This is the second article in a three-part series on chemotherapy. For an overview on chemotherapy, read more about understanding chemotherapy, or find out about side effects of chemotherapy.

How chemotherapy is different from other cancer treatments

Years of research and testing have made today's chemotherapy a focal point of cancer treatment. Unlike radiation therapy and surgery, chemotherapy is an effective way to kill cancer cells throughout the entire body. In some cases, chemotherapy is the only treatment necessary. In other cases, chemotherapy is combined with radiation therapy, surgery, and/or other systemic (whole-body) treatments, such as hormone therapy to reduce the risk of a cancer recurrence (the return of cancer) by destroying any remaining cancer cells in the body.

Your chemotherapy treatment plan

The drug or combination of drugs that your doctor recommends depends on the type, stage, and grade of your cancer, as well as your age, health, and tolerance of certain side effects. Your oncologist will meet with you before your treatment begins to answer questions and share information. Each person's regimen (treatment plan) is different and may change in response to individual reactions. To receive the full benefit of chemotherapy, it is important to follow the schedule and drug doses your doctor recommends. Most people receive chemotherapy in periods of treatment followed by periods of recovery. Several of these cycles complete a course of chemotherapy, which generally lasts three months or longer.

Questions to ask the doctor

Knowing the types of questions to ask your doctor can decrease your anxiety about chemotherapy. Consider asking the following questions:

• What is the goal of chemotherapy (especially if radiation therapy or surgery has been done)?
• Which drugs will I be given?
• What will my treatment plan include?
  • How often and for how long will I be taking chemotherapy?
  • How will the drug(s) be administered?
  • What tests will be performed to know if the chemotherapy is working?
• What types of short-term and long-term side effects can I expect with these drugs?
• What is the standard of care for my particular cancer, and how/why does my treatment plan differ from the standard of care?
• Are there clinical trials I am eligible to join?
• Are there patient education materials available for me to read? Do you recommend any websites for additional information?
• How do I reach you after office hours if I have signs or symptoms?
• Will chemotherapy affect my fertility (ability to have children)?
• Will chemotherapy have an effect on my sexuality? For more information, read about sexual and reproductive health.

Before you begin chemotherapy

Depending on the anticipated side effects of the prescribed chemotherapy, it's important to plan ahead. Before treatment, assemble a support team by talking with friends and family and educate yourself about cancer and its treatment. Your nurse or social worker can provide information on support groups. There may also be organizations that help with the cost of chemotherapy, if it's not fully covered by insurance. Arrangements can often be made at work and for childcare to allow time for your treatments and recovery.

A few tasks should be addressed before starting treatment.

• Schedule a complete dental checkup and cleaning. Chemotherapy can cause mouth sores and reduce the body's ability to fight infection, so it is best to have a complete dental checkup and cleaning before beginning chemotherapy.
  
  
• Discuss with your doctor the need for any heart studies, such as an echocardiogram (echo). Some chemotherapeutic drugs have unwanted effects on the heart, and a baseline measure of your heart health may be recommended.
  
  
• Men: Discuss with your doctor whether your chemotherapy is associated with infertility (inability to father a child). If so, you may wish to consider sperm banking.
  
  
• Women: Because chemotherapy can generate misleading test results, it is important to schedule an appointment to get a Pap test (used to detect irregular cells on the cervix, which may turn cancerous). Women are also encouraged to ask their doctors if chemotherapy will affect their fertility.
  
  
• If you prefer to keep your head covered in the event of hair loss, consider buying a wig or head coverings, such as turbans, hats, or scarves before treatment begins. Hair loss, either partial or complete, affects many people who receive chemotherapy.

Starting chemotherapy

Knowing what to expect can help you relax during your treatment. Your oncology nurse or other health-care professional will be with you during the entire procedure and can answer any questions you might have. Review with your nurse what you should or should not eat or drink the day of your treatment, so the chemotherapy works most effectively. In addition, tell the nurse about all medications you are taking, including drugs prescribed by doctors other than your oncologist, dietary or herbal therapies, including vitamins, and over-the-counter drugs.

Many people find that bringing a person from their support team helps them relax during treatments. A friend or family member is welcome to join you and can help you remember information that will be provided by the oncology team.

On the day of the treatment you will meet the nurse or other health professionals who will be administering your chemotherapy; undergo a brief physical examination to check 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 in your arm—if you are to receive the chemotherapy intravenously; have a blood sample drawn to perform a blood count and profile other fluid levels; and meet with your oncologist who reviews the results of your blood tests, assesses your condition before each treatment, and orders the chemotherapy.

Chemotherapy may be given in a variety of ways, but injection into an IV is one of the most common methods. Many people undergo minor surgery before chemotherapy to receive an implantable port; this port remains intact and is used as the entry site for your IV medications, thus eliminating the need to find a vein at each therapy 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 administered in minutes, hours, or even days, if given by continuous infusion.

After treatment

After chemotherapy is finished, the following sequence (order) of events is common:

• The IV catheter is removed. (Implantable ports remain for the duration of chemotherapy.)
  
  
• Your vital signs are checked. Sometimes your vital signs can be checked during and after completion of therapy.
  
  
• Your oncologist and nurse will review what side effects to expect and how to manage them.
  
  
• You will receive supportive medications (to prevent or reduce treatment side effects) and instructions for their use.
  
  
• Often, patients are advised to drink a lot of fluids over the next 48 hours to help flush the drugs through their system. Discuss with your doctor whether this is appropriate for you.
  
  
• Because chemotherapy usually remains in the body for 48 hours after treatment, proper handling of urine, stool, vomit, semen, and vaginal secretions is necessary. You will be advised to protect family members from waste or other body fluids that may contain chemotherapeutic agents by routinely flushing the toilet twice after use for the next 48 hours.
  
  
• Ask for the phone number of the office and your oncologist's answering service, so you can contact the doctor if needed.

Many times, patients feel fine immediately following chemotherapy and will even return to work that day. Check with your medical team as to the type and level of activities they recommend on treatment days.

What to expect during your course of chemotherapy

Cycles of chemotherapy include the treatment followed by time for your body to recover from the effects of the drugs. Use a calendar to schedule the days you receive drugs and the days you will need to have tests done. Your doctor and nurse can help you anticipate what you will experience throughout the cycles. There may be initial periods within each cycle when you will lose your appetite and feel particularly tired and later periods when you feel fine. Low blood test results indicate times when you will be more susceptible to infection. Your oncology nurse will advise against associating with crowds of people or interacting with children (especially those with illnesses or infections) at this time. By marking your calendar, you can schedule activities when you are most able to enjoy them.

The importance of following the treatment schedule

You will benefit most from chemotherapy if you follow the treatment plan. The words "compliance" and "persistence" refer to how closely you follow your treatment schedule. Talking with your doctor about how you feel throughout treatment will help minimize discouraging side effects and maximize your compliance. Working with your doctor to complete the full course of chemotherapy gives you the best chance to avoid recurrence of the disease.

Communicating with your doctor

In most cases, the effective doses and schedules of drugs to treat specific cancers have already been determined from clinical trials. Receiving the full course of chemotherapy will give you the best chance to benefit from treatment. However, if you experience certain side effects, the treatment plan may be adjusted. To make the most of your treatment, talk with your doctor about any side effects you may be experiencing. In addition, take proper doses of your medication at the appropriate times and discuss with your medical team any additional medications you take, including aspirin, vitamins, or dietary or herbal supplements.

Additional Resources

National Cancer Institute (NCI): Chemotherapy and You: A Guide to Self-Help During Cancer Treatment

Mayo Clinic: Chemotherapy

Breastcancer.org: Before You Begin Chemo

Breastcancer.org: Getting Chemo: Step by Step

Breastcancer.org: Staying on Track with Chemotherapy

Chemocare.com: Care During Chemotherapy and Beyond

Last Updated: February 13, 2006