Monday 1 August, 2016

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

What is chemotherapy?

Chemotherapy (sometimes just called ‘chemo’) is the use of drugs to kill or slow the growth of cancer cells. The drugs are called cytotoxics, which means toxic to cells (cyto). Some of these drugs are obtained from natural sources such as plants, while others are completely created in a laboratory.

How does it work?

Most chemotherapy drugs enter the bloodstream and travel throughout the body to reach cancer cells in the organs and tissues. Sometimes chemotherapy is delivered directly at the tumour site rather than via the bloodstream.

Chemotherapy drugs damage cells as they divide. This makes the drugs effective against cancer cells, which divide much more rapidly than most normal cells do. However, some normal cells – such as hair follicles, bloods cells, and cells inside the mouth or bowel – also divide rapidly. Side effects occur when chemotherapy damages these normal cell. Unlike cancer cells, normal cells can recover, so most side effects are temporary.

How is chemotherapy given?

Chemotherapy is most often given via a vein (intravenously). It is sometimes given in other ways, such as by mouth as tablets (orally), as a cream, or as injections into different parts of the body.

Why have chemotherapy?

Chemotherapy can be used for different reasons:

To achieve remission or cure

In many cases, the aim of chemotherapy is to cause the signs and symptoms of cancer to reduce or disappear (remission). The treatment may be called curative chemotherapy. It could be given either on its own or with other treatments, such as surgery and radiotherapy.

To help other treatments

Chemotherapy is sometimes given either before or after other treatments. Used before (neoadjuvant therapy), its purpose is to reduce the cancer so your main treatment is more effective. If chemotherapy is given after your main treatment (adjuvant therapy), its aim is to get rid of any remaining cancer cells.

To control the cancer

Even if chemotherapy cannot achieve remission (see above), it may be used to control the cancer’s growth and stop it spreading for an extended period of time. This may be called palliative chemotherapy.

To relieve symptoms

By shrinking a tumour that is causing pain and other symptoms, chemotherapy can improve quality of life. This is also called palliative chemotherapy.

To stop cancer coming back

Chemotherapy might be given for months or years after the initial chemotherapy has achieved remission of the cancer. This is called maintenance chemotherapy. It aims to prevent or delay the cancer returning.

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 types of chemotherapy will cause side effects. However, there are ways to manage these. The drugs used for chemotherapy are constantly being improved to give you the best possible results and to reduce potential side effects.

Where will I have treatment?

Most people have chemotherapy during day visits to a hospital or treatment centre. In some cases, an overnight or extended hospital stay may be needed. People who use a portable pump or have oral chemotherapy can have their treatment at home. Some programs provide a visiting nurse to give chemotherapy in your home. Your treatment team will discuss which options are available to you.

How long does treatment last?

How often and for how long you have chemotherapy depends on the type of cancer you have and the drugs that are used. You will usually have a number of treatment sessions to try to destroy all the cancer cells, and these may be daily, weekly or monthly.

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, 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. Maintenance treatment (to prevent the cancer coming back) and palliative treatment (to control the cancer or relieve symptoms) may last many months or years.

When to call your treatment team or 000

Chemotherapy can temporarily affect the white blood cells that usually fight infection, so even a minor infection can rapidly become serious. Let your GP or treating specialist know if you have symptoms that may indicate an infection (e.g. sore throat, night sweats, stinging on passing urine, easy bruising). Contact them urgently or call 000 if you have any of these symptoms:

  • a temperature of 38°C or above
  • persistent or severe nausea or vomiting
  • redness or swelling around the site of the intravenous chemotherapy device or the previous injection
  • shaking chills
  • severe abdominal pain, constipation or diarrhoea
  • unusual bleeding (e.g. nose bleeding for over 30 minutes)
  • any serious unexpected side effects or sudden deterioration in health.

How do I prepare for chemotherapy?

Chemotherapy affects everyone differently, so it can be hard to know exactly how to prepare. However, a number of general issues are worth considering in advance.

Look after yourself

Try to stay as healthy as you can before and during treatment. Eat a nourishing diet, drink lots of water, get enough sleep, and balance rest and physical activity. Good nutrition and regular exercise can help with some side effects of chemotherapy.

Freeze some meals

You may not feel like cooking during the weeks of your chemotherapy treatment. Consider making some meals ahead and freezing them. Sometimes, family and friends will arrange a meal roster.

Arrange transport

Plan how you will get to chemo sessions. If travelling by car, ask about parking. Since you won’t know how you will feel, it is best to arrange a driver for at least your first session. You can call Cancer Council 13 11 20 to find out if there are transport to treatment services in your area.

Sort out work

If you are working, talk to your employer about what time you are likely to need off. It is hard to predict how chemotherapy will affect you, so you could discuss the option of flexible hours.

Check your teeth

It is often a good idea to visit your dentist for a check-up before chemotherapy begins. The dentist can check for any current mouth infections that may cause issues if chemotherapy affects your immune system.

Organise help at home

If you have young children, you may need to arrange for someone to look after them during the treatment sessions and possibly afterwards if you become unwell from side effects. Older children may need lifts to and from school and activities. Some support with housework and errands can also ease the load. Consider asking one friend or family member to coordinate offers of help.

Discuss your concerns

Keep a list of questions for your oncologist and add to it whenever a new question occurs to you. If you are feeling anxious about the diagnosis and treatment, try talking to a family member or friend, or to your GP or another member of your health care team.

Prepare for side effects

Talk to your treatment team about the likely side effects of the chemotherapy drugs you are having. Ask whether you should take medicine to prevent nausea and vomiting. If you may lose your hair, think about whether you want to choose a wig, hats or scarves before treatment starts.

Check other medicines

Make sure your doctor knows about any other medicines or therapies you are using. Some over-the-counter medicines, home remedies, herbs and vitamins can interfere with the chemotherapy.

Pack a chemo bag

A bag for your chemo sessions could include: warm clothing layers in case you get cold; healthy snacks; lip balm; and something to pass the time, such as books, magazines, crossword puzzles, and a laptop computer or tablet.

Ask about chemotherapy

Some types of chemotherapy can affect your fertility. If you think you may want to have children in future, talk to your health care team about your options before chemotherapy begins.

How much does treatment cost?

Chemotherapy drugs are expensive, but most people pay only 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.

Ask your specialist or treatment centre for a written quote that shows what you will have to pay. You will usually have to cover the cost of any medicines that you take at home to relieve the side effects of chemotherapy (such as anti-nausea medicine).

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

Can I have chemotherapy during pregnancy?

Being diagnosed with cancer during pregnancy is rare. In Australia, about one in 2500 women is affected.1

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.

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 the side effects of chemotherapy on your blood cells increase 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. Having chemotherapy in the first trimester (12 weeks) may increase the risk of birth defects, but there seems to be a lower risk in the later stages of pregnancy. 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.2

However, chemotherapy drugs may affect a developing baby in other ways. For example, chemotherapy may cause premature delivery, and preterm babies often have other health issues, such as respiratory problems. Your doctor can talk in detail about your specific situation and what is best for your health and your unborn baby.

Many pregnant women with cancer feel anxious about the potential impact of treatment on their unborn child. It may be easier to cope if you are well informed about treatments and side effects.

1. YY Lee et al., ‘Incidence and outcomes of pregnancy-associated cancer in Australia, 1994-2008: a population-based linkage study', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 119, 2012, pp. 1572-82.

2. FA Peccatori et al., ‘Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up', Annals of Oncology, vol. 24, suppl. 6, 2014, vi160-70.

Reviewed by: Dr Andrew Haydon, Medical Oncologist, The Alfred Hospital and Cabrini Hospital, VIC; Elaine Arnold, McGrath Breast Care Clinical Nurse Consultant, Northern Beaches, NSW; Mish Blacher, Consumer; Nicole Loft, Haematology Nurse Practitioner, Royal Adelaide Hospital, Central Adelaide Local Health Network, SA; Simoene Smith, 13 11 20 Cancer Information Consultant, Cancer Council NSW, NSW.

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