Several treatments are available for cancer. The most common of them are Chemotherapy, surgeryand radiation therapy. Chemotherapy involves the administration of drugs that kills cancer cells. It is given in cycles for optimum efficacy and to recover from side effects. Treatment adherence is the key to positive outcomes. Therefore, patients should not skip or delay their chemotherapy cycles.

Need For Chemotherapy Cycles

Patients undergo chemotherapy in several cycles. The patients usually have 4-8 treatment cycles. The duration between one round of therapy and the start of the next is referred to as one cycle. So in a 28-day treatment cycle, the oncologist administers chemotherapeutic drugs on the 1st, 2nd, and 3rd day and there would be drug-free days from the 4th to the 28th day. Doctor plans the treatment in the chemotherapy cycles due to the following reasons:

Therapeutic efficacy: When administered in cycles, this treatment approach enhances treatment efficacy and improves outcomes. It is because not all cancer cells divide uncontrollably at a given point. Some are at the resting stage. Chemotherapy only kills those cells that divide rapidly. Thus, administering the drug in cycles helps kill all the cancer cells.
Body recovery: Chemotherapy has several side effects. These are nausea, vomiting, fatigue and higher infection risk. Continuous administration of these drugs may cause severe side effects that the body cannot tolerate. The oncologists, depending upon the type of cancer and age of the patients, along with other factors, devise customised chemotherapy cycles for the patients. It provides the time for the body to recover from the side effects.

Why Do People Skip Chemotherapy Cycles?

There are several reasons for skipping or delaying the chemotherapy cycles. Some of them are:

Side Effects: Some patients cannot tolerate the side effects of chemotherapy. It may lead to skipping or completely stopping the chemotherapy cycles. However, today, advanced chemotherapeutic drugs are available for certain types of cancer with fewer side effects. If the side effects are severe, the doctor may administer medications that can help in managing them.
Infection: If the patient has an infection or fever, the doctor may delay the chemotherapy cycle. The oncologists resume the chemotherapy once the patient recovers from illness.
Low White Blood Cell Count: The patients may have low white blood cell count after the chemotherapy cycle. The doctor may delay the subsequent cycles if the patients have a very low white blood cell count after the chemotherapy cycle. Very low white blood cell count may increase the risk of infection.
Hospitalisations: Chemotherapy may cause severe fatigue and weakness. If the patients need hospitalisation, the doctor may delay the chemotherapy cycle until they are fit for getting chemotherapy.
Other Issues: Several other issues lead to the skipping or delaying of the chemotherapy cycle. These are financial constraints, family responsibilities, job requirements and depression and anxiety due to the disease.

Why Should You Not Skip Chemotherapy Cycles?

Patients should not skip or delay their chemotherapy cycles. If there is any delay or skipping of the dose (especially the oral drugs), the patient should immediately inform the doctor. They should seek advice for a further course of treatment. Patients should not skip chemotherapy cycles due to the following reasons:

Neutralise the Effect of Prior Cycles: Skipping or delaying the chemotherapy cycles may offset the results obtained with the prior chemotherapy cycles. As already discussed, some cells are in the resting stage and may divide after completing the previous cycle. Therefore, the disease may reach the pre-treatment stage if these cells are not killed through the next treatment cycle.
Need for Change of Treatment: It is essential to note that chemotherapy administration varies for each patient depending on the type and stage of cancer. When a patient skips the chemotherapy cycle, the disease may progress to the next stage, and the oncologists may have to change the complete course of treatment, and eventually, the patient may have to take medicine from the beginning. The patient may also require adjuvant therapy.
Progression of Cancer to Advanced State: In fast-growing cancers, such as inflammatory breast cancer, skipping chemotherapy may cause the disease to quickly progress to an advanced stage. The oncologists may prescribe intensive chemotherapy treatment along with surgery or radiation therapy.
Reduced Survival and High Mortality: Several studies have concluded that skipping or delaying the chemotherapy cycles may reduce the survival rate and increase mortality. For instance, a study on colon cancer patients revealed that patients who completed chemotherapy have a significant survival advantage, whereas those who did not complete chemotherapy have relatively lower survival rates.

How to Improve the Patients’ Adherence to Chemotherapy?

Cancer has a devastating effect on the life of the patients and their family members. Therefore, improving the patients’ adherence to treatment is essential to improve survival and reduce mortality. Some of the ways to improve patients’ adherence are:

Detailed Information: The healthcare provider must provide clear information to patients with cancer. It includes the type of treatment and side effects. It will help the patient to prepare for the treatment in advance.
Greater level of Psychological Support: Psychological support through counselling is required for both the patients and their family members. Studies have found that people with a higher degree of support have a high adherence rate.
Financial Support: Several NGOs collect funds for the treatment of cancer patients. Further, the Central and State governments have several schemes to assist cancer patients financially. Therefore, there is a need to create public awareness about such schemes.
Strategic Alteration in Therapy: The doctor may alter the treatment when the patients cannot tolerate the current chemotherapy cycles. It may include lowering the dose of the drugs. It will reduce the side effects and allow the patients to complete the chemotherapy cycles.

Conclusion

Chemotherapy works well when the patients stick to the scheduled chemotherapy cycles. Unlessin emergency conditions, patients should complete their chemotherapy cycles. Further, the healthcare professionals should also look into the reasons, which force the patients to skip the treatment. Psychological support and counselling, if considered, are found to have a positive impact on treatment adherence and completion.

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References

Morris M, Platell C, Fritschi L, Iacopetta B. Failure to complete adjuvant chemotherapy is associated with adverse survival in stage III colon cancer patients. Br J Cancer. 2007;96(5):701-707.
National Cancer Institute. Chemotherapy to Treat Cancer. Available at: https://www.cancer.gov/about-cancer/treatment/types/chemotherapy. Accessed on: 24th December 2021.
Cancer Research UK. Your chemotherapy plan. Available at: https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/chemotherapy/planning/your-chemotherapy-plan. Accessed on: 24th December 2021.