Chemotherapy is the treatment of cancer using anti-cancer (cytotoxic) drugs. The aim is to kill cancer cells while doing the least possible damage to normal cells.
Cancer cells are cells in our body that divide and multiply quickly in an uncontrolled fashion. These cells can form a lump or mass that keeps getting bigger and bigger (local spread) and can also travel to other parts of the body through the lymphatic system and bloodstream (metastatic spread).
How does chemotherapy work?
Chemotherapy drugs travel through the bloodstream and kill cells in the body that grow quickly (such as cancer cells). They also kill fast-growing normal cells. This is why they cause major side effects throughout the body.
Fortunately, our bodies are amazing at healing and even when normal cells are damaged, they grow again. Damaged cancer cells are less likely to grow back and this is why chemotherapy can slow or cure the spread of cancer.
What does chemotherapy do?
Depending on your type of cancer and how advanced it is, chemotherapy can:
When chemotherapy destroys cancer cells to the point that your doctor can no longer detect them in your body and they will not grow back.
When chemotherapy keeps cancer from spreading, slows its growth, or destroys cancer cells that have spread to other parts of the body.
Ease cancer symptoms
When chemotherapy shrinks tumours that are causing pain or pressure.
How is chemotherapy given?
Sometimes one type of chemotherapy drug is given by itself, either as tablets or capsules, or in a drip (intravenous or IV infusion). More often, two or more drugs are given together.
Chemotherapy drugs do not get into the brain, spinal cord or fluid bathing the brain and spinal cord very well, so for a few cancers, the drugs are inserted into the base of the spine through a process called lumbar puncture.
Is chemotherapy painful?
Having chemotherapy does not usually hurt. If you have a drip you will feel a brief sting as the needle goes in, but then the pain should stop. However, if the pain continues, or starts during the infusion, let the doctor or nurse know immediately.
Will I have to stay in hospital?
Most people have their chemotherapy as an outpatient. Usually you have to spend a few hours at the hospital for each treatment. This is because you often have to have a blood test first, and your doctors must wait for the result to check your blood count is okay before they can give you the treatment. Some people stay in hospital overnight or for two or three days.
If you live a long way from the hospital, you will probably be able to stay free of charge or at low cost at a comfortable hostel or motel. Family members can stay (at a reduced rate) in some hostels.
How is the type of chemotherapy chosen?
The type of treatment that your specialist chooses for you depends on:
- what type of cancer you have
- how far it has spread
- your general health.
Chemotherapy has been used for many years, and new and better treatments are being discovered all the time, so your doctors will select the best treatment for you and your type of cancer.
Your doctors will keep a close eye on you during your treatment. You may have blood tests, x-rays and scans to see how you are doing.
If necessary, your doctors will change your drugs or how they give them to you. Sometimes they will stop the treatment early or continue it for longer than planned. It all depends on how your body and the cancer respond to the treatment.
How long will treatment last?
Your treatment could last several weeks or several months. You will probably get one dose of treatment at a time or over a few days, and then you will be given a rest before having the next treatment. Treatment cycles are usually two to four weeks apart. Spacing out your treatment in this way gives your body a chance to recover from any side effects.
Blood tests monitor cell counts
Before you have each treatment, a blood sample will be taken. This test (known as a blood count) measures the different cells in your blood. You need to have blood counts because chemotherapy drugs can lower blood cell levels.
If any part of your blood count is too low, your doctors might give you a longer time between treatments, they may change your drugs or give you additional treatment that boosts blood counts.
Chemotherapy can help other treatment
Chemotherapy can be used alone, or sometimes it is started after surgery, when a tumour is removed. In this way, the chemotherapy kills any cancer cells that were not removed during surgery.
Sometimes chemotherapy is given before surgery or radiation, to make the cancer smaller, so that these treatments are likely to work better.
In terms of carrying out other activities while being treated, do only what you feel comfortable doing. You may find you can go on with your normal life, or that you have to take things much easier. The important thing is to look after yourself during chemotherapy so that your body is strong enough to cope with the drugs.
Do not do anything that you do not need to. Put your own needs and wishes first.
Most people keep working during their chemotherapy and arrange time off to go to hospital for each treatment. Some people work part time instead of full time, while others take a few days off around each treatment. Others take an extended break for the whole course of the treatment.
Talk to your employer, family and friends and work out what suits you. Do not force yourself to do too much.
Tell your doctor about other medications
Before you start chemotherapy, give your specialist a list of all the medications that you are taking, including occasional paracetamol (eg, Panadol), aspirins, anti-inflammatories (eg, Nurofen), vitamins, or treatments from herbalists, naturopaths, homoeopaths, etc.
If you want to take any new medications while having chemotherapy, ask your specialist about these before you begin taking them. Some chemotherapy drugs do not mix well with other medicines.
Can I drink alcohol?
It is usually fine to drink a little alcohol during treatment, but check with your specialist first – some chemotherapy drugs do not mix well with alcohol.
Can I drive?
You will probably find it best to get someone to drive you to and from hospital for the first treatment, as you might not feel well enough to drive. If you feel okay to drive after your first treatment, you will probably be fine to do so for following appointments.
Does chemotherapy cause cancer?
Some people who have chemotherapy may get another form of cancer much later in life. However, this rarely happens, and it is much more likely that your treatment will either cure you or control your cancer. If this question concerns you, talk it over with your specialist.
Emotions & cancer Cancer Society of NZ, 2010
How we can help? Wide range of support options Cancer Society of NZ
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Questions you may wish to ask about chemotherapy Cancer Society of NZ
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The side effects you might experience from chemotherapy depend on the drugs you receive and how they affect you.
Tiredness is common with chemotherapy. There is also an increased risk of developing a fever, getting infections and suffering from anaemia.
Other effects can include disturbances or irritation to various areas, eg, skin, hair, appetite, bowels, mouth and throat, and possibly to sexual functioning, though not everyone has the same reactions.
Most side effects go away
Most side effects are short lived and go away within a few days or weeks. They are not experienced between treatments and usually disappear shortly after the treatment stops.
However, some side effects are permanent. Ask your specialist or oncology nurse what to expect, and whether you are likely to get any permanent effects.
What side effects will I get?
You are unlikely to experience all of the possible side effects, but tell your doctor or nurse about any effects you do get, as they need to know how you are coping with the drugs. They may be able to help control the side effects, or they may want to change the treatment to try to avoid them.
Chemotherapy mainly affects parts of the body where normal cells rapidly divide and grow. These include the lining of the mouth, skin and hair, the digestive system, the testes and the bone marrow (where blood cells are produced).
Infection and fever
White blood cells, produced in the bone, are essential for fighting infections. Chemotherapy reduces the amount of white cells produced, making it difficult for you to fight off infections.
What can you do?
Call your cancer doctor or nurse if:
- Your temperature is 38oC or more.
- You feel unwell even with a normal temperature.
- If you have signs of infection such as swelling, redness, or pain, in any area.
Do not ‘wait to see what happens’. Follow the advice of your medical team. You may need to go to hospital for intravenous antibiotics.
Myths about fever
Be careful not to believe these myths about fever:
‘Fevers come and go – it’s best just to let them run their course.’
Fevers are always an indication that something is wrong, and should be treated and reported. If they get too high, they can lead to dehydration and seizures. When someone is undergoing chemotherapy or radiation treatment, fevers often indicate infection, which is serious and requires medical attention.
‘Fevers help burn up whatever is wrong.’
High fevers do not destroy bacteria that cause infection. This is why your doctor or healthcare team will treat both the fever and the possible infection – if your white blood cell count is low, your body will not be able to fight off the infection on its own.
Red cells are produced by the bone, and carry oxygen around the body. Chemotherapy may reduce the amount of red cells produced, making you feel tired, low in energy, dizzy, light-headed, and breathless.
What can you do?
- Let your cancer doctor or nurse know if you feel tired, low in energy, dizzy, light-headed, and breathless.
- Conserve your energy where you can - rest adequately, and eat a balanced diet.
Platelets are produced by the bone and help the blood to clot and prevent bleeding. Chemotherapy can lower the number of platelets, which increases your risk of bleeding, and you may bruise easily.
What can you do?
- Be careful when using sharp objects like a knife, scissors, razor.
- To prevent bleeding gums, use a soft toothbrush and brush gently.
- Apply gentle but firm pressure to any cuts you get until the bleeding stops.
- Contact your cancer doctor or nurse immediately if you have any unexplained bleeding or bruising. You may need a platelet transfusion.
Feeling tired, fatigue, or tiredness is a very common side effect of chemotherapy. It can be caused by a number of factors such as the chemotherapy itself, poor appetite, not sleeping well, dehydration, or anaemia.
What can you do?
- If you do get tired, try to take things easier. Only do as much as you feel comfortable doing.
- Try to plan rest times in your day.
- Also try to ensure you are drinking plenty of fluids, eating well and having some form of gentle physical activity. This will help you cope better with the treatment.
- Do not be afraid to ask for some help. Family, whanau, friends and neighbours may be happy to have the chance to help you - tell them how they can help.
- If you are not sleeping well, tell your doctor or nurse. They may be able to suggest ways to help, or prescribe sleeping tablets or a mild relaxant.
- Watch this video by Dr Mike Evans about fatigue and cancer.
Feeling sick or vomiting
Some types of chemotherapy can cause nausea (feeling sick like you want to vomit), vomiting, or both. Depending on the type of chemotherapy, these feelings can occur while you are getting chemotherapy, right after, or many hours or days later.
Not everyone feels sick after chemotherapy and anti-sickness medication has greatly improved over the past decade.
What can you do?
- Anti-sickness medication is frequently given to prevent sickness occurring. It is important to take your medication for nausea exactly as prescribed. Check with your doctor or nurse if you can drive while on this medication.
- If nausea or vomiting persists longer than 24 hours, contact your oncology nurse or doctor.
- If you feel sick, try some of these ideas:
- If you feel sick before treatments, eat lightly before each treatment.
- Eat smaller amounts more often.
- Eat slowly and chew well to help you digest your food better.
- Eat your main meal at the time of the day when you feel best.
- Try not to eat fatty things.
- Eat dry toast or crackers - they often help.
- Drink clear, cool and unsweetened drinks like apple juice.
- Do not do anything too strenuous after a meal, but try not to lie down for at least two hours after a meal.
- Try breathing deeply through your mouth whenever you feel like being sick.
- If cooking or cooking smells make you feel sick, ask others to cook for you, or prepare meals between treatments and freeze them.
- Ask the nurse or hospital social worker where you can learn relaxation or meditation methods.
Not wanting to eat (loss of appetite)
You may have no problems with your appetite during treatment, or you may not feel like eating at all. Changes to your appetite can be because of your treatment, your cancer or just because of the whole experience of having cancer and being treated for it.
Your sense of taste may change. This change can last for the duration of chemotherapy but will then return to normal once chemotherapy stops.
What can you do?
- Try different foods until you find foods that you enjoy.
- Eat smaller amounts more often, or try drinking special liquid supplement foods that you can get from your pharmacist.
- Even when you are unable to eat very much, it is important to drink plenty of clear fluids.
- Your hospital may have its own diet information for cancer patients. You can also talk to the hospital or community dietitian for advice about what to eat.
Some people gain weight during chemotherapy. Talk to a dietitian if this becomes a problem for you. Any weight gained during chemotherapy can be due to medication, but usually comes off when treatment stops.
Loosing your hair during chemotherapy, depends on the type of chemotherapy given. Ask your specialist what to expect based on your treatment plan. Your hair may start to fall out two to three weeks after the first treatment or it may not fall out for quite a while. Your scalp may feel hot or itchy just before it starts to fall out.
What can you do?
- You might want to wear a hairnet at night to catch all the hairs, or use a mini vacuum to clean the hairs from your pillow.
- Many people find losing their head hair very upsetting. Try to remember that it will grow back. Until it does, you might want to wear a wig. It is a good idea to get a wig fitted before you start losing your hair, so that it matches as closely as possible your style and colour. You may want to get your hair cut shorter so that it fits better under a wig. Spend some time choosing one that suits you.
- The Government helps pay the cost of a wig. You must get a certificate from your doctor that states you are entitled to a wig. Some people do not bother with a wig. They stay bald or cover up with a scarf or hat.
- Your hair will grow back again when your treatment stops. It takes between 4 and 12 months to grow back a full head of hair. It is possible your new hair may be a different texture or colour. Your scalp may be quite itchy as your hair grows back. Frequent shampooing can help.
- There is no medical reason why you have to cover up your head. However, your scalp will be more sensitive to the sun than normal, so you should wear a hat or a high protection sunscreen (SPF 30+) on your scalp when you are in the sun. In the winter your head may feel much colder than it normally would.
Sore or dry mouth or throat
The cells that make up the lining of your mouth replace themselves very frequently. Chemotherapy affects these cells, and can lead to a sore mouth or mouth ulcers.
What can you do?
- It is important to keep your teeth, gums and mouth very clean during your treatment to help stop infections. The nurses can show you how to do this. Use a very soft toothbrush or a cotton bud for your teeth and gums, and avoid vigorous or rough brushing.
- Use a mouthwash regularly. Do not use a commercial one (readymade or bought) because they can be too drying and make your mouth more painful. Ask your doctor or nurse for advice or you can make one yourself by mixing 1 tsp of salt and 1 tsp of baking soda (sodium bicarbonate) in 4 cups of warm water. Use it three times a day after meals or as often as you need to. Your specialist may give you a special liquid mouthwash.
- Eat soft foods and have lots to drink. Do not have anything with a high acid level such as grapefruit, tomatoes or oranges and avoid spicy foods and spirits.
- Use a lip balm or ointment on your lips if they are dry.
- If your mouth or throat is dry and you have trouble swallowing, try some of these ideas:
- suck on ice blocks
- drink lots of liquids
- moisten foods with butter
- dunk dry biscuits in tea
- blend foods and eat soups and ice creams
- ask your dentist, doctor or nurse about artificial saliva do not smoke.
- If your mouth is very sore or if you get ulcers or thrush (a white coating in the mouth), see your doctor or nurse straightaway for advice on treatment.
Itchy skin and other skin problems
Chemotherapy may cause your skin to redden, peel or become dry and itchy. You might also get drying and cracking of the fingers around the nails. Your nails may become coloured, brittle and ridged. You may get some acne.
What can you do?
- Use a lotion or cream to stop the dryness. Apply while your skin is still damp after washing.
- Avoid perfumes, cologne, or aftershave lotion that could irritate the skin.
- Avoid long, hot showers that can dry the skin. Have short, cool showers or sponge baths.
- It is especially important to cover up your skin and use a high protection sunscreen (SPF 30+) in the sun when having chemotherapy.
- Your skin may go red or thicken where the injection or the drip goes in. If this happens, tell your doctor or nurse immediately.
- Tell your doctor about any skin problems.
Diarrhoea is frequent bowel movements that may be soft, loose or watery.
Chemotherapy can cause diarrhoea because it affects the healthy cells that line the large or small bowel. It can also speed up your bowels.
What can you do?
- Eat small frequent meals.
- Drink clear fluids between meals to replace lost fluids.
- Avoid seeds, pips and skins in fruit, vegetables and grains.
- Avoid spicy foods, greasy foods and foods that cause gas such as beans, cabbage, broccoli.
- Avoid cow's milk. Lactose (milk sugar) in milk can cause cramping pains and diarrhoea.
- Mild cheese and yoghurt are low in lactose and can be eaten.
- Let your doctor know if your diarrhoea lasts longer than 24 hours or if you have pain, cramping or bleeding with diarrhoea.
Constipation is when bowel movements become less frequent and stools are hard, dry and difficult to pass. You may also get stomach cramps, gas in the tummy, or pain in the rectum (lower bowel).
Chemotherapy and pain medication can cause constipation. Other factors that may make constipation worse are poor appetite, dehydration, spending a lot of time sitting or lying down.
What can you do?
- Drink at least 6 to 8 cups of fluid (1500ml) each day, and keep yourself well hydrated.
- Eat regular meals. Do not miss breakfast.
- Add extra fibre to your food; for example, add wheat-bran flakes to your breakfast cereal or use them in cooking.
Relationships and sexuality
For some people, having cancer and treatment for it has no effect on their sexuality and sex lives. For others, it can have a profound impact, affecting how they feel about themselves, their attractiveness, and their sexual desire. Dealing with any changes is an ongoing process of adjustment.
The side effects of chemotherapy may mean that you do not feel like having sex because you feel unattractive, too tired, are nauseous or are in pain. It is important to keep communication open with your partner – for both of you to share your fears and needs.
Sexual intercourse is only one of the ways you can express affection for each other. Gestures of affection, gentle touches, cuddling, and fondling can also foster intimacy and closeness.
- Woman may find their periods become less regular or stop altogether.
- They may get hot flushes or other symptoms of menopause, and an itchy, burning or dry vagina.
- Women may also get vaginal infections, such as thrush.
- Ask your doctor or nurse for something to help if you have any of these problems.
- During treatment some men may have difficulties achieving or maintaining an erection, though others will be fine.
- For most men their usual sex drive and fertility return some time after treatment is over.
- Talk to someone you trust if you are experiencing ongoing problems with sexual relationships. Friends, nurses, or your doctor may be able to help.
Fertility and contraception
You may become infertile, either temporarily or permanently, during treatment. However, contraception should be used if a woman has not gone through menopause, because there is a slight risk of miscarriage or birth defects for children conceived during treatment. Talk to your doctor about this before you start treatment.
What can you do?
- It is usually recommended that contraception is used for at least 12 months after chemotherapy is completed.
- If you are pregnant now, talk to your doctors about it straight away.