Common questions about chemotherapy
Chemotherapy (sometimes just called “chemo”) is the use of drugs to kill or slow the growth of cancer cells. The drugs are also called cytotoxics, which means toxic to cells (cyto). Some drugs come from natural sources such as plants, while others are completely made in a laboratory.
Answers to some common questions about chemotherapy are below.
All cells in the body grow by splitting or dividing into two cells. 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.
There are many different types of chemotherapy drugs, and each type destroys or shrinks cancer cells in a different way. You might have treatment with a single chemotherapy drug or several drugs. When more than one drug is given, this is called combination chemotherapy and it aims to attack cancer cells in several ways. The chemotherapy drugs you have depend on the type of cancer. This is because different drugs work on different cancer types. Sometimes chemotherapy is the only treatment needed, but you may also have other treatments.
To achieve remission or cure (curative chemotherapy) – Chemotherapy may be given as the main treatment with the aim of causing the signs and symptoms of cancer to reduce or disappear (often referred to as remission or complete response).
To help other treatments – Chemotherapy can be given before or after other treatments such as surgery or radiation therapy. If used before (neoadjuvant therapy), the aim is to shrink the cancer so the other treatment (usually surgery) is more effective. If given after (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 (chemoradiation).
To control the cancer – Even if chemotherapy cannot achieve remission or complete response (see above), it may be used to control how the cancer is growing and stop it spreading for a period of time. This is known as 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.
Chemotherapy is most often given into a vein (intravenously). It is sometimes given in other ways, such as tablets you swallow (oral chemotherapy), as a cream you apply to the skin 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 treatment team will decide the most appropriate way to deliver the drugs.
Chemotherapy damages cells that divide rapidly, such as cancer cells. However, some normal cells – such as blood cells, hair follicles and cells inside the mouth, bowel and reproductive organs – also divide rapidly.
Side effects happen when chemotherapy damages these normal cells. As the body constantly makes new cells, 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.
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 first injection may be uncomfortable. If you have something more permanent, such as a central venous access device, it should not be painful. Your oncologist or haematologist will let you know which method is suitable for your situation. Some chemotherapy drugs can cause inflamed veins (phlebitis), which may be sore for a few days.
Chemotherapy drugs are expensive. The Pharmaceutical Benefits Scheme (PBS) subsides the cost of many chemotherapy drugs for people with a current Medicare card.
You usually have to contribute to the cost of oral chemotherapy drugs you take at home. This is known as a co-payment. Depending on the arrangements in your state or territory, and whether you are treated as an inpatient or an outpatient or in a private or public hospital, you may have to contribute to the cost of some intravenous chemotherapy drugs. Ask your treatment centre for a written estimate that shows what you will have to pay.
There may also be other out-of-pocket expenses. For example, 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).
Being diagnosed with cancer during pregnancy is rare – it is estimated that one in every 1000 pregnant women is affected.
Having chemotherapy in the first trimester (12 weeks) may increase the risk of miscarriage or birth defects, but there seems to be a lower risk in the later stages of pregnancy. Chemotherapy drugs may also cause premature delivery, and preterm babies often have other health issues, such as respiratory problems.
If you are already pregnant, it may still be possible to have some types of chemotherapy. It’s best to discuss the potential risks and benefits with your oncologist or haematologist before treatment begins. In some cases, chemotherapy can be delayed until after the baby’s birth. The treatment recommended will be based on the type of cancer you have, its stage, other treatment options and how to avoid harming your developing baby.
If you have chemotherapy during pregnancy, you will probably be advised to stop 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. Talk to your doctor about your specific situation and what is best for your health and your unborn baby.
You will be advised not to breastfeed during chemotherapy as drugs can be passed to the baby through the breastmilk.
As chemotherapy may harm an unborn baby, increase the risk of miscarriage, affect sperm or cause birth defects, you will be advised not to get pregnant or father a child while you are having chemotherapy.
How often and for how long you have chemotherapy depends on the type of cancer you have, the reason for having treatment, the drugs that are used and whether you have side effects.
Often people have chemotherapy over 3–6 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 continue for many months or years. If you feel upset or anxious about how long treatment is taking or the impact of side effects, let your treatment team know.
Most people have chemotherapy as an outpatient 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 the available options with you.
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 nourishing food, drink lots of water, get enough sleep, and balance rest and physical activity. Good nutrition and regular exercise can help reduce some chemotherapy side effects. If you smoke, try to quit.
Ask about fertility – Some types of chemotherapy can affect your fertility. Whether you are a man or a woman, if you think you may want to have children in future, talk to your specialist 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.
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 gathermycrew.org.au.
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 Cancer Council 13 11 20 for support. You could also learn relaxation or meditation strategies to manage anxiety as these have been found to benefit cancer patients going through treatment.
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.
Freeze some meals – You may not feel like cooking during the weeks of your chemotherapy treatment. Consider making some meals ahead and freezing them or have ready-to-eat food available (e.g. tinned fruit, yoghurt, soup). Sometimes, family and friends will arrange a meal roster.
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 decayed teeth that may cause issues if they need to be removed while you’re having chemotherapy.
Prepare for side effects – Talk to your treatment team about likely side effects. Ask whether you can take medicine to prevent nausea and vomiting. Buy a thermometer so you can check your temperature during treatment. If you are likely to lose the hair from your head, think about whether you want to cut it or choose a wig before treatment starts.
Check other medicines – Tell your doctor about any other medicines you are using. Some over-the-counter medicines, alternative and home remedies, herbs and vitamins can affect how chemotherapy works, leading to over or under treatment of the cancer.
During and after treatment, you will see a range of health professionals who specialise in different aspects of your care. The main specialist doctor you will see when having chemotherapy is a medical oncologist for solid cancers or a haematologist for blood cancers. You may be referred to a medical oncologist or haematologist by your general practitioner (GP) or by another specialist such as a surgeon. Treatment options will often be discussed with other health professionals at what is known as a multidisciplinary team (MDT) meeting. It is important to have a relationship with a GP as they will be involved in your ongoing care, particularly once cancer treatment finishes.
GP – assists you with treatment decisions and works in partnership with your specialists in providing ongoing care pharmacist dispenses medicines and gives advice about dosage and side effects
medical oncologist or haematologist – treats cancer with drug therapies such as chemotherapy, targeted therapy and immunotherapy (systemic treatment)
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 or nurse practitioner – administers drugs, including chemotherapy, and provides care, information and support throughout your treatment; a nurse practitioner works in an advanced nursing role and may prescribe some medicines and tests
pharmacist – dispenses medicines and gives advice about dosage and side effects
palliative care specialist and nurses – work closely with the GP and cancer team to help control symptoms and maintain quality of life
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 and 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.
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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.