Understanding ChemotherapyDownload this book (pdf, 1.05 mb)
What is chemotherapy?
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).
Many of these drugs are obtained from natural sources such as plants, while others are completely developed in the laboratory. There are many types of chemotherapy drugs, which are often used in different combinations and at different strengths.
How does it 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. When normal cells are damaged, this can cause side effects.
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?
Chemotherapy can be given in a variety of ways. 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.
- 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.
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.
Where will I have treatment?
Most people have chemotherapy on an outpatient basis 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 long does treatment last?
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 6-12 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?
Chemotherapy drugs are expensive, but most people only have to pay for a fraction of the cost because many drugs are heavily subsidised by the Pharmaceutical Benefits Scheme (PBS).
- There are some drugs that are not covered by the PBS. Check with your nurse, specialist or pharmacist whether you will receive these drugs and if you will have to pay for them.
- You may also have to pay for medications 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 - about one in 1000 women are affected.
It is possible for some pregnant women to have chemotherapy. Your medical team will discuss all of the available treatment options with you. Their recommendations will be based on:
- the type of cancer you have
- its stage
- the other treatment options, and
- how to avoid harming your developing baby.
Sometimes chemotherapy or other treatment can be delayed until after the baby's birth.
If you have chemotherapy during pregnancy your doctor will probably advise you to stop having it at least 3-4 weeks before your delivery date. This is because chemotherapy increases your risk of bleeding or getting an infection during the birth. Stopping chemotherapy allows your body time to recover from the side effects.
Researchers are currently doing long-term studies on women and children to explore this issue further. It is known that giving chemotherapy in the first trimester (12 weeks) increases the risk of birth defects. However, some studies on children who were exposed to chemotherapy in the womb during the second and third trimesters show that chemotherapy did not affect their development.
Different chemotherapy drugs may affect a developing baby in different ways. For example, chemotherapy may cause premature delivery. Pre-term babies often have other health problems, such as respiratory problems and delayed development.
Your doctor can talk in detail about your specific situation and what is best for your health and your unborn baby. Most pregnant women with cancer will feel very anxious and afraid about what will happen to their unborn child. Being well informed about your diagnosis, possible treatments and side effects can make it easier to make decisions and cope with what happens.
Which health professionals will I see?
Your general practitioner (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:
|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||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|
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.