What is the longest period of time that one of your patients has been on chemo? Are they living off of chemo now?

Another excellent question this month!  The length of chemotherapy differs tremendously depending on a person's individual type of cancer.  The longest period of time that my patients stay on chemotherapy is over two and a half years.  Then they live off chemotherapy without any problems. However, this length of two and half years is just for a specific type of leukemia (acute lymphoblastic leukemia, or ALL) and does not apply to most cancers in children and young adults.  The average length of chemotherapy for my patients is six to nine months.

Why is there such variation in treatment length?  This is because the strategy for fighting cancer is different for each person's own disease.  In acute lymphoblastic leukemia (ALL), we have learned over the years that if we stop treatment before two years that the cancer will come back.  However, we also have learned that the therapy does not have to be as intense as in the beginning to prevent the cancer from returning.  During the last part of ALL treatment called "Maintenance" (or sometimes called "Continuation"), the chemotherapy consists of different pills to take by mouth everyday, and usually one other type of chemotherapy to take by mouth once per week.  This part of treatment with oral (by mouth) therapy is usually tolerated very well without drops in blood counts or the need for hospitalizations.  It's a way of insuring that even if a leukemia cell tries to make a comeback after hiding for a year and a half, there will still be chemotherapy around to do the job.  This approach has been very successful and is one of the reasons that ALL now has 80% or higher cure rates.

Other types of cancers, like solid tumors, don't require extended periods of Maintenance chemotherapy.  The treatment for these cancers is very intense throughout the whole time, but may last as little as six months.  The cancers with shorter treatment times do not usually "hide out" like leukemia does, so that's why they don't need chemotherapy for as long.  It's always a good idea to discuss with your doctor or nurse practitioner how long your chemotherapy will be, and to try to get a sense of how intense it will be throughout the treatment (for example, will the chemotherapy get easier like it does in treating ALL?).  This can help you to plan important events ahead of time, like school and vacations!