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  1. 1. Chemotherapy
  2. 2. • There are now over 90 different chemotherapy drugs, some of which have many side effects and some of which do not. • Most chemo regimens are given in cycles: every day for a week or two, then off for a week or two, or some combination thereof. • Hence, you may experience fatigue immediately after a treatment but then experience an upsurge of energy during your week off from chemo. • These cycles of treatment can last up to 6 months or longer.
  3. 3. Chemotherapy: What Is It and How Does It Work? • We now know what has to take place for cancer to develop. • First, an abnormal cell has to get past your immune system and appear in your body. • A malignant tumor is an abnormal cell that can survive ANYWHERE in your body, hence making it more dangerous. • The malignant tumor continues to divide and subdivide in rapid succession after it should have stopped. • It can't "turn off." • It is the malignant tumor, that chemotherapy drugs have been designed to kill.
  4. 4. • Chemotherapy drugs "aim" to destroy rapidly dividing cells. Unfortunately, this not only includes rapidly dividing cancer cells, but other fast replicating cells as well—especially your hair cells, blood cells and cells in your digestive tract. • These too are "hit" by the chemo. • Because of this, all of the cancer chemotherapy drugs have the potential (not a guarantee, and each person reacts differently, but a potential) to cause one or more side effects. • In knowing this ahead of time, you can learn to soulfully side step, in your dance with chemo, the more problematic manifestations of these adverse drug effects by being prepared and being "in the know."
  5. 5. • For example, such side effects could include a decrease in white blood cells called neutropenia (normal white blood cell count [WBC] is between 4,000-10,000) which could cause infections; a decrease in red blood cells called anemia (normal red blood cell count [RBC] is between 4.0 and 6.0) which can lead to a lack of energy; a decrease in blood platelets leading to bruising (normal platelet counts are usually between 150,000 and 450,000); as well as nausea, vomiting, tingling, numbness, mouth sores, loss of hair, skin rash, dizziness, drowsiness, taste changes (such as a metallic taste in your mouth), and blurred vision.
  6. 6. Strategies to Cope With Chemo Anxiety and Side Effects • Research has shown that if you have a history of motion sickness or aversion to certain food odors, you will tend to be more nauseas and experience more vomiting before or after getting chemotherapy. • Those of us who are highly anxious will also tend to have more problems with chemotherapy. • For example, one research study showed that highly anxious chemotherapy patients suffered twice as much (18.1%) "anticipatory nausea"—nausea from being worried about getting chemo—than did mildly anxious patients (9.8%).
  7. 7. • Psychologists believe that those of us who undergo chemotherapy and appraise the process as "threatening," or who are unprepared to cope with its demands, will be more likely to experience a "negative outcome," than those of us who view chemo as a challenge or an ally, as Randy Stein did. • Between 25%-65% of us who undergo chemo will develop a phobiclike fear of it. • The term phobia comes from the Greek term, phobos, which means "flight," or "terror.“ • The most potent trigger for "anticipatory" anxiety is when the nurse cleans our skin with rubbing alcohol just prior to giving us the chemo. • Just like Pavlov's dogs who learned to salivate to a tone that preceded food, we cancer patients, after four or five chemo treatments, begin to feel nauseas or dizzy in response to the alcohol or the nurse's perfume. • These reactions can be either "clinic specific," limited to the actual chemo room, or "pervasive," occurring throughout the entire day prior to receiving our chemo treatment.
  8. 8. Therapy for Chemo Phobia • Behavior therapy, cognitive-behavioral therapy, hypnosis, progressive muscle relaxation and biofeedback are the most common ways that therapists like myself treat anticipatory nausea or chemo-phobia. • In behavior therapy, I would attempt to eliminate your fear by modifying your behavior. • With cognitive-behavioral therapy, I Larry would attempt to challenge and modify your fear producing thoughts. • My initial goal would be to get you to remain relaxed when simply imagining that you are going to the chemo office. • Then I'd gradually expose you to the actual chemotherapy session that you fear, while helping you remain relaxed by having you do some deep breathing from your lower stomach and muscle relaxation exercises.
  9. 9. Many times, you will find yourself thinking in distorted ways that help maintain your fear of chemotherapy. There are four common ways to distort your thinking. • All-or-nothing/black-and-white thinking: You see things in extreme. ("Too feel good, I will avoid all treatment. If I go and get chemo, I will be constantly throwing up and in pain.") • Overgeneralization: You take one event and apply that experience to all other like experiences ("My cousin's neighbor passed out, threw up, and experienced repeated infections when she underwent chemo. All chemo drugs are painful and dangerous to all people with any kind of cancer.") • Disqualifying the positive: You reject positive experiences by insisting that they "don't count:" ("That one nice lady at the hospital who said she never threw up or had pain with her chemo must have been a fluke! Chemo is not like that.") • And, Magnification and minimization: You exaggerate the importance of negative characteristics while minimizing the positive. ("Although Susan had energy to go places and could eat small meals, look how much she naps. See, that's the sneaky way chemo gets to you.")
  10. 10. Recommendations For Getting Through Chemo • For the counselor or therapist who is treating a cancer patient with chemo phobia, I'd recommend that you help your client reframe their situation from seeing chemo as poison to viewing chemo as a "friend." • Help your client be a part of the decision making process regarding their treatment. And help your client with "skill acquisition," (e.g., distraction, relaxation, counter conditioning, calming and reassuring imagery and so on), to help alleviate some of the undesirable effects of the various treatments.
  11. 11. References • Krumbhaar EB (1919). "tole of the blood and the bone marrow in certain forms of gas poisoning". JAMA 72: 39–41. • Goodman LS, Wintrobe MM, Dameshek W, Goodman MJ, Gilman A, McLennan MT. (1946). "Nitrogen mustard therapy". JAMA 132 (3): 126–132. • Perera FP (November 1997). "Environment and cancer: who are susceptible?".Science 278 (5340): 1068–73. • Damayanthi Y, Lown JW (June 1998). "Podophyllotoxins: current status and recent developments". Curr. Med. Chem. 5 (3): 205–52.