The Story So Far… Seema’s life changed when she found a lump in her breast one morning. the reports confirm that it is breast cancer. From denial to anger, she experiences different emotions while she goes through surgery. But she also has hope, and the determination to survive, for the sake of her little son. Let’s see what is in store for her.
When Seema returned to the hospital a week after her surgery, the pathology report awaited her. They found that her cancer had spread to two lymph nodes and that she would need to continue treatment with chemotherapy and radiation therapy. As Seems’s pathology results also showed Estrogen and Projesterone receptor positive status, it meant that her tumour got encouraged to grow by the presence of these hormones. To block this effect, she had to take a medicine (commonly Tamoxifen is used for young patients) that blocked the effects of estrogen and projesterone hormones to prevent recurrence of cancer. Once she completed her chemotherapy cycles, she will start anti-estrogen therapy where the doctor would prescribe Tamoxifen tablet that has to be taken daily for next 5 years. Tamoxifen is generally safe and does not commonly cause disturbing side effects.
Seema now understood that her treatment would go on for a few more months. It made her feel frustrated to think she would be in and out of hospitals for such a long time but she kept telling herself that she needed to take it one day at a time.
Two weeks after her surgery, Seema began chemotherapy. She was prescribed four cycles of Adriamycin and Cyclophosphamide (AC) 2 drug combination regimen, followed by four cycles of Taxane chemotherapy.
The doctor explained her about the chemotherapy treatment. Each cycle of (AC) regimen will be administered once in 2 weeks. Before each cycle of chemotherapy, Seema has to undergo routine blood investigations like CBP (complete blood picture), KFT (kidney function test), LFT (liver function tests) and the oncologist explained to her that chemotherapy would be administered only if the lab reports were normal. Otherwise, she would be treated for any problems indicated by the tests, till her results were normal. Only after that would they continue her cancer treatment. If this happened, there might be delays in her treatment. The oncologist also advised a baseline echocardiography test to check Seema’s heart function before the chemotherapy as one of the drugs Adriamycin had risk of causing longterm damage to heart especially for people with existing heart conditions. Hence it was necessary to check if Seema had any problems with her heart.
Since she would have to undergo eight cycles of chemotherapy, the doctor told her that a chemoport would be a better option for her as she could avoid getting pricked for an intravenous cannula for each chemo cycle.
The chemo port is a small device which is implanted below the skin directly into one of the large veins so that we can directly take chemotherapy or any other IV drugs through the port and there won’t be a need to repeatedly puncture her veins. The doctor explained that this is a simple day care procedure that would be performed under local anesthesia (process that creates temporary numbness in the area), so that Seema would have minimal discomfort. It would take a couple of hours to complete the procedure to insert the chemo port. “If you do not want the chemo port, that’s also fine, we can go ahead with the intravenous cannula for every cycle, Seema”, the doctor said.
Seema thought for a while and she decided to go for a chemo port.
A day before the start of chemotherapy, Seema had to visit the hospital for the chemo port insertion, it was a day care procedure, The port was inserted in a simple procedure as said earlier by doctor, under local anesthesia, in the chest just below the collar bone, just as she was told. It took about a couple of hours for the procedure to be over.
Now Seema can have her chemotherapy medications delivered directly into the port rather than a vein. So, there will be no need for needle sticks. Apart from the chemo drugs, even other medications also can be delivered through this.
She spoke to the HR of her company about working for a lesser number of hours each week for the next few weeks. She was surprised at how helpful they were. They agreed to allow her to work only three days a week, for flexible hours. This way she could continue working while undergoing chemotherapy.
The care manager from Onco.com began preparing Seema for what lay ahead of her.
“The oncologist has prescribed chemotherapy with adriamycin and cyclophosphamide. These drugs can cause some side-effects like hair fall, vomiting, mouth sores, loss of appetite, some tingling and numbness over her hands and feet and a lot of tiredness. Sometimes they also cause diarrhoea.
“Just know that these are expected and there is nothing to worry. The side effects are temporary and will go away after the chemotherapy ends. These side effects of chemotherapy can also be managed using supportive medications that will be prescribed by your doctor. I will guide you through the process and get you some help from our oncologists if required”
Seema hoped the side effects would not be too severe. Fortunately, she would be working from home and so she could rest in between her work.
The side effect she most feared was hair loss. She has had fairly long hair since she was a young lady. Her mother would spend half of every Sunday oiling, washing and drying her long, dark hair. Seema could not recall a time when she did not have long hair. Her friends in school and college had envied her beautiful hair, often asking her for tips for hair growth.
Now, to see that long hair fall out in clamps would be too much for Seema. So she decided to have it chopped very short before starting chemotherapy. It was a brave thing for her to do, but she wanted to do it, to spare herself the pain of seeing her hair on the pillow, on the comb and on the floor.
For the next eight weeks, Seema and her husband visited the hospital once in two weeks, to complete four cycles of chemotherapy. They would be at the hospital in the morning and would return home by evening.
After returning home from the hospital each time, Seema would stay in bed for the next 24 hours. The fatigue was overpowering and she just needed to rest. After that she would slowly regain her strength and would be able to follow her daily routine, even managing to spend some time with her son and get some office work done.
The nausea and vomiting too would subside after the two to three days. If it got unbearable, Seema took the tablet prescribed by her oncologist.
The care manager had provided Seema with a comprehensive high-protein diet plan prepared by a nutritionist tailor-made to her preferences from onco.com. Seema followed this plan and only ate freshly cooked home-made food. Rohan also kept serving her fresh fruits and salads between meals. She kept a bottle of water with her at all times to remind herself to drink more water.
On most days, she felt too tired to do anything. But on days when she felt a little stronger, she walked about the park with Rohan and her son. Just feeling the sunlight and light breeze on her skin made her feel better.
Whenever she stepped out, she wore a scarf around her head so that no one could see the missing hair. It was not that she wanted to hide her illness, but she just didn’t want to hear any pity-filled comments from anyone at this time.
Even her relatives who had heard of her illness had only offered sympathy. “So sad, such a young girl!” or “Everything is in God’s hands” were common phrases that Seema heard from them. She just couldn’t understand why everyone assumed she was going to die. She was healthier than most of them!
Sometimes such words and incidents made her anxious and she found it difficult to fall asleep at night. Rohan noticed this and encouraged Seema to practice meditation so that she could keep her mind calm and away from negative thoughts.
Initially, Seema did not like meditation, but after a week of trying it, she slowly found herself more relaxed. She realised her muscles were less tense and she was able to sleep better at night. Since then, she meditated daily, making it a part of her routine.
Within about fifteen days of starting with chemo, Seema became accustomed to this routine. She knew when she would feel more tired and at what hours of the day she would have more energy. She was able to complete her office work on time and even played with her son most evenings.
The care manager checked on her from time to time to see if she was doing fine. He also reminded her to continue her arm exercises to prevent lymphedema (swelling in arms) after surgery.
On days when she felt tired and didn’t feel like eating anything, Rohan made some soups for her. Of these, the lemon coriander soup was her favourite as it even stopped the nausea for sometime.
Some days she felt very low and nothing seemed to make sense on such days. But she kept reminding herself that this was a temporary phase of her life. She was getting the best medical care and she would beat cancer for sure. She only needed to focus on eating well and sleeping well. With time, her body will recover and then she can give her son the full attention he deserved.
In this manner, she filled her mind with positive talk, and she filled her stomach with nutritious food. She knew the drugs were working inside her body, and she must work on her mind to win this fight.
As she was nearing completion of all her 8 cycles of chemotherapy she was feeling more and more positive as the worst was getting over and she would soon be at the last leg of her treatment journey, radiation treatment. She started having questions about it and she got help from Onco.com care manager who answered all her queries and shared information blogs and videos about radiation treatment. She was now prepared to begin the next course of her journey against cancer.
What else does this journey have in store for Seema? Will she make it?
Watch Dr Harshvardhan explain all about chemotherapy: