This article, the second in a three-part series, outlines what you will experience before, during, and after treatment. The other articles in this series provide an overview of chemotherapy, including the various types, and describe the side effects of treatment.
Listen to the Cancer.Net Podcast: Chemotherapy - What to Expect, adapted from this feature
If your treatment plan includes chemotherapy, a team of highly trained medical professionals, led by a medical oncologist, will work together to provide you with the best possible care. This health care team may include the following medical professionals.
Medical oncologist. A medical oncologist is a doctor who specializes in treating cancer with medication. This doctor will oversee your chemotherapy treatments and work closely with other members of the oncology team to develop your treatment plan.
Oncology nurse. An oncology nurse specializes in caring for patients with cancer, including giving chemotherapy. Your nurse can answer questions, provide information about the treatments, monitor your health during treatment, help you manage potential side effects, and offer support and counseling to you and your family.
Other health care professionals. There are a number of other specialists who will work to care for all of your physical and psychological needs during treatment, including pharmacists, social workers, nutritionists or dietitians, physical therapists, and dentists. Learn more about the oncology team.
Consultation and informed consent. Before treatment begins, you will meet with a medical oncologist who will review your medical records and perform a physical examination. Based on the size and location of the cancer, your age, your overall health, and a number of other factors, the doctor will work with you to develop a specific treatment regimen (schedule). This treatment schedule may consist of a specific number of cycles given over a specific period of time or may involve treatment that continues for as long as your cancer responds. The doctor will also discuss the potential risks and benefits of chemotherapy with you.
If you choose to receive chemotherapy, you will be asked to give written permission (informed consent) and undergo tests to plan the treatment. The informed consent form confirms that you have received information about your treatment options and that you are willing to undergo chemotherapy. By signing the informed consent form you are also telling your health care team that you understand there is no guarantee the treatment will achieve the intended results.
Meanwhile, you will learn what you should or should not eat or drink on the day of your treatment so the chemotherapy will work most effectively. In addition, tell the doctor about all medications and dietary or herbal supplements you are taking, including prescription and over-the-counter drugs. This is also your opportunity to ask questions. Find a list of potential questions.
Other preparations. Depending on the most common side effects of the prescribed chemotherapy, your doctor may recommend making arrangements to address the following aspects of your health.
- Nausea and vomiting: Nausea and vomiting are common side effects of some types of chemotherapy. Because the best way to manage nausea and vomiting is to prevent it, it is important to talk with your health care team about your risk of experiencing these side effects before treatment begins. Fortunately, there are many medications that can prevent nausea and vomiting in most patients. Learn more about ASCO’s guideline for preventing these side effects.
- Dental health: Chemotherapy can cause mouth sores and dry mouth, as well as reduce the body's ability to fight infection, so it is best to have a complete dental checkup and cleaning before beginning chemotherapy. Learn more about dental health during cancer treatment.
- Heart health: Some types of chemotherapy affect the heart, so it may be helpful to measure your heart health before treatment for comparison. One test you may undergo is an echocardiogram (echo), which uses ultrasound waves to create a moving picture of the heart.
- Reproductive health: Some types of chemotherapy can affect fertility (a woman’s ability to conceive a child or maintain a pregnancy and a man’s ability to father a child), so both men and women should discuss their options for preserving fertility before treatment. Learn more about fertility and cancer treatment. In some situations, women should schedule an appointment to get a Pap test (used to detect irregular cells on the cervix, which may turn cancerous) because chemotherapy can cause misleading test results.
Because chemotherapy given during pregnancy is capable of harming the fetus (unborn baby)—particularly if given during the first trimester of pregnancy when the fetus' organs are still developing—women should take precautions to avoid pregnancy during treatment and inform their doctor if they become pregnant. Learn more about pregnancy and cancer.
- Hair: Hair loss (either partial or complete) affects many people who receive chemotherapy. Ask your medical oncologist whether the treatment you will be receiving is likely to cause this side effect. If it will, you may want to think about whether you would prefer to keep your head covered during treatment and whether you’d like to buy a wig or head coverings, such as turbans, hats, or scarves, before treatment begins.
In addition, this is the time to make logistical arrangements. For example, if your treatment is not fully covered by insurance, you may want to contact organizations that could provide financial assistance. Also talk with your employer to arrange time off from work for treatments and recovery.
On the day of the treatment, you may choose to bring a friend or family member who can support you and help you remember information provided by the oncology team. You may also bring items—such as MP3 players, DVDs, books, or a blanket—to make your treatment time as comfortable as possible.
If you are receiving chemotherapy by intravenous injection, one of the most common methods, you will:
- Meet the nurse or other health professionals who will administer your chemotherapy
- Undergo a brief physical examination to check your vital signs (blood pressure, pulse, respiration rate, and temperature)
- Have your height and weight measured to calculate the appropriate doses of chemotherapy
- Have an intravenous (IV) catheter (slender tube) inserted into a vein in your arm
- Have a blood sample drawn
- Meet with your oncologist who will review the results of your blood tests, assess your condition before each treatment, and order the chemotherapy
Many people undergo minor surgery before chemotherapy to receive an implantable port—a round metal or plastic disk that is used as the entry site for the IV medications, eliminating the need to find a vein at each treatment session.
The actual treatment includes pre-chemotherapy medications to prevent side effects—such as nausea, anxiety, inflammation, or possible allergic reaction—followed by the chemotherapeutic medications, which may be given in minutes, hours, or even days if given by continuous infusion.
Meanwhile, if your medication is oral or topical, you will simply pick it up at the pharmacy and take it at home. Your health care team will provide instructions about how often to take the medication or how to apply it. Ask what side effects you can expect and which ones should prompt you to call your doctor. Your pharmacist can also help answer your questions.
To receive the full benefit of chemotherapy, it is important to follow the schedule of treatments recommended by your doctor.
After a session of chemotherapy is finished, the IV catheter will be removed (although implantable ports will remain for the duration of chemotherapy) and your vital signs will be checked.
Your oncologist and/or nurse will review what side effects to expect throughout the cycles of chemotherapy and provide medication and tips to manage them. Specific instructions may include:
- Avoiding interacting with crowds of people or with children (especially those with illnesses or infections) while your immune system is temporarily weakened
- Drinking lots of fluids over the next 48 hours to help flush the drugs through your system
- Ensuring proper handling of urine, stool, vomit, semen, and vaginal secretions because chemotherapy typically remains in your system for 48 hours after treatment. For example, flushing the toilet twice after use will help protect family members from waste or other body fluids that may contain chemotherapeutic agents.
In addition, your medical team can tell you what type and level of activities they recommend on treatment days.
Before you leave, ask for the phone number of the office and your oncologist's answering service so that you can contact the doctor with any questions or concerns.