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Chemotherapy treatment

Most cancers have treatment protocols that set out which drugs to have, how much and how often. 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.

You might have treatment with a single chemotherapy drug or a combination of two or more drugs. Your specialist will record the choice of chemotherapy drugs, the dose and the treatment schedule in a treatment plan. You will have tests throughout treatment to monitor your response and your treatment plan may be adjusted based on the results and any side effects you have.

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, the drugs used and whether you have any side effects.

Chemotherapy is commonly given as a period of treatment followed by a break. This is called a cycle. You will usually have a number of treatment cycles, and these may be daily, weekly or monthly. The length of the cycle depends on the chemotherapy drugs being given.

The break between cycles lets your body recover and regain its strength. If you need more time to recover, the specialist may decide to delay your next cycle. If you have any concerns about changes to your treatment or any delays, talk to your specialist.

What to expect when having chemotherapy

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.

Tests you may have

To prepare for chemotherapy and between cycles, you will have a number of tests to help plan treatment:

  • weight and height measured to work out the right dose
  • blood 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.

For some chemotherapy drugs you may also have:

  • heart monitoring tests to see if the drugs are affecting your heart
  • lung function tests to check whether the drugs are affecting your lungs.

While receiving chemotherapy you will usually be:

  • seated in a reclining chair in a room with other patients; during treatment it’s a good idea to shift your weight in the chair
  • able to bring someone with you and to walk around the room (e.g. if you need to go to the toilet) given anti-nausea (antiemetic) medicine so you don’t feel sick
  • given several glasses of water to drink to help flush the chemotherapy drugs through the kidneys and bladder
  • monitored throughout the session – nurses will talk to you about ways to manage side effects
  • able to travel to and from chemo by yourself; it’s recommended that someone is with you the first time in case you feel unwell and to write down any instructions or advice.

Chemotherapy drugs are most commonly given as a liquid through a drip inserted into a vein (intravenous infusion). A single session could take from 20 minutes to several hours. Chemotherapy will usually be given during day visits to your hospital or treatment centre. Sometimes it is given through a portable pump that you can use at home.

Some people can react to the infusion process (e.g. flushing, skin rashes, difficulty breathing, anxiety). You will be monitored and may be given medicine to help prevent this. Reactions can occur during or several hours after the infusion. They are more common with the first infusion, so it may be given more slowly than later treatments.

Ways of injecting drugs

To prepare for IV chemotherapy, the treatment team will insert a narrow tube into a vein. The type of device used will depend 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.

Cannula – A small plastic tube 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 can be 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 thin plastic tube that remains in your vein throughout the course of treatment, often for several weeks or months. It allows medical staff to give chemotherapy and other drugs, fluid or blood transfusions, and draw blood. Inserting a CVAD takes only a few minutes under local anaesthetic, and it shouldn’t cause discomfort or pain. Common types are:

  • 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. You may have a port for months to years.

Portable pump – This device is programmed to give a prescribed amount of chemotherapy continuously for up to a week. The pump does not need to be connected to a power point and is usually attached to a central line. It is quite small and can be carried in a bag or belt holster and tucked under a pillow when sleeping.

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. You may visit the clinic or a nurse may regularly visit you at home to help clean all tubes or lines. For some lines, it’s important to keep the area dry when showering or bathing. Contact your doctor or nurse immediately if you have pain, discomfort, redness or swelling around the line or port. If there are signs of an infection, you will be given medicine and the device may need to be replaced.

There are other ways of having chemotherapy, depending on the drugs being used and the type of cancer you have.

Oral chemotherapy – Some people are able to take chemotherapy as 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.

Injections – Less commonly, chemotherapy can be injected using a needle into different parts of the body:

  • into a muscle, usually in your buttock or thigh (intramuscular)
  • just under the skin (subcutaneous)
  • into the fluid around the spine (intrathecal, also known as a lumbar puncture)
  • into an artery (intra-arterial)
  • into your abdominal area (intraperitoneal)
  • into the outer lining of the lungs (intrapleural)
  • into the bladder (intravesical)
  • into the tumour (intralesional; this method is rare).

Cream – Some skin cancers are treated using a chemotherapy cream applied directly to the skin. This is called topical chemotherapy.

Transarterial chemoembolisation (TACE) – Used for primary liver cancer or some types of cancer that have spread to the liver, TACE involves injecting high doses of chemotherapy directly into the liver tumours. At the same time, tiny plastic beads or soft, gelatine sponges are injected to block the blood supply to the tumour (embolisation).

For some types of cancer, you may be given chemotherapy as part of another treatment, such as a stem cell transplant or radiation therapy, or in combination with other drug therapies.

high-dose chemotherapy – Usually given as part of a stem cell transplant for blood cancers, such as leukaemia or lymphoma. It kills off all the cancer cells before the new, healthy blood cells are given. The transplant usually occurs a day or two later.

chemoradiation (chemoradiotherapy) – This is when chemotherapy is combined with radiation therapy. The chemotherapy drugs make the cancer cells more sensitive to radiation therapy. Chemoradiation is commonly used for brain, bowel, cervical and oesophageal cancers.

hormone therapy – May be used after chemotherapy. Some cancers, such as breast and prostate cancer, can grow in response to hormones. Drugs that block these hormones may be given as tablets or injections.

targeted therapy – Often used in combination with chemotherapy, targeted therapy drugs may be given through a drip in a vein, as injections or as tablets.

immunotherapy – May be used in combination with chemotherapy. Usually given through a drip in a vein.

steroids – Often given with chemotherapy to ease or prevent nausea, manage allergic reactions, make chemotherapy more effective or directly treat the cancer. Steroids are usually given as tablets. Side effects include indigestion, an increased appetite, mood swings, difficulty sleeping, increased blood glucose levels and muscle weakness.

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 may also be 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.

While you are waiting, you may want to:

  • read a book or magazine, or listen to music or a podcast
  • complete a crossword or other puzzle, knit, crochet or embroider
  • chat with a companion
  • write or draw in a journal
  • meditate or practise relaxation techniques or just have a rest
  • use a laptop, smartphone, tablet or ereader – 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. You may find it helpful to join a support group to meet other people going through a similar experience.

Chemotherapy is strong medicine, so it is safest for people without cancer to avoid direct contact with the drugs. Oncology nurses and doctors may wear gloves, goggles, gowns or masks because they are exposed to chemotherapy drugs every day. When the treatment session is over, these items are disposed of in special bags or bins.

After each chemotherapy session, the drugs may remain in your body for up to a week. During this time, very small amounts of the drugs may be released from the body in your vomit, urine, faeces (poo), blood, saliva, sweat, semen or vaginal discharge, and breastmilk.

You may worry about the safety of family and friends while you are having chemotherapy. There is little risk to visitors, including children, babies and pregnant women, because they aren’t likely to come into contact with any chemotherapy drugs or body fluids.

The safety measures listed below are recommended for people who are providing care or have other close contact with you during the recovery period at home. If you have questions, talk to your treatment team or call Cancer Council 13 11 20.

Chemotherapy safety in the home

Follow these safety measures to reduce exposure to chemotherapy drugs at home, both for you and your family and friends. Safety precautions can  vary depending on the drugs you receive, so ask your treatment team about your individual situation.

Use a plastic bucket – If you need to vomit, use a plastic bowl or bucket (or a plastic bag with no holes). Empty into the toilet and flush the toilet twice. Don’t use the bowl or bucket for anything else and throw it out after your final chemotherapy session.

Clean up spills – Keep a supply of cleaning cloths, paper towels and disposable waterproof gloves handy. If any body fluids (during the week after a treatment session) or chemotherapy drugs spill onto household surfaces, put on a pair of waterproof gloves, soak up the spill with paper towels, clean around the area with a disposable cloth and soapy water, and rinse the area with water. Put used gloves, cloths and paper towels in a plastic bag, then put the bag in the bin.

Take care going to the toilet – For a week after a treatment session, sit down to use the toilet. Put the lid down before flushing to avoid splashing. Flush the toilet with a full flush twice. If you have a septic or composting system, check with the manufacturer about whether this is safe.

Wear disposable gloves – During the week after a treatment session, wear disposable waterproof gloves when handling containers, clothing or bedsheets soiled with vomit or other body fluids. Put the gloves in a plastic bag and throw out after use.

Keep tablets whole – Don’t crush, chew or cut chemotherapy tablets. If you can’t swallow a tablet whole, ask your oncologist or pharmacist whether the drug comes in other forms, such as a liquid.

Put medicines in a safe place – Store all tablets, capsules or injections as directed by your oncologist or pharmacist – they often need special storage to keep them effective and safe. Keep them out of reach of children and do not store them in a pill organiser with other medicines.

Handle laundry carefully – Wash items soiled with body fluids, such as clothing, bedsheets and towels, separately from other laundry. Use the longest washing machine cycle (hot or cold water can be used), and wash twice.

Practise safe sex – If having any type of sex, use barrier contraception, such as a condom, female condom or dental dam, to protect your partner from any chemotherapy drugs that may be present in your body fluids.

Pregnancy and breastfeeding – Avoid conceiving while having chemotherapy. If you already have a baby, you will not be able to breastfeed during your course of chemotherapy.

You might wonder whether experiencing side effects is a sign that the chemotherapy is working. However, having side effects usually does not indicate how successful the chemotherapy is going to be.

Throughout treatment, you will be closely monitored by your specialist. You will have tests to see how well the chemotherapy drugs are working and whether 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.

Telehealth appointments

You may be able to have some appointments with your health professionals from home over the phone or a video link. This is known as telehealth and it can reduce the number of times you need to attend hospital.

Although telehealth can’t replace all face-to-face appointments, you can use it to talk about a range of issues including test results, prescriptions and side effects. For more information talk to your treatment team or call Cancer Council 13 11 20.

Featured resource

Understanding Chemotherapy

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This information is reviewed by

This information was last reviewed August 2020 by the following expert content reviewers: Clinical A/Prof Rosemary Harrup, Director, Cancer and Blood Services, Royal Hobart Hospital, TAS; Katie Benton, Advanced Dietitian, Cancer Care, Sunshine Coast Hospital and Queensland Health, QLD; Gillian Blanchard, Oncology Nurse Practitioner, Calvary Mater Newcastle, NSW; Stacey Burton, Consumer; Dr Fiona Day, Staff Specialist, Medical Oncology, Calvary Mater Newcastle, and Conjoint Senior Lecturer, The University of Newcastle, NSW; Andrew Greig, Consumer; Steve Higgs, 13 11 20 Consultant, Cancer Council Victoria; Prof Desmond Yip, Clinical Director, Department of Medical Oncology, The Canberra Hospital, ACT.