How Chemotherapy Impacts Brain Cancer Treatment
- “Antiques Roadshow” star Theo Burrell, 38, who is living with glioblastoma, an aggressive form of brain cancer, says her latest scans have been “clear,” defying the odds her doctors initially gave her in 2022 when she was diagnosed. However, her ongoing treatment is making day-to-day life challenging.
- Burrell says she’s awaiting her 11th round of chemotherapy to help manage her brain cancer. She admits side effects like fatigue and nausea – common side effects of chemotherapy – alongside an occasional seizure, make quality of life a challenge.
- Glioblastoma (GBM) grows and spreads very quickly. Patients typically have an average survival rate of 15 months with treatment and less than six months if left untreated.
- Chemotherapy stops cancerous cells from growing, dividing, and spreading to other organs. It works by traveling through the bloodstream and killing cancerous cells. However, the process also impacts healthy cells, leading to the grueling side effects we’ve come to know.
- A chemotherapy drug called temozolomide is often used to treat gliomas. The most common side effects associated with this treatment include nausea, constipation, fatigue, and a drop in blood counts.
- There are medications and interventions your doctor can offer to help mitigate these side effects, so it’s important to keep your medical team in the loop about any new symptoms you are feeling.
In her signature, raw yet emotional style, she posted on Instagram that her latest scans show no active cancer cells—a hopeful sign that her chemotherapy regimen is holding the disease at bay.
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WATCH: Chemotherapy For Glioma: What Are The Side Effects And How Can I Manage Them?
But the good news comes with a heavy cost. Now in her tenth round of chemotherapy, Burrell described a recent visual seizure and a cascade of debilitating side effects that left her bedridden for days. The physical toll of chemotherapy, which comes with side effects like nausea, fatigue, and emotional exhaustion, has forced her to cancel plans and retreat from daily life.
“In terms of managing side effects, the standard approach is to use an anti-nausea drug, often Zofran, before the patient takes the chemotherapy every night — and then, as needed,” Dr. Colman explains.
Diagnosed in 2022, Burrell, 38, has explored multiple treatment paths to manage the aggressive brain cancer. While the current protocol is working, she admits the journey is wearing thin.
“It’s a mixed message—of good news and moans,” she shared, bracing herself for cycle 11 with cautious resolve.
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However, Burrell has remained steadfast in her fight against brain cancer. Since her diagnosis, she’s become a public advocate for advancing research into the disease. She also admitted she’s continuing to fight for her young son, who was very young when she was diagnosed. She hopes to defy the odds and continue seeing him grow into a young man one day.
Helping Patients Better Understand Brain Cancer
Coping With Grueling Chemotherapy
Chemotherapy is an effective tool for oncologists to help treat cancer by stopping cancerous cells from growing, dividing, and spreading to other organs. Chemo works by traveling through the bloodstream, killing cancerous cells. However, the process also impacts healthy cells, leading to side effects.
Patients almost universally experience fatigue, often alongside gastrointestinal side effects, such as nausea. Doctors have many effective medications to combat chemo-induced nausea. “But mitigating that fatigue often depends on the patient,” says Dr. Renata Urban, a gynecologic oncologist at the University of Washington in Seattle.
WATCH: What You Think You Know About Chemotherapy Side Effects May Be Wrong
“Neuropathy is probably one of the most challenging side effects,” says Dr. Renata Urban, a gynecologic oncologist at the University of Washington in Seattle. Neuropathy results from damage to the peripheral nerves. It usually resolves after chemotherapy treatment, but sometimes symptoms can persist. While it’s typically characterized by numbness or a pins-and-needles sensation in the hands and feet, neuropathy can have several different symptoms, including:
- Weakness in the hands or feet
- Stabbing or burning pain in the hands or feet
- Difficulty gripping, such as when holding a fork
- Difficulty with fine motor skills, such as writing or buttoning a shirt
Nausea and vomiting are common side effects of chemotherapy. When chemotherapy affects the rapidly dividing cells in the stomach lining, the resulting cellular havoc in the gastrointestinal tract can lead to side effects such as nausea and vomiting. However, doctors can help patients mitigate the hit with various medications before, during, and after treatment.
“Part of the chemotherapy prescription includes a set regimen of anti-nausea medications,” says Dr. Renata Urban, a gynecologic oncologist at the University of Washington in Seattle. “We also ensure that patients have medications at home that they can use should they develop nausea after treatment.”
Hair loss is another side effect of chemotherapy.
WATCH: Coping with hair loss.
“For cancer patients, losing one’s hair can be unbelievably stressful. To start with, the dread of losing one’s hair can lead to some sleepless nights and feelings of anxiety,” Dr. Samantha Boardman, a New York-based psychiatrist and author, told SurvivorNet.
Chemotherapy can cause hair loss. It usually begins about three to four weeks after chemotherapy and continues throughout treatment.
It happens because this treatment targets quickly dividing cells throughout the body. That includes cancer cells but also hair cells.
Most patients can expect regrowth four to six weeks after treatment. However, it is possible when your hair grows back, you may notice some changes in its color and texture.
RELATED: How are chemotherapy side effects managed for ovarian cancer treatment?
Tips to Navigating Chemo Side Effects
Doctors don’t have an arsenal of prescription medications to combat fatigue. However, you can do several things to help minimize the hit and restore your energy.
- Exercise: While it may be counterintuitive, physical activity can help alleviate side effects, especially fatigue. “Although ovarian cancer is not common, we often draw upon the experience of patients with breast cancer and colon cancer, who have shown that physical activity can not only improve quality of life but may also have beneficial impacts on cancer outcomes,” Dr. Urban says.
- Eat well: Even though nausea may interfere with your ability to eat a healthy diet, it’s essential to ensure you’re eating appropriately, getting enough protein, and not losing weight. Not only will nourishing your body support your recovery, but it may also help you feel more energized.
- Sleep: Want to mitigate fatigue? Be sure to maintain your regular sleep-wake cycle while on treatment. Sticking to a set sleep schedule helps reduce fatigue by ensuring enough hours for your body to heal and restore itself each night. It may also help you recover more quickly by keeping energy levels high during the daytime.
Understanding Burrell’s Glioblastoma Diagnosis
Diagnosing gliomas involves a multi-step approach that includes clinical assessment, imaging studies, histopathological examination, and molecular testing.
As patients are diagnosed, they’re observed for typical glioma symptoms. These may include:
- Headaches
- Seizures
- Cognitive or Behavioral Changes
- Visual or Speech Changes and Impairments
- Loss of Body Weight and Deconditioning
- Changes in mental function, mood, or personality
- Changes in speech
- Sensory changes in hearing, smell, and sight
- Loss of balance
- Changes in your pulse and breathing rate
During the clinical assessment, the physician will take a detailed history, focusing on the onset and progression of symptoms. Since gliomas can present with non-specific symptoms that overlap with other neurological conditions, ruling out conditions like stroke, infections, or inflammatory disorders is essential during the initial clinical evaluation.
Patients then undergo a neurological exam that tests cranial nerve function, motor strength and coordination, sensory function, and cognitive abilities.
Next, patients undergo an MRI, which provides doctors with a visualization of the tumor.
“If you’re suspected of having a tumor on imaging and our neurosurgeons think that tumor can come out, they will take a piece of that tumor out first and confirm in the operating room and with our pathologists that, in fact, what they are looking at is a tumor,” Dr. Alexandra Miller, Director of the Neuro-Oncologist Division at NYU Langone Health, tells SurvivorNet. “And if it is, they resect it at that time. It’s not usually a two-step procedure.”
If surgery cannot be performed due to tumor location or patient-specific factors, a less invasive stereotactic biopsy can be obtained. Once the tissue sample is obtained, it’s examined under a microscope for molecular testing. At this stage, the tumor is given a grade, which determines how aggressive it is.
WATCH: Molecular testing for glioma patients
- Grade I-II gliomas – These are considered low-grade and tend to grow slowly. “The grade one is a very indolent, benign tumor that can be cured with surgery alone,” Dr. Henry Friedman, Deputy Director of the Preston Robert Tisch Brain Tumor Center at Duke, tells SurvivorNet.
- Grade III gliomas—These are considered high-grade and tend to grow more rapidly. They are typically classified as malignant and require more aggressive treatment, which can include surgery, radiation, and chemotherapy.
- Grade IV gliomas – These are the most aggressive gliomas, which are locally aggressive and require treatment intensification. Glioblastomas are the most common grade IV glioma, “which is by far the most well-known and feared tumor in the lay population and, quite frankly, the medical population,” Dr. Friedman explains.
How Are Gliomas Treated?
Burrell has already undergone surgery to remove her tumor, followed by chemotherapy and radiation, which helped extract the remaining bits of the cancer that surgery could not remove. Specific details of her ongoing treatment remain unclear at this time. However, the route she took early on is typical for glioblastoma treatment.
“The first step is always the neurosurgery. How much can you take out? Is it safe to do surgery? Do you have to rely on a biopsy? Can you even do a biopsy?” Dr. Friedman tells SurvivorNet.
The main treatment options are:
Observation—Some benign, small, and without symptoms of gliomas or tumors located in inoperable locations can be recommended for observation.
Surgery is often the first-line treatment for gliomas, with the goal of achieving maximal safe resection, where the largest amount of tumor is removed without causing significant neurologic deficits. For low-grade gliomas, surgery alone can sometimes be curative.
After surgery, pathologists examine the tumor tissue to understand its features and molecular makeup. This added step helps doctors outline an appropriate treatment.
“We go through a very elaborate process of diagnostics, which includes looking at it under the microscope through our pathology team,” Dr. Friedman explained to SurvivorNet.
WATCH: The Role of Surgery in Treating Gliomas
Radiation and chemotherapy are often needed after surgery because removing the tumor completely is usually not possible due to the tumor’s ability to spread into surrounding brain tissue.
Radiation therapy uses high–energy X–rays to target and kill tumor cells. It is often used after surgery to target residual tumor cells.
Chemotherapy – These medications kill or slow the growth of cancer cells. Chemotherapy can be used alongside radiation or following radiation and is often used in higher-grade tumors.
The Food and Drug Administration (FDA) has approved some drug treatments, including temozolomide (Temodar), to help patients with this aggressive disease. Temozolomide is a chemotherapy drug patients can take after surgery and radiation therapy.
Targeted therapy and immunotherapy are newer treatments designed to target specific genetic mutations in the tumor or to stimulate the immune system to fight the cancer. Their role in the treatment of gliomas is continuing to evolve.
Other FDA-approved drugs for treating glioblastoma include lomustine (Gleostine), intravenous carmustine (Bicnu), carmustine wafer implants, and Avastin (bevacizumab).
Avastin is a targeted drug therapy that blocks glioblastoma cells from requesting new blood vessels that feed and allow the tumor to grow.
The FDA approved Vorasidenib, an IDH inhibitor. It works by blocking the mutated enzyme, slowing tumor growth, and extending the time before disease progression. IDH mutant gliomas tend to grow more slowly and have a better prognosis than IDH wild-type gliomas.
Dr. Alexandra Miller tells SurvivorNet that Vorasidenib is a “huge breakthrough for people with IDH mutant tumors.”
“What I tell my patients is that we have these effective treatments, but what they do is they delay the time to when this tumor comes back. Only in exceptional circumstances would we ever talk about getting rid of one of these cancers, a few,” Dr. Daniel Wahl, professor of radiation and oncology at the University of Michigan, tells SurvivorNet.
How Parents Find Strength in Children During Cancer Battle
Facing cancer as a parent can be incredibly daunting. Fearful thoughts about leaving your children may creep into your mind and add even more to your overflowing plate.
“No matter what your prognosis is, it’s essential to talk openly and honestly with kids,” said Laura Nathan-Garner, Director of Strategic Communications at MD Anderson Cancer Center.
“Cancer patients with children can have increased motivation to endure difficult treatment but may also be concerned about the emotional impact of the illness on their offspring,” Dr. Cindy Moore of Massachusetts General Hospital Cancer Center explained to The ASCO Post, an oncology newspaper.
Based on Burrell’s cancer journey posts, she remains focused on the impact her diagnosis is having on the short and long-term psyche of her son.
Dr. Moore said parents living with cancer should seek out an opportunity to discuss their biggest concerns with their healthcare teams so an effective communication plan can be created to explain their diagnosis to their kids.
Burrell’s Cancer Journey
Burrell’s cancer journey began in 2022 when she was diagnosed with glioblastoma.
“Receiving my diagnosis, at the age of 35, when my son was one year old, was devastating,” Burrell previously told U.K.-based news outlet The Sun.
Burrell is among the team of experts that appeared on the popular television show that comes from auction houses. She appeared on the British version of the show, which tours throughout the U.K., valuing various treasures and trinkets. She has been a part of the show since 2018.
However, she says things changed seemingly in a flash after her diagnosis.
“Overnight, everything had changed. Suddenly, I’d gone from being a healthy person in the middle of my life with a new baby to having incurable cancer with maybe only a year or two left to live,” Burrell said.
After being diagnosed, Burrell said she immediately underwent surgery to remove the tumor. She also had chemotherapy and radiation. She said in a recent interview since her diagnosis, she’s gone through the rigors of treatment.
“I’ve lost my hair, I’m no longer allowed to drive, and no longer able to work,” she said.
“What followed was months of surgery and treatment to try and prolong my life, and … I continue to make the best of each day,” Burrell added, saying she’s “doing quite well.”
Since her diagnosis, Burrell has become a brain cancer advocate and is focusing on the positive.
Questions for Your Doctor
If you have been diagnosed with glioblastoma, here are some questions you may consider asking your doctor:
- What stage is my brain cancer?
- What are the treatment options for my brain cancer?
- Am I a good candidate for temozolomide?
- Am I a good candidate for Optune?
- What are the risks and benefits of the recommended treatment?
- What are the side effects of the recommended treatment?
- How long will it take to recover from treatment, and will I be able to return to work and normal activities?
- What’s the likelihood that insurance will cover the recommended treatment
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