All you need to know about preventive chemo
A medical term made familiar by Kate Middleton, this postsurgery treatment is used to reduce the recurrence of cancer
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fter a torrent of memes and obsessive discussions around the ‘disappearance’ of Kate Middleton, speculations came to a rest in late March. In a video released by the Kensington Palace, the Princess of Wales announced the reason for her prolonged absence. “In January, I underwent major abdominal surgery in London and at the time, it was thought that my condition was non-cancerous,” the Princess of Wales said in the video, as reported by Time magazine. “The surgery was successful. However, tests after the operation found cancer had been present.” “My medical team therefore advised that I should undergo a course of preventative chemotherapy and I am now in the early stages of that treatment,” she had said. Ever since, the term ‘preventative chemotherapy’ has entered mainstream lexicon, making everyone curious about what it entails.
Technically referred to as ‘adjuvant therapy’, preventative/preventive chemotherapy is a crucial strategy to thwart the recurrence of cancer
In a country like India that has recently earned itself the title of the ‘Cancer capital of the world’, courtesy Apollo Hospitals’ Health of the Nation Report 2024, understanding the significance of preventative chemotherapy gathers greater relevance.
TREATMENT CYCLE
“Adjuvant chemotherapy is administered after the primary therapy — often surgery— to target and eradicate any remaining cancer cells that may have spread beyond the initial tumour site,” says Dr Narender Kumar Thota, HOD and consultant hemato oncologist and stem cell/ bone marrow transplant (BMT) specialist at KIMS Hospitals, Secunderabad. The purpose of the treatment is to significantly reduce the risk of cancer recurrence or metastasis.
The decision to go for adjuvant chemotherapy is determined by doctors based on multiple factors. These include cancer type and stage, the presence of (molecular or biochemical) biomarkers in the body, the extent of tumour removal, and the patient’s overall health. “Drug selection in this treatment is tailored to each patient’s specific situation. It involves utilising chemotherapy agents with proven efficacy against the cancer type being treated,” Kumar explains.
Adjuvant chemotherapy is administered in cycles, with each cycle comprising treatment — the medicines can be administered intravenously or as tablets — followed by a rest period to allow for recovery. Though effective, Kumar takes care to mention that chemotherapy drugs can lead to side effects due to their effect on both cancerous and healthy cells. Issues such as fatigue, nausea, hair loss, and susceptibility to infections are common. Monitoring and follow-up are crucial throughout treatment and post-treatment phases. This involves regular assessments for treatment response, side effect management, and surveillance for cancer recurrence. Through careful consideration and monitoring, adjuvant chemotherapy aims to improve long-term outcomes and quality of life for cancer patients.
Mumbai-based Renuka Rathore, 35, a breast cancer survivor, vividly recalls her experience with adjuvant chemotherapy. “Initially, I was apprehensive about undergoing more treatment,” she shares. “But knowing it could prevent cancer from coming back gave me the strength to endure.”
A MULTIFACETED APPROACH
Adjuvant chemotherapy does not have a onesize-fits all solution. The word ‘chemoprevention’ can be used in different contexts, says Dr Anusheel Munshi, head of radiation oncology, Manipal Hospital, New Delhi. It can mean the use of certain agents to prevent the onset of certain cancers. For example, there have been studies that used medications such as tamoxifen to prevent breast cancer in higher risk patients. Similarly, studies have explored the use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) for reducing colorectal cancer risk. Some vitamins like vitamin C and D have also been tried to help prevent cancer. However, not many of these agents that have been tested have become a standard of care, Munshi notes. This is primarily because of the possible side effects of long term use of these agents.
“What has become more established as a prevention strategy is focussing on avoiding established risk factors like habits (smoking, alcohol) and lifestyle (junk food, obesity, sedentary style),” he adds to underline the importance of adopting a preventive lifestyle to pre-empt the disease. In addition, early reporting of symptoms and cancer screening tests for certain types has been known to improve outcomes. Different cancers require different treatment approaches and systemic therapy/chemotherapy agents. Since present-day cancer management requires multidisciplinary care, it is always encouraged that treating hospitals have multidisciplinary tumour boards staffed with experts from relevant specialities to decide comprehensive treatment plans for patients.
PSYCHOLOGICAL & EMOTIONAL TOLL
The physical side effects of chemotherapy can exacerbate feelings of depression, sadness, and hopelessness. For Rathore, for instance, the treatment was physically taxing, marked by bouts of nausea, fatigue, and hair loss. Adjuvant chemotherapy left Nandita Gill, 30, a Delhi-based homemaker with an unwelcome companion — weight gain. It felt like an added punishment as the pounds piled on, she says. “Each day was a reminder of the physical toll chemotherapy took on my body, leaving me feeling trapped in a cycle of discomfort and frustration. Despite my efforts, shedding the weight seemed like an impossible task, casting a shadow over my recovery journey,” Gill recalls.
“Body image concerns resulting from chemotherapy-induced physical changes, such as hair loss and weight fluctuations, can significantly impact self-esteem,” says Dr Neerja Agarwal, psychologist and co-founder of Emoneeds in Gurugram. Counselling and support aimed at promoting self-acceptance beyond physical appearance are crucial in fostering resilience and improving overall wellbeing, she observes.
Coping with cancer treatment also presents challenges like strained relationships and financial stress. It’s also important to acknowledge the intense fear and anxiety that often accompanies a cancer diagnosis, compounded by uncertainties about the treatment’s effectiveness and potential outcomes. “Providing tailored emotional support, including relaxation techniques, mindfulness practices, and cognitive-behavioural therapy (CBT), can help individuals manage these feelings and build resilience,” Agarwal adds.
Delhi resident Rakesh Kumar, 47, a colon cancer patient underwent the treatment because “the fear of cancer returning loomed large.” “Preventive chemotherapy felt like a necessary step in safeguarding my future,” he reflects. Despite grappling with side effects such as neuropathy and gastrointestinal discomfort, Kumar remains resolute in his commitment to the treatment, finding solace in the prospect of long-term remission.
The marathon, one of the oldest in the world, attracted 30,000 runners this year
The city of Boston, US, is anticipating a $200 million economic windfall on the wings of the 128th Boston Marathon. Held on Monday, 15 April, the marathon welcomed 30,000 runners and a vast number of spectators from 130 countries including India. This turnout heralded a full-scale return to the cherished Patriot’s Day tradition after the event shifted to a virtual format or limited attendance during the covid era.
Boston Chamber of Commerce chief Jim Rooney compared the marathon weekend’s impact to that of the Super Bowl. Some hotels were booked months in advance of the event, with average prices of roughly $510 a night, according to Hopper. Local restaurants were prepared for full houses, said Rooney. Alex Galitsky, a participant who’d run more than 20 marathons, managed to secure a three-night hotel stay for $1,300, which he considered a bargain given the current market. “It’s a very prestigious marathon but it’s so expensive,” said Galitsky, 48, who works in market research for pharmaceuticals at Ipso SA.
The annual race, organised by the Boston Athletic Association, had competitors vying for a coveted title and a substantial prize purse of $1.2 million. The historic 26.2-mile (42-kilometer) race, stretching from Hopkinton to the heart of the city at Copley Square, is one of the world’s oldest annual marathons. This year had Bank of America Corp. stepping in as the new primary sponsor.
The race is equally known for its supporters, who don the famed red socks and come armed with cowbells and posters, to create a vibrant atmosphere — all under the watchful eyes of security personnel. The event’s heightened safety measures and increased medical services are a response to the 2013 bombings, which killed three people and injured hundreds of other spectators near the finish line.
Christina Abossedgh, a senior compliance officer and vice president at Goldman Sachs Group Inc., was among the thousands running for charity — she was raising funds for Expect Miracles Foundation, which focuses on cancer research. “Cancer reaches and touches everybody,” she said. “When people think of marathons, they think of a handful and Boston is one of them. I wanted to make sure I was hitting on a subject that I can’t pick up the pen or pick up the lab coat and work on myself.” Abossedgh, 38, took the Amtrak from New York City (to Boston) with her two Yorkies. Monday’s race was her sixth overall marathon and her fourth major one.
The economic impact of the marathon is expected to extend far beyond race day — it also marks the unofficial start of Boston’s tourism season. With the pandemic era receding, Rooney envisions a banner year for tourism, bolstered by the return of in-person university graduations and an uptick in city visits. “It will be the biggest year for tourism since the pandemic, with people eager to return to travel,” said Rooney.