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Comment by borbulon | Hacker News Reader

Having cancer myself, I can tell you that there are a lot of misconceptions about what life “under chemo” is like. I’m in a clinical trial for pills now, but when I was doing infusions, the worst of them had me out of commission for about 4 days - chemo day (which was about schedule, not side effects), then days 4, 5, and sometimes 6 after chemo day. The rest were completely manageable, in fact I looked forward to working.

This is not to belittle his experience or cast him in a negative light; I wish him well and I know that overall it leaves you feeling less than normal, and I can completely relate. But “under chemo” is not always as debilitating as you might think.

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> the worst of them had me out of commission for about 4 days - chemo day (which was about schedule, not side effects), then days 4, 5, and sometimes 6 after chemo day

Isn't chemo tolerated differently in different patients? It's still anecdotes, but I've heard many stories of people, some usually very dynamic, being strongly weakened by it. To the point some even decide it's not worth it and stop the treatment altogether. I personally know someone currently under chemo too.

Anyway, it's good you tolerate it well and I wish you a good recovery!

Yes, it's different for different patients.

It's also true that chemo treatment has gotten better over the years. Chemo 20 years ago was much harsher and it's not the same anymore. Advancements in pharmacology.

> Isn't chemo tolerated differently in different patients?

Chemo subsumes a large number of different medications. What they have in common is that they are basically poison, and you hope that the cancer cells die faster than you. The effects differ wildly between different treatments and patients.

"under chemo" though, isn't some single shared experience. Everyone in that infusion room with you is getting some different sort of poison cocktail in a different strength. And most of the drugs are, quite literally, poison. There's at least 7 broad, very different types of chemo drugs, and subcategories under that. Also, very different total duration and frequencies of infusion. And they all may have other things going on in terms of cancer progression, other unpleasant treatments (radiation, surgical procedures, etc) going on at the same time, and so on.

Doxorubicin might be a good example. It has nicknames like "red death" and "red devil", and many unpleasant secondary side effects. Side effects that are different from other chemo drugs, including an unusually high rate of congestive heart failure.

No, you're right, but the fact that Stallman is 70, and "under chemo," and still giving talks would suggest that whatever chemo he's under is relatively easy on his body.

Most chemo nowadays will make you feel sick for a day or two, but they also usually give you something to manage the symptoms. If it had been a few days since his last dosage, he was probably feeling decent all other things considered. Radiation therapy, on the other hand, is still being burned alive from the inside out, and even opioids are insufficient most of the time. My dad tried to ration my mom's painkillers during her treatments below what was prescribed for her. I told him I was going to quit my job and drive down there to keep him away from her if he wasn't going to be supportive.

even radiation is different for different people - I have had a couple of treatments for brain metastases and due to my proximity to Boston I am lucky to get the most up-to-date treatments available. There's something called Proton Beam Stereotactic Radiosurgery which is a single session, they are somehow able to curve the beam so it enters in three different places and the place where the beam(s) meet is the place that gets the treatment. It's a single session and I don't have any side effects at all.

But yes, when I spoke to radiation oncologist when I was diagnosed 2.5 years ago (and before they had a full picture of what my cancer looked like), he told me to expect to be hospitalized multiple times because the lymph nodes they'd treat were so close to my esophagus and the treatments would burn my espohagus. "Thankfully" the cancer was spread too far and the field was too large for radiation, so the only radiation treatments I've had have been the ones described above.

More info on the different kinds of Stereotactic Radiosurgery: https://www.mayoclinic.org/tests-procedures/stereotactic-rad...

Modern management of side effects can help a lot, but it's not a surefire thing for any given patient on any given chemo.

When I did chemo, I had cycles with 5 days on - and I couldn't do anything useful during that week, or most of the next week. It was, truly, an awful experience. I completely understand and respect how some people can decide treatment isn't worth it and surrender to the disease.

I have a friend who has been suffering from blood cancer for about 7 years now. Her father died around the time she was diagnosed and she was a 25 year post office employee, so she was able to retire with an inheritance and live her life. She's spent more time on ships on vacation this year than the total vacation time I've taken in my 40+ years on this planet including childhood trips.

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