image

Chemotherapy 101: A Guide to Your Treatment

Chemotherapy 101: A Guide to Your Treatment

Reviewed by Jasper Clinical Board

Last updated 5/24/21


A Guide to Your First Treatment

Depending on the type of cancer you have and the stage it’s at, your doctor may recommend chemotherapy treatment, or “chemo.” But even if you know someone who’s had chemo before, it’s often not the same type that applies to your case. That’s because chemo isn’t one single treatment—it’s a category containing more than 100 drug-based treatments, including injectable or IV therapies, oral medication, and topical applications. 
All of these drug treatments have the same ultimate goal: to kill fast-growing cancer cells in your body. Unlike radiation and surgery, which target cancer cells in specific areas of the body, chemotherapy works throughout the entire body.
The chemotherapy drug (or drugs) selected will depend on whether your doctor wants to take a broad approach or a targeted approach for specific proteins and cell processes. No matter which treatment method is selected, the active ingredient of chemotherapy is designed to interfere with a cancer cell’s ability to divide and reproduce.
Sometimes, chemotherapy is the only treatment you’ll need. Other times it will be used in tandem with other treatments, such as surgery, internal or external radiation therapy, hormone therapies, or immunotherapy. Knowing the details of your treatment plan—what you’re doing, why you’re doing it, and how it works—can help you prepare and make informed decisions about your care.

Choosing a Chemotherapy Treatment

Early in the process, you and your medical team will examine the treatment options available. Factors your doctor will consider include the type of cancer, where it is, how big it is, if it's spread to other parts of the body, and how it affects your overall health. Based on your individual situation, as well as on successful outcomes of similar patients, your medical team will make a recommendation for a treatment plan. 
Your doctor may recommend chemotherapy for a few reasons:
  • to shrink a tumor before surgery (known as neoadjuvant therapy)
  • to kill remaining cancer cells after surgery or radiation (known as adjuvant therapy)
  • to boost the effectiveness of other treatments, such as targeted therapies or drugs to help the immune system fight cancer
  • to prepare the body for upcoming treatments, such as a bone marrow transplant
  • to reduce symptoms and slow the progression of cancer
  • to eliminate the cancer entirely
When your doctor makes a recommendation, it will include what drugs will be used, what doses will be administered, how the drugs will be given, and how often and for how long. These numbers are formulated based on what data from clinical trials has shown works best for your personal physiology, including weight, body surface area, and pre-existing health conditions. You’ll be given a schedule that makes the most of the treatment’s anticancer actions while minimizing side effects. All of these factors are carefully calculated to ensure the treatment is both safe and effective for you.
Choosing a treatment plan is an intensely personal decision. Talk with your healthcare team about the possible short- and long-term side effects of each treatment option presented, as well as how these side effects are managed. If you’d like to seek out a second opinion before committing, ask your doctor’s office for your medical records and recommendations. (This usually entails you signing a release form to have your records shared with you or the physician giving the second opinion.) 
Different oncologists may have different experiences with various treatments, so seeking multiple opinions can help you make a decision or confirm your current treatment plan. Note that one additional benefit of a second opinion is having more opportunities to be enrolled in clinical trials. Centers designated by the National Cancer Institute (NCI) can be good starting points for second opinions, and those that are also members of the National Comprehensive Cancer Network (NCCN) are good starting points for trials.
Some people may also find it helpful to discuss their treatment options with people they trust, including family members, friends, a cancer support group, or an oncology social worker. Be careful when doing research online, as many sites can be inaccurate or misleading. Discuss any information you find on the internet with your health care team. 
In discussing your treatment options, don’t be afraid to speak up if the information you receive does not make sense. Your healthcare team wants to make sure that you fully understand the information they provide, so you can feel confident in your treatment decisions.

Preparing for Treatment

image
Chemotherapy affects everyone differently, so it can be hard to know exactly how to prepare. However, experts generally recommend a few things:

Practice Healthy Habits 

Good nutrition and regular exercise can help reduce some of the side effects of chemotherapy, so eat nourishing food, drink lots of water, sleep, and stay physically active. If you don’t have a regular exercise routine, start by taking short walks every day or following a beginner’s workout plan.

Schedule Routine Check-Ups

Though you are seeing a doctor for your cancer, they are likely a specialist who will be focused solely on treating your cancer. Other aspects of routine healthcare, such as cholesterol screenings and preventive screenings (pap, mammogram, prostate check, colonoscopy, etc.) should be performed by your regular physician. Let them know you are about to undergo treatment, and ask if they have any recommendations based on the kind of treatment you are receiving. 

Schedule a Dental Cleaning

Because chemotherapy and radiation put you at higher risk of bacterial infections, a dental cleaning/checkup is typically recommended before starting these treatments to make sure you're at a good baseline. Dental cleanings and dental work loosen the bacteria in your mouth, which can get into your system when you swallow. This also happens to a lesser degree through tooth brushing and natural bacterial shedding, especially when you have buildup. Your dentist will also be able to give you some tips and even products to help with mouth sores and dryness, which also often accompany these drugs.

Discuss Fertility 

You or your partner should not get pregnant while you're having treatment, since chemotherapy drugs can damage sperm and eggs as well as cause birth defects. Some chemotherapy treatments can also affect fertility and future reproductive options. If fertility is a concern, talk with your health care team and fertility specialist before beginning chemotherapy to discuss the options available. 

Prep Your Home and Think About Your Schedule 

Think about how you’ll take care of yourself at home before you go in for treatment. In addition to preparing home for treatment, consider things like transportation (who will drive you to and from your appointments), work schedule, and help with meals, child care, homecare, yardwork, and pet care. 

Discuss Your Concerns. 

It’s normal to feel anxious about what’s ahead. Talk about your fears with your doctor, nurse, or a counselor who specializes in helping cancer patients. A support group might be helpful, too, as people who have been through chemotherapy and have coped with it may have insights to help you. If you have children, you may want to make sure their teacher or a counselor at school knows what’s happening as well.

Prepare for Side Effects 

Your side effects will depend on the drug (or combination of drugs) administered. They may include aches and pains, nausea, fatigue, insomnia, hair loss, mouth sores, dry skin, brittle nails, diarrhea, or a loss of appetite. Talk to your treatment team about the likely side effects (including potential allergic reactions) of the chemotherapy drugs you’ll be receiving, and ask what medications you can take (prescription, over-the-counter, or homeopathic) to alleviate side effects. The Cleveland Clinic’s Chemocare.com is an excellent resource for learning more about side effects from specific drugs, and they even have a nurse line that you can call with questions. If hair loss is expected, think about whether you want to cut your hair before treatment starts, and explore options for purchasing a wig or head covering, if desired. 

What to Expect During Treatment

image

IV and Injection Treatment

Traditional chemotherapy is often given as an infusion or injection. With infusions, chemotherapy drugs are put into your body through a soft, thin tube (called a catheter) that's placed in a vein—typically, one located on your forearm or hand. Sometimes, a small tube called a port is implanted into the chest, which allows the infusion to be administered directly to the bloodstream without multiple needle sticks. An infusion can last from a few hours to several days, depending on the drug and dosage. In some cases, however, a chemo drug may be injected quickly with a syringe either into your IV or directly into your skin.
Depending on the type of chemotherapy you’re receiving and the duration of your infusion, you may get your chemotherapy at home, in your doctor’s office, at a clinic or outpatient infusion center, or at the hospital. Typically, you’ll receive a “chemo teaching” session before you begin your treatment, so be sure to ask for one if it hasn’t come up. 
Chemotherapy centers try to make you as comfortable as possible by providing recliners, private rooms (or privacy partitions), and a soothing environment. During infusions, you may find it helpful to bring a book, a journal, a good movie, or some other activity to help pass the time. Some centers will even allow you to bring a companion if you’d like to have company (and if not, you can stay connected with video calls on your phone or computer). If you’ll be getting treatment for several hours, ask about options for eating while you are there. Some treatment centers provide snacks and meals (either for free or sold at a reasonable price), while others will encourage you to bring an insulated bag or cooler with snacks.
Before your IV chemotherapy starts, you will undergo routine pre-checks, including a short physical exam, a blood sample, and measurement of your height and weight to ensure you get the correct dose of chemotherapy. From there, an IV tube will be put in your arm, unless you have a port, in which case a needle with a flexible tube will be placed in the port." Prior to the infusion, you may be given medication to prevent nausea or possible allergic reactions. Then, the infusion begins.
Chemotherapy infusion times can range from 5 minutes to 8 hours (and sometimes even more), depending on the medications being administered. You can use this time to relax, eat, work, read, knit, watch television, or engage in just about any hobbies or activities that you can do from your treatment room. The IV stand will even roll with you in case you want to use the restroom, take a walk, or sit outside. 
Throughout the chemotherapy, your nurse will come in and check your vitals and make sure you aren't reacting to the medications. When the chemotherapy drugs are fully administered, the nurse will remove your IV. Note that when this happens, as well as when a bag needs to be changed or if there’s any other problem with the function of the line, the machine will start beeping. If this happens, make sure your nurse is on their way so as not to disrupt treatment. Once your session is over, you may be asked to stay in the treatment room for up to 30 minutes after your IV is removed to ensure you do not have any adverse reactions to the medications used.

Oral Treatment

Some chemotherapy treatments are taken by mouth. In these treatments, a pill, liquid, or capsule is prescribed to be taken at home. You will be given instructions on how and when to take it, as well as special guidelines for storing and handling your chemotherapy drugs. It’s important that you follow these directions, which may include:
  • Mixing (or not mixing) your drug with food, liquid, or other drugs
  • Wearing gloves when touching the pills or capsules
  • Storing your medication in a refrigerator or special container
  • Keeping drugs out of reach of others, especially children and pets
  • Disposing of excess drugs or packages at a pharmacy
Be sure to follow these guidelines carefully, as they are in place to ensure your oral chemotherapy is both effective and safe.
Because oral chemotherapy is typically administered at home, it’s important for you to maintain communication with your doctor or nurse, especially if you have problems taking your chemotherapy drugs due to side effects. By providing this information to your doctor, they can make changes to your treatment plan as needed.

Topical Treatment

Topical chemotherapies are applied directly to the skin in the form of a gel, cream, or ointment. These are often self-administered at home, so you will be given instructions on how and when to apply the medication, as well as any equipment required to apply the medication (such as special gloves). You will also be instructed on how to store, handle, and dispose of the container your topical chemotherapy comes in. Be sure to follow these guidelines carefully, as they are in place to ensure your topical chemotherapy is both effective and safe.
Because topical chemotherapy is typically administered at home, it’s important for you to maintain communication with your doctor or nurse, especially if you have side effects keeping you from applying the medication as directed, such as pain or sensitivity at the application site.

What to Expect After Treatment

The side effects of any form of chemotherapy treatment will vary based on the drug (or drugs) used, the dosage, and the person taking it; some experience severe side effects, while others experience mild symptoms or no symptoms at all. Be sure to talk to your treatment team about which side effects are most common with your specific chemotherapy drug (or drugs), how long they might last, and when you should call the doctor’s office about them.
Some side effects most commonly associated with chemotherapy treatments include:
  • Fatigue
  • Inability to concentrate or focus (sometimes referred to as “chemo brain”)
  • Changes to appetite
  • Nausea and vomiting
  • Constipation
  • Diarrhea
  • Tinnitus and/or hearing loss (temporary or permanent)
  • Numbness, tingling and pain in the fingers and toes
  • Hair loss
  • Easily-bruised skin
  • Nosebleeds and/or bleeding gums
  • Mouth sores
  • Sore throat and/or pain with swallowing
  • Dry skin
  • Infections
In addition to physical symptoms, stay aware of any mood changes, including anxiety, irritability, frustration, and depression. Though such mood changes are normal, help is available to help you address and navigate your emotions during chemotherapy.
Keep a journal of the symptoms you experience in the hours and days after treatment, and tell your doctor or nurse about these side effects. Telling your team early on can help make sure these side effects don’t get worse.
While undergoing treatment, you may become immunocompromised, which means your body is not able to fight off infection as easily as it normally would. When your immune system is weakened by cancer treatments, it’s important to follow your doctor’s advice to take steps to protect yourself against infection.
You may need to protect others, too. In the 48 hours after treatment, a small amount of chemotherapy is present in your urine, stool, and vomit. This chemotherapy waste can be hazardous to others in your household, so your doctor may give you some guidelines to protect your friends, family and pets.

Monitoring and Results

image
In addition to check-ins on side effects, your doctor may ask you to undergo regular blood testing. It’s important to routinely check the levels of red blood cells, white blood cells, and platelets in your body, as chemotherapy can affect these levels. If your counts are too low, a treatment session may be postponed until your blood tests reveal levels are once more in a safe range. This can be tough emotionally, but it’s necessary to do so that your chemo treatment is safe. You may also have blood tests to check how well your liver and kidneys are working, which can help your doctor make adjustments to your treatment plan if needed.
Depending on the type of cancer you have, you may be able to have your blood tested for biomarkers, which can tell your doctor how well the treatment is working. You may also undergo scans and other tests to monitor your cancer during chemotherapy treatment. These tests can give your doctor a clear picture of how your body is responding to the treatment, and what adjustments (if any) need to be made.

The content on this website is intended to provide the best possible information for you, but should not be considered—or used as a substitute for—medical advice. If you have questions about your diagnosis or treatment, please contact your health care provider(s). For questions or comments about this content, please email us at support@jasperhealth.com.