The Cold Truth About Respiratory Infections

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The Pathogens That Came In From The Cold

Yesterday, we asked you about your climate-themed policy for avoiding respiratory infections, and got the above-depicted, below-described, set of answers:

  • About 46% of respondents said “Temperature has no bearing on infection risk”
  • About 31% of respondents said “It’s important to get plenty of cold, fresh air, as this kills/inactivates pathogens”
  • About 22% of respondents said “It’s important to stay warm to avoid getting colds, flu, etc”

Some gave rationales, including…

For “stay warm”:

❝Childhood lessons❞

For “get cold, fresh air”:

❝I just feel that it’s healthy to get fresh air daily. Whether it kills germs, I don’t know❞

For “temperature has no bearing”:

❝If climate issue affected respiratory infections, would people in the tropics suffer more than those in colder climates? Pollutants may affect respiratory infections, but I doubt just temperature would do so.❞

So, what does the science say?

It’s important to stay warm to avoid getting colds, flu, etc: True or False?

False, simply. Cold weather does increase the infection risk, but for reasons that a hat and scarf won’t protect you from. More on this later, but for now, let’s lay to rest the idea that bodily chilling will promote infection by cold, flu, etc.

In a small-ish but statistically significant study (n=180), it was found that…

❝There was no evidence that chilling caused any acute change in symptom scores❞

Read more: Acute cooling of the feet and the onset of common cold symptoms

Note: they do mention in their conclusion that chilling the feet “causes the onset of cold symptoms in about 10% of subjects who are chilled”, but the data does not support that conclusion, and the only clear indicator is that people who are more prone to colds generally, were more prone to getting a cold after a cold water footbath.

In other words, people who were more prone to colds remained more prone to colds, just the same.

It’s important to get plenty of cold, fresh air, as this kills/inactivates pathogens: True or False?

Broadly False, though most pathogens do have an optimal operating temperature that (for obvious reasons) is around normal human body temperature.

However, given that they don’t generally have to survive outside of a host body for long to get passed on, the fact that the pathogens may be a little sluggish in the great outdoors will not change the fact that they will be delighted by the climate in your respiratory tract as soon as you get back into the warm.

With regard to the cold air not being a reliable killer/inactivator of pathogens, we call to the witness stand…

Polar Bear Dies From Bird Flu As H5N1 Spreads Across Globe

(it was found near Utqiagvik, one of the northernmost communities in Alaska)

Because pathogens like human body temperature, raising the body temperature is a way to kill/inactivate them: True or False?

True! Unfortunately, it’s also a way to kill us. Because we, too, cannot survive for long above our normal body temperature.

So, for example, bundling up warmly and cranking up the heating won’t necessarily help, because:

  • if the temperature is comfortable for you, it’s comfortable for the pathogen
  • if the temperature is dangerous to the pathogen, it’s dangerous to you too

This is why the fever response evolved, and/but why many people with fevers die anyway. It’s the body’s way of playing chicken with the pathogen, challenging “guess which of us can survive this for longer!”

Temperature has no bearing on infection risk: True or False?

True and/or False, circumstantially. This one’s a little complex, but let’s break it down to the essentials.

  • Temperature has no direct effect, for the reasons we outlined above
  • Temperature is often related to humidity, which does have an effect
  • Temperature does tend to influence human behavior (more time spent in open spaces with good ventilation vs more time spent in closed quarters with poor ventilation and/or recycled air), which has an obvious effect on transmission rates

The first one we covered, and the third one is self-evident, so let’s look at the second one:

Temperature is often related to humidity, which does have an effect

When the environmental temperature is warmer, water droplets in the air will tend to be bigger, and thus drop to the ground much more quickly.

When the environmental temperature is colder, water droplets in the air will tend to be smaller, and thus stay in the air for longer (along with any pathogens those water droplets may be carrying).

Some papers on the impact of this:

So whatever temperature you like to keep your environment, humidity is a protective factor against respiratory infections, and dry air is a risk factor.

So, for example:

  • If the weather doesn’t suit having good ventilation, a humidifier is a good option
  • Being in an airplane is one of the worst places to be for this, outside of a hospital

Don’t have a humidifier? Here’s an example product on Amazon, but by all means shop around.

A crock pot with hot water in and the lid off is also a very workable workaround too

Take care!

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  • A Planet of Viruses – by Carl Zimmer

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    We’ve reviewed numerous books on the immune system before, and this one’s mostly not about that.

    Instead, this one focuses on the viruses themselves, and the part they play in our world, for good and for ill. Popular awareness tends to focus on the ill, of course.

    But, there’s a lot that viruses do for us too, including:

    • Weak/harmless viruses that keep our immune systems on their toes and ready
    • Bacteriophage viruses that kill and consume pathogens that, left unchecked, would do the same to us
    • Endogenous retroviruses that have become symbiotic with the human organism, without which our species would quickly go extinct

    He also talks about biological warfare, and how we cannot bury our heads in the sand by avoiding research on those grounds, because someone will always do it anyway, so (as the motto of the immune system itself might say), best to be prepared.

    The author is a science journalist, by the way, and has no PhD, but does have a flock of Fellowships and assorted scientific awards and honors, so he appears to be doing good work so far as the scientific community is concerned.

    Bottom line: if you’d like to know more about viruses than “they’re very small and can cause harm”, then this book will open a whole new world.

    Click here to check out A Planet of Viruses, and upgrade your knowledge!

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  • Healthiest-Three-Nut Butter

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    We’re often telling you to “diversify your nuts”, so here’s a great way to get in three at once with no added sugar, palm oil, or preservatives, and only the salt you choose to put in. We’ve picked three of the healthiest nuts around, but if you happen to be allergic, don’t worry, we’ve got you covered too.

    You will need

    • 1 cup almonds (if allergic, substitute a seed, e.g. chia, and make it ½ cup)
    • 1 cup walnuts (if allergic, substitute a seed, e.g. pumpkin, and make it ½ cup)
    • 1 cup pistachios (if allergic, substitute a seed, e.g. poppy, and make it ½ cup)
    • 1 tbsp almond oil (if allergic, substitute extra virgin olive oil) (if you prefer sweet nut butter, substitute 1 tbsp maple syrup; the role here is to emulsify the nuts, and this will do the same job)
    • Optional: ¼ tsp MSG or ½ tsp low-sodium salt

    Method

    (we suggest you read everything at least once before doing anything)

    1a) If using nuts, heat your oven to 350℉ / 180℃. Place the nuts on a baking tray lined with baking paper, and bake/roast for about 10 minutes, but keep an eye on it to ensure the nuts don’t burn, and jiggle them if necessary to ensure they toast evenly. Once done, allow to cool.

    1b) If using seeds, you can either omit that step, or do the same for 5 minutes if you want to, but really it’s not necessary.

    2) Blend all ingredients (nuts/seeds, oil, MSG/salt) in a high-speed blender. Note: this will take about 10 minutes in total, and we recommend you do it in 30-second bursts so as to not overheat the motor. You also may need to periodically scrape the mixture down the side of the blender, to ensure a smooth consistency.

    3) Transfer to a clean jar, and enjoy at your leisure:

    Enjoy!

    Want to learn more?

    For those interested in some of the science of what we have going on today:

    Take care!

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  • 6-Minute Core Strength – by Dr. Jonathan Su

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    We don’t normally do author biographies here, but in this case it’s worth noting that Dr. Su is a physiotherapist, military rehab expert, and an IAYT yoga therapist. So, these things together certainly do lend weight to his advice.

    About the “6-minute” thing: this is in the style of the famous “7-minute workout” and “5 Minutes’ Physical Fitness” etc, and refers to how long each exercise session should take. The baseline is one such session per day, though of course doing more than one set of 6 minutes each time is a bonus if you wish to do so.

    The exercises are focused on core strength, but they also include hip and shoulder exercises, since these are after all attached to the core, and hip and shoulder mobility counts for a lot.

    A particular strength of the book is in troubleshooting mistakes of the kind that aren’t necessarily visible from photos; in this case, Dr. Su explains what you need to go for in a certain exercise, and how to know if you are doing it correctly. This alone is worth the cost of the book, in this reviewer’s opinion.

    Bottom line: if you want core strength and want it simple yet comprehensive, this book can guide you.

    Click here to check out 6-Minute Core Strength, and strengthen yours!

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Related Posts

  • How Does One Test Acupuncture Against Placebo Anyway?
  • In Crisis, She Went to an Illinois Facility. Two Years Later, She Still Isn’t Able to Leave.

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Series: Culture of Cruelty:Inside Illinois’ Mental Health System

    State-run facilities in Illinois are supposed to care for people with mental and developmental disabilities. But patients have been subjected to abuse, neglect and staff misconduct for decades, despite calls for change.

    Kaleigh Rogers was in crisis when she checked into a state-run institution on Illinois’ northern border two years ago. Rogers, who has cerebral palsy, had a mental health breakdown during the pandemic and was acting aggressively toward herself and others.

    Before COVID-19, she had been living in a small group home; she had been taking college classes online and enjoyed going out with friends, volunteering and going to church. But when her aggression escalated, she needed more medical help than her community setting could provide.

    With few viable options for intervention, she moved into Kiley Developmental Center in Waukegan, a much larger facility. There, she says she has fewer freedoms and almost nothing to do, and was placed in a unit with six other residents, all of whom are unable to speak. Although the stay was meant to be short term, she’s been there for two years.

    The predicament facing Rogers and others like her is proof, advocates say, that the state is failing to live up to the promise it made in a 13-year-old federal consent decree to serve people in the community.

    Rogers, 26, said she has lost so much at Kiley: her privacy, her autonomy and her purpose. During dark times, she cries on the phone to her mom, who has reduced the frequency of her visits because it is so upsetting for Rogers when her mom has to leave.

    The 220-bed developmental center about an hour north of Chicago is one of seven in the state that have been plagued by allegations of abuse and other staff misconduct. The facilities have been the subject of a monthslong investigation by Capitol News Illinois and ProPublica about the state’s failures to correct poor conditions for people with intellectual and developmental disabilities. The news organizations uncovered instances of staff who had beaten, choked, thrown, dragged and humiliated residents inside the state-run facilities.

    Advocates hoped the state would become less reliant on large institutions like these when they filed a lawsuit in 2005, alleging that Illinois’ failure to adequately fund community living options ended up segregating people with intellectual and developmental disabilities from society by forcing them to live in institutions. The suit claimed Illinois was in direct violation of a 1999 U.S. Supreme Court decision in another case, which found that states had to serve people in the most integrated setting of their choosing.

    Negotiations resulted in a consent decree, a court-supervised improvement plan. The state agreed to find and fund community placements and services for individuals covered by the consent decree, thousands of adults with intellectual and developmental disabilities across Illinois who have put their names on waiting lists to receive them.

    Now, the state has asked a judge to consider ending the consent decree, citing significant increases in the number of people receiving community-based services. In a court filing in December, Illinois argued that while its system is “not and never will be perfect,” it is “much more than legally adequate.”

    But advocates say the consent decree should not be considered fulfilled as long as people with disabilities continue to live without the services and choices that the state promised.

    Across the country, states have significantly downsized or closed their large-scale institutions for people with developmental and intellectual disabilities in favor of smaller, more integrated and more homelike settings.

    But in Illinois, a national outlier, such efforts have foundered. Efforts to close state-operated developmental centers have been met with strong opposition from labor unions, the communities where the centers are located, local politicians and some parents.

    U.S. District Judge Sharon Johnson Coleman in Chicago is scheduled in late summer to decide whether the state has made enough progress in building up community supports to end the court’s oversight.

    For some individuals like Rogers, who are in crisis or have higher medical or behavioral challenges, the state itself acknowledges that it has struggled to serve them in community settings. Rogers said she’d like to send this message on behalf of those in state-operated developmental centers: “Please, please get us out once and for all.”

    “Living Inside a Box”

    Without a robust system of community-based resources and living arrangements to intervene during a crisis, state-operated developmental centers become a last resort for people with disabilities. But under the consent decree agreement, the state, Equip for Equality argues, is expected to offer sufficient alternative crisis supports to keep people who want them out of these institutions.

    In a written response to questions, Rachel Otwell, a spokesperson for the Illinois Department of Human Services, said the state has sought to expand the menu of services it offers people experiencing a crisis, in an effort to keep them from going into institutions. But Andrea Rizor, a lawyer with Equip for Equality, said, “They just don’t have enough to meet the demand.”

    For example, the state offers stabilization homes where people can live for 90 days while they receive more intensive support from staff serving the homes, including medication reviews and behavioral interventions. But there are only 32 placements available — only four of them for women — and the beds are always full, Rizor said.

    Too many people, she said, enter a state-run institution for short-term treatment and end up stuck there for years for various reasons, including shortcomings with the state’s discharge planning and concerns from providers who may assume those residents to be disruptive or difficult to serve without adequate resources.

    That’s what happened to Rogers. Interruptions to her routine and isolation during the pandemic sent her anxiety and aggressive behaviors into overdrive. The staff at her community group home in Machesney Park, unsure of what to do when she acted out, had called the police on several occasions.

    Doctors also tried to intervene, but the cocktail of medications she was prescribed turned her into a “zombie,” Rogers said. Stacey Rogers, her mom and legal guardian, said she didn’t know where else to turn for help. Kiley, she said, “was pretty much the last resort for us,” but she never intended for her daughter to be there for this long. She’s helped her daughter apply to dozens of group homes over the past year. A few put her on waitlists; most have turned her down.

    “Right now, all she’s doing is living inside a box,” Stacey Rogers said.

    Although Rogers gave the news organizations permission to ask about her situation, IDHS declined to comment, citing privacy restrictions. In general, the IDHS spokesperson said that timelines for leaving institutions are “specific to each individual” and their unique preferences, such as where they want to live and speciality services they may require in a group home.

    Equip for Equality points to people like Rogers to argue that the consent decree has not been sufficiently fulfilled. She’s one of several hundred in that predicament, the organization said.

    “If the state doesn’t have capacity to serve folks in the community, then the time is not right to terminate this consent decree, which requires community capacity,” Rizor said.

    Equip for Equality has said that ongoing safety issues in these facilities make it even more important that people covered by the consent decree not be placed in state-run institutions. In an October court brief, citing the news organizations’ reporting, Equip for Equality said that individuals with disabilities who were transferred from community to institutional care in crisis have “died, been raped, and been physically and mentally abused.”

    Over the summer, an independent court monitor assigned to provide expert opinions in the consent decree, in a memo to the court, asked a judge to bar the state from admitting those individuals into its institutions.

    In its December court filing, the state acknowledged that there are some safety concerns inside its state-run centers, “which the state is diligently working on,” as well as conditions inside privately operated facilities and group homes “that need to be addressed.” But it also argued that conditions inside its facilities are outside the scope of the consent decree. The lawsuit and consent decree specifically aimed to help people who wanted to move out of large private institutions, but plaintiffs’ attorneys argue that the consent decree prohibits the state from using state-run institutions as backup crisis centers.

    In arguing to end the consent decree, the state pointed to significant increases in the number of people served since it went into effect. There were about 13,500 people receiving home- and community-based services in 2011 compared with more than 23,000 in 2023, it told the court.

    The state also said it has significantly increased funding that is earmarked to pay front-line direct support professionals who assist individuals with daily living needs in the community, such as eating and grooming.

    In a statement to reporters, the human services department called these and other improvements to the system “extraordinary.”

    Lawyers for the state argued that those improvements are enough to end court oversight.

    “The systemic barriers that were in place in 2011 no longer exist,” the state’s court filing said.

    Among those who were able to find homes in the community is Stanley Ligas, the lead plaintiff in the lawsuit that led to the consent decree. When it was filed in 2005, he was living in a roughly 100-bed private facility but wanted to move into a community home closer to his sister. The state refused to fund his move.

    Today, the 56-year-old lives in Oswego with three roommates in a house they rent. All of them receive services to help their daily living needs through a nonprofit, and Ligas has held jobs in the community: He previously worked in a bowling alley and is now paid to make public appearances to advocate for others with disabilities. He lives near his sister, says he goes on family beach vacations and enjoys watching professional wrestling with friends. During an interview with reporters, Ligas hugged his caregiver and said he’s “very happy” and hopes others can receive the same opportunities he’s been given.

    While much of that progress has come only in recent years, under Gov. JB Pritzker’s administration, it has proven to be vulnerable to political and economic changes. After a prolonged budget stalemate, the court in 2017 found Illinois out of compliance with the Ligas consent decree.

    At the time, late and insufficient payments from the state had resulted in a staffing crisis inside community group homes, leading to escalating claims of abuse and neglect and failures to provide routine services that residents relied on, such as help getting to work, social engagements and medical appointments in the community. Advocates worry about what could happen under a different administration, or this one, if Illinois’ finances continue to decline as projected.

    “I acknowledge the commitments that this administration has made. However, because we had so far to come, we still have far to go,” said Kathy Carmody, chief executive of The Institute on Public Policy for People with Disabilities, which represents providers.

    While the wait for services is significantly shorter than it was when the consent decree went into effect in 2011, there are still more than 5,000 adults who have told the state they want community services but have yet to receive them, most of them in a family home. Most people spend about five years waiting to get the services they request. And Illinois continues to rank near the bottom in terms of the investment it makes in community-based services, according to a University of Kansas analysis of states’ spending on services for people with intellectual and developmental disabilities.

    Advocates who believe the consent decree has not been fulfilled contend that Illinois’ continued reliance on congregate settings has tied up funds that could go into building up more community living options. Each year, Illinois spends about $347,000 per person to care for those in state-run institutions compared with roughly $91,000 per person spent to support those living in the community.

    For Rogers, the days inside Kiley are long, tedious and sometimes chaotic. It can be stressful, but Rogers told reporters that she uses soothing self-talk to calm herself when she feels sad or anxious.

    “I tell myself: ‘You are doing good. You are doing great. You have people outside of here that care about you and cherish you.’”

    This article is republished from ProPublica under a Creative Commons license. Read the original article.

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  • What happens when I stop taking a drug like Ozempic or Mounjaro?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Hundreds of thousands of people worldwide are taking drugs like Ozempic to lose weight. But what do we actually know about them? This month, The Conversation’s experts explore their rise, impact and potential consequences.

    Drugs like Ozempic are very effective at helping most people who take them lose weight. Semaglutide (sold as Wegovy and Ozempic) and tirzepatide (sold as Zepbound and Mounjaro) are the most well known in the class of drugs that mimic hormones to reduce feelings of hunger.

    But does weight come back when you stop using it?

    The short answer is yes. Stopping tirzepatide and semaglutide will result in weight regain in most people.

    So are these medications simply another (expensive) form of yo-yo dieting? Let’s look at what the evidence shows so far.

    It’s a long-term treatment, not a short course

    If you have a bacterial infection, antibiotics will help your body fight off the germs causing your illness. You take the full course of medication, and the infection is gone.

    For obesity, taking tirzepatide or semaglutide can help your body get rid of fat. However it doesn’t fix the reasons you gained weight in the first place because obesity is a chronic, complex condition. When you stop the medications, the weight returns.

    Perhaps a more useful comparison is with high blood pressure, also known as hypertension. Treatment for hypertension is lifelong. It’s the same with obesity. Medications work, but only while you are taking them. (Though obesity is more complicated than hypertension, as many different factors both cause and perpetuate it.)

    Wegovy injections
    Obesity drugs only work while you’re taking them. KK Stock/Shutterstock

    Therefore, several concurrent approaches are needed; taking medication can be an important part of effective management but on its own, it’s often insufficient. And in an unwanted knock-on effect, stopping medication can undermine other strategies to lose weight, like eating less.

    Why do people stop?

    Research trials show anywhere from 6% to 13.5% of participants stop taking these drugs, primarily because of side effects.

    But these studies don’t account for those forced to stop because of cost or widespread supply issues. We don’t know how many people have needed to stop this medication over the past few years for these reasons.

    Understanding what stopping does to the body is therefore important.

    So what happens when you stop?

    When you stop using tirzepatide or semaglutide, it takes several days (or even a couple of weeks) to move out of your system. As it does, a number of things happen:

    • you start feeling hungry again, because both your brain and your gut no longer have the medication working to make you feel full
    CAPTION.
    When you stop taking it, you feel hungry again. Stock-Asso/Shutterstock
    • blood sugars increase, because the medication is no longer acting on the pancreas to help control this. If you have diabetes as well as obesity you may need to take other medications to keep these in an acceptable range. Whether you have diabetes or not, you may need to eat foods with a low glycemic index to stabilise your blood sugars
    • over the longer term, most people experience a return to their previous blood pressure and cholesterol levels, as the weight comes back
    • weight regain will mostly be in the form of fat, because it will be gained faster than skeletal muscle.

    While you were on the medication, you will have lost proportionally less skeletal muscle than fat, muscle loss is inevitable when you lose weight, no matter whether you use medications or not. The problem is, when you stop the medication, your body preferentially puts on fat.

    Is stopping and starting the medications a problem?

    People whose weight fluctuates with tirzepatide or semaglutide may experience some of the downsides of yo-yo dieting.

    When you keep going on and off diets, it’s like a rollercoaster ride for your body. Each time you regain weight, your body has to deal with spikes in blood pressure, heart rate, and how your body handles sugars and fats. This can stress your heart and overall cardiovascular system, as it has to respond to greater fluctuations than usual.

    Interestingly, the risk to the body from weight fluctuations is greater for people who are not obese. This should be a caution to those who are not obese but still using tirzepatide or semaglutide to try to lose unwanted weight.

    How can you avoid gaining weight when you stop?

    Fear of regaining weight when stopping these medications is valid, and needs to be addressed directly. As obesity has many causes and perpetuating factors, many evidence-based approaches are needed to reduce weight regain. This might include:

    • getting quality sleep
    • exercising in a way that builds and maintains muscle. While on the medication, you will likely have lost muscle as well as fat, although this is not inevitable, especially if you exercise regularly while taking it
    Man walks on treadmill
    Prioritise building and maintaining muscle. EvMedvedeva/Shutterstock
    • addressing emotional and cultural aspects of life that contribute to over-eating and/or eating unhealthy foods, and how you view your body. Stigma and shame around body shape and size is not cured by taking this medication. Even if you have a healthy relationship with food, we live in a culture that is fat-phobic and discriminates against people in larger bodies
    • eating in a healthy way, hopefully continuing with habits that were formed while on the medication. Eating meals that have high nutrition and fibre, for example, and lower overall portion sizes.

    Many people will stop taking tirzepatide or semaglutide at some point, given it is expensive and in short supply. When you do, it is important to understand what will happen and what you can do to help avoid the consequences. Regular reviews with your GP are also important.

    Read the other articles in The Conversation’s Ozempic series here.

    Natasha Yates, General Practitioner, PhD Candidate, Bond University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Kate Middleton is having ‘preventive chemotherapy’ for cancer. What does this mean?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Catherine, Princess of Wales, is undergoing treatment for cancer. In a video thanking followers for their messages of support after her major abdominal surgery, the Princess of Wales explained, “tests after the operation found cancer had been present.”

    “My medical team therefore advised that I should undergo a course of preventative chemotherapy and I am now in the early stages of that treatment,” she said in the two-minute video.

    No further details have been released about the Princess of Wales’ treatment.

    But many have been asking what preventive chemotherapy is and how effective it can be. Here’s what we know about this type of treatment.

    It’s not the same as preventing cancer

    To prevent cancer developing, lifestyle changes such as diet, exercise and sun protection are recommended.

    Tamoxifen, a hormone therapy drug can be used to reduce the risk of cancer for some patients at high risk of breast cancer.

    Aspirin can also be used for those at high risk of bowel and other cancers.

    How can chemotherapy be used as preventive therapy?

    In terms of treating cancer, prevention refers to giving chemotherapy after the cancer has been removed, to prevent the cancer from returning.

    If a cancer is localised (limited to a certain part of the body) with no evidence on scans of it spreading to distant sites, local treatments such as surgery or radiotherapy can remove all of the cancer.

    If, however, cancer is first detected after it has spread to distant parts of the body at diagnosis, clinicians use treatments such as chemotherapy (anti-cancer drugs), hormones or immunotherapy, which circulate around the body .

    The other use for chemotherapy is to add it before or after surgery or radiotherapy, to prevent the primary cancer coming back. The surgery may have cured the cancer. However, in some cases, undetectable microscopic cells may have spread into the bloodstream to distant sites. This will result in the cancer returning, months or years later.

    With some cancers, treatment with chemotherapy, given before or after the local surgery or radiotherapy, can kill those cells and prevent the cancer coming back.

    If we can’t see these cells, how do we know that giving additional chemotherapy to prevent recurrence is effective? We’ve learnt this from clinical trials. Researchers have compared patients who had surgery only with those whose surgery was followed by additional (or often called adjuvant) chemotherapy. The additional therapy resulted in patients not relapsing and surviving longer.

    How effective is preventive therapy?

    The effectiveness of preventive therapy depends on the type of cancer and the type of chemotherapy.

    Let’s consider the common example of bowel cancer, which is at high risk of returning after surgery because of its size or spread to local lymph glands. The first chemotherapy tested improved survival by 15%. With more intense chemotherapy, the chance of surviving six years is approaching 80%.

    Preventive chemotherapy is usually given for three to six months.

    How does chemotherapy work?

    Many of the chemotherapy drugs stop cancer cells dividing by disrupting the DNA (genetic material) in the centre of the cells. To improve efficacy, drugs which work at different sites in the cell are given in combinations.

    Chemotherapy is not selective for cancer cells. It kills any dividing cells.

    But cancers consist of a higher proportion of dividing cells than the normal body cells. A greater proportion of the cancer is killed with each course of chemotherapy.

    Normal cells can recover between courses, which are usually given three to four weeks apart.

    What are the side effects?

    The side effects of chemotherapy are usually reversible and are seen in parts of the body where there is normally a high turnover of cells.

    The production of blood cells, for example, is temporarily disrupted. When your white blood cell count is low, there is an increased risk of infection.

    Cell death in the lining of the gut leads to mouth ulcers, nausea and vomiting and bowel disturbance.

    Certain drugs sometimes given during chemotherapy can attack other organs, such as causing numbness in the hands and feet.

    There are also generalised symptoms such as fatigue.

    Given that preventive chemotherapy given after surgery starts when there is no evidence of any cancer remaining after local surgery, patients can usually resume normal activities within weeks of completing the courses of chemotherapy.The Conversation

    Ian Olver, Adjunct Professsor, School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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