Chemotherapy and Neutropenia
by Lorna Stevens (excerpts of article printed in CONTACT 1994 - Candlelighters Newsletter, Canada)
We are often asked for information pertaining to, in particular, the types of neutropenia (NEW-TROH-PEE-NEE-AH) caused by cancer chemotherapy.
Neutropenia is a common side effect for as many as one in three patients receiving chemotherapy treatment.
The neutrophils are the main white blood cell defense against infections, and are, along with the cancer cells, killed by the chemotherapy.
The most common symptoms include fevers, mouth sores, ear infections, pneumonia and other sores and infections. The mouth, a major entry point for bacteria,, can be a real trouble spot.
Chemotherapy may have to be delayed until the body can produce more neutrophils and a lower dosage may have to be given, resulting in the treatment being less effective.
The longer the neutrophil level remains low, the greater the chance of getting an infection with potentially serious results.
When infection develops, antibiotics are given and hospitalization can occur for an average 10 day stay per occurrence of potentially life-threatening infections.
It is much harder for the doctor to treat the patient as every occurrence of potential infection saps the strength and greatly affects the total quality of life.
New drugs have been produced which help the bone marrow to make neutrophils, and help restore the body's defense against infection. These drugs are known as granulocyte colony stimulating factors. They help keep the number of neutrophils in the blood above the danger level all or most of the time. The shorter the time the neutrophil count is low, the less chance there is of developing fever or infection.
These drugs may improve the lives of patients with neutropenia by decreasing the number and severity of infections and reducing hospitalizations. These and other treatment options should be discussed with the doctor.
These drugs are expensive but less expensive than the potential hospital stays. The compassionate value is immeasurable. Here are some comments from families and physicians:
"There is no question that G-CSF is keeping these patients out of the hospital and away from doctors' offices. Because our hospital budget is being reduced every year, we are forced to find ways to meet the budgetary restrictions. Reduction in hospitalization is a major strategy and keeping neutropenic patients out of the hospital has had an important impact on cost-savings."
"As physicians our goal is to practice preventative medicine. This is a very exciting drug. We can provide medication to avoid frequent serious infections. The impact on the patient's quality of life will be dramatic."
Her chemotherapy began and remission was achieved.
She relapsed and chemotherapy was re-started, remission again achieved. Chemotherapy continued for 2 1/2 years and had to be stopped because of a severe case of chicken pox. The 2nd remission lasted 6 months. The option of a bone marrow transplant was present as her best chance to live at the age of seven.
She was hospitalized 32 days and it turned out, cyclic neutropenia was transplanted. Thankfully to Neupogen's experimental use, she is now 19 and doing very well.
"My son was diagnosed with Burkitts Lymphoma October 1993. The disease advanced; he was a Stage Three and the chemotherapy treatments were intense with only two weeks between each. As a result, we spent most of the five months in the hospital. The side effects were severe, coupled with neutropenia. My son had his braces on and the window was so small between recoveries that they could not be removed. Hence, he had the worst case of mouth sores ever seen, and they just couldn't heal.
I read every piece of literature available. Luckily, one of them was a booklet provided by the Neutropenia Support Association. A phone call offered me information about Neupogen, and some options that had not even been presented to me by any of the hospital staff.
The battle began, and it was all uphill. Most of the staff were unfamiliar with this approved drug and tried to persuade us to consider an experimental, free drug. Finally, our staff doctor listened, read the information I offered, and agreed that my son was too sick to risk the chance of more side effects. Even so, he had to override the wishes of the Oncology Head, who resisted the use of any colony stimulating factor drugs.
Neupogen provided a necessary option and throughout the rest of his treatment, the side effects eased completely in one of the blocks, and lessened them by at least 60% in the other. During one session, my son did not even experience any neutropenia effects other than low counts, and was able to go home for almost a week.
The frustration, battling, additional stress, and more significantly, my son's suffering were unnecessary. Hospitals should not be making decisions for the patients, but rather, should be educating their staff to present all the options available.