Chemotherapy Treatment Cost in India

Cells are always in a stage of division and they either grow or get replaced as part of the body's normal functions. But in cancer, the production of cells takes place in an uncontrolled fashion. As a result, more and more cells get produced and they start occupying more space and hinder the spaces for useful cells.

In chemotherapy, the drugs hinder the cells’ ability to reproduce and continuously divide. Any single drug or a combination of drugs can be used. The drugs are either delivered into the bloodstream directly or it can be aimed to target the specific cancer cells and sites. The chemotherapy drugs work in the following ways:

• Prevent cell division or mitosis in case of the cytotoxic drugs
• The food sources of the cancer cells are targeted which comprise of the enzymes and hormones that are required for growth
• The suicide of cancer cells is targeted which is known as apoptosis.
• The growth of new blood vessels that supply the tumor is stopped to starve it. The effectiveness of this step is questioned however since it can accelerate the ability of the tumor to resist the treatment and cause further metastasis. Instead, the proteins that are deployed by the cancer cells to carry out metastasis should be targeted in treatment.

Depending on the kind of cancer the patient may undergo chemotherapy orally or intravenously where the drug is injected into the vein or somewhere else.

Orally: If the health of patient permits then tablets can be taken at home as well. But regular hospital visits have to be continued for check of health and good response to treatment. The drug is usually in capsules or in a liquid state. And the dose also must be taken as per the time prescribed exactly. If the patient misses taking one dose at any time, then they must inform their healthcare provider immediately.

Intravenous chemotherapy:  In this kind, the drug is directly injected into a vein with the help of a needle or gets delivered through an intravenous infusion.

At times the drug can also be administered in the following way:

• As an injection into a muscle in the arm, thigh or somewhere else
• Injected into space which is between the layers of tissues that cover the spinal cord and brain, intrathecally
• An intraperitoneal injection where it is delivered directly into the part of the body where the liver, intestines, and stomach are located.
• Intra arterially injected into the artery that can lead to cancer. The drug is given through a drip or pumped to get assured a constant rate of delivery.
• If the patient needs a continuous infusion, ambulance infusion, protracted venous infusion then they may have to wear the pump for several weeks or quite a few months. While receiving the medication the patient can walk around.

The devices used for delivering the solution comprise of a central line, catheter and a portacath. The latter is a thin soft and flexible, implantable port that will go into a vein. It has a port or opening right under the skin of the arm or chest. This port has got a thin rubber disc with special needles that can allow medicines to pass or collect blood. In some cases, it can be applied as a cream or ointment topically for rubbing into the skin.

In surgeries, scalpels, lasers, and electric currents are used, similarly for combating cancer a host of chemotherapy drugs are used to counteract. Their actions are different and they all kill it in different ways and based on that the classification is done. Drugs belonging to the same class have one method of killing the cancer cells, that is by attacking the same target within that cell.

Regardless of how the medications are delivered, they are ingested into the plasma, and then transported around the body. The most popular method of intravenous injection discussed above is. This is actually the most effective way to get this into the bloodstream although oral administration is most convenient and does not require any special equipment.

A drug mixture is favored since each drug destroys or attacks cancer cells in different ways and in different stages, therefore a combination helps the drugs together to be more successful. This form is known as combined chemotherapy.

Enlisted below are some kinds of chemotherapy agents that are based on their chemical structures and their methods of acting on cancer cells.

Alkylating agents: These are some of the most frequently used cancer medicinal products and some of the first-ever used. We act directly on DNA causing the cross-linking of DNA strands, irregular base pairing, and DNA strand breakage, thereby preventing the cell division. Such agents are non-specific in the cell cycle process, meaning they can destroy the cell at various and many stages of the cell cycle. They are proven to be very successful in treating increasingly rising cancers. Such agents on rapidly growing cells are not very healthy. Some of the agents are cyclophosphamide, chlorambucil, thiotepa, and busulfan.

Antimetabolites:These agents work by replacing the building blocks in the molecules of the DNA. In this way they alter the enzyme functions that are required for the metabolism of the cell and protein synthesis. So, they work by mimicking the nutrients that the cells require for their growth and trick the cell into feeding upon it eventually leading its starvation at some point of time. These are cell cycle specific and are most effective during the S phase of the cell division since they mainly act upon the cells that undergo synthesis of new DNA responsible for the cell formation. The cells that are growing and dividing quickly show the toxicities that are associated with these drugs. Some of the examples are purine antagonists or pyrimidine antagonists and folate antagonists.

Plant alkaloids: These are agents derived from plants. Their main aim is to exactly stop the division of a cancer cell and prevent its multiplication. They act throughout the cell cycle, but some are more effective in S and M Phases thus making the cell cycle specific. Some of the plant alkaloids that are used in chemotherapy are actinomycin D, mitomycin and doxorubicin.

Antitumor antibiotic: These drugs are not cell cycle-specific and they act by getting themselves bond with the DNA and prevent the RNA or ribonucleic acid production which is a key step to the creation of proteins which are very important for the survival of the cell. These are not the same that are employed for treating bacterial infections, but they can make the strands of DNA responsible for genetic material to uncoil thus discontinuing the cell production. Mitoxantrone, bleomycin and doxorubicin are some of this kind of antitumor antibiotics.

Prescribing the right amount of dosage of these drugs is difficult since more amounts will definitely and aggressively kill the cancer cells but will also have greater side effects attached to it and reducing it will also affect the chances of treating cancer successfully. So optimum dosage has to be administered to reap maximum benefits with the least side effects.

With recent scientific advances made, the effects of chemotherapy are far more manageable than it was a few years back. The side effects can be in the range of mild to severe depending on the extent and on some individual factors. Everyday life will be affected along with the recovery depending on the kind of side effects one suffers after chemotherapy.

Nausea and vomiting: Antiemetic drugs can cure this problem among almost 70% of people who suffer from this and it should be continued even when the problem has subsided. Along with that ginger or ginger supplements can be taken to increase the effectiveness of the drug.

Hair loss or Alopecia: Hair tends to grow thin and brittle within weeks post the treatment. And this can be in any part of the body. It has no other physical consequence but can cause depression. A cold cap can be advised to keep the scalp cool during the administration of the dose and it can prevent further loss of hair. But patients with leukemia cannot use this since the medication is required to reach the scalp. And hair usually grows back after the treatment gets over along with flaky nails. Even the skin can grow over sensitive to sunlight. And patients should avoid peak sun hours and use good sunblocks.

Fatigue: This can be felt at some time like after specific activities and patients are advised to rest as much as possible and prevent themselves from getting tired. Too much fatigue can be reported to the doctor and a significant drop in the red blood cells can lead to anemia.

Impairment of hearing: Patient can lose his or her temporary powers of hearing or in some unfortunate cases have them lost permanently.

Susceptibility of contracting infection due to low count of white blood cells: A process called neutropenia happens when chemotherapy is targeted with white blood cell reduction from our immune system and they cannot combat infection. Patients grow very susceptible to other infections. Some antibiotics can help, and extra caution should be practiced in maintaining personal hygiene, food preparation, avoiding other infected people and leaving unattended skin wounds. If they have any infection that means they need to be immediately hospitalized for the receiving of intravenous antibiotics.

Bleeding troubles as a result of low blood platelet count: Thrombocytopenia causes blood clotting problems where low numbers of platelets prevent any cuts or bruises to heal quickly. Even blood flow from small cuts become difficult to control. A blood transfusion may be required if the blood platelet number reduces too much. Soft toothbrushes and electric razors should be used and avoid handling too many sharp tools.

Anemia or low red blood cell count: Heart palpitations and shortness of breath are some of the results for low RBC count and in severe shortage can require a blood transfusion. Erythropoietin is the drug used for the production of RBS and good sources of iron should be incorporated in the diet for recovery like green leafy vegetables, beans, and meats.

Mucositis: inflammation of the mucous membrane in parts of the digestive system can be one of the side effects. The mouth can hurt, and ulcers may appear in the lining. Eating drinking or even talking can grow very painful with risks of infection. Caphosol is one drug that is prescribed. After the treatment is finished, the side effects reduce as well.

Appetite loss: The body’s metabolism gets affected and as a result patient suffers weight loss and appetite loss till the chemotherapy treatment is continued. Patients who cannot ingest even smaller meals might be given a nasogastric tube for feeding, which goes to the stomach via the nose directly.

Pregnancy and fertility: Libido may get affected and may have an effect on the sperm count in men and the quality of eggs produced in females thus affecting fertility among both men and women. It usually returns after treatment but cannot be guaranteed. Patients who are wishing to have children later should consider freezing sperm and embryos for use in the future before the treatment starts. It is best to avoid being pregnant currently to avoid transferring any congenital disease. But if conceived then they must reveal it to the doctor immediately.

Problems in the bowel: Constipation, as well as diarrhea, can be a result of chemotherapy and they show their heads right after the treatment begins.

Cognitive and mental health problems: 75% of patients report loss of attentiveness, problems in thinking and short-term memory. This can persist for even months and years after the treatment is over. Mood swings and depressions are also quite common.