What is chemotherapy? Chemotherapy is the use of drugs to target and kill cancer cells. Chemotherapy medicines are cytotoxic (toxic to the cells). These drugs are used to target cancer cells that might have spread further away from the primary tumour or cancer cells that are in the blood stream.
Chemotherapy is usually given after surgery but it can also be given prior to surgery in order to reduce or shrink the cancer, this is known as neo-adjuvant chemotherapy treatment.
How does chemotherapy work? Chemotherapy slows or stops the growth of the cancer by targeting rapidly dividing or fast growing cells. Normal cells can also be affected and that is why patients experience side effects with treatment. Normal cells recover well from chemotherapy.
Surgery alone or surgery combined with radiotherapy is an effective treatment for cancer that is limited to the area of the breast, chest and lymph nodes. Chemotherapy is recommended whenever there is a chance that the cancer cells have move further than the breast and lymph nodes. Chemotherapy drugs circulate in the blood stream and can therefore kills cancer cells that have spread.
Your doctor will design your chemotherapy schedule around your individual situation and diagnosis.
How is chemotherapy given? Each patient will have a specific combination of drugs to treat their situation. Chemotherapy can be taken as tablets, capsules or it can be given by intravenous drip. For breast cancer it is usually given by intravenous drip.
Your cancer specialist or oncologist will co-ordinate your chemotherapy and it will be administered by specially trained chemotherapy nurses. Chemotherapy is usually given on the day ward over a few hours so you will be able to go home the same day. The drip can be uncomfortable but most people don’t find chemotherapy painful.
Your chemotherapy schedule will be discussed with you before you start treatment. For breast cancer the cycle is usually set at every 3 weeks with a total of between 4 and 8 sessions but this can change depending on your situation.
You will have a detailed discussion with a healthcare provider before your first chemotherapy session where your treatment will be explained to you so that you know what to expect. It is a good idea to write all your questions down so that you can ask them at this time
Can I continue working during chemotherapy? This depends on your individual experience and where you are in your chemotherapy schedule. The sessions tend to get harder as you progress so you might find that you need to take a couple of days off after each cycle, maybe even 3-4 days when you are near the end of your chemotherapy schedule. Many woman find it difficult to manage the tiredness of working a full day or for long hours. Try to balance the working time with your energy levels and ask your doctor for a medical certificate if you are needing time off work. Resting when you are tired is vital to recovering well afterwards.
What can I do to reduce the side effects?
- Drink lots of water
- Take frequent short rests
- Practice deep breathing techniques
- 15 – 30 minute walk
- Avoid aspirin
- Avoid alcohol
- Focus on a diet with plenty of fresh vegetables, fruit and quality protein. Avoid processed, preserved and fast-foods.
- Join a support group. There can be a lot of anxiety with chemotherapy and just knowing that others have been through a similar experience can allay your concerns. Less anxiety reduces the intensity of the side effects.
The side effects of chemotherapy
Tiredness is the most common side effect during chemotherapy treatment. It can last for days after each treatment. It will improve after the first 3-4 days but some tiredness can remain even until your next chemotherapy session begins. Try to balance rest with activity. Focus on getting a lot of down time in the first week and gradually increasing activities in the 2nd and 3rd week. It can seem daunting but studies have shown that a 30 minute walk will increase your energy levels and decrease those feelings of exhaustion. In fact the 30 minute walk habit should become one for life as it helps to maintain a healthy weight and reduces the risk of recurrence.
Changes to taste and appetite are normal side effects during chemotherapy and can interfere with your enjoyment of food and drinks. A ‘metallic’ taste in the mouth is most commonly reported. Experiment with different foods if you find that your usual choices don’t taste great but remember to keep away from highly processed foods that are high in salt and calories. If your appetite is poor, focus on small regular meals with high nutritional values.
Nausea and vomiting is another common side effect of chemotherapy and can be very distressing. Speak to your doctor if you start to feel nauseous as there are some medications that can help. Nausea will usually start 4-6 hours after the chemotherapy is administered and it can last for several days. Anti-nausea medications are a routine part of most chemotherapy treatments now. Try not to let the nausea build to severe levels – its easier to kept at bay rather than treat it once it is already bad.
Hair loss is a common side effect of chemotherapy but it is temporary. The rate and amount of hair loss depends on the chemotherapy you are receiving and it can affect the hair on all parts of the body.
Your hair will start to grow back as soon as your treatment schedule is finished and grows at approximately 1cm/month. The colour, thickness and texture of your hair might be different to before you did the chemotherapy.
It can be very emotionally distressing. Speaking to your oncology nurse and other patients can be very helpful. Having a plan for a wig, scarf or hat in advance can be a positive move.
Effects on the blood must be monitored closely by your doctor. Your blood cells can be affected in different ways –>
- White blood cells, which help fight infection, can drop too low and this will put you at risk of infection.
- Red blood cells, which carry oxygen from the lungs around the body, can drop and cause anemia. This can lead to tiredness, lack of energy and make you look pale.
- Platelets, which help your blood to clot, can drop to low levels and result in easy bruising and you may bleed longer than normal are a minor injury.
Speak to your nurse or doctor if you feel very run down, tired and bruise easily and especially if you develop a fever. Your chemotherapy dose may be adjusted or even stopped for a period of time until your blood count returns to safe levels. If your doctor suspects infection you may be prescribed antibiotic therapy.
Mouth ulcers and a sensitive lining of the mouth can develop with chemotherapy. Be sure to use a soft tooth brush and gargle daily with saline.
Skin sensitivity and changes in pigmentation can develop with chemotherapy. Your skin may become sun sensitive and it may become very dry. Be aware and protect the skin with sunscreen if you are in direct sunlight and apply hydrating low pH lotion to the skin daily to avoid dryness.
Fertility can be affected by chemotherapy, often causing periods to stop and sometimes triggering early menopause. Your age and the chemotherapy drugs used will determine how much your fertility is affected. If you think that you may want to have a baby in the future discuss this fully with your doctor before starting chemotherapy. It is very important that you don’t become pregnant while you are undergoing chemotherapy treatment.
Indigestion and heartburn can be triggered during chemotherapy or if it is something you suffer with, it can feel worse. Usually this is due to dexamethasone which is used as an anti-nausea drug. PPI drugs can be prescribed to counteract the acid but this needs to be decided by your doctor.
Bowel movement changes are common as a side effect of the chemotherapy drugs and the anti-nausea drugs. Constipation can be easily managed with a fibre supplement, laxative and good hydration. Diarrhoea can sometimes be a concern and you should let your oncology nurse or doctor know right away if you do experience this.