Chemotherapy
What is chemotherapy?
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy can treat cancer cells anywhere in the body because it circulates in the blood. There are many types of chemotherapy drugs that can be given on their own or as a combination, where several different drugs are used together.
Chemotherapy can be given in conjunction with other treatments, including surgery, radiotherapy, hormonal therapy and biological therapies.
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Why give chemotherapy?
Chemotherapy can be given for different reasons, depending on your cancer. It can be used to . It can be given before or after surgery or radiotherapy, to ensure that cells that cannot be seen are killed, thus reducing the chance of the cancer returning. Where a cure is not possible, chemotherapy can be given to control the growth of the cells, this is known as palliative chemotherapy.
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How is chemotherapy given?
Chemotherapy drugs are administered in different ways. Most are given into a vein by injection or an . Some may be given by , or . Others can be given as an , or e.g. the bladder .
Chemotherapy can be taken orally as a tablet or capsule, or . A lot of chemotherapy drugs can be given as a daypatient, however some treatments require a stay in hospital.
There are different ways of injecting chemotherapy into the blood stream. They are via a cannula, a P.I.C.C line, a central line or a port.
Cannula: the nurse or doctor inserts a very fine tube into the patient’s arm or hand and the chemotherapy is given through this. This cannula is usually removed on the same day.
P.I.C.C line: peripherally inserted central catheter (can be called Groshong). This is a flexible tube that is inserted into a vein in the arm and advanced up until the tip sits in the right atrium of the heart. This catheter can be left in position for a number of months.
Central line: is inserted through the skin in the chest into a major vein . This line can also be left in place for a number of months.
Port: also known as a portacath. This has a small reservoir implanted under the skin; it does not have an external catheter. A needle is inserted into the reservoir and removed at the end of the treatment. The port can be used for as long as needed.
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What are the side effects of chemotherapy?
Almost all drugs have unwanted side effects. These are usually temporary and disappear once you stop taking the medicine. It is important to remember that chemotherapy can affect people in different ways. The most usual side effects are
Nausea and vomiting
Some chemotherapy drugs make you feel or , however many people experience no sickness at all. When it occurs, will depend on the drugs given and can be from a few minutes to several hours after chemotherapy injections. The sickness may last for a few hours or, in rare cases, for several days.
If you are receiving a drug that can cause sickness, your doctor will prescribe you medications to prevent this, called anti-emetics. You may receive them immediately before your treatment and in tablet form, for when you go home. The aim of the anti-emetics is to prevent any nausea and vomiting so if you do experience any nausea or vomiting it is important to tell your doctor. Some anti-emetics work well for some people and not for others, and your doctor will be able to prescribe another one for you. You may need a combination of anti-emetics to help prevent any nausea and vomiting.
If you do experience nausea these hints might be helpful:
- eat small amounts of food regularly
- avoid fatty foods
- avoid foods that make you feel sick
- avoid taking a lot of fluid just before you eat
- taking ginger or peppermint can help
- take plenty of fluid in small amounts throughout the day
Infection
Chemotherapy can affect your bone marrow, which is responsible for making blood cells. White blood cells fight infection and when these are low in your body (neutropenia) you are more prone to picking up infections. While on chemotherapy it is important to avoid children and adults who have colds or other infections, such as chickenpox, shingles or measles. You should contact your doctor if you have a sore throat, cough, pain passing urine, redness or swelling (e.g. at a catheter site) or have a temperature of or over 38ºC. You should take extra care with your personal hygiene , making sure you wash your hands well after using the bathroom. A well balanced diet should be maintained, foods should be washed thoroughly and fast food/take away foods should be avoided. You will have regular blood tests taken to measure your number of white blood cells. Sometimes your doctor will prescribe a white blood cell growth factor called GCSF, which is given as a subcutaneous injection under the skin.
Anaemia
Anaemia occurs when the red blood cells that carry oxygen around your body are reduced. You may feel very lethargic, breathless, dizzy and light headed. You will have regular blood tests taken to measure your red blood cell count (haemoglobin). You may need to get a blood transfusion or your doctor may prescribe a subcutaneous injection to stimulate red blood cell production called erythropoietin.
Bruising
Platelets are another blood cell that are produced in the bone marrow, they help to stop bleeding by clotting the blood. If your you will be more prone to bruising and bleeding. It is important to inform your doctor if you have unusual or prolonged bleeding or if you notice a pinpoint like rash on your body. Your platelet count will be measured regularly and you may need to receive a platelet transfusion.
Sore mouth
The cells lining your mouth can be affected by chemotherapy, causing a sore mouth. It is therefore important to take special care of your oral hygiene. Your doctor will prescribe mouthwashes, which should be used regularly. You should use a soft bristled toothbrush, remove and clean dentures regularly, drink plenty of fluid keeping your mouth moist, keep your lips moist by applying Vaseline and avoid very hot or acidic drinks. If you develop an ulcer, inform your doctor as these can become infected. Chemotherapy can also cause your sense of taste to change, this will resolve after your treatment has finished.
Hair Loss (Alopecia)
Not all chemotherapy drugs cause hair loss; some may thin the hair while others do not affect it at all. You may lose all body hair including your eyelashes and pubic hair, which can be very distressing. Your doctor or nurse will let you know if the chemotherapy you are receiving causes hair loss. Your hair can begin to fall out within a few weeks of your first treatment and will begin to grow back a few weeks after your last treatment. It is important to pick out a wig before your hair falls out so that a close match can be obtained. Some people find it beneficial to cut their hair very short before it falls out and to wear a hair net at night, as it can be very upsetting to wake up in the morning with a lot of hair on you pillow. Not everyone will want a wig and there are other alternatives if required (scarves/turbans). It is important not to use chemical hair dyes or to perm your hair while you are on treatment. Avoid using hair dryers, curling tongs and curlers Pat your hair gently after washing and use a soft or baby brush.
If you find hair loss extremely distressing there is a method available to try to reduce the amount of hair loss. This is called scalp cooling. It works by cooling the head and reducing the blood flow to the scalp thus reducing the amount of drug reaching the hair follicles. This treatment does not work for everyone can only be given in certain circumstances and is not available in every hospital. You can ask your doctor or nurse about scalp cooling.
Constipation and diarrhoea
Chemotherapy can also cause a change in your bowel habits. Some may cause diarrhoea. Passing watery bowel motions more than twice a day is known as diarrhoea. If you have diarrhoea you should drink plenty of fluids, avoid a high fibre diet and contact your doctor if it persists, there are medications that can be taken to relieve this symptom.
Chemotherapy may also slow down the movement of the bowel, making it difficult to pass a bowel motion, this is called constipation. If you experience constipation, it is important to maintain a high fluid intake, eat a high fibre diet and tell your doctor if it persists as you may need to go on medication to help relieve it (laxatives).
Fatigue
Fatigue may be due to your cancer itself, or as a result of symptoms caused by the cancer. It can also be a side effect of treatment. Fatigue can affect you physically and emotionally. It can be very frustrating, as it does not go away with rest. Fatigue can remain for up to six months after your treatment has finished. It can be very difficult but there are some ways that can help to manage your symptoms of fatigue.
These include getting some support from family or friends e.g. getting them to do the shopping You should rest when you are tired and by keeping a fatigue diary you will be able to identify when your energy levels are highest so you can plan your work for this time. Maintaining a well balanced diet is also important. Inform your doctor or nurse of your fatigue and they will be able to help with some symptoms. A booklet called Understanding Fatigue is available from the Irish Cancer Society.
Call the National Cancer Helpline on 1800 200 700 for a copy or click here to download.
Skin/nail changes
Some drugs can affect your skin. It can become dry or discoloured. Any rashes should be reported to your doctor. Chemotherapy also makes your skin more sensitive to sunlight You should protect your skin at all times from the sun by wearing a hat, a long sleeved shirt and by using a of at least 15 with a UVA rating of 4-5 stars. You should also avoid the sun between the hours of 11am and 3pm.
Your nails may grow more slowly and become more brittle and flaky. Sometimes the shape and colour of your nails may change.
Other changes
Some chemotherapy drugs can cause damage to your kidneys. To prevent this, fluids may be given to you before and after your treatment. It is also important to drink as much fluid as possible while at home- about one and a halflitres per day.
Some drugs can also affect your nerve endings. They may cause numbness, tingling or a burning sensation in your hands and feet, this is known as peripheral neuropathy. This side-effect is almost always temporary and goes away after treatment stops, however it can take several months to go away completely. You should tell your doctor if you experience these symptoms, as there are medications available, or your treatment may have to be changed slightly.
Some chemotherapy drugs can cause a continuous sound (buzzing or ringing) in your ears called tinnitus, this needs to be mentioned to your doctor as some changes will have to be made to your treatment.
Sex and Fertility
Some people go through chemotherapy with no change to their sex lives; others find that their sex lives are temporarily or permanently changed in some way due to their treatment. Any changes that occur are usually temporary e.g. fatigue and anxiety can affect your sex life but these pass following the completion of treatment.
There is no medical reason to stop having sex while on chemotherapy, however it is advised to use condoms while on treatment. Do not presume that you are infertile while on chemotherapy, you should use a reliable method of contraception throughout your treatment and for some time afterwards. Pregnancy should be avoided during chemotherapy, in case the drugs harm your baby. Many doctors believe it is better not to get pregnant for 2 years after your chemotherapy ends. There can also be a risk of miscarriage, or birth defects in children. You should speak to your doctor if you have any worries.
Infertility
Some cancer treatments, and sometimes the disease itself can cause infertility. This may be permanent or temporary. You should discuss the possible risk of infertility with your doctor before you start your treatment.
Female fertility Some drugs used to treat cancer have no effect on your fertility; other drugs can however affect your ovaries. Your periods may become irregular or stop, during treatment or for a few months afterwards. You may get some symptoms of the menopause e.g. hot flushes, however your periods may return to normal after a few months. In general the younger you are, the more likely your periods are to return to normal and you will still be able to have children. The nearer you are to menopause, the more likely chemotherapy is to stop your periods permanently. When you are finished treatment, there are blood tests that can be done to show if you are fertile or not. Many doctors believe it is better not to get pregnant for 2 years after your chemotherapy ends.
If there is a risk that your chemotherapy will cause long-term infertility, you may have the option of freezing your eggs before treatment begins. The unit at the Rotunda Hospital, Dublin provides a service where eggs can be frozen. You must be referred there by your oncologist, be over 18 and be able to give an informed consent. It is important to remember that you may not be suitable for this procedure, you should talk to your oncologist before you start your treatment.
Male fertility For men, the cancer itself or the treatment can cause infertility; this may be temporary or permanent. Do not presume that you are infertile during chemotherapy; you should use a reliable form of contraception throughout your treatment and for a few months after.
It may be possible to store your before treatment begins, they can then be used at a later date. The unit at the Rotunda Hospital, Dublin provides a service where sperm can be frozen. You will need to be referred there by your oncologist, be over 16 and be able to give an informed consent. Some blood tests will also have to be taken. It is important to discuss this with your doctor before your treatment begins.
Coping with infertility
You may feel devastated if you are told that you can no longer have children. It can take a while to sort out your emotions and be able to talk about them. It may be helpful to talk to your partner or friend about how you are feeling. There is no right or wrong way to react, however the full impact may only hit you when your treatment has finished.
Pregnancy and cancer
If you become pregnant before your cancer is diagnosed it is important to discuss all your options with your doctor. It may be possible to delay starting your chemotherapy until later in your pregnancy or until your baby is born, however depending on your situation you may not have a choice. In some cases it is possible to have chemotherapy and deliver a healthy baby too.
You can also talk in confidence about any of the above, to one of the helpline nurses on the National Cancer Helpline 1800 200 700.
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Life after chemotherapy
Many people are surprised at how long it takes to get back to normality after treatment. It is important to know that it can take at least a year for you to get over the effects of treatment. Don’t be in a rush to get back to your normal routine with work, just do as much as you are comfortable with.
You may feel very anxious after treatment. You may miss the regular contact with the people who looked after you in hospital or worry about the cancer coming back. There are support groups available that provide patients and family with information, advice and emotional support, you can contact the National Cancer Helpline 1800 200 700 for more details.
Following you treatment you will have regular follow up visits with your specialist. They will allow your doctor to check for signs of recurrence of the cancer, or follow up on any side effects you still have. Your doctor will also be able to check for signs of new effects that may develop after you have finished your treatment. In rare cases, some types of chemotherapy may cause long-term damage to the heart and lungs. There is also a slight risk of developing a second cancer because of the treatment, therefore it is very important, if you are between check-ups and you have a symptom or problem that worries you, to let your doctor know.
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