Chemotherapy When you’re having chemotherapy, you’re absorbing drugs capable of destroying cancer cells. The side effects can be significant, but you might decide the short-term discomfort is worth it for the chance to cure or slow your cancer.
How does it work? Most people having chemotherapy are treated with cytotoxic drugs. Cytotoxic means “toxic to cells” and while those drugs can help knock out the cancer cells in your body, they also have an effect on your body’s normal cells. That’s why chemotherapy can cause unpleasant side effects. The good news is that most of the common side effects such as fatigue, nausea, vomiting, hair loss and hair thinning are temporary and usually return to normal.
The other kind of chemotherapy treatment to emerge in recent years is targeted treatment, where drugs work directly on molecules involved in the growth and spread of cancer cells. If you’re having a targeted treatment, you’ll still have some side effects, but they’ll be different to what happens when cytotoxic chemicals affect normal cells.
The type of chemo that’s right for you will depend on what kind of cancer you have and if it has spread.
Why would I do it? Chemotherapy destroys cancer cells and it’s often used on its own to cure a cancer. But it can also be used before surgery or radiotherapy to make a large cancer more manageable, or after surgery or radiotherapy to eliminate any remaining cells so the cancer won’t return. Chemo can also be used during palliative care to help control symptoms by slowing cancer growth, giving you a better quality of life for longer.
What will it be like? Most chemotherapy drugs are delivered intravenously through a drip that goes straight into the bloodstream, but some go straight into a muscle, under the skin, into the fluid around the spine or brain, into a body cavity like the chest or the pelvis, or directly into a tumour. Drugs can also be applied onto the skin as a cream or taken as a pill.
If you’re having intravenous treatment, you’ll make regular visits to a hospital or clinic for sessions that could last anywhere from 20 minutes to several hours or even days depending on the kind of drugs. If it’s going to take days you might have to stay in the hospital or clinic overnight, or you may be offered a home infusion. For a home infusion you’ll be given a small pump programmed to give you the right dose at the right time through a tube inserted in your chest or in the crook of your arm.
If you’re having oral treatment, you’ll be given information about exactly when and how to take your pills. If you’re using a chemotherapy cream you’ll get clear instructions on when and how to apply it. It’s important you follow these directions. If you don’t, the treatment may not work properly.
Chemotherapy is given in cycles made up of periods of treatment followed by rest periods so normal cells in your body have time to repair. Depending on the kind of cancer you have and the drugs being used, your therapy cycles may last days, weeks or months.
Words to know
Cytotoxic drugs a family of drugs known to destroy cancer cells (but also affect normal cells)
Home infusion an intravenous chemo treatment that can be managed by you at home
Intravenous going straight into the vein
Palliative care treatment to relieve symptoms without trying to cure the cancer
Targeted treatment a branch of chemo in which drugs work directly on molecules related to the growth and spread of certain cancer cells
Questions to ask
What’s this going to achieve? Ask your care team if the aim of your chemo is to cure the cancer, control it, stop it from returning or just minimise the impact of symptoms.
Are there any alternative treatments I could be using? Feel confident about asking if chemo is really necessary. If it has been suggested for symptom management, for example, you might prefer to try complementary therapies like acupuncture and meditation.
What side effects am I likely to experience? Different drugs have different effects, so ask your care team about the likely side effects. And remember, while some people may have a severe reaction, others get few side effects. Chemo could make you tired. It could give you nausea, constipation or diarrhoea, make your hair fall out or irritate your skin. Or it may simply give you a fuzzy head. For more about physical and emotional side effects, take a look at Getting Through.
Expert's insight: Keith Cox Nurturing the mind and body goes a long way to making chemo a positive experience, says nurse practitioner Keith Cox of the Sydney Cancer Centre.
“You need to look after yourself. Years ago we’d say that if you felt tired and lethargic, you should lie down and sleep. We now know that you need gentle exercise, as well as rest. We also know that the mind is very powerful. Positive thinkers do seem to handle chemotherapy much better. Music therapy and meditation is very good for the soul. Some people use visualisation and focus on the tumour, saying this chemo is destroying all of the cancerous cells and therefore doing me some good.
“People usually have their blood count checked on the day of treatment so the pharmacy can prepare the right combination of drugs. Some people say waiting for the blood count to come back can be annoying. To avoid this, you can get your blood test done at a local pathology unit the day before.
“It’s good to look after your skin and your veins by massaging your arms and hands with moisturiser. Your skin does become dry. You could get your partner to do it for you. Massage is a good way to have that one-on-one touch.”
More help
Cancer Council Helpline 13 11 20 A free, confidential telephone support service run by Cancer Councils in each state and territory. Specially trained staff can answer your questions about cancer and offer emotional or practical support. The Helpline is open between 9am and 5pm, Monday to Friday (some states have extended hours). You can call from anywhere in Australia for the cost of a local call.
Photo by Bruce Daly
SUE OPIE While having an 18-week course of chemotherapy, Sue Opie didn’t suffer too many debilitating side effects or hair loss.
Sue was diagnosed with follicular lymphoma at age 44, after discovering lumps in her groin and neck. It’s a slow-growing cancer, but she was given immediate chemotherapy and a specific treatment called MabThera (rituximab). She took six months off from her job to spend time with her husband, Gavin, and their three young boys – and to tackle the cancer head-on. Scans indicate her tumours have disappeared and she is cautiously optimistic.
“The thing is, you go in feeling normal and healthy and you just take a deep breath because you know that the side effects can be hair loss, tiredness and sickness. But you look beyond that because you just want to get this foreign alien out of your body.
“Before I started, my husband and I went to an education session about the whole process. And they tell you little helpful things like to bring a cardigan because you can get cold. I also went to a ‘Look Good… Feel Better’ hair and make-up workshop*. The information about head coverings and wigs was good and I also met other women who had also started chemo.
“It’s very daunting going into the cancer ward on the first day. You go with preconceived images of people with cancer and how sick they are, like that Bette Midler movie Beaches. I was surprised that so few people on the cancer ward had lost their hair. Even in the last five years, the drugs have improved so much.
“My first session took nine hours all up, because they start you off slowly. The time went quickly though and Gavin was with me the whole time, which was great. The first cycle is an unknown because you’re anticipating the side effects, but I’ve been very fortunate. The first night and day of each cycle are the worst.
“The anti-nausea tablets are great and a bicarb soda rinse is good for the metallic taste in the first week, as is exercise, lots of water and a good diet. It’s maintenance really. And dealing with one stage at a time.”
* For more about Look Good... Feel Better workshops, go to www.lgfb.org.au or call