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Ryan Leonard

English 102 11am

Professor Newport

April 27, 2017

Reevaluating the Standard: Why Chemotherapy Should be a

Last Resort Cancer Treatment

Chemotherapy is one of the most common forms of cancer treatment to date. It

is also arguably one of the more expensive, physically and emotionally tolling forms of

treatment. Essentially, chemotherapy kills any living tissue that grows fast. This

includes the rapidly growing cancer cells, but unfortunately also includes other rapidly

growing cells that are needed for daily function. Wet membranes including mouth,

stomach lining, as well as skin cells and white blood cells are all destroyed during

chemotherapy administration. Why then would chemotherapy treatment persist as

number one when many alternative, less destructive, forms of treatment exist? Many

doctors fail to encourage patients to consider chemotherapy alternatives because of self

interest receiving large incentives to promote chemotherapy. There are instances where

chemotherapy is an appropriate course of action, however, many patients could benefit

from targeted therapy, immunotherapy, photodynamic therapy and other treatments.

Even though chemotherapy can help fight cancer in patients, it should be considered as

a last resort cancer treatment because of its comparably worse physical, emotional and

financial burden in lieu of alternative treatments.

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There are many physical side effects of chemotherapy treatment all of which

depend on the quantity and what type of chemo the patient receives. According to the

MD Anderson website, the most common side effects of chemotherapy include:

temporary hair loss, fatigue, nausea, pain, increased risk of infection, depression,

increased sun sensitivity, numbness or weakness in the hands and feet, and

chemobrain (Chemotherapy). Chemobrain is a commonly used term for cognitive

issues that include poor concentration and memory problems. According to the Centers

for Disease Control and Prevention (CDC) each year about 650,000 cancer patients

receive chemotherapy (Preventing Infections in Cancer Patients). Cancer.orgs cancer

treatment & survivorship facts a figures for 2016-2017 cites that 75 percent of cancer

patients receiving chemotherapy experience mental impairments during treatment and

for some the problems continue for months after treatment. Janet Pollard, a 54 year old

cancer survivor, received six chemotherapy sessions and has shared her tough

experience.

I had six sessions, one every three weeks, provided my blood tests were okay.

The drugs were delivered intravenously via a drip. After my first session I

struggled to sleep -- I had to keep going to the toilet, had a headache and

although I wasnt in severe pain, I was uncomfortable...The next two sessions

were relatively trouble-free, then after the fourth I had a reaction, which made me

shake violently so I was admitted to hospital. My white blood cell count was

extremely high and my heart rate was fast, so I spent two days in hospital,

getting chest x-rays, and having fluid and antibiotics administered through a drip.
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I recovered and went home, but had a similar reaction to the next session,

staying in hospital for a night this time (Potter).

Pollards experience is not unlike many other chemotherapy patients. The drugs take a

tremendous toll on the body and cause a lot of discomfort. Chemotherapy patients are

also more susceptible to infections. According to the CDC, Each year in the United

States, 60,000 cancer patients are hospitalized because their low white blood cell count

led to a serious infection. One in 14 of these patients dies (Information For Patients

and Caregivers). There are many other treatment options available to cancer patients

that would reduce the amount of discomfort and risk a patient experiences.

Targeted therapies are a newer types of treatment that work by targeting the

particular pathway that makes the cancer grow. With targeted therapies there may be

no side effects whatsoever or small ones such as a rash. They do a much better job of

treating the cancer. The downside is that there are so many types of different cancers

that behave differently and are transcribed differently in the body. Therefore the targeted

therapy for one type of cancer will not be effective to treat a different type of cancer.

The University of Utah Health website describes targeted therapy as follows: Targeted

therapy drugs attack specific proteins or cell functions that help cancer cells grow. Like

chemo, these medicines work throughout the body. But they work in different ways.

Because these medicines mainly target cancer cells, the side effects are often different

and less severe than those from chemo (Esophageal Cancer: Targeted Therapy).

The site goes on to talk about the specific drugs that are approved for use to treat

specific cancers.
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Certain targeted therapies also give hope to patients in very late stages of

cancer, where chemotherapy is not even recommended. Marina Symcox is an example

of this. She was 38 when she was diagnosed with metastatic gastrointestinal sarcoma

and was sent to hospice care 3 years later because traditional chemotherapy was not

stopping/shrinking the growth. In a last effort to save his wife, Symcoxs husband

searched for clinical trials of targeted therapies, and found a study at the Oregon Health

& Science University in Portland. Remembering that time, Symcox stated, I basically

was carried from Tulsa to Oregon. My tumors were huge, my belly was swollen with

them. But it turns out that my cancer was a perfect match for Gleevec (imatinib), the

drug they were testing. Within 48 hours my

tumors were liquefying and my belly was

sagging as if Id just had a baby. I knew it was

working. Symcox is alive and well today

because of the target therapy drug trial that she

risked her life for. Gleevec is now an FDA

approved targeting therapy drug for cancer treatment (Millar).

Immunotherapy is another alternative to chemotherapy that patients should be

aware of. The National Cancer Institute explains how immunotherapy works. One

reason that cancer cells thrive is because they are able to hide from your immune

system. Certain immunotherapies can mark cancer cells so it is easier for the immune

system to find and destroy them. Other immunotherapies boost your immune system to

work better against cancer (Wood). There is a lot of potential for immunotherapy

because in the trials that have been conducted and some immunotherapies that have
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been FDA approved, immunotherapy techniques have presented fewer and less serious

side effects compared to chemotherapy and radiation. A study cited by the American

Society of Clinical Oncology explains a side by side comparison of an immunotherapy

drug versus a standard chemotherapy drug used for patients with Non-small-cell lung

cancer (NSCLC) which accounts for 85 percent of all lung cancers. This research

completed in 2016 showed that the median survival was higher among patients who

were treated with immunotherapy (14.9 months) versus patients who were treated with

chemotherapy (8.2 months). The severe adverse effects were also much lower in

patients who received immunotherapy--35 percent of chemotherapy recipients

experienced severe effects, whereas only 16 percent of immunotherapy patients did

(Advance of the Year: Immunotherapy 2.0). One problem with this type of therapy,

however, is that it hasnt been around long enough to study its long term side effects.

Pam Griffith is a stage III lung cancer survivor who has benefited greatly from

immunotherapy treatment. Originally Griffith was started on a strong chemotherapy

treatment that made her very sick. She states that she didnt know if she was going to

continue the treatment. The chemo treatments and radiation therapy ended up not

working for Griffith. Chemotherapy greatly suppresses the immune system by killing

white blood cells and during that time the cancer grew. Her doctors then told her about

an immunotherapy drug called nivolumab that was still in clinical trials. She was

approved by Bristol Myers-Squibb to start treatment. After the second administration,

doctors already noticed that the cancer had shrunk and she started feeling better. The

hair she had lost from her chemotherapy treatment was growing back during her

immunotherapy treatment. As far as the side effects go, this is what Griffith had to say:
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The side effects to this drug treatment therapy for me have been quite minimal. Its just

been a blessing and its saved my life (Immunocommunity). Today Griffith

experiences occasional body and joint aches but believes that it is worth the benefits of

immunotherapy treatment.

The list of alternative

treatments goes on. Photodynamic

therapy, hormone therapy, stem cell

transplant, hyperthermia, laser

therapy, and natural treatments are

options for patients. These therapies

are not for the future. Many are

readily available options for cancer patients.

In addition to the physical toll that chemotherapy has on its recipients, most

patients also experience an emotional toll as well. In a study published in the De

Gruyter Journal titled Psychometric Development of Chemotherapy Side Effects Fear

Scale where researchers assessed 202 chemotherapy patients, they found that the

level of fear related to the consequences of chemotherapy that patients experience

emotionally is very high (Vasic 61). In addition a 2016 article in the Journal of Cancer

Nursing titled, Longitudinal Trends in Anxiety, Depression, and Quality of Life During

Different Intermittent Periods of Adjuvant Breast Cancer Chemotherapy, a study was

conducted with 88 women who were receiving chemotherapy. They were given a Self-

rating Anxiety Scale, Self-rating Depression Scale and a Functional Assessment of

Cancer Therapy. The conclusion of the study is stated as follows: The Breast Cancer
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patients had psychological distress during intermittent periods between adjuvant

chemotherapy, as evidenced by anxiety and depression, which were highest in the third

cycle. Furthermore, quality of life was lowest at the third chemotherapy cycle and

highest at the first chemotherapy cycle (Jiayuan 48). In a series of reports from the

U.S. Food and Drug Administrations Patient-Focused Drug Development Initiative

based off of a public held meeting to hear from people living with breast cancer about

their disease and its impact, one patient said While I read and was told about all the

possible side effects, nothing could prepare me for the emotional and mental upheaval I

would experience. I literally felt like I was dying and I questioned my decision to do the

chemotherapy. Every day I contemplated quitting (The Voice of the Patient).

Another major emotional toll on chemotherapy patients is alopecia or hair loss. This

can be especially hard for women, because most cultures associate beauty and

femininity with hair. It is apart of many peoples gender identity and a symbol of

sexuality. When chemotherapy starts and hair starts to fall out, it takes a toll on patients

sense of identity. At least 65 percent of chemotherapy patients experience hair loss

(Trueb 5). This is an emotionally tolling experience for the patient. In a clinical review at

the University of Nottingham that examined the psychological impact of alopecia, and

found that cancer patients with alopecia had a poorer body image and womens self

esteem was especially lowered after hair loss (Hunt and McHale 952). Drugs are being

developed to reduce hair loss during chemotherapy, but more side effects are a major

deterrent to starting on an additional drug during treatment.

Caring for and watching a loved one go through chemotherapy treatment is an

emotionally tolling experience as well. One of the major side effects of chemotherapy
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treatment is fatigue. Not only are family members concerned and stressed about the

effectiveness of the treatment, but other factors such as taking on more rolls as a result

of patient fatigue, and a feeling of no sense of control add to the stress. According to the

results of the report by the National Profile of Family Caregivers in Canada, 2002, of the

caregivers, 50 percent suffered physical health problems and 48 percent suffered

mental health problems. In addition, of the family caregivers, 54 percent had financial

difficulties and 66 percent had trouble in their working life due to their chemotherapy

patient caregiver roles. The study showed that physical problems included indigestion,

changes in appetite, irregular eating habits, headaches, chronic fatigue, weight gain or

loss, muscle pain, difficulty concentration, and emotional symptoms such as

restlessness, insomnia, decreased self-esteem and social isolation. In the article titled

Experiences of Family Caregivers of Cancer Patients Receiving Chemotherapy, it

explained a study conducted of 16 caregivers whose family members received at least

two rounds of chemotherapy. One of them explained Cancer is a word unfamiliar to us.

So I was shocked, I was very much shocked and I couldnt pull myself together for a few

months. Its been too heavy a burden for me...cancer, it is something devastating

(sercekus et al 5063). In addition caregivers are more likely to suffer from depression

because of the social isolation associated with the caregiver's desire to not leave their

loved ones side.

Other forms of treatment will have some emotional/psychological toll on the

patient, but it is arguably less. Psychologically patients and caregivers are affected by

the cancer itself. Many are worried about how it might take or shorten theirs or their

loved ones life. Living and witnessing the physical toll of chemotherapy, however, adds
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to the emotional toll as described above. Because other forms of treatment are less

tolling on the body, they are likely to have a lesser emotional response as well.

The financial toll of chemotherapy treatment is also a major burden to patients.

Although the cost of treatment will vary from patient to patient depending on the type of

chemotherapy, the duration, and the type of insurance the patient has access to, it can

cost more or about the same as other treatments that are more effective and that result

in fewer symptoms. The cost will also vary between the type of setting the patient will

receive their treatment. Receiving chemotherapy treatment in hospitals costs 24

percent more than receiving treatment in a physician's office or other outpatient

department (Nicastro). The most expensive chemotherapy costs around $46,000 for

colon cancer and the least expensive chemotherapy cost $8,960 for genitourinary

cancer. According to an analysis by Milliman, cancer patients getting active treatment

with chemotherapy account for 22 percent of cancer patients, but incur almost 4 times

the per-person cost of cancer patients not receiving chemotherapy (10 Statistics on

the Cost of Cancer Treatment in America).

Immunotherapy treatment however is one of the more expensive treatments--

some can cost over $100,000 per year. Also because some of the new forms of

treatments are just being developed and approved, the cost can also be very high for

patients.

In an article written by Peter Ubel, MD, titled Do Oncologists Have an Incentive

to Prescribe Expensive Treatments, Ubel explains that oncologists make a large

portion of their money selling drugs to their patients. He goes on to explain how the

process works. A doctor first purchases the chemotherapy drugs from pharmaceutical
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companies, and after the drugs are prescribed to the patients, the insurance company is

billed the original cost of the drug plus a markup dictated by the doctor. The markup

amount is a percentage of the treatment, so the higher the cost of the treatment, the

bigger the cut the doctor receives (Ubel). For example, lets say the doctor is

considering two options for treatment. One treatment has a pharmacy cost of $8,000.

The other treatment has a cost of $100,000. The doctor charges 107% of the original

cost of the drugs he sells. Which drug is the doctor going to prescribe and push? Well,

it depends on each doctors ethics, but there is a huge financial incentive for the doctor

to push for the $100,000 treatment. The doctor will make $7000 off of the $100,000

treatment (7%x$100,000) versus $560 off of the $8,000 treatment. The unfortunate part

about this is that many times the patents are not aware of the differences in cost. In the

process of researching and writing this paper, it is easy to see that exact costs of drugs

are difficult to find doing a general search. Also, many times patients put their trust in

their doctors. Janet Pollard, the 54 year old cancer patient whose chemotherapy

experience was explained earlier, also is on record saying that she put her trust in her

physician. When I was told I needed chemo, I cried, but I felt that I needed to follow

the consultant oncologists advice almost unquestionably. I wanted to hand over

responsibility to the professionals and just let them do what they thought best (Potter).

Janets situation illustrates a common situation of many patients. Doctors hold positions

of power that patients put their trust in, and many are pursuing their careers to help their

patients to the best of their ability regardless of compensation. Many deny being

influenced by finances at all, however, it contradicts the logic of human nature (even if

the influence is subconscious).

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Chemotherapy's effectiveness in treating cancer is comparably worse than other

forms of treatment. In a 2004 article in the journal of Clinical Oncology a study was

presented that concluded that the overall contribution of chemotherapy to five-year

survival in American adults was 2.1 percent (Barton 553). The other 97.9% percent that

contributed to five-year survival were other treatments including surgery,

immunotherapies, targeted therapies, natural treatments such as diet and lifestyle

changes. This was the statistic from 2004. A 2017 study of chemotherapys

contribution to five-year survival rate could be predicted to be comparably lower since

hundreds of new treatments have been approved by the FDA for their safety and

effectiveness in treating different types of cancer.

Chemotherapy should be considered as a last resort cancer treatment because

of its comparably worse physical, emotional and financial burden in lieu of alternative

treatments. The side effects of chemotherapy take a larger toll on the body than

immunotherapies, targeted therapies, and natural treatments. It is also less effective

with less than 3 percent five-year survival rate. One down side of the newer treatments,

however, is that the long term side effects are still unknown because they havent been

studied for long enough. The emotional consequences of chemotherapy are also much

more severe because the physical toll plays into the emotional side. Any cancer patient,

regardless of the treatment, is going to have emotional struggles, but with less physical

struggles it is easier to build a positive outlook. This includes family members as well.

Finally, the financial toll of chemotherapy is very hard on cancer patients and

their families. Also the huge payouts that doctors receive from chemotherapy drugs

should be part of the discussion of why chemotherapy is still the number one form of
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cancer treatment. There is no data to show causation, but there needs to be more

research as to why chemotherapy is still the default treatment. It is important research

that would protect cancer patients and help expose any professionals taking advantage

of them. This would also ensure further progress on the newer targeted therapy, and

immunotherapy treatments.

Works Cited
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Advance of the Year: Immunotherapy 2.0 American Society of Clinical Oncology,

www.asco.org/research-progress/reports-studies/clinical-cancer-

advances/advance-year-immunotherapy-20

Barton, Michael, et al. The Contribution of Cytotoxic Chemotherapy to 5-year Survival

in Adult Malignancies. Clinical Oncology, vol. 16, 2004, pp. 549-560.

Cancer Treatment & Survivorship Facts & Figures 2016-2017. American Cancer

Society, 2016, www.cancer.org/content/dam/cancer-org/research/cancer-facts-

and-statistics/cancer-treatment-and-survivorship-facts-and-figures/cancer-

treatment-and-survivorship-facts-and-figures-2016-2017.pdf

Chemotherapy. The University of Texas MD Anderson.

https://www.mdanderson.org/treatment-options/chemotherapy.html

Chemotherapy, Radiation Therapy and Immunotherapy. Oncosec, 15 August 2013,

www.oncosec.com/chemotherapy-radiation-therapy-and-immunotherapy/

Esophageal Cancer: Targeted Therapy. University of Utah Health.

www.healthcare.utah.edu/healthlibrary/centers/cancer/doc.php?

type=34&id=besot19

Hunt, Nigel and McHale, Sue. The Psychological Impact of Alopecia. BMJ, vol. 331,
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2005, pp. 951-953

Immunocommunity. The Answer to Cancer. www.theanswertocancer.org/online-

community-for-cancer-immunotherapy/stories-from-patients-and-caregivers/pam-

griffith-patient-story

Information for Patients and Caregivers. Centers for Disease Control and Prevention,

18 November 2015, https://www.cdc.gov/cancer/preventinfections/patients.htm

Jiayuan, Zhang et al. Depression, and Quality of Life During Different Intermittent

Periods of Adjuvant Breast Cancer Chemotherapy. Cancer Nursing, vol. 10,

2016, pp. 334-359.

Jiayuan, Zhang et al. Longitudinal Trends in Anxiety, Depression, and Quality of Life

During Different Intermittent Periods of Adjuvant Breast Cancer Chemotherapy

Cancer Nursing, vol. 10, 2016, pp. 26-57.

Mccarthy, Bridie et al. Emotional Resistance Building: how family members of loved

ones undergoing chemotherapy treatment process their fear of emotional

collapse. Journal of Advanced Nursing, vol. 71, 2015, 837-848

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Millar, Heather. Gastrointestinal Stromal Tumors Already Proving to Be Treatable With

Targeted Therapies. Cure, 23 March 2016, www.curetoday.com/publications

/cure/2016/gastrointestinal-2016/gastrointestinal-stromal-tumors-already-proving-

to-be-treatable-with-targeted-therapies

Mumford, Nathan. The 20 Biggest Cancer Lies Youve Been Brainwashed To Believe

By the Criminal Fraudsters Who Run the For Profit Cancer Industry. Karen E.

Mumford Cancer Foundation, 16 April 2016, www.kemfoundation.org/blog/

2016/4/6/the-20-biggest-cancer-lies-youve-been-brainwashed-to-believe-by-the-

criminal-fraudsters-who-run-the-for-profit-cancer-industry

Nicastro, Steve. How Much does Chemotherapy Cost?, Everyday Health, 18

September 2014, http://www.everydayhealth.com/news/how-much-does-

chemotherapy-cost/

Potter, Laura. What it Feels Like to have Chemotherapy. Netdoctor, 14 January

2016, www.netdoctor.co.uk/healthy-living/a26083/what-does-it-feel-like-to-have-

chemotherapy/

Preventing Infections in Cancer Patients. Centers for Disease Control and Prevention,

26 April 2017, www.cdc.gov/cancer/preventinfections/providers.htm

Preventing Infections in Cancer Patients. Centers for Disease Control and Prevention,
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18 November 2015, www.cdc.gov/cancer/preventinfections/patients.htm

Sercekus, Pinar et al. Experiences of Family Caregivers of Cancer Patients Receiving

Chemotherapy. Asian Pac J Cancer Prev, vol. 15, 2014, 5063-5069

Stegall, Jonathan. Chemotherapy: What to know (and the alternatives). Cancer Tutor,

28 March 2017, www.cancertutor.com/chemotherapy-alternatives/

Trueb, RM. Chemotherapy-induced hair loss. Skin Therapy Lett, vol. 15, no. 7, 2010,

pp. 5-7.

Ubel, Peter. Do oncologists have an incentive to prescribe expensive treatments.

KevinMD, 4 July 2012, www.kevinmd.com/blog/2012/07/oncologists-incentive

-prescribe- expensive-treatments.html

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Scale. De Gruyter, vol 34, no. 1, 2017, pp. 55-64.

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Administrations Patient-Focused Drug Development Initiative. Food and Drug

Administration, 2 April 2015,www.fda.gov/downloads/Drugs/NewsEvents

/UCM464932.pdf
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Wood, Lauren. Immunotherapy. National Cancer Institute, 4 May 2017,

www.cancer.gov/about-cancer/treatment/types/immunotherapy#1

10 Statistics on the Cost of Cancer Treatment in America, Cancer Insurance, 16 April

2014, www.cancerinsurance.com/blog/ten-statistics-on-the-cost-of -cancer-

treatment-in-america