Dr. Alexander Kappelman (Guest): Okay, thanks for having me today. Yeah, most people are a little scared and nervous when they come to our infusion center to start their chemotherapy treatment. The classical chemotherapy that attacks DNA is kind of the stuff that we still use frequently. There had been a lot of advances and new biologic treatments that have changed some of the side effect profile, but we still use a lot of the chemotherapies that we’ve had since the1960s, ‘70s and even back in the 1950s. We try to put the patients at ease when they come in to the infusion center and go over some of the possible side effects that they might have. We often get a lot of questions about hair loss. We get a lot of questions about nausea and vomiting, and another big thing that comes a lot is interacting with people. Most people come into our infusion center with the idea that they’re going to lose their hair, they’re going to feel sick the entire time they’re getting chemotherapy, and that they really need to kind of stay home and hunker down and not really go out there and live their life and be around people. I think the hair loss, nausea and vomiting, feeling sick and crowds are three things that come up frequently that I think people have a misconception of.
Melanie: In those misconceptions, let’s start with the hair loss and nausea, because those are the two biggest things that we hear. Does that happen all the time with every chemo or not really all the time?
Dr. Kappelman: No, it really does not. It’s very cancer and drug-specific. There are some major classes of chemotherapy drugs, such as Rituxan, and another drug class called anthracyclines that you can almost guarantee around 100 percent of the time, patients are going to lose their hair. Really, there’s actually more chemotherapy agents that do not cause hair loss than there are that do cause hair loss.
Melanie: Okay. So what are some other things that you hear? When people are asking about chemotherapy, is it intended to kill only those specific cancer cells, or does it kill many other cells in the body as well?
Dr. Kappelman: Yeah, obviously the goal is to eradicate any cancerous cell that is there or to prevent any new cancer from coming back. It does have other targets other than the chemo, and some of our older agents are not as specific as some of our new agents. Those cancer cells are going to attack very rapidly growing cells in our body. These occur all over our body, but some of the ones we think about are the hair, the GI tract, and some of our blood cells such as white blood cells, platelets, and red blood cells. Some of the newer agents now are more designed and have specific targets that avoid some of those other cells, and so they lead to different side effects.
Melanie: What about the going out? If you’re feeling that tired, are there things you can do during chemotherapy that make it so that you have a little bit more energy? Because I think one of the other big myths is that you will have no energy, and so you just sleep until you’re done with this treatment.
Dr. Kappelman: Yes, fatigue is one of the biggest things that patients complain about. It can happen from a number of different reasons. But studies have shown over and over that the best thing that people can do is exercise. Exercise is being compared to drug, and exercise wins out in every study. Really, the best thing people can do is get out there and do low-impact exercising or do as much as you’re able to do. Walking, yoga, just stretching, and things like that are very good to try to get rid of some of the fatigue.
Melanie: What about your immune system, Dr. Kappelman? Is that compromised during chemotherapy?
Dr. Kappelman: It absolutely is. And then there are certain times during your chemotherapy cycle or during your chemotherapy treatment that you’re going to be at a higher risk of infection or a higher risk of maybe having a bleed than during other times of your treatment.
Melanie: What about the toxicity level? Going back to the going out thing, are you a toxic person going around? Should you not be around pregnant women or infants or the elderly?
Dr. Kappelman: No.
Melanie: Is any of that true at all?
Dr. Kappelman: There are times. You should avoid people who are actively sick themselves. You by no means are contagious to anybody else around you. The worry is that someone might pass something on to you. If you’re in a group of people and someone is sick, visibly sick, you want to stay away from them. If people are not sick and you want to go out to dinner or you want to go into a group, you want to go to church or whatever you want to do, that’s perfectly fine.
Melanie: Dr. Kappelman, one of the bigger myths that I’ve heard is that the cure is worse than the disease and that people don’t want to go through chemotherapy because they just don’t want to have some of these side effects that we’ve been discussing. Is the cure worse than the disease itself?
Dr. Kappelman: Well, it depends. We do put people through a lot of side effects and through a lot of aches and pains with chemotherapy, but the oncologist will only prescribe chemotherapy when they think it’s absolutely necessary to one, make you feel better, or two, to make you live longer. Although it is very difficult, chemotherapy is difficult and there’ll be ups and downs during the treatment. Overall though, I think it’s a positive thing. I can’t say that it’s not easy to go through. It is very tough, but we’re doing it for a reason, and that’s to make you ultimately feel better and to live longer.
Melanie: In just the last minute, Dr. Kappelman, please give the listeners your best advice and tell them why they should come to Maine Medical Center if they have to experience chemotherapy.
Dr. Kappelman: I do think we have an excellent team here. We have physicians, nurse practitioners, nurses, pharmacists, administrative staff, our nurse assistants. We all just work very well as a team, and our focus is on the patient and on the patient’s family and their needs. In Maine Medical Center, one of our models is patient-centered care and we really try to stick to that and make sure that the patient is really the focus, and we’ll do whatever we need to do to get that patient through this hard time. I guess, I think, just our team approach to care at Maine Medical Center -- and we have a lot of certified individuals in pharmacy and in nursing, and so we’ve dedicated our lives to this. So I think we provide excellent care.
Melanie: Thank you so much. You’re listening to MMC Radio. For more information, you can go to mainemedicalcenter.org. That’s mainemedicalcenter.org, mmc.org. This is Melanie Cole. Thanks so much for listening and have a great day.