Medication Therapy

General information on chemotherapy

Characteristic of cancer cells is an increased cell division, which leads to the development of tumors. This is where chemotherapies and cytostatics interfere. They interrupt the cell division process, for example, by integrating into the cancerous DNA. They can also inhibit metabolic processes of cancer cells that are important for cell division.

Patient undergoing chemotherapy

It is important to know that cytostatics can also have side effects on the cell division processes of healthy cells, for example, in the skin, mucosa, hair, and hematopoietic cells of the bone marrow. However, most of the side effects disappear after having completed chemotherapy.

In recent years there has been an increase in combining so-called targeted drugs. These include mainly antibodies and kinase inhibitors. Depending on the type of tumor, these targeted drugs are used either individually or in combination with cytostatics. Often enough, the combination of drugs leads to a more effective treatment of the tumor disease. The use of a certain drug combination strongly depends on the type and stage of the individual patient's cancer.

Chemotherapy can be reasonable in different stages of various tumor diseases. Depending on the individual case, it can be employed either before or after surgical removal of the tumor (so-called neoadjuvant or adjuvant chemotherapy), in combination with radiation therapy, or independently from surgery or radiation therapy.

Whether chemotherapy is a good option needs to be decided individually and after performing detailed diagnostics. This includes, for instance, examining cancerous tissue samples and determining the exact spread of cancer. The interdisciplinary oncology outpatient clinics at NCT are specialized in compiling all relevant information for decision making and carrying out the necessary examinations. All further steps are discussed in detail with the patient.

Often enough a decision is made against chemotherapy. This can have various reasons, for instance, when other treatment methods seem more promising. Certain cancers are known to be not very susceptible to chemotherapy; in these cases, it is not the treatment option of first choice. Other cancers can be treated very effectively with targeted therapies, so that  additional chemotherapy is not useful.

During the consultation session, the attending physicians at NCT offer the patients a detailed overview of the chances of success and possible side-effects of chemotherapy.

Most cytostatics are administered by injection into a vein. Only few cytostatics can be taken as tablets. It is recommended to many patients to have a so-called port implanted in order to ease the administration of cytostatics. A port is a small reservoir which is implanted under the skin close to the collarbone during an ambulatory surgical procedure and has a connection to large veins. This reservoir can be punctured by the attending physician in order to connect it to the cytostatic infusion.

NCT offers its patients undergoing chemotherapy a total of 60 specially designed infusion chairs in its day care units (30 chairs each on the ground and first floors of day care units I and II). Additional chairs for chemotherapy on a day care basis are provided by the Department of Internal Medicine (Department of Hematology, Internal Medicine V). The individual type of tumor disease determines the clinic in which chemotherapy is applied. Leukemia, for instance, is mainly treated at the Department of Internal Medicine, while skin and breast tumors are mainly treated at NCT day care units I and II. This distribution into different treatment areas offers our patients more security: All therapies are supervised appropriately by specialized nurses and physicians. This enables NCT as a comprehensive cancer center to appropriately deal with the increasing complexity of oncologic therapies.

Usually our patients can go back home after having received their chemotherapy. However, in rare cases it might be necessary to receive inpatient chemotherapy. NCT provides several beds at the Department of Internal Medicine of Heidelberg University Hospital for these cases. Particular factors, for example, especially intensive chemotherapies, or individual factors such as severe concomitant diseases may call for supervision also during the night.

The composition of chemotherapy is adjusted individually for all patients. Thereby it is not only important to consider the type of cancer, but also other factors, such as the patient's height and weight, as well as his/her kidney and liver functions.

The duration of chemotherapy may vary considerably. Short-term schemes, where infusions take less than an hour or even only minutes, as well as long-term schemes, which can take a whole day, are possible.

Most importantly, trained specialists need to supervise the patient constantly during the whole therapy. This way they can react more quickly to possible side effects (for example, interrupt the infusion in case of an allergic reaction or the like).

In case of emergency, at Heidelberg University Hospital all kinds of specialists can be found who are able to appropriately treat even unexpected reactions to chemotherapy.

After having completed chemotherapy, various check-ups are performed. It depends on several factors whether chemotherapy is continued or not. These factors are mainly the reaction of the tumor to chemotherapy, the tolerability of chemotherapy, the physical overall condition and alternative treatment options. Very often, chemotherapy is completed as planned. NCT offers its patients regular aftercare examinations after having completed chemotherapy. This also includes specific examinations for early detection of possible late effects of chemotherapy.

General information on targeted therapy

Targeted therapies are new kinds of medication-based cancer therapy. They target and attack specific features of the tumor or tumor attributes which facilitate cancer cell growth. The growth of the tumor can be inhibited in this way. Only if the tumor has such attributes, can a patient benefit from such a targeted therapy. The treatment is not available for every kind of tumor. Targeted therapies are applied alone or in combination with chemotherapy or radiation therapy.

Please consult your attending physician. He has an overview of currently running trials related to your illness and will inform you in detail.

Information on side effects can be found in the patient handbook on p. 20-21.
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