Many different types of chemotherapy drugs are used in a variety of ways to treat different types of cancer. The benefits of chemotherapy include destroying cancer cells, shrinking existing tumors and preventing cancer cells from thriving and multiplying. The goal is to prevent or slow down the progression of disease to help extend life. Since these drugs can have serious side effects, chemotherapy benefits must be weighed against risk factors and expected outcome.
Shrink Tumors: A cancerous tumor is a collection of abnormally growing cells. When chemotherapy is used to shrink an existing tumor, the benefit is to improve the patient's quality of life by decreasing the pain and pressure caused by the tumor. Although the tumor is likely to continue to grow or come back, shrinking a tumor can control the disease to the extent that a cancer patient will live longer. Chemotherapy is also used to shrink tumors prior to surgery or radiation treatments.
Manage Cancer: Because cancer cells can grow and spread quickly, one chemotherapy benefit is to slow down or prevent that growth. Chemotherapy can help prevent cancer cells from spreading from the original site to other parts of the body. At times, chemotherapy is used to destroy any cancerous cells that remain in the body after radiation treatment or surgery and may also be used to help make radiation treatments more effective. Chemotherapy is often the treatment used when cancer that was eliminated in the past comes back to the same area or to another part of the body. In advanced stages of cancer, chemotherapy may be used to help relieve symptoms and improve quality of life even though it cannot extend life.
Cure Cancer: In some cases, chemotherapy completely eliminates cancer cells or tumors from the body. According to the American Cancer Society, if the cancer does not return for many years, it may be considered cured, but since cancer can return at any time, physicians do not generally establish a complete cure as the primary chemotherapy benefit. Treatment plans and goals vary, as do the benefits expected from chemotherapy, depending on the type of cancer, or where it originated, and how advanced it is at the time of treatment.
Chemotherapy--or chemo for short--destroys cancer cells, and can also stop or slow the spread or growth of these cells. Despite the obvious benefits of chemo treatment, there are several disadvantages to this form of treatment that should be considered before finalizing your cancer treatment strategy.
Side Effects During Treatment: The most significant disadvantage of chemotherapy is the development of treatment-related side effects. During treatment, you may experience a variety of gastrointestinal, musculoskeletal or constitutional symptoms. According to the National Cancer Institute (NCI), individuals undergoing chemo frequently report experiencing such symptoms as nausea, vomiting, loss of appetite, constipation or diarrhea. Fever and fatigue are also common side effects experienced by chemotherapy patients. The most apparent and emotionally challenging side effect associated with chemo treatment is alopecia--a medical condition in which your hair falls out. This condition may only affect certain areas of your body, such as the scalp, but may also extend to the face or limbs. The Mayo Clinic notes that chemo patients may also develop painful mouth sores or may bruise easily. Though these side effects may be significant, the majority of these symptoms will disappear once chemo treatment is stopped.
Side Effects After Treatment: The NCI notes that, in some instances, side effects related to chemotherapy may not become evident until months or years after treatment has ended. These effects may include heart or kidney problems, lung tissue damage or nerve damage. Chemo treatment may also lead to infertility, which can affect your ability to conceive a child. Though chemotherapy has been proven effective in the resolution of several types of cancer, there is always a risk that the cancer may reemerge after treatment has ended.
Treatment Schedule: Depending on the type or severity of your cancer, your chemotherapy schedule may require that you visit your oncologist for daily or weekly treatments. According to the NCI, chemo treatment is typically administered intravenously (IV), but may also be given in an injection, oral pill or liquid or a topical cream. Traditional IV treatments may last for several hours, which may be inconvenient if you have family or job responsibilities.
Treatment Costs: Even if you have medical insurance, the cost of chemo treatment can be expensive--especially if you require long-term treatment. According to Johns Hopkins Medicine Health Alerts, one in five cancer patients under the age of 65 delayed or avoided chemo treatment based solely upon treatment costs. This problem is becoming worse as newer anticancer drugs emerge, especially as more than one type of chemo drug may be necessary to treat your type of cancer. If you have difficulty paying for your chemotherapy, Johns Hopkins Medicine Health Alerts states that some pharmaceutical companies offer programs that can help pay for your treatment.
Many people are concerned about having chemotherapy, because of the side effects that can occur. However, side effects can often be well controlled with medicines, and some people have only a few side effects.
Some people ask what would happen if they did not have the treatment. Treatment can be given for different reasons and the potential benefits will vary depending upon the individual situation.
In people with early cancer, surgery is often done with the aim of curing the cancer and chemotherapy may be given to reduce the risks of it coming back. It is helpful to discuss with your cancer specialist how much the chemotherapy may reduce the chance of the cancer coming back in your particular situation.
If the cancer is at a more advanced stage, the aim of treatment may be to control the cancer. This can lead to a reduction in symptoms, a better quality of life, and it can possibly prolong life. However, for some people the treatment will have no effect upon the cancer and they will get the side effects without any of the benefit. If you choose not to have treatment in this situation, you can still be given supportive (palliative) care, with medicines to control any symptoms.
The decision about whether to have chemotherapy treatment can be a difficult one and you may need to discuss it in detail with your doctor.
Where chemotherapy treatment is given
Chemotherapy units are very specialised and not all hospitals have them, so you may need to travel for treatment. Chemotherapy drugs are usually prepared in a special area of the hospital pharmacy. All the drugs are carefully checked by the pharmacy staff to ensure that they are the right ones for you. Chemotherapy tablets, capsules or creams can be given to you to take home.
Most intravenous chemotherapy drugs can be given to you as a day patient at the hospital. This may take from half an hour to a few hours. However, some treatments, such as having chemotherapy into the abdominal cavity, will mean a short stay in hospital – perhaps overnight or for a couple of days. For some chemotherapy treatments – for example, high-dose chemotherapy – you will need to stay in hospital longer, perhaps for a few weeks. Your doctor or nurse will explain exactly what your treatment will involve before it starts.
If you are having chemotherapy by intramuscular injection, subcutaneous injection, intrathecal injection, or intracavity injection into the bladder, it is usually given in the outpatients department or the chemotherapy day unit at the hospital. It may also be given on certain wards within the hospital.
Sometimes, specialist chemotherapy nurses can visit you at home to give intravenous chemotherapy. This sort of service is only available in some parts of the UK and with some types of chemotherapy treatment. You can ask your doctor whether it is possible to have your treatment at home.
Points to remember when having chemotherapy at home
Chemotherapy tablets, capsules or injections may need to be stored in a particular way, such as in the fridge. Always follow the instructions given by your pharmacist.
It is important not to touch some chemotherapy drugs with your fingers. You can check this with your pharmacist.
All drugs must be stored out of the reach of children as they could cause serious harm if taken by accident.
If you are having intravenous chemotherapy by pump and you notice any leakage of the drug from the pump or tube it is essential to let the nurse or doctor at the hospital know immediately.
If you feel unwell at any time, phone the nurse or doctor at the hospital for advice.
Planning your chemotherapy treatment
Your treatment will depend on a number of factors including:
the type of cancer you have
where in the body the cancer is
how far it has spread (if at all)
your general health.
How often you have your treatment and how long the whole course of treatment takes will depend on:
the type of cancer you have
the particular chemotherapy drugs you are having
how well the cancer responds to the drugs
any side effects the drugs may cause.
Before starting chemotherapy, you will have your height and weight checked. This is used to work out the right dose of chemotherapy for you.
Intravenous chemotherapy is usually given as several sessions of treatment, unless you are having continuous treatment by infusion pump. Depending on the drug, or drugs, each treatment can last from a few hours to a few days. Each treatment is generally followed by a rest period of a few weeks to allow your body to recover from any side effects and so that the number of cells in your blood can go back to normal. The treatment and the rest period together make up a cycle of treatment. The number of cycles you have will depend on how well your cancer is responding to the chemotherapy.
Your doctor or chemotherapy nurse will explain your treatment plan to you. If you have any questions, don't be afraid to ask. It often helps to make a list of questions and to take a close relative or friend with you to remind you of things you want to know but may easily forget. You may need some tests before starting your course of treatment. These will include blood tests and perhaps urine tests or heart tests.
Before each cycle of chemotherapy, you will normally have blood tests and see the doctor or specialist chemotherapy nurse. This can take some time. Your GP, practice nurse or the staff at a hospital close to your home may be able to test your blood a day or two before your treatment, so that you do not have to wait so long on the day of your treatment. If your blood is tested at your GP surgery, or at another hospital, the results can be sent to the hospital where you are having your treatment. Sometimes, you may need to have x-rays or scans.
All chemotherapy drugs are prepared specially for you and you may have to wait while the hospital pharmacy department gets them ready. To help pass the time, it can be helpful to take a book, personal stereo, iPod, newspaper, crosswords or perhaps some letters to write.
It may take several months to have all the chemotherapy needed to treat your cancer. When chemotherapy is given by an infusion pump it can be given continuously over a time varying from several days to several weeks.
Some people having their chemotherapy as tablets or capsules take them daily for several weeks or months, before they have a rest period.
Changes in the treatment plan
Your doctors will use blood tests and sometimes urine tests to monitor the effect that the chemotherapy is having on your body.
If you have a tumor that can be seen on a scan or felt by the doctor, the hospital staff will regularly check the effects of the chemotherapy on the cancer. The results from your blood tests and any scans or x-rays can show how much the cancer is responding to the treatment.
Depending on the results of the tests, your treatment plan may sometimes need to be changed. There can be many reasons for this and your doctor will tell you why your treatment needs to be changed if this is necessary. It may be because the drugs you are having are starting to cause damage to particular parts of the body, such as the bone marrow, kidneys, liver or nerves in the hands or feet.
Sometimes it can be because the chemotherapy is not shrinking the cancer enough. If this is the case, then changing to different drugs may be more effective.
Sometimes, your treatment may need to be delayed because the chemotherapy drugs are stopping your bone marrow from working properly. Delaying the chemotherapy gives your bone marrow a chance to recover before the next session of drugs is given.