Cancer treatments - chemotherapy

Chemotherapy is the use of drugs to destroy cancer. The drugs may be taken as tablets or, more commonly, given by intravenous drip directly into a vein. Many different drugs are available, which generally work by killing or slowing the growth of fast-growing cells. Cancers are made up of fast-growing cells.

Other fast-growing cells, such as those in hair follicles, are also affected, which is why hair loss is a common side effect. Chemotherapy medications are also known as cytotoxic or anti-cancer medications.

Different uses of chemotherapy#

Depending on individual factors such as the type of cancer, where it is, and the person’s age and general health, chemotherapy may be used:

• as the only form of treatment
• together with radiotherapy
• before surgery to shrink a tumour
• after surgery to kill off any remaining cancer cells

The major aims of chemotherapy are to cure the cancer or increase the chance of cure, improve survival, and reduce symptoms and improve quality of life.

Where and how it is given#

Chemotherapy can be given as an inpatient (with an overnight hospital stay) or, more commonly, as an outpatient (a day visit). Your doctor may prescribe one or more drugs depending on the location, type and stage of the cancer. For example, a typical schedule for breast cancer might include three different chemotherapy drugs.

Having chemotherapy should be painless. You may feel a cool sensation as the drug enters a vein, because the fluid is cooler than your blood.

The way chemotherapy is given depends on individual factors, and may include:

• oral tablets or capsules
• injection into a vein (intravenous)
• injection under the skin (subcutaneous)
• injection into the spinal fluid (intrathecal)
• injection into the chest cavity (intrapleural)
• injection into the abdominal cavity (intraperitoneal)
• very rarely, injection into an artery

Methods of intravenous treatment#

Chemotherapy is usually given intravenously, meaning the drugs are delivered into a vein. Methods include:

• Cannula – a thin plastic tube about 1.5 cm long inserted into a vein in your arm or hand. The drugs are given through a drip attached to the cannula, which is removed once they have been given.
• Central line – also called a Hickman line, a peripherally inserted central catheter (PICC) or a port. This semi-permanent drip goes into a large vein near the heart and can stay in for several months if needed. It may be put in under local anaesthetic in the radiology (x-ray) department, or in an operating theatre under general anaesthetic, and can be used to take blood as well as to give chemotherapy. The line is removed once treatment is completed.

A central line may be used if:

• it is difficult to put a cannula into your veins
• you need chemotherapy continuously, for example 24 hours a day using a small portable pump
• you are likely to need chemotherapy for a long time
• the chemotherapy might damage small veins

Chemotherapy and other drugs#

Your doctor may advise you to avoid some other medications during a chemotherapy cycle. This can include prescription and over-the-counter medicines, vitamins, and herbal and natural remedies, because some may reduce the effectiveness of chemotherapy or increase the risk of side effects. It is best to discuss all medications and supplements with your doctor.

Side effects#

Not everyone experiences side effects. They depend on the type of drug, the dose and frequency of treatment, and individual factors, and can be mild or quite severe. Common side effects include:

• fatigue
• loss of appetite
• nausea and vomiting
• bowel changes such as diarrhoea or constipation
• hair loss (alopecia)
• infection
• reduced levels of red and white blood cells and platelets
• mouth ulcers or mouth infections
• skin problems such as itchiness or extreme light sensitivity

It is important to discuss side effects with your doctor or chemotherapy nurses. Side effects can be treated, and there are things you can do to help prevent or manage them. If they are severe, it may be necessary to take a break from treatment, reduce the dose, change treatment or stop altogether. Almost all side effects will disappear once your chemotherapy treatment is completed.

Coping with side effects#

Discuss any side effects and preventive strategies with your doctor or chemotherapy nurse. Helpful strategies may include the following.

Fatigue#

• Drink plenty of water in the days after treatment.
• Exercise gently whenever possible.
• Plan activities for times when you feel most energetic, perhaps in the mornings.
• Take afternoon naps if necessary.

Appetite and eating#

• Eat a healthy diet with plenty of fresh fruit, vegetables, lean meats and wholegrain cereals.
• Avoid high-fat, spicy or rich foods.
• Eat when you feel hungry. You may need to experiment with your eating habits; for example, you may prefer your main meal in the morning, or to snack lightly through the day rather than have three main meals.

Hair#

• Treat your hair gently and use mild shampoos.
• Avoid harsh treatments such as dyes, perms, hair rollers, gels and sprays.
• Try satin, cotton or polyester pillowcases, which may feel more comfortable against your scalp.
• Use wigs, scarves, hats or turbans to cover hair loss.

Reducing the risk of infection#

• Avoid people who have obvious infections such as colds or the flu, though there is no need to avoid people in general or crowded areas.
• Wash your hands with soap after using the toilet, before preparing food and before eating.
• Be extra careful around sharp implements, because chemotherapy may make it harder for your blood to clot. For example, wear gloves when gardening and consider an electric shaver instead of razor blades.

Mouth care#

• Brush your teeth at least twice a day.
• Rinse your mouth with salt water at least four times a day to reduce the risk of mouth problems.
• Use any mouthwash your doctor prescribes, as these reduce the risk of infections or ulcers. Avoid over-the-counter mouthwashes unless your doctor says they are okay.
• Avoid hard or crunchy foods if you have a mouth infection. Try soups and soft, wet foods such as stews or ice cream.

Skin and sun#

• Avoid sun exposure. If outside, wear protective clothing such as a broad-brimmed hat and a long-sleeved top, and apply sunblock (SPF 30+) to exposed skin.
• Moisturising lotions can help reduce skin itchiness.

Emotional wellbeing#

• Avoid over-the-counter drugs, natural therapies or supplements unless your doctor says they are okay.
• Seek help if you feel depressed or anxious. See your doctor for advice and referral if talking with family and friends doesn’t help.

Tests and warning signs#

You will have regular blood tests during chemotherapy to make sure it is safe to continue, and you may have scans, such as CT scans, to see how well the treatment is working.

Notify your doctor or chemotherapy centre at once if you have any of the following:

• feeling suddenly unwell in any way
• fever higher than 38°C (100.4°F)
• chills or sweats
• abnormal bruising or bleeding
• continuous vomiting
• severe diarrhoea or constipation
• abdominal pain

If you can’t contact your doctor or the hospital, go to the emergency department of your nearest hospital and tell the staff that you are having chemotherapy.

Key points#

• A central line is removed once your chemotherapy treatment is completed.
• Your doctor may advise you to avoid taking some other medications during a chemotherapy cycle.
• Some preparations may reduce the effectiveness of chemotherapy or increase the risk of side effects.
• It is important to discuss side effects with your doctor or chemotherapy nurses.
• Side effects can be treated, and there are things you can do to help prevent or manage them.

Where to get help#