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  • Understanding chemotherapy

    Contents

    Chemotherapy is the use of drugs to kill or slow the growth of cancer cells.

    Chemotherapy drugs are also called cytotoxics, which means poisonous (toxic) to cells (cyto). There are many types of chemotherapy drugs, which are often used in different combinations. Sometimes drugs known as targeted therapies are used instead of or with chemotherapy. Targeted therapies target growth mechanisms specific to cancers, minimising harm to healthy cells.
     

    How does chemotherapy work?

    Most chemotherapy drugs enter the bloodstream and travel throughout the body to reach cancer cells in different organs and tissues.

    Chemotherapy drugs target and injure rapidly dividing cells, but because it is not cancer specific, both cancer cells and some normal cells are affected. Side effects are caused when normal cells are damaged.

    Cancer cells don’t repair easily, so they recover more slowly than normal cells. By the time your next treatment starts, your body’s normal cells have recovered but the cancer cells have not. This means that more cancer cells are destroyed with every treatment.

    Why have chemotherapy?

    Chemotherapy can be used for different reasons:

    Cure
    Some cancers can be cured by chemotherapy on its own or in combination with other treatments, such as surgery or radiotherapy. The aim of the treatment is to destroy all cancer cells.

    To help other treatments
    Chemotherapy can be given either before or after other treatments. Used beforehand, its purpose is to make the cancer smaller so your main treatment is more effective (neo-adjuvant therapy). If chemotherapy is given after your main treatment, its aim is to get rid of any remaining cancer cells (adjuvant therapy).

    To control the cancer
    If the cancer is too large and can’t be cured, chemotherapy can be used to control the cancer’s growth for an extended period of time.

    Symptom relief
    When the cancer can’t be cured but causes symptoms such as pain, treatment – such as chemotherapy – can provide relief. This is called palliative treatment.

    How is chemotherapy given?

    Most people have chemotherapy through a vein (intravenously). It can also be prescribed orally (tablets or capsules), as a cream, 
or as injections into different parts of the body.

    Does chemotherapy hurt?
    Having intravenous chemotherapy may feel like having your blood taken.

    • If you have a temporary tube (cannula) in your hand or arm, only the initial injection should hurt
    • If you have a central venous access device, it should not be painful. 


    Some treatments will cause side effects. However chemotherapy drugs are constantly being improved to give you the best possible results and to reduce side effects. 
If you feel burning, coolness, pain or any other unusual sensation where a cannula or central venous access device enters your body, or if you have tenderness or redness over the injection site, tell your doctor or nurse immediately.

    Where and how often will I have treatment?

    Most people have chemotherapy during day visits to a hospital or clinic. Sometimes an overnight hospital stay may be needed.

    Some people can have chemotherapy at home if they use a portable pump or have oral chemotherapy.

    How often and how long you have chemotherapy depends on the type of cancer you have and the drugs that are used. You may have treatment daily, weekly or monthly for several months to a year.

    Chemotherapy is commonly given in courses (cycles), with rest periods in between. This allows normal cells to recover and your body to regain its strength. If your body needs more time to recover, your next cycle may be delayed.

    Your doctor will discuss your treatment plan with you. Many people have chemotherapy over six to twelve months, but you may have it for a shorter or longer period.

    Some people who have chemotherapy to control the cancer or to relieve symptoms (palliative treatment) may have regular treatment for many months or years.

    How much does treatment cost?

    The Pharmaceutical Benefits Scheme (PBS) covers the cost for many drugs for people who have a medicare card. There are some drugs that are not covered by PBS. Check with your specialist, pharmacist or nurse, whether there is any cost. You may have to pay for medication to relieve the side effects of chemotherapy such as anti-nausea drugs.

    If you have private health insurance and elect to have your treatment privately, you may have to pay for out-of-pocket expenses and contribute to the cost of the drugs. Check with your doctor and your health fund before you start treatment.

    Can chemotherapy be given during pregnancy?

    Being diagnosed with cancer during pregnancy is rare. It is possible for some pregnant women to have chemotherapy. Your medical team will discuss all of the available treatment options with you.

    Your doctor can talk in detail about your specific situation and what is best for your health and your unborn baby.
     

    Treatment

    Intravenous (IV) chemotherapy

    Chemotherapy is most commonly given as a liquid drip into your vein (intravenously). Depending on the treatment, this may take about 20 minutes or several hours. Sometimes you may receive chemotherapy over a few days.

    Before chemotherapy, you may be given medication so you don’t feel sick (anti-nausea or anti-emetic medication). You may also be encouraged to drink several glasses of water during the treatment. You will probably be in a room or a lounge area with other patients when you are getting the chemotherapy. You are usually able to walk to the toilet during your treatment.

    The nurses will assess you before chemotherapy, and monitor you during and after the treatment. They will let you know when you are able to go home.

    Your nurses will also talk to you about managing side effects and tell you about any medication you need to take at home.

    Many people feel well enough to travel to and from the hospital
 or clinic by themselves during chemotherapy. However it is recommended that a relative or friend comes with you to your first appointment to support you and help you travel home if necessary.

    Inserting the tube
    To prepare you for IV chemotherapy, you will need to have a tube inserted. There are different types – your doctor will choose the most appropriate one depending on how often you need chemotherapy and how long each treatment will last.

    • cannula – a small plastic tube that is temporarily inserted into a vein using a needle. When the needle is removed, the cannula remains in place in your arm or the back of your hand. The cannula can be kept in place for a few days if necessary. 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 entire course of treatment, often for several weeks to months. Blood for testing can sometimes be taken through this tube.

    Common types of CVADs include:

    • peripherally inserted central catheter (PICC) – inserted into the arm
    • port-a-cath (port) – small device inserted under the skin of the 
chest or arm
    • central line – inserted into the chest or neck

    All tubes or lines need to be kept clean to prevent infection or blockage. If you have a CVAD, a nurse may visit you at home to clean, dress and flush your line, or you may go to a clinic to have this done. This usually happens on a weekly or monthly basis.

    A line doesn’t cause pain or discomfort if it is properly placed and cared for, although you will be aware that it is there. Tell your doctor or nurse immediately if you have pain, discomfort, redness or swelling around the line. This may indicate that you have a problem with the line.

    Intravenous chemotherapy at home
    Some people are able to have their chemotherapy at home using a portable pump. The pump is programmed to give the prescribed amount of chemotherapy over a specified period.

    A chemotherapy pump can be carried in a bag or belt holster. It is usually attached to a CVAD usually PICC or port. The nurses at the clinic or hospital will show you how to care for the pump.

    Other ways of having chemotherapy

    There are other methods of having chemotherapy but your options will depend on the type of cancer you have and what your doctor recommends.

    Oral chemotherapy
    Many people need to take tablets or capsules at home. Your doctor, nurse or pharmacist will tell you how and when to take them, and how to handle the medication safely.

    Cream
    Some skin cancers are treated using a chemotherapy cream applied directly to the skin.

    Injections
    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, for example, the hepatic artery in the liver
    • intraperitoneal – into your abdominal area (peritoneum)
    • intrapleural – into the outer lining of the lungs
    • intravesical – into the bladder
    • intralesional – into the tumour; this treatment is rare. 


    Chemotherapy wafers
    Some people who have surgery for a brain tumour (craniotomy) will have small, dissolvable gel wafers of chemotherapy placed directly into the tumour site during the operation.

    High-dose chemotherapy
    This is a treatment given as part of a bone marrow or peripheral blood stem cell transplant for conditions such as leukaemia or lymphoma. The high-dose chemotherapy kills off all the cancer cells in the blood before the new, healthy cells are transplanted a day or two later.

    Chemoembolisation
    Used for liver cancer—or some types of cancer that have spread to the liver—chemoembolisation is
 a procedure of injecting chemotherapy directly into the blood vessels supplying a tumour. The chemotherapy is mixed with tiny spheres that block the vessels and stop the tumour getting nutrients and oxygen.

    Tell your doctor if you plan to take over-the-counter medications, home remedies or complementary therapies such as herbal or nutritional supplements. Some remedies worsen side effects or affect how chemotherapy works in your body. For example, the herb St John’s Wort can reduce the effectiveness of some drugs.

    Chemotherapy is time consuming

    When you have chemotherapy you may spend a lot of time waiting, usually in hospitals: waiting for the doctor, for blood tests, for test results, for your drugs to be prepared and for the drugs 
to be given. There are sometimes additional delays due to safety checks, emergencies and busyness of the treatment centre.

    Reading a book or magazine, doing crosswords, listening to music or talking to a companion can help pass the time.

    Take water and snacks in case there are long waiting times. Most hospitals also have a cafeteria so if you are there all day you can buy lunch.

    Many treatment centres allow you to use a laptop, tablet or other electronic device, but there are sometimes restrictions on certain power points and the staff may request that you turn it off. Some people like to write or draw in a journal, meditate or practise relaxation techniques.

    At first, you may be anxious seeing people who are sick because 
of cancer or their treatment. You may not identify with them, but many people find support from the other people who are receiving chemotherapy at the same time as them.

    Safety precautions

    Some people worry about the safety of their friends and family during chemotherapy treatment.

    Your family and friends, including children, babies and pregnant women, can visit you while you’re having chemotherapy. The chemotherapy won’t harm them as long as they don’t have any direct contact with the drugs. However if people without cancer come into direct contact with chemotherapy drugs, they may be harmed.

    When you are receiving chemotherapy, you will notice that 
the oncology nurses and doctors wear gloves, goggles, gowns, and sometimes masks. This protective clothing reduces their risk of exposure to the drugs as they administer the chemotherapy. After treatment is over, these items are disposed of in special bags or bins.

    After you have had chemotherapy, the drugs may remain in your body for up to a week after treatment. This depends on the types of drugs used. It is possible for the drugs to be passed into urine, stools and other body fluids such as saliva, vomit, semen and breast milk. Care needs to be taken so that other people are not exposed to the drugs through contact with your body fluids.

    Chemotherapy safety at home
    Your medical team may recommend that you follow the below safety guidelines during chemotherapy. Safety precautions may vary depending on the drugs you receive so ask your medical oncologist about your individual situation. If you have any specific concerns—for example, if you use incontinence or ostomy aids—discuss them with your oncologist. For more information call Cancer Council 13 11 20.

    • After using the toilet, flush it once with the lid down for up to a week following a treatment session.
    • Wash items soiled with body fluids in a separate load. Choose the maximum cycle that the fabric will allow. After washing and line drying, these items can go back 
into general use.
    • Keep a supply of disposable rubber gloves and cleaning cloths on hand. To dispose of used gloves and cloths, seal them in a plastic bag before putting them in the bin.
    • Wear rubber gloves when handling clothing or bed sheets soiled with vomit or any other body fluids.
    • If body fluids or chemotherapy medication spill onto household surfaces (such as
 the carpet or a mattress), wear rubber gloves, soak up the spill with disposable paper towels, clean around the area with a disposable cloth and soapy water, and rinse the area with water.
    • If medication spills on your skin, wash it with soap and running water. Contact the hospital if any redness or irritation caused by the spillage doesn’t clear up within the hour.
    • Take precautions to avoid pregnancy
 while you are having chemotherapy. If you have a baby, you will not be able to breastfeed during your course of chemotherapy.
    • Protect your partner from your body fluids 
by using a condom or a female condom if
 you have any type of sex within a few days after a treatment session. Your doctor or nurse can give you more information about how long you need to use this protection.
    • Don’t crush or cut chemotherapy tablets. If you can’t swallow a tablet whole, talk to your doctor.
    • Store chemotherapy tablets, capsules 
or injections as directed by your doctor or pharmacist. Keep them out of reach of children. Seal empty tablet containers in a plastic bag and return them to your pharmacy or hospital oncology department.

    Chemotherapy and infections

    You are usually more prone to infections while you are having chemotherapy.

    If any of your relatives or friends have an infectious illness, such as a cold or the flu, discuss it with your doctor or nurse. They may suggest that your loved ones wait until they are well before getting too close to you.

    Is the treatment working?

    Your doctor will use several methods to measure how well the chemotherapy is working. You will probably have physical examinations, blood tests and scans. These tests can show if the cancer has shrunk or disappeared. If the cancer has shrunk or hasn’t grown, the chemotherapy may continue.

    You may wonder whether getting side effects is a sign that the chemotherapy is working. Side effects vary from person to person and from drug to drug and they do not show whether the treatment is effective or not.

    If tests show that the cancer has disappeared it will be a great relief. The doctors may refer to this as remission, which means there is no evidence of active cancer. Although the cancer is gone, your doctor will monitor you for several months or years before you are considered cured. This is because cancer can sometimes come back in the same place or grow in another part of the body.

    Adjuvant chemotherapy is often used to prevent cancer coming back, so it may not be possible to tell if this treatment has been effective for some years. If chemotherapy is being given as palliative treatment, the relief of your symptoms will tell you if the treatment is working.

    Targeted therapies

    Other drugs may be used instead of, or together with chemotherapy to target particular types of cancer cells while minimising harm to healthy cells. These are called targeted therapies.

    Targeted therapies have different actions to help destroy or stop the growth of cancer cells. Not all cancers respond to targeted therapies, and some of these therapies are only available in clinical trials. Talk to your doctor for more information.

    Drug therapies
    There are several types of targeted drug therapies for cancer:

    • Angiogenesis inhibitors – for cancer cells to grow and spread from their primary site to other areas of the body, they need to make their own blood vessels. Drugs known as angiogenesis inhibitors attack developing blood vessels so that the cancer can’t grow and spread.
    • Enzyme inhibitors – these drugs may block certain proteins or enzymes that tell cancer cells to grow. They are sometimes called small molecule drugs.
    • Apoptosis-inducing drugs – apoptosis means cell death. These drugs target the part of the cancer cell that tells it when to die.

    Immunotherapies
    Immunotherapies (also called biological therapies) strengthen the immune system so it finds and kills cancer cells. There are two types of immunotherapy:

    • Active immunotherapies – therapies that stimulate your immune system to fight infection and disease. You might be given a vaccine to make your body produce antibodies to fight cancer.
    • Passive immunotherapies – using man-made (synthetic) antibodies developed in a laboratory to get your immune system to fight cancer cells.

    Side effects of targeted therapy

    You may have side effects that are caused by the targeted therapy rather than by the chemotherapy. Side effects depend on the medication used. Some typical effects are fevers, allergic reactions, rashes, diarrhoea and blood pressure changes.

    Rarely, some targeted therapies may cause life-threatening side effects. Your doctor will discuss this with you.

    Which health professionals will I see?

    Your GP will refer you to a specialist, who can advise you about your treatment options. Your GP may also play an important role in your ongoing care and help you manage any side effects you experience.

    You will be cared for by a range of health professionals when you have chemotherapy. This multidisciplinary team will probably include:

    Health professional Role
    Medical oncologist and haematologist Specialists who can prescribe and coordinate the course of chemotherapy
    Radiation oncologist  Specialist who prescribes and coordinates the course of radiotherapy, which is sometimes used with chemotherapy
    Registrar A qualified doctor undergoing additional training to be a specialist (for example as a medical oncologist or radiation oncologist)
    Nurses Specially trained in chemotherapy they give the course of treatment and support and assist you through all stages of your treatment
    Cancer nurse coordinator/ clinical nurse consultant/ cancer care coordinator  Coordinates your care and liaises on your behalf with different specialist care providers
    Pharmacist Dispenses medications and gives advice about drugs, dosage and side effects
    Social worker, physiotherapist and occupational therapist  Link you to support services and help you to resume your normal activities
    Dietitian Recommends an eating plan to follow while you are in treatment and recovery
    Palliative care team Helps you and your family with needs you have, including symptom management

     

    Managing side effects

    The most important effect of chemotherapy is that it kills cancer cells. However chemotherapy can also affect normal cells that rapidly divide and grow, such as those in the bone marrow, digestive tract, skin, hair and reproductive organs. When the normal cells are damaged, this can cause side effects.

    • It is natural to worry about side effects. However whether or not you experience side effects, and how severe they are, depends on the type of drugs you’ve been prescribed and how you react individually from one treatment period to the next.
    • Side effects vary greatly. Some people will have no side effects, others will experience a range. If you have side effects, they will usually start during the first few weeks of treatment.
    • Most side effects are temporary and can be managed. They tend to gradually disappear once treatment has stopped.

    You should talk to your doctor or nurse before your treatment begins about the side effects you should watch out for or report, and who to contact out of hours if you have immediate concerns.

    If the side effects impact on your appearance and self-esteem, you may find it helpful to attend a free Look Good... Feel Better program, which teaches you about using skin care, hats, wigs and cosmetics. To book, call 1800 650 960 or visit www.lgfb.org.au.

    Chemotherapy diary
    It can be useful to record information about your chemotherapy treatment in one place so you recall details about any side effects you’re experiencing and what helped to reduce them. Some people like to write down notes. Other people choose to record things another way—for example, by using their smartphone.

    Share the information you record with your doctors and nurses so that they can give you suggestions for dealing with side effects or adjust your treatment, if appropriate.

    Feeling tired and lacking energy

    Feeling tired and lacking energy (fatigue) is the most common—and often debilitating—side effect of chemotherapy. Fatigue can include feeling exhausted, drowsy, confused or impatient. You may have a heavy feeling in your limbs or find it difficult to do daily activities.

    Fatigue can appear suddenly and rest may not relieve it. You might still feel tired for weeks or months after a treatment cycle ends.

    • Save your energy. Help your body recover by doing less and resting more.
    • Let people help you. Family, friends and neighbours often want to assist but may feel unsure about what to do. They could help with shopping, child-care, driving or housework.
    • If you are employed, consider whether you could take some time off, reduce your hours 
or work from home during or after chemotherapy. Some workplaces might allow you to work flexibly around your treatment.
    • If there is a time during the day when you tend to feel most energetic, try to plan activities during this time.
    • Do light exercise, such as walking. If you have a normal exercise routine and you feel up to it, ask your doctor if you can exercise.
    • Don’t start any new exercise activities until you have recovered from treatment.
    • Try to get more sleep at night and take naps during the day if you can.
    • If you aren’t sleeping well, tell your health care team. Only take sleeping pills that are recommended or prescribed by your doctor.
    • Some people benefit from doing relaxation or meditation exercises.
    • Try to eat a healthy, well-balanced diet with plenty of fruits and vegetables.
    • Check with your doctor whether your fatigue is related to low red blood cells (anaemia) so that this can be treated.

    Loss of appetite, nausea or vomiting

    It is common for your appetite to change when you are going through chemotherapy. Sometimes you may not feel hungry, or you may not enjoy the foods you used to like. Some treatments temporarily change the taste of foods.

    Chemotherapy may make you feel sick (nauseous) or vomit. Not everyone feels sick during or after chemotherapy, but if nausea affects you, it usually starts a few hours after treatment. Nausea may last for many hours and be accompanied by vomiting or retching.

    Anti-nausea or anti-vomiting medication can help. This medicine can be taken before, during or after treatment. It may be available as:

    • injections – usually given before chemotherapy

    • tablets – can be taken regularly at home

    • wafers – dissolved under or on top of the tongue

    • suppositories – placed in the rectum where they dissolve
.

    Your medical oncologist will tell you if the drugs you are given are likely to cause nausea and vomiting. You may be prescribed medication in advance so you don’t experience the side effects, 
or so they are reduced. It may take some time before you find a medication that works for you, so let your nurse or doctor know if you still have nausea after a few days taking the medication or if you have vomited for more than 24 hours.

    Trying to eat as well as possible will help you recover sooner and cope better with the treatment and its side effects.

    • Eat a light meal before your treatment (e.g. soup and dry biscuits or toast), and drink as much fluid as possible.
    • Sip small amounts of liquid often, rather than trying to drink a lot at once. Sucking on ice cubes, ice-blocks or jellies can also help to increase your fluid intake.
    • If your stomach is upset, try drinking fizzy drinks such as soda water or dry ginger ale.
    • If you wake up feeling sick, eat a dry biscuit or a slice of toast rather than skipping food altogether or forcing yourself to have a full meal.
    • Breathe deeply and gently through your mouth if you feel like you’re going to vomit.
    • If you are nauseous or have vomited a lot, try to keep your fluids up so that you don’t get dehydrated. If you aren’t able to keep fluids down, contact your doctor immediately.
    • Avoid strong odours and cooking smells.
    • Eat and drink slowly. Chew your food well to make it easier to digest.
    • Prepare meals between treatments and freeze them for the days you don’t feel like cooking.
    • Be flexible about your meals. Try to eat when you are hungry, and don’t delay eating when you feel like it.
    • Eat small, frequent snacks instead of large meals.
    • If the taste of certain types of food has changed, don’t force yourself to eat them. Your sense of taste should return to normal after treatment ends, but it may take several weeks.
    • Speak to the hospital dietitian for advice about eating.
    • Call Cancer Council Helpline for free information about eating healthily during and after treatment.

    Hair loss

    Many people having chemotherapy worry about hair loss. Some people lose all their hair quickly, others lose it after several treatments, and others may only lose a little hair or none at all.

    When hair loss does occur, it usually starts two to three weeks after the first treatment and grows back when chemotherapy is completed. Your scalp may feel hot, itchy, tender or tingly before and while your hair is falling out. Some people find that the skin on their head is very sensitive, and they may develop pimples on their scalp.

    Although losing head hair is most common, you may also lose hair from your eyebrows, eyelashes, arms, legs, chest and pubic region.

    Whether or not you lose your hair depends on the drugs you receive. Some drugs don’t cause this side effect. Ask your doctor if this is a possible side effect and discuss how you can prepare for it.

    It takes four to twelve months to grow back a full head of hair. When your hair first grows back, it may be a different colour or curly (even if you have always had straight hair). In time your hair usually returns to its normal condition.

    Many people find losing their hair very difficult. You may feel that hair makes up a part of your overall image and its loss can make you feel physically unattractive, vulnerable or sad. It’s natural to feel this way. Talking to your medical team may be helpful.

    • Keep your hair and scalp very clean.
    • Use a mild shampoo like baby shampoo. If you want to use lotion on your head, use sorbolene. Check with your nurse before using any other hair or skin care products.
    • Comb or brush your hair gently using a large comb or hairbrush with soft bristles.
    • Wear a light cotton turban or beanie to bed if you are cold at night, or to collect hair.
    • Use a cotton, polyester or satin pillowcase, as nylon can irritate your scalp.
    • If you prefer to leave your head bare, protect it against sunburn and the cold.
    • Make an appointment with a hairdresser who can make your hair look as good as possible even if it is thin or patchy.
    • Avoid perms and dyes, and limit the use of hair dryers, rollers and harsh products.
    • If your eyelashes fall out, wear glasses or sunglasses to protect your eyes from the sun and dust while outside.
    • Tell your nurse or doctor if the skin on your scalp is very sensitive, or if you have a lot of discomfort and itchiness.
    • Wear a wig, toupee, hat, scarf or turban. Do whatever feels the most comfortable and gives you the most confidence.
    • Some hospitals or treatment centres have a wig library where you can borrow a wig if you need one. Ask your doctor or nurse for more information.
    • If you want to purchase a wig and you have private health insurance, check with your fund to see if you are eligible for a rebate.
    • Call Cancer Council Helpline for assistance in finding a wig library or shop.

    Skin problems

    Your skin may darken, peel or become dry and itchy when you are having chemotherapy. It is also likely to be more sensitive to the sun. Protect your skin from the sun – especially between 10am and 3pm – by wearing high-protection sunscreen (SPF 30+), a hat and protective clothing. This advice applies to everyone but it is even more important for people having chemotherapy.

    • Shower using a moisturising soap or sorbolene cream as a soap replacement.
    • After showering, gently pat your skin dry with a towel. Try not to rub your skin too hard.
    • Use a moisturising lotion or cream containing the ingredient urea to stop the dryness.
    • Dust cornflour over the itchy parts of your skin.
    • Wear loose, non-restricting clothing. Choose cotton fabric instead of rough wool or synthetic fibres.
    • Wash your clothing in mild detergent for people with sensitive skin.
    • Stop shaving or waxing until your skin is completely healed.
    • Drink plenty of water.
    • If your skin becomes red or sore in the area where the intravenous device went
 in, tell your doctor or nurse immediately.

    Constipation or diarrhoea

    Some chemotherapy drugs, pain relief medicines and anti-nausea drugs can cause constipation or diarrhoea. Tell your doctor or nurse if your bowel habits have changed.

    After a bout of constipation or diarrhoea, eat a balanced diet with fresh fruits, vegetables, wholegrain bread and pasta.

    Constipation

    • Eat more high-fibre foods, such as wholegrain bread and pasta, 
bran, fruit and vegetables, nuts and legumes (e.g. baked beans 
or lentils).
    • Sometimes drinking fruit juice can help ease constipation. Try 
prune, apple or pear juice.
    • Drink plenty of other fluids, both warm and cold, to help loosen 
the bowels.
    • Do some light exercise such as walking.
    • Don’t use enemas or suppositories. They are not recommended for 
people having chemotherapy.
    • If you have constipation for more than a couple of days, let your 
doctor or nurse know. They may change your medication or give you other medication to relieve it. 


    Diarrhoea

    • Choose bland foods such as clear broth or boiled rice. Avoid spicy 
foods, wholegrain products, fatty or fried foods, rich gravies and 
sauces, and raw fruits or vegetables with skins or seeds.
    • Limit alcohol, fruit juice, soft drinks, strong tea or coffee and 
dairy products, as these may further stimulate the bowel.
    • Drink water to help replace the fluids lost through diarrhoea.
    • Diarrhoea can usually be treated at home with over-the-counter 
medication. Talk to your doctor or pharmacist.
    • If the diarrhoea becomes severe, it can cause dehydration and 
you may need to be admitted to hospital.

    Mouth sores

    Some chemotherapy drugs can cause mouth sores such as ulcers or infections. This is more likely if you have had or are having radiation to the head, neck or chest, or if you have dental or gum problems.

    If you notice any change in your mouth or throat, such as sores, ulcers or thickened saliva, or if you find it difficult to swallow, contact your doctor. You should also discuss any dental problems with your doctor before seeing the dentist. If you need any dental work, tell your dentist you are having chemotherapy.

    • Use a soft toothbrush to clean your teeth twice a day.
    • Don’t use commercial mouthwashes containing alcohol as they may dry out
or irritate your mouth. Instead, try homemade mouthwash 
(one teaspoon bicarbonate of soda or salt in a glass of warm water) at least four times a day. This helps keep your mouth clean, while the salt mouthwash helps heal mouth sores.
    • Sip fluids, especially water, and eat moist foods such as casseroles or soups if you have a dry mouth. Moisten foods with butter and sauces.
    • Try sucking on ice while you’re having intravenous chemotherapy to reduce mouth ulcers.
    • Blend foods to make them easier to eat.
    • Nourishing drinks such as milkshakes, smoothies and supplements add extra energy to your diet and feel soothing.
    • Avoid very hot foods, and spicy, acidic or coarse foods, (e.g. nuts or grains), as these can aggravate mouth sores.
    • Don’t smoke or drink alcohol, as this irritates tissue in the mouth.

    Memory and concentration changes

    Some people say they have trouble thinking clearly after chemotherapy. This is called cognitive impairment or, sometimes, ‘chemo brain’. You may find that it takes you more time to process information, or you may experience short-term memory loss or have trouble concentrating for long periods.

    There is some evidence that self-help techniques such as relaxation, exercise and memory games can be beneficial. You can also try focusing on activities that don’t require too much concentration. For example, you might choose to read magazines with short articles instead of books with several characters or complex storylines. Tell your doctor if this issue is affecting your day-to-day life.

    • Use a calendar to keep track of tasks, appointments, social commitments, birthdays, etc.
    • Write down things you have
 to remember. For example, make to-do lists or write down where you parked the car.
    • Learn something new, 
take up a new hobby, or do crosswords, word or number puzzles.
    • Plan activities to do things that require more concentration when you are fresher, such as in the morning.
    • Get plenty of sleep. Deep sleep is important for memory and concentration.
    • Do light exercise each day as this may help you to clear your mind and sleep better.
    • Talk to others about how you’re feeling—for example, your partner or colleagues—to prevent misunderstandings and frustration.

    Effects on the blood and immune system

    Some chemotherapy drugs affect the bone marrow, which is the soft and spongy material inside the bones. The bone marrow makes three types of blood cells:


    • red blood cells – carry oxygen throughout the body

    • white blood cells – fight infection

    • platelets – help blood to clot and prevent bruising.

    The bone marrow’s job is to maintain normal levels of blood cells (your blood count) to keep you fit and healthy. When chemotherapy affects the bone marrow, your blood count is reduced. The count may fall with each treatment. This can cause problems such as anaemia, infections and bleeding problems, depending on the type of blood cell affected.

    Your health care team will do regular blood tests to make sure your blood cells return to normal levels before your next treatment.

    Anaemia

    A low red blood cell count is called anaemia. This can make you feel tired, lethargic, dizzy or breathless.

    You may need a blood transfusion to build up your red blood cells and treat the anaemia.

    Eating a nourishing diet with foods rich in iron and B vitamins is also important if you are anaemic. Wholegrain breads and cereals, lean meat and green leafy vegetables are good sources of iron and vitamin B.

    Infections

    If white blood cell numbers drop during chemotherapy treatment, it can make colds and flu harder to shake off. Scratches and cuts may get infected easily or take longer to heal.

    See your doctor if you are unwell—even if you just have a cold. Sometimes doctors recommend taking antibiotics as a precaution against infection. If you are having chemotherapy in winter, check with your doctor about having the flu vaccine.

    You may have an injection of granulocyte-colony stimulating factor (G-CSF) after chemotherapy if your doctor thinks it will be useful for you. It increases the number of neutrophils, which are a type 
of white blood cell that help protect against infection. If G-CSF is given, your doctor or nurse will speak to you about possible side effects. Some people may experience bone pain or tenderness at the injection site or show signs of an allergic reaction.

    When to contact your doctor

    Contact your doctor urgently if any of the following occur:

    • chills or sweats
    • a temperature of 38°C or more
    • persistent or severe vomiting
    • severe abdominal pain, constipation or diarrhoea
    • unusual bleeding
    • tenderness, redness or swelling around the site of the 
intravenous chemotherapy device
    • any serious unexpected side effects or sudden deterioration 
in health.

    Also, contact your GP or treating specialist if you experience:

    • sweating, especially at night
    • sore throat
    • mouth ulcers
    • burning or stinging on passing urine
    • easy bruising.

    Reducing your risk of infection

    • Keep a thermometer at home to check your temperature.
    • Some people having chemotherapy prefer to avoid crowded places such as shopping centres or public pools to reduce the risk of picking up an infection. This is not always practical, so use your commonsense.
    • Wash your hands with soap and water before preparing food and eating, and after using the toilet.
    • Use separate boards and utensils for raw and cooked foods, and clean thoroughly with hot, soapy water.
    • Leftover food should be stored in airtight containers in the fridge as soon as possible.
    • Store raw and cooked foods separately.
    • Try to eat freshly cooked or freshly prepared foods.
    • Don’t eat food or drinks past their use-by or best before dates.
    • Wash fruits and vegetables well, or peel where possible.
    • Avoid pre-made sandwiches, salads and takeaway foods; soft cheeses; raw or rare fish, meat and eggs; unpasteurised dairy products and soft-serve ice-creams.
    • Avoid people who are unwell, especially if they have the flu, conjunctivitis, measles, mumps, a cold sore or chickenpox.

    Bleeding problems

    A decrease in platelets can cause you to bleed for longer than normal after minor cuts or scrapes, or to bruise more easily. You may need a platelet transfusion if they are low.

    • Be careful when using scissors, needles, knives or razors. Small cuts or nicks can harbour germs where an infection can start.
    • Use an electric razor to minimise the chance of nicking yourself.
    • Use a soft toothbrush to avoid irritating your gums.
    • Wear thick gloves when gardening to avoid injury, and to prevent infection from soil, which contains bacteria.
    • If you bleed, apply pressure for about 10 minutes and bandage, if appropriate.

    Nerve and muscle effects

    Some drugs can cause tingling and loss of sensation in your fingers and/or toes, and muscle weakness in your legs. If this happens, tell your doctor or nurse before your next treatment. Your treatment may need to be changed or the problem carefully monitored.

    Change in hearing

    Some chemotherapy drugs can affect your hearing. You may lose some of your ability to hear high-pitched sounds. It can also cause a continuous ringing noise in the ears known as tinnitus. Let your doctor know if you notice any change in your hearing.

    Sex and fertility

    Chemotherapy may impact on your desire or ability to have sex because you feel tired or unwell. It may also affect sexual organs and functioning in both women and men. This can lead to a temporary or permanent effect on your ability to have children (your fertility).

    Changes in sexuality

    Many people have a range of worries that cause them to lose interest in sex while they’re having treatment. They may feel less confident about who they are and what they can do, or there may be a physical reason for not being able or ready to have sex. For example, vaginal dryness or erection difficulties are common issues after treatment.

    Partners may also feel concerned about having sex – they might fear injuring the person with cancer or feel uncomfortable with the changes in their partner. If you have sex after receiving chemotherapy, you should take safety precautions.

    Sexual intercourse may not always be possible, but closeness and sharing can still be a part of your relationship. Talk about how you’re feeling with your partner, and take time to adapt to any changes.

    Try to see yourself as a whole person (body, mind and personality) instead of focusing only on what has changed.

    Changes in fertility

    It is best for you and your partner to talk to your doctor about how chemotherapy might affect you personally and what options are available if you want to have children in the future. Women may be able to store eggs (ova) and men may be able to store sperm for use at a later date. This needs to be done before chemotherapy starts.

    Effects on women


    Some women’s periods become irregular during chemotherapy but return to normal after treatment.
 For other women, chemotherapy may cause periods to stop completely (menopause).
 After menopause, women can’t have children by natural means.

    The signs of menopause include hot flushes, sweating—especially at night—and dry skin.
 Menopause, particularly if it’s early (before age 40), may cause bones to become weaker and break more easily. This is called osteoporosis.
Talk to your doctor about medication to treat the symptoms of menopause.

    Effects on men

    Chemotherapy drugs may lower the number of sperm produced 
and reduce their ability to move. This can sometimes cause 
infertility, which may be temporary or permanent.

    The ability to get and keep an erection may also be affected 
but this is usually temporary. If the problem is ongoing, seek medical advice. 
For more information, call Cancer Council Helpline for free resources on sexuality and intimacy. 


    Contraception

    Although chemotherapy reduces fertility, it is still possible for some women to become pregnant while having chemotherapy, and a man having chemotherapy could still make his partner pregnant. 


    Chemotherapy drugs can harm an unborn baby, so women should not become pregnant during the course of chemotherapy, and men should not father a child. Should you or your partner become pregnant, talk to your treating doctor immediately. 
The type of birth control you choose will depend on what you and your partner are comfortable using. Ask your doctor for advice about the best type of birth control method for you. Some people choose to use barrier contraception (e.g. condoms), which provide protection against any cytotoxic drug by-products that may be secreted in body fluids. Young women may be prescribed the Pill as a contraceptive and to help protect the ovaries from the effects of chemotherapy.

    Making treatment decisions

    Sometimes it is difficult to decide on the right treatment. You may feel that everything is happening so fast you don’t have time to think things through. If you are feeling unsure about your options, check with your doctor how soon your treatment should start, and take as much time as you can before making a decision.

    Understanding details about the disease, the available treatments and their possible side effects will help you make a well-informed decision. This decision will also take into account your personal values and the things that are important to you and your family. It is common to feel overwhelmed by information so it may help if you read and talk about the cancer gradually.

    • Weigh up the advantages and disadvantages of different treatments, including the impact of any side effects.
    • If only one type of treatment is recommended, ask your doctor why other choices have not been offered.
    • If you have a partner, you may want to discuss the treatment options together. You can also talk to friends and family. 


    You have the right to accept or refuse any treatment offered by your doctors and other health care professionals. Some people with advanced cancer choose treatment even if it only offers a small benefit for a short period of time. Others want to make sure the benefits outweigh the side effects so that they have the best possible quality of life. Some people choose options that focus on reducing symptoms and make them feel as well as possible.

    Question checklist

    You may find this checklist helpful when thinking about the questions you want to ask your doctor about your disease and treatment. If your doctor gives you answers that you don’t understand, ask for clarification.

    • Why do I need chemotherapy?
    • What are the advantages and disadvantages of chemotherapy 
for me?
    • How successful is chemotherapy for my type of cancer?
    • Are there any other treatments I can have instead?
    • How much does treatment cost?
    • What drugs will I be receiving? How will they be given?
    • How often will I receive this treatment? How long will I have treatment?
    • Where will I have the chemotherapy? Can I have it close to where I live?
    • What are the possible side effects of this treatment and what can I do to control them?
    • Are there any complementary therapies that will help?
    • How will I know if the treatment is working?
    • Will chemotherapy affect my sex life and fertility?
    • After treatment has finished, will I need check-ups?
    • Who should I contact for information or if I have a problem during treatment? Who is my after-hours contact?

     

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