Common questions about chemotherapy
If you have been diagnosed with cancer, your doctors may recommend that you have chemotherapy. This is a common cancer treatment, but people often have a number of questions about it. The answers below provide some general information.
Your health care team can give you more details about your particular treatment.
Learn more about:
- How does it work?
- How is chemotherapy used?
- Why have chemotherapy?
- How is chemotherapy given?
- Why does chemotherapy cause side effects?
- Does chemotherapy hurt?
- How much does treatment cost?
- Can I have chemotherapy during pregnancy?
- How long does treatment last?
- Where will I have treatment?
- How do I prepare for chemotherapy?
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.
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 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.
When you’ve got to have chemo, it’s quite frightening because you’ve only heard bad things about it. But then I spoke to the oncologist and he explained the benefits.Phil
How is chemotherapy given?
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. For more on this, see Chemotherapy treatment explained.
Why does chemotherapy cause side effects?
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.
See Managing chemotherapy side effects for more information and talk to your treatment team for tips on dealing with side effects.
Does chemotherapy hurt?
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.
How much does treatment cost?
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).
For more on paying for treatment, see Cancer care and your rights.
Can I have chemotherapy during pregnancy?
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. For more on this, see Sexuality and fertility.
How long does treatment last?
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.
Where will I have treatment?
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.
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.
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