatments, clinical trials, or palliative approaches. But the prognosis is often limited. It is normal to feel anger, depression, and denial during this transition. Adjusting perspectives and priorities takes time and support. Eventually, with help, most can reach a stage of acceptance and appreciate the value of focusing on quality of life. Each person’s journey with coping when chemotherapy stops working is unique. But there are always options to bring meaning to the time that remains.
