Chemotherapy

Wednesday 1 August, 2018

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


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 come from natural sources such as plants, while others are completely made in a laboratory.

How does it work?

All cells in the body grow by splitting into two cells or dividing. Chemotherapy damages cells that are dividing rapidly. Most chemotherapy drugs enter the bloodstream and travel throughout the body to target rapidly dividing cancer cells in the organs and tissues. This is known as systemic treatment. Sometimes chemotherapy is delivered directly to the cancer. This is known as local chemotherapy.

How is chemotherapy used?

You might have treatment with a single chemotherapy drug or a combination of several drugs. There are many different types of chemotherapy drugs, and each type destroys or shrinks cancer cells in a different way.

The chemotherapy drugs you have depend on the type of cancer. This is because different drugs work on different types of cancer. Sometimes chemotherapy is the only treatment needed, but you may also have surgery, radiation therapy or other drug therapies.

Why have chemotherapy?

Chemotherapy can be used for different reasons:

To achieve remission or cure

In many cases, chemotherapy causes the signs and symptoms of cancer to reduce or disappear (often referred to as remission or complete response). The treatment may be called curative chemotherapy.

To help other treatments

Chemotherapy is sometimes given either before or after other treatments. If used before (neoadjuvant therapy), the aim is to reduce the cancer so the other treatment is more effective. If chemotherapy is given after the other treatment (adjuvant therapy), the aim is to get rid of any remaining cancer cells. Chemotherapy is often given with radiation therapy to make the radiation therapy more effective.

To control the cancer

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

To relieve symptoms

By shrinking a cancer 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 continue for months or years after remission. This is called maintenance chemotherapy, and it may be given with other drug therapies. It aims to prevent or delay the cancer returning.

Why does chemotherapy cause side effects?

Chemotherapy works on cells that are dividing rapidly. Cancer cells divide rapidly, as do some healthy cells. These include cells in your blood, mouth, digestive system and hair follicles.

Side effects occur when chemotherapy damages these normal cells. Unlike cancer cells, normal cells can recover, so most side effects are temporary. The drugs used for chemotherapy are constantly being improved to give you the best possible outcomes and to reduce potential side effects. See Managing side effects for more information, and talk to your health care team for tips on dealing with side effects.

"When you've got to have chemo, it's quite frightening because you've only heard bad things about it. But then I spoke to the oncologist and he explained the benefits." - Phil

How is chemotherapy given?

Chemotherapy is most often given via a vein (intravenously). It is sometimes given in other ways, such as tablets you swallow (oral chemotherapy), as a cream, or as injections into different parts of the body. The choice depends on the type of cancer being treated and the chemotherapy drugs being used. Your treating team will decide which is the most appropriate way to deliver the drugs.

Does chemotherapy hurt?

Having a needle inserted for intravenous chemotherapy may feel like having blood taken. If you have a temporary tube (cannula) in your hand or arm, only the initial injection may be uncomfortable. If you have a central venous access device, it should not be painful. Your oncologist will let you know which method is suitable.

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. Sometimes a visiting nurse can give you intravenous chemotherapy in your home. Your treatment team will discuss which options are available to you.

How much does treatment cost?

Chemotherapy drugs are expensive. People do not pay for intravenous chemotherapy received in a public hospital as the cost is covered by the Pharmaceutical Benefits Scheme (PBS). People have to contribute to the cost (co-payment) of oral chemotherapy drugs. You will usually have to pay for any medicines that you take at home to relieve the side effects of chemotherapy (such as anti-nausea medicine). Ask your specialist or treatment centre for a written quote that shows what you will have to pay.

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 chemotherapy drugs. Check with your doctor and health fund before you start treatment.

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 cycles, and these may be daily, weekly or monthly.

Often people have chemotherapy over 6–12 months, but it's possible to have it for a shorter or longer period. Maintenance chemotherapy (to prevent the cancer coming back) and palliative treatment (to control the cancer or relieve symptoms) may last many months or years.

Can I have chemotherapy during pregnancy?

Being diagnosed with cancer during pregnancy is rare. In Australia, about one in 1000 women is affected. 1

While it is possible for some women to have chemotherapy during pregnancy, sometimes chemotherapy and other cancer treatments are delayed until after the baby's birth. 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.

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 babies 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.

If you have chemotherapy during pregnancy, you will probably be advised 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. 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.

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.

Ask about fertility

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

Pack a chemo bag

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

Look after yourself

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

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. Ask one friend or family member to coordinate offers of help, or use an online tool such as candoapp.com.au or caringbridge.org.

Discuss your concerns

If you are feeling anxious about the diagnosis and having chemotherapy, talk to a family member or friend, your GP or a member of your health care team, or call 13 11 20 for support. You could also learn relaxation or meditation strategies to cope with anxiety.

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.

Talk to your employer

If you are working, talk to your employer about how much 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 or taking some leave.

Check your teeth

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

Prepare for side effects

Talk to your treatment team about the likely side effects of the chemotherapy drugs you are having. Ask whether you can take medicine to prevent nausea and vomiting. If you may lose your hair, think about whether you want to cut your hair before treatment starts.

Check other medicines

Make sure your oncologist 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.

Which health professionals will I see?

During chemotherapy you will be cared for by a range of health professionals who specialise in different aspects of your treatment. This is called a multidisciplinary team (MDT) and it may include some or all of the professionals listed below.

Note that only some patients see a cancer care coordinator. It is important to maintain or develop a relationship with a general practitioner (GP). This health professional will be involved in your ongoing care, particularly once the cancer treatment finishes.

Health professionals you may see
Role
GP assists you with treatment decisions and works in partnership with your specialists in providing ongoing care
medical oncologist* or haematologist* treats cancer with drug therapies such as chemotherapy, targeted therapy and immunotherapy (these are known as systemic treatments)
radiation oncologist* treats cancer by prescribing and overseeing a course of radiation therapy
surgeon surgically removes tumours and performs some biopsies; specialist cancer surgeons are called surgical oncologists
cancer care coordinator coordinates your care, liaises with other members of the MDT, and supports you and your family throughout treatment; may also be a clinical nurse consultant (CNC) or clinical nurse specialist (CNS)
nurse administers drugs, including chemotherapy, and provides care, information and support throughout your treatment
palliative care specialist* and nurses work closely with the GP and oncologist to help control symptoms and maintain quality of life
pharmacist dispenses medicines and gives advice about dosage and side effects
dietitian recommends an eating plan to follow while you are in treatment and recovery
social worker links you to support services and helps you with emotional, practical or financial issues
occupational therapist, physiotherapist assist with physical and practical problems, including restoring movement and mobility after treatment and recommending aids and equipment
psychologist, counsellor help you manage your emotional response to diagnosis and treatment

*Specialist doctor


Reviewed by:  Dr Prunella Blinman, Medical Oncologist, Concord Cancer Centre, Concord Repatriation General Hospital, and Clinical Senior Lecturer, Sydney Medical School, The University of Sydney, NSW; Gillian Blanchard, Oncology Nurse Practitioner, Calvary Mater Newcastle, and Conjoint Lecturer, School of Nursing and Midwifery, The University of Newcastle, NSW; Julie Bolton, Consumer; Keely Gordon-King, Psychologist, Cancer Council Queensland, QLD; John Jameson, Consumer; Dr Zarnie Lwin, Medical Oncologist, Royal Brisbane and Women's Hospital, and Senior Lecturer, School of Medicine, The University of Queensland, QLD; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Dr Felicia Roncolato, Medical Oncology Staff Specialist, Macarthur Cancer Therapy Centre, NSW.

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, no. 13, 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, 2013, pp. vi160–70.

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