Chemotherapy

Written by: 
Suzi Lewis-Barned, medical writer

Chemotherapy is a type of drug therapy to treat many types of cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., as well as some non-cancerousMalignant, a tumour that may invade surrounding tissues or spread to distant parts of the body. conditions such as the skin disorder psoriasis. It may be offered as a stand-alone treatment or, more often, combined with other cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. treatments, including radiotherapy and surgery.

One of the best ways to prepare for chemotherapyThe use of chemical substances to treat disease, particularly cancer. is to find out as much as you can about it and write down any questions you might want to ask your medical team

What chemotherapy treatment involves

During chemotherapyThe use of chemical substances to treat disease, particularly cancer. treatment, patients receive a course - or courses - of powerful drugs, known as 'cytotoxic' medicines.

These may be administered in a number of different ways:

As tablets or capsules that are swallowed (less common)

  • By injection(s) into one or a number of different sites
  • Through an intravenous (IV) dripA means for the continuous injection into a vein. into a vein
  • Using a pump that releases a controlled amount of drugs very slowly into your bloodstream over a few days or weeks
  • As a cream (this option may be used for some skin cancers and affects only the cells in the area where the cream is applied).

Some chemotherapyThe use of chemical substances to treat disease, particularly cancer. treatments are used to treat a range of different types of cancers while others target a specific cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body..

There are over 60 types of chemotherapyThe use of chemical substances to treat disease, particularly cancer. treatments available.

Because chemotherapyThe use of chemical substances to treat disease, particularly cancer. targets cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. cells in different ways, patients having such treatment are usually given a combination of two or three types, with dosages carefully calculated by a specialist.

What happens during a chemotherapy session?

Chemotherapy may be given over different time periods depending on the type of cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., the drugs being used and the way the therapy is being given.

Some people have intravenous chemotherapyThe use of chemical substances to treat disease, particularly cancer. (injected into a vein via a dripA means for the continuous injection into a vein.), which can involve staying in hospital for a few nights at regular intervals; others receive chemotherapyThe use of chemical substances to treat disease, particularly cancer. as an outpatient, returning home straight after treatment.

Chemotherapy is often given for between four and six courses, although this may vary and may depend on:

  • The type of cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.
  • How well the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. is responding to the treatment
  • Which drugs you are having
  • How your body is dealing with any side-effects.

How can you prepare for treatment?

One of the best ways to prepare for chemotherapyThe use of chemical substances to treat disease, particularly cancer. is to find out as much as you can about it and write down any questions you might want to ask your medical team. You may also want to ask whether you will need to take any precautions after chemotherapyThe use of chemical substances to treat disease, particularly cancer. (see below).

As well as preparing questions about these issues, you may also want to think about:

  • Keeping your future diary arrangements flexible as your treatment plan may change
  • Talking to your doctor about any risks to your fertility (see Cancer treatments and fertility and Infertility)
  • Scheduling a pre-treatment appointment with your dentist, because chemotherapyThe use of chemical substances to treat disease, particularly cancer. can affect the inside of your mouth
  • How you might deal with any hair loss, or other possible side effects outlined by your doctor
  • Finding someone willing to help you with domestic chores if necessary
  • Looking at ways of reducing any anxieties
  • Stocking up on essentials at home and preparing and freezing some meals.

After chemotherapy

Sometimes chemotherapyThe use of chemical substances to treat disease, particularly cancer. drugs, or their by-products, may pass out of your body in your urine, faeces or vomit and these can harm or irritate the skin of anyone coming into contact with them. To reduce these risks, some doctors suggest that for at least 48 hours after treatment you:

  • Sit down while urinating (men and women)
  • Close the lid of the toilet when flushing to avoid any splashes
  • Make sure the toilet seat is left clean and dry
  • Wash your hands thoroughly with soap and water
  • Use a condom when having sexual intercourse (or refrain from sexual activity) and avoid pregnancy for at least 6 months after your treatment ends as the medicines might be harmful to a developing fetusAn unborn child from eight weeks of development onwards.
  • Wear rubber gloves when handling any soiled items of clothing.

Tip If you have chemotherapyThe use of chemical substances to treat disease, particularly cancer. drugs at home, avoid touching them with your bare hands and, of course, keep them out of the reach of children. If you are unsure how to handle or store your medication, talk to your doctor

Taking care of yourself

You may be advised to:

  • Avoid eating undercooked meat and raw food, including eggs, because of the greater risk of infectionInvasion by organisms that may be harmful, for example bacteria or parasites.
  • Drink plenty of fluids to avoid dehydrationWater deficiency in the body. and constipation
  • Apply soothing creams to your anal area, which may become sore if you have diarrhoeaWhen bowel evacuation happens more often than usual, or where the faeces are abnormally liquid..

Side-effects

The medicines used in chemotherapyThe use of chemical substances to treat disease, particularly cancer. kill cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. cells and stop them multiplying. However, healthy cells in some parts of the body where cells grow more rapidly are also sensitive to the effects of chemotherapyThe use of chemical substances to treat disease, particularly cancer., and this can cause side-effects.

Although it is unlikely that your doctor will be able to tell you in advance which, if any, of these you will experience, or how serious or long-lasting they will be, certain side-effects or after-effects are associated with particular medicines, so it's a good idea to ask your doctor to explain these to you before you start treatment.

Side-effects may be short-term (acuteHas a sudden onset.), long-term (chronicA disease of long duration generally involving slow changes.), and/or delayed (late). They may be physical and/or emotional:

  • Short-term effects occur immediately after treatment and may include an allergic or hypersensitivity reaction
  • Long-term (or chronicA disease of long duration generally involving slow changes.) effects develop during treatment and continue afterwards
  • Late effects are delayed, appearing months or sometimes years after the treatment ends.

The side-effects of chemotherapyThe use of chemical substances to treat disease, particularly cancer. may include:

  • Fatigue
  • Nausea
  • Hair loss
  • Early or premature menopauseThe time of a woman’s life when her ovaries stop releasing an egg (ovum) on a monthly cycle. in women
  • Infertility in men and women (see Cancer treatments and fertility)
  • Weight loss
  • Damage to the heart
  • Reduced lung capacity and breathing difficulties
  • Kidney and urinary problems
  • Neuropathy (numbness, tingling and other sensations in certain areas of the body, especially the hands and feet)
  • Muscle weakness
  • Cognitive problems such as memory loss or inability to focus
  • Osteoporosis
  • Changes in the texture and appearance of the hair and nails
  • Secondary cancers
  • Deep vein thrombosis (DVTDeep vein thrombosis: the obstruction of one of the deep veins, often in the calf, by a blood clot. )
  • Anxiety or depression
  • Skin rashes
  • Lower resistanceThe ability of a microbe, such as a type of bacteria, to resist the effects of antibiotics or other drugs. to infections - higher temperatures, mouth sores and stomach upsets, which may also reduce your appetite.

There are some ways that you can help to manage or avoid some of these, as outlined below.

Why does chemotherapy cause these side-effects?

Side-effects occur when healthy organs and cells are damaged by repeated exposure to high doses of chemotherapyThe use of chemical substances to treat disease, particularly cancer.. How long the after-effects last depend on many factors, including if and when the damaged organs and cells repair themselves.

How can you manage or avoid side-effects?

Your doctor will be able to give you advice on some of the ways you can manage or avoid after-effects, but the information in this section may be helpful.

  • Hair loss. There are various options to help you to avoid hair loss, including 'scalp cooling', but this is not suitable for everyone. In scalp cooling, two different cooling machines can be used before your treatment session starts: one is like a cap, while the other resembles the type of hair-dryer on a stand that is seen in some hairdressing salons. The cooling technique works by reducing the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. supply to the hair follicles and thereby the amount of chemotherapyThe use of chemical substances to treat disease, particularly cancer. that reaches them, so the hair itself is less likely to fall out.
  • Weight loss. This is sometimes an issue for people with cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. and anyone undergoing treatment. Your doctor or dietitianA specialist in food and nutrition. should be able to recommend ways to help you to combat at least some aspects of weight loss.

Complementary therapies

Around a third of all cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. patients regularly use complementary therapies while undergoing cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. treatment or recovering afterwards. Patients have reported using them to boost their immune systemThe organs specialised to fight infection., to hasten recovery, to relieve the side-effects, to enhance their general health and wellbeing, and to combat stressRelating to injury or concern. and relax.

In at least one study, those patients offered complementary treatments - most often reflexology or aromatherapy - by their medical team felt that using therapies with these aims in mind achieved positive outcomes. However, it is important to be aware that not all medical professionals recommend the continued use of these therapies once treatment has started.

Tip Some complementary treatments, such as certain herbal medicines, may interfere with the effects of chemotherapyThe use of chemical substances to treat disease, particularly cancer., so if you wish to use these therapies it is especially important to discuss it with your doctor

Nutritional supplements

Many people take antioxidantA chemical that can neutralise damaging substances called oxygen free radicals. supplements to lessen the side-effects of chemotherapyThe use of chemical substances to treat disease, particularly cancer.. Some antioxidantA chemical that can neutralise damaging substances called oxygen free radicals. products may also reduce the effectiveness of chemotherapyThe use of chemical substances to treat disease, particularly cancer., however.

How you might feel

People experience chemotherapyThe use of chemical substances to treat disease, particularly cancer. in different ways. Some people look towards the end of treatment with a sense of relief and excitement, but it's not unusual to feel any of the following:

  • A sense of anger
  • Uncertainty about the future
  • A loss of interest in things that had meant a great deal to you before your treatment.

If you feel worried, anxious or stressed for much of the time, you should see your doctor, who will be able to offer help and advice.

Getting emotional support

Many people look for extra emotional support while they are having treatment. Talking about how you feel with family and friends and asking them for help may not always be easy, but it can help you to manage your emotions and get through some of the more difficult times.

There may be a local support group where you can share your experiences with others, and your doctor may also be able to recommend a counsellor who can help you come to terms with your feelings and plan your future.