Interview with Heather Wakelee, MD
Dr Wakelee is Assistant Professor of Medicine in the Division of Oncology at Stanford University in Stanford, California.
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Chemotherapy and quality of life
DR LOVE: And maybe you can kind of paint a picture, because there are a bunch of different regimens that are used or chemotherapy combinations, so it’s not like everybody uses the same thing. Maybe you can kind of paint a broad picture about generally what people experience.
DR WAKELEE: So with lung cancer therapy, almost always we use a combination of two drugs when we’re talking about this adjuvant or after surgery chemotherapy. One of the drugs is almost always a drug called cisplatin and cisplatin is a chemotherapy drug that’s been around for a long time. When we first started using it, it was a very difficult to get because it causes a lot of nausea and vomiting and can affect kidneys and do other bad things, but over the years we’ve learned a lot about how to give it safely. And so we now give it with a lot of intravenous fluids, fluid going in through the vein, to make sure that we protect the kidneys. And one of the great things about oncology that I’ve been able to witness over the last five to ten years is improvements in how we can control nausea and vomiting so that people really don’t have to suffer with those symptoms anymore for the most part.
There are exceptions where people have a hard time, but by using a cocktail of three or four different types of antinausea medications, most of my patients are able to continue to lead their lives without having the nausea be a major problem, even with the treatment.
Preventing Treatment-Related Nausea and Vomiting
DR LOVE: Can people work?
DR WAKELEE: Many of them do. I mean people do need to take off, obviously the day of treatment, a few days after. Many people decide they’re not quite feeling up to working. I mean they’ve just been through a big surgery. The chemotherapy is draining, fatigue, which can build up over those three months of therapy is a big issue. Some people find that not working gives them more time to worry about their cancer and they don’t like that. So I really leave it up to the individual and my patients who want to keep working, most of them are able to keep working. And patients who feel like they really need the time off, I think that some people really do need that extra space just to be able to rest and focus on their healing.
DR LOVE: When people ask you “how long will it be before I feel like my old self again,” of course, they’re not just recovering from the chemo, but also the surgery, what do you generally observe?
DR WAKELEE: Well the chemotherapy itself takes about three months as we’ve talked about before and going through the side effects, again, we can manage it with the newer treatments, but it does take a toll. People are fatigued. That fatigue persists for another, probably one or two months and so I usually tell people that by six months or so from the start of their chemotherapy, the chemotherapy effects will be gone. And that also tends to coincide with when most of the surgery effects are going to be getting better.
