Friday 1 August, 2014

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On this page: What is chemotherapy? | How does it work? | Why have chemotherapy? | How is chemotherapy given? | Does chemotherapy hurt? | Where will I have treatment? | How long does treatment last? | How much does treatment cost? | Can chemotherapy be given during pregnancy? 

The information in these pages is for adults having chemotherapy, although some of it will be relevant for children. Talk to your doctor for specific information about chemotherapy for children.

What is chemotherapy?

Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. Chemotherapy drugs are also called cytotoxics, which means poisonous (toxic) to cells (cyto). Some of these drugs are obtained from natural sources such as plants, while others are completely developed in the laboratory. There are many types of chemotherapy drugs, which are often used in different combinations and at different strengths.

How does it work?

Most chemotherapy drugs enter the bloodstream and travel throughout the body to reach cancer cells in different organs and tissues.

Chemotherapy drugs target and injure rapidly dividing cells, but because the drugs are not cancer specific, both cancer cells and some normal cells are affected. When normal cells are damaged, this can cause side effects.

By the time your next treatment starts, your body's normal cells have usually recovered but the cancer cells have not. This is because cancer cells don't repair easily, so they recover more slowly than normal cells. This means that more cancer cells are destroyed with every treatment.

Some types of chemotherapy can be delivered directly at the tumour site rather than travelling through the bloodstream. Examples are chemotherapy wafers for brain cancer and chemoembolisation for liver cancer. As the treatment is localised, side effects are less common.

Why have chemotherapy?

Chemotherapy can be used for different reasons:
  • Cure: Some cancers can be cured by chemotherapy on its own or in combination with other treatments, such as surgery or radiotherapy. 
  • To help other treatments: Chemotherapy can be given either before or after other treatments. Used beforehand(neo-adjuvant therapy), its purpose is to make the cancer smaller so your main treatment is more effective. If chemotherapy is given after your primary treatment (adjuvant therapy), its aim is to get rid of any remaining cancer cells that may not be seen on scans.
  • To control the cancer: If the cancer is too large and can't be cured, chemotherapy can be used to control the cancer's growth for an extended period of time.
  • Symptom relief: When the cancer can't be cured but causes symptoms such as pain, treatment – such as chemotherapy – can provide relief. This is called palliative treatment.

How is chemotherapy given?

Chemotherapy can be given in a variety of ways. Most people have chemotherapy through a vein (intravenously). It can also be prescribed orally (tablets or capsules), as a cream, or as injections into different parts of the body. 

Does chemotherapy hurt?

Having intravenous chemotherapy may feel like having your blood taken. 

  • If you have a temporary tube (cannula) in your hand or arm, only the initial injection may hurt.
  • If you have a central venous access device, it should not be painful.

Some treatments will cause side effects. However, chemotherapy drugs are constantly being improved to give you the best possible results and to reduce side effects.

If you feel burning, coolness, pain or any other unusual sensation where a cannula or central venous access device enters your body, or if you have tenderness or redness over the injection site, tell your doctor or nurse immediately.

Where will I have treatment?

Most people have chemotherapy on an outpatient basis during day visits to a hospital or clinic. Sometimes an overnight hospital stay may be needed. Some people can have chemotherapy at home if they use a portable pump or have oral chemotherapy.

How long does treatment last?

How often and how long you have chemotherapy depends on the type of cancer you have and the drugs that are used. You may have treatment daily, weekly or monthly for several months to a year.

Chemotherapy is commonly given in courses (cycles), with rest periods in between. This allows normal cells to recover and your body to regain its strength. If your body needs more time to recover, i.e. for the blood count to return to normal, your next cycle may be delayed.

Your doctor will discuss your treatment plan with you. Sometimes people have chemotherapy over 6-12 months, but it's possible to have it for a shorter or longer period.

Some people who have chemotherapy to control the cancer or to relieve symptoms (palliative treatment) may have regular treatment for many months or years.

How much does treatment cost?

Chemotherapy drugs are expensive, but most people only pay a fraction of the cost as many drugs are heavily subsidised by the  Pharmaceutical Benefits Scheme (PBS). However, there are some drugs that are not covered by the PBS.

Your nurse, specialist or clinic will tell you what you will have to pay. You will usually have to cover the cost of medications taken at home to relieve the side effects of chemotherapy (such as anti-nausea drugs).

If you have private health insurance and elect to have your treatment privately, you may have to pay for out-of-pocket expenses and contribute to the cost of the drugs. Check with your doctor and your health fund before you start treatment.

Can chemotherapy be given during pregnancy?

Being diagnosed with cancer during pregnancy is rare – about one in 1000 women are affected.

It is possible for some pregnant women to have chemotherapy. Your medical team will discuss all of the available treatment options with you. Their recommendations will be based on the type of cancer you have, its stage, the other treatment options, and how to avoid harming your developing baby. Sometimes chemotherapy or other treatment can be delayed until after the baby’s birth.

Most pregnant women with cancer feel anxious about the potential effect of treatment on their unborn child. Being well-informed about possible treatments and side effects can make it easier to make decisions and cope with what happens.

If you have chemotherapy during pregnancy, your doctor will probably advise you to stop having it at least 3–4 weeks before your delivery date. This is because chemotherapy increases your risk of bleeding or getting an infection during the birth. Stopping chemotherapy allows your body time to recover from the side effects.

Researchers are currently doing long-term studies on women and children to explore this issue further. It is known that giving chemotherapy in the first trimester (12 weeks) increases the risk of birth defects. However, some studies on children who were exposed to chemotherapy in the womb during the second and third trimesters show that chemotherapy did not affect their development.

Different chemotherapy drugs may affect a developing baby in different ways. For example, chemotherapy may cause premature delivery. Pre-term babies often have other health problems, such as respiratory problems and delayed development.

Your doctor can talk in detail about your specific situation and what is best for your health and your unborn baby.

Information reviewed by: A/Prof Paul Craft, Medical Oncologist, The Canberra Hospital, Medical Oncology, Australian National University Medical School and Clincial Director, Canberra Region Cancer Centre, ACT; Kate Archibald, Clinical Nurse Specialist (Oncology), Monash Health, VIC; Elaine Arnold, McGrath Breast Care Clinical Nurse Consultant, Northern Beaches Health Service, NSW; Ilne Geddes, Consumer; Tina Griffiths, Nurse Coordinator Chemotherapy, Cancer Services, Olivia Newton- John Cancer & Wellness Centre, VIC; and Cecelia van Raders, Team Leader, Cancer Council Helpline, Cancer Council Queensland, QLD.

Updated: 01 Aug, 2014