Chemotherapy

Chemotherapy is a type of cancer drug therapy. Chemotherapeutic agents affect cells that grow and divide rapidly. As the cancer cells virtually do not have mechanisms of growth restriction, they are the first candidates to suffer from cytotoxic medications. Unfortunately, chemotherapeutic drugs are not selective and can also damage healthy tissues and organs. Treatment in Europe allows people with cancer to receive the most novel anticancer medications, reduce the undesirable side effects of chemotherapy and benefit from new modifications of the procedure. With Booking Health you are free to choose among all the specialized European hospitals, as the cost of treatment will be affordable.

Content

1. Indications
2. Therapeutic regimens
3. How to tolerate chemotherapy better
4. Efficacy of treatment
5. Peculiarities of chemotherapy in European hospitals
6. Chemotherapy in European hospitals with Booking Health

Indications

Chemotherapy may be used in different types of malignant neoplasms. Two basic requirements are active blood supply of the tumor and its sensitivity to one or several chemotherapeutic agents. Thus, this type of cancer treatment is administered in:

• Lung malignancies
• Gastro-intestinal tumors
• Osteosarcoma
• Breast cancer
• Brain tumors
• Blood cancer
• Etc.

In patients with blood cancer the specific therapeutic regimen is used, i.e. high-dose chemotherapy with the subsequent bone marrow transplantation. In this case chemotherapy is aimed at the destruction of a patient's own bone marrow, so high doses of drugs are introduced.

It should be noted that sensitivity to chemotherapy may change throughout the treatment course, i.e. a tumor may develop resistance. Acquired poor drug response is connected with one of the following causes:

• Those malignant cells that have survived after the initial course of chemotherapy change their DNA (i.e. mutate) and create genes that maintain drug resistance
• Malignant cells learn to repair the damaged DNA
• Malignant cells learn to pump the drug out with the help of the p-glycoprotein molecules
• Malignant cells deactivate mechanisms that transport drugs inside them
• Malignant cells learn to inactivate the drug

Regardless of the therapeutic regimen and type of cancer you have, chemotherapy pursues one of the following goals:

1. Curative therapy. In this case chemotherapy may be an independent therapy or a part of the complex treatment that manages to destroy a tumor and metastases completely. This is the most favourable outcome.
2. Therapy to control the disease. In this case cytotoxic drugs slow down tumor growth and prevent it from spreading to distant body regions. Suppressive drug action contributes to better quality of life and survival.
3. Symptomatic therapy. In this case chemo alleviates symptoms, e.g. pain or complaints caused by tumor pressure. Symptomatic drug courses do not affect survival.

Before choosing the type of chemotherapy, physicians carry out numerous laboratory and instrumental examinations. Based on the results, they discuss with a patient suitable medical options, goals of treatment, risks and benefits. In European hospitals a patient receives all the necessary medical information and is a full-fledged participant of the decision-making process.

Therapeutic regimens

Chemotherapy is a powerful anticancer treatment with numerous advantages and indications. The most common areas of its administration are:

• Before other interventions (e.g. surgery or radiotherapy). Such a method is called neoadjuvant chemotherapy and aimed at tumor shrinkage. Neoadjuvant protocol improves results of the subsequent therapy.
• After other interventions (e.g. surgery or radiotherapy). Such a method is called adjuvant chemotherapy and aimed at the destruction of the remaining atypical cells. Adjuvant protocol contributes to achieving long-term remission.
• As the monotherapy. This protocol is common in blood cancers, when there is no single primary tumor and pathological cells are located in the whole bloodstream.
• Treatment of recurrent cancer. Cancer recurrence often means that there are tiny malignant loci that cannot be detected by means of US scan, CT scan or MRI. Thus, physicians tend to use chemo that enters most body regions. 
• Treatment of metastatic cancer. Cancer spreading throughout the body is also connected with presence of microscopic metastases and requires systemic treatments.

Treatment in Europe offers patients a variety of chemotherapeutic protocols. After investigating all the information and discussing it with an attending physician, a patient can choose to have his chemo at the doctor's office (outpatient procedure) or at hospital (inpatient procedure). In some cases therapy can even be performed at home, if drugs are given by mouth and a patient does not experience severe side effects.

Basically, cytotoxic medications may be given in different ways, such as:

1. By mouth. This is the less stressful regimen for many people, as medications are in capsules or pills. Liquid medications are also available. After receiving the comprehensive information about the therapeutic scheme, a patient may start it at home. Such an option is especially convenient for those who require long courses, when it is necessary to take medications daily for 3-4 weeks. Chemo without hospital admission reduces cost of treatment and is more comfortable for many people.
2. Into the vein. Intravenous administration is the second most frequent one. The procedure is performed through an intravenous cannula and takes from several minutes to several hours.
3. In the muscle or under the skin. This type of chemo is carried out as a single shot and does not take much time.
4. Into the artery. This method is more targeted as the medication is injected into the blood vessel that feeds the tumor. Intra-arterial chemotherapy is more invasive compared to the intravenous one but often has better tolerability.
5. Into the peritoneum. This is the local procedure of injecting drugs directly into the abdominal cavity. It is called HIPEC – hyperthermic intraperitoneal chemotherapy. HIPEC is used for cancer that has spread to peritoneum, i.e. colon cancer, ovarian cancer, etc.
6. Into the cerebrospinal fluid (CSF). Intrathecal chemo is indicated to people with malignant neoplasms of the brain and spinal cord. When injected into the CSF, drugs better penetrate into the nervous tissue through the blood-brain barrier.
7. Locally. In certain skin cancer forms creams with chemotherapeutic agents may be used. It is obvious that a patient applies these creams at home, without hospital admission, which is connected with lower cost of treatment.

In most cases chemotherapy is administered in courses, so that a patient has enough time to recover between them without altering treatment efficacy. Side effects are the price we pay for killing malignant cells that are hidden and too small to remove them surgically.

How to tolerate chemotherapy better

Some people do not experience side effects of chemotherapy at all, while others require medical assistance to overcome them. The most typical complaints that accompany chemo are:

• Nausea, loss of appetite, sore mouth
• Tiredness
• Bleedings
• Anemia
• Hair loss
• Infections

Some of these are connected with drugs toxicity, others are connected with immunosuppression. However, a person should not suffer during the entire treatment course. To improve the way a patient feels, physicians recommend the following:

• Prefer small meals and eat slowly, avoid drinking water during meals
• Avoid irritating and spicy food products
• Pay attention to relaxation techniques, such as acupuncture, breathing techniques, meditation, etc.
• Have rest during day if you continue working (e.g. have naps); be more active physically (e.g. have a short walk) if you don’t work now
• Have enough sleep; use hypnotic drugs if necessary
• To avoid hair loss, refuse from hair dyes, cut your hair short and use soft-bristle brushes
• Use sunscreen with a SPF of 30 and higher
• Avoid crowds and people with symptoms of infectious diseases
• Take anti-nausea drugs, drugs to maintain normal blood pressure and blood sugar levels; you will receive detailed recommendations from your physician

Efficacy of treatment

Despite the risks of side effects development, chemotherapy remains the obligatory part of the numerous cancer treatment protocols. It is often used as monotherapy in patients with advanced cancer, when surgery is no longer recommended. For instance, over 26% of patients with stage 4 colon cancer undergo chemotherapy alone. In case of lung cancer this figure reaches 18%. Up to 90% of all patients with stage 3 and 4 cancer receive chemo in combination with other treatments. According to different clinical trials, chemotherapy positively influences the 5-year relative survival rate.

The efficacy of complex therapeutic schemes (e.g. HIPEC, chemoradiotherapy or combination of chemotherapy with targeted drugs) must be assessed separately, as the treatment methods mutually enhance each other.

Peculiarities of chemotherapy in European hospitals

Cancer treatment in Europe demonstrates excellent results due to a combination of extensive relevant experience, conventional and novel medications, precise diagnostic techniques and high skills of healthcare providers. The main points are as follows.

Comprehensive approach to the treatment. Even when a patient comes from another country and schedules only a course of chemotherapy, European healthcare professionals assess his condition and may offer more suitable options. Of course, in most cases just undergoing chemo is enough, but in some people it can be substituted with more beneficial interventions.

Careful preliminary examination. Chemotherapeutic medications can be administered only in people with normal kidney and liver function. Thus, it is essential to make the relevant blood tests prior to the course start. The concomitant pathologies that require additional therapy can also be detected. In most oncological centers such examination is included in the total cost of treatment, as well as the doctor’s appointment.

International protocols with individual adjustments. Oncologists all over the world have free access to the international chemotherapeutic protocols. Availability of drugs themselves may be restricted, but not the availability of information. In Europe, international protocols are adjusted to the needs of the patient. Oncologists consider sensitivity of malignant cells to medications, results of previous treatments, etc. The individual approach is based on the local clinical trials and experience of large oncological centers. Adjusted protocols are used when the conventional ones fail to demonstrate the desired efficacy.

Comfortable wards, maximum attention and care. The subjective feelings during the inpatient chemotherapy are important. In Europe patients stay in the comfortable wards, in the specialized departments. They can always ask nurses and attending physicians any questions in order to feel confident and safe.

Symptomatic remedies. Chemotherapy protocols in Europe include not only schemes of cytotoxic drugs administration, but also information about drugs against nausea, hypotension, etc. Caregivers aim to fight cancer without general health worsening due to chemotherapy side effects.

Privacy. Every patient can be sure that no one outside the doctor’s office will know about his condition. Health information is strictly protected here.

Careful follow-up. Most people need more than just one chemotherapy course. It is necessary to undergo a control examination between the courses. Diagnostic tests allow estimating kidney and liver function, tumor response to the therapy, etc. In European hospitals such examination is often included in the overall cost of treatment.

Explanation of the whole treatment scheme. European oncologists provide patients with information about each step of therapy. A person knows in advance if he will need the repeated chemo or another intervention. This helps patients stay confident and take timely measures.

Chemotherapy in European hospitals with Booking Health

If your cancer treatment scheme includes chemotherapy and you want to get the maximum benefit from it, you may schedule a medical program in one of the European hospitals. European caregivers have enough resources to admit both citizens and international medical tourists. High quality of healthcare and affordable cost of therapy annually attract hundreds of thousands patients from USA, Arab countries, former Soviet Socialist republics, etc.

In most cases chemotherapy must be performed without any delay, so it is essential for people with cancer to avoid long waiting lists. The obstacle is, leading European hospitals always have waiting lists, and foreign patients go in the bottom of it. And this is only the first of issues you may face during the treatment planning.

To make your therapy timely and effective, contact Booking Health – the medical tourism provider with an outstanding experience in the sphere of oncology. For many years, Booking Health has worked with oncological centers without intermediates and any extra charges will be excluded from the cost of therapy.

To make it more obvious, here you can find the list of Booking Health services for cancer treatment in Europe:

• Choosing the oncological hospital based on the annual qualification profile, as different healthcare facilities may specialize on different cancer types
• Establishing preliminary communication with your attending physician
• Preparing the necessary medical program with an approximate price estimate in advance, without repeating laboratory and instrumental examinations
• Excluding additional coefficients for foreign patients from the cost of therapy (saving up to 50%)
• Booking the appointment on the necessary date, without postponing start of treatment
• Monitoring the implementation of medical program by our independent physicians
• Help in buying medicines for further therapeutic courses, if necessary
• Communication with the healthcare facility after treatment completion, scheduling additional courses
• Control of prices and return of unspent funds
• Organization of additional medical interventions or examinations, if necessary
• Trip planning: visa issuing, booking accommodation and tickets, transfer
• Services of a personal medical coordinator and an accompanying interpreter, information support

Authors: Dr. Nadezhda Ivanisova, Dr. Sergey Pashchenko