Many people are concerned about having chemotherapy, because of the side effects that can occur. However, side effects can often be well controlled with medicines, and some people have only a few side effects.
Some people ask what would happen if they did not have the treatment. Treatment can be given for different reasons and the potential benefits will vary depending upon the individual situation.
In people with early cancer, surgery is often done with the aim of curing the cancer and chemotherapy may be given to reduce the risks of it coming back. It is helpful to discuss with your cancer specialist how much the chemotherapy may reduce the chance of the cancer coming back in your particular situation.
If the cancer is at a more advanced stage, the aim of treatment may be to control the cancer. This can lead to a reduction in symptoms, a better quality of life, and it can possibly prolong life. However, for some people the treatment will have no effect upon the cancer and they will get the side effects without any of the benefit. If you choose not to have treatment in this situation, you can still be given supportive (palliative) care, with medicines to control any symptoms.
The decision about whether to have chemotherapy treatment can be a difficult one and you may need to discuss it in detail with your doctor.
Where chemotherapy treatment is given
Chemotherapy units are very specialised and not all hospitals have them, so you may need to travel for treatment. Chemotherapy drugs are usually prepared in a special area of the hospital pharmacy. All the drugs are carefully checked by the pharmacy staff to ensure that they are the right ones for you. Chemotherapy tablets, capsules or creams can be given to you to take home.
Most intravenous chemotherapy drugs can be given to you as a day patient at the hospital. This may take from half an hour to a few hours. However, some treatments, such as having chemotherapy into the abdominal cavity, will mean a short stay in hospital – perhaps overnight or for a couple of days. For some chemotherapy treatments – for example, high-dose chemotherapy – you will need to stay in hospital longer, perhaps for a few weeks. Your doctor or nurse will explain exactly what your treatment will involve before it starts.
If you are having chemotherapy by intramuscular injection, subcutaneous injection, intrathecal injection, or intracavity injection into the bladder, it is usually given in the outpatients department or the chemotherapy day unit at the hospital. It may also be given on certain wards within the hospital.
Sometimes, specialist chemotherapy nurses can visit you at home to give intravenous chemotherapy. This sort of service is only available in some parts of the UK and with some types of chemotherapy treatment. You can ask your doctor whether it is possible to have your treatment at home.
Points to remember when having chemotherapy at home
- Chemotherapy tablets, capsules or injections may need to be stored in a particular way, such as in the fridge. Always follow the instructions given by your pharmacist.
- It is important not to touch some chemotherapy drugs with your fingers. You can check this with your pharmacist.
- All drugs must be stored out of the reach of children as they could cause serious harm if taken by accident.
- If you are having intravenous chemotherapy by pump and you notice any leakage of the drug from the pump or tube it is essential to let the nurse or doctor at the hospital know immediately.
- If you feel unwell at any time, phone the nurse or doctor at the hospital for advice.
Planning your chemotherapy treatment
Your treatment will depend on a number of factors including:
- the type of cancer you have
- where in the body the cancer is
- how far it has spread (if at all)
- your general health.
How often you have your treatment and how long the whole course of treatment takes will depend on:
- the type of cancer you have
- the particular chemotherapy drugs you are having
- how well the cancer responds to the drugs
- any side effects the drugs may cause.
Before starting chemotherapy, you will have your height and weight checked. This is used to work out the right dose of chemotherapy for you.
Intravenous chemotherapy is usually given as several sessions of treatment, unless you are having continuous treatment by infusion pump. Depending on the drug, or drugs, each treatment can last from a few hours to a few days. Each treatment is generally followed by a rest period of a few weeks to allow your body to recover from any side effects and so that the number of cells in your blood can go back to normal. The treatment and the rest period together make up a cycle of treatment. The number of cycles you have will depend on how well your cancer is responding to the chemotherapy.
Your doctor or chemotherapy nurse will explain your treatment plan to you. If you have any questions, don't be afraid to ask. It often helps to make a list of questions and to take a close relative or friend with you to remind you of things you want to know but may easily forget. You may need some tests before starting your course of treatment. These will include blood tests and perhaps urine tests or heart tests.
Before each cycle of chemotherapy, you will normally have blood tests and see the doctor or specialist chemotherapy nurse. This can take some time. Your GP, practice nurse or the staff at a hospital close to your home may be able to test your blood a day or two before your treatment, so that you do not have to wait so long on the day of your treatment. If your blood is tested at your GP surgery, or at another hospital, the results can be sent to the hospital where you are having your treatment. Sometimes, you may need to have x-rays or scans.
All chemotherapy drugs are prepared specially for you and you may have to wait while the hospital pharmacy department gets them ready. To help pass the time, it can be helpful to take a book, personal stereo, iPod, newspaper, crosswords or perhaps some letters to write.
It may take several months to have all the chemotherapy needed to treat your cancer. When chemotherapy is given by an infusion pump it can be given continuously over a time varying from several days to several weeks.
Some people having their chemotherapy as tablets or capsules take them daily for several weeks or months, before they have a rest period.
Changes in the treatment plan
Your doctors will use blood tests and sometimes urine tests to monitor the effect that the chemotherapy is having on your body.
If you have a tumour that can be seen on a scan or felt by the doctor, the hospital staff will regularly check the effects of the chemotherapy on the cancer. The results from your blood tests and any scans or x-rays can show how much the cancer is responding to the treatment.
Depending on the results of the tests, your treatment plan may sometimes need to be changed. There can be many reasons for this and your doctor will tell you why your treatment needs to be changed if this is necessary. It may be because the drugs you are having are starting to cause damage to particular parts of the body, such as the bone marrow, kidneys, liver or nerves in the hands or feet.
Sometimes it can be because the chemotherapy is not shrinking the cancer enough. If this is the case, then changing to different drugs may be more effective.
Sometimes, your treatment may need to be delayed because the chemotherapy drugs are stopping your bone marrow from working properly. Delaying the chemotherapy gives your bone marrow a chance to recover before the next session of drugs is given.