Chemotherapy

Chemotherapy is probably the most well known cancer treatment. It is designed to target cells which grow and multiply quickly, and since cancer cells divide faster than most cells in the body, they are selectively killed by the chemotherapy. However some fast-growing healthy cells, like those of the skin, hair, intestines, and bone marrow can also be affected and that’s how side effects can happen.

There are over 30 different types of chemotherapy drugs available, and they can be used alone or in combination to treat a wide variety of cancers.

Chemotherapy is a form of systemic treatment, in other words it uses the bloodstream to travel around the body to reach cancer cells wherever they may have spread to. This is particularly useful when we need to target cancer cells but despite modern scanning technology, we are not able to detect their exact location.

Before you can begin chemotherapy, your doctor will discuss the purpose of treatment, the potential benefits, any associated risks and best options for your individual needs moving forward. You will then be required to sign a consent form. Before and during therapy you will have a range of tests completed to check your overall health, you will be monitored using blood samples.

Chemotherapy Goals

The goals of a person’s cancer treatment depends entirely on the individual needs of the patient. Chemotherapy can be used to shrink and slow the cancer growth, or it can be used to remove and cure cancer all together. Chemotherapy can be given in the hospital via IV (Intravenous Therapy), or some types may be administered by tablet which may be taken at home.

Your chemotherapy plan is something that should be discussed with your oncology team. They will help you to determine your chemotherapy goals and expectations moving forward. This will depend on:

• Your cancer type
• The size of your tumour and its location
• The stage of cancer
• Your overall health
• Your reaction to side effects
• Previous cancer treatments
  
  

How is Chemotherapy Administered?

• Intravenous Chemotherapy (IV )(into the vein) : An IV is a therapy that delivers fluid directly into a patient’s vein. IV chemotherapy can take anywhere between minutes to hours, and some chemotherapy treatments work best when received over a few days. In this case, a patient is required to have a chemoport device inserted underneath the skin and wear a small pump which will administer the chemotherapy in a slow release fashion over  2-4 days. Most IV chemotherapy these days are done as a daycase and seldom require overnight admission.
  
  

• Oral chemotherapy: Some chemotherapy may be in the form of a tablet or a capsule. Oral cancer treatments are becoming frequently more common. They are designed to be more convenient for the patient but will only work if taken on time as prescribed. Oral chemotherapy does not necessarily have fewer side effects than intravenous chemotherapy, sometimes they may even be worse.
  
  
• Intra-arterial chemotherapy (into the artery): By injecting the chemotherapy into an artery – the chemotherapy will be carried directly to the tumour and will have higher concentration compared to if used IV. However intra-arterial chemotherapy is more complicated as it requires placement of a catheter (tube) done under specialist guidance through an artery directly next to the tumour.
  
  
• Intraperitoneal chemotherapy (into the abdominal cavity): For cancers that involve the peritoneum – the surface of the abdomen and the intestines, stomach and liver. The chemotherapy is inserted directly into the abdomen via a catheter. Sometimes the chemotherapy is warmed up and is known as HIPEC (hyperthermic intraperitoneal chemotherapy)
  
  
• Topical chemotherapy: Topical chemotherapy is administered as a cream to the skin.

What is the Timeline and Schedule  for Chemotherapy?

Before you begin your treatment, you will often be told how long to expect your treatment to go for. This can take anywhere from 3-6 months usually, or it can continue as long as the treatment is working to control the tumour. IV chemotherapy is usually given in “cycles” for example a 3 weekly cycle means if you have chemotherapy today, you then go home to rest for 3 weeks, and then return for your next round of chemotherapy. The scheduled breaks in between allow time for your normal cells to recover and your body to heal.

Your Chemotherapy Team

When you undergo chemotherapy, you will find a whole team of professionals will be alongside you throughout this journey. The two main professionals will be an oncologist, a doctor who is in charge of your treatments, and an oncology nurse, who will look after your health and manage your side effects.

IV Treatment

The most common chemotherapy administered is IV chemotherapy. One of the most important steps in this process is the placement of an IV tube into your arm. Where possible the team will usually use a vein found in your arm. If you have previous surgery to remove all the axillary (armpit) lymph nodes, then that arm cannot be used. If the chemotherapy leaks out into the skin it can cause extreme skin irritation known as extravasation. So it is very important the specially trained nurses administer the chemotherapy.

Where it is not possible to safely find a vein in your hand or if the chemotherapy needs to be given over many cycles long term, you may need a “chemoport” through a minor surgery. This chemoport is a round disk that allows an IV to be inserted easily, meaning a nurse does not need to insert a needle into your vein. After your chemotherapy has been administered, your needle will be removed, but your chemoport will be cleaned and ready remain for future use.

Supportive Care during Chemotherapy

• Appetite: You may feel a slight loss of appetite following chemotherapy. It is always best to try to maintain an adequate calorie and nutrient intake, as malnutrition can lead to delayed recovery, muscle loss which is hard to recover and lowered immunity.
  
  

• Blood counts: Your bone marrow might be affected by the chemotherapy and may not be able to make enough blood cells such as hemoglobin, white cells and platelets. Your doctor will need to monitor your counts to make sure they are healthy before proceeding with chemotherapy. Boosters such as GCSF (granulocyte colony stimulating factor) can be given to boost up white cell counts. Sometimes it is necessary to transfuse a patient or prescribe iron supplementation to improve blood count production.
  
  

• Constipation: May sometimes be caused by the anti-emetics (anti-vomiting) medications given with chemotherapy such as ondansetron, granisetron, palonosetron. Patients will need to increase their fibre intake and sometimes take laxatives.
  
  

• Diarrhea: Certain chemotherapies can cause watery bowel movements. It is important to replenish your fluids and remain hydrated for your overall health if this occurs. The doctor may prescribe anti-diarrheals such as loperamide and hidrasec.
  
  

• Fatigue: Feeling Studies have shown that a regular exercise programme can help to reduce fatigue significantly and even lower the risk of cancer.

Exercise guidelines for cancer patients

• Fertility: Chemotherapy has been known to affect fertility in both men and women. Therefore younger patients who intend to have a family in the future may consider sperm storage or embryo storage. Chemotherapy can also affect an unborn baby, and it is very important to practice contraception during chemotherapy and after for a period of 6 months at least.
  
  

• Hair loss: Chemotherapy can sometimes induce full body hair loss. This typically takes place at around a few weeks after treatment begins. Not all chemotherapies cause hair loss.
  
  
  

• Mouth sores: Chemotherapy has been known to affect the cells found inside a patients throat and mouth. These sores are known as mucositis, which typically disappear when your chemotherapy is over. The doctor will prescribe mouth washes and medications to promote faster healing.
  
  

• Nausea and vomiting: Anti-vomiting medication are routinely prescribed along with chemotherapy these days. As a result we seldom see severe vomiting. However, certain chemotherapy drugs are more prone to cause nausea and your doctor may need to give you extra anti-vomiting medication. Certain groups of people can be more susceptible to nausea, including those who are highly anxious, younger patients, female and a history of motion sickness.
  
  

• Nerves: Some chemotherapies can lead to nerve damage and may first manifest as numbness especially the finger tips and toes. These include drugs such as cisplatin, oxaliplatin, taxane and vincristine. It is important for patients to report these changes to the oncologist as they need to reduce the dose or stop the treatment before functional damage occurs such as the patient not being able to write, drive or do up their buttons.
  
  

• Secondary Cancers: Survivors of cancer are at very slightly increased risk of a second cancer later in life, especially children who are particularly, this tends to be either acute leukemia or myelodysplasia. Myelodysplasia is a blood cancer where the normal parts of the blood are either not made or are abnormal.
  
  
• Thinking and memory: After chemotherapy, some patients have noted difficulty concentrating and thinking clearly. This is known as “chemo brain” and usually slowly gets better after chemotherapy is completed.
  
  
  

There are many ways an oncologist can help with side-effects, ranging from supportive medication, support, counselling, reducing the dose of chemotherapy and lengthening the time interval between chemotherapy.

After Care

As with all cancer treatments, aftercare is essential to restore and maintain a patient’s health. You may also be given strict rules, such as to avoid people with colds, drink plenty of fluids, and rest for several days following your chemotherapy.

You should ensure that your oncology team schedules regular testing, examinations and regular check-ups to ensure you are able to minimize long-term side effects and any late effects moving forward