Common questions about chemotherapy

All cells in the body grow by splitting or dividing into 2 cells. Cancer cells are cells that divide rapidly and grow out of control. 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. Occasionally, 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 used to treat cancer, but you may also have other treatments.

Chemotherapy can be used for different reasons:

To achieve remission or cure (curative chemotherapy) – Chemotherapy may be given as the main treatment with the aim of reducing or ending the signs and symptoms of cancer (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 that the other treatment (usually surgery) is more effective. If given after (adjuvant therapy), the aim is to get rid of any remaining cancer cells to try to cure the cancer. 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, 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. In rare cases, palliative treatment can also achieve remission.

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. Called maintenance chemotherapy, it may be given with other drug therapies to stop 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), a cream you apply to the skin, or 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.

When these normal cells are damaged, side effects may occur. Some people have few or mild side effects, while others may feel more unwell. 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. At first, it may be uncomfortable to have the temporary tube (cannula) put into your hand or arm, but it can then be used for the rest of the chemotherapy session. If you have something more permanent, such as a central venous access device, it shouldn’t be painful.

Some chemotherapy drugs can cause inflamed veins (phlebitis), which may be sore for a few days. It is important to let your treatment team know if this is a problem because there may be ways to reduce this discomfort or pain.

Chemotherapy drugs can be expensive. However, the Pharmaceutical Benefits Scheme (PBS) subsidises 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 cost 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.

There may be other out-of-pocket expenses. For example, you will usually have to pay part of the cost for any medicines that you take at home to relieve the side effects of chemotherapy (such as anti-nausea medicine). Remember to keep copies of your receipts if you are getting your prescriptions filled at different pharmacies, or ask your pharmacy to collate your prescription receipts. Once you have spent a certain amount of money on drugs in a year, you will be eligible for reduced cost or free drugs through the PBS Safety Net.

You have a right to know whether you will have to pay for treatment and drugs and, if so, what the costs will be. This is called informed financial consent. Ask your treatment centre for a written estimate that shows what you will have to pay.

Download our booklet ‘Cancer Care and Your Rights’

Being diagnosed with cancer during pregnancy is rare – it is estimated that 1 in every 1000 pregnant women are 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 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. 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. Talk to your doctor about your specific situation and what is best for your health and your unborn baby.

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 protecting your developing baby.

You will be advised not to breastfeed during chemotherapy as drugs can pass through breastmilk and may harm the baby.

See Cancer Council Victoria’s information ‘Cancer and pregnancy’

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.

Chemotherapy treatment before or after surgery is often given for up to 6 months. 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 usually have their treatment at home. Sometimes a visiting nurse can give you chemotherapy intravenously or by injection in your home.

Chemotherapy affects everyone differently, so it can be hard to know how to prepare for treatment. However, there are some things you can think about doing in advance to make it easier to cope with chemotherapy treatment and any side effects that you may experience.

Ask about fertility – Some types of chemotherapy can affect male and female fertility. If you think you may want to have children in future, talk to your specialist about your options before chemotherapy begins.

Download our booklet ‘Fertility and Cancer’

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. Regular exercise and good nutrition can help reduce some of the side effects of chemotherapy. If you smoke, try to quit.

Organise help – If you have children, you may need to arrange for someone to look after them when you have treatment. While you may be able to  drive after treatment, it’s recommended that someone drive you on the first day. A friend or family member may coordinate other offers of help (e.g. with housework), or try online tools such as candoapp.com.au or gathermycrew.org.au.

Pack a chemo bag – A bag for your chemo sessions could include warm clothing; healthy snacks; lip balm; and something to pass the time, such as books, headphones for listening to music, or a laptop.

Discuss your concerns – If you are feeling anxious about the diagnosis and having chemotherapy, talk to a family member or friend, your health care team, or call Cancer Council 13 11 20. You could also learn relaxation or meditation strategies to manage anxiety.

Freeze some meals – You may not feel like cooking during your treatment. Consider making some meals ahead of time 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.

Prepare for side effects – Talk to your treatment team about possible 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 hair loss is likely, think about having it cut or choosing a wig before treatment starts.

Check your teeth – It is a good idea to visit your dentist before chemotherapy begins. Infection and bleeding are more likely during chemotherapy, so it is best to have any tooth decay treated before starting treatment. Dental problems that arise during treatment may also interrupt your treatment schedule.

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 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 tumours) or a haematologist (for blood cancers). You may be referred to a medical oncologist or a 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. Ask your doctor if your case has been discussed at an MDT meeting.

It is a good idea to build a relationship with a GP because they will be involved in your ongoing care, particularly after your cancer treatment ends.

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 (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 – helps with nutrition concerns and recommends changes to diet during 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