Chemo in 2020 Versus 1988 - Advancements But Some Things Never Change

by GregP_WN

My history with cancer goes back to 1988 when I got a crash course in what Hodgkin's Lymphoma is. That whirlwind started fast, then slowed down to a steady speed over the next 32 years. There have been some fantastic advances in cancer treatments, chemo, and the treatment of side effects. But some things haven't changed. 

Advancements In Chemo Treatments

Chemo Delivery - When I was diagnosed in 88, there wasn't a lot of time spent on education about the whole process. They didn't tell me what to expect, how it would work, the purpose of what they were doing, the side effects to expect or how to deal with them. It was pretty much just "sit down in that chair right there and we'll be with you in a minute". 

My treatment was ABVD, a treatment for Hodgkin's Lymphoma that, at the time, was still relatively new and was one of the "new promising treatments" out for Hodgkin's. Prior to this chemo regimen being developed by an American Cancer Society funded researcher, a Hodgkin's diagnosis had a cure rate of about 10%. After this treatment was put into use, the success rate went from 10% to 90%. That's a fantastic improvement! 

The procedure at that time was to go to the "lab" which was a small room inside another room where one lady would stick my finger and take blood about like someone checking their sugar. If everything was good, I would go sit in "the chair". The nurse would bring the bag of chemo drugs over and hook me up to the IV. The bag was a small bag, the size that most anti-biotics come in, if you've ever had IV anti-biotics. This little bag was dripped as fast as it would drip, taking only about 15 to 20 minutes. 

No "pre-meds" were given, no anti-nausea drugs, nothing but just the chemo. It was mixed so pure or hot, that it would burn as it was going in. After it was done they would say "OK, that's it, see you next week" and off I went on my way home. 

Chemo in 2020 - My how times have changed. I started treatment for my 5th diagnosis a few weeks ago. This is my first chemo treatment since 1989 when I finished up a treatment regimen for a relapse of my first Hodgkin's Lymphoma diagnosis. Technically, I'm having immunotherapy, it's not "chemo" exactly, but it's delivered the same way, by IV drip. The first thing that I noticed different is the administering of pre-meds. an IV bag of fluids was started, on a relatively slow drip. Then some other drugs to address pain, nausea, and other possible side effects were given. Some by mouth (pill) and others injected into the IV drip. 

Other differences between then and now is the types of treatments available. Today, there are hundreds of clinical trials going on that are testing the safety and effectiveness of different drugs for the treatment of cancer. Some are given by traditional IV, others are oral pills, and others are direct intratumoral injections. I am receiving these injections for the clinical trial I am on. 

Yes, it hurt. 

Needle In The Neck

After the pre-meds were dripping for 30 minutes or so, the main course, Keytruda in my case, was started. Again, it's not called chemo for some reason. It looks just like the delivery of chemo in 1988 but, whatever. When that was started it was a small bag, but it was being delivered using an IV pump that mixed the two bags, diluting it enough to eliminate any possible burning or other side effects. 

I didn't feel a thing, as opposed to my first chemo treatment in 1988. Then, I watched that red drug drip down the tube and get closer to my hand, wondering what this was going to feel like. What would it do to me? Would I feel anything? Is it going to hurt? Will my arm swell up? Along with about a hundred other questions. Yes, it burned like hell, hurt, things swelled up, and those hundred other questions were just about all answered with a "yes, it will". This time, no pain, no swelling, no side effects felt, no nothing. It's actually a little odd feeling, since I went through two years of treatments back then and experienced so many different things.

The actual treatment process was similar to 1988, but advancements made through experience in chemo and drug delivery have taught the doctors better ways of doing it. 

Facility Differences - In 1988 the facility I was treated at was part of the Methodist Hospital organization in Memphis. This is obviously a large town, and the clinic was a well respected facility in the cancer world at the time. Looking back at that facility now it was a toy. It was probably smaller than a lot of local doctor's offices these days. The waiting room would probably hold 20 people or so and the infusion room, called the treatment room then, was small compared to today's facilities. There was one room with 5 chairs in it along one wall, the other side of the room had an enclosure where the same nurse that was hanging my chemo drugs was mixing them up. 

We were all within 3 feet of each other and would talk, laugh, cry, compare, and support each other. The whole room was probably only 20 feet long by 12 feet wide. 

Vicc

Today, the facility that I am going to is Vanderbilt-Ingram Cancer Center. A part of Vanderbilt University Medical Center in Nashville, TN. VICC is one of only two National Cancer Institute-designated Comprehensive Cancer Centers in Tennessee. 

The process now isn't even recognizable compared to 1988. First the check-in process is a real "process" now. We go to the lab first. I stop at one desk to give them my name, they tell me to have a seat and someone will call me up. We get a text message telling us to come to desk number XX for check-in. This person will ask the same old questions we've been asked at every visit for the last 11 years, then tell me to have a seat and someone will call you to the lab. A few minutes later another text message tells us to come to the desk at the lab door. They ask who I am again, DOB, etc, then show me through the door into a room with 8 chairs in small curtained off cubicles. Each station has a computer, and the tech will ask several of the same questions I've already answered 10 times. Then they will start the process. Instead of sticking my finger and getting a single drop of blood, they access my port and draw anywhere from 8 to 18 vials of blood. Then they ask what else I have going on that day. Treatment? More blood draws? This is so they know whether they should leave the port accessed with the IV tube hanging out of it, or remove it. 

Once I'm done with this part of the process we go across the hallway to a waiting room to see the oncologist. This waiting room is probably 100 ft. by 50 ft. and could hold a hundred people. When we are called by a nurse to go back we walk down a long hallway of exam rooms to a small room where vitals are checked, then on to the exam room where the doctor will come in and see how I am doing and evaluate me before sending me off for the rest of the procedure. 

Vicc Waiting Room

One section of the massive waiting room at VICC

There are probably 20 doctors seeing patients in this facility and hundreds of patients coming and going. A far cry from the size and scope of patient and treatment volume done in 1988. 

When the doctor is satisfied that I am OK for treatment, they tell us to go to the Infusion lab. This is on another floor from where this doctor's exam rooms are. The infusion room process is to again check in, answer those same questions to be sure I know who I am again, and again pull up a chair and wait. This waiting room has enough seats for probably 25 to 30 people. What they call an "infusion lab" isn't just one room here. It's an entire section of this floor probably taking up a 200 ft. x 200 ft. section. It is a big square with a hallway running around the square with treatment rooms lining the outside of the room. I haven't counted, but I'm going to guess there are probably 100 rooms or more. Some with chairs for you to just come in an sit. And others with beds, or a spot for a hospital bed for those unable to walk in for treatment. 

Each of these infusion rooms has a TV, a big comfortable treatment chair, another chair for your assistant, wife, helper, brother, mother, or whatever to sit in while you are getting treatment. There is privacy, while a feeling of comfort knowing that the room just through the curtain has a swarm of nurses and doctors to handle your issues. The infusion room at Methodist in 88 was only for the patient, nobody was allowed to accompany you back to that room. Even if she does nothing but sit with me, it's a good feeling to have my Sweetie with me through this. 

There is also a room that they call the "research room" where we go to sit for a few hours after I receive the injection of a trial drug. It's a spot where the nurses can stop in and monitor me to be sure I don't have any side effects or issues. This being a trial drug, there is a lot of "trial and hopefully no errors" involved. I guess that's why they are called "trials". 

There are also rooms that are basically hospital rooms that a person can stay in overnight when the situation calls for it. The facility I was treated at in Memphis in 88 had nothing like this. I am pretty sure that they hadn't even considered the possibility of a person spending the night in a treatment room. 

Staff wise, I have no idea how many nurses, PA's, doctors, and support staff are at Vanderbilt-Ingram Cancer Center, even just in this infusion facility, there must be over 100. My first facility had maybe a dozen people, total. 

Port Getting Keytruda Iv Pump Keytruda Keytruda Iv Pump Display

The staff will ask us if we need anything, several times. Blanket, snack, water, or just whatever. Anything to make the patient more comfortable and the process a little easier. Being a patient covering over 32 years, I can attest that this is a welcome gesture. When we are being treated for cancer and in a beaten down, vulnerable state of mind and body, a simple bottle of water and snack is much more than a bottle of water and a snack. Back in "the day" we weren't there long enough to even drink a bottle of water or eat anything, so nothing was offered, not that they probably wouldn't have done so, but it just wasn't part of the process then. 

State of the art equipment, the latest procedures, and drugs are used at VICC, just as they are in many other top cancer treatment facilities in the US. Looking back at the process, equipment, drugs, etc in 1988, I'm sure they were new and state of the art, but now, looking back, all of it seems like the dark ages compared to now. Times change, advancements happen, technology has taken over. 

These two facilities I am comparing are as different as night and day, but it's also a little like an apple/oranges comparison. If I were to walk into that facility at the Memphis Methodist campus today, I'm sure it would be more like VICC, but, that exact clinic doesn't even exist today however. The two doctors who were partners split up and went their separate ways and the doctor who treated me at that time is now in Louisville, KY. I tracked him down when I was diagnosed with my third DX in 2008. It was good to talk to him, he gave me confidence and hope that the process was going to be successful and that everything was going to be alright. 

What Remains The Same? 

While things change and advancements happen, some things still remain the same. The feeling of sitting in "the chair" hasn't changed. Anyone who has ever had the misfortune of sitting in the chair will understand this feeling. Sitting there waiting for the drug to hit your veins still remains. 

Chemo Chair

The drugs may be new and improved, the equipment might be the latest state of the art, the technology is the latest, the room is better, but you are still sitting there realizing that a chemical drug meant to kill your cancer is dripping into your body with unknown residual and immediate side effects possible, while you hope that it does it's job with minimal side effects. But, what remains is, we all take treatment differently, and cancer and cancer treatments treat us all a little differently, so we don't know what the end result will be. 

The roller coaster of emotions is still the same, fear, anxiety, stress, disbelief, sadness, anger, doubt, denial, depression, guilt, and a long list of others are still there. Time, technology, advanced drugs, and improved methods of diagnosis, and delivery of treatment will never take those away from us. 

And one of the biggest things that remains the same is HOPE! 

Hope Changes Everything

A person just diagnosed with cancer in today's world can go into it feeling more confident that their treatments, side effects, and outcome will be as best as they can be now. Compared to 32 years ago, this person is confident that I am worlds away and ahead of where I started in cancer treatments in 1988. I trust that the doctors and nurses at VICC will carry me through this to the position I hope to be in when all of this is done. 

My Library of Articles About My 3rd, 4th, and 5th Diagnoses

You can’t put a Price on a Life-This Just In….Yes You Can 
Diagnosis #5 Because Apparently #4 Wasn’t Enough 
Things Usually Go Right, But Sometimes They Go Left Down The Highway to Hell

Dear Family-I’m Sorry I Gave You Cancer….4 Times 
Learning to Live As a Laryngectomee 
2 Weeks Out From Life Saving, Life Altering Surgery 
Tonight You Won’t Be Able to Speak, What Will You Say Today?

Gratitude and Humility-How Do You Get It? 
10 Positive Things With a 4th Diagnosis….Wait..What? 
Random Thoughts While Waiting For Cancer Surgery 
Diagnosis #4 Just Got Real 
Dancing With Cancer For The 4th Time 

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