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Making chemo less toxic New drugs take some of the sting out of cancer treatments that can wrack the body By BILL KETTLER Mail Tribune Peggy Cockrell never knew what "tired" meant until she started chemotherapy. The 54-year-old Ashland woman has been fighting breast cancer for almost two years. Like many cancer patients, she began to feel anemic as the cancer-fighting drugs destroyed healthy red blood cells, too. "Chemo-tired is like no other tired," said Cockrell, human resources manager for Ashland Community Hospital. "You can sleep for 16 hours and wake up just as tired as when you lay down. It's lay-down-on-the-floor-can't-function tired." Cockrell wanted to keep working during her treatments to preserve some semblance of an ordinary life. "Work is therapy," she said. "One of the things I learned was that it's important to keep your life as close to normal as possible. You want to hang on to the things that are most important in your life." Her doctors prescribed a substance called erythropoietin, which encourages her system to manufacture red blood cells. She works half time "and a little more," shepherding the Ashland hospital through an expansion project. "I'm not so tired," she said. "I can continue to function." Erythropoietin and other new "supportive-care" drugs have dramatically reduced the side effects of chemotherapy that used to make cancer treatments nearly as awful as the disease. The new drugs prevent anemia, fight nausea and help patients resist infection by stimulating production of white blood cells. "There are lots of new treatments out there that make chemotherapy much less toxic," said Medford oncologist Dr. Richard Karchmer. Drugs that prevent nausea help patients continue to eat (and enjoy eating) at a time when they desperately need nutrition, Karchmer said. "All these people are weak physically. They've lost weight, and their nutritional status is marginal anyway." Oncologists "pre-treat" cancer patients with medicines that minimize the side effects of cancer-fighting drugs. Physicians develop each patient's pre-treatment regimen based on the cancer drug's known side effects and the individual's response to the drugs. Doctors also prescribe drugs to combat cancer's effects on other parts of the body. Lisa Matchett of Medford, for example, takes a bone-strengthening drug because breast cancer has weakened her bones. She also takes anti-nausea medicines along with her "chemo." "If you've got babies to take care of, you can't be sick," said Matchett, a single mom who's raising three children under the age of 10. Supportive-care drugs add substantially to the costs of cancer treatments. Erythropoietin costs from $400 to $600 per injection (depending on size of the dose), and patients typically receive one weekly injection for the duration of their chemotherapy. Drugs that increase a patient's white blood cell count cost about $150 per injection and may be administered daily for seven to 10 days. Anti-nausea medicines may cost $70 per day for pills to $150 for intravenous drugs. "There's nothing cheap out there," Karchmer said. "All these drugs are very expensive. It took years to develop them." Karchmer said supportive-care drugs help many people, but they're not a panacea. Pharmaceutical companies have advertised drugs such as erythropoietin quite heavily, creating an impression that all cancer patients can benefit from them. "A lot of (cancer patients) are tired," Karchmer said, "but it has nothing to do with their blood count. (Erythropoietin's) not for everybody." People who can get help from the drugs sometimes can't afford them. Some insurance plans fail to cover the supportive-care drugs, said Karen Johnson, a nurse in Karchmer's office. "It all depends on the (insurance) package you bought," Johnson said. "Every insurance treats them differently." Johnson said physicians' offices try to find supportive-care drugs for patients whose insurance doesn't cover them. Drug companies sometimes provide free drugs for low-income patients or provide a limited number of free doses from their sample stock. Karchmer said reducing side effects often improves a patient's mental outlook as well as physical condition. "Obviously, it's very uncomfortable to be getting treatment and be sick at the same time," he said. "Chemo becomes a bad experience." Cockrell, now in her second course of chemotherapy, said the supportive-care drugs allow her to enjoy life in a way that cancer patients 10 or 15 years ago could not have imagined. "People used to be so sick they couldn't move," she said. "It doesn't have to be that way now." Reach reporter Bill Kettler at 776-4492, or e-mail [email protected] Mail Tribune Home | Ottaway Newspapers, Inc. | Dow Jones & Co., Inc. | Privacy | Contact Us Copyright � 2001 Mail Tribune, Inc.