Your oncologist will record the choice of chemotherapy drugs, the dose and the treatment schedule in a treatment plan. In deciding on which drugs and dose to give you, your oncologist will usually consult clinical guidelines for your cancer type. These guidelines are based on the available evidence. You can ask your oncologist which guidelines they are following.
Most chemotherapy drugs have protocols that set out how much and how often to have a drug – you can find information about protocols for chemotherapy at eviQ Cancer Treatments Online. Your specialist may need to tailor the protocols to your individual situation. Tests throughout treatment will monitor your response, and your treatment plan may be adjusted based on the results.
The treatment course
How often and for how long you have chemotherapy depends on the type of cancer you have, the reason for having treatment and the drugs used.
Chemotherapy is commonly given as a period of treatment followed by a break. This is called a cycle. The length of a cycle depends on the chemotherapy drugs being given.
The break between cycles lets your normal cells recover and your body regain its strength. If your body needs more time to recover, your next cycle may be delayed. If you have any concerns about changes to your treatment or any delays, discuss these with your medical oncologist or haematologist.
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.
What to expect
This information will apply in most cases, but you may find that things are done slightly differently depending on how you have chemotherapy and where you have treatment.
To prepare for chemotherapy and between cycles, you will have a number of tests to help plan treatment:
- weight and height checked to work out the right dose
- blood and urine tests to check how well your kidneys and liver are working and the number of blood cells
- x-rays and scans to check that you are fit for treatment and see how the tumour is responding to treatment
- heart monitoring tests to record your heartbeat (ECG) or heart ultrasound (ECHO) to see if the drugs are affecting your heart
- lung function tests to check the effect of some chemotherapy drugs on your lungs.
While receiving chemotherapy you will be:
- seated in a padded chair in a room with other patients; you are usually able to walk around the ward (e.g. if you need to go to the toilet)
- given anti-nausea or antiemetic medicine so you don't feel sick
- encouraged to drink several glasses of water to help ensure that the chemotherapy drugs don't sit in the kidneys or bladder too long
- monitored throughout the session – nurses will talk to you about ways to manage side effects
- able to travel to and from chemo by yourself, though it's recommended that someone is with you the first time in case you feel unwell.
Many people are given steroids with their chemotherapy to ease or prevent nausea. Steroids may also be used to manage allergic reactions, to make chemotherapy more effective, or to directly treat the cancer. Steroids may cause indigestion, increase in appetite, irritability or mood swings, difficulty sleeping or increase in blood glucose levels. Some people also experience muscle weakness.
Intravenous (IV) chemotherapy
Chemotherapy is most commonly given through a liquid drip into your vein (intravenously). Depending on the treatment, a single session could take from 20 minutes up to several hours. It will usually be given during day visits to your hospital or treatment centre. Sometimes chemotherapy is given via a portable pump you are able to use at home (see below).
Ways of injecting drugs
To prepare you for IV chemotherapy, you will have a narrow tube inserted, usually in a vein in your arm. The treatment team will select the most appropriate device depending on how often you need chemotherapy, how long it will take to give each dose, and how long the device will need to stay in place.
A small plastic tube is inserted into a vein in your arm or the back of your hand and taped securely into place. Having a cannula put in can be uncomfortable, but it shouldn't take too long. The cannula is kept in place if you need to stay in hospital for a few days. If you have day treatment every few weeks, the cannula is usually put in and taken out each time you visit.
Central venous access device (CVAD)
A type of thin plastic tube that remains in your vein throughout the course of treatment, often for several weeks or months. Blood for testing can sometimes be taken through this tube. A CVAD shouldn't cause discomfort or pain. Common types of CVADs include:
- central line – inserted into the chest or neck
- Hickman line – inserted into the chest
- PICC (peripherally inserted central catheter) line – inserted into the arm
- port-a-cath (port) – a small device inserted under the skin of the chest or arm.
This device is programmed to give a prescribed amount of chemotherapy continuously over a few days. The pump is usually attached to a central line and is quite small. It can be carried in a bag or belt holster, and can be tucked under a pillow when sleeping. Your hospital or treatment centre will explain how to care for the pump, and they can answer any questions you may have.
Caring for your line or port
Before you go home, a nurse will show you how to look after your line or port to prevent infection or blockage. A nurse may regularly visit you at home to help clean all tubes or lines. It's important to keep the area dry when showering or bathing, and to contact your doctor or nurse immediately if you have pain, discomfort, redness or swelling around the line. If these are signs of an infection, you will be given medicine to help fight the infection, and the device may need to be replaced.
Other ways of having chemotherapy
There are other ways of having chemotherapy, depending on the drugs being used and the type of cancer you have.
Some people are able to take chemotherapy tablets or capsules at home. Your doctor, nurse or pharmacist will tell you how and when to take them, and how to handle the drugs safely.
Less commonly, chemotherapy can be injected using a needle into different parts of the body:
- intramuscular – into a muscle, usually in your buttock or thigh
- subcutaneous – just under the skin
- intrathecal – into the fluid around the spine (also known as a lumbar puncture)
- intra-arterial – into an artery
- intraperitoneal – into your abdominal area (peritoneum)
- intrapleural – into the outer lining of the lungs
- intravesical – into the bladder
- intralesional – into the tumour; this method is rare.
Some skin cancers are treated using a chemotherapy cream applied directly to the skin. This is called topical chemotherapy.
Transarterial chemoembolisation (TACE)
Used for liver cancer or some types of cancer that have spread to the liver, transarterial chemoembolisation involves injecting high doses of chemotherapy directly into the tumour. At the same time, tiny plastic beads or soft, gelatine sponges are also injected to block the blood supply to the tumour (embolisation).
Waiting for chemotherapy
When you have chemotherapy, you may spend a lot of time waiting for health professionals, for blood tests, for test results, for your drugs to be prepared and for the drugs to be given. There are sometimes additional delays because of necessary safety checks, emergencies or the workload of the treatment centre. Many treatment centres will provide biscuits and water, tea and coffee, but it's a good idea to bring your own water bottle and snacks in case of long delays.
To help pass the time, you may want to:
- read a book or magazine, or listen to music or a podcast, such as The Thing About Cancer
- complete a crossword or other puzzle
- chat with a companion
- write or draw in a journal
- meditate or practise relaxation techniques
- use a laptop, tablet or other electronic device – check with the nurses whether this is okay and if power points are available.
At first, you may feel uncomfortable being around people who are sick because of cancer or their treatment. You may not identify with them. However, many people gain support from others who are receiving chemotherapy at the same time.
"I became good friends with a lady who began chemotherapy on the same day as me. We ended up going walking several times a week for 18 months. The companionship was a great support." - Tania
If you smoke, try to quit or cut down before chemotherapy starts as smoking may affect how well the treatment works and make side effects worse. Quitting can be difficult, especially if you're feeling anxious about the cancer diagnosis and treatment. For support and advice, talk to your doctor, call the Quitline on 13 78 48, download the My QuitBuddy app or visit quitnow.gov.au.
You might wonder whether experiencing side effects is a sign that the chemotherapy is working. However, side effects usually do not indicate how successful the chemotherapy is going to be.
Your doctor may do physical examinations and other tests to see if the cancer has shrunk or disappeared after chemotherapy. This is called the treatment response and it helps your doctor decide whether to continue or change the chemotherapy plan.
If tests show that the cancer has shrunk and is unable to be detected, this may be called remission or complete response, which means there is no evidence of active cancer. Depending on the guidelines for the type of cancer you have, this may mean chemotherapy can stop or it may continue for a period of time. Once you've completed the course of chemotherapy, your doctor will monitor you for several months or years. This is because cancer can sometimes come back in the same place or grow in another part of the body.
Key points about chemotherapy
What it is
- Chemotherapy is the use of drugs that kill or slow the growth of cancer cells.
- You may have one drug or a combination of drugs depending on the cancer type.
How chemotherapy is given
- Most commonly given via a thin tube into a vein (intravenously).
- Chemotherapy is sometimes given by mouth as tablets or capsules (orally).
- For some types of cancer, chemotherapy is given in other ways, e.g. cream for skin cancer, injections for liver cancer.
- A medical oncologist or haematologist prescribes the course of chemotherapy. Other health professionals also provide care as part of a multidisciplinary team.
Safety of chemotherapy
- It is safest for people without cancer to avoid direct contact with chemotherapy drugs, so nurses and doctors wear protective clothing when giving chemotherapy. However, there is little risk to visitors during and after your chemotherapy treatment.
- Your treatment team will advise you about taking precautions at home so your family members don't come into contact with chemotherapy drugs or your body fluids, such as urine or vomit.
- Your family and friends should also handle chemotherapy drugs with care.
Expert content reviewers:
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..